以保障服务创新促发展能力提升——“枣惠保”为群众撑起“保护伞”

Core Insights - The "Zao Huibao" program has effectively mitigated high medical costs for the public and dispersed health risks over the past four years, with over 1.4 million participants and claims exceeding 94 million yuan [1][2] Group 1: Program Overview - "Zao Huibao" is a customized inclusive commercial health insurance project initiated by the government in Zaozhuang, Shandong Province, with China Life Property & Casualty Insurance as the main underwriter and eight other insurance companies participating [1] - The program has adopted a combination of co-insurance and online-offline promotion models, achieving significant participation and claim amounts [1] Group 2: Product Development - The insurance company conducts annual loss assessments and actuarial reviews to optimize coverage plans, balancing inclusivity and sustainability [2] - The deductible for 2025 will be reduced from 15,000 yuan in 2023 to 8,000 yuan, allowing more patients to benefit from inclusive financial services [1][2] Group 3: Premium Adjustments - The company has implemented differentiated pricing based on demographic factors such as age, gender, and health status to enhance fairness and adaptability [2] - Premiums for low-income individuals and those with pre-existing conditions have been significantly reduced, with fees as low as 10 yuan for certain groups [2] Group 4: Claims Processing Innovations - The program has streamlined the claims process by synchronizing commercial insurance payouts with basic medical insurance settlements, reducing the burden on insured individuals [3][4] - A one-stop settlement system has been established, allowing for automatic claims processing without the need for extensive documentation, significantly reducing processing time from approximately 20 days to under 10 minutes [4] Group 5: Cross-Province Medical Treatment - The "Zao Huibao" program has introduced an "exemption from application for direct compensation" system for patients seeking treatment outside their home province, enhancing convenience and reducing financial pressure [5] - The system automatically triggers claims for eligible patients, ensuring timely payments directly to their social security or designated bank accounts [5] Group 6: Future Directions - The Zaozhuang Medical Security Bureau aims to expand coverage and improve service sustainability while adhering to the principles of commercial insurance [5]