惠民保变革：差异化定价众口难调 衔接商保创新药目录有“时差”

Core Viewpoint - The article discusses the challenges and opportunities facing the "惠民保" (Huimin Bao) insurance product, which serves as a bridge between social insurance and commercial health insurance, particularly in light of new regulatory guidance aimed at promoting high-quality development in urban commercial medical insurance [1][2]. Group 1: Regulatory Changes and Market Dynamics - The National Financial Supervision Administration issued a notice emphasizing the need for urban commercial medical insurance to incorporate new medical technologies and adhere to differentiated pricing principles, avoiding low-price competition and monopolistic practices [1][6]. - The notice aims to clarify the distinction between commercial insurance and social insurance, promoting a reasonable expectation of coverage among the public [1][4]. - Experts indicate that while the market for Huimin Bao is estimated at 150 to 200 billion yuan, interest from insurance companies remains low due to the product's unique design that does not align well with traditional commercial insurance logic [3][4]. Group 2: Differentiated Pricing and Product Design - Some regions are experimenting with differentiated pricing for Huimin Bao, with premiums varying based on age and health status, which aligns with regulatory expectations [3][4]. - The concept of differentiated pricing is seen as a potential breakthrough for the market, allowing for higher premiums for higher-risk groups while still being competitive compared to other health insurance products [3][4]. - However, there is caution among some cities regarding the implementation of differentiated pricing, as they view Huimin Bao as a basic layer of commercial insurance that should not overly complicate the product design [4][6]. Group 3: Integration with Innovative Drug Coverage - The upcoming commercial insurance innovative drug directory, expected to be released in November, is anticipated to be integrated into local Huimin Bao products, focusing on high-value innovative drugs that exceed basic insurance coverage [8][10]. - The overlap between the special drug coverage of Huimin Bao and the basic medical insurance directory is currently high, necessitating further refinement of the product design [9][10]. - The successful integration of innovative drugs into Huimin Bao is seen as crucial for alleviating the financial burden on patients for high-cost medications, aligning with government objectives [8][10].