让普惠保险之“普”不缩水，“惠”可持续

Core Viewpoint - The recent notification from the Financial Regulatory Bureau aims to establish rules for the operation of urban commercial health insurance, ensuring its long-term and stable development [1] Group 1: Current Status of Urban Commercial Health Insurance - Urban commercial health insurance has rapidly gained popularity across the country due to its low threshold, low premium, and high coverage, becoming an important part of the multi-tiered medical security system [1] - Over 200 products have been launched across 30 provinces, with an average of 150 million insured participants [1] - By 2024, more than 90% of urban commercial health insurance products will cover specific high-cost drug claims, affecting 160 innovative drug varieties and covering 89 types of indications [1] Group 2: Challenges Faced - Issues include imprecise product pricing due to a lack of reliable historical data on disease incidence, claim rates, and cost rates, which affects the sustainability of insurance companies and consumer trust [2] - Market competition is chaotic, with some companies engaging in unfair low-price competition and misleading sales practices, disrupting the market environment [2] Group 3: Balancing Coverage and Affordability - Achieving broad coverage ("普") and effective benefits ("惠") requires a careful balance; excessive focus on coverage may lead to reduced benefits, while an emphasis on affordability may compromise product sustainability [3] - The notification mandates insurance companies to define insurance responsibilities and exclusions based on customer needs and to set premium rates using sufficient data science, adhering to the principle of risk pricing [3] Group 4: Market Order and Competition - The notification emphasizes maintaining market order, requiring insurance companies to adhere to fair competition principles and avoid price wars and monopolistic practices [3] - This shift encourages companies to enhance product and service diversity, moving from price competition to offering higher quality and personalized protection plans [3] Group 5: Sustainable Development of Inclusive Insurance - Sustainable development of inclusive insurance cannot rely solely on insurance companies reducing profits; it requires a comprehensive assessment and evaluation mechanism to stimulate market vitality [4] - Technological empowerment, such as big data and AI, is crucial for accurately analyzing risk profiles and needs, improving underwriting efficiency, and simplifying the application process [4] - Collaborative development with health management and elderly care sectors can transform inclusive insurance from mere risk compensation to a comprehensive "prevention-coverage-service" model [4] Group 6: Conclusion - The regulated development of urban commercial health insurance is a key exploration for the maturity of inclusive insurance, requiring solid institutional design, technological innovation, and collaborative efforts to achieve a virtuous cycle of coverage and benefits [4]