《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]

Core Viewpoint - The Financial Regulatory Administration has released guidelines to promote the high-quality development of health insurance, outlining the overall development strategy and phased goals for the sector, aiming to enhance sustainable development capabilities and better meet public health insurance needs [1][2]. Group 1: Development Strategy - The guidelines emphasize the need to deepen health insurance reforms and enhance the regulatory framework to optimize the development environment for health insurance [1]. - Health insurance is identified as a crucial component of the social security network, linking the insurance industry with healthcare and impacting national and public welfare [1]. Group 2: Challenges and Issues - Despite rapid growth, the health insurance sector faces challenges such as a lack of product diversity, insufficient operational capabilities, weak foundations, underdeveloped specialized institutions, and inadequate collaboration with the medical and pharmaceutical sectors [1][2]. - These issues are seen as constraints on improving service and protection levels within the industry [1]. Group 3: Focus Areas for Development - The guidelines outline specific focus areas for four main types of health insurance: commercial medical insurance, commercial long-term care insurance, disability income loss insurance, and disease insurance [1]. - There is a plan to broaden product forms and functions, supporting the development of floating income health insurance and establishing a new health service protection system [1]. Group 4: Industry Foundation and Innovation - The guidelines aim to strengthen the industry's foundation by enhancing the professional capabilities of insurance companies and accelerating digital transformation [2]. - There is a push for policy support for health insurance companies to explore specialized operations and promote collaboration within the health industry, particularly in facilitating flexible and effective payments for innovative drugs and medical devices [2].

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]

Core Viewpoint - The National Financial Supervision Administration has released guidelines to promote the high-quality development of health insurance, emphasizing the need for reform, sustainable development, enhanced regulation, and an optimized environment for health insurance [2]. Group 1: Development Strategy - The guidelines outline the overall strategy and phased goals for the future development of health insurance [2]. - Health insurance is identified as a crucial type of insurance that provides financial protection against health-related losses, linking it to the broader social security framework and public welfare [2]. Group 2: Key Focus Areas - The guidelines propose deepening health insurance reforms, specifically targeting four main types of insurance: commercial medical insurance, commercial long-term care insurance, disability income loss insurance, and disease insurance [2]. - There is a strong emphasis on enhancing the sustainable development capacity of health insurance [2]. - The guidelines call for strengthening the regulation of health insurance to ensure better compliance and oversight [2]. - An optimized development environment for health insurance is highlighted to better meet the health protection needs of the public [2].

Core Viewpoint - The National Financial Regulatory Administration has issued guidelines to promote the high-quality development of health insurance, emphasizing the need for a comprehensive and multi-layered commercial medical insurance product system that includes new medical technologies, drugs, and devices [10][11]. Group 1: Development of Commercial Medical Insurance - Actively develop commercial medical insurance and construct a comprehensive, multi-layered product system [12]. - Encourage the inclusion of new medical technologies, drugs, and devices in insurance coverage [12]. - Support the establishment of personal account-based long-term medical insurance and diversify service forms [12][11]. Group 2: Long-term Care and Disability Income Insurance - Accelerate the development of commercial long-term care insurance and disability income loss insurance [13]. - Provide insurance services that combine cash payments with care services, addressing home, community, and institutional care needs [13]. - Support the conversion of life insurance benefits into care expenses for insured individuals who become disabled [13]. Group 3: Disease Insurance and Health Management - Steadily develop disease insurance, revising definitions based on disease spectrum changes and medical advancements [13]. - Promote the integration of health insurance with health management, creating a new service guarantee system that combines prevention, management, and protection [14]. Group 4: Regulatory and Market Environment - Strengthen regulatory frameworks and enhance the efficiency of health insurance operations [16]. - Establish a standardized system for health insurance, including demonstration clauses and service evaluation metrics [18]. - Promote collaboration among regulatory bodies, insurance organizations, and health service providers to enhance product development and market performance [18].

Core Viewpoint - The National Financial Regulatory Administration has issued guidelines to promote the high-quality development of health insurance, emphasizing its critical role in the national health security system by 2030 [1][3]. Group 1: Overall Requirements - The guidelines are guided by Xi Jinping's thoughts and aim to deepen reforms in the health insurance sector, enhancing service and protection levels [3]. - By 2030, a multi-level health insurance market will be established to meet diverse needs across the entire population and lifecycle [3]. Group 2: Deepening Health Insurance Reform - The development of commercial medical insurance will be prioritized, creating a comprehensive product system that includes new medical technologies and treatments [4]. - There will be a focus on commercial long-term care insurance and disability income loss insurance, integrating cash benefits with care services [4]. - The guidelines encourage the development of disease insurance that adapts to changes in disease patterns and medical technology [5]. Group 3: Enhancing Sustainable Development Capacity - Strengthening professional capabilities and establishing a dynamic adjustment mechanism for actuarial parameters are key focuses [7]. - The guidelines promote the digital transformation of health insurance, utilizing AI and big data to improve management and service delivery [7]. - Health insurance companies are encouraged to explore innovative business models that integrate health management with insurance products [7]. Group 4: Strengthening Health Insurance Regulation - The establishment of a specialized statistical and regulatory evaluation system for health insurance is emphasized [8]. - The guidelines call for improved market order and the prevention of illegal activities within the health insurance sector [8]. Group 5: Optimizing the Health Insurance Development Environment - The creation of a standardized industry framework and the promotion of collaboration among various stakeholders are highlighted [9]. - Efforts will be made to enhance public awareness and understanding of health insurance through educational initiatives [9].