2025 Short-term Health Insurance Overall Claim Rate Announced: Over 60% of insurers have a claim rate below 50%, with a median of nearly 42%

From “internet celebrity” million-dollar medical insurance that costs hundreds of thousands of yuan to universal affordable health insurance, short-term health insurance has long become a common part of people’s lives and an important vehicle for the insurance industry to serve public health protection. How good is this health protection? The comprehensive claim ratio, seen through this “mirror,” offers some insights.

Recently, the “Daily Economic News” reporter compiled data on the 2025 comprehensive claim ratios of short-term health insurance from insurance companies. The information disclosed by 131 insurers shows that the industry median is only 41.73%, with an average of 41.72%. Compared to 2024, the industry median has increased, and extreme value data has decreased. Overall, the industry’s comprehensive claim ratio remains relatively low.

“From the perspective of long-term industry development, a comprehensive claim ratio around 70% is relatively reasonable. If the claim ratio is too low, it indicates that the proportion of premiums used for actual protection is insufficient, which may lead consumers to feel that the ‘protection value is lacking,’ affecting industry trust and product sustainability. If the claim ratio is too high, it could cause operational instability and impact the insurance company’s ongoing viability,” said Zhu Junsheng, a postdoctoral fellow and professor of applied economics at Peking University, to the “Daily Economic News.” Based on the business logic of commercial health insurance, under a reasonable expense structure, gradually increasing the comprehensive claim ratio to about 70% can enhance consumers’ sense of protection and maintain the company’s profitability at controllable expense levels, forming a healthy and sustainable industry model.

Over 60% of insurers’ comprehensive claim ratios do not exceed 50%

Short-term health insurance mainly refers to health insurance policies with a coverage period of one year or less, which do not guarantee renewal. Common products include million-dollar medical insurance and one-year critical illness insurance. The comprehensive claim ratio is an important indicator to evaluate an insurance company’s profitability and risk control ability. It can be simply understood as the proportion of the premiums received by the insurer that is actually used for claims. Its precise calculation formula is: (Reinsurance paid claims + Reinsurance unliquidated claims reserve transfer difference) ÷ Earned premiums after reinsurance. The transfer difference of unliquidated claims reserve can be understood as the difference between the reserve for claims paid this year and the claims reserve that remains unsettled at the end of last year.

According to the “Notice on Regulating Short-term Health Insurance Business” issued in 2021, insurance companies should disclose the overall comprehensive claim ratio of personal short-term health insurance business on their official websites every six months. The claim ratio for the first half of the year should be disclosed no later than the end of July each year, and the annual claim ratio no later than the end of February of the following year.

The “Daily Economic News” reporter’s statistics show that among 131 insurers that disclosed relevant data, over 60% of short-term health insurance business had a comprehensive claim ratio of no more than 50%. Compared to the same period in 2024, the claim ratios of various insurers fluctuated. The median comprehensive claim ratio for short-term health insurance in the industry was 41.73%, a slight increase from 2024. However, since short-term health insurance products are mainly one-year policies, past claim ratios have limited reference value for the current year.

But from the data, the overall claim ratio for short-term health insurance remains relatively low. “A claim ratio around 70% for short-term health insurance is relatively reasonable. If it is too low, it means the product price is high, and consumer benefits are hard to guarantee; if it is too high, the insurance company may suffer losses, making business unsustainable,” Zhu Junsheng told reporters. A low claim ratio does not necessarily reflect a low risk occurrence rate but indicates a higher expense structure, meaning a significant portion of the premiums paid by consumers goes toward channels and operational costs rather than direct risk coverage, which affects the sense of protection.

Currently, many products like million-dollar medical insurance are sold mainly through online channels. Under a digital, traffic-driven sales model, online traffic costs, channel expenses, and operational expenditures account for a large proportion. The shift to online channels improves product reach, making it easier for consumers to access protection, but also faces high customer acquisition costs, which compresses the insurance product’s own claim space.

Extreme value data of comprehensive claim ratios has decreased compared to 2024

Focusing on individual institutions, the gap in short-term health insurance claim ratios remains significant. The highest comprehensive claim ratio can reach 766.31%, while some are as low as around 1%. Some institutions’ short-term health insurance comprehensive claim ratios are even negative. For example, Guohua Life’s 2025 short-term health insurance comprehensive claim ratio is 766.31%, far higher than others; Yanzhao Property & Casualty’s is -352.06%.

Specifically, in 2025, five institutions have a comprehensive claim ratio exceeding 100%: BYD Property & Casualty, Huahai Property & Casualty, Anmeng Property & Casualty, Guobao Life, and Guohua Life, with ratios of 103.99%, 104.75%, 124.66%, 145.91%, and 766.31%, respectively. Ten institutions have negative claim ratios, including Yanzhao Property & Casualty, Xin’an Auto Insurance, Hesheng Health, Huarong Property & Casualty, Hongkang Life, Zhongcheng Insurance, Dingcheng Life, Beijing Life, Peak Mountain Property & Casualty, and Railway Self-Insurance.

Data shows that in 2025, the extreme values of comprehensive claim ratios for short-term health insurance have decreased compared to 2024, and the gap between the maximum and minimum ratios has narrowed. In 2024, due to certain business reasons, some institutions’ ratios soared as high as 860.02%, with extreme negative values reaching -10133.97% and -1842.39%.

However, these figures only reflect the claims situation and business development over a period and should not be the sole reference for an institution’s short-term health insurance claim ratio. Industry research indicates that insurers with a high proportion of newly launched products or new policies tend to have relatively low claim ratios in the short term. As existing policies enter renewal cycles and the number of policyholders with health issues accumulates, claim ratios are expected to gradually rise.

It is also worth noting that in these comprehensive claim ratio disclosures, the “Daily Economic News” reporter observed some new developments. For example, Tokio Marine & Nichido Fire Insurance (China) Co., Ltd. stopped selling personal short-term health insurance from October 20, 2025, after only about three years of operation; Guohua Life did not launch new personal short-term health insurance business in 2025, meaning its short-term health insurance business mainly comes from renewals.

“Currently, the short-term health insurance market is indeed in a fiercely competitive ‘red ocean’ stage. Some institutions’ withdrawal is an inevitable result of stricter regulation and market survival of the fittest. This reflects the industry’s shift from extensive expansion to high-quality development,” said Su Xiaotian, product manager at Beijing PaiPaiWang Insurance Agency Co., Ltd. Shenzhen branch.

Future market will feature both strong players and niche differentiation

The direction of product design and innovation also reflects the current development status of health insurance products. Many years ago, health insurance products mainly targeted healthy populations. In recent years, more health insurance products aimed at non-standard bodies have emerged, continuously expanding the scope of health protection. Some products are even exploring innovations like zero deductibles.

“Relying solely on premium and claim ratio competition is gradually shifting toward ‘medical-pharmaceutical-insurance’ ecosystem capability competition. Efficient customer operation, long-term health management, and digital service capabilities will determine market share and profitability,” Zhu Junsheng said. AI (artificial intelligence) and health service entry points will become key factors for insurers to continuously attract and retain customers.

From the perspective of property, life, and health insurance institutions, property insurers will still lead in the rapid growth of short-term health insurance scale. Life insurers and specialized health insurers will develop long-term medical insurance and differentiated products alongside short-term health insurance. In terms of innovation directions, property, life, specialized health insurers, and internet platforms will actively participate in competition. Product innovation will mainly focus on responsibility dimensions (high coverage, zero deductible), service network dimensions (specialized medical services, out-of-hospital medication, full-process services), and target groups (non-standard bodies, sub-healthy populations).

Su Xiaotian stated that the future market pattern will feature both dominant players and niche differentiation. Leading institutions will leverage scale effects and ecosystem services to capture major market share, while small and medium-sized institutions need to focus on specific populations or niche diseases to deepen their presence. The industry as a whole will move away from pure price wars toward a new stage of value competition centered on service quality, risk control, and customer experience.

Regarding the comprehensive claim ratio, Su Xiaotian believes that improving the claim ratio and consumer experience in short-term health insurance depends on “cost reduction, efficiency enhancement, and service upgrading.” Insurance companies should refine operations to reduce reliance on high-fee channels, use technology to improve risk control efficiency, and pass savings back to consumers by optimizing product responsibilities—such as moderately lowering deductibles, expanding coverage—and transforming products from simple expense reimbursement to full-process health management services. This way, consumers can perceive service value even without claims, substantially enhancing their sense of gain.

Daily Economic News