普惠保险增量扩面 2024年6月，国家金融监管总局发布了《关于推动普惠保险高质量发展的指导意见》，系统阐明了普惠 保险的内涵、目标、原则，擘画了未来5年普惠保险发展蓝图，为行业实践提供了清晰的路径。 中国普惠金融研究院（CAFI）研究显示，当前普惠保险占整体保险保费收入约7%，未来5年，随着数 智化发展、生态中多方力量协同等，普惠保险保费规模将达到约万亿元，市场份额将会翻一番。这也意 味着普惠保险将在金融体系中占据更重要的地位。 记者注意到，近年来，普惠保险产品服务供给不断丰富。2023年7月，山西金融监管局联合山西市场监 督管理局、山西财政厅共同印发了《山西省个体工商户保险保障项目实施方案》，增强了个体工商户风 险抵御能力；同年，深圳金融监管局会同深圳市人力资源和社会保障局等共同印发了《深圳市新就业形 态劳动者综合保障实施方案》，为新业态劳动者提供意外伤害保障，构筑了综合保障安全网。 "扩大普惠保险的覆盖面是起点，终点是我们要把它做成可持续性的业务，这中间就是要坚守商业属 性，按照保险的规律进行市场化的运作，使它能够解决'不可能三角'的问题，使普惠保险能够走上健康 发展的轨道，得以发挥它应有的价值。"徐敬惠 ...

Core Viewpoint - The article discusses the introduction of a "dual directory" system for medical insurance and commercial health insurance in China, with the preliminary results for 2025 announced, highlighting the inclusion of 121 innovative drugs in the commercial health insurance directory [2][3][6]. Group 1: Dual Directory System - The "dual directory" system for medical insurance and commercial health insurance is officially established, marking a significant shift in the healthcare payment landscape [6][10]. - The preliminary review results for the 2025 medical insurance and commercial health insurance innovative drug directories have been released, with 121 drugs approved for the commercial health insurance directory [11][12]. Group 2: Innovative Drug Directory - The commercial health insurance innovative drug directory includes 121 drugs, focusing on high-value medications that are not covered by basic medical insurance, particularly targeting cancer and rare diseases [14][24]. - Among the approved drugs, five CAR-T therapies, which are high-cost cancer treatments, have been included, reflecting the directory's emphasis on addressing the needs for innovative therapies [24][26]. Group 3: Impact on Healthcare - The introduction of the commercial health insurance innovative drug directory aims to bridge the gap in coverage for innovative drugs, allowing patients to access high-cost treatments through commercial insurance [14][31]. - The integration of data between medical insurance and commercial health insurance is expected to facilitate synchronized billing and improve patient access to necessary medications [33][34]. Group 4: Market Trends - The rapid development of commercial health insurance products, such as million-dollar medical insurance plans, indicates a growing market for innovative drug coverage [23][30]. - The article highlights the significant increase in claims for innovative drugs, with companies like Ping An Health reporting a 70% year-on-year growth in special drug expenses [36].

Investment Rating - The industry investment rating is "Overweight," indicating that the industry index is expected to outperform the CSI 300 index by 10% or more over the next six months [6]. Core Insights - The report highlights the recent regulatory guidance from the China Banking and Insurance Regulatory Commission (CBIRC) aimed at promoting the high-quality development of urban commercial health insurance, specifically the "Hui Min Bao" initiative. This marks a significant step towards systematic management and sustainable growth in the sector [5]. - The policy emphasizes a balance between "inclusive positioning" and "commercial attributes," aiming to expand coverage while adhering to commercial insurance principles. This shift is crucial for the long-term sustainability of the products [5]. - The report discusses the need for product optimization through "precise pricing" and "risk prevention," advocating for differentiated pricing based on health status and other factors to enhance fairness and adaptability in insurance offerings [5]. - The report also stresses the importance of ecological protection by discouraging "involution competition" and promoting information sharing among insurance companies, which is expected to improve risk identification and matching capabilities [5]. - Investment suggestions include focusing on life insurance liability transformation and recognizing the optimistic outlook for the equity market, particularly given the historical low long-term interest rates and the potential for improved pricing strategies [5]. Summary by Sections Regulatory Developments - The CBIRC issued a notice on July 31, 2025, to promote the high-quality development of urban commercial health insurance, marking a new phase for "Hui Min Bao" [5]. Product Development - The notice requires insurance companies to adopt differentiated pricing and conduct regular loss assessments to ensure sustainable product offerings [5]. Market Outlook - The report suggests that the life insurance sector is undergoing a transformation, with a focus on capacity enhancement and demand release as consumer awareness grows [5]. Investment Recommendations - The report advises investors to pay attention to large listed insurance companies with strong competitive advantages, as the sector is currently undervalued [5].

城市商业医疗险，即人们常说的"惠民保"。对于监管新规，多家"惠民保"运营机构表示，规范精准定价 是大方向，但由于项目续保责任延续等原因，今年可能不一定能够实现。有券商机构分析称，预计率先 开展寿险渠道及产品高质量转型，产品定价具备优势且深度布局健康险产服体系的头部保险公司将更为 受益。 "惠民保"不得搞低价无序"内卷" 过去，"惠民保"实行统一费率，定价不分年龄、不分性别，有既往病史也能参保。此次《通知》提出， 要遵循风险对价原则，实现差异化定价，原则上应当基于不同群体的年龄、性别、健康状况等因素进行 相应的责任分级或费率分组，不断提升产品和服务的公平性和适配性。这意味着，惠民保或将告别统一 费率。 一位资深"惠民保"市场运营人员告诉广州日报全媒体记者，精细化定价对年轻人、标准体来说意味着价 格更低，更普惠，但对于老年人和带病体这类风险大的群体来说，价格肯定更高。 日前，国家金融监管总局向各保险公司印发《关于推动城市商业医疗险高质量发展的通知》（以下简称 《通知》），要求城市商业医疗险（惠民保）突出普惠定位，坚守商业属性，遵循保险规律，规范精准 定价。 《通知》显示，保险公司应当遵循公平竞争原则开展城市商业医 ...

Core Insights - The compensation rate is a critical feedback mechanism for assessing the actuarial pricing ability and risk management level of insurance companies, serving as a key decision-making basis for strategy adjustments and model optimization [1] - As of August 1, 2025, 132 insurance companies have disclosed their short-term health insurance compensation rates for the first half of the year, with over 60% reporting rates below 50%, while more than 10 companies have rates exceeding 100% [2][3] Group 1: Compensation Rate Overview - Short-term health insurance, defined as policies with a duration of one year or less without guaranteed renewal clauses, has gained popularity due to high coverage and low prices [2] - In the disclosed data, over 60% of the 132 insurance companies reported overall compensation rates for short-term health insurance not exceeding 50%, with variations in year-on-year rates [2][3] - The compensation rates for short-term health insurance vary significantly among individual companies, with the highest reaching 1412.19% and some reporting as low as 1% or even negative values [3] Group 2: Factors Influencing Compensation Rates - The high compensation rates are attributed to three main factors: rising medical inflation, inadequate product pricing, and increased adverse selection risks [3] - The "wide entry and strict exit" nature of short-term health insurance attracts individuals with pre-existing conditions, leading to potential compensation losses due to weak underwriting controls [3] - Some companies, like China Life, reported negative compensation rates due to the release of reserves for pending claims, indicating volatility in their short-term health insurance business [3] Group 3: Market Trends and Regulatory Environment - The short-term health insurance market has seen rapid growth, particularly among property insurance companies, with health insurance premium income reaching 160.9 billion yuan in the first half of the year, a 9.08% increase year-on-year [4] - Regulatory bodies have issued guidelines to ensure that insurance companies set reasonable rates and coverage limits based on actual medical costs and claims experience [5] - Future developments in short-term health insurance are expected to focus on product upgrades, risk control technology advancements, and deeper ecosystem collaboration between insurers and healthcare providers [7]

Investment Rating - The industry investment rating is "Overweight" indicating that the industry index is expected to outperform the CSI 300 index by 10% or more over the next six months [36]. Core Insights - The report highlights a recent decline in the non-bank financial index by 2.4%, with the securities and insurance indices dropping by 3.2% and 0.1% respectively, indicating a synchronized downturn in these sectors [4][8]. - The political bureau meeting emphasized enhancing the attractiveness and inclusivity of the domestic capital market, which is expected to support the recovery of the capital market [4]. - The introduction of new regulations in the futures brokerage sector aims to prevent unhealthy competition and ensure a fair trading environment, which is anticipated to promote high-quality development in the financial industry [4]. - The resumption of VAT on newly issued government bonds is expected to impact the yield of insurance investments, although the overall effect on fixed-income assets may be limited due to the current performance of the equity market [4]. - The report suggests focusing on large, financially robust brokerage firms and comprehensive insurance companies as potential investment opportunities [4]. Summary by Sections Market Review - The non-bank financial index fell by 2.4%, with the securities index down by 3.2% and the insurance index down by 0.1% [8]. - Average daily trading volume in the stock market decreased by 0.8% to 22,156 billion yuan [17]. Industry News - The political bureau meeting on July 30 highlighted the need to enhance the capital market's attractiveness and inclusivity [34]. - The Ministry of Finance announced the resumption of VAT on newly issued government bonds starting August 8, which may lead to a "rush" for long-term bonds [34]. - The China Banking and Insurance Regulatory Commission issued guidelines for the high-quality development of urban commercial health insurance, emphasizing the need for fair pricing and sustainable operations [34]. Investment Recommendations - For brokerages, the report recommends capitalizing on opportunities related to mergers and acquisitions, wealth management transformation, and improving return on equity [4]. - For insurance companies, the focus should be on those with competitive advantages under the new regulatory framework aimed at high-quality development [4].

Core Viewpoint - The article discusses the challenges and opportunities facing the "惠民保" (Huimin Bao) insurance product, which serves as a bridge between social insurance and commercial health insurance, particularly in light of new regulatory guidance aimed at promoting high-quality development in urban commercial medical insurance [1][2]. Group 1: Regulatory Changes and Market Dynamics - The National Financial Supervision Administration issued a notice emphasizing the need for urban commercial medical insurance to incorporate new medical technologies and adhere to differentiated pricing principles, avoiding low-price competition and monopolistic practices [1][6]. - The notice aims to clarify the distinction between commercial insurance and social insurance, promoting a reasonable expectation of coverage among the public [1][4]. - Experts indicate that while the market for Huimin Bao is estimated at 150 to 200 billion yuan, interest from insurance companies remains low due to the product's unique design that does not align well with traditional commercial insurance logic [3][4]. Group 2: Differentiated Pricing and Product Design - Some regions are experimenting with differentiated pricing for Huimin Bao, with premiums varying based on age and health status, which aligns with regulatory expectations [3][4]. - The concept of differentiated pricing is seen as a potential breakthrough for the market, allowing for higher premiums for higher-risk groups while still being competitive compared to other health insurance products [3][4]. - However, there is caution among some cities regarding the implementation of differentiated pricing, as they view Huimin Bao as a basic layer of commercial insurance that should not overly complicate the product design [4][6]. Group 3: Integration with Innovative Drug Coverage - The upcoming commercial insurance innovative drug directory, expected to be released in November, is anticipated to be integrated into local Huimin Bao products, focusing on high-value innovative drugs that exceed basic insurance coverage [8][10]. - The overlap between the special drug coverage of Huimin Bao and the basic medical insurance directory is currently high, necessitating further refinement of the product design [9][10]. - The successful integration of innovative drugs into Huimin Bao is seen as crucial for alleviating the financial burden on patients for high-cost medications, aligning with government objectives [8][10].

Core Viewpoint - The article discusses the evolving landscape of "Hui Min Bao," a special type of commercial health insurance in China, amid new regulatory guidelines aimed at promoting high-quality development in urban commercial medical insurance [2][3]. Regulatory Developments - The National Financial Supervision Administration issued a notice emphasizing the need for urban customized commercial medical insurance to incorporate new medical technologies, drugs, and devices into its coverage [2]. - The notice also calls for adherence to the principle of risk pricing, differentiation in pricing, and avoidance of low-price, disorderly competition [2][3]. Market Positioning and Challenges - Experts express concerns about the future positioning of Hui Min Bao, particularly regarding its alignment with the principles of differentiated pricing and its ability to maintain its inclusive nature [3][4]. - There are questions about how to define "monopolistic sales" in a market where many Hui Min Bao products have merged, leading to a "one city, one insurance" model [3][7]. Pricing Strategies - Some regions are experimenting with differentiated pricing for Hui Min Bao, with premiums adjusted based on age and health status [4]. - The approach aims to balance risk and affordability, ensuring that the overall insurance burden on families does not increase [4][5]. Product Design and Market Interest - Hui Min Bao products are primarily designed for individuals with pre-existing conditions, using a model of relaxed underwriting combined with reduced compensation ratios [5]. - Despite an estimated market potential of 150 to 200 billion yuan, interest from insurance companies remains limited due to the unique nature of Hui Min Bao products [5][6]. Policy Support and Implementation - Effective policy support is deemed crucial for achieving the inclusive nature of Hui Min Bao, with recent initiatives from the healthcare department aimed at enhancing its operational framework [6][8]. - The upcoming commercial insurance innovation drug directory is expected to be integrated into local Hui Min Bao products, enhancing their coverage of innovative drugs [10][12]. Overlap with Basic Medical Insurance - There is a significant overlap between the special drug lists of Hui Min Bao and basic medical insurance, with a reported 40% similarity [10][11]. - This overlap is attributed to timing discrepancies in the adjustments of the two insurance categories, which may complicate the integration of new drugs into Hui Min Bao [11][12]. Future Considerations - The article highlights the need for a clear understanding of how innovative drugs will be incorporated into Hui Min Bao and the implications for patient access and insurance coverage [10][13]. - The potential for increased claims due to the inclusion of innovative drugs is considered low, as Hui Min Bao products are designed to be flexible in terms of premium and coverage adjustments [13].

2025.08. 03 惠民保，这一长期承担着介于社保与商保之间社会保障功能的特殊商业健康险险种，再度站在了发展 的十字路口。 近日，国家金融监督管理总局办公厅发布《关于推动城市商业医疗险高质量发展的通知》（下称《通 知》），提出城市定制型商业医疗保险应该及时将医疗新技术、新药品、新器械应用纳入责任范围； 遵循风险对价原则，实现差异化定价；不得搞低价无序"内卷式"竞争，不得进行垄断性、排他性销 售等系列要求。 该通知提及的"城市商业医疗险"，即通常所说的城市定制型商业补充医疗险（下称"惠民保"）。通 知明确，推动相关参与方准确把握商业保险与社会保险的区别，避免模糊或混淆二者的关系，促进全 社会形成合理保障预期。 同时，"下半年，国家医保局主导的商保创新药目录的遴选和落地在即，从短期落地来看，该目录可 能率先嵌入城市惠民保中。"一名受访的惠民保领域资深学者说。 近期，第一财经对话了多名业界专家、地方医保部门及惠民保承办方相关负责人、保司及创新药企人 士，他们均提出，目前，政府多部门将反"内卷式"竞争、"差异化定价"、支持创新药发展等诸多期 待集惠民保于一身，但无论是惠民保与商保创新药目录的衔接，还是前述《通知》 ...

惠民保，这一长期承担着介于社保与商保之间社会保障功能的特殊商业健康险险种，再度站在了发展的 十字路口。 近日，国家金融监督管理总局办公厅发布《关于推动城市商业医疗险高质量发展的通知》（下称《通 知》），提出城市定制型商业医疗保险应该及时将医疗新技术、新药品、新器械应用纳入责任范围；遵 循风险对价原则，实现差异化定价；不得搞低价无序"内卷式"竞争，不得进行垄断性、排他性销售等系 列要求。 这些担忧至少包括三点：其一，今后惠民保究竟如何定位？尤其是实施差异化定价后，产品是否仍符合 惠民属性？其二，为减少无序竞争，近年来惠民保产品大量合并，在"一城一保"乃至"一省一保"的区域 市场，如何界定"垄断性销售"？其三，对于实施产品准入和价格封顶的惠民保产品而言，政府协商价能 发挥多大效用？如果一款创新药被纳入商保创新药目录但尚未衔接进入地方惠民保，能否享有"进院"优 待？ 差异化定价之争 "0~22岁(含)无既往症人群一年69元，23~50岁(含)无既往症人群一年99元，50岁以上及既往症人群一年 149元。" 近年来，有部分地区正尝试惠民保产品差异化定价，比如前述中部某市惠民保的保费设计。自2021年产 品上线以来，该 ...