Tongling Social Security Center of Anhui Province actively docked with the municipal medical insurance center, and set up a "joint office" service comprehensive window for matters involving different departments such as insurance registration and social insurance relationship transfer, so as to facilitate the people to handle different matters of social security and medical insurance. The picture shows the citizens consulting about medical insurance and social security in the lobby of Tongling Municipal Service Center.
Photo by Pan Wei (People’s Picture)
At the end of April this year, Shanghai customized commercial supplementary medical insurance "Huhuibao" jointly underwritten by nine insurance companies was officially launched.
Photo by Wang Chu (people’s picture)
Hainan Supervision Bureau of China Banking and Insurance Regulatory Commission, China and Hainan Provincial Medical Security Bureau launched an innovative health insurance product "Huiqiongbao" in Hainan, and participants of basic medical insurance in Hainan Province can apply for insurance online.
Wang Qizuo (Xinhua News Agency)
No age, no household registration, no occupation, and insufficient annual premium. 200 yuan … … Recently, the "Beijing Pratt & Whitney Health Insurance" jointly designed and developed by five insurance companies, namely China People’s Insurance Company, China Life Insurance Company, Taikang Insurance Company, China Pacific Insurance Company and China Ping An Company, has attracted wide attention since its launch. The data shows that in just over ten days from July 26th to August 9th, the number of participants has exceeded one million.
Since last year, a number of similar supplementary medical insurance products have been launched all over the country, most of which are cooperated by local government departments and commercial insurance companies, such as "Jin Huibao", "Jin Huibao", "Tian Yi Yong Ning Bao" and "Hui Rong Bao", which focus on universal characteristics and attract many consumers to participate in insurance. What are the characteristics of this kind of "inclusive insurance"? How to develop customized insurance steadily?
Low threshold, high upper limit and wide range
With the development of economy and society, people’s awareness of health and risk management has been continuously improved.
Recently, Wu Yao, who works in Changji, Xinjiang, intends to continue to buy "Jinhui Insurance" for his parents who are far away from their hometown in Shanxi. "I worked in Xinjiang after graduation, almost five or six years. Being far apart, I seldom have a chance to go home for a visit in a year. What worries me most is my parents’ health. With the basic medical insurance and this supplementary insurance, you don’t have to delay the diagnosis and treatment because of the cost. The annual premium in 59 yuan is not high. " Wu Yao said.
Whether it’s "Jinhui Insurance" or "Beijing Pratt & Whitney Health Insurance", many insured people have the same idea as Wu Yao: they don’t spend much, so they are prepared. Specifically, this kind of insurance also embodies the characteristics of inclusiveness everywhere in its design.
— — The threshold for participation is low. "Pratt & Whitney Insurance" breaks through many restrictions of traditional commercial insurance, does not limit age and household registration, does not require previous health status, and the premium standard can be affordable for most people. For example, "Beijing Pratt & Whitney Health Insurance" clearly covers five categories of people with specific past diseases, such as malignant tumors, liver and kidney diseases, cardiovascular and cerebrovascular diseases and glucose and lipid metabolic diseases, and realizes "insurability and claim settlement" by increasing the deductible and reducing the proportion of compensation, without worrying about being refused insurance.
— — The upper limit of protection is high. Compared with the low premium, the maximum compensation limit of "inclusive insurance" is mostly above one million yuan. For example, "Jin Huibao" has an annual premium of 59 yuan, which can provide a maximum of 3 million yuan of supplementary medical insurance for the basic medical insurance insured in Shanxi Province; Tianjin’s "Jin Hui Bao" has an annual premium of 68 yuan, including 1 million yuan for hospitalization expenses and 1 million yuan for certain high drug expenses, with a maximum guarantee of 2 million yuan.
— — Wide coverage. For many insured people, once they get sick, whether insurance can cover more effective drugs is related to the quality of insurance products. At present, most universal insurances clearly list the reimbursable drugs in the contract. For example, in the List of Certain High-priced Drugs of Huirongbao in Sichuan, drugs such as Dacotinib Tablets for the treatment of lung cancer, Cindilizumab Injection, Vinaike pull-tab for the treatment of leukemia and Nilotinib Capsules are clearly included in the scope of protection.
According to the relevant person in charge of PICC China, "Beijing Pratt & Whitney Health Insurance" and other products are customized commercial medical insurance in cities, which are usually guided by the local government, closely linked with the basic medical insurance in various places by adopting the mode of "one city, one policy", and are one-year medical insurance products with Pratt & Whitney nature for all local insured people. At present, the number of insured products of "Beijing Pratt & Whitney Health Insurance" has exceeded 1.36 million.
"The biggest advantage of this kind of products is that they are cheap, the insurance coverage is high, and the insurance conditions are relaxed, benefiting the elderly and the sick; Its disadvantage is that the vast majority of products are one-year medical insurance, and there is no mandatory agreement to guarantee renewal. It is integrated and complementary with basic social security and traditional commercial insurance. " The person in charge said.
The guarantee effect has attracted much attention.
Are consumers willing to buy "inclusive insurance"?
"I have carefully read the terms of Beijing Pratt & Whitney Health Insurance, and I feel more humane than commercial insurance, which is a kind of welfare!" Qi Hang, who is studying in Peking University, said that his parents have taken the initiative to buy the local "Min Hui Bao" in Huai ‘an, Jiangsu Province, and they plan to buy this kind of universal insurance after graduation and social security. "It is necessary to invest in your health in advance while you are young and in good health."
However, some people are worried about the claim effect and sustainability of inclusive insurance. Li Xinxin, who is engaged in the art training industry in Chongqing, said that an insurance company had introduced "Yuhuibao" before, but he is still on the sidelines. "This kind of inclusive insurance is a new thing, and it is still uncertain about its protection effect. For example, is the claim settlement procedure troublesome? How to connect with basic medical insurance and other commercial insurance? How can insurance companies maintain their support capabilities for a long time? " Li Xinxin said.
It is worth noting that "inclusive insurance" is more popular among office workers. Take Beijing Pratt & Whitney Health Insurance as an example. According to the data released before, among the 1 million insured persons, the proportion of urban workers participating in insurance is as high as 78.37%, and the proportion of urban and rural residents participating in insurance is 20.57%. The demand for medical insurance for on-the-job personnel is more vigorous. From the age of participation, "post-70s" and "post-80s" are the main participants, accounting for 42.7%.
Zhang Ming, head of Taikang Pension Pratt & Whitney Insurance Department, told the author that up to now, Taikang Pension has carried out urban customized Pratt & Whitney insurance projects in more than 20 cities across the country, providing urban customized Pratt & Whitney insurance for more than 10 million insured persons. In the design of product liability, the high security is instigated by small premiums, and the risk of large medical expenses caused by serious and serious diseases is accurately guaranteed; In terms of risk management and control, whether it is front-end product pricing or back-end claims service, this kind of inclusive insurance needs to be closely connected with local medical insurance. "Compared with traditional commercial insurance, Pratt & Whitney insurance is a product superimposed on basic medical insurance, focusing on ‘ Pratt & Whitney ’ Two words. For example, most commercial medical insurance will require health notification, and some sick people or sub-healthy people may not meet the insurance requirements, while most patients with previous diseases of Pratt & Whitney Insurance can apply for insurance and claim compensation to achieve real popularization; Usually, the premium price of commercial medical insurance increases with age, and most inclusive insurance is the average price of young and old, and the pricing is affordable. " Zhang Ming said that with the promotion of such products, higher requirements have actually been put forward for insurance companies, which need to make more efforts in scientific pricing and refined management.
However, "inclusive insurance" is not all-inclusive, and there are still restrictions and thresholds for compensation, which consumers should treat rationally. Yu Baorong, a professor at the Research Center of Health Insurance and Health Economics in university of international business and economics, said that because of the low premium, the fund pool of the whole insurance is relatively limited. For example, the minimum deductible of Beijing Pratt & Whitney Health Insurance is 30,400 yuan, and the money under the deductible is for patients to pay. Therefore, this kind of insurance is more practical for patients with serious illness and high medical expenses.
Promote the sustainable development of inclusive insurance
It is understood that inclusive insurance was first launched in Shenzhen. In 2015, the Shenzhen Supplementary Medical Insurance Project for Serious and Extraordinary Diseases, which was first promoted by the Shenzhen Municipal Government and underwritten by Ping An Pension Insurance, began to operate, becoming the first city and project in China to pilot customized commercial medical insurance in cities. As of last year, the number of participants has reached 7.8 million, covering more than half of the basic medical insurance participants in Shenzhen, and the number of beneficiaries of claims has exceeded 100,000, which has become an important guarantee to prevent people from becoming poor and returning to poverty due to illness.
The relevant person in charge of Pratt & Whitney Insurance of Ping An Pension Insurance Co., Ltd. told the author that the original intention of Pratt & Whitney Insurance was to help the construction of local multi-level medical security system with commercial insurance and reduce the medical expenses of people with severe and special diseases. Compared with traditional commercial insurance and national social insurance, its characteristics are reflected in two aspects: first, according to the local medical insurance policy, it provides customized product protection programs to make up for the medical security gap of local residents; Second, according to the urban population structure and regional characteristics, products suitable for different cities are launched. "For example, Hainan ‘ Hui Qiongbao ’ Innovation ‘ Medical insurance+commercial insurance ’ The mechanism is of positive significance for reducing the burden of medical expenses for Hainan patients, improving the accessibility of medicines for citizens with high quality, and effectively preventing poverty due to illness and returning to poverty due to illness. "
However, while the universal insurance is popular, there are also phenomena of scrambling to lower prices and exaggerating publicity. On May 28th this year, China Banking and Insurance Regulatory Commission issued the Notice of the General Office of China Banking and Insurance Regulatory Commission, China on Regulating the Urban Customized Commercial Medical Insurance Business of Insurance Companies, requiring insurance companies to make a scientific and reasonable protection plan in accordance with the operating rules of commercial insurance and the principle of marketization; Standardize business development, improve management service efficiency and risk control ability. At the same time, the regulatory requirements were clarified, and violations such as vicious competition at low prices and false propaganda were investigated and dealt with, so as to maintain market order and ensure the smooth operation of the business.
In Baorong’s view, inclusive insurance is essentially commercial insurance, which is a product different from social insurance. Its sustainability depends on the number of participants, the level of premiums, the size of welfare packages, the scope and degree of benefits. Among them, maintaining the balance between premium income and compensation expenditure is fundamental. "At present, most of China’s inclusive health insurance products have just entered the market. Whether it is the medical insurance department, the regulatory department or the commercial insurance company, they should find their own position, clarify the boundaries and clarify their responsibilities, so that they can truly become an effective part of China’s multi-level medical security system." Yu Baorong said.
