金融专场-2025 研究框架线上培训 摘要 寿险产品不仅是保险合同，更是价值观念的传递，需不断扩展业务范围 以满足客户多样化需求。寿险公司通过并购扩大市场份额、获取客户资 源并提升产品多样性，优化资产负债表，提高资本回报率，实现规模经 济效应。 寿险与财险在承保标的和风险管理上存在显著区别。财险承保物体，风 险评估相对简单；寿险承保人的生命，涉及复杂的人口统计和精算模型， 存在利率风险。寿险销售更侧重于价值观念的传递，而非简单的产品定 价。 保险公司定价逻辑基于成本加成法，包括死亡赔付、运营费用和时间成 本。精算师通过分析历史数据预测未来现金流，并根据预定利率贴现计 算保单现值，死差、费差和利差是定价的关键因素。 中国保险行业经历了三波发展：2013 年重疾险驱动，2015 年代理人考 试取消推动，2020 年后惠民保冲击。惠民保以低成本满足大众需求， 对传统重疾险市场造成冲击，新业务价值断崖式下降。 Q&A 保险公司的定价逻辑主要基于成本加成法。具体来说，一张保单包括三项主要 成本：死亡赔付、运营费用和时间成本（即投资收益率）。在此基础上，公司 会对死亡率、费用和利率进行加成，从而确定最终价格。这就是所谓的 ...

在国务院新闻办9月22日举行的新闻发布会上，国家金融监督管理总局局长李云泽表示，我国第二大保 险市场地位更加稳固，保险业累计赔付9万亿元，较"十三五"时期增长61.7%。来自金融监管总局的数据 显示，截至2025年二季度末，保险公司和保险资产管理公司总资产39.2万亿元，较年初增加3.3万亿元， 增长9.2%。我国保险业在保障和改善民生、防灾减损、服务实体经济等方面发挥着越来越重要的作 用。 筑牢民生保障底线 城乡居民大病保险是对大病患者发生的高额医疗费用给予进一步保障的制度性安排。大病保险由政府负 责基本政策制定、组织协调、筹资管理，并加强监管指导。商业保险机构则发挥专业优势承办大病保险 项目，通过市场机制作用，提高大病保险的运行效率、服务水平和质量。 2021年，原中国银保监会印发《保险公司城乡居民大病保险业务管理办法》，规范保险公司经营行为， 维护参保群众合法权益。在此基础上，监管部门对经办大病保险的商业保险公司进行动态调整，严格新 增承办主体，同时加强现场检查力度，及时将不符合条件的公司移除出名单，推动大病保险制度平稳有 序运行。来自金融监管总局的数据显示，目前我国大病保险已服务12.2亿城乡居民。 ...

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 insurance sector in Xinjiang has evolved significantly over the past 70 years, transitioning from a disaster relief tool to a vital component of social security and industrial support [2][3] - China People's Insurance Group (PICC) plays a crucial role in providing various insurance products and services, enhancing the local economy and community welfare [3][5] Group 1: Social Security and Healthcare - PICC's Xinjiang branch has focused on developing major illness insurance, long-term care insurance, and inclusive medical insurance, contributing to a multi-layered medical security system [3] - As of now, 926.54 million people in regions like Kashgar and Aksu have received major illness insurance coverage, with claims amounting to 721 million yuan [3][4] - The "Huimin Bao" program, launched in Aksu, offers universal health commercial supplementary insurance with a premium of 100 yuan per person, providing coverage to 2.0887 million residents [4] Group 2: Agricultural Insurance - PICC has expanded agricultural insurance to support Xinjiang's key crops, providing risk coverage for 6.765 million acres of wheat, corn, and rice, with claims totaling 116 million yuan [6] - The company has also provided 12.789 billion yuan in risk coverage for the cotton industry and 1.5 billion yuan for livestock in southern Xinjiang [6] - Innovative insurance products have been developed for specialty crops, with a total risk coverage of 4.371 billion yuan [6] Group 3: Industrial Support - PICC has tailored insurance solutions for over 400 high-tech enterprises, offering comprehensive risk coverage for technological innovation [7] - As of June 2025, the company has provided 19.528 billion yuan in property insurance for enterprises in Aksu and 11.235 billion yuan for small and medium-sized enterprises in Kashgar [7] Group 4: Technological Innovation in Insurance - The company employs a "insurance + risk reduction service + technology" model to enhance risk management and service efficiency [8] - Technological advancements such as remote sensing, drones, and big data have improved claim processing efficiency by over 80% and reduced costs by 60% [8] - The integration of technology in agriculture has helped mitigate disputes over loss assessment and reduced the risk of over-insurance claims [8] Group 5: Overall Impact - Insurance serves as a safety net for livelihoods and a catalyst for rural revitalization, contributing to the high-quality development of Xinjiang [9]

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 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]

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 Viewpoint - The insurance protection issues for new employment form laborers, exceeding 84 million in China, are increasingly attracting social attention, with regulatory bodies emphasizing the need for tailored insurance products for this demographic [1][3]. Group 1: Current Insurance Products and Market Status - The participation rate of new employment form laborers in commercial medical insurance is 37.2%, indicating that the market is still in its early stages [3][9]. - Major insurance products for this group include "Million Medical Insurance," which covers hospitalization costs up to 1 million yuan, and "Hui Min Bao," a government-guided supplementary medical insurance [3][4]. - The insurance product matrix for new employment form laborers has evolved from a single type to a more diversified offering, including four main categories: basic protection, occupational liability, health protection, and pension protection [4][5]. Group 2: Types of Insurance Products - Basic protection focuses on accident insurance, achieving high coverage rates through platforms like Meituan and Ele.me, with some riders having 100% coverage [4]. - Occupational liability insurance covers third-party losses due to the insured's professional actions, with products like ride-hailing driver liability insurance and domestic service liability insurance [4][5]. - Health protection products include short-term "Million Medical Insurance" and "Hui Min Bao," with nearly 30 such products already covering new employment form laborers [5][6]. - Pension protection relies on social insurance and commercial annuity insurance, but participation rates are low due to the need for long-term contributions [5][6]. Group 3: Challenges and Gaps - The insurance landscape for new employment form laborers is characterized by three gaps: the disparity between product types and income stability, the mismatch between coverage and actual needs, and the high cost of premiums versus economic capability [6][9]. - The current insurance offerings are primarily short-term, with a lack of long-term products that cater to the unique needs of this labor group [6][9]. Group 4: Recommendations for Improvement - To balance low premiums and high coverage, a "five-in-one" inclusive insurance system is recommended, focusing on policy support, product innovation, regulatory collaboration, infrastructure development, and top-level design [7][8]. - Risk management and scenario-based product innovation can help achieve this balance, with a shift from post-incident compensation to pre-incident risk prevention [8][9]. Group 5: Role of Stakeholders - The responsibility for protecting new employment form laborers should be shared among platform enterprises, individuals, and the government, with suggestions for a "third type of laborer" protection model [12][13]. - Recent pilot programs have established alternative injury protection mechanisms for new employment form laborers, with over 10 million participants [13][19]. - The government should enhance policy guidance and financial support to improve insurance uptake among low-income groups [13][14].

Core Viewpoint - Jiangsu Financial Regulatory Bureau is implementing a comprehensive set of measures to enhance financial services, focusing on consumer protection and financial support for businesses and individuals [1][2][3][4][5][6][7] Group 1: Financial Support Initiatives - The bureau is promoting personal consumption loans and service industry loans with interest subsidy policies, effectively lowering financing costs and stimulating consumer potential [2] - By mid-2025, the health insurance premium income in Jiangsu reached 32.659 billion yuan, with claims amounting to 8.724 billion yuan, indicating a growing insurance market [2] - Various local initiatives, such as "Su Xin Action" in Suqian and "Red Salt Loan" in Yancheng, have successfully provided significant credit support to businesses and individual entrepreneurs [2] Group 2: Consumer Protection Measures - A coordinated mechanism for financial consumer rights protection has been established, focusing on combating illegal intermediaries and enhancing information sharing among departments [3] - The bureau has initiated collective actions against illegal activities, leading to numerous cases being filed by law enforcement [3] - The establishment of a city-level mechanism in Xuzhou for illegal intermediary governance demonstrates a collaborative approach to maintaining financial order [3] Group 3: Enhanced Financial Services - Jiangsu is improving accessibility in pension finance by promoting barrier-free facilities and developing personal and commercial pension products [4] - By mid-2025, personal pension insurance premium income reached 1.366 billion yuan, covering 110,100 individuals, while commercial pension accounts totaled 580 million yuan [4] - Financial services for foreign nationals are being optimized, including the integration of foreign banks into domestic payment systems and the provision of multilingual support [4] Group 4: Financial Education and Awareness - A multi-channel financial education network has been established, focusing on community engagement and innovative outreach methods [5] - Initiatives like the "Financial Protection in 100 Communities" campaign and the creation of financial safety maps aim to enhance public financial literacy [5] - Localized financial education efforts, such as the use of regional dialects and creative materials, are being employed to make financial knowledge more accessible [5] Group 5: Dispute Resolution and Accessibility - The bureau is expanding financial dispute mediation services, with plans to add 100 new mediation points across the province by 2025 [6] - Innovative solutions for financing challenges, such as a quick loan application process and targeted agricultural loans, are being implemented to improve access to finance for small businesses [6] - The rapid response to insurance needs for new energy vehicles in Nanjing highlights the bureau's commitment to addressing consumer concerns promptly [6] Group 6: Overall Impact - Jiangsu Financial Regulatory Bureau aims to create a reliable financial environment that supports both businesses and consumers, acting as a "safety shield" and "warm bridge" for the community [7]

Group 1 - Jiangsu Financial Regulatory Bureau focuses on "finance for the people" through institutional innovation, technological empowerment, and service enhancement, showcasing a comprehensive approach to improve financial services [1] - By mid-2025, Jiangsu's personal insurance companies are expected to have health insurance payouts of 8.724 billion yuan, with "惠民保" covering over 10 million people and elderly care community beds exceeding 4,000 [1][2] - The implementation of personal consumption loan interest subsidy policies aims to stimulate consumption and reduce financing costs, with health insurance premium income reaching 32.659 billion yuan and payouts of 8.724 billion yuan by mid-2025 [2] Group 2 - Jiangsu Financial Regulatory Bureau enhances consumer protection by establishing a coordination mechanism for financial consumer rights protection and cracking down on illegal financial activities [3] - Collaborative efforts with law enforcement have led to the identification of hundreds of leads and dozens of criminal cases related to illegal loan intermediaries and other financial crimes [3] - The insurance industry is actively involved in combating illegal "agent refund" practices, promoting industry cooperation to maintain financial order [3] Group 3 - The bureau promotes the development of pension financial services, with personal pension insurance premium income reaching 1.366 billion yuan and commercial pension accounts totaling 80,700 by mid-2025 [4] - Efforts to improve services for foreign nationals include facilitating access to digital RMB wallets and enhancing banking services with multilingual support [4] - The establishment of seven elderly care communities with 4,090 operational beds reflects the ongoing commitment to enhancing financial services for the elderly [4] Group 4 - Financial education initiatives are being expanded through a multi-channel approach, including community outreach and integration with local events to raise awareness [5] - The bureau has launched various risk awareness campaigns, utilizing digital media and community engagement to disseminate financial knowledge [5] - Innovative financial education tools, such as local language materials and online programs, are being developed to enhance understanding of financial concepts [5] Group 5 - The bureau is advancing financial dispute resolution by adding over 100 new mediation service points by 2025, aiming to improve access to conflict resolution [7] - Quick responses to specific issues, such as insurance for new energy vehicles, demonstrate the bureau's proactive approach to resolving industry challenges [7] - Innovative solutions, like mobile loan applications and new financing models, are being implemented to address the financing difficulties faced by small and micro enterprises [7]