山东省惠民保工作已开展近4年，参保群众异地就医报销经历了从垫资到免申直赔的过程。省医保局二级巡视员李伟光介绍了这一转变的实现过程。 为了加快完善多层次医疗保障体系，山东自2021年启动了惠民保相关工作，经过近4年的实践探索，全省16市均按"一城一策"推出了各具特点的惠民保产 品。在2024年，山东省全面实现了惠民保市域内"一站式"结算，参保人在本地医院出院时在医院窗口刷医保卡，就能同步完成基本医保、大病保险、医疗 救助以及惠民保的报销，参保群众只需支付剩余费用，无需再向保险公司提交材料申请理赔，也大大减轻了个人垫付费用的压力。 在此基础上，为进一步解决惠民保参保群众异地就医理赔不便利不顺畅的问题，如，垫付费用时间长、申请手续繁琐等，经过充分的调研论证，今年4 月，省医保局印发了《关于推进定制型商业医疗保险异地结算理赔工作的通知》，在确保参保群众数据安全的基础上，积极推进惠民保异地免申直赔工 作。所谓的惠民保异地免申直赔，就是通过打通基本医保和惠民保的数据壁垒，实现了必要的信息共享，参保人异地看病之后，不用来回跑腿，也不用主 动申请提交材料，惠民保会自动核算出应报销的费用。目前，经过技术方案设计、试点探索、全省 ...

Core Insights - The health insurance network in China is continuously evolving, enhancing public awareness and demand for risk protection [1][2] - Insurance companies play a crucial role in the multi-tiered medical security system and are driving innovations in health services [1][2] Group 1: Health Insurance Development - The basic medical insurance system is a vital part of the social security framework, aimed at reducing medical costs for the public and improving welfare [1] - Catastrophic health insurance provides additional coverage for high medical expenses beyond basic insurance, requiring no extra payment [1] - China Life Insurance has fully covered urban and rural residents' catastrophic health insurance across 14 cities in Guangxi from 2013 to 2015, currently serving over 40 million insured individuals [1] Group 2: Service Innovations - China Life's Nanning branch has established partnerships with nearly 1,800 medical institutions, facilitating extensive coverage for medical billing [2] - The company promotes a one-stop instant settlement system combining basic insurance, catastrophic insurance, and medical assistance, allowing patients to complete reimbursements upon discharge [2] - Efforts are made to extend services to remote communities, ensuring accessibility and understanding of insurance policies through local language explanations [2] Group 3: Poverty Alleviation Initiatives - In Tian Deng County, a poverty alleviation initiative called "Four Guarantees" was launched, focusing on health, employment, industry, and basic safety nets [3] - The initiative includes full subsidies for vulnerable groups, a collaborative insurance model for employment, and agricultural production insurance [3] - The program aims to enhance the community's ability to resist poverty and improve overall economic stability [3][4] Group 4: Commercial Insurance Growth - The "Hui Min Bao" product has gained traction, addressing the insurance needs of low-income, elderly, and pre-existing condition populations [5] - Launched in April 2022, this initiative has successfully implemented customized commercial insurance across 14 cities in Guangxi [5] - The "Hui Min Bao" business not only alleviates medical expenses for participants but also supports the innovation of medical products and services [5]

9月23日，2025年"惠绵保"上线发布会在绵阳举办。作为政府部门指导的普惠型健康保险，2025年产品 迎来多项重磅升级：新增129元优选款，免赔额再降，加大对未成年人的关爱力度！即日起，绵阳市基 本医保参保人(含职工、城乡居民)、绵阳市户籍人员和绵阳市新市民均可参保，每年仅需89元或129 元，最高可享300多万元医疗保障，保障范围更广、惠民力度更大。 政府多方支持 切实减轻患者医疗费用负担 "惠绵保"运行三年多以来，取得了良好的社会效益，不仅提升了绵阳市民的医疗保障水平，更促进了医 疗服务的公平性和可及性。截至目前，"惠绵保"累计赔付金额突破0.93亿元，为1.11万户家庭减轻高额 医疗负担，理赔最大年龄为102岁，最小刚出生仅3个月，最高减轻费用负担达70%。 绵阳市人民政府副秘书长王代辉表示，人民健康是社会主义现代化的重要标志。"惠绵保"作为绵阳市多 层次医疗保障体系的有力补充，极大地减轻了重病患者的医疗负担，是覆盖全市、惠及全民，守护绵阳 人民健康的一道重要防线。 绵阳市人民政府、绵阳市医疗保障局、国家金融监督管理总局绵阳监管分局、绵阳市财政局、绵阳市市 场监督管理局、绵阳市民政局、国家税务总局绵阳 ...

数据显示，中国人寿寿险广西分公司2024年总保费规模171亿元，同比增长36%，承接全区14个地市 2024-2026年城乡居民大病保险项目；2024年度，"防贫四保"项目累计发放理赔金903.66万元；"惠邕 保"项目自启动以来，累计参保人数突破275万人次，赔付金额超1.7亿元……在八桂大地的民生保障与 乡村振兴征程中，中国人寿的健康险实践孕育出一张张温暖的"防护网"。 ● 本报记者 吴杨 让保障跟着群众痛点走 广西的民生痛点，藏在喀斯特地貌的局限与产业发展的诉求中：天等县"八山一水一分田"，绝大多数人 靠体力谋生，一场意外就可能让家庭返贫；武鸣区漫山沃柑承载着58%农村人口收入，大病与意外是悬 在果农头顶的"风险之剑"；南疆国门城市崇左，部分群体曾长期面临投保无门的困境。中国人寿的健康 险实践，从群众的这些"急难愁盼"中精准发力，让每款产品都成为对症良方。 八月的天等县都康乡多信村，玉米叶上的晨露未干，村民农军（化名）坐在堂屋老木凳上，手里攥着一 张被反复摩挲的理赔单——这是他治疗急性心力衰竭的"救命钱"。2024年6月，农军被纳入边缘易致贫 户，29.27万元住院费经基本医保、大病保险报销后，自付部分 ...

Investment Rating - The report maintains an "Outperform" rating for the biopharmaceutical industry [1] Core Viewpoints - The growth of healthcare expenses, which reached 9.06 trillion yuan in 2023, is outpacing GDP growth, indicating that commercial health insurance may provide a solution to the pressures faced by the medical insurance system [3][15] - The commercial health insurance sector is expected to grow significantly, with premiums projected to reach 97.74 billion yuan by 2024, driven by low penetration rates and the need for additional funding sources [20][24] - Policies are increasingly supportive of commercial health insurance, particularly in relation to innovative drugs, which are now being included in the commercial health insurance directory [71][76] Summary by Sections Part 1: Healthcare Financing System - The healthcare financing system in China consists of government, social, and personal contributions, with social contributions being the main driver for future growth [10][15] Part 2: Growth of Health Insurance - The commercial health insurance market is expected to fill a significant funding gap, with an estimated shortfall of over 1.7 trillion yuan by 2030 [21][22] - Medical insurance is the primary source of compensation within commercial health insurance, with a compensation rate of approximately 68.79% in 2022 [27][31] Part 3: Core Products of Medical Insurance - The report highlights the importance of medical insurance as a key focus area, noting that it directly compensates for medical expenses, unlike critical illness insurance [31][35] Part 4: Policy Support for Health Insurance Development - A series of policies since 2009 have aimed to promote the development of commercial health insurance, with specific targets for market size and coverage [71][72] Part 5: Investment Recommendations - The report suggests focusing on innovative drug companies with rich pipelines, DTP pharmacies, and companies in the TPA industry, as well as innovative medical devices and high-end medical service providers [77]

乐城全球特药险2025版上线 据介绍，乐城全球特药险2025版再度升级——A款基础特药版(49元/人)保额提升至200万元，覆盖120种 全球特药(含70种海外特药、50种国内特药)，0免赔额，性价比突出;B款升级尊享版(99元/人)在A款基础上增 加10种进口特许器械保障，并将乐城园区内住院医疗保额提升至100万元，扩展涵盖在乐城就医前15天关联医 疗费用。同时，产品继续坚持"零门槛"参保原则，不限年龄、职业和健康状况，海南省户籍人员、当地医保 参保人、常住"新市民"及在琼外籍人士均可投保。 据了解，乐城全球特药险是由海南博鳌乐城国际医疗旅游先行区管理局、国家金融监督管理总局海南监 管局、海南省医疗保障局等多部门共同支持和指导下推出的普惠型补充医疗保险，旨在进一步满足人民群众 对优质先进医疗和创新药械的可及、可付需求。自2020年首次推出以来，该产品作为国内首个将国外已上 市、国内未上市药品纳入保障范围的健康保险产品，实现了中国患者境外特药报销从"无"到"有"的重大突 破。 截至今年8月30日，乐城全球特药险累计赔付金额达3075万元，惠及765个患者家庭，年均综合赔付率约 60%。同时，乐城海外特药还与北 ...

Core Viewpoint - China Life Insurance Nanning Branch (Nanning Guoshou) emphasizes its commitment to financial services for the real economy and improving people's livelihoods through innovative practices in health insurance [1][2]. Group 1: Health Insurance Initiatives - Nanning Guoshou has participated in the "Hui Yong Bao" project for four consecutive years, providing comprehensive health insurance coverage for a premium of 79 yuan per year, offering benefits up to several million yuan for hospitalization and rare diseases [1][2]. - The project has enrolled over 2.75 million participants, with total claims exceeding 170 million yuan, reducing the medical burden for participants by an average of 6.2% [2]. - The insurance scheme allows the use of personal medical insurance accounts for family coverage, enhancing accessibility and collaboration within the multi-tiered medical insurance system [2]. Group 2: Comprehensive Medical Coverage - Nanning Guoshou provides urban and rural residents with major illness insurance, covering 5.76 million insured individuals, and has established partnerships with nearly 1,800 medical institutions for extensive claim settlement [2]. - The company has paid out a total of 1.062 billion yuan in claims, implementing a one-stop settlement process for basic medical insurance, major illness insurance, and medical assistance [2]. Group 3: Targeted Insurance Products - In 2024, Nanning Guoshou will offer inclusive insurance products tailored for specific groups, including women's health and student safety insurance, with total coverage exceeding 100 billion yuan [3]. - The company has launched a "New Citizen Exclusive Protection Plan" for new urban residents, providing flexible insurance options and risk coverage for nearly 30,000 individuals [3]. - The "Anti-Poverty Insurance" project aims to support around 70,000 migrant workers with coverage for accidents, serious illnesses, and disabilities, while collaborating with government departments for health monitoring and risk prevention [3].

Core Points - The reform of medical insurance and commercial insurance payment systems aims to simplify the process for 1.4 billion insured individuals, transforming the way medical expenses are paid in China [1][3] - The integration of medical insurance and commercial insurance allows for real-time settlement, significantly reducing the time and complexity involved in claims processing [3][4] - The reform addresses the dual challenges of "underfunded medical insurance" and "stagnant commercial insurance development," enhancing the efficiency and effectiveness of both systems [4][9] Summary by Category Changes in Payment Process - The new system enables simultaneous settlement of medical insurance and commercial insurance, eliminating the previous lengthy claims process [3] - Patients can now see the breakdown of reimbursements from both insurance types at the time of hospital settlement, leading to a significant reduction in out-of-pocket expenses [6][10] Impact on Patients - Chronic disease patients benefit from reduced personal expenses, with some insurance products lowering annual out-of-pocket costs from 6,000 yuan to 1,800 yuan [6] - Cancer patients experience improved reimbursement rates, with some seeing their out-of-pocket costs drop from 40% to 10% after combining insurance reimbursements [6] - Individuals with pre-existing conditions can now access more affordable insurance options, with premiums for certain plans decreasing from 3,000 yuan to 800 yuan annually [6] Challenges and Solutions - Hospitals face the challenge of upgrading their information systems to support the new payment model, with 57% of hospitals needing significant investment for system modifications [7] - The establishment of a unified "Medical Insurance and Commercial Insurance Settlement Cloud Platform" aims to streamline the integration process for hospitals [7] - Insurance companies must adapt to a new model that emphasizes proactive health management rather than reactive claims processing [7][9] Data Security and Privacy - The reform incorporates measures to protect patient data, ensuring that only necessary information is shared while maintaining privacy [9] - The acceptance of data sharing among patients has increased significantly, indicating growing trust in the system [9] Overall Effectiveness - Initial results show that the reform has led to a 22% average decrease in patient out-of-pocket expenses and a 70% improvement in hospital settlement efficiency [10] - The number of commercial insurance products available for individuals with pre-existing conditions has increased significantly, reflecting a more inclusive insurance market [10] - The reform is expected to enhance the overall medical insurance level in China by 15-20 percentage points while controlling the growth rate of medical insurance fund expenditures [9]

为深化医疗保障制度改革,完善多层次医疗保障体系,进一步减轻群众就医负担,威海市于2021年9月推出 了首款定制型商业医疗保险产品——"威你保",对群众医疗费用经各项医保政策报销后个人负担仍较重 的部分给予再次保障,特别是将以往没有制度安排的医保目录外部分费用纳入了保障范围,同时产品保障 内容还积极向健康管理领域延伸,提供了线上体检报告解读等免费健康咨询和指导等服务项目,为群众构 建起了"医保+商保"的双重保障制度。目前,"威你保"已推出4期产品,持续进行方案优化升级,累计投保达 158万人次,为群众减负超1.1亿元,超过6万人次投保群众从"威你保"中获得受益,减轻了就医负担。今年, 结合群众需求变化和前四期的运行经验,按照"两坚持,两提升"思路,对"威你保"产品方案进行了进一步完 善升级,全面加大对群众的保障力度,今天起正式推出。 2025版"威你保"产品保障待遇全面升级 "优",即连续投保享优待。2025版"威你保"将对累计投保满5年的群体赔付比例提高2%,并在其医保政策 范围外住院费用保障范围中增加"免陪照护服务",帮助投保人减轻住院陪护的负担。 "增",即大幅扩充增值服务内容。全力为投保群众打造"健康+ ...

Core Viewpoint - The article discusses the launch of the upgraded "Weini Bao 2025," a customized commercial health insurance product in Weihai City, aimed at enhancing the multi-tiered medical security system and reducing the financial burden on citizens [2][3]. Group 1: Product Overview - "Weini Bao" was first introduced in September 2021, providing additional coverage for medical expenses not fully reimbursed by basic health insurance, including out-of-pocket costs for non-covered items [2]. - The product has undergone four iterations, with a total of 1.58 million policies sold, resulting in over 110 million yuan in reduced medical expenses for the insured [2]. - The 2025 version maintains its government-supported positioning within the multi-tiered medical security system, emphasizing a non-profit approach and no restrictions based on age, health status, or pre-existing conditions [3][4]. Group 2: Coverage and Benefits - The premium rates remain unchanged, with specific rates set for different age groups, ensuring affordability for all participants [4]. - The coverage includes hospitalization costs after basic insurance reimbursements, outpatient drug expenses, and special drug costs, with a focus on severe illnesses [4]. - The 2025 version introduces enhanced benefits, such as a 2% increase in compensation for those who have held policies for over five years and new services like "no co-payment care" for hospitalization [5]. Group 3: Service Enhancements - The product now offers a wider range of value-added services, including discounts on medications, eye exams, and free children's photography, available to all policyholders regardless of claims [5]. - The application process has been simplified, allowing for online enrollment and payment through various methods, including personal health insurance accounts [6][7]. - The claims process has been optimized for efficiency, enabling automatic reimbursement for medical expenses incurred both within and outside the province, reducing the need for upfront payments by policyholders [7].