在理赔服务方面，目前，医疗责任理赔支持双通道理赔，对于本市基本医保参保人符合赔付的案 件，"北京普惠健康保"会发短信提醒参保人理赔，对医保内自付责任和医保外住院自费责任进行主动赔 付，参保人可以通过"北京普惠健康保"微信公众号填写领款人账户等相关信息，无需提供医疗票据等理 赔材料（特殊情况除外），进一步简化理赔流程；对于非本市基本医保参保人（比如新市民等）的理赔 案件，参保人可以通过"北京普惠健康保"微信公众号线上申请理赔。特药责任理赔则提供特药直付和事 后报销两种选择，推荐优先使用特药直付服务，购药时仅需支付自付部分，无需垫付全款，参保人可通 过"北京普惠健康保"微信公众号线上申请理赔，十分便捷。 此外，2026年度"北京普惠健康保"还为全体参保人提供两大类实用健康服务，切实减轻用药、就医及术 后护理负担。一是购药折扣权益，涵盖门店购药、网上购药及原研药购买，参保人全年购药可享九折优 惠，年度补贴总额1800元，单次最高补贴400元，全年可使用12次，让日常用药更省钱省心；二是通用 服务，覆盖陪诊、上门护理、居家康复等场景，参保人就医后全年可免费使用5次，在家即可享受专业 服务，有效解决就医护理难题。参保人 ...

由江苏省医疗保障局、国家金融监督管理总局江苏监管局指导监督的2026年度"江苏医惠保1号"投保通 道将于今晚(12月31日)24时正式关闭，还未办理的江苏医保参保人请抓紧！ "江苏医惠保1号"投保不限户籍、不限年龄、不限职业、不限健康状况，已成为江苏基本医保参保人的 必备补充保障。据了解，目前投保人数已突破530万。 低保费、低门槛、高保额 作为江苏省级的普惠型商业补充医疗保险，"江苏医惠保1号"始终践行"低保费、低门槛、高保额"的承 诺。基础版保费每年仅158元，升级版每年258元，即可获得高达百万元的医疗费用保障。其保障范围广 泛，不仅涵盖医保目录内的自付费用，还对医保目录外药品和医用耗材费用按规定予以报销，有效减轻 大病负担，符合条件的费用还可享二次补报。 升级版更将质子重离子治疗、CAR-T药品等尖端医疗技术纳入保障，且不排斥既往病史患者，实现"可 保可赔"。此外，投保人还可享有多元化的健康管理服务，包括34项投保即享的个性化健康服务及27项 专项健康管理服务，全方位守护参保人健康。 家住常州的杨先生，自产品上线以来连续投保。去年他因帕金森病在中国人民解放军第一O一医院住院 治疗，总医疗费用达23.7 ...

一、投保门槛低，覆盖全省老少 2026年度"江苏医惠保1号"不限年龄、户籍、职业、健康状况等，覆盖全省老少，有江苏基本医保的居 民就能投保。 用一顿饭钱、一件衣服钱，守护家人的健康一整年。和基本医保紧密衔接的江苏人的补充医保"江苏医 惠保1号"将于12月31日投保结束，记者从相关部门获悉，目前"江苏医惠保1号"投保人数已突破500万 人，投保时间仅剩2天，还未办理的请抓紧，为自己和家人添一份保障。 "江苏医惠保1号"由江苏省医疗保障局、国家金融监督管理总局江苏监管局指导监督，是面向全省、打 破既往病史投保限制，与基本医疗保险相衔接的普惠型商业补充医疗保险。具备五大优势亮点，守护更 全面。 二、保费无压力，2版方案可选 2026年度"江苏医惠保1号"基础版158元/年，累计保障320万元；升级版258元/年，累计保障400万元。一 顿饭钱、一件衣服的钱，就获得一整年的安心保障。 三、衔接"双通道"，用药保障全面 "江苏医惠保1号"衔接医保"双通道"政策，投保患者在定点零售药店购买"双通道"药品，医保报销 后，"江苏医惠保1号"还将按规定进行赔付。 四、院内自费药，突破目录范围 投保人员在医疗机构住院或接受门特治 ...

责任编辑：秦艺 12月22日金融一线消息，北京市唯一由政府指导监督的普惠型商业补充医疗保险产品——2026年度"北 京普惠健康保"目前参保人数已经突破330万人。项目组提醒，本年度"北京普惠健康保"参保通道即将于 2025年12月31日24时关闭，仅剩最后一周时间。 在医疗保障方面，2026年度"北京普惠健康保"不仅报销医保内自付费用，还将医保外住院自费费用纳入 保障，保险责任内费用扣除对应免赔额后按比例赔付，无论是重疾治疗中的住院自付部分，还是自费药 品、诊疗项目费用，都能按约定获得赔付，切实缓解家庭就医经济压力。 在特药保障方面，其优势更为突出。药品清单已增至159种，全面覆盖多种高发癌症、罕见病的特效药 品，同时包含CAR-T疗法、高值慢病药等多种创新药，充分满足大病治疗的用药需求。更值得关注的 是，特药保障无免赔额，健康人群赔付比例达65%，既往症人群为35%，累计保额提升至150万元，有 效破解了"特效药太贵用不起"的民生难题，让患者能够安心接受治疗。 当前，距离"北京普惠健康保"参保通道关闭仅剩最后一周时间，疾病无情，保障有价，切勿等到家人遭 遇病痛才追悔莫及，别让"没赶上参保"成为压垮家庭的遗憾 ...

Core Points - The "Beijing Inclusive Health Insurance" has opened enrollment for the 2026 plan, with a premium of 195 yuan per person per year, and the self-payment threshold for healthy individuals reduced to 15,000 yuan [1][3] - The coverage for diseases has expanded to 87 types, and the list of reimbursable drugs has increased to 159, including 57 domestic special drugs and 65 overseas special drugs [2][3] - The total coverage amount has been raised to 3.5 million yuan, and the reimbursement ratio for special drugs has increased by 5 percentage points [1][2] Summary by Category Insurance Features - The insurance period for the 2026 plan is from January 1 to December 31, 2026, with a total coverage amount of 350 million yuan [1] - The self-payment threshold for healthy individuals has been lowered from 30,404 yuan to 15,000 yuan, with reimbursement of 25% for expenses between 15,000 yuan and 30,404 yuan after basic medical insurance [1][3] Drug Coverage - The list of reimbursable drugs now includes 159 items, with the addition of 37 innovative drugs, including high-value chronic disease medications [2] - The reimbursement ratio for healthy individuals has increased from 60% to 65%, while for individuals with pre-existing conditions, it has risen from 30% to 35% [2] Health Services - New online and offline 10% discount on drug purchases has been introduced, allowing for an annual subsidy of 1,800 yuan [2] - For insured individuals with no claims in the past three years, the deductible for out-of-pocket expenses has been reduced significantly [2][3] Enrollment Conditions - The enrollment conditions remain flexible, with no restrictions on age, residency, occupation, or health status, covering various groups including those with specific pre-existing conditions [3] - The program has seen over 15 million enrollments and processed 419,000 claims since its launch, with the fastest payouts occurring within 1-2 working days [3]

Core Insights - The "Beijing Inclusive Health Insurance" for 2026 was launched, emphasizing its role as a government-guided supplementary medical insurance aimed at alleviating high medical costs and preventing poverty due to illness [1][2] - The insurance has seen over 15 million participants since its inception in 2021, maintaining a low premium of 195 yuan per person per year while increasing the total coverage to 3.5 million yuan [1][2] Summary by Sections Product Features - The insurance maintains a low premium of 195 yuan per person per year and has upgraded the cumulative coverage to 3.5 million yuan [1] - The product features include low thresholds for participation, high coverage, and quick claims processing, with a focus on inclusivity and broad coverage [1] Service Enhancements - The deductible for healthy individuals has been reduced from 30,400 yuan to 15,000 yuan [2] - The coverage for innovative drugs outside the medical insurance directory has been expanded to 159 types [2] - Reimbursement rates for special drugs have increased by 5 percentage points for both healthy individuals and those with pre-existing conditions, reaching 65% and 35% respectively [2] - New benefits include a 10% discount on medication purchases for both insured and uninsured individuals, and an extended sales period allowing for year-round enrollment [2] Additional Benefits - For individuals with three consecutive years of enrollment and no claims, the deductible for healthy individuals is further reduced to 5,000 yuan, and for specific pre-existing conditions, it is lowered to 15,000 yuan [2] - Participants can access free annual health services, including emergency kits, health check-ups, and weight management equipment [2] - The regulatory body emphasizes the importance of commercial health insurance in enhancing public welfare and encourages continuous product optimization and efficient claims processing [2]

Core Points - The 2026 "Beijing Inclusive Health Insurance" was officially launched, supported by various government departments and representatives from six member units of the mutual insurance body [1] - This insurance product aims to provide affordable and accessible supplementary medical insurance for residents of Beijing, with over 15 million participants in the past four years [1] - The annual premium remains at 195 yuan per person, with total coverage increased to 3.5 million yuan, featuring optimized benefits such as lower claim thresholds and expanded coverage for specific medications [1][2] Summary by Sections - **Insurance Features** - The insurance maintains a low premium of 195 yuan per person per year and increases the cumulative coverage to 3.5 million yuan [1] - Key enhancements include reduced claim thresholds, expanded coverage for specific medications, and a 5% increase in reimbursement rates for special medications [1] - Continuous participants with no claims for three years will benefit from reduced deductibles for out-of-pocket expenses and one free health service annually [1] - **Enrollment Conditions** - The 2026 plan continues the "inclusive coverage" philosophy, with no restrictions on age, residency, occupation, or health status, allowing coverage for specific pre-existing conditions [2] - Participants who initially enrolled as healthy individuals can continue to receive benefits even if they develop specific pre-existing conditions during the coverage period [2] - **Claims Process** - The insurance offers a proactive and expedited claims process, with 89% of claims processed quickly since the fast claims feature was introduced [2] - Eligible claimants receive SMS notifications for claims, and the process requires minimal documentation, allowing for payments to be received within 1-2 working days [2] - **Enrollment Deadline** - The enrollment deadline for the 2026 plan is December 31, 2025, with coverage effective from January 1 to December 31, 2026 [2]

Core Points - The 2026 "Beijing Universal Health Insurance" was officially launched, marking a significant development in the city's healthcare offerings [1][4] - This insurance is the only government-guided supplementary medical insurance in Beijing, emphasizing accessibility and public welfare [5] Product Features - The annual premium remains at 195 yuan per person, with total coverage upgraded to 3.5 million yuan [6] - The threshold for claims has been lowered, with the self-payment responsibility for healthy individuals reduced from 30,404 yuan to 15,000 yuan, and an additional 25% reimbursement for expenses between these amounts [6] - The range of covered special medications has expanded to 87 diseases and 159 drugs, including both domestic and international options [6] - Reimbursement rates for special medications have increased by 5 percentage points for both healthy individuals and those with pre-existing conditions [6][7] Accessibility and Coverage - The insurance is available to all Beijing residents regardless of age, occupation, or health status, promoting inclusivity [8] - Individuals can use their personal medical insurance accounts to pay for premiums, facilitating family coverage [8] Claims and Support - The program has processed 419,000 claims over four years, with a maximum single claim amount reaching 761,100 yuan [9] - The quick claims process allows eligible individuals to receive payments within 1-2 working days, significantly reducing the financial burden during medical emergencies [9] - The insurance aims to provide comprehensive support for all age groups, ensuring that everyone can access necessary medical care [9][10]

Core Viewpoint - The "Beijing Universal Health Insurance" is a government-guided supplementary medical insurance aimed at providing affordable healthcare, with over 15 million participants in four years [1][2] Group 1: Product Features - The insurance is available to all Beijing basic medical insurance participants, regardless of age, occupation, or health status, with a premium of 195 yuan per person per year and a total coverage amount upgraded to 3.5 million yuan [2][3] - Key enhancements include a reduction in the self-payment threshold for healthy individuals from 30,404 yuan to 15,000 yuan, and an additional 25% reimbursement for expenses between 15,000 yuan and 30,404 yuan [3][4] - The range of special drug coverage has expanded to 87 diseases and 159 drugs, including 57 domestic and 65 overseas special drugs, improving accessibility and affordability for patients [3][4] Group 2: Service Improvements - The reimbursement ratio for special drugs has increased by 5 percentage points, with healthy individuals now reimbursed at 65% and those with pre-existing conditions at 35% [3] - New health services include a 10% discount on online and offline drug purchases and exclusive services for loyal users, such as free health services and equipment [3][4] - The insurance has processed 419,000 claims over the past four years, with a maximum single claim amount of 761,100 yuan and a fast claim process where 89% of claims are settled quickly, often within 1-2 working days [4]

Core Points - The 2026 Beijing Inclusive Health Insurance will open for enrollment, with a reduced deductible for healthy individuals set at 15,000 yuan, down from 30,404 yuan, and an increase in the reimbursement rate for special drugs by 5 percentage points [1] - The coverage for special drugs has expanded to 87 diseases and 159 products, including 57 domestic and 65 overseas special drugs, along with 37 innovative drugs [1] - The annual premium remains unchanged at 195 yuan per person, with a total coverage amount upgraded to 3.5 million yuan [1] Summary by Sections Deductible and Reimbursement Changes - The deductible for healthy individuals is reduced to 15,000 yuan, with 25% reimbursement for personal expenses between 15,000 yuan and 30,404 yuan after basic medical insurance [1] - For expenses exceeding 30,404 yuan, healthy individuals will receive 80% reimbursement, while those with specific pre-existing conditions will receive 40% [1] Special Drug Coverage - The reimbursement rate for special drugs has increased from 60% to 65% for healthy individuals and from 30% to 35% for those with specific pre-existing conditions [1] - The list of covered diseases has expanded to 87, and the drug list now includes 159 products, enhancing accessibility and affordability for patients [1] Additional Benefits and Enrollment - New online and offline 10% discount on medications is introduced, covering common drugs, chronic disease medications, and original research drugs [1] - Continuous enrollment benefits include lower deductibles for those with no claims in the past three years, and a range of health management services [1] - Enrollment is open to all individuals with basic medical insurance in Beijing, including new residents and specific government-managed groups [1] - The insurance is jointly guided by the Beijing Medical Security Bureau and the Beijing Financial Committee, with multiple insurance companies involved in underwriting [1]