Core Viewpoint - The development pattern of "Hui Min Bao" products, as an important carrier for multi-level payment of innovative drugs and medical devices in China, is set to undergo significant adjustments [1][2]. Group 1: Regulatory Changes - The National Financial Supervision Administration issued a notice on July 31 to further standardize the business model of urban customized commercial health insurance, emphasizing scientific premium setting and differentiated pricing principles [2]. - Insurance companies are required to base premium rates on reliable historical data regarding disease incidence, payout rates, and cost rates, ensuring fairness and adaptability in products and services [2]. Group 2: Market Trends - The scale of medical insurance premiums has been growing, with the scale surpassing critical illness insurance in 2024, indicating a significant boost from "Hui Min Bao" for insurance companies in the medical sector [3]. - In 2024, there were 173 "Hui Min Bao" products operating across 30 provinces, with an average operational time of 3.6 years, and the premium scale reached 20 billion yuan [3]. Group 3: Industry Collaboration and Product Development - There is a need for better collaboration between pharmaceutical companies and insurance providers to develop specialized insurance products for innovative drugs and medical devices [5]. - The establishment of a selection mechanism for innovative drugs based on clinical value is essential, along with exploring innovative payment methods linked to clinical outcomes [5]. Group 4: Future Directions - The focus will be on designing insurance products for individuals with pre-existing conditions and enhancing patient service experiences [3][4]. - The integration of innovative drugs into insurance product directories should not lead to price competition but rather promote a fair distribution of benefits among stakeholders [4].

Core Viewpoint - The recent notice from the National Financial Supervision Administration emphasizes the need for high-quality development of urban commercial medical insurance, particularly focusing on product management and precise pricing strategies [2][6]. Group 1: Market Overview - Urban commercial medical insurance, known as "惠民保," serves as a supplementary insurance for individuals with basic medical insurance, covering large medical expenses not reimbursed by basic insurance [3]. - The market for "惠民保" has seen a slowdown in growth over the past two years, with the number of operational products decreasing from 211 to 199 compared to 2023 [3]. Group 2: Regulatory Changes - The notice outlines six key requirements, including the need for differentiated pricing based on factors such as age, gender, and health status, moving away from the current uniform pricing model [2][8]. - The notice reinforces the commercial nature of "惠民保," urging insurance companies to operate independently and ensuring that consumers voluntarily choose to participate [6][12]. Group 3: Pricing and Product Management - The notice mandates that insurance companies utilize reliable historical data to determine insurance rates and implement differentiated pricing to enhance fairness and adaptability of products [8][9]. - Currently, many "惠民保" products use a uniform rate model, which may lead to issues such as adverse selection and imbalance in risk sharing [9]. Group 4: Market Conduct and Competition - The notice prohibits low-price, disorderly competition and emphasizes fair competition principles, ensuring that insurance companies do not engage in monopolistic practices [10][11]. - There is a growing concern regarding the sustainability and quality of "惠民保" products due to low pricing and similar coverage, prompting some regions to introduce upgraded versions with higher premiums [11]. Group 5: Future Directions - The notice encourages the exploration of differentiated pricing mechanisms, which could lead to improved product sustainability and better alignment with the needs of different demographic groups [9][12]. - It also highlights the importance of distinguishing between commercial insurance and social insurance to clarify responsibilities and optimize the insurance structure [12].

城市定制型商业医疗保险(以下简称"城市商业医疗险")业务，迎来规范发展新阶段。 7月31日，金融监管总局向业内发布《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》)， 从突出普惠定位、坚守商业属性、规范精准定价、提升服务能力、共建良好生态、注重统筹规划六个维 度，全面规范城市商业医疗险业务，推动实现商业可持续发展，保护保险消费者合法权益。 回应社会关切 推动实现可持续发展 城市商业医疗险，即我们常说的"惠民保"，是由地方政府及相关部门指导、保险公司商业运作、与基本医 保衔接的商业保险，具有投保门槛低、保费低、保额高等特点。 一方面，要突出城市商业医疗险普惠定位。《通知》要求，保险业要坚持以人民为中心的发展思想，围绕 人民群众的优质医疗保障需求，优化城市商业医疗险产品供给，及时将医疗新技术、新药品、新器械应用 纳入责任范围，提供覆盖广泛、公平可得、保费合理、保障有效的保险服务。要努力扩大城市商业医疗险 的惠及面，推动商业医疗保险可及可信、可保可赔、可感可知。 另一方面，城市商业医疗险要坚守商业属性，遵循保险规律。《通知》指出，城市商业医疗险应当遵循市 场化、法治化原则，坚持保险公司自主经营，人民群众 ...

Core Viewpoint - The new regulatory guidelines emphasize the importance of balancing the inclusive nature and commercial attributes of urban commercial health insurance (惠民保), aiming for sustainable development while adhering to market principles [1][5]. Group 1: Regulatory Guidelines - The Financial Regulatory Bureau issued a notification on July 31, requiring urban commercial health insurance to focus on inclusivity while maintaining its commercial nature [1]. - The notification mandates that insurance companies optimize product offerings to meet diverse health protection needs, ensuring broad coverage and reasonable premiums [2][5]. - Insurance companies are instructed to base pricing on reliable historical data, ensuring fair and differentiated pricing according to factors like age, gender, and health status [3][5]. Group 2: Market Competition - The notification prohibits "involution-style" competition, urging insurance companies to avoid chaotic price wars and maintain fair competition [4][5]. - Companies must enhance product diversity and adhere to internal control management during product development, sales, and claims processes [4]. - Sales practices must be transparent, with clear communication of product functions and obligations to prevent misleading information [4][5]. Group 3: Long-term Development - Experts believe the guidelines aim to curb unhealthy competition and ensure service quality, promoting the long-term health of 惠民保 [5]. - The focus is on transitioning from short-term expansion to long-term value creation, supporting a multi-tiered medical insurance system [5].

Core Viewpoint - The new regulatory guidelines aim to enhance the quality and accessibility of urban commercial health insurance (惠民保), emphasizing a balance between inclusivity and commercial viability [1][4]. Group 1: Regulatory Guidelines - The Financial Regulatory Bureau issued a notification on July 31, promoting high-quality development of urban commercial health insurance, focusing on inclusivity and adherence to insurance principles [1]. - The notification mandates that insurance companies implement differentiated pricing based on factors such as age, gender, and health status to improve fairness and adaptability of products [2][3]. - Insurance companies are required to base their pricing on reliable historical data regarding disease incidence, payout rates, and cost rates, ensuring scientific and accurate pricing [2]. Group 2: Market Conduct - The notification emphasizes the need for insurance companies to operate independently while ensuring voluntary participation from consumers, promoting a sustainable business model [2]. - Companies are instructed to avoid "involution" or cutthroat competition, ensuring fair competition and maintaining service quality [4]. - The guidelines also prohibit setting predetermined payout rates or creating discriminatory entry and exit conditions for insurance contracts [4]. Group 3: Industry Impact - The new regulations are expected to optimize the risk pool structure by implementing tiered pricing, which aligns costs with risk profiles [3]. - The guidelines aim to enhance consumer satisfaction and trust in the insurance industry by promoting transparency and ethical practices [2][4]. - The notification serves as a strategic framework for the sustainable development of urban commercial health insurance, contributing to a multi-tiered medical security system [4].

在各地惠民保加速上新之际，监管新规出炉。7月31日，金融监管总局向各保险公司印发《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》），要求城市商业医疗险（惠民保）突出普惠定 位，坚守商业属性，遵循保险规律，规范精准定价。 在业内专家看来，惠民保作为一种政府主导、市场化运作的产品，本质上仍属于商业医疗保险，长期可 持续发展必须遵从商业属性、市场规律。此次监管新规再次强调遵从惠民保的专业规律和市场导向，有 助于引导惠民保健康规范发展，避免保险机构过度竞争。 强调普惠定位 城市商业医疗险，也就是惠民保，是由地方政府及相关部门指导、保险公司商业运作、与基本医保衔接 的商业保险，具有投保门槛低、保费低、保额高等特点。近年来，城市商业医疗险在多地落地并快速发 展，满足人民群众多层次多样化的健康保障需求。 《通知》首先强调了城市商业医疗险的普惠性定位，要求保险业坚持以人民为中心的发展思想，围绕人 民群众的优质医疗保障需求，优化城市商业医疗险产品供给，及时将医疗新技术、新药品、新器械应用 纳入责任范围，提供覆盖广泛、公平可得、保费合理、保障有效的保险服务。要努力扩大城市商业医疗 险的惠及面，推动商业医疗保险可及可 ...

在坚持普惠性同时，城市商业医疗险也应当遵循市场化、法治化原则。《通知》指出，坚持保险公司自主经营，人民群众自愿投保。各公司要按 照商业保险的基本原则和客观规律开展业务，坚持保费收取与保障程度相适配、扩面提质与商业可持续发展相结合，以规范经营和诚信服务促进 业务健康发展，不断提升保险消费者满意度。各地保险业协会要发挥自律组织作用，加强健康保险宣传和政策解读，塑造可信赖、能托付、有温 度的保险业良好形象。 在产品定价方面，《通知》提到，保险公司应当围绕目标客户需求，合理拟定城市商业医疗险的保险责任、责任免除等重要条款内容。要根据充 分可靠的疾病发生率、赔付率、费用率等历史数据，科学厘定保险费率，并在产品精算报告中详细列示。要遵循风险对价原则，实现差异化定 价，原则上应当基于不同群体的年龄、性别、健康状况等因素进行相应的责任分级或费率分组，不断提升产品和服务的公平性和适配性。对于首 次纳入保险合同的责任，应当基于历史经验数据和医疗、医保、医药等相关方提供的基础数据，科学准确定价。 在各地惠民保加速上新之际，监管新规出炉。7月31日，金融监管总局向各保险公司印发《关于推动城市商业医疗险高质量发展的通知》（以下简 称《 ...

Core Viewpoint - The Financial Regulatory Bureau has issued a notice aimed at promoting the high-quality development of urban commercial health insurance, emphasizing the need for improved product management and precise pricing [1] Group 1: Product Management - Insurance companies are required to align their products with the needs of target customers, ensuring that key terms such as insurance responsibilities and exclusions are well-defined [1] - There is a call for the use of reliable historical data on disease incidence, claim rates, and cost rates to scientifically determine insurance premiums [1] Group 2: Pricing Strategy - The notice emphasizes the principle of risk pricing, advocating for differentiated pricing based on factors such as age, gender, and health status of different groups [1] - Insurance companies should enhance the fairness and adaptability of their products and services through appropriate responsibility grading or premium grouping [1] Group 3: Data Utilization - For newly included responsibilities in insurance contracts, pricing should be based on historical experience data and foundational data provided by relevant parties in the medical and insurance sectors [1]