2025年12月30日，工作刚满半年的李雨桐在研究许久后，卡着截止日期的前一天，在手机上完成了 2026年度"北京普惠健康保"的参保。"工作时间不久，预算有限。195元能给健康买一个保障和心安，还 能直接用医保个人账户缴费，我感觉比较值。"李雨桐说。65岁的陈国平也在子女的建议下进行了"北京 普惠健康保"续保，"理赔门槛降了一半多"。 2026年1月1日起，2026年度惠民保在全国多地陆续生效。新一年的惠民保在延续亲民保费的基础 上，通过扩大特药目录、降低理赔门槛、拓展保障人群等一系列升级举措，让这份普惠性补充医疗保 险，不仅成为中老年群体的"安心之选"，也成了年轻人眼中的"高性价比保障选择"。 《中共中央关于制定国民经济和社会发展第十五个五年规划的建议》提出，要"健全多层次医疗保 障体系"。近期召开的全国医疗保障工作会议也明确提出，要支持商业健康保险发展，支持商业健康保 险与基本医保衔接互补、差异化发展，积极落地商保创新药品目录。 作为衔接基本医保与商业健康保险的重要载体，惠民保正迎来新一轮高质量发展周期。然而，"惠 民保用得上吗""低保费是否意味着低保障""买了惠民保还要买其他商业保险吗"等疑问，仍萦绕在 ...

Core Insights - The recent launch of the 2026 version of the Huiminbao products emphasizes "upgraded protection" and "comprehensive enhancement," with unchanged premiums but higher coverage and lower claims thresholds [1][2] - Huiminbao, a city-customized commercial health insurance, has evolved over ten years to become a crucial part of China's multi-tiered medical security system, shifting from price competition to value competition [1][3] Product Features - The 2026 version of Huiminbao products focuses on expanding special drug coverage, including CAR-T therapy and rare disease medications, significantly enhancing their appeal to consumers [2][3] - The coverage range is extending to chronic disease management and health management services, with examples like dental services and health assessments included in the Anhui Huiminbao 2026 version [3] - Premiums remain stable while coverage limits are increasing, such as the Beijing Puhui Health Insurance maintaining a premium of 195 yuan per person per year while raising the total coverage to 3.5 million yuan [3] Pricing Strategy - Differentiated pricing is becoming a mainstream trend in new Huiminbao products, allowing for tailored premiums based on age and health status [4][5] - This approach enhances the attractiveness of Huiminbao to healthier populations and supports sustainable development by avoiding the pitfalls of uniform pricing [5][6] Market Dynamics - The transformation of Huiminbao reflects a balance between inclusivity and sustainability, with significant participation rates and increasing renewal rates indicating a positive trend [8] - The long-term positioning of Huiminbao is seen as a middle layer in the multi-tiered insurance system, complementing basic medical insurance and commercial health insurance [8] Future Directions - Future Huiminbao products are expected to evolve towards precision, ecological integration, and technological advancement, relying more on data for product design and enhancing service efficiency [9] - Recommendations for Huiminbao include maintaining its inclusive positioning, continuous innovation in products and services, and leveraging insurance technology to improve actuarial and risk management capabilities [9]

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]