在"健康中国"战略与上海国际金融中心建设的双重驱动下，商业健康险正成为连接医疗、医药与民生保 障的关键纽带。今年8月，国家金融监督管理总局上海监管局等七部门联合印发《关于促进商业健康保 险高质量发展助力生物医药产业创新的若干措施》（简称"新18条"），为上海商保与生物医药产业 的"双向赋能"提供了清晰的政策框架。 政策引航，市场破局。作为"新18条"落地的重要实践，上海保险业正加速构建与基本医保相衔接的补充 保障体系。其中，12月即将面市的上海"新团险"模式，因其在多元支付机制和保障范围上的重大突破， 备受业界关注。 破局"支付难"："新团险"撬动多元共付，筑牢民生保障"防护网" 最关键的突破在于多元化筹资与支付机制。"新18条"明确支持职工使用医保个人账户历年结余支付保 费。黄芹芹表示，"新团险"构建的"企业出资+医保个账"的职工共付及家庭共济机制，既盘活了沉淀资 金，也打破了企业预算有限的"天花板"，显著提升了保障的可持续性和杠杆效应。 "新18条"的核心目标之一，是推动商业健康险成为生物医药这一"新质生产力"的关键支付端。然而，要 有效承接住创新药械的支付需求，商业保险必须具备足够的市场规模和覆盖面。 ...

Core Points - The "Hui Tang Bao" product, a pure public welfare supplementary commercial health insurance, was officially launched on November 6, 2023, in Tangshan, with participation from various regulatory and insurance bodies [1] - The insurance scheme has already covered over 2.097 million residents of Tangshan since its initial launch in 2022, with total claims amounting to approximately 270 million yuan [3] - The product aims to alleviate high medical costs for residents and is integrated into the city's multi-tiered medical insurance system [3] Group 1 - The "Hui Tang Bao" product is a key component of Tangshan's "3+2" medical insurance system, providing essential supplementary coverage to basic medical insurance [3] - The insurance industry in Tangshan is committed to maintaining a correct development direction in line with national financial policies [3][4] - The Tangshan Insurance Industry Association will enhance coordination and self-regulation to ensure the sustainability of this public welfare initiative [4] Group 2 - The 2026 "Hui Tang Bao" product features five key highlights aimed at improving the quality and accessibility of medical coverage [5][6] - The product will continue to offer two versions, "Youth Version" and "Universal Version," to cater to different demographic needs [6] - Enrollment for the 2026 "Hui Tang Bao" is open until December 31, 2025, with no restrictions on age, occupation, residency, or medical history for applicants [7]

Core Insights - The conference "Focusing on Bay Area Collaboration and Expanding International Cooperation: 2025 Health and Life Sciences Conference" successfully concluded in Guangzhou, highlighting the importance of international collaboration in the health and life sciences sector [2][3][42] - Key topics included medical service collaboration, regulatory innovation in pharmaceuticals and medical devices, biomanufacturing ecosystems, and cross-border healthcare mechanisms [3][42] Group 1: Conference Overview - The conference was guided by the Guangzhou International Biological Island Management Committee and co-hosted by various health organizations, showcasing strong support from numerous pharmaceutical companies and financial institutions [2][3] - The event attracted representatives from health authorities in mainland China, Hong Kong, Macau, and international health organizations, emphasizing the global perspective on health cooperation [3][42] Group 2: Key Presentations - Meng Dongping, Secretary of the China Chamber of Commerce for Import and Export of Medicines and Health Products, emphasized the resilience and opportunities in China's health industry, particularly in the Greater Bay Area [6] - Dr. Gina Samaan from the World Health Organization highlighted the importance of cross-national cooperation in enhancing emergency response systems and public health resilience [6][7] - William Adi Teja from Indonesia's drug regulatory authority discussed Indonesia's regulatory innovations aimed at promoting pharmaceutical innovation and attracting investment [9] Group 3: Regional Development and Innovation - Tian Peilong from Guangzhou's Industrial and Information Technology Bureau presented Guangzhou's advantages in the biopharmaceutical sector, including a robust industrial ecosystem and strong medical resources [11] - Huang Weijian, Director of the Guangzhou International Biological Island Management Committee, outlined the island's role as a core engine for biopharmaceutical innovation, housing over 700 companies [13] Group 4: Roundtable Discussions - A roundtable discussion focused on enhancing the accessibility and affordability of innovative pharmaceuticals and medical devices in the Bay Area, with participants advocating for simplified regulatory standards and increased policy support [15][16] - Another roundtable addressed cross-border healthcare cooperation, emphasizing the need for integrated service systems and the potential for the Bay Area to attract international patients [23] Group 5: Multi-layered Healthcare System - Chen Xingwei, President of the Guangdong Provincial Health Economics Association, stressed the importance of a multi-layered healthcare system to ensure equitable access to healthcare innovations [31] - The Guangzhou Medical Insurance Bureau's initiatives, such as the "Sui Suikang" insurance product, aim to address the challenges of accessing innovative medications [32][34] Group 6: Future Outlook - The conference concluded with a vision for the Greater Bay Area to continue leveraging its advantages in institutional innovation and regional collaboration to build a high-quality health ecosystem [42]

Core Points - The National Healthcare Security Administration (NHSA) announced that the new basic medical insurance drug list and the first commercial insurance innovative drug list will be released online and offline in Guangzhou on the first weekend of December, with implementation starting January 1, 2024 [1] - The recent negotiations involved 120 domestic and foreign enterprises, with 127 drugs outside the basic medical insurance drug list and 24 drugs for the commercial insurance innovative drug list participating in price negotiations [3] - The commercial insurance innovative drug list was established to better meet the diverse medication needs of the public, with 121 high-value drugs approved through this new list [7] Industry Insights - The commercial health insurance market in China is experiencing rapid growth, with the original insurance premium income reaching 977.3 billion yuan in 2024, an increase of 8.2% year-on-year [7] - The total expenditure of the basic medical insurance fund is projected to reach 2.97 trillion yuan in 2024, providing solid support for healthcare services [7] - The NHSA is exploring solutions to synchronize settlements between basic medical insurance and commercial health insurance, with several regions already implementing one-stop payment platforms [9]

Core Viewpoint - The article discusses the recent establishment of a commercial health insurance (CHI) innovative drug directory in China, marking a significant shift towards a dual-track payment system for innovative drugs, alongside the traditional national medical insurance system [4][6][12]. Group 1: Introduction of Commercial Health Insurance Innovative Drug Directory - The CHI innovative drug directory focuses on high-innovation, clinically valuable drugs that cannot be included in the basic medical insurance directory due to their high costs [4][6]. - This directory aims to address the multi-layered payment challenges for innovative drugs, with the implementation of supportive measures still pending [4][6]. Group 2: Transition to Dual-Track Payment System - The introduction of the CHI innovative drug directory represents a historic transition from a single-track medical insurance system to a dual-track system combining both national medical insurance and commercial health insurance [6][12]. - The new policy is expected to alleviate the financial pressure on the basic medical insurance fund while enhancing access to innovative drugs [6][12]. Group 3: Current Challenges in Commercial Health Insurance - There are significant disparities in coverage provided by commercial health insurance for innovative drugs, with only 7.7% of the market being covered by CHI [7]. - The current commercial health insurance market is small, and expanding its scale is a pressing issue, with group insurance being a potential avenue for growth [12][13]. Group 4: Implementation and Operational Challenges - The successful implementation of the CHI innovative drug directory requires collaboration among the National Medical Insurance Administration, pharmaceutical companies, and insurance providers [10]. - There are concerns regarding the ability of existing commercial health insurance products, such as "Hui Min Bao," to adequately cover innovative drugs due to low reimbursement rates [11][12]. Group 5: Need for Improved Payment Mechanisms - The article emphasizes the need for improved payment mechanisms, such as direct settlement systems, to facilitate the integration of innovative drugs into hospitals [16]. - Establishing a collaborative mechanism between medical insurance and commercial health insurance is crucial for effective implementation and data sharing [16].

相伴五年，守护四季，2026年度"北京普惠健康保"全新上线！11月3日，北京商报记者了解到，"北京普 惠健康保"2026版保障继续升级，加量不加价。具体来看，健康人群自付费用起付线降至1.5万元；特药 责任报销比例提高5个百分点；特药保障病种覆盖扩展至87种，并新增线上线下9折购药权益。 整体而言，2026年度"北京普惠健康保"保障范围更广了，健康服务也更实用。从专属服务层面看，连续 参保更优待，对于三年连续参保且无出险记录的被保人，可以在"专属服务"中选择一项并免费体验。 普惠再升级保障更精准 11月3日，2026年度"北京普惠健康保"上线发布会在京举行，2026年度"北京普惠健康保"保费仍维持195 元/人/年，累计保额升级至350万元，并带来五大升级点，包括"一降、一扩、一提、二增"，产品保障内 容迎来了全面优化。 "一降"体现在理赔门槛降低，健康人群自付责任起付线由3.04万元降至1.5万元，1.5万—3.04万元之间自 付费用新增报销25%。3.04万元（与北京市大病保障共用一个起付线，不重复计算）以上费用，健康人 群仍然报销80%，特定既往症人群报销40%。 "一扩"体现在特药保障范围进一步扩大， ...

Core Points - The Beijing Universal Health Insurance for 2026 has officially opened for enrollment, with over 15 million participants and more than 340,000 claims paid since its launch [1] - The insurance is guided by the Beijing Municipal Medical Security Bureau and the Beijing Financial Supervisory Committee, with a stable premium of 195 yuan per person per year [1] - The program aims to alleviate high medical costs and prevent poverty due to illness, contributing to a multi-tiered medical security system [1] Summary by Categories Enrollment and Participation - Cumulative enrollment has exceeded 15 million participants [1] - Over 340,000 claims have been paid out [1] Insurance Features - The insurance maintains a premium of 195 yuan per person per year [1] - It operates under the principles of "no age limit, no medical history limit" and "cost recovery with minimal profit" [1] Service Enhancements for 2026 - The deductible for healthy individuals has been reduced from 30,400 yuan to 15,000 yuan [1] - The coverage for innovative drugs outside the medical insurance catalog has been expanded to 159 types [1] - The reimbursement ratio for special drugs has increased by 5 percentage points, reaching 65% for healthy individuals and 35% for those with pre-existing conditions [1]

Core Points - "Hebei Medical Insurance" was officially launched on October 28, 2025, in Shijiazhuang, with participation from various leaders and organizations, marking a significant step in enhancing healthcare coverage in Hebei Province [1][3] Group 1: Product Overview - The insurance is available for basic medical insurance participants and new citizens in Hebei Province, with premiums set at 99 yuan/year for ages 0-20, 139 yuan/year for ages 21-50, and 179 yuan/year for ages 51 and above, providing up to 6 million yuan in medical coverage for all age groups [2][13] - The product is designed as a beneficial supplement to basic medical insurance, addressing gaps in coverage and activating healthcare resources to meet public health needs more effectively [3][11] Group 2: Key Features - The insurance is guided by the Hebei Provincial Medical Security Bureau, ensuring compliance, transparency, and reliability in product design and operation [11] - It allows for broad eligibility, with no restrictions on age, occupation, or health status, including coverage for pre-existing conditions with specified deductibles and payout ratios [12] - The coverage includes inpatient medical expenses within and outside the basic medical insurance scope, specific domestic and overseas drug costs, and CAR-T treatment expenses, with a total maximum coverage of 6 million yuan [14] - It features zero deductible for 95 types of global specialty drugs and 5 types of CAR-T treatments, addressing high-incidence diseases in Hebei and reducing the financial burden on patients [15] - The claims process is designed to be convenient, with immediate payouts upon discharge and synchronized settlements with basic medical insurance, facilitating a one-stop service for patients [17]

Core Insights - The article discusses the challenges faced by Huiminbao, a type of supplementary health insurance in China, which cannot freely price or manage risks like commercial insurance, nor can it enforce participation and provide fiscal backing like social insurance [1][2]. Group 1: Market Trends - Huiminbao, introduced in Shenzhen in 2015 and expanded nationwide in 2020, is currently in a market adjustment phase, with the proportion of operational products decreasing from 74.3% in 2023-2024 to 66.78%, and further to 65.54% in 2024-2025 [2]. - As of July 2023, there are 313 Huiminbao products with over 171 million participants, highlighting its role in alleviating high out-of-pocket medical expenses [2][3]. Group 2: Challenges and Risks - The average participation rate for 53 publicly available Huiminbao products in 2023 was only 18.9%, significantly below the critical threshold of 70%-80% needed for effective risk dispersion [3]. - Many Huiminbao projects are facing a "death spiral" due to low participation rates and high claim thresholds, with some regions requiring a payout rate of 80%, leading to increased financial strain on these programs [3][4]. Group 3: Strategies for Improvement - To enhance participation rates, some regions have expanded eligibility to flexible employment groups and allowed the use of personal medical account balances for payments, although these measures may face diminishing returns [4]. - Insurance companies are encouraged to transition towards health management service providers, utilizing data analytics for better risk management and offering value-added services to increase user engagement [5]. Group 4: Future Directions - The article suggests that the government should focus on long-term institutional support rather than short-term interventions, allowing the market to operate more freely while enhancing the role of commercial insurers in Huiminbao projects [4][5]. - There is a call for greater clarity in coverage responsibilities, improved pricing models based on demographic factors, and a reduction in product homogeneity to restore consumer confidence and industry reputation [4][5].

长沙晚报掌上长沙10月20日讯（全媒体记者 曹开阳）10月20日，湖南省普惠型商业补充医疗保险项目——"湖南 医惠保2026"在长沙正式启动。这一年度缴费128元起、提供政策内外各200万元的最高保障的惠民工程，标志着 湖南在构建多层次医疗保障体系方面取得了重要进展，为全省参保群众织就了一张更加坚实、广泛的健康"保障 网"。 政策引领，服务"健康湖南"大局 "湖南医惠保2026"是在湖南省医疗保障局、国家金融监督管理总局湖南监管局等单位共同指导下，由中国人寿保 险股份有限公司湖南省分公司与中国人民财产保险股份有限公司湖南省分公司主承保，联合在湘11家保险机构共 同推出的普惠型商业补充医疗保险。 湖南省医疗保障局副局长邓洁云在致辞中表示，"湖南医惠保2026"是湖南省深入贯彻落实"健康中国"战略的重要 实践，是完善民生保障体系的关键举措。这一产品通过政府引导、市场运作的模式，实现了基本医保与商业保险 的有效衔接，充分体现了我们推进共同富裕、增进民生福祉的坚定决心。 国家金融监督管理总局湖南监管局人身保险监管处处长郭春高表示："湖南医惠保2026"的推出是深入贯彻落实中 央金融工作会议精神，推动普惠保险高质量发展 ...