上海团险版商保目录呼之欲出 新型团险定价“兼顾惠民属性”

Core Insights - The article discusses the challenges and opportunities in expanding group insurance coverage for innovative drugs and medical devices in Shanghai, following the release of new policies aimed at promoting high-quality development in commercial health insurance [1][11]. Group 1: Policy and Market Development - Shanghai's new measures encourage the development of group health insurance products that cover innovative drug and device costs, allowing the use of employees' personal medical accounts for these products [1][11]. - Several leading commercial health insurance companies are collaborating to develop new group insurance products, with multiple innovative products expected to launch in the second half of the year [1][3]. Group 2: Product Design and Market Needs - The new group insurance products will introduce a group insurance version of the commercial insurance drug directory, focusing on coverage outside of basic medical insurance [3][4]. - The design of the group insurance drug directory aims to cater to the needs of chronic and common diseases while also considering the inclusion of innovative drugs [4][5]. Group 3: Pricing and Risk Management - To manage the increased claims from high-priced innovative drugs, insurers may need to adjust deductibles, reduce basic insurance reimbursements, or increase premiums [6][7]. - Insurers are utilizing big data from medical insurance to better assess medical costs and risks associated with the new group insurance products [7][10]. Group 4: Market Demand and Challenges - There is uncertainty regarding whether companies will allocate additional budgets for the new group insurance products, and how employees will respond to potential changes in coverage and costs [9][10]. - The potential market for group insurance is significant, with an estimated market size exceeding historical levels if the demand from the 13 million workers in Shanghai is activated [10][11].