盘活医保个账“沉睡”资金 险企探索创新支付新场景

Core Viewpoint - The integration of basic medical insurance and commercial health insurance is moving from policy guidance to practical implementation, exemplified by AIA's launch of a new medical insurance product that allows payment through individual medical accounts in Shanghai [1][2]. Group 1: Policy and Market Context - The Chinese government has been promoting the development of a multi-tiered medical insurance system, as indicated by policies like the "Healthy China 2030" plan and the new "National Ten Measures" for the insurance industry [2]. - Shanghai's local government has accelerated the exploration of practical measures to integrate basic medical insurance with commercial health insurance, laying a foundation for commercial health insurance to access the medical payment system [2][4]. Group 2: Product Features and Innovations - AIA's "AIA Smart Choice Medical Insurance" offers comprehensive coverage for high medical expenses, including key responsibilities such as hospitalization for serious illnesses and outpatient expenses, with a maximum payout limit of 5 million yuan and a low deductible of 5,000 yuan [3]. - The product includes personalized configurations for high-quality medical resources and outpatient drug/device coverage, supporting over 300 special drugs and three types of special devices, with a cumulative limit of 4 million yuan [3]. Group 3: Financial Efficiency and Family Coverage - The inefficiency of individual medical account usage has been a concern, with younger, healthier individuals accumulating funds while those with higher medical needs face shortages [4]. - Recent policy changes have expanded the scope of beneficiaries for individual medical accounts, allowing funds to be used for family members, thus creating a family insurance model that enhances the utilization of "sleeping" medical funds [4][5]. Group 4: Industry Implications and Future Directions - AIA's integration of medical insurance with individual accounts represents a significant release of policy benefits, allowing insured individuals to convert idle medical funds into enhanced family health coverage without additional cash outlay [5]. - The industry can learn from AIA's experience in three areas: product innovation aligned with policy, a new payment model that activates dormant medical funds, and the transition of commercial health insurance from a reimbursement model to a health service model [5][6].