惠民保“上新”

Core Insights - The article discusses the evolution and challenges of the Huiminbao insurance scheme, highlighting its significant growth in premium contributions and the disparity in claims experiences among insured individuals [2][3][4] - The introduction of a new commercial insurance drug directory is expected to enhance the coverage of innovative drugs under Huiminbao, while also addressing the sustainability of the insurance model [3][5][6] Group 1: Huiminbao Overview - Huiminbao has been promoted nationwide for nearly six years, with "special drug liability" becoming a standard feature, contributing approximately 18 billion yuan in innovative drug payments last year, a ninefold increase from 2021 [2] - The scheme faces challenges due to a high proportion of elderly and pre-existing condition participants, leading to a "death spiral" in its development [2][3] - Some Huiminbao products are responding to payout pressures by increasing deductibles and reducing high-value drug payment limits, which indirectly lowers medical benefits [2][3] Group 2: Regulatory Changes and Trends - The recent notification from the National Financial Regulatory Administration emphasizes that urban commercial health insurance, including Huiminbao, should align premium collection with coverage levels and avoid chaotic low-price competition [3][8] - The 2026 version of Huiminbao is seeing a shift towards "premium stratification" rather than low premiums, with an expansion of coverage to include chronic diseases, mental health medications, and overseas drugs [3][4][5] Group 3: Special Drug Coverage Expansion - The number of drugs covered under Huiminbao is set to reach 672 by 2024, with a significant focus on cancer and rare disease medications, which account for over 40% of the innovative drugs listed [4][5] - Some regions are expanding their special drug coverage to include high-value innovative drugs for chronic diseases, with certain areas approaching the coverage levels of pure commercial health insurance [5][6] Group 4: Pricing and Risk Management - The core of commercial health insurance is the dynamic balance between funding and benefits, with low premiums slowing the growth of Huiminbao's funding and affecting benefit enhancements [8][11] - The 2026 version of Huiminbao introduces a trend of "layered" special drug and medical coverage, allowing for both standard and upgraded insurance options [8][9] Group 5: Inclusion of New Citizens and Cross-Region Medical Services - Strategies to attract healthier and younger participants include lowering claim thresholds and increasing reimbursement rates for outpatient services and common illnesses [12][13] - New policies in various regions are expanding coverage to include new citizens and those seeking medical services in different locations, enhancing the inclusivity of Huiminbao [12][13]