(Source: Beijing Business Today)
National health literacy continues to rise, driving growing public demand for multi-tiered, high-quality medical coverage. Access to insurance for individuals with conditions such as hypertension, hyperlipidemia, nodules, and other health abnormalities is increasingly drawing social attention. On 10 11, China Business News reported that since 9, major insurers including China Life and Taikang have rolled out a wave of new health insurance products. Unlike earlier million-yuan medical plans that competed primarily on sum assured and price, this latest iteration targets substandard and older-risk populations, incorporating specialized care, innovative drugs, and AI-driven health management into their offerings.
Rising Demand and Supply: Innovation in Insurance for Pre-existing Conditions
The 4 billion people with pre-existing conditions, once considered "high-risk and difficult to price," are now becoming the primary battleground for unlocking growth in commercial health insurance.
Recently, multiple insurers have launched medical insurance products with no health declaration or simplified health declarations, bringing previously excluded individuals with pre-existing conditions and the elderly into the coverage scope.
For example, Taikang Life's "Health Heart Enjoyment Edition" medical insurance is positioned as a broad-coverage, high-value solution for specialized and international care. Through simplified health declarations and expanded access to specialized medical resources, it enables elderly individuals and those with chronic conditions to afford quality healthcare coverage. China Life's "Guoshou Kangyibao Easy Enjoyment 1.0" medical insurance (internet-exclusive) offers eligible applicants—including those with stable nodules (lung, thyroid, or breast), polyps, fatty liver, uterine fibroids, or certain prior surgical histories—the opportunity to purchase coverage. PICC Property & Casualty's "AI Fubankang" million-medical insurance plan extends the initial enrollment age limit to 80 years, allowing older adults and individuals with pre-existing conditions to qualify for coverage.
From a product perspective, the new health insurance offerings in this wave exhibit distinct characteristics.
First, underwriting standards are gradually relaxing. Coverage for pre-existing conditions has become the primary focus. Products from various providers have generally simplified health disclosures, moving away from blanket rejections. They now apply refined risk stratification for common chronic conditions like nodules and hypertension, breaking the old model of "easy to buy, hard to claim" and automatic exclusions for pre-existing conditions.
Second, the integration of insurance + services + AI has become standard, shifting product supply from "basic coverage" to "quality enhancement." AI health concierge, online consultations, critical illness green channels, escort services, and chronic disease management are no longer marketing add-ons but integral components of products and services. This drives a business model transformation from post-event reimbursement to managed care encompassing pre-event prevention, in-process medical treatment, and post-event rehabilitation.
The surge in the sick-patient insurance market stems from converging supply and demand forces. Wu Zewei, a special researcher at Subang Bank, notes that rising health awareness among residents has left a vast population with abnormal chronic indicators unable to qualify for traditional health insurance products, creating a significant coverage gap. Industry competition dynamics have also shifted: insurers are no longer competing solely on price and sum insured for standard-risk clients but are instead targeting niche segments. Simultaneously, policy initiatives encourage commercial insurers to strengthen multi-layered medical protection systems.
No. Party Name Administrative Penalty Decision Number Major Illegal or Irregular Acts Penalty Content Deciding Authority {0} Hengfeng Bank Co., Ltd. Treasury Operation Center Shanghai Financial Regulatory Bureau Penalty Decision No. [Year] {1}-{2} Inaccurate five-tier classification of bond assets, failure to strictly manage credit for interbank business, inaccurate separation of trading book and banking book, insufficient independence in bond investment operations, and inaccurate net asset value calculation for custodial products Fine of RMB {3} million Shanghai Financial Regulatory Bureau {4} Guo Qiang (Senior Expert, Product Manager, and General Manager of the Foreign Currency and Credit Investment Division at the time) Shanghai Financial Regulatory Bureau Penalty Decision No. [Year] {5}-{6} Inaccurate five-tier classification of bond assets Warning and fine of RMB {7} million Shanghai Financial Regulatory Bureau {8} Sun Zengchan (Assistant to the President and Vice President of Yongcheng Property & Casualty Insurance Company at the time) Shanghai Financial Regulatory Bureau Penalty Decision No. [Year] {9}-{10} Failure to use approved or filed insurance terms and rates; lax underwriting management for health and accident insurance business Warning and fine of RMB {11} million Shanghai Financial Regulatory Bureau {12} Wei Jiangyan (Corporate Client Manager at the North Branch Business Department of Shanghai Bank at the time) Shanghai Financial Regulatory Bureau Penalty Decision No. [Year] {13}-{14} Serious violation of prudent operating rules in working capital loan management Warning and fine of RMB {15} million Shanghai Financial Regulatory Bureau {16} Hua Shuai (Client Manager at the North Branch Business Department of Shanghai Bank at the time) Shanghai Financial Regulatory Bureau Penalty Decision No. [Year] {17}-{18} Warning and fine of RMB {19} million Shanghai Financial Regulatory Bureau
The rapid growth of critical illness insurance has not been without challenges. Its innovation directly confronts a series of severe hurdles that go beyond traditional health insurance. These challenges stem from fundamental differences in risk and are most evident in core areas such as data infrastructure, actuarial logic, and risk management.
Wu Zewei stated that the main challenges in current development include insufficient risk identification capabilities, significant health variations among non-standard cases, and limited historical underwriting and claims data. Product development must also balance inclusivity; any deviation in risk pricing can easily impact the product's long-term stability. For insurers, the core challenge lies in preventing underwriting losses and ensuring sustainability as a large number of pre-existing condition cases are added.
However, following industry evolution patterns, the shift of health insurance from covering healthy individuals to covering those with pre-existing conditions is an inevitable trend as the sector enters its deep-water phase. Insurers must therefore transform their business strategies and optimize operational systems to overcome development challenges associated with insuring people with pre-existing conditions.
Lin Xianping, Executive Deputy Secretary-General of the China Urban Experts Think Tank Committee and Associate Professor at Zhejiang University City College, stated that insurers must build a granular risk assessment system leveraging multi-dimensional health data to balance product innovation with long-term business goals. On one hand, insurers should continuously refine underwriting guidelines by offering tiered coverage options—including graded acceptance, exclusions, or conditional acceptance—for conditions such as nodules and fatty liver disease. By harnessing big health data and AI-driven risk models, they can enhance risk identification capabilities and enable scientifically accurate actuarial pricing. On the other hand, insurers should integrate insurance products with proactive health management services through ongoing interventions and follow-up care to reduce the likelihood of future claims. Additionally, they should strengthen collaborations with healthcare providers to streamline access to medical treatment, claims processing, and premium resource allocation. Clear customer communication is essential: explicitly explain exclusions and manage expectations appropriately. This approach strikes a balance between innovation and risk control, ensuring sustainable business growth.
"The entire industry must move beyond a mindset focused solely on claims, extending insurance services forward. We need to shift from basic underwriting to holistic health management throughout the lifecycle, truly upgrading coverage from 'being able to insure' to 'providing quality care,'" an industry expert concluded.
Beijing Business Today reporter Li Xiumei
