国家金融监督管理总局数据显示，2024年，我国健康险保费规模已逼近万亿大关，基本接近有10亿人参 加的居民基本医保的总体筹资水平，增长速度也逆转了前三年放缓的趋势。但当前，最需要保障的市场 ——带病人群，仍然被系统性地排除在外。 近年来，以百万医疗险为代表的健康险产品不约而同地放宽既往症限制，甚至"免健康告知"的产品也不 在少数。在董佳所经手的客户中，带病体或者为父母配置健康险的客户大致占八成，而这些客户从投保 到理赔，心情往往犹如"过山车"——投保前"挑花眼"，核保时却仍可能被拒之门外，即便投保成功，还 面临"可保不可赔""不承诺续保"等风险。 健康险保费规模近万亿，带病人群为何"可保难赔"丨"病有所保"大调研 作者：吴斯旻 "产品数量过多还是过少？"从事商业健康保险(下称"健康险")销售4年后，董佳日益受到这一问题的困 扰。 艾社康近期发布的一份关于多层次医疗保障研报也显示，中国近4亿人属于带病人群，他们贡献了约 60%的医疗支出，但其贡献的商保保费占比仅为5%左右。这一背景下，创新药械企业发现，商保"放 量"的空间似乎仍然窄小。 上述情况正倒逼健康险行业转型。"近期，金融监管部门号召健康险公司做了几次行 ...

Core Insights - The insurance industry in China has shown stable growth in premium income and claims payout in the first half of the year, with total premium income reaching 3.74 trillion yuan, a year-on-year increase of 5.3%, and claims payout amounting to 1.35 trillion yuan, up 9.41% [2] Group 1: Claims Data and Health Risks - The most claimed insurance type by China Life Insurance was medical insurance, with 2.26 million claims and a payout of 3.467 billion yuan, where respiratory diseases, bodily injuries, and digestive system diseases accounted for 52.69% of the claims [2] - The most claimed insurance type by China Pacific Life Insurance was critical illness insurance, with 1.947 million claims and a payout of 9.92 billion yuan, where the highest claims were for malignant tumors, minor strokes, and acute myocardial infarctions [3] - Chronic diseases significantly contribute to medical expenses, with the top five chronic diseases being coronary artery disease, hypertension, hyperlipidemia, thyroid nodules, and chronic gastritis [3] Group 2: Technological Advancements in Claims Processing - Insurance companies are leveraging technology to enhance claims processing efficiency, with Ping An Life introducing an intelligent review engine that can process 93% of claims within 60 seconds [6] - Xinhua Insurance has implemented a direct connection service for seamless claims processing, covering 12 provinces and serving approximately 993 clients with a payout of 3.09 million yuan [7] - The insurance industry has activated emergency claims procedures in response to major disasters, with Tai Ping Life initiating 65 emergency plans in the first half of the year [7] Group 3: Evolving Insurance Landscape - Advances in medical diagnostics and treatment are reshaping the insurance landscape, particularly in life and health insurance, with early diagnosis leading to better treatment outcomes and a shift in risk assessment [8] - The Munich Re report indicates that while cancer remains a leading cause of death claims, the mortality rate has improved significantly over the past few decades, suggesting a need for insurance companies to adapt their policies accordingly [9] - The complexity of critical illness insurance products is increasing, necessitating continuous updates in medical knowledge for insurance professionals to effectively manage claims [9]

Core Insights - The article discusses the importance of health insurance for fathers, especially with the upcoming Father's Day and expectations of interest rate cuts in the market [1] - It emphasizes that different age groups of men have varying risks and insurance needs, suggesting tailored insurance configurations based on age and health status [2][4] Group 1: Insurance Configuration by Age - For men under 30, the priority should be on accident insurance, followed by medical insurance and critical illness insurance, as they face high risks of accidents and diseases [3] - Men aged 30 to 45 should focus on critical illness and medical insurance, with an emphasis on increasing coverage to manage high medical costs, while also considering term life insurance [3] - For men aged 45 to 60, medical insurance and cancer insurance should be prioritized due to increased health risks, with additional coverage for critical illness and life insurance based on individual circumstances [3] Group 2: Life Insurance Recommendations - The article suggests that family breadwinners should consider life insurance coverage that equals family debts plus 5 to 10 years of living expenses, minus existing savings [3] - Term life insurance is recommended for those with lower income and higher insurance needs, while whole life insurance is suitable for those who can afford higher premiums and have estate planning needs [4] - It is advised that insurance premiums should not exceed 10% to 20% of the family's annual income, and early investment in insurance is encouraged to avoid higher premiums with age [4]

Summary of Conference Call Notes Company and Industry Overview - **Company**: New Mile Group and Love Insurance - **Industry**: Healthcare and Insurance Key Points and Arguments Love Insurance's Strategic Initiatives - Love Insurance collaborates with New Mile Group to explore managed healthcare, focusing on disease screening, hospitalization, and chronic disease management, addressing the payment challenges posed by an aging population [2][5] - The company adheres to an "ecological development strategy" integrating medical care, health, and insurance, achieving total assets of 45.2 billion yuan, ranking 44th among 92 life insurance companies in China, and has been profitable for two consecutive years with a solvency ratio of 188% [2][6] - Managed healthcare aims to integrate resources, enhance efficiency, and reduce costs, improving patient experience and health outcomes [2][7] Market Dynamics and Opportunities - The healthcare insurance market in China is still in its early stages, with a low market share and high product homogeneity, presenting opportunities in niche markets and combining health services with insurance [4][19] - The demand for high-quality original drugs and imported consumables is increasing, with commercial health insurance currently accounting for only 4% to 6.77% of the market, indicating a potential growth space of 20% [2][11] Policy and Regulatory Environment - The 2025 National Medical Insurance Work Conference encourages the differentiated development of commercial insurance and the development of long-term care insurance [12][13] - The relaxation of DRG (Diagnosis-Related Group) and DIP (Disease-Related Payment) policies creates favorable conditions for the development of commercial insurance [14] Managed Healthcare Model and Applications - Love Insurance's managed healthcare model has successfully implemented in pilot hospitals, with 4,288 members generating premium income of 260.56 million yuan and hospital revenue of 16.46 million yuan [4][21] - The model is applied in four scenarios: health check-ups, specialized disease management, hospitalization, and services for new citizens [22][23] Challenges and Future Outlook - The health insurance market faces challenges such as low patient willingness to pay out-of-pocket and the need for hospitals to adapt to new service models [30][31] - The future focus includes increasing the proportion of health insurance products to at least 50% of overall business, with specific premium income targets set for 2025 [36][37] Collaboration and Integration - Love Insurance and New Mile Group aim for deep integration through shared strategic goals, operational systems, and incentive mechanisms, with a focus on achieving explosive growth and becoming an industry innovation model [66][67] Additional Important Insights - The integration of managed healthcare with commercial insurance is seen as a way to address the challenges posed by the current medical insurance system in China, particularly in light of rising out-of-pocket expenses for consumers [59] - The collaboration between Love Insurance and New Mile Group is positioned as a model for future healthcare and insurance integration, leveraging each other's strengths to enhance service delivery and market reach [65][67]

Group 1: Strategic Overview - New Mile Health Group has transitioned from a single medical focus to a comprehensive health industry model, integrating medical care, elderly care, pharmaceuticals, and insurance [3] - The company identifies "medical + insurance" as a key solution to address the challenges of an aging population, particularly in terms of medical capacity and payment ability [3][4] Group 2: Market Opportunities - Policy support, such as the Sanming medical reform and emphasis on commercial insurance collaboration, has created new growth opportunities for managed healthcare [5] - Increased public health awareness and the need for differentiated health management services are driving demand for managed healthcare solutions [5] Group 3: Collaboration with Aixin Life - Aixin Life's strategic partnership with New Mile Health Group aims to leverage the latter's extensive hospital management experience to overcome industry barriers [3][4] - The collaboration focuses on integrating medical resources with insurance capabilities, enhancing customer acquisition and retention through tailored insurance products [6][7] Group 4: Business Performance - As of now, New Mile Health has nearly 5,000 members, generating approximately 3 million yuan in premium income and 17 million yuan in hospital revenue [5] - The conversion rate for insurance clients at New Mile's hospitals is 50%, significantly higher than traditional sales channels, with customer satisfaction exceeding 95% [11] Group 5: Future Outlook - The company plans to expand its managed healthcare model to include a broader demographic, focusing on both healthy and chronic patients [14] - Emphasis will be placed on preventive care, screening, and rehabilitation, moving beyond traditional treatment models to create a comprehensive health management ecosystem [14]