城市商业医疗险新规下发 六大维度推动“惠民保”高质量发展

Core Viewpoint - The issuance of the "Notice" by the National Financial Supervision and Administration aims to promote the high-quality development of urban commercial health insurance, emphasizing inclusivity, commercial attributes, product management, risk management, and market order [1][7][9] Group 1: Regulatory Framework - The "Notice" serves as an implementation and extension of the State Council's opinions on strengthening regulation and preventing risks in the insurance industry, marking a new phase for urban customized commercial health insurance [1][7] - It emphasizes the need for insurance companies to operate autonomously while ensuring that the insurance products meet the needs of the public for quality medical coverage [3][6] Group 2: Product Development and Management - The document highlights the importance of optimizing the supply of urban commercial health insurance products to include new medical technologies, drugs, and devices, ensuring broad coverage and reasonable premiums [2][4] - As of 2024, over 90% of "惠民保" products include specific high-cost drug claims, with the number of drugs covered increasing from 2021 to 2024, reaching 672 [2][8] Group 3: Pricing and Risk Management - The "Notice" mandates that insurance companies adopt precise pricing strategies based on historical data, ensuring that premium rates align with the level of coverage provided [3][5] - It encourages the establishment of a data-driven pricing and underwriting mechanism to enhance risk management capabilities across the insurance value chain [8][9] Group 4: Market Order and Consumer Protection - The document calls for improved sales practices, requiring clear communication of product functions and protections for consumer rights [6][7] - It stresses the need for fair competition among insurance companies, discouraging low-price, disorderly competition, and promoting diverse product offerings [6][7] Group 5: Industry Development and Future Outlook - The "Notice" is seen as a significant step towards refining the operational boundaries of urban commercial health insurance, transitioning from rapid growth to meticulous management [7][8] - It reinforces the role of commercial health insurance as a vital supplement to basic medical insurance, aiming to fill coverage gaps for high-cost medical expenses [2][7]