Core Insights - The "Zao Huibao" program has effectively mitigated high medical costs for the public and dispersed health risks over the past four years, with over 1.4 million participants and claims exceeding 94 million yuan [1][2] Group 1: Program Overview - "Zao Huibao" is a customized inclusive commercial health insurance project initiated by the government in Zaozhuang, Shandong Province, with China Life Property & Casualty Insurance as the main underwriter and eight other insurance companies participating [1] - The program has adopted a combination of co-insurance and online-offline promotion models, achieving significant participation and claim amounts [1] Group 2: Product Development - The insurance company conducts annual loss assessments and actuarial reviews to optimize coverage plans, balancing inclusivity and sustainability [2] - The deductible for 2025 will be reduced from 15,000 yuan in 2023 to 8,000 yuan, allowing more patients to benefit from inclusive financial services [1][2] Group 3: Premium Adjustments - The company has implemented differentiated pricing based on demographic factors such as age, gender, and health status to enhance fairness and adaptability [2] - Premiums for low-income individuals and those with pre-existing conditions have been significantly reduced, with fees as low as 10 yuan for certain groups [2] Group 4: Claims Processing Innovations - The program has streamlined the claims process by synchronizing commercial insurance payouts with basic medical insurance settlements, reducing the burden on insured individuals [3][4] - A one-stop settlement system has been established, allowing for automatic claims processing without the need for extensive documentation, significantly reducing processing time from approximately 20 days to under 10 minutes [4] Group 5: Cross-Province Medical Treatment - The "Zao Huibao" program has introduced an "exemption from application for direct compensation" system for patients seeking treatment outside their home province, enhancing convenience and reducing financial pressure [5] - The system automatically triggers claims for eligible patients, ensuring timely payments directly to their social security or designated bank accounts [5] Group 6: Future Directions - The Zaozhuang Medical Security Bureau aims to expand coverage and improve service sustainability while adhering to the principles of commercial insurance [5]

齐鲁晚报·齐鲁壹点记者闫明 通讯员宋健 林婷婷 崔广勋 在当前诸多地方"惠民保"出现发展瓶颈、可持续发展受到制约的情况下，由中国人寿财险山东省枣庄市中心支公司主承、8家保险公司参与共保的"枣惠 保"却相当"吃香"，受到越来越多的群众青睐，成为多层次医疗保障体系的重要补充。项目启动近四年来，采用共保体和线上线下相结合的推动模式，参保 人数突破140万人，赔款金额超9400万元，单笔最高赔款超30万元，有效缓解了患病人员经济负担，增强了群众获得感。日前，国家和山东省医疗保障局 领导专程前来调研，对"枣惠保"诸多创新性成效予以充分肯定。 产品演进与群众需求同频 "枣惠保"是枣庄市首款政府指导、市场运作的定制型普惠商业医疗保险项目。中国人寿财险山东省枣庄市中心支公司作为主承保单位，始终以高度的政治 责任感推进这一民生工程，厚植为民情怀，突出普惠定位。每个承保年度开始前，都要在市医保局、金融监管分局的指导下牵头共保公司对上一年经营情 况开展损益核算和精算回溯，不断优化年度保障方案，着力平衡"普惠性"与"可持续性"。共保体建立清晰的集体决策和议事规则，动态调整理赔起付线和 特药目录等核心要素，2025年起付线由2023年 ...