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》）。 ...

Core Viewpoint - The Financial Regulatory Administration has issued guidelines to promote the high-quality development of health insurance, focusing on improving service efficiency and management in critical illness and long-term care insurance [1] Group 1: Health Insurance Development - The guidelines support insurance companies in enhancing critical illness insurance services and operational efficiency [1] - There is an emphasis on providing refined and standardized management services for long-term care insurance [1] Group 2: Management and Compliance - The guidelines call for the standardization of entrusted management contracts, leveraging the professional advantages of insurance companies [1] - There is a focus on comprehensive services including health protection scheme design, consulting, health management, medical service investigation, and payment auditing [1] - The guidelines stress the importance of compliance and fairness in the design of entrusted management business plans and fund payments [1]

同时，指导意见将夯实行业基础，提升保险公司专业能力，加快数字化转型，加强数据积累和挖掘 运用；加强健康保险公司在专业领域先行探索的政策支持力度，推进健康保险公司特色化、专业化经 营；促进健康产业协同发展，支持健康保险对创新药械进行更为灵活、有效的支付，提升创新药械的可 支付性和可及性；强化监管引领，有力有序有效防范化解风险。 【纠错】 【责任编辑:刘子丫】 新华社北京9月30日电（记者张千千）金融监管总局30日对外发布《关于推动健康保险高质量发展 的指导意见》，明确了健康保险未来一段时间发展的总体思路和阶段性目标，提出深化健康保险改革， 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，更好地满足人民群众健康保障需 求。 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。但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表示，指导意见分别对健康保险的主要险种 ...

Core Viewpoint - The National Financial Regulatory Administration has released guidelines to promote the high-quality development of the health insurance industry, focusing on key insurance types and enhancing regulatory measures to better meet public health protection needs [2][3][5]. Group 1: Development Focus - The guidelines outline development priorities for four main types of health insurance: commercial medical insurance, commercial long-term care insurance, disability income loss insurance, and disease insurance [2]. - There is an emphasis on developing commercial medical insurance to create a comprehensive and multi-tiered product system, including coverage for new medical technologies, drugs, and devices, while encouraging products that benefit individuals with pre-existing conditions and rare diseases [3]. Group 2: Sustainable Development - The guidelines call for strengthening professional capabilities and establishing a health insurance actuarial retrospective mechanism to enhance the core competitiveness of health insurance companies [4]. - It supports pilot programs for combining health insurance with life insurance to better meet consumer needs for comprehensive protection [4]. Group 3: Regulatory Enhancements - The guidelines propose strengthening regulatory leadership and establishing specialized statistical and evaluation systems to standardize market order [5]. - There is a focus on improving service levels through enhanced cooperation between insurance companies and their branches, as well as increasing the efficiency of complaint handling and service delivery [6]. Group 4: Industry Transformation - The introduction of these guidelines is expected to facilitate a shift in the health insurance industry from a "fee reimbursement" model to a "health management" model, supporting diverse health protection needs throughout the life cycle [6].

本报记者 刘琪 9月30日，国家金融监督管理总局（以下简称"金融监管总局"）发布消息，为贯彻落实《国务院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》精神，提升健康保险服务保障水平，金融监管总局近日印发了《关于推动健康保险高质量发 展的指导意见》（以下简称《意见》）。 从主要内容来看，《意见》共有五个部分：一是总体要求。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。二 是深化健康保险改革。分别对健康保险的主要险种，即商业医疗保险、商业长期护理保险、失能收入损失保险和疾病保险等四 大类险种的发展重点进行规划，同时规范各类经办承办服务。三是增强可持续发展能力。引导保险公司加强专业能力建设，提 升数智化应用水平，增强健康保险公司核心竞争力。四是加强健康保险监管。强化监管引领，规范市场秩序，查处违法违规行 为。五是优化健康保险发展环境。建立健全行业规范体系，促进多方协同合作，加强健康保险知识普及。 前述负责人表示，下一步，金融监管总局将重点做好以下工作：一是积极与其他部门沟通协调，持续为健康保险发展营造 良好政策环境。二是加快研究出台浮动收益型健康保险等配套业务细则，督促各保险公司落实《意见》要求，丰富 ...

Core Insights - The health insurance industry in China is set to receive new development guidelines aimed at promoting high-quality growth and enhancing regulatory measures to mitigate risks [1][3] Group 1: Industry Development Goals - The health insurance sector is crucial for providing financial protection against health-related losses, with a market that includes various types of insurance such as commercial medical insurance and long-term care insurance [3] - The market size of health insurance is expanding, with projected premium income of 977.3 billion yuan in 2024, and claims payments amounting to 405.2 billion yuan [3] - The new guidelines outline a 2030 development goal to enhance the role of health insurance within the national health security system, promoting a multi-layered market that meets diverse needs [4] Group 2: Innovative Measures - The guidelines propose several forward-looking initiatives, including support for personal account-based long-term medical insurance, encouraging individuals to plan and save for their health [5] - In long-term care insurance, the guidelines emphasize the integration of cash benefits with care services, indicating a shift towards providing market-oriented professional care [6] - The guidelines also advocate for the integration of health insurance with health management, focusing on a comprehensive system that includes prevention, management, and post-claim support [6] Group 3: Enhancing Industry Sustainability - The guidelines stress the importance of strengthening professional capabilities within insurance companies and establishing a measurable actuarial review mechanism [7] - There is a push for digital transformation in health insurance to enhance operational capabilities [7] - The guidelines provide opportunities for innovative pilot programs for well-rated health insurance companies, including increased cost-sharing for health management services and the combination of health and life insurance products [7]

Core Viewpoint - The National Financial Regulatory Administration has issued guidelines to promote the high-quality development of health insurance, aiming for a more integrated and multi-level health insurance market by 2030 [1] Group 1: Development of Health Insurance - The guidelines emphasize the active development of commercial medical insurance, creating a comprehensive and multi-tiered product system that includes new medical technologies and treatments [2] - There is a focus on the development of long-term care insurance and disability income loss insurance, aligning with home, community, and institutional care needs [2] - The guidelines advocate for the steady development of disease insurance, with regular updates to disease definitions and incidence rates [3] Group 2: Integration and Collaboration - The integration of health insurance with health management is encouraged, promoting a new service system that combines prevention, management, and protection [3] - The guidelines call for collaboration between health insurance and the broader health industry, enhancing service networks and integrating with medical and pharmaceutical sectors [4] Group 3: Regulatory Enhancements - Strengthening the regulatory framework for health insurance is a priority, including the establishment of independent financial rules and product oversight [7] - The guidelines propose measures to improve market order and address illegal activities within the health insurance sector [7] Group 4: Sustainable Development - The guidelines highlight the need for enhancing the professional capabilities of insurance companies and improving their data-driven operations [5] - There is an emphasis on increasing the core competitiveness of health insurance companies through innovative strategies and integrated health management [5] Group 5: Environment Optimization - Establishing a standardized system for health insurance is crucial, including the development of model clauses and evaluation metrics for services [8] - The guidelines promote multi-party collaboration to enhance information sharing and support the development of regional health insurance products [8]

海报制作：张千千 新华社国内部出品 新华社权威快报 国家金融监督管理总局对外发布 《关于推动健康保险高质量 发展的指导意见》 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 新华社国内部出品 国家金融监督管理总局9月30日对外发布《关于推动健康保险高质量发展的指导意见》，明确了健 康保险未来一段时间发展的总体思路和阶段性目标。 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。 指导意见提出，深化健康保险改革，分别对健康保险的主要险种，即商业医疗保险、商业长期护理 保险、失能收入损失保险、疾病保险等四大类险种的发展重点进行规划。同时，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，更好地满足人民群众健康保障需求。 记者：张千千 ...