Core Insights - The demand for mid-range health insurance products is rising due to increased health management awareness among residents and diverse medical insurance needs [1][2] - Major insurance companies are actively launching mid-range health insurance products, driven by opportunities arising from healthcare payment reform [1][2] - The growth of mid-range health insurance is a natural outcome of the multi-tiered healthcare system, addressing consumer needs for better medical services without the high costs of premium insurance [1][3] Market Dynamics - The mid-range health insurance market is becoming competitive, providing consumers with more choices to meet their multi-tiered healthcare needs [2] - However, the market faces challenges such as product homogeneity, complex terms, and low consumer recognition [2][3] - Insurance companies need to optimize product design to cater to diverse consumer needs and enhance market acceptance [2][3] Product Development - Companies should adopt modular design concepts to offer customizable coverage options, allowing consumers to select and combine benefits according to their needs [2] - There is a need for timely inclusion of innovative drugs and new technologies in mid-range health insurance coverage [2][3] Service Enhancement - Improving service quality and customer experience is essential, including offering value-added services and simplifying claims processes [3] - Regular employee training is necessary to enhance staff understanding of insurance terms and medical knowledge [3] Risk Management - Establishing a robust risk management system is crucial for assessing and monitoring medical risks, as well as controlling payout costs [3] Consumer Awareness - Increasing consumer awareness and understanding of mid-range health insurance is vital for market growth [3] Industry Impact - The rise of mid-range health insurance is significant for improving the multi-tiered healthcare system in China, meeting demands for high-value medications and innovative therapies [3][4] - The development of mid-range health insurance is expected to foster collaboration between the insurance and pharmaceutical industries [3][4]

7月1日，国家医保局联合国家卫生健康委出台的《支持创新药高质量发展的若干措施》（以下简称 《若干措施》）发布。其中提出的"增设商业健康保险创新药品目录"备受关注。 在当日国家医保局举行的新闻发布会上，国家医保局医药管理司司长黄心宇表示："基本医保和商 业健康保险都是我国多层次医疗保障体系的重要组成部分。《若干措施》提出了加强对创新药研发支 持，支持创新药进入医保药品目录和商保创新药目录，鼓励创新药临床应用，提高创新药多元支付能 力，以及强化组织保障等5方面16条具体举措。未来一段时间，将为支持我国创新药的高质量发展提供 积极助力。" 《若干措施》提出，适应多层次医疗保障体系发展需要，增设商业健康保险创新药品目录，重点纳 入创新程度高、临床价值大、患者获益显著且超出基本医保保障范围的创新药，推荐商业健康保险和医 疗互助等多层次医疗保障体系参考使用。 商保重要性日益凸显 数据显示，我国基本医保体系已覆盖超过13亿人，参保率稳定在95%。2024年，医保基金支出达 2.97万亿元，为医疗体系运行和医药产业发展提供了坚实保障。自2018年以来，149种创新药（主要为1 类创新药）纳入医保目录，占新增药品数量的17%。 ...

Core Viewpoint - The recent regulatory notice aims to standardize the rapidly growing urban commercial health insurance sector, emphasizing its role as a beneficial supplement to basic medical insurance and ensuring sustainable development while protecting consumer rights [1][2][5]. Group 1: Regulatory Framework - The notice outlines multiple aspects for regulating urban commercial health insurance, including promoting inclusivity, adhering to commercial principles, and enhancing product management and pricing accuracy [1]. - It emphasizes the need for insurance companies to operate under market principles, ensuring that products are developed based on consumer needs and historical data [4][9]. Group 2: Market Dynamics - Urban commercial health insurance has gained popularity due to its government backing, low entry barriers, and high coverage, but it faces sustainability risks due to issues like unclear responsibilities and high product homogeneity [3][7]. - As of October 2024, there are 298 urban commercial health insurance products, with a slowdown in new product launches, indicating ongoing discussions about sustainability in the sector [7]. Group 3: Pricing and Risk Management - The notice calls for precise risk management and differentiated pricing based on demographic factors such as age and health status, aiming to prevent adverse selection and ensure the viability of insurance products [7][8]. - Insurance companies are required to conduct regular assessments of their products' profitability and adjust pricing and coverage accordingly to maintain sustainability [8]. Group 4: Consumer Protection and Market Conduct - The notice mandates that insurance companies enhance sales practices, ensuring accurate communication of product features and preventing misleading sales tactics [10]. - It also prohibits unhealthy competition practices, such as price wars, and emphasizes the importance of fair competition and consumer rights protection [9][10]. Group 5: Collaborative Governance - The notice encourages collaboration among various stakeholders, including regulatory bodies and local governments, to create a coherent framework for urban commercial health insurance [11]. - It aims to clarify the distinction between commercial and social insurance, promoting a better understanding of their roles in the healthcare system [11].

日前，国家金融监督管理总局下发《关于推动城市商业医疗险高质量发展的通知》(以下简称《通 知》)，规范城市定制型商业医疗保险业务，推动这一普惠性商业保险产品实现可持续发展。城市定制 型商业医疗险在业内俗称"惠民保"，由保险公司依据《中华人民共和国保险法》市场化运作，对于分散 和转移健康风险、减轻被保险人高额医疗费用负担具有重要意义和积极作用。 扩面提质突出普惠性 近年来，保险业围绕人民群众的优质医疗保障需求，优化"惠民保"产品供给，及时将医疗新技术、新药 品、新器械应用纳入责任范围，为人民群众提供覆盖广泛、公平可得、保费合理、保障有效的保险服 务。 众惠财产相互保险社董事长李静认为，"惠民保"作为基本医保的重要区域性补充，在多层次医疗保障体 系建设中承担着衔接基础保障与个性化需求的重要职能，是连接基本医保与商业健康险的纽带。"惠民 保"在一定程度上缓解了公众面对高额医疗费用的负担，有助于拓展保险的深度和广度，也引导公众进 一步关注商业保险。因此，规范发展的"惠民保"可提升保障体系韧性，使医保基金更多聚焦基础托底功 能，形成"基本医疗保险广覆盖、城市商业医疗险精准补充"的梯次保障架构。 今年4月下旬，2025年度 ...

Group 1 - The central government emphasizes the importance of social assistance systems to support vulnerable groups, particularly the elderly and low-income families, in ensuring basic living standards and social stability [1] - The meeting highlights the need for a tiered and categorized social assistance system to address the diverse needs of different groups, including the elderly, unemployed, and those suffering from severe illnesses [1] Group 2 - In Nantong, nearly 20% of elderly residents have received home-based elderly care services, showcasing a dual support system that combines material assistance with emotional support [2][4] - The local government allocates budget for community and home-based elderly care services, providing monthly subsidies to low-income elderly individuals [3] - Community volunteers conduct regular visits to elderly residents, offering companionship and assistance, which helps alleviate feelings of loneliness among the elderly [4] Group 3 - In Pingxiang, a resource-depleted city, community workers assist laid-off workers in applying for temporary aid and low-income support, demonstrating a proactive approach to social welfare [5][6] - The community has implemented a grid-based service model to ensure comprehensive coverage of support for vulnerable groups, including the elderly and those with health issues [6] Group 4 - In Xining, a multi-tiered medical insurance system has been established, allowing for significant reimbursement of medical expenses for chronic illnesses, thus reducing the financial burden on families [7][8] - The local government has created a seamless reimbursement process for medical expenses, ensuring that low-income individuals can access necessary healthcare without incurring substantial out-of-pocket costs [8]

Group 1 - The central government emphasizes the importance of social assistance systems to support vulnerable populations, particularly the elderly and those affected by unemployment or illness [1] - The meeting highlights the need for a tiered and categorized social assistance system to ensure basic living standards for low-income groups [1] - The article discusses the challenges faced by elderly individuals with multiple vulnerabilities, such as being single, ill, or living alone, particularly in aging regions and resource-depleted cities [1] Group 2 - In Nantong, nearly 20% of elderly individuals have received home-based elderly care services, showcasing a dual support system of material and spiritual assistance [2][4] - The local government provides monthly subsidies for low-income elderly individuals, including a service budget for community support, which enhances their quality of life [3][4] - The community has implemented a dynamic identification mechanism for vulnerable groups, ensuring that those on the edge of social assistance are included in support programs [3] Group 3 - In Pingxiang, a resource-depleted city, community workers assist laid-off workers in accessing temporary aid and job placement services, demonstrating a proactive approach to social support [5][6] - The community has developed a network of support that includes regular visits and assistance in navigating social services, which has proven effective for families in need [6] - The local government has created flexible job opportunities for displaced workers, integrating social welfare with employment initiatives [6] Group 4 - In Xining, a multi-layered medical insurance system has been established, allowing for significant reimbursement of medical expenses for chronic illnesses [7][8] - The local government has implemented a comprehensive medical assistance program that includes full funding for the most vulnerable populations, ensuring access to necessary healthcare [8] - The integration of various medical assistance programs allows for streamlined reimbursement processes, significantly reducing out-of-pocket expenses for patients [8]

日前，国家金融监督管理总局下发《关于推动城市商业医疗险高质量发展的通知》（以下简称《通 知》），规范城市定制型商业医疗保险业务，推动这一普惠性商业保险产品实现可持续发展。城市定制 型商业医疗险在业内俗称"惠民保"，由保险公司依据《中华人民共和国保险法》市场化运作，对于分散 和转移健康风险、减轻被保险人高额医疗费用负担具有重要意义和积极作用。 扩面提质突出普惠性 近年来，保险业围绕人民群众的优质医疗保障需求，优化"惠民保"产品供给，及时将医疗新技术、新药 品、新器械应用纳入责任范围，为人民群众提供覆盖广泛、公平可得、保费合理、保障有效的保险服 务。 众惠财产相互保险社董事长李静认为，"惠民保"作为基本医保的重要区域性补充，在多层次医疗保障体 系建设中承担着衔接基础保障与个性化需求的重要职能，是连接基本医保与商业健康险的纽带。"惠民 保"在一定程度上缓解了公众面对高额医疗费用的负担，有助于拓展保险的深度和广度，也引导公众进 一步关注商业保险。因此，规范发展的"惠民保"可提升保障体系韧性，使医保基金更多聚焦基础托底功 能，形成"基本医疗保险广覆盖、城市商业医疗险精准补充"的梯次保障架构。 今年4月下旬，2025年度 ...

Core Insights - The healthcare insurance system in China is set to cover nearly 20 billion medical reimbursements from 2021 to 2024, with 2024 figures projected to be 1.6 times that of 2020 [1] - The system aims to enhance quality and expand coverage, focusing on vulnerable groups including the elderly and children, while providing targeted support for low-income populations [1][11] Group 1: Childcare and Maternal Health - The healthcare insurance system is strengthening maternity insurance, with 253 million participants and cumulative expenditures of 438.3 billion yuan, benefiting 96.14 million people by June 2025 [3] - Newborns can now enroll in basic health insurance using their birth certificates, and nearly 60% of regions provide direct maternity benefits to female employees [3] Group 2: Elderly Care - A long-term care insurance system is being established, with 190 million participants expected by the end of 2024, addressing the needs of disabled individuals requiring long-term care [5] Group 3: General Health Coverage - The employee health insurance system has expanded its outpatient mutual aid mechanism, allowing personal accounts to cover near relatives, with over half of the regions implementing this nationwide [7] Group 4: Chronic Disease Management - Ten types of outpatient chronic diseases can now be reimbursed directly across provinces, benefiting 560 million people and reducing out-of-pocket expenses by 590 billion yuan [9] - The dynamic adjustment of the healthcare drug list has led to the inclusion of 402 new drugs since the start of the 14th Five-Year Plan [9] Group 5: Support for Low-Income Populations - The healthcare insurance policies have benefited 673 million low-income individuals in rural areas, alleviating over 650 billion yuan in medical expenses [11]

Core Viewpoint - The article highlights the achievements and future plans of China's medical insurance system during the "14th Five-Year Plan" period, emphasizing the stability and expansion of coverage, the financial support for the healthcare industry, and the ongoing reforms to improve the quality and efficiency of medical services [1][2]. Group 1: Medical Insurance Coverage and Financial Support - The basic medical insurance coverage rate has remained stable at around 95%, with 1.327 billion people enrolled in 2024 [1][3]. - Cumulative medical insurance fund expenditure reached 12.13 trillion yuan, with an annual growth rate of 9.1%, providing robust financial support for healthcare services [1][2]. - Nearly 200 billion medical insurance reimbursements were utilized by patients from 2021 to 2024, marking a 1.6 times increase compared to 2020 [3]. Group 2: Multi-tiered Medical Security System - A multi-tiered medical security system is being established, consisting of a unified medical insurance information platform, basic medical insurance, critical illness insurance, and medical assistance [4]. - As of June 2025, 253 million people participated in maternity insurance, with cumulative expenditures of 438.3 billion yuan [4]. - Long-term care insurance has covered 190 million people, addressing the care needs of disabled individuals [5]. Group 3: Regulation and Management of Medical Insurance Funds - The National Medical Insurance Administration has intensified efforts to regulate medical insurance funds, focusing on reducing fraud and ensuring proper fund usage [6][7]. - In the first half of the year, 335,000 medical institutions were inspected, recovering 16.13 billion yuan in misused funds [7]. - The administration has implemented data-driven approaches to enhance the precision of fund management and fraud detection [7]. Group 4: Drug Price Governance - Drug pricing remains a significant concern, with the government encouraging market-driven pricing while maintaining oversight to prevent price manipulation [9][10]. - Since 2018, ten rounds of centralized drug procurement have been conducted, covering 435 drugs, which has helped lower drug prices and improve accessibility [11]. - The administration has taken measures to address abnormal drug pricing, urging companies to adhere to fair pricing practices [12].

Core Insights - The "14th Five-Year Plan" aims to enhance the national medical insurance system, achieving a stable coverage rate of approximately 95% and a cumulative expenditure of 12.13 trillion yuan, with an annual growth rate of 9.1% [1][3] Group 1: Medical Insurance Coverage - By 2024, nearly 200 million medical visits will benefit from insurance reimbursement, representing a 1.6 times increase compared to 2020 [3] - As of June 2025, 253 million people are expected to participate in maternity insurance, with cumulative expenditures reaching 438.3 billion yuan and benefits enjoyed by 96.14 million people [3] Group 2: Long-term Care and Elderly Support - A long-term care insurance system is being established, with 190 million participants expected by the end of 2024, addressing the needs of disabled individuals [3] - Over 95% of village clinics will be included in the insurance system, facilitating access to medical services for the elderly [3] Group 3: Medical Institutions and Cross-Province Services - By June 2025, the number of designated medical institutions for insurance will reach 1.1 million, expanding the coverage of employee insurance to include close relatives [4] - The number of cross-province designated medical institutions has reached 644,000, benefiting 560 million medical visits and reducing out-of-pocket expenses by 590 billion yuan [4] Group 4: Support for New Medical Technologies - A total of 402 new drugs have been added to the insurance catalog since the beginning of the "14th Five-Year Plan," with ongoing reforms in payment methods to promote new technologies and equipment in clinical applications [4] Group 5: Poverty Alleviation and Future Directions - Medical assistance policies have benefited 673 million rural low-income individuals, alleviating over 650 billion yuan in medical expenses [5] - The National Medical Insurance Administration aims to manage insurance funds effectively while supporting the development of the pharmaceutical industry and enhancing the availability of safe and efficient medical products and services [5]