兰及五号 目間最高劃/ 保险工 2025 年 10 月 10 日 版 发行业 相关研究 若研究祝 证券分析师 罗钻辉 A0230523090004 luozh@swsresearch.com 孙冀齐 A0230523110001 sunjq@swsresearch.com 联系人 请务必仔细阅读正文之后的各项信息披露与声明 孙冀齐 (8621)23297818× sunjg@swsresearch.com 申万宏源研究微信服务号 看好健康险的二次腾飞机遇 ――《关于推动健康保险高质量发展的指导意见》点评 新"国十条"在健康险领域迎来专项落实。9 月 30 日，金管局发布《关于推动健康保险高质 量发展的指导意见》(简称"《意见》")，标志着新"国十条" 在健康保险领域的专项落实，外 部环境、客户需求变化叠加政策支持态势下，看好低利率时代健康险产品的二次腾飞机遇。 明确健康险的四大分类,进一步完善多元化健康保障及服务体系。1) 明确健康保险的产品分 类、政策定位及发展方向:i) 商业医疗保险:政策定位为"积极发展",需构建"全覆盖、多 层次"的产品体系，扩大保障范围，提升保险费率与承保风险的匹配度；ii) 商业长 ...

Group 1: Core Objectives and Strategies - The report emphasizes the importance of revitalizing Northeast China, particularly focusing on Liaoning's development efforts [1] - China Insurance aims to align with national and provincial policies, enhancing its service capabilities to meet diverse insurance needs across various sectors [2] - The company actively participates in infrastructure projects and provides comprehensive insurance services to major enterprises, with a total risk coverage of 400 billion yuan [2] Group 2: Environmental and Social Contributions - The company promotes environmental pollution liability insurance and has provided 2.188 million yuan in risk coverage for various industries [3] - China Insurance has invested 3 million yuan in projects for the harmless treatment of dead livestock, contributing to rural ecological construction [3] - The company has developed innovative insurance products to support rural revitalization and has signed cooperation agreements with local agricultural authorities [8] Group 3: Technological Advancements and Financial Support - The company implements a "Digital Agricultural Insurance" initiative, utilizing advanced technologies for precise underwriting and claims [9] - China Insurance has provided nearly 700 million yuan in insurance coverage for various health-related initiatives, benefiting over 970,000 people [13] - The company has facilitated loans totaling nearly 700 million yuan to farmers, addressing financing challenges in the agricultural sector [12] Group 4: Community and Disaster Response - China Insurance has provided nearly 6 billion yuan in risk coverage for food safety liability insurance across over 200 food-related enterprises [7] - The company has paid out over 2.4 billion yuan in claims since 2022 to assist individuals affected by natural disasters [13] - The company has launched initiatives to protect the rights of migrant workers, providing nearly 100 million yuan in risk coverage [14]

Group 1 - The Shanghai Financial Regulatory Bureau, in collaboration with various departments, has issued measures to promote the high-quality development of commercial health insurance to support innovation in the biopharmaceutical industry, outlining 18 specific work measures across five areas [1][2] - Shanghai aims to expand the coverage of commercial health insurance, diversify product offerings, and accelerate the development of commercial nursing insurance to establish a multi-tiered commercial health insurance product system [1] - The measures encourage the development of health insurance products tailored to specific groups such as the elderly, children, and those with chronic conditions, while also supporting insurance companies in enhancing health management services [1][2] Group 2 - The initiative includes plans to deepen the interconnectivity of medical, health insurance, and commercial insurance data, using clinical trial data and disease adaptation as pricing references for insurance companies [2] - Shanghai will innovate payment mechanisms for innovative drugs and medical devices, facilitating their integration into hospitals and insurance coverage, while ensuring that cases involving these innovations are not included in the disease-based payment scope [2] - The measures are expected to stimulate the commercial health insurance market, positioning it as a crucial pillar in the health protection system and a key participant in the multi-faceted payment system for new and superior drugs and devices [2]

Group 1 - The core viewpoint of the news is the introduction of measures by the Shanghai Financial Regulatory Bureau to promote the high-quality development of commercial health insurance, enhancing the insurance industry's ability to serve public health needs and improving the accessibility and affordability of innovative drugs and medical devices [1][2] - The measures include five main areas with 18 specific actions aimed at broadening the coverage of commercial health insurance and developing a multi-tiered product system [1] - There is a focus on developing health insurance products tailored for specific groups such as the elderly, children, and those with chronic illnesses, as well as enhancing health management services to reduce risks [1][2] Group 2 - The measures encourage the development of group health insurance products that involve employer contributions and cover innovative drug costs, aiming to establish a risk adjustment mechanism in key economic sectors [1][2] - There is an emphasis on deepening the interconnectivity of medical, health insurance, and commercial insurance data, using clinical trial data as pricing references for insurance companies [2] - The introduction of innovative payment mechanisms for new drugs and medical devices is supported, facilitating their integration into hospitals and insurance coverage, while also promoting tax deductions and funding optimization for commercial health insurance [2]

Core Viewpoint - Shanghai has introduced a new set of 18 measures aimed at promoting the high-quality development of commercial health insurance to support innovation in the biopharmaceutical industry, focusing on enhancing the multi-payment mechanism, particularly in commercial health insurance [1][2]. Group 1: Policy Overview - The new measures are a deepening upgrade of the previous "28 measures" and represent the first systematic policy document in China to construct a dual empowerment mechanism between commercial health insurance and biopharmaceutical innovation [1]. - The measures address long-standing issues of insufficient collaboration among multiple departments in the development of commercial health insurance, providing support and guidance for the standardized development and innovation of health insurance products [1][2]. Group 2: Data Sharing and Product Development - The new policies emphasize the establishment of a data-sharing mechanism among medical institutions, pharmaceutical companies, and commercial insurance companies to enhance product development and actuarial needs [2][3]. - The measures support the development of various health insurance products, including group insurance, welfare insurance, nursing insurance, and specialized products for specific populations, particularly focusing on the needs related to innovative drugs and medical devices [2][3]. Group 3: Targeted Support for Specific Populations - The new measures encourage insurance companies to include elderly individuals, those with pre-existing conditions, and chronic patients in their coverage, thereby broadening the service population of commercial health insurance [4]. - There is a focus on providing diversified customized services to new citizens and specific groups in new industries and business formats [4]. Group 4: Purchasing and Funding Mechanisms - The measures propose a matching engine for health insurance products based on individual profiles and characteristics, facilitating easier access to insurance products for consumers [5]. - Employers are encouraged to purchase group health insurance for employees, with provisions for shared premium payments between employers and employees, utilizing personal account balances for premium payments [5]. Group 5: Claims and Payment Innovations - The new measures aim to enhance the application of medical insurance data in commercial insurance settlements, optimizing the synchronization of settlements between medical insurance and commercial insurance [6]. - There is a focus on improving the accessibility and affordability of innovative drugs through collaborative mechanisms involving commercial insurance, medical insurance, charitable organizations, and pharmaceutical companies [6].

Group 1 - The core viewpoint of the news is the introduction of measures by the Shanghai Financial Regulatory Bureau to promote the high-quality development of commercial health insurance, enhancing the insurance industry's ability to serve public health needs and improving the accessibility and affordability of innovative drugs and medical devices [1][2] - The measures include five main areas with 18 specific actions aimed at broadening the coverage of commercial health insurance and enriching product forms, particularly focusing on developing commercial nursing insurance and a multi-tiered product system [1] - There is an emphasis on encouraging the development of health insurance products tailored for specific groups such as the elderly and those with chronic conditions, as well as enhancing health management services to reduce risks [1][2] Group 2 - The measures advocate for the creation of group health insurance products that involve employer contributions, covering innovative drug and device costs, and aligning with basic medical insurance for seamless settlement [1][2] - There is a push for deepening the interconnectivity of medical, health insurance, and commercial insurance data, using clinical trial data as pricing references for insurance companies, and supporting a "one-stop" settlement service [2] - The introduction of innovative payment mechanisms for new drugs and devices is encouraged, facilitating their integration into hospitals and insurance coverage, while also promoting tax deductions and optimized funding to support the growth of commercial health insurance [2]