Core Insights - AIA Life Insurance has launched a new medical insurance product called "Smart Choice Medical Insurance," which aims to provide customized healthcare solutions to meet the diverse and high-quality medical protection needs of families [1][2]. Product Features - The "Smart Choice" product features a flexible combination of "core protection + personalized configuration," allowing customers to tailor their medical insurance plans according to their needs [1][2]. - The core coverage includes general and critical illness hospitalization, proton and heavy ion medical treatments, outpatient expenses for CAR-T therapy, and special hospitalization allowances, with a cumulative payout limit of 5 million yuan and an annual deductible of only 5,000 yuan [2][3]. - Optional coverage includes high-quality medical resources and outpatient drug/device protection, with zero deductible for outpatient general drugs and specific drugs, covering over 300 special drugs and three types of special devices, each with a cumulative limit of 4 million yuan [3]. Market Context - The launch aligns with the increasing demand for multi-layered and diversified medical protection as living standards and healthcare levels improve [1]. - Government policies, such as the "National Ten Articles" and the "Healthy China 2030" plan, emphasize the importance of commercial health insurance in building a multi-tiered medical protection system, which opens new opportunities for insurance companies [1][4]. Customer-Centric Approach - AIA Life Insurance emphasizes a customer-driven approach in its business innovation, allowing customers to define their protection needs through a modular design [4]. - The product integrates comprehensive health services covering pre-diagnosis, diagnosis, and post-diagnosis support, enhancing the overall healthcare experience for customers [3].

Core Viewpoint - China Ping An's new business value in life and health insurance reached 22.335 billion yuan in the first half of 2025, marking a year-on-year growth of 39.8%, indicating significant growth potential in commercial health insurance due to rapid economic development in China [1][5]. Industry Insights - The Chinese government is placing high importance on the construction of a multi-level security system, emphasizing the necessity for collaboration between basic medical insurance and commercial health insurance [3][4]. - Policies supporting the high-quality development of commercial health insurance have been introduced this year, presenting historic opportunities for the sector [3][4]. - The basic medical insurance system covers 1.326 billion people with a participation rate of 95%, but the overall funding level is low, necessitating a focus on basic coverage [4]. Company Strategy - China Ping An is optimistic about the future of commercial health insurance, noting that the sector has maintained double-digit growth in premiums over recent years [5][6]. - The company plans to enhance the development of "insurance + medical" products to support the construction of a comprehensive medical ecosystem, focusing on differentiated and advantageous services [6][7]. - Ping An aims to deepen collaboration in the pharmaceutical insurance sector and actively participate in the construction of a drug directory to promote standardization and professional development within the industry [7].

Core Insights - The article highlights the importance of secondary reimbursement in China's medical insurance system, which is often overlooked by insured individuals, leading to significant financial losses [3][6]. Group 1: Current Status of Secondary Reimbursement - As of the first quarter of 2025, only 27.3% of eligible medical expenses were actually claimed for secondary reimbursement, indicating a lack of awareness among insured individuals [3]. - The secondary reimbursement system is part of a multi-tiered medical insurance framework, including major illness insurance, medical assistance, supplementary medical insurance, and employee personal accounts [4][5]. Group 2: Mechanisms of Secondary Reimbursement - Major illness insurance allows for reimbursement of 50% of medical expenses exceeding 50% of the local per capita disposable income, with no cap on the reimbursement amount [4]. - Medical assistance provided 873 billion yuan in funding in 2024, benefiting nearly 39.67 million people, with additional support for low-income households [4]. - Supplementary medical insurance has been established in 27 provinces, increasing reimbursement rates from 50% to an average of 70% for outpatient services [4]. Group 3: Challenges in Awareness and Application - A survey indicated that only 36% of insured individuals had a basic understanding of secondary reimbursement policies, and only 22% were aware of the specific application process [6]. - The complexity of the application process, requiring various documents and differing policies across regions, contributes to the low application rates [6]. Group 4: Efforts to Simplify Processes - The National Medical Insurance Administration has implemented a one-stop settlement reform, with 219 cities achieving this by June 2025, allowing for automatic calculation and settlement of various insurance claims [7]. Group 5: Maximizing Secondary Reimbursement Benefits - Insured individuals are encouraged to actively seek information about policies, retain all medical receipts, and inquire about eligibility for secondary reimbursement during hospital visits [9]. - Special provisions exist for certain demographics, such as higher reimbursement rates for individuals under 25 and additional benefits for seniors over 65 [9]. Group 6: Future Outlook and Policy Optimization - The 2025 work plan aims to increase the reimbursement rate for major illness insurance, lower the threshold for claims, and simplify application procedures, with a target of raising the application rate to over 50% [11]. - The total scale of the national medical insurance fund reached 3.2 trillion yuan in 2024, with 6.3% allocated for secondary reimbursement, indicating a focus on improving fund efficiency [11].

"多层次医疗保障，在这次的草案中没有得到明显体现。" "作为学者，我们要提议《医疗保障法》应该是扩展版的多层次，主体责任不仅仅是基本医疗保障，它 应该是一个多层次医疗保障的角色。从顶层设计、政策支持、医保商保衔接，还要明确医保主管部门的 角色，这是非常重要的。" 从多方反馈来看，业界讨论的焦点在于商业健康保险未被写入此次《医疗保障法（草案）》当中，这让 多位业内学者和从业人员直言对商业健康险发展和未来定位的担忧。 医疗保障法是上位法，是坐标系。多位学者呼吁，多层次医疗保障体系中不能缺了商业医疗保险的这一 个角色。如若顶层设计明确，未来制定和完善商业健康保险自身发展的相关法律法规也将拥有更好的方 向指引和抓手。 从《医疗保障法》立法进程看，2021年国家医保局发布征求意见稿，明确立法框架；2023年被列入全国 人大常委会立法规划第二类项目；再到今年4月，国务院常务会议原则通过草案，进入全国人大审议阶 段，整整历经4年。 一位学者向健闻咨询透露，目前《医疗保障法（草案）》已初步通过审议，但具体实施时间需全国人大 常委会最终决定。草案存在修改的可能性，但是否会经历多轮修改，均是未知数。 "商业健康保险"出现在附则， ...

Core Insights - The adjustment of the medical insurance drug catalog in 2025 has seen a significant increase in the number of drugs passing the formal review, with a new commercial insurance innovative drug catalog attracting industry attention [1][3] - The parallel submission of the basic medical insurance catalog and the commercial insurance innovative drug catalog aims to provide comprehensive coverage for different patient groups based on their payment capabilities, enhancing drug accessibility and market competitiveness [1][8] Summary by Sections Basic Medical Insurance Catalog - A total of 718 submissions were received for the basic medical insurance catalog, involving 633 drug generic names, with 534 passing the formal review [3] - The number of drugs passing the formal review from the catalog outside the basic insurance has increased significantly, with 310 out of 472 submissions approved, compared to 249 in 2024 [3] - The approved drugs cover various fields, including oncology, chronic diseases, and rare diseases, with notable entries like monoclonal antibodies and a popular weight-loss drug [3][4] Commercial Insurance Innovative Drug Catalog - The newly established commercial insurance innovative drug catalog received 141 submissions, with 121 passing the initial review, resulting in a pass rate of approximately 85.82% [5] - This catalog also includes drugs for oncology, chronic diseases, and rare diseases, primarily focusing on Western medicine, along with a few traditional Chinese medicines [5][6] - The establishment of this catalog reflects the government's commitment to building a multi-tiered medical insurance system, providing supplementary coverage for high-value drugs not included in the basic insurance [6][8] Dual Submission and Market Strategy - Several drugs have successfully passed the formal review for both the basic medical insurance catalog and the commercial insurance innovative drug catalog, indicating a strategic approach by pharmaceutical companies to expand market coverage [7][8] - The dual submission allows companies to target both broad patient groups through basic insurance and high-value innovative drugs through commercial insurance, enhancing drug accessibility and competitiveness [8]

Core Viewpoint - The article discusses the introduction of a "dual directory" system for medical insurance and commercial health insurance in China, with the preliminary results for 2025 announced, highlighting the inclusion of 121 innovative drugs in the commercial health insurance directory [2][3][6]. Group 1: Dual Directory System - The "dual directory" system for medical insurance and commercial health insurance is officially established, marking a significant shift in the healthcare payment landscape [6][10]. - The preliminary review results for the 2025 medical insurance and commercial health insurance innovative drug directories have been released, with 121 drugs approved for the commercial health insurance directory [11][12]. Group 2: Innovative Drug Directory - The commercial health insurance innovative drug directory includes 121 drugs, focusing on high-value medications that are not covered by basic medical insurance, particularly targeting cancer and rare diseases [14][24]. - Among the approved drugs, five CAR-T therapies, which are high-cost cancer treatments, have been included, reflecting the directory's emphasis on addressing the needs for innovative therapies [24][26]. Group 3: Impact on Healthcare - The introduction of the commercial health insurance innovative drug directory aims to bridge the gap in coverage for innovative drugs, allowing patients to access high-cost treatments through commercial insurance [14][31]. - The integration of data between medical insurance and commercial health insurance is expected to facilitate synchronized billing and improve patient access to necessary medications [33][34]. Group 4: Market Trends - The rapid development of commercial health insurance products, such as million-dollar medical insurance plans, indicates a growing market for innovative drug coverage [23][30]. - The article highlights the significant increase in claims for innovative drugs, with companies like Ping An Health reporting a 70% year-on-year growth in special drug expenses [36].

Core Insights - The adjustment of the medical insurance drug catalog for 2025 has seen a significant increase in the number of drugs passing the formal review, with a new commercial insurance innovative drug catalog introduced, attracting high industry attention [1][3][5] Summary by Sections Medical Insurance Drug Catalog - The National Healthcare Security Administration (NHSA) received 718 applications for the basic medical insurance catalog, with 534 passing the initial review, including 472 applications from outside the catalog, marking a notable increase from 249 in 2024 [3] - The approved drugs cover various fields such as oncology, chronic diseases, and rare diseases, with a significant number of monoclonal antibody injections passing the review [3][4] Commercial Insurance Innovative Drug Catalog - The newly established commercial insurance innovative drug catalog received 141 applications, with 121 passing the initial review, resulting in a pass rate of approximately 85.82% [5] - This catalog also includes drugs for oncology, chronic diseases, and rare diseases, primarily focusing on Western medicine, with some traditional Chinese medicine included [5][6] Dual Track Submission - Several drugs have simultaneously passed the reviews for both the basic medical insurance catalog and the commercial insurance innovative drug catalog, indicating a strategy to cater to different patient payment capabilities [7][8] - The dual submission approach allows for broader market coverage and addresses the needs of high-value innovative drugs that may not be included in the basic insurance catalog [8] Industry Implications - The increase in the number of drugs passing the reviews reflects the growing investment in innovative drug research and development in China, with a focus on enhancing patient access to essential medications [4][6] - The establishment of the commercial insurance innovative drug catalog signifies the government's commitment to building a multi-tiered medical security system, providing supplementary coverage for high-value drugs not included in the basic insurance [6][8]

Core Insights - The article emphasizes the urgent need for innovative payment pathways for high-value drugs, particularly CAR-T therapies, highlighting the challenges these therapies pose to health insurance systems and the necessity for commercial health insurance to adapt beyond traditional models [1] Group 1: Policy Framework - The government has positioned commercial health insurance as the "second pillar" of medical insurance, aiming to create a collaborative system comprising basic medical insurance, commercial health insurance, and charitable support [2] - The recent policy documents outline the establishment of a commercial health insurance directory for innovative drugs, prioritizing drugs with high innovation and clinical value [3] Group 2: Market Goals and Implementation - The goal is to cover 500 million people by 2030, with a projected market size for commercial health insurance reaching 2 trillion yuan by 2030, where payments related to innovative drugs will account for over 30% (approximately 600 billion yuan) [4] - A data integration platform is proposed to facilitate collaboration between medical institutions and pharmaceutical companies, promoting data sharing and streamlined payment processes [4] Group 3: Opportunities and Challenges - Three key opportunities for commercial health insurance include the establishment of a dedicated payment directory for innovative drugs, enhanced data access for insurance companies, and the development of comprehensive evidence for drug approval [5] - Four main challenges include data barriers due to concerns over data privacy, misalignment in product offerings between insurers and pharmaceutical companies, difficulties in hospital collaboration, and inefficient patient outreach strategies [6][7][8][9] Group 4: Strategic Recommendations for Pharmaceutical Companies - Companies are encouraged to collaborate in data sharing initiatives, providing real-world evidence to assist insurers in optimizing payment models [10] - Joint product development between pharmaceutical companies and insurers is recommended to enhance clinical value assessment and risk pricing [11] - Pharmaceutical companies should lead initiatives to establish dual payment agreements with hospitals, ensuring that insurance settlements are not included in medical insurance assessments [12] - A multi-faceted approach involving patient engagement strategies is essential to improve outreach and increase insurance coverage among healthy populations [14] Group 5: Lifecycle Strategy - Companies should embed commercial insurance payment considerations during the clinical trial phases to prepare for future insurance directory inclusion [15] - Prior to market launch, companies should focus on submitting comprehensive health technology assessment reports to facilitate early inclusion in commercial insurance directories [16] - During the initial market phase, leveraging commercial insurance to enhance patient access and data collection for future medical insurance negotiations is crucial [18] - Post-medical insurance inclusion, companies should focus on building a comprehensive care model that integrates economic evaluations and real-world data collection [19][21] Conclusion - The positioning of commercial health insurance as a second pillar opens a pathway for innovative drug payments, but successful implementation requires a shift from policy compliance to ecosystem collaboration, ensuring patient accessibility and commercial sustainability by 2030 [23]

Group 1 - The total asset scale of Beijing's insurance industry reached 1.3 trillion yuan by the end of 2021, growing by 19.4% compared to the beginning of the year, ranking second nationwide and accounting for 5.1% of the national total, an increase of 0.3 percentage points year-on-year [1] - Non-auto insurance business of property insurance companies in Beijing saw a year-on-year growth of 12.6%, with its business proportion approaching 60%, an increase of 5.4 percentage points year-on-year [1] - The comprehensive reform of auto insurance led to a nearly 20% decrease in average premiums for commercial auto insurance, with the comprehensive cost ratio being 1.7 percentage points lower than the national average [1] Group 2 - In 2021, Beijing's insurance industry provided risk protection for the entire society with a year-on-year increase of 2.9 times, and paid various claims amounting to 83.85 billion yuan, a year-on-year growth of 13.6% [2] - The industry actively engaged in disaster prevention services, with pre-paid claims and disaster prevention expenses increasing by 24.3% and 11.1% year-on-year, respectively [2] - Beijing's insurance sector supported pandemic prevention efforts by achieving full coverage of basic insurance for adverse reactions to first and second category vaccines, covering over 90% of the national COVID-19 vaccination doses [2]

Group 1: Health Insurance Market Growth - The commercial health insurance market in China has rapidly developed, with a variety of products and expanding service coverage [1] - In 2021, health insurance premium income reached 880.36 billion yuan, a year-on-year increase of 7.7%, while claims paid amounted to 408.53 billion yuan, up 39.9% [1] Group 2: Major Insurance Products and Services - Health insurance products mainly include disease insurance, medical insurance, medical accident insurance, nursing insurance, and disability income loss insurance [1] - The introduction of critical illness insurance has alleviated the financial burden on urban and rural residents, with over 140 million claims paid by China Life in 2021 [2] Group 3: Big Illness Insurance System - The big illness insurance system was established to reduce the financial burden of major illnesses for urban and rural residents, covering 1.22 billion people [3] - The reimbursement rate for insured individuals has increased by 10 to 15 percentage points [3] Group 4: Supplementary Medical Insurance - The rapid development of short-term medical insurance, particularly "Hui Min Bao," has provided additional medical coverage for residents [4] - By the end of 2021, 27 provinces had launched over 200 "Hui Min Bao" products, with total premiums exceeding 14 billion yuan [5] Group 5: Long-term Care Insurance - Long-term care insurance has become a focus due to aging population issues, with over 1 billion people covered by pilot programs [7] - The pilot programs have provided long-term care services to over 700,000 disabled elderly individuals [7] Group 6: Innovations in Insurance Products - Companies are increasingly offering insurance products tailored for new citizens, with 55 products available from Nongyin Life [6] - The "Ai Ta Bao" product, aimed at women, has been launched to enhance coverage and services for female citizens [6]