原标题："中保"观察 | 从头部险企健康险理赔"结构"，看实际保障力度被低估 来源：中保新知 今年过年不送礼，送礼就要送健康。关于健康的祝福，已成为挂在每一个人嘴边的口头禅。马年春节前 后，健康保障、健康管理也已经成为宏观经济与民生领域的热点话题。 其一是北京市医保局、金融监管总局北京监管局等九部门于2月联合印发《北京市支持商业健康保险高 质量发展的若干措施》，从产品创新、数据共享到医保商保协同，全方位为商业健康险高质量发展保驾 护航；其二是马年央视春晚上，健康AI应用"蚂蚁阿福"的高调亮相，也在加速推动健康管理进入全民视 野。 在政策与科技的双轮驱动下，大众对健康的关注热情持续攀升。那么，作为重要的健康保障工具，商业 健康险的发展现状如何，行业理赔力度怎样？近期金融监管总局披露的保险业务数据，以及人身险公司 相继出炉的年度理赔报告，或是解读商业健康险发展、观测理赔服务的重要窗口。 01 业务增速放缓 最新数据显示，2025年商业健康险保费为9973亿元，同比增幅2.04%，距离业内期待的万亿保费规模仅 一步之遥。剖析商业健康险"万亿"大关期待落差的原因，有业内人士直言，这背后主要受人身险公司健 康险业务小幅 ...

【环球网保险报道 记者 冯超男】在聚焦于保障人民健康目标上，"十五五"规划建议提出，加快建设健康中国。而 作为经济社会发展的"稳定器"与"助推器"，保险业在多层次医疗健康体系建设中，其独特价值与重要作用愈发凸 显。 特别是商业健康险领域，如今正紧扣着长寿时代脉搏，顺应全民健康意识觉醒时代浪潮，正从传统大病风险兜 底，向着覆盖全生命周期、融合多元服务的方向深度转型升级。 政策春风吹来，市场顺势而为。在持续释放的政策红利滋养下，各大险企积极相应，如构建起普惠医疗、百万医 疗、中高端医疗在内的多层次医疗保险体系，兼顾不同人群的保障需求；积极参与国家和地方长期护理保险试点 工作，创新研发失能保险产品等。 这场深刻行业变革下，产品端上最直观的体现，莫过于保障边界的持续拓宽。以往，医疗险产品多聚焦健康人 群，依靠严苛的健康告知与核保流程筛选风险。如今，随着行业理念的升级与产品创新的提速，越来越多医疗险 打破这一局限，将保障触角延伸至非健康人群与带病人群，让保障覆盖面更具包容性，真正贴合全人群的健康需 求。 科技赋能促发展，合规坚守破除梗阻 尤为值得关注的是，2026年1月22日，中国保险行业协会召开的健康保险高质量发展工 ...

Core Insights - The healthcare payment system in China is transitioning from a "basic medical insurance" model to a "basic medical insurance + commercial insurance" multi-collaboration model, creating new growth momentum in the healthcare service sector and increasing demand for professional commercial insurance services [2][3] - The rapid expansion of the innovative pharmaceutical and medical device market, projected to grow from RMB 92.3 billion in 2019 to RMB 162 billion by 2024, with a compound annual growth rate (CAGR) of 11.9%, is driving the healthcare service sector [2] - The commercial health insurance market is expected to reach RMB 23,568 billion by 2030, with a CAGR of 15.8% from 2024 to 2030, indicating significant growth potential [2] Industry Dynamics - The dual-track growth of the healthcare payment system highlights the challenges in industry chain collaboration, with insurance companies facing constraints in talent and data, while innovative pharmaceutical companies encounter value realization bottlenecks [3] - Commercial insurance service providers are positioned as key players to address these challenges, facilitating collaboration across the industry chain [3] Key Players and Strategies - Major insurance companies like Ping An and China Pacific Insurance are enhancing their service offerings by building health management systems to improve the attractiveness and service experience of commercial insurance products [4] - Internet giants such as Ant Group leverage their large user base and technological advantages to innovate in direct payment models and digital empowerment, aiming to lower barriers for users in insurance participation and claims [4] - Specialized platform companies like Meixin Health focus on resource integration and technological empowerment, utilizing AI risk control and data platforms to connect pharmaceutical companies, insurers, and patients [5] Meixin Health's Performance - Meixin Health, as the largest multi-payment platform in China, has demonstrated a differentiated competitive advantage through its asset-light model, achieving revenue growth from RMB 1.069 billion in 2022 to RMB 2.035 billion in 2024, effectively doubling its revenue [6] - The adjusted net loss for Meixin Health has significantly narrowed from RMB 447 million to RMB 80 million, indicating a strong trend towards profitability [6] - In the first ten months of 2025, Meixin Health reported revenue of RMB 1.873 billion, a 34% year-on-year increase, with an adjusted net loss of RMB 55 million, continuing the trend of improving financial performance [6] Future Outlook - The healthcare payment sector is entering a new development cycle characterized by policy benefits, data assets, and product iteration, with commercial insurance service providers expected to see exponential growth in value as the payment ecosystem matures [7] - Meixin Health is well-positioned to solidify its market position through its business layout, platform-based operational model, technological advantages, and robust financial performance [7]

Group 1 - The meeting conveyed the spirit of the group and headquarters' 2026 work conference and the strict governance of the Party and discipline inspection work conference, promoting the company's three-year development plan and new annual financial policies [2][3] - The meeting summarized the achievements of the provincial system in 2025 and the 14th Five-Year Plan period, and set future development goals for the next three years, emphasizing the theme of "Striving for Shaanxi, Co-constructing and Sharing" [3][5] - The company reported a total premium income of 18.26 billion yuan, maintaining a solid market-leading advantage, and provided risk protection exceeding 2.4 trillion yuan with nearly 7 billion yuan in claims paid [5][6] Group 2 - The company will strictly implement the 2026-2028 three-year development plan, focusing on high-quality development and the theme of "Striving for Shaanxi, Co-constructing and Sharing," while promoting ten key projects [7][9] - The meeting outlined seven key areas for current work, including strengthening Party building, enhancing service capabilities, improving business quality, and optimizing operational management [11][12] - The company aims to enhance risk prevention and control capabilities, ensuring effective management of existing risks and prevention of new risks [11][12]

（文章来源：每日经济新闻） 中信证券认为，在基本医保管理边界逐渐明晰的趋势下，商保有望成为医疗健康产业支付端的核心增 量，当前政策红利、数据资产与商业健康险产品迭代共振有望开启医疗健康产业多元化支付体系发展新 周期。下一阶段，中信证券认为商保综合服务提供商有望解决保司端人才、数据制约，打开创新药械企 业创新价值兑现面临的结构性瓶颈，进一步助推商业健康险行业边际加速发展。认为伴随商保支付渗透 率提升与数据智能驱动的控费模式成熟，具备药险资源整合能力与技术壁垒的平台型公司，有望脱颖而 出成长为行业龙头。持续建议关注以下三条投资主线：1）平台型公司赋能药险协同，开启支付体系"换 挡升级"新周期。2）创新药械——创新药械有望受益于商业健康险带来的增量支付额以及估值体系提 升；3）民营医疗终端——迎来新支付方，打开未来业绩成长空间。 ...

Core Viewpoint - The expectation for the commercial health insurance market to reach a trillion yuan in 2025 was not realized, with total premiums recorded at 997.3 billion yuan, falling short by 27 billion yuan [2][3]. Group 1: Market Performance - In 2025, the commercial health insurance premium growth was only 2.04% year-on-year, marking the lowest growth rate in five years [8][10]. - The health insurance premiums from life insurance companies decreased by 0.41% year-on-year to 769.9 billion yuan, while property insurance companies saw an increase of 11.31% in annual premiums [3][5]. - The monthly premium for December 2025 showed a negative growth of 3.6%, contrasting with a positive growth of 3.3% in November [3]. Group 2: Market Dynamics - The decline in life insurance companies' health insurance premiums is attributed to a drop in critical illness insurance sales and the challenges faced by long-term medical insurance due to repeated reductions in preset interest rates [4][12]. - The market is experiencing a structural adjustment, with traditional main products showing weak growth and a mismatch between supply and demand [11][12]. Group 3: Future Outlook - Despite the disappointing performance in 2025, there is optimism for future growth driven by product innovation and scientific pricing, with expectations that the trillion yuan target could be achieved in 2026 [2][13]. - The release of new policies aimed at promoting high-quality development in health insurance is expected to guide the market towards new growth directions, including the integration of insurance with healthcare services [13][14]. - Key future trends include focusing on innovative products for high-risk groups, enhancing service models towards comprehensive health management, and fostering collaboration across the healthcare ecosystem [14].

Core Insights - The commercial health insurance premium for 2025 reached 997.3 billion yuan, falling short of the expected one trillion yuan mark by 27 billion yuan [1][2] - The growth rate of commercial health insurance premiums was only 2.04%, marking the lowest growth rate in the past five years [5][7] - Despite the current challenges, there is optimism for future growth driven by product innovation and scientific pricing [1][9] Group 1: Premium Performance - The premium for commercial health insurance in 2025 was 997.3 billion yuan, with a year-on-year increase of 2.04% [2] - In the first eleven months of 2025, the total premium reached 943.9 billion yuan, leading to expectations of surpassing one trillion yuan [2] - The December premium saw a shift from a positive growth of 3.3% in November to a negative growth of 3.6%, contributing to the overall shortfall [2][3] Group 2: Market Dynamics - The decline in premiums was primarily due to a slight decrease in health insurance business from life insurance companies, which saw a 5.9% year-on-year drop in December [2][3] - Property insurance companies, on the other hand, experienced growth in health insurance premiums, with December showing an 8.8% increase [2][3] - The market is witnessing a structural shift, with life insurance companies struggling with traditional products while property insurers capitalize on short-term health insurance offerings [3][8] Group 3: Future Outlook - The industry anticipates significant growth potential in the commercial health insurance market, with expectations of reaching the one trillion yuan target in 2026 [9][10] - The release of new policies aimed at promoting high-quality development in health insurance is expected to drive future growth [9][10] - Key areas for growth include product innovation targeting chronic illness and elderly populations, as well as a shift towards comprehensive health management services [11]

保险业2025年成绩单出炉。 记者从中国保险行业协会获悉，在政策支持和市场需求的双重驱动下，商业健康保险近10年的年均复合 增长率超过20%，在售医疗保险产品超过1.1万个。 1月22日，中国保险行业协会召开健康保险高质量发展工作座谈会，围绕商业健康保险发展、深化商业 保险与医药医疗领域交流合作等进行研讨。会后，中国保险行业协会、中国精算师协会、中国银行保险 资产管理业协会、中国银行保险信息技术管理有限公司四家机构集体发声，明确了开展商业医疗险净成 本表编制工作、推动保险资金服务医疗健康养老产业发展等方面的未来布局。 在东吴证券非银金融首席分析师孙婷看来，伴随产品创新迭代和科学定价，商业健康险市场未来发展空 间仍然较大。 国家金融监督管理总局最新披露的数据显示，2025年，保险业原保险保费收入首次突破6万亿元大关， 达到6.12万亿元，同比增长7.4%，增速有所放缓；全年赔付支出2.44万亿元，同比增长6.2%。截至2025 年末，行业总资产41.31万亿元，较年初增长15.1%。 其中，人身险实现原保险保费收入4.65万亿元，同比增长9.1%；财产险实现原保险保费收入1.47万亿 元，同比增长2.6%。 在 ...

Core Viewpoint - The report from CICC highlights that recent policy initiatives from four Chinese regulatory bodies aim to address the challenges faced by the commercial health insurance sector, potentially leading to a new era of development in the industry [1][2]. Group 1: Policy Initiatives - The China Insurance Industry Association is promoting the establishment of model clauses for commercial health insurance and a drug payment list to standardize product design and enhance coverage [2]. - The China Actuarial Society is advancing the creation of net cost tables for commercial health insurance and innovative drug cost assessments to fill data gaps in pricing and improve risk quantification [2]. - The China Banking and Insurance Regulatory Commission is working on optimizing health insurance product checks, integrating medical insurance and commercial insurance data, and upgrading data infrastructure to resolve issues related to data silos [2]. - The China Banking and Insurance Asset Management Association is guiding insurance funds to support the development of the medical, health, and elderly care industries, injecting more patient capital into the sector [2]. Group 2: Investment Opportunities - The report suggests focusing on leading internet platforms and large insurance groups that are committed to building systematic payment solutions for commercial insurance [2]. - It also recommends investing in leading brokerage channels and related entities that excel in corporate group insurance with higher fundraising efficiency [2]. - Companies that continuously enhance their health insurance operational capabilities or benefit from the health insurance market's growth, including reinsurers and insurers, are highlighted as potential investment targets [2]. - Additionally, pharmaceutical and medical service companies that stand to gain from the incremental growth of commercial insurance payments are identified as investment opportunities [2].

Core Insights - The commercial health insurance sector in China is undergoing a significant transformation, evolving from a supplementary option in the medical insurance system to a key component supporting a multi-tiered medical security framework [1] - By November 2025, the premium scale of commercial health insurance is projected to reach 944 billion yuan, marking a year-on-year growth of 2.39%, with expectations to surpass 1 trillion yuan for the first time in 2025 [1] Policy and Market Dynamics - Since 2025, there has been a concentrated effort in policy development for commercial health insurance, with multiple departments releasing important documents that outline a clear blueprint for industry growth [2] - The "Guiding Opinions on Promoting High-Quality Development of Health Insurance" was issued in September 2025, proposing a "new five-year plan" for the market [2] - The National Healthcare Security Administration and the Ministry of Human Resources and Social Security released the "Commercial Health Insurance Innovative Drug Directory (2025)" to enhance the integration of commercial health insurance with basic medical insurance [2] Industry Growth and Product Development - The commercial health insurance sector has become an indispensable part of the multi-tiered medical security system, with a compound annual growth rate exceeding 20% over the past decade [3] - There are over 11,000 medical insurance products currently available, reflecting a rich and diverse product supply [3] - As of 2025, insurance funds directed towards the medical and elderly care sectors have exceeded 30 billion yuan, covering various sub-sectors such as biotechnology and medical devices [4] Innovation in Drug Coverage - The commercial health insurance sector is increasingly supporting pharmaceutical innovation, with estimated total payouts for innovative drugs and devices reaching approximately 14.7 billion yuan in 2025, maintaining a compound annual growth rate of 70% [5] - The industry has shifted from tentative coverage of a few specialty drugs to systematic coverage of new technologies and high-value treatments [5][6] Future Challenges and Opportunities - The commercial health insurance market is at a crossroads, with five key growth points identified for 2026, including the emergence of high-quality medical demand and the importance of product innovation and service resource integration [7] - The industry is experiencing a "hot and cold" phenomenon, with traditional long-term products under pressure while the medical insurance segment shows resilience [7] - The focus is shifting towards enhancing the user experience and ensuring sustainable growth through improved service networks and payment systems [8] Evolving Product Landscape - Inclusive products like "Hui Min Bao" are transitioning to a high-quality development path, moving away from low-cost models to more sustainable and well-structured offerings [8] - Long-term care insurance and disability insurance are recognized as promising areas, integrating health protection with elder care services [8] Industry Effectiveness and Collaboration - Ongoing debates about the effectiveness of coverage highlight the need for nuanced evaluations that consider different insurance types and their operational logic [9] - The future of commercial health insurance will involve clearer roles in collaboration with basic medical insurance, focusing on enhancing quality and service [10] - The industry is expected to emphasize layered supply and collaborative development, ensuring that growth translates into real benefits for families facing major health challenges [10]