"到2030年，健康保险在国家健康保障体系中的重要作用进一步发挥。"在金融监管总局9月30日发布的 《关于推动健康保险高质量发展的指导意见》（下称《意见》）中，健康保险未来一段时间发展的总体 思路和阶段性目标被明确提出。 "《意见》对商业健康险的意义重大。除了设定总发展目标之外，还有颇多业内之前一直与监管讨论的 创新点和突破点，例如账户医疗险、分红健康险，以及提高健康管理在净保费中的占比等，拓展了商业 健康险的业务形态和范围。"一名险企高管对第一财经记者表示。 账户医疗险、分红健康险来了 《意见》明确，到2030年，健康保险在国家健康保障体系中的重要作用进一步发挥。团体健康保险和个 人健康保险协同发展，满足全人群和全生命周期多样化需求的多层次健康保险市场格局基本形成。健康 保险监管制度体系更加健全，监管效能充分体现。 健康保险为被保险人因健康原因或者医疗行为的发生而导致的财务损失提供保障，是保险业发挥筑牢社 会保障网功能的重要险种，连接医疗卫生等产业，关系国计民生。随着经济社会发展和健康中国战略的 推进，人民群众健康保障需求日益提升，健康保险重要性不断增强。 金融监管总局相关负责人在答记者问中表示，健康保险在 ...

Summary of Conference Call on Commercial Health Insurance in China Industry Overview - The Chinese medical security system consists of basic medical insurance, supplementary medical insurance, and commercial health insurance, with commercial health insurance accounting for only 4% of the total, indicating significant growth potential [1][2][6]. Key Points and Arguments 1. **Development Focus**: Future development of commercial health insurance should focus on meeting diverse, high-value health needs of customers, emphasizing product innovation, service quality improvement, and expanded coverage [1][3][5]. 2. **Integration with Social Insurance**: The integration of commercial health insurance with social insurance is evolving, with products like million medical insurance gradually merging into the second tier of protection, focusing on non-basic medical insurance coverage [1][4][12]. 3. **Challenges in Commercial Health Insurance**: The industry faces dual challenges from both demand and supply sides, necessitating an increase in insurance payout ratios and the development of products that genuinely meet customer needs, such as high-value critical illness insurance [1][6][8]. 4. **Impact of Inclusive Insurance**: Inclusive insurance products like Huiminbao have raised public awareness of health insurance but have also encroached on the commercial health insurance market, highlighting the potential for tax-advantaged health insurance to grow significantly [1][7][10]. 5. **Critical Illness Insurance Market**: The critical illness insurance market is experiencing challenges due to declining pricing rates and reduced product attractiveness, necessitating reforms to enhance appeal and achieve real transactions [1][8][21][22]. 6. **Internet Consultation Services**: Internet outpatient services play a significant role in commercial health insurance by increasing customer interaction and reducing claims costs, thus benefiting all parties involved [1][19]. Additional Important Insights - **Market Gaps**: There is a substantial gap in the commercial health insurance market, particularly in high-quality medical services outside of basic insurance, especially in first- and second-tier cities [6]. - **Regulatory Support**: Government policies and regulatory improvements are essential for creating a conducive environment for the growth of commercial health insurance [5][12]. - **Long-term Care Insurance**: The long-term care insurance market is still in its infancy, with low coverage levels and significant room for growth, requiring both government and commercial involvement [23][24]. - **Product Pricing**: The pricing of commercial health insurance products needs to be evaluated from multiple stakeholder perspectives to ensure balance and fairness [20]. This summary encapsulates the critical aspects of the conference call regarding the commercial health insurance landscape in China, highlighting both opportunities and challenges within the industry.

Core Insights - The commercial health insurance market faces challenges in covering rare disease patients, as the inclusion of this group increases the "outflow" of claims, necessitating a corresponding increase in "inflow" through premium collection [1][3] - The National Healthcare Security Administration reported that there are approximately 100 rare disease drugs in the national medical insurance catalog, with a projected payment of 8.6 billion yuan for these drugs in 2024, representing 7.7% of total drug payments during the agreement period [1][2] - Despite the growing number of rare disease treatments, insurance companies remain cautious in underwriting these patients due to the inherent risks associated with genetic and hereditary conditions [3][4] Group 1: Market Dynamics - Approximately 40 new drugs submitted for commercial insurance in the second half of the year include around half for rare diseases [2] - The commercial health insurance market is evolving, with some insurers beginning to relax underwriting restrictions for pre-existing conditions, yet they still exhibit caution towards rare disease coverage [2][5] - The market for rare disease insurance is limited due to the small patient base and the high variability in treatment costs and risks associated with different rare diseases [4][5] Group 2: Challenges in Coverage - The insurance industry faces "three difficulties" in covering rare diseases: the hereditary nature of many conditions, the predominance of outpatient treatment, and the high costs of self-funded medications [2][4] - Many insurance policies exclude congenital diseases, leading to a lack of coverage for a significant portion of rare disease patients [4][5] - The lack of precise actuarial data on rare diseases complicates risk assessment and pricing for insurers, leading to higher premiums and conservative coverage terms [4][5] Group 3: Patient Experience - Patients with rare diseases often find that even when insurance products are available, the coverage is inadequate, with many facing high out-of-pocket expenses due to high deductibles and limited reimbursement for outpatient treatments [8][9] - A significant drop in reimbursement rates for pre-existing conditions has been reported, with some patients experiencing a reduction from 75% to 20% in coverage [9][10] - The market for rare disease insurance products is hindered by the perception of high risk and the potential for adverse selection, making it difficult for insurers to sustain profitable operations [5][10] Group 4: Regulatory and Market Trends - The integration of commercial insurance with basic medical insurance is seen as a potential solution to enhance coverage for rare diseases, with initiatives like the "dual catalog" negotiations for innovative drugs [10][11] - The lack of a specific rare disease drug catalog from the government has led to confusion and delays in the approval of treatments for rare diseases [11] - The disparity in coverage across different regions and the challenges in accessing outpatient medications remain significant barriers for patients [10][11]

Core Insights - The insurance industry has significantly enhanced its social security role during the "14th Five-Year Plan" period, with total claims reaching 9 trillion yuan, a 61.7% increase compared to the "13th Five-Year Plan" period [1] - The insurance sector has focused on increasing supply, optimizing structure, and addressing shortcomings, summarized as "one increase, one optimization, one supplementation" [2][3] Group 1: Performance and Growth - The insurance industry has provided risk coverage for 800 million agricultural households through agricultural insurance [1] - Commercial pension and health insurance have accumulated reserves of 11 trillion yuan, with financial services continuously expanding [1] - Motor vehicle insurance has covered over 1.6 billion vehicles, a 40% increase from the previous five-year period [2] - Export credit insurance has provided risk coverage of 4.4 trillion USD, a 52% increase compared to the "13th Five-Year Plan" [2] Group 2: Structural Optimization - Insurance funds have invested over 5.4 trillion yuan in stocks and equity funds, an 85% increase from the end of the "13th Five-Year Plan" [2] - The insurance sector has provided over 10 trillion yuan in risk coverage for technology insurance, supporting 3,600 innovative projects [3] - The average insurance amount for major grain crops has increased by 72% during the "14th Five-Year Plan" [3] Group 3: Financial Support and Reforms - The insurance industry has actively participated in financial reforms, including long-term investment initiatives and support for technology enterprises [3][5] - By the second quarter of 2025, the balance of insurance company funds reached 36.23 trillion yuan, a year-on-year increase of 17.39% [5] - The insurance sector has implemented cost optimization measures, resulting in a reduction of 350 billion yuan in costs for life insurance companies since 2024 [6]

对于当下行业发展健康险特别是医疗险的趋势，多位险企人士表示，DRG（疾病诊断相关分组付费） 与DIP（按病种分值付费）医保改革，将构建基础医保托底、商保分层供给的立体化健康保障新格局， 给商业健康险带来诸多产品创新机遇，今年，商业健康险创新药品目录的制定，都为医疗险发展增添了 动能。 "公司正在全面推进健康险和健康服务布局，将资源向健康类业务倾斜，大幅提升健康保障型业务年化 新保费的占比，重点关注一年期健康险和健康服务。"华南地区一家寿险公司负责人向记者表示。据了 解，其一年期健康险主要发力方向是中高端医疗险。 医疗险成为各大险企发展健康险的主要战场，让健康险内部结构进一步发生变化，据了解，医疗险目前 已经成为健康险市场的新支柱，取代了以往重疾险的主导地位。 据业内人士介绍，健康险主要由重疾险、医疗险、护理险、失能险等险种构成，医疗险和重疾险目前占 据着健康险市场的绝大部分份额，护理险、失能险虽然也有险企在布局，但占比仍然比较小。 嵌入健康管理服务 目前，一些险企在尝试把健康管理服务嵌入健康险，推动客户进行自我健康管理，鼓励客户定期体检， 降低疾病风险。越来越多的健康险产品正在走出传统的纯保险保障模式，一张保 ...

今日 国新办新闻发布会 介绍 近五年金融业发展成就 1 ① 全球 第二大保险市场 地位更加稳固 ，规模持续增长 "一行一局一会"齐聚 ②累计赔付9万亿 较上一个五年增长61.7% ③保险法修订在加快推进 5年来发布各类规制171件 ④寿险公司压降成本3500亿 财险公司综合成本率近十年最低 今日，国新办举行新闻发布会，人民银行行长潘功胜先生，金融监管总局局长李云泽先 生，证监会主席吴清先生等，介绍近五年金融业发展成就，并回答大家关心的问题。 人民银行行长潘功胜先生表示，近五年，朝着"加快建设金融强国"的战略目标，金融事 业取得新的重大成就，国际竞争力和影响力显著增强。 一是，金融体制改革全面深化，顶层设计更加完善；二是，种类齐全、竞争充分的金融 机构、市场、产品体系更加健全；三是，金融服务的质量、效率、普惠性大幅提升。 对于银行和保险业的发展情况，金融监管总局局长李云泽先生，从三方面进行了总结。 一是，行业高质量发展实现新跨越；二是，金融服务再上新台阶；三是，金融监管开创 新局面，详见上图。 总结近五年金融业发展情况 此外，关于保险机构分类监管、寿险业"报行合一"、保险资金投资情况等都有提及. . . | 方 ...

Core Viewpoint - The financial regulatory authority emphasizes the implementation of the new development concept, focusing on optimizing financial resource allocation and enhancing service quality in key areas and weak links, summarized as "one increase, one optimization, and one supplementation" [1] Group 1: Increase Supply - The focus is on increasing supply to support economic and social development goals, with significant financing for major projects such as the Yangtze River High-Speed Railway and the South-to-North Water Diversion Project, providing ample funding for 102 major projects during the 14th Five-Year Plan [2] - Infrastructure loan balance reached 54.5 trillion yuan, a 62% increase compared to the end of the 13th Five-Year Plan [2] - The use of over 700 billion yuan in policy-based development financial tools has leveraged over 9 trillion yuan in investments [2] - Loans to the wholesale, retail, accommodation, and catering sectors increased by 80% [2] - Export credit insurance has provided risk coverage of 4.4 trillion USD, a 52% increase from the 13th Five-Year Plan period [2] Group 2: Optimize Structure - The focus is on optimizing the structure by directing resources towards new productive forces, with loans to high-tech enterprises reaching nearly 19 trillion yuan, growing at an annual rate of over 20% [3] - Insurance funds invested in stocks and equity funds exceeded 5.4 trillion yuan, an 85% increase from the end of the 13th Five-Year Plan [3] - Cumulative risk coverage for technology insurance surpassed 10 trillion yuan, supporting 3,600 innovative application projects [3] - Financial regulatory authority has initiated four pilot projects in the technology sector, resulting in over 1 trillion yuan in new investments [3] Group 3: Supplement Weak Links - The authority aims to strengthen financial support for weak links, enhancing financing accessibility for small and micro enterprises, with 17 trillion yuan in loans deferred during the pandemic, benefiting over 10 million businesses [4] - A total of 22 trillion yuan in loans has been issued to support small and micro enterprises since last year [4] - Loans to poverty-stricken areas reached 31.5 trillion yuan, with nearly 400 billion yuan in small loans for impoverished populations [4] - The average annual growth rate of inclusive agricultural loans is 14.6% [4] - Insurance coverage for major grain costs and planting income has increased by 72% during the 14th Five-Year Plan [4] - Health insurance services have provided economic compensation of 1.8 trillion yuan for patients over the past five years [4]

北京商报讯（记者 李秀梅）金融监管总局局长李云泽9月22日在国新办举行的"高质量完成'十四五'规 划"系列主题新闻发布会上介绍，5年来商业健康险为患病人群累计支付1.8万亿元经济补偿。 ...

Core Insights - The domestic commercial health insurance premium income reached 622.3 billion yuan in the first half of the year, showing a year-on-year growth of 2.3%, indicating that the sector has not yet fully tapped its growth potential [1] - The market is expected to reach 977.4 billion yuan in 2024, just a step away from the trillion-yuan market scale, highlighting the vast development prospects and new challenges for the sector [2] - The integration of commercial health insurance with medical and pharmaceutical resources is anticipated to create leading enterprises in the medical innovation payment service sector in China [1][2] Industry Trends - The current domestic health insurance market has a relatively low proportion of medical insurance compared to mature international markets, where the proportion typically reaches 60% [2] - There is a growing demand for high-end medical services and personalized health management, but the domestic commercial health insurance sector has not rapidly responded to these new market needs [2] - Successful companies in the medical and pharmaceutical innovation payment service sector have established a closed-loop business model integrating "medical + pharmaceutical + health insurance" [2][3] Company Developments - Companies like Meixin Health are exploring new collaborations with health insurance, aiming to redefine health insurance as a service-oriented product that focuses on user efficacy and comprehensive service experience [3][4] - Meixin Health has submitted its IPO application to the Hong Kong Stock Exchange, attracting significant attention from the capital market [5] - From 2022 to 2024, Meixin Health's revenue is projected to grow from 1.069 billion yuan to 2.035 billion yuan, with a compound annual growth rate of 38% [4][5] Financial Performance - In 2024, Meixin Health's revenue from intelligent drug solutions is expected to contribute 1.207 billion yuan, accounting for 59.3% of total revenue, while intelligent insurance solutions are projected to generate 731 million yuan, making up 35.9% [5] - The gross margin for intelligent insurance solutions has increased from 72% in 2022 to 81.5% in 2024, indicating strong resilience and competitive barriers in its online insurance business [5]

Core Viewpoint - The National Health Commission (NHC) has stated that off-label drug use is currently not covered by basic medical insurance, and patients must bear the associated treatment costs [1][4]. Group 1: Regulatory Framework - The NHC and the National Medical Insurance Administration (NMIA) have emphasized the need for medical institutions to strengthen the regulation of doctors' prescribing behaviors [2][4]. - Off-label drug use, defined as the use of drugs outside the approved indications, dosages, or populations, is legally supported under the Physician Law and the Drug Administration Law when no effective treatment alternatives exist and with patient consent [2][3]. Group 2: Clinical Practice and Monitoring - Experts indicate that off-label drug use is not synonymous with inappropriate use, as clinical observations often reveal new indications for existing drugs [3]. - The NHC has previously issued guidelines for comprehensive drug evaluation, focusing on safety, efficacy, economic viability, innovation, suitability, and accessibility [3]. Group 3: Insurance Coverage and Challenges - Off-label drug use is not included in the basic medical insurance payment scope, leading to potential financial burdens for patients, especially those with chronic diseases or requiring expensive treatments [4][7]. - Commercial health insurance varies in its willingness to cover off-label drug use, with many policies stipulating that reimbursement is contingent upon adherence to approved indications [7][8]. Group 4: Future Directions in Insurance - Some insurance companies are exploring innovative products that would cover off-label drug use based on clinical guidelines, indicating a potential shift in the insurance landscape [8].