“沪惠保”如何答好“普惠”民生答卷

Core Insights - The "Hu Hui Bao" program, a customized commercial supplementary health insurance in Shanghai, has opened its enrollment window for 2025, attracting over 4 million participants on the first day, highlighting its significant appeal as the largest "benefit insurance" project in the country [1][8] - Since its launch in 2021, "Hu Hui Bao" has adhered to principles of government guidance, commercial operation, and public benefit, with cumulative enrollment exceeding 26 million by the end of March 2025 and total claims surpassing 2.2 billion yuan [1][8] - The program has undergone multiple upgrades over the years, enhancing coverage while maintaining stable premium rates, with the maximum coverage amount increasing from 2.3 million yuan to 3.1 million yuan [2][3] Enrollment and Coverage - "Hu Hui Bao" is characterized by low thresholds, high coverage, and broad accessibility, allowing all Shanghai basic medical insurance participants to enroll regardless of age, health status, or occupation [2][3] - The premium has remained unchanged since 2022 at 129 yuan per year, while the coverage has been enhanced, with the deductible decreasing from 20,000 yuan in 2022 to 12,000 yuan in 2024 [2][3] Service and Claims - The program has expanded its service offerings, including coverage for specific high-cost medications and advanced treatments, with the number of covered domestic specialty drugs increasing from 41 to 48 in 2025 [3][4] - Claims processing has improved significantly, with an average case resolution time of just 2.3 days and a 90% application rate for electronic medical data, enhancing the overall user experience [5][6] Financial Sustainability - "Hu Hui Bao" operates under a co-insurance model involving multiple insurance companies to ensure risk sharing and sustainable operations [4][10] - The program aims for a "break-even" model, balancing high claim rates with low premiums, which is essential for maintaining its long-term viability [10][11] Innovations and Benefits - New benefits for 2025 include a 10% discount on original research drugs and online consultations with top-tier specialists, catering to the healthcare needs of various demographics, especially those with mild conditions [7][10] - The program has also expanded its family account pooling, allowing for broader coverage among relatives, enhancing its appeal to families [11]