China Life Insurance Wins Multiple Awards at National Smart Healthcare Security Competition

Recently, the National Smart Medical Insurance Competition Award Ceremony was held in Shanghai. China Life Insurance Co., Ltd. (hereinafter referred to as “China Life”) received recognition for its innovative practices and deep applications in the field of intelligent medical insurance, with four branch projects winning awards. Among them, the Hangzhou branch took first place, the Guangzhou and Qingyuan branches each received second place, and the Guangxi Zhuang Autonomous Region branch was awarded third place. This fully demonstrates China Life’s strength and responsibility in serving the national healthcare security system and promoting the digital transformation of medical insurance.

The competition was jointly organized by the National Healthcare Security Administration and the Shanghai Municipal Government. Its aim is to stimulate innovation in the use of new information technologies in healthcare reform, further promote innovation in the pharmaceutical and health industry, and improve the health security level of the people. The competition included 11 categories such as innovative drug development, real-world post-market research, and comprehensive value assessment of medicines and medical devices, attracting 802 teams nationwide. After rigorous selection, 178 teams stood out.

Healthcare security is the foundation of people’s livelihood and a shield of happiness. China Life’s branches across the country actively leverage their advantages, fully integrate local diverse and personalized needs, and use intelligent technology as a link to consolidate high-quality resources. They provide practical, replicable paths for building a new smart medical insurance ecosystem and improving the quality of livelihood security.

First Prize

Fast Payment in One Second, New Model for Direct Commercial Insurance Claims

China Life Insurance Hangzhou Branch

The China Life Hangzhou branch actively responded to the National Healthcare Security Administration’s deployment of the “1+3+N” multi-layered medical security system, and cooperated with the provincial healthcare security bureau to pilot the “dual platform, one channel” model for healthcare and commercial insurance. This provides policyholders with high-quality, efficient fast claim and direct payment services, promoting orderly integration and coordinated development of healthcare and commercial health insurance.

Led by Zhejiang Provincial Healthcare Security Bureau, the application relies on the Zhejiang Smart Medical Insurance Platform (Medical Insurance Platform) and the Commercial Insurance Integrated Service Platform (Commercial Insurance Platform) as core carriers. It builds a secure data exchange link through hardware-encrypted dedicated lines (“one channel” trusted space). The platform focuses on the core needs of insured persons, offering identity verification, real-time push of healthcare settlement information, automatic claims calculation for commercial insurance, and fund settlement, covering four key scenarios: rapid claims, direct claims, claims verification, and product development. It breaks the traditional concept of “basic medical insurance and commercial insurance operating independently” and constructs a “medical insurance + commercial insurance” collaborative service system at the provincial level. Through trusted data spaces, it synchronizes healthcare settlement and commercial insurance claims, and integrates health management with insurance services, shifting healthcare from “post-claim reimbursement” to a full-cycle service of “prevention, intervention, and post-coverage.”

By 2025, the one-stop settlement for commercial insurance such as Hangzhou’s惠民保 (Huimin Insurance), corporate supplementary medical insurance, and personal commercial medical insurance has processed 945,200 claims, benefiting 91,400 insured individuals, with a payout of 262 million yuan. With rich project operation experience, China Life Hangzhou provided extensive real claims data and core business support for system development. The project not only enhances fairness and accessibility of healthcare services but also improves the multi-layered healthcare security system, strengthens social trust, and sets an industry benchmark for data element circulation and application.

(图：China Life Insurance Hangzhou Branch Award Certificate)

Second Prize

Multi-layered Medical Security Precise Empowerment and Collaboration Platform

China Life Insurance Guangzhou Branch

The Guangzhou branch of China Life Insurance closely aligns with the national healthcare reform direction, leveraging its professional advantages to collaborate with the Guangzhou Healthcare Security Bureau and other parties to build a multi-layered, precise empowerment and collaboration platform for medical security, injecting new momentum into healthcare reform through intelligent technology. The platform, supported by AI, cloud computing, big data, and other next-generation information technologies, constructs a unique “three horizontal, four vertical” intelligent architecture, achieving comprehensive upgrade in security, service, and governance. The “three horizontal” connects basic medical insurance, critical illness insurance, medical assistance, and commercial health insurance, enabling automatic benefit linkage and integrated expense calculation; the “four vertical” covers data collection, intelligent analysis, business collaboration, and service output, forming a closed-loop operation. The platform adopts a high-standard five-layer architecture, complies with national information security standards, with core system availability ≥99.99%, encrypted storage of sensitive data, core response time ≤2 seconds, balancing security and efficiency. It advances breakthroughs in product design, risk control, and ecological collaboration, promoting the transformation and upgrading of the healthcare security system.

For the public, it enables “one-stop, seamless” settlement and instant claims for healthcare, commercial insurance, and medical assistance, reducing claims processing time from 5-7 days to within 10 seconds, alleviating advance payment pressure; it optimizes services for special groups, solving operational difficulties and making protection warmer. For the industry, it significantly improves underwriting and claims efficiency for commercial insurance, shifting the industry from “scale expansion” to “quality improvement”; it also helps achieve precise healthcare governance and eases fund expenditure pressure. For society, the platform activates the health industry ecosystem, promotes deep integration of healthcare security and health management, creating a virtuous cycle of “security promotes health, health reduces burden,” providing strong support for building a Healthy China.

(图：China Life Guangzhou Branch Award Ceremony)

Second Prize

Smart Connected Government Healthcare, Quick Payment Benefits People’s Livelihood

China Life Insurance Qingyuan Branch

The Qingyuan branch of China Life Insurance, in partnership with government departments (Qingyuan Healthcare Security Bureau) and public medical institutions (Qingxin People’s Hospital), jointly broke through traditional service barriers to successfully establish a new cooperation model for direct payment of patient medical expenses within medical institutions by social health insurance (medical insurance) and commercial insurance. The Qingyuan “direct payment” model connects systems directly, shares information, and coordinates settlement, greatly reducing the burden on the public: patients discharged from Qingxin People’s Hospital only need to pay the personal copayment after reimbursement by basic medical insurance and Qingyuan GuoShou commercial insurance, without having to pay upfront.

The implementation of the Qingyuan “direct payment” model completely breaks the previous barriers of “two lines, two processes” for medical insurance and commercial insurance, upgrading the service to “one door, multiple affairs.” Medical expenses are quickly settled synchronously, reducing reimbursement time to within 5 minutes, significantly improving the efficiency of medical settlement services. Patients no longer need to collect receipts or travel back and forth, greatly enhancing their dignity and sense of gain during medical treatment. In hospital service surveys, patient satisfaction with settlement services increased from 68% to over 95% after the “direct payment” model was implemented. Currently, six major hospitals within Qingyuan have joined the project and are developing system interfaces. As the “direct payment” service expands, the beneficiary scope will continue to grow.

(图：China Life Qingyuan Branch Award Ceremony)

Third Prize

“Intelligent Navigation, Worry-Free Major Illness”: Simulation and Precise Supervision Platform under Healthcare and Commercial Insurance Collaboration

China Life Insurance Guangxi Zhuang Autonomous Region Branch

To shift from “patients running around” to “data running,” from “single-point supervision” to “full-process prevention,” and from “passive claims” to “active prediction,” under the guidance of the Guangxi Healthcare Security Bureau, China Life Guangxi Branch launched the Guangxi Healthcare Insurance Simulation and Precise Supervision Platform. Its goal is to enhance the quality and efficiency of critical illness insurance through technological empowerment, building a “precise, collaborative, sustainable” healthcare security system. The platform focuses on three core scenarios: data sharing, dynamic monitoring, and linked risk control within healthcare and commercial insurance collaboration, establishing a closed-loop support system with “one database + one platform + three subsystems,” including a regional healthcare data base, an integrated business platform, and three core subsystems for major illness claims, intelligent supervision and review of healthcare and commercial insurance, and healthcare fund simulation and prediction.

Under the platform’s support, it has achieved: a) reduced operational costs, with claims data circulation shortened from 7-15 days to T+1 day, halving labor costs; b) improved data quality, with error rates below 0.01% and ICD-10 standardization over 99%, laying a solid foundation for precise risk control; c) reduced fund losses, with the intelligent supervision system reviewing nearly 40 million documents from 6,980 medical institutions in the first half of 2024, identifying 264,800 suspicious data points involving approximately 26.25 million yuan, effectively curbing fund waste; d) ensured fund balance, with the simulation system maintaining prediction errors within 3%, providing important basis for policy adjustments and stable fund operation.

(图：China Life Guangxi Branch Award Ceremony)

These cases exemplify China Life’s comprehensive efforts in advancing digital transformation and actively serving the people. In the future, China Life will continue to leverage its strengths, supported by technology, driven by scenarios, and oriented by value, to enrich product offerings, expand coverage, and ensure that the benefits of intelligent medical insurance reach more people. It aims to help build a collaborative, efficient, inclusive, and convenient multi-layered healthcare security system, safeguarding people’s health and strengthening the foundation of social security.

(Edited by: Wang Lei)