Core Insights - The article discusses the evolution and current state of the "Hui Min Bao" (惠民保) insurance products, highlighting their significance in addressing the high medical costs faced by the public over the past decade [1][9]. Group 1: Market Development - Since its inception in 2015, the Hui Min Bao insurance has expanded from a pilot program in Shenzhen to a nationwide initiative, with a total of 313 local products launched by July 31, 2025 [2]. - The market has shifted from "incremental expansion" to "stock optimization," with 202 products currently in stable operation, over 80% of which are traditional Hui Min Bao products [2]. - New products in 2025 are driven by two main trends: expanding coverage to underserved areas and enhancing existing products to meet diverse consumer needs [2]. Group 2: Coverage and Innovation - Hui Min Bao products have evolved to offer more comprehensive coverage, including outpatient expenses, special drug coverage, and chronic disease management [4]. - On average, each Hui Min Bao product covers 41 special drugs and 28 types of conditions, with over 80% of traditional products including special drug responsibilities [4]. - The inclusion of innovative treatments, such as CAR-T therapy, and local specialty drugs reflects a commitment to enhancing treatment options for patients [5]. Group 3: Challenges and Solutions - The "death spiral" challenge arises from a high dropout rate of healthy individuals, leading to an increased proportion of high-risk insured, which threatens the sustainability of the insurance model [6][7]. - Some products have seen participation rates below 10%, and certain products have payout rates exceeding 100%, putting pressure on the operational viability of Hui Min Bao [7]. - The industry is moving towards consolidation and optimization of products to reduce competition and improve sustainability [7]. Group 4: Pricing and Service Innovations - Hui Min Bao is transitioning from a uniform pricing model to a differentiated pricing strategy based on age, health status, and group participation, aiming to attract healthier individuals [8]. - Various value-added services are being introduced to enhance the experience for policyholders, including health management services and expedited claims processing [8]. - Collaboration between government and insurance companies is being strengthened to lower operational costs and improve risk management through data sharing [8]. Group 5: Future Outlook - Expanding the coverage of special drugs is expected to create a complementary mechanism between commercial insurance and public health insurance, enhancing the overall healthcare system [9]. - The future of Hui Min Bao will depend on effectively managing risk, setting reasonable premium rates, and preventing adverse selection to ensure long-term stability [9]. - With a stable market foundation and accelerated product innovation, Hui Min Bao is poised for high-quality development, contributing significantly to China's multi-tiered healthcare system [9].

◎记者 周亮 11月以来，广州等多地的惠民保产品进入2026年投保期。上海证券报记者注意到，不少产品在维持低保 费的基础上，也在保障责任、起付线、特药目录等方面进行了升级。 作为普惠保险的典型产品，惠民保从试点到全国推广，已走过十年发展历程。十年间，各地惠民保"百 花齐放"，产品数量稳定在两百款左右，已成为缓解群众"看病贵"难题的重要力量。但在"死亡螺旋"与 保障范围扩宽等挑战之下，惠民保未来如何实现可持续发展与健康运营，也是业内关注的话题。 "存量优化"格局 惠民保，又称城市定制型商业医疗保险，是由地方政府相关部门指导、保险公司商业运作、居民自愿参 保的一种补充医疗保险产品。惠民保最早于2015年在深圳出现，2020年开始在全国范围内推广。 根据复旦大学经济学院副院长、风险管理与保险学系主任许闲教授团队发布的《2025年城市定制型商业 医疗保险（惠民保）知识图谱》，截至2025年7月31日，全国累计推出313款地方性惠民保产品。 历经十年发展，惠民保市场格局已从"增量扩张"转向"存量优化"。当前正常运营产品稳定在202款，传 统型惠民保占比超八成，市场基本盘趋于稳固。 就2025年新产品来看，市场呈现"双轮 ...

2025.11.14 本文字数：3733，阅读时长大约6分钟 作者 |第一财经 吴斯旻 惠民保面向全国推广即将进入第六年，"特药责任"俨然已成标配。据行业估算，去年惠民保以不到200 亿的保费规模贡献了约18亿元的创新药支付金额，是2021年的约9倍。 但对于全国每年约1.5亿左右的参保人而言，理赔获得感却不尽相同——有人单次获赔近80万元，有人 一年获赔了30次，但也有慢病患者"月月就医却没有一次达到起付门槛"，有患者因既往症而遭遇"赔付 减半"，还有的异地就医者、新市民被惠民保拒之门外。 低保费、高赔付率目标，叠加老年人和带病体的参保比例增加，让惠民保的发展面临"死亡螺旋"。部分 惠民保为了应对赔付压力，通过提高免赔额、下调高值药支付限额等方式，减缓保费上涨压力，却又隐 形地降低了医疗福利水平。与此同时，今年首版商保创新药目录出台后，惠民保被寄予承接该目录、增 加创新药支付的业界期待。 在此背景下，今年发布的《国家金融监督管理总局办公厅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，城市商业医疗险（即惠民保）要按照商业保险的基本原则和客观规律开展业 务，坚持保费收取与保障程度相适配、扩面提 ...

Core Viewpoint - The article discusses the evolution and challenges of the "Hui Min Bao" (惠民保) insurance scheme in China, highlighting its rapid growth in coverage and the increasing complexity of claims and benefits, particularly in relation to innovative drugs and treatments [3][4][6]. Group 1: Overview of Hui Min Bao - Hui Min Bao has been promoted nationwide for nearly six years, with "special drug liability" becoming a standard feature. In the previous year, it contributed approximately 1.8 billion yuan in innovative drug payments from a premium scale of less than 20 billion yuan, marking a ninefold increase from 2021 [3][4]. - The scheme faces challenges due to varying experiences among the 150 million insured individuals, with some receiving substantial claims while others struggle to meet deductibles or face reduced payouts due to pre-existing conditions [3][4]. Group 2: Regulatory Changes and Trends - The recent notification from the National Financial Regulatory Administration emphasizes the need for commercial health insurance, including Hui Min Bao, to align premium collection with coverage levels and avoid chaotic low-price competition [4][8]. - The 2026 version of Hui Min Bao is introducing a trend of "premium stratification," moving away from low premiums to better match coverage levels, with new inclusions for chronic diseases and overseas drugs [4][6]. Group 3: Expansion of Special Drug Coverage - As of 2024, 90% of Hui Min Bao projects include "special drug liability," with a total of 672 drugs covered, reflecting a 1.8 times increase since 2021. The focus remains on cancer and rare disease medications, with over 40% of the drugs being innovative cancer treatments [6][7]. - Some regions are expanding their special drug coverage to include high-value drugs for chronic diseases, with certain plans approaching the coverage levels of pure commercial health insurance [7][8]. Group 4: Pricing and Risk Management - The core of commercial health insurance is the dynamic balance between funding and benefits. The low premium model of Hui Min Bao has slowed funding growth, impacting benefit enhancements [10][12]. - The 2026 version of Hui Min Bao is adopting a risk stratification approach, allowing for differentiated pricing based on factors like age and health status, which aims to enhance fairness and adaptability in product offerings [10][11]. Group 5: Inclusion of New Citizens and Cross-Regional Medical Services - The new Hui Min Bao products are increasingly targeting healthy individuals and young people by lowering deductibles and enhancing coverage for outpatient services and common illnesses [16][18]. - Several regions are allowing the use of personal medical insurance accounts for family members and expanding coverage to include new citizens and those seeking medical services across regions [17][18].

Core Insights - The "惠民保" (Huimin Insurance) has expanded its coverage to include chronic diseases, mental health medications, outpatient drugs, overseas drugs, and original research drugs, reflecting a shift in the insurance landscape [1][2] - The insurance scheme has seen a significant increase in claims, with approximately 18 billion yuan paid for innovative drugs in the previous year, a ninefold increase from 2021 [1] - However, the experience of claims varies widely among the 150 million insured individuals, with some facing high out-of-pocket costs due to thresholds and pre-existing conditions [1][6] Group 1: Policy Changes and Trends - The recent notification from the National Financial Regulatory Administration emphasizes the need for commercial health insurance to align premium collection with coverage levels and avoid low-price competition [2] - The 2026 version of "惠民保" has introduced a tiered premium structure, moving away from the previous low-cost model, and has expanded coverage to include more drug categories [2][3] - The number of drugs covered under "惠民保" is expected to reach 672 by 2024, with a significant focus on innovative treatments for cancer and rare diseases [3] Group 2: Coverage Expansion - The 2026 "北京普惠健康保" (Beijing Universal Health Insurance) will cover 87 disease categories and 159 drugs, including new treatments for Alzheimer's and CAR-T therapy [4] - The "齐鲁保2026版" (Qilu Insurance 2026) has expanded its coverage to include 3 high-value medical devices and additional innovative drugs for chronic conditions [4] - Many regions are now including outpatient drugs and original research drugs in their coverage, indicating a trend towards more comprehensive health insurance products [3][4] Group 3: Risk Management and Pricing Strategies - The insurance sector is adopting a risk-based pricing model, allowing for differentiated premiums based on age, health status, and pre-existing conditions [6][10] - The introduction of tiered coverage options aims to balance the need for affordable premiums with adequate benefits, particularly for high-risk groups [6][10] - Recent adjustments have led to increased reimbursement rates for patients with pre-existing conditions, reflecting a shift towards more equitable coverage [8][10] Group 4: Inclusion of New Demographics - The 2026 "惠民保" products are increasingly targeting new citizens and those seeking medical care outside their registered locations, broadening the scope of insured individuals [10][11] - Initiatives to allow family members to share health insurance accounts and to include flexible workers and retirees in coverage are being implemented in various regions [10][11] - The trend towards inclusivity aims to enhance the overall participation rate in the "惠民保" scheme, particularly among younger and healthier individuals [10]

Core Insights - The conference "Focusing on Bay Area Collaboration and Expanding International Cooperation: 2025 Health and Life Sciences Conference" successfully concluded in Guangzhou, highlighting the importance of international collaboration in the health and life sciences sector [2][3][42] - Key topics included medical service collaboration, regulatory innovation in pharmaceuticals and medical devices, biomanufacturing ecosystems, and cross-border healthcare mechanisms [3][42] Group 1: Conference Overview - The conference was guided by the Guangzhou International Biological Island Management Committee and co-hosted by various health organizations, showcasing strong support from numerous pharmaceutical companies and financial institutions [2][3] - The event attracted representatives from health authorities in mainland China, Hong Kong, Macau, and international health organizations, emphasizing the global perspective on health cooperation [3][42] Group 2: Key Presentations - Meng Dongping, Secretary of the China Chamber of Commerce for Import and Export of Medicines and Health Products, emphasized the resilience and opportunities in China's health industry, particularly in the Greater Bay Area [6] - Dr. Gina Samaan from the World Health Organization highlighted the importance of cross-national cooperation in enhancing emergency response systems and public health resilience [6][7] - William Adi Teja from Indonesia's drug regulatory authority discussed Indonesia's regulatory innovations aimed at promoting pharmaceutical innovation and attracting investment [9] Group 3: Regional Development and Innovation - Tian Peilong from Guangzhou's Industrial and Information Technology Bureau presented Guangzhou's advantages in the biopharmaceutical sector, including a robust industrial ecosystem and strong medical resources [11] - Huang Weijian, Director of the Guangzhou International Biological Island Management Committee, outlined the island's role as a core engine for biopharmaceutical innovation, housing over 700 companies [13] Group 4: Roundtable Discussions - A roundtable discussion focused on enhancing the accessibility and affordability of innovative pharmaceuticals and medical devices in the Bay Area, with participants advocating for simplified regulatory standards and increased policy support [15][16] - Another roundtable addressed cross-border healthcare cooperation, emphasizing the need for integrated service systems and the potential for the Bay Area to attract international patients [23] Group 5: Multi-layered Healthcare System - Chen Xingwei, President of the Guangdong Provincial Health Economics Association, stressed the importance of a multi-layered healthcare system to ensure equitable access to healthcare innovations [31] - The Guangzhou Medical Insurance Bureau's initiatives, such as the "Sui Suikang" insurance product, aim to address the challenges of accessing innovative medications [32][34] Group 6: Future Outlook - The conference concluded with a vision for the Greater Bay Area to continue leveraging its advantages in institutional innovation and regional collaboration to build a high-quality health ecosystem [42]

Group 1 - The "Sui Sui Kang" supplementary health insurance program in Guangzhou has opened for enrollment for the 2026 fiscal year, with over 2 million participants on the first day [1] - The program, initiated in December 2020, allows for insurance coverage without age or pre-existing condition restrictions, and offers reimbursement for self-paid medications without disease or drug type limitations [1] - The annual premium remains at 180 yuan, providing coverage up to 2.45 million yuan, including hospitalization, outpatient services, and more [1] Group 2 - The first five-year pilot of "Sui Sui Kang" has been successfully completed, with stable enrollment between 3.53 million and 3.84 million participants from 2021 to 2025, and an annual renewal rate exceeding 80% [3] - Over the five years, the program has provided coverage for 18.28 million instances, with 880,000 claims totaling 2.57 billion yuan, reducing the financial burden of medical expenses by 37.8% for claimants [3] - In 2026, the program will introduce a subsidy of 200 to 400 yuan for eligible insured individuals, enhancing participant satisfaction [3] Group 3 - Yidu Technology, a leader in AI healthcare, has developed the "AI Medical Brain" YiduCore, which offers comprehensive solutions for urban insurance programs, including product design, system setup, and intelligent claims processing [4] - The company has participated in the development and operation of "benefit insurance" projects across 5 provinces and 13 cities, serving over 40 million insured users [4] - Yidu Technology aims to leverage its technological expertise and operational capabilities to enhance the smart and inclusive service experience of the "Sui Sui Kang" program for Guangzhou residents [4]

Group 1: Support for New Citizens' Entrepreneurship and Employment - New citizens face challenges such as difficulty in credit recognition, income verification, and lack of effective collateral when accessing financial services [2][3] - Regulatory bodies are utilizing big data to bridge the information gap between new citizens and financial institutions, with initiatives like the Beijing Financial Comprehensive Service Network [2] - Shandong's regulatory body has encouraged banks to innovate products and services tailored for new citizens, exemplified by Qilu Bank's launch of a dedicated loan program for new citizens [3] Group 2: Housing Support Initiatives - Financial innovations are being explored to enhance housing support for new citizens, with a significant focus on first-time home loans [4][5] - In Guangdong, 90% of personal housing mortgage loans are for first homes, aiding new citizens in achieving housing stability [4] - Chongqing's regulatory body has integrated financial services for new citizens into the Chengdu-Chongqing economic circle strategy, facilitating cross-regional fund usage for housing [4] Group 3: Medical and Insurance Support - New citizens often have limited capacity to withstand risks from illness or accidents, prompting regulatory bodies to guide insurance institutions in developing innovative products [6] - Guangdong has included new citizens in a city-customized commercial health insurance program, covering 93,000 individuals by the end of March [7] - In response to pandemic-related risks, Chongqing's regulatory body has facilitated comprehensive risk coverage for restaurants affected by business interruptions, benefiting over 16,000 employees [7]

不断夯实基层战斗堡垒。搭建立体式全覆盖的党员教育培训体系和党支部标准化规范化建设体系。完善 党建荣誉平台，打造可视化荣誉评价模型，发挥示范引领作用。创建省公司级"四强"党支部，并高标准 创建省公司级营销员党建示范点。持续加强党员学习，提高政治觉悟，把增强党性、严守纪律、砥砺作 风贯通起来，融入日常、化为习惯，营造干事创业的良好氛围。 构建多层次医疗保障"广东模式" 近年来，中国人寿寿险广东省分公司始终坚持人民至上，围绕"一个国寿 一生守护"的经营理念，坚定 走好普惠为民的实践之路。 政企联动，让金融服务惠民有感。积极参与政保融合业务的创新发展，近三年来，为全省17个地市超 3500万人次提供城市定制型商业医疗保险保障，累计赔付超150万人次，赔付金额超15亿元。城乡居民 大病保险2024年为全省8个地市3000多万人提供大病保险保障，共赔付130多万人次，赔付金额超14亿 元。委托经办业务多点创新，2014年该公司开启政保融合委托经办业务，在16个地市累计承办80余个项 目，累计服务人群超8900万人次，累计协议管理资金超过6800万元。积极推进长期护理保险试点，为 650万人提供长期护理保险服务。护航"两新 ...

Core Insights - "Sui Suikang" reported a compensation amount of 240 million yuan for the first half of 2025, with 59,000 individuals receiving compensation, resulting in an average payout of 14,000 yuan per person [1]. Group 1: Compensation Details - In the first half of 2025, the "one-stop" settlement system supported by over 2,700 designated medical institutions in Guangzhou allowed insured individuals to receive compensation without upfront payments or applications, achieving immediate settlement upon discharge [1]. - Among the compensation cases in the first half of the year, 57,000 cases utilized the "one-stop" settlement, accounting for 97% of the total claims [1]. Group 2: Policy Integration - In 2025, "Sui Suikang" aligned with national policies encouraging childbirth by introducing compensation for assisted reproductive expenses, with a total of 261 individuals compensated, and the highest individual payout reaching 3,431.6 yuan [1]. - Additionally, the program provided hospitalization allowances for minors, compensating 111 individuals with a total payout of 21,000 yuan [1].