| Notice by the China Insurance Regulatory Commission on Issuing the Key Points of Work on the Protection of Rights and Interests of Insurance Consumers in 2015 | | 中国保监会关于印发《2015年保险消费者权益保护工作要点》的通知 |
| (No. 26 [2015], China Insurance Regulatory Commission) | | （保监发〔2015〕26号） |
| All departments of the China Insurance Regulatory Commission (“CIRC”); all local CIRC offices; the Training Center; the Insurance Association of China; the Insurance Institute of China; the China Association of Actuaries; the Insurance Asset Management Association of China; China Insurance Security Fund Co., Ltd.; and China Insurance Information Technology Management Co., Ltd.: | | 机关各部门，各保监局，培训中心，中国保险行业协会，中国保险学会，中国精算师协会，中国保险资产管理业协会，中国保险保障基金有限责任公司、中国保险信息技术管理有限责任公司： |
| For the purpose of carrying out the spirit of the National Insurance Regulatory Work Conference of 2015 and the Opinions of the China Insurance Regulatory Commission on Strengthening the Work on the Protection of Rights and Interests of Insurance Consumers, this Commission has formulated the Key Points of Work on the Protection of Rights and Interests of Insurance Consumers in 2015, which are hereby issued to you for your implementation in light of reality. | | 为贯彻落实2015年全国保险监管工作会议精神和《中国保监会关于加强保险消费者权益保护工作的意见》，我们拟定了《2015年保险消费者权益保护工作要点》。现印发给你们，请结合本单位实际贯彻执行。 |
| China Insurance Regulatory Commission | | 中国保监会 |
| February 26, 2015 | | 2015年2月26日 |
| Key Points of Work on the Protection of Rights and Interests of Insurance Consumers in 2015 | | 2015年保险消费者权益保护工作要点 |
| According to the deployment of the National Insurance Regulatory Work Conference of 2015, the work on the protection of rights and interests of insurance consumers in 2015 will closely center around the general theme of “making progress steadily,” adhere to “focusing on service, strict supervision, preventing risks, and promoting development,” profoundly carry out the Several Opinions of the State Council on Accelerating the Development of the Modern Insurance Service Industry and the Opinions of the China Insurance Regulatory Commission on Strengthening the Work on the Protection of Rights and Interests of Insurance Consumers, and with strengthening insurance companies' primary responsibility for protecting the lawful rights and interests of consumers as the main line, with intensifying transparency regulation and supervisory inspection as the means, and with advancing the building of rules and mechanisms and the credit system as the foundation, comprehensively advance the various work on the protection of rights and interests of insurance consumers in accordance with the law. | | 按照2015年全国保险监管工作会议部署，2015年保险消费者权益保护工作将紧紧围绕保监会党委提出的坚持稳中求进总基调，坚持“抓服务、严监管、防风险、促发展”，主动适应保险业发展新常态，深入贯彻《国务院关于加快发展现代保险服务业的若干意见》和《中国保监会关于加强保险消费者权益保护工作的意见》，以强化保险公司维护消费者合法权益的主体责任为主线，以加大透明度监管和监督检查力度为手段，以推进制度机制建设和信用体系建设为基础，依法全面推进保险消费者权益保护各项工作。 |
| I. Focusing on the sources and strengthening insurance companies' primary responsibility for protecting the rights and interests of consumers | | 一、抓源头，强化保险公司维护消费者权益主体责任 |
| 1. Pushing insurance companies to underscore and strengthen the protection of rights and interests of consumers. In supervision, insurance companies shall be pushed to establish consumer affairs committees. The managements of the institutions at all levels of insurance companies shall be directed to study the major issues involving the lawful rights and interests of consumers on a regular basis, and the annual reporting system of the institutions at all levels of the insurance companies on the protection of consumers' rights and interests shall be established and improved. Insurance companies shall be supervised in implementing laws and regulatory requirements on the protection of consumers' lawful rights and interests in their internal control systems including but not limited to the formulation of insurance clauses, sales management, claims settlement and compensation payment, customer service, and complaint handling, and the accountability enforcement, dishonesty punishment, and consumer's information protection rules shall be improved. Insurance companies shall be driven to improve the system of remuneration distribution, and it must be ensured that there are no inappropriate incentives for acts damaging the lawful rights and interests of consumers. | | （一）督促保险公司重视和加强消费者权益保护工作。督促保险公司建立消费者事务委员会。引导保险公司各级机构管理层定期研究涉及消费者合法权益的重大问题，建立并完善保险公司各级机构消费者权益保护工作年度报告制度。监督保险公司将维护消费者合法权益的法律规定和监管要求贯彻落实到保险条款制定、销售管理、理赔给付、客户服务和投诉处理等各环节的内控制度之中，健全责任追究、失信惩戒、消费者信息保护制度。推动保险公司完善薪酬分配制度，确保不存在对损害消费者合法权益行为的不当激励。 |
| 2. Strictly curbing misleading sales. In supervision, insurance companies shall be pushed to intensify control of sales conduct and strictly implement the client information authenticity management and enforce accountability for misleading sales. The building of the customer demand adaptability system and differentiated sales system for personal insurance products shall be advanced. The regulation of false publicity in product introduction meetings and product promotions, signing of insurance contracts on behalf of consumers without written authorization or ratification by consumers, and deduction of insurance premiums without the consent of consumers shall be strengthened. The building of third-party evaluation system of insurance products and the system of paying sales commissions after passing return visits shall be explored. | | （二）深入治理销售误导。督促保险公司加大销售行为管控力度，严格落实客户信息真实性管理和销售误导责任追究。推进人身险产品客户需求适应性制度建设和区分销售制度建设。加强对产品说明会及产品推介中的不实宣传行为、未经消费者书面授权或追认而代替其签订保险合同行为、未经消费者同意即扣划保险费行为的监管。探索建立保险产品第三方评价制度和回访合格后支付销售佣金制度。 |
3. Advancing the resolution of difficulties in claim settlement. Insurance companies shall be guided in establishing fair and transparent procedures for claim settlement and compensation payment and for dispute resolution. Insurance companies shall be driven to establish a fast-track mechanism for settling small-claim simple cases, reduce claim documents, optimize claim settlement procedures, and promote the convenient claim settlement services and transparent claim settlement procedures. Quality monitoring shall be carried out for insurance claim settlement services, and underwriting and claim assessment qualification certification shall be promoted.
．．．．．． | | （三）推进治理理赔难。指导保险公司建立公正透明的理赔给付处理和争议解决程序。推动保险公司建立小额简易案件快速处理机制，减少索赔材料，优化理赔流程，推进理赔服务便捷化、理赔过程透明化。开展保险理赔服务质量监测，推进核保核赔资格认证。
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