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%

Everyday Economic News Reporter | Yuan Yuan Everyday Economic News Editor | Zhang Yiming

From “internet celebrity” million-dollar medical insurance that costs hundreds of thousands of yuan to universal affordable health insurance covering all citizens, 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 comprehensive claim ratio of short-term health insurance from insurance companies in 2025. 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 values have decreased. However, 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 lead to unstable operations 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 cost structure, gradually increasing the comprehensive claim ratio to about 70% can enhance consumers’ sense of protection and maintain the company’s profitability within controllable costs, 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, one-year critical illness insurance, etc. The comprehensive claim ratio is an important indicator to evaluate an insurance company’s profitability and risk control ability. Simply put, it reflects the proportion of actual claims paid out of the premiums received by the insurer. Its strict calculation formula is: (Reinsurance paid claims + Reinsurance outstanding claims reserve transfer difference) ÷ Earned premiums after reinsurance. The reserve transfer difference can be understood as the difference between the reserve for claims paid this year and the outstanding claims reserve 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 not exceeding 50%. Compared to the same period in 2024, claim ratios varied among companies. 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 the data shows that 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’s too low, it means the product price is high, and consumer benefits are hard to guarantee; if it’s too high, insurance companies may incur 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 proportion of costs in the fee structure, meaning that a significant part 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, the proportion of online traffic costs, channel expenses, and operational expenditures is high. The shift to online channels improves product reach, making it easier for consumers to access protection, but also faces the challenge of 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 claim ratio gap for short-term health insurance remains large. The highest can reach 766.31%, while some are as low as about 1%. Some institutions even have negative comprehensive claim ratios for short-term health insurance. For example, Guohua Life’s 2025 short-term health insurance comprehensive claim ratio is 766.31%, far higher than others; Yanzhao Property & Casualty Insurance’s is -352.06%.

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

From the data, the extreme claim ratio values for short-term health insurance in 2025 have decreased compared to 2024, and the gap between the maximum and minimum has narrowed. In 2024, due to certain business reasons, some institutions’ claim ratios soared to 860.02%, with extreme negative values reaching -10,133.97% and -1,842.39%.

However, these figures only reflect the claims situation and business development over a period and cannot 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 found 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, reflecting the industry’s shift from extensive expansion to high-quality development,” said Su Xiaotian, product manager at Shenzhen Fenpei Insurance Agency Co., Ltd., to the “Daily Economic News.”

Future market will feature both strong players and niche differentiation

Product design and innovation directions also reflect 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 are aimed at non-standard bodies, continuously expanding the scope of protection. Some health insurance products are even exploring innovative directions such as zero deductible.

“Relying solely on premium and claim ratio competition is gradually shifting toward a ‘medical-pharmaceutical-insurance’ closed-loop 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.

Looking at property and life insurance institutions, property insurers will still lead in the rapid growth of short-term health insurance scale. Life insurers and specialized health insurance companies will develop long-term medical insurance and differentiated products alongside short-term health insurance. In terms of innovation, 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, outside hospital drugs, full-process services), and target groups (non-standard bodies, sub-healthy populations).

Su Xiaotian said 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 should 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 of short-term health insurance and enhancing consumer benefits depend on “cost reduction and efficiency increase” and “service upgrade.” 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, allowing consumers to perceive service value even outside of claims, thereby substantially improving their sense of gain.