2026年度“北京普惠健康保”开放参保，起付线降至15000元，特药报销比例提高

Core Points - The 2026 "Beijing Universal Health Insurance" opens for enrollment with significant changes to coverage and reimbursement policies [1] - The self-payment threshold for healthy individuals is reduced to 15,000 yuan, enhancing accessibility to insurance benefits [2] - The reimbursement rate for special medications is increased by 5 percentage points, expanding the range of covered diseases and medications [3] - New online and offline 10% discount for purchasing medications is introduced, making it more affordable for insured individuals [4] - Continuous insurance benefits are optimized for long-term participants, including lower self-payment thresholds and exclusive health management services [5] - Enrollment is open to a wide range of individuals, including those with various health statuses and residency qualifications in Beijing [5] - The insurance program has seen steady growth in enrollment and claims, with over 15 million participants and significant payouts [7] Summary by Sections Enrollment and Coverage - The enrollment deadline is set for December 31, 2025, with coverage effective from January 1 to December 31, 2026, at a fixed premium of 195 yuan per person per year [1] - The total coverage amount is upgraded to 3.5 million yuan [1] Self-Payment and Reimbursement - The self-payment threshold for healthy individuals is reduced from 30,404 yuan to 15,000 yuan, with a 25% reimbursement for expenses between these amounts [2] - For expenses exceeding 30,404 yuan, healthy individuals can receive 80% reimbursement, while those with specific pre-existing conditions receive 40% [2] Special Medication Coverage - The reimbursement rate for special medications is raised to 65% for healthy individuals and 35% for those with specific pre-existing conditions [3] - The range of covered diseases expands to 87, with a total of 159 medications included, including 57 domestic and 65 overseas special medications [3] Discounts and Benefits - A new 10% discount for purchasing medications online and offline is introduced, covering a variety of medication types [4] - Continuous participants with no claims in the past three years benefit from lower self-payment thresholds and exclusive health management services [5] Accessibility and Growth - The program is accessible to all individuals with basic medical insurance in Beijing, including new residents and specific government-designated groups [5] - Since its launch, the program has seen over 15 million participants and more than 340,000 claims, with the highest single payout reaching 761,100 yuan [7]