Core Insights - The article discusses the evolution and challenges of the Huiminbao insurance scheme, highlighting its significant growth in premium contributions and the disparity in claims experiences among insured individuals [2][3][4] - The introduction of a new commercial insurance drug directory is expected to enhance the coverage of innovative drugs under Huiminbao, while also addressing the sustainability of the insurance model [3][5][6] Group 1: Huiminbao Overview - Huiminbao has been promoted nationwide for nearly six years, with "special drug liability" becoming a standard feature, contributing approximately 18 billion yuan in innovative drug payments last year, a ninefold increase from 2021 [2] - The scheme faces challenges due to a high proportion of elderly and pre-existing condition participants, leading to a "death spiral" in its development [2][3] - Some Huiminbao products are responding to payout pressures by increasing deductibles and reducing high-value drug payment limits, which indirectly lowers medical benefits [2][3] Group 2: Regulatory Changes and Trends - The recent notification from the National Financial Regulatory Administration emphasizes that urban commercial health insurance, including Huiminbao, should align premium collection with coverage levels and avoid chaotic low-price competition [3][8] - The 2026 version of Huiminbao is seeing a shift towards "premium stratification" rather than low premiums, with an expansion of coverage to include chronic diseases, mental health medications, and overseas drugs [3][4][5] Group 3: Special Drug Coverage Expansion - The number of drugs covered under Huiminbao is set to reach 672 by 2024, with a significant focus on cancer and rare disease medications, which account for over 40% of the innovative drugs listed [4][5] - Some regions are expanding their special drug coverage to include high-value innovative drugs for chronic diseases, with certain areas approaching the coverage levels of pure commercial health insurance [5][6] Group 4: Pricing and Risk Management - The core of commercial health insurance is the dynamic balance between funding and benefits, with low premiums slowing the growth of Huiminbao's funding and affecting benefit enhancements [8][11] - The 2026 version of Huiminbao introduces a trend of "layered" special drug and medical coverage, allowing for both standard and upgraded insurance options [8][9] Group 5: Inclusion of New Citizens and Cross-Region Medical Services - Strategies to attract healthier and younger participants include lowering claim thresholds and increasing reimbursement rates for outpatient services and common illnesses [12][13] - New policies in various regions are expanding coverage to include new citizens and those seeking medical services in different locations, enhancing the inclusivity of Huiminbao [12][13]

Core Insights - The "惠民保" (Huimin Insurance) has expanded its coverage to include chronic diseases, mental health medications, outpatient drugs, overseas drugs, and original research drugs, reflecting a shift in the insurance landscape [1][2] - The insurance scheme has seen a significant increase in claims, with approximately 18 billion yuan paid for innovative drugs in the previous year, a ninefold increase from 2021 [1] - However, the experience of claims varies widely among the 150 million insured individuals, with some facing high out-of-pocket costs due to thresholds and pre-existing conditions [1][6] Group 1: Policy Changes and Trends - The recent notification from the National Financial Regulatory Administration emphasizes the need for commercial health insurance to align premium collection with coverage levels and avoid low-price competition [2] - The 2026 version of "惠民保" has introduced a tiered premium structure, moving away from the previous low-cost model, and has expanded coverage to include more drug categories [2][3] - The number of drugs covered under "惠民保" is expected to reach 672 by 2024, with a significant focus on innovative treatments for cancer and rare diseases [3] Group 2: Coverage Expansion - The 2026 "北京普惠健康保" (Beijing Universal Health Insurance) will cover 87 disease categories and 159 drugs, including new treatments for Alzheimer's and CAR-T therapy [4] - The "齐鲁保2026版" (Qilu Insurance 2026) has expanded its coverage to include 3 high-value medical devices and additional innovative drugs for chronic conditions [4] - Many regions are now including outpatient drugs and original research drugs in their coverage, indicating a trend towards more comprehensive health insurance products [3][4] Group 3: Risk Management and Pricing Strategies - The insurance sector is adopting a risk-based pricing model, allowing for differentiated premiums based on age, health status, and pre-existing conditions [6][10] - The introduction of tiered coverage options aims to balance the need for affordable premiums with adequate benefits, particularly for high-risk groups [6][10] - Recent adjustments have led to increased reimbursement rates for patients with pre-existing conditions, reflecting a shift towards more equitable coverage [8][10] Group 4: Inclusion of New Demographics - The 2026 "惠民保" products are increasingly targeting new citizens and those seeking medical care outside their registered locations, broadening the scope of insured individuals [10][11] - Initiatives to allow family members to share health insurance accounts and to include flexible workers and retirees in coverage are being implemented in various regions [10][11] - The trend towards inclusivity aims to enhance the overall participation rate in the "惠民保" scheme, particularly among younger and healthier individuals [10]