Core Insights - The health insurance market, nearing a trillion yuan scale, is set to receive new regulatory guidance aimed at enhancing high-quality development and supporting the Healthy China strategy [1][2] Regulatory Developments - The Financial Regulatory Bureau has issued guidelines to strengthen regulation and mitigate risks in the health insurance sector, emphasizing the need for a multi-layered health insurance market that meets diverse needs across the population and lifecycle by 2030 [1][2] - The guidelines address existing issues such as product homogeneity, insufficient industry capabilities, and inadequate collaboration with medical services, aiming to optimize policies and clarify future directions for health insurance [2][3] Reform Initiatives - Key reform measures include the integration of long-term care insurance with home, community, and institutional care, allowing for cash benefits alongside care services [2][3] - The guidelines propose updating critical illness definitions and regularly reviewing disease incidence rates to keep pace with medical advancements [2][3] Health Management and Industry Collaboration - The guidelines advocate for a new health service guarantee system that combines prevention, management, and post-care support, promoting collaboration between health insurance and the broader health industry [3][4] - There is a push for insurance companies to enhance their health service networks and integrate deeply with medical and pharmaceutical sectors to support the development of health and biopharmaceutical industries [3][4] Introduction of New Insurance Products - The guidelines introduce concepts such as dividend-based health insurance, which combines basic disease coverage with savings and investment features, addressing consumer concerns about the value of premiums paid [4][6] - The focus on long-term health insurance products aims to improve sustainability and address the challenges posed by an aging population [6][7] Digital Transformation and Consumer Protection - The guidelines emphasize the need for digital transformation in health insurance, leveraging AI and big data to enhance operational efficiency and customer satisfaction [6][7] - Measures to improve complaint handling and regulatory oversight are highlighted to ensure consumer rights are protected and to maintain market order [6][7] Future Directions - The Financial Regulatory Bureau plans to foster a favorable policy environment for health insurance, expedite the development of floating income health insurance, and maintain strict regulatory oversight to protect consumer rights [7][8] - The anticipated impact of these guidelines includes a shift towards long-term business models and innovative products, enhancing the competitive landscape of the health insurance market [7][8]

Core Viewpoint - The Financial Regulatory Bureau has issued guidelines to promote the high-quality development of health insurance, emphasizing strong regulation and risk prevention to support the Healthy China strategy [1]. Group 1: Deepening Health Insurance Reform - The guidelines specify reform requirements for key health insurance products, including commercial medical insurance, long-term care insurance, income loss insurance due to disability, and disease insurance [3]. - As of the end of August, the original insurance premium income for health insurance from life insurance companies was 578.4 billion, accounting for 16.16% of total premium income, while property insurance companies reported 181.5 billion, making up 14.88% of their total [3]. Group 2: Product System and Coverage - The guidelines propose constructing a comprehensive, multi-tiered commercial medical insurance product system, incorporating new medical technologies, drugs, and equipment into coverage [4]. - Long-term medical insurance should adjust pricing based on risk categories and enhance the matching of premium rates with underwriting risks [4]. - The guidelines encourage the development of commercial long-term care insurance that meets home care, community care, and institutional care needs, offering a combination of cash benefits and care services [4]. Group 3: Enhancing Sustainability and Competitiveness - The guidelines emphasize the need for insurance companies to enhance their core competitiveness through professional capability building and digital application improvements [6]. - Issues such as product homogeneity and insufficient operational capabilities in the health insurance sector have been identified as constraints on service quality [6]. Group 4: Regulatory Strengthening - The guidelines call for strengthened health insurance regulation, including non-site monitoring and on-site inspections to combat malpractice and protect consumer rights [8]. - Future efforts will focus on creating a favorable policy environment for health insurance development and expediting the introduction of supporting business details for floating income health insurance [8].

金融监管总局数据显示，截至今年8月末，人身险公司健康险的原保险保费收入为5784亿元，占同期人 身险公司全部原保险保费收入的比重为16.16%；而财产保险公司今年前8个月的健康险原保险保费收入 为1815亿元，占财产保险公司同期全部原保险保费收入的比重为14.88%。 深化改革。 9月30日，金融监管总局发布《关于推动健康保险高质量发展的指导意见》（简称《意见》），从深化 健康保险改革、增强可持续发展能力、加强健康保险监管、优化健康保险发展环境等方面，提出15项任 务举措，进一步强监管防风险，以健康保险高质量发展服务健康中国战略。 深化健康保险改革 《意见》对健康保险主要险种——商业医疗保险、商业长期护理保险、失能收入损失保险和疾病保险， 分别提出了深化改革的要求。 因此，本次《意见》提出要强化保险公司主体责任和总精算师管理责任，建立可检视、可计量的健康保 险精算回溯机制，完善精算参数动态调整规则。完善再保险机制运用。加强健康保险专业人才队伍建 设，加大跨学科复合型人才培养力度。 同时，要加快推进健康保险数智化转型，增强数智化经营服务能力。加强数据积累，规范应用人工智 能、大数据等科技手段，改善经营管理，优化 ...

Core Viewpoint - The article discusses the release of the "Guiding Opinions on Promoting High-Quality Development of Health Insurance" by the Financial Regulatory Bureau, which outlines 15 measures aimed at enhancing the regulation and sustainable development of health insurance in China, aligning with the Healthy China strategy [2]. Group 1: Deepening Health Insurance Reform - The Opinions propose specific reform requirements for major health insurance types, including commercial medical insurance, long-term care insurance, disability income loss insurance, and disease insurance [4]. - As of the end of August, the original insurance premium income for health insurance from life insurance companies was 578.4 billion yuan, accounting for 16.16% of total premium income, while property insurance companies reported 181.5 billion yuan, making up 14.88% of their total [4]. Group 2: Product System and Service Enhancement - The Opinions aim to establish a comprehensive, multi-tiered commercial medical insurance product system, incorporating new medical technologies, drugs, and devices into coverage [5]. - It encourages long-term medical insurance to price according to risk categories and improve the matching of premium rates with underwriting risks [5]. - The document supports the development of personal account-style long-term medical insurance and the expansion of coverage for disability income loss insurance [5]. Group 3: Sustainable Development and Professional Capacity - The Opinions emphasize enhancing the sustainable development capacity of health insurance companies through professional capability building and digital application improvements [8]. - It identifies issues such as product homogeneity and insufficient industry operational capacity that hinder service quality [8]. - The document calls for strengthening the responsibilities of insurance companies and improving actuarial management mechanisms [8]. Group 4: Regulatory Strengthening - The Opinions stress the importance of regulatory oversight to maintain market order and address illegal activities, including financial misconduct and misleading sales practices [11]. - The Financial Regulatory Bureau plans to enhance communication with other departments to create a favorable policy environment for health insurance development [11]. - It also aims to expedite the research and implementation of supporting business details for floating income health insurance [11].

上证报中国证券网讯（记者 韩宋辉）上证报记者9月30日获悉，金融监管总局近日印发《关于推动健康 保险高质量发展的指导意见》（下称《意见》)，通过拓宽健康保险产品形态和功能，支持浮动收益型 健康保险发展，规范各类经办承办服务，增强健康保险可持续发展能力等，明确健康保险未来一段时间 发展的总体思路和阶段性目标，以健康保险高质量发展服务健康中国战略。 业内专家表示，健康保险为被保险人因健康原因或者医疗行为而导致的财务损失提供保障，连接医疗卫 生等产业，是保险业发挥筑牢社会保障网功能的重要险种。随着经济社会发展和健康中国战略推进，人 民群众健康保障需求日益提升，健康保险重要性不断增强。 "健康保险在持续快速发展的同时，产品形态单一、行业经营能力不足、基础薄弱、专业机构发展不及 预期、与医疗医药协同不够等阶段性问题也逐步显现，制约了服务保障水平的提升。"金融监管总局有 关司局负责人答记者问时表示，《意见》针对性地优化现有政策，打通卡点堵点，明确健康保险未来方 向和发展重点，正本清源，推动高质量发展。 拓宽产品形态和功能 丰富健康保险内涵 根据《意见》，我国要积极发展商业医疗保险，多方面拓宽健康保险产品形态和功能，进一步 ...

金融监管总局相关司局负责人表示，健康保险为被保险人因健康原因或者医疗行为的发生而导致的财务 损失提供保障，是保险业发挥筑牢社会保障网功能的重要险种，连接医疗卫生等产业，关系国计民生。 随着经济社会发展和健康中国战略的推进，人民群众健康保障需求日益提升，健康保险重要性不断增 强。健康保险在持续快速发展的同时，产品形态单一、行业经营能力不足、基础薄弱、专业机构发展不 及预期、与医疗医药协同不够等阶段性问题也逐步显现，制约了服务保障水平的提升。2024年9月，国 务院印发了《关于加强监管防范风险推动保险业高质量发展的若干意见》，明确要求"提升健康保险服 务保障水平""支持浮动收益型保险发展"。因此，金融监管总局研究制定了《意见》，针对性地优化现 有政策，打通卡点堵点，明确健康保险未来方向和发展重点，正本清源，推动高质量发展。 北京商报讯（记者 李秀梅）9月30日，金融监管总局印发了《关于推动健康保险高质量发展的指导意 见》（以下简称《意见》）。 ...

北京商报讯（记者 李秀梅）9月30日，金融监管总局印发了《关于推动健康保险高质量发展的指导意 见》（以下简称《意见》）。 《意见》提到，加强监管上下联动，推进政策制度有效实施。引导保险公司优化健康保险经营绩效管 理，完善考核评价体系。督促保险公司强化投诉源头治理，加大投诉处理力度。深化保险公司总分机构 联动，切实提高健康保险销售、承保和理赔服务水平。 ...

北京商报讯（记者 李秀梅）9月30日，金融监管总局印发了《关于推动健康保险高质量发展的指导意 见》（以下简称《意见》）。 《意见》提到，探索符合健康保险特点的发展战略和经营模式，深耕健康管理，促进医养康养相结合。 支持监管评级良好的健康保险公司，试点提高健康管理在健康保险产品净保费中的成本分摊比例上限， 试点健康保险与人寿保险组合销售，更好满足消费者综合保障需求，相关产品依法报送备案。 ...

Core Viewpoint - The article discusses the issuance of the "Guiding Opinions on Promoting High-Quality Development of Health Insurance" by the Financial Regulatory Bureau, emphasizing the need to enhance the health insurance sector's service and guarantee levels in response to increasing health protection demands and the aging population [1][12]. Summary by Sections 1. Increasing Demand for Health Insurance - The demand for health insurance is rising due to an aging population and increasing life expectancy, with the average life expectancy in China reaching 79 years [5]. - There is a growing need for commercial health insurance products, particularly for quick settlement of medical expenses and coverage of more medications not included in basic medical insurance [7][8]. 2. Breaking Through Bottlenecks - The health insurance sector has seen rapid growth since 2014, with commercial health insurance premium income expected to reach 977.3 billion by the end of 2024, more than six times the amount a decade ago, with a compound annual growth rate of approximately 20% [11]. - Despite this growth, challenges such as product homogeneity and insufficient operational capabilities are emerging, which hinder service improvement [11][12]. 3. Deepening Health Insurance Reform - The opinions outline a focus on enhancing the health management service system and promoting collaboration between health insurance and the healthcare industry [15][22]. - Specific areas of development include commercial medical insurance, long-term care insurance, and disability income loss insurance, with a push for integrating new medical technologies and drugs into insurance coverage [16][20]. 4. Enhancing Sustainable Development Capabilities - The article emphasizes the need for insurance companies to strengthen their responsibilities and improve actuarial management, as well as to enhance the professional talent pool in health insurance [24][25]. - It also highlights the importance of digital transformation and the use of big data and AI to improve operational efficiency and customer satisfaction [25]. 5. Strengthening Health Insurance Regulation - The regulatory framework will be improved to ensure compliance and fair pricing in health insurance products, with a focus on enhancing the overall market order [27][28]. - Measures will be taken to combat malpractice and protect consumer rights, ensuring a more transparent and efficient health insurance market [28]. 6. Optimizing the Health Insurance Development Environment - The article calls for the establishment of standardized health insurance clauses and evaluation systems to improve service quality and consumer understanding [31][32]. - It also encourages collaboration between various stakeholders to promote the development of group health insurance and improve public awareness of health insurance [32]. 7. Future Arrangements - The Financial Regulatory Bureau plans to create a favorable policy environment for health insurance development and to enhance product offerings to meet public demand for high-quality health protection [35].

《意见》提到，稳步发展疾病保险。结合疾病谱变化和医疗技术发展情况，及时修订疾病保险的疾病定 义。定期开展疾病发生率检视，适时更新人身保险业重大疾病经验发生率表。支持监管评级良好的保险 公司开展分红型长期健康保险业务。 北京商报讯（记者 李秀梅）9月30日，金融监管总局印发了《关于推动健康保险高质量发展的指导意 见》（以下简称《意见》）。 ...