Provide richer medical coverage and better solve the problem of difficult and expensive access to the doctor.
"Beneficial insurance" to bring tangible benefits (Financial Eye)
003010 (January 25, 2021, page 18)
Beijing Baohui, Hangzhou Citizen Insurance, Wuhan Baohui insurance? Recently, the city's customized commercial medical insurance (commonly known as "Huimin insurance") blossomed, and was favored by consumers in many places.
High security and low threshold
"Huimin insurance" mainly protects individual out-of-pocket medical expenses in the medical insurance catalog, fully reflecting the universality of the benefits.
Early in the morning, Lishui City, Zhejiang Province, Yunhe County residents Zhang Huaisheng came to the local administrative service center, in Zhejiang Bowie business window queue. "I heard that Zhejiang Bao Li annual premium is only 100 yuan, you can get a large proportion of medical expenses reimbursement protection, and not capped. Although you can insure online, but still want to come to the scene to find out." He said.
According to the staff, Zheli Insurance is a supplemental medical insurance led by the local government and underwritten by commercial insurance companies. Lishui City, urban and rural residents of basic medical insurance, regardless of age, occupation, past medical history, etc., can voluntarily participate in the insurance. The scope of coverage is mainly the medical expenses still to be borne by individuals after reimbursement by basic medical insurance and major disease insurance, including the expenses within the scope of medical insurance and those outside the scope of medical insurance in accordance with the requirements of list management. The reimbursement rate is designed to focus on patients with major diseases, in which expenses within the basic medical insurance catalog are reimbursed by basic medical insurance and major disease insurance, and expenses outside the scope of medical insurance that meet the requirements of list management are paid at a minimum of 18,000 yuan, of which 75% are under 200,000 yuan, 85% between 200,000 yuan and 500,000 yuan, 90% between 500,000 yuan and 1,000,000 yuan, and 9% of
"Take Ms. Ye, a low-income household, for example. in 2019, the cost of her treatment for non-Hodgkin's lymphoma ****counts for about 1 million yuan. After being reimbursed by basic medical insurance and major disease insurance, individuals still have to bear nearly 300,000 yuan. It is estimated that with the government's subsidy, her personal expenditure can be reduced to about 50,000 yuan, greatly reducing her personal burden." The staff said.
"The price is not high and the coverage is good. It's really cost-effective." Zhang Huaisheng said.
Similar to Bao Li in Zhejiang, most of the products of "Huimin Insurance" around the world are "one-city-one-policy" customized commercial medical insurance guided by local governments and underwritten by insurance companies. They are generally characterized by high protection, low premiums and a low threshold for enrollment, which is an important reason for their popularity among consumers.
Many commercial health insurance policies, such as reimbursement-based medical insurance and catastrophic illness insurance, also offer higher levels of coverage. Compared with these commercial health insurance policies, what are the advantages of the "beneficiary insurance"?
Mr. Jiang, a citizen of Lishui, said he had been planning to take out commercial health insurance, but because of his longstanding lung nodules, he failed to take out insurance many times. "Zheli Insurance does not make insurance restrictions on past medical history. I finally insurance success."
"Although some consumers are interested in purchasing commercial health insurance, they have no way to insure due to their advanced age and chronic illnesses. In this regard, many 'beneficiary insurance' products have greatly reduced the threshold of access, effectively solving the problem of these consumers being unable to insure, providing medical protection for more residents, and fully embodying the universality of the products." Wang Xiangnan, deputy director of the Research Center for Insurance and Economic Development of the Chinese Academy of Social Sciences, said.
"'Beneficial insurance' covers more people and is more closely linked to the basic livelihood of society, which is its most significant advantage over other commercial health insurance." Beijing Life Insurance Co., Ltd. said that the Beijing Hui Insurance, for example, the current 1,158,000 participants, people over 60 years old accounted for 29.76%, which is very good to meet the protection needs of the elderly. At the same time, the elderly premiums have not been adjusted upward, unified at 79 yuan.
Many consumers believe that the low price of "people's insurance" is also a major advantage in comparison
In addition, some "people's insurance" products also provide a wealth of additional services. For example, Beijing Jinghui Bao participants can enjoy preferential physical examination, tumor tumor screening, online graphic consultation, serious outpatient green channel, the purchase of special drugs delivery and other services, through the disease prevention, analysis, diagnosis, treatment of the whole process, to help better solve the problem of difficult to see the doctor, expensive to see the doctor.
Efficient integration of multiple resources
"Beneficiary insurance" is conducive to improving the multi-level medical insurance system and increasing the efficiency of the use of health insurance funds.
The recent executive meeting of the State Council proposed to accelerate the development of commercial health insurance. Support the development of more major disease insurance products, and do a good job of convergence with basic medical insurance. Improve the ability of urban and rural residents to protect major disease insurance.
Zhu Ming, director of Nankai University's Center for Health Economics and Medical Security Research, said, "Beneficial Insurance" as a universal supplemental health insurance can effectively reduce the burden of individual out-of-pocket medical expenses within the health insurance directory, and at the same time reduce the pressure on the payment of basic medical insurance; many "Beneficial Insurance" products also include medical insurance products, such as medical insurance products, which can be used to protect the health of the population, and also to protect the health of the population. Many "people's insurance" products also include reasonable medical expenses outside the medical insurance catalog into the scope of coverage. For example, the Shenzhen supplemental medical insurance for serious illnesses, Beijing Jinghuibao and other special drugs for lung cancer, breast cancer, leukemia and other diseases, the reimbursement rate is higher, is to improve the effective supplement to the medical insurance system.
In addition, in some places, "beneficiary insurance" has realized the efficient integration and utilization of various resources, making it more convenient for residents to participate in insurance. Take the Shenzhen Critical Illness Supplementary Medical Insurance, the first "people's insurance" product launched in China in 2015, as an example. Local basic medical insurance participants can participate in the insurance through personal expenses or group insurance. As for the balance of the individual account of the health insurance eligible employee status participants, you can also use the health insurance account to pay for insurance, can be said to "not spend a penny".
Zhu Minglai believes that, for some cities with a young population structure and a large health insurance fund balance, revitalizing the basic health insurance fund balance and improving the insurance treatment of the insured is an effective measure.
Gan Weimin, chairman of Ping An Pension Insurance Co, said the number of people taking part in critical illness supplemental medical insurance in Shenzhen has been increasing every year since 2015. Last year, the number of people participating in the supplementary medical insurance reached 7.8 million, covering more than 60 percent of the number of people participating in basic medical insurance in Shenzhen. The cumulative number of claims exceeded 100,000, with the highest claim amount of 1.15 million yuan for a single person.
"The city's customized commercial medical insurance fully pools the resources of all parties, which is conducive to further improving the multi-level medical insurance system and better protecting patients' access to medical care." Gan said.
Experts believe that "benefiting the people's insurance" can not only improve the level of medical insurance, but also help expand housing.
People's consumption. "From international experience, improve the level of protection is conducive to reducing the worries of residents, to enhance the willingness to consume, enhance the ability to consume has a better leverage. This is also the reason why some local governments actively support the development of 'Huimin Insurance'." Wang Xiangnan said.
Both to applaud more to applaud
Provide diversified services, standardize marketing propaganda, so that consumers are clearly insured
"Beneficial insurance" for consumers to provide a richer choice of medical insurance, but at the same time, due to the product threshold is low, some of the product marketing propaganda in the presence of misleading behavior, may infringe on the legitimate rights and interests of consumers; some products marketing propaganda, there are misleading behavior, may infringe on the legitimate rights and interests of consumers; some of the products marketing propaganda in the presence of misleading behavior. However, at the same time, due to the low threshold of the products, there are misleading behaviors in the marketing and publicity of some products, which may infringe on the legitimate rights and interests of consumers. In this regard, experts suggest that the "people's insurance" product design should be further optimized to promote its standardization and healthy development, both to be more popular.
-Providing diversified health services to enhance the attractiveness of the product and the participation rate.
Experts have pointed out that due to the low threshold of Huimin insurance products, people with high risk of illness tend to have a stronger willingness to insure, the risk of adverse selection is high, and they may face greater pressure to pay out in the future, which makes it difficult to continue to operate in a sound manner. In this regard, the experts suggest that the "Huimin insurance" can provide diversified services to enhance the attractiveness of the product, and thus increase the participation rate, reduce the risk of product management.
"For example, it can provide health management services such as medical checkups and major disease screenings to increase the rights and interests of the insured and user stickiness, so as to increase the participation rate and premium income. At the same time, this is also conducive to help participants better understand the physical condition, early detection of disease risk, early response, both add customer health protection, but also reduce the cost of potential claims." Zhu Ming said.
Zhu Minglai, from the experience of Shenzhen, the deep involvement of the relevant departments is an important reason for the high number of participants. Local governments can provide appropriate incentives, data support, and participation in product design for underwriting companies to better support the development of "Huimin Insurance" according to the actual situation.
--Standardize marketing and promotional behavior to ensure that consumers are clearly insured.
Consumers have reported that they were attracted by the high coverage and low premiums when they purchased the "Huimin Insurance" products, only to find out that the product was designed with a certain deductible, and that if the annual medical expenses were not high, the product would not come in handy; and that some of the promises made were due to be renewed, and then discontinued after a short period of time.
"Some of the customized medical insurance policies are also falsely advertised in the name of the government. In this regard, the local banking and insurance regulators will focus on investigation and handling." The head of the Banking and Insurance Regulatory Commission (BIRC) said.
--Strengthening sustainable operation ability and preventing malicious price competition.
"Huimin insurance" products rapid development at the same time, but also appeared to fight price wars and other phenomena. In this regard, the CBIRC requires that the design, development and management of customized medical insurance products should strictly comply with the regulatory system and be based on the necessary historical data, combined with local characteristics, reasonably estimate the size of the number of participants, do a good job of measuring premiums and rates, and scientifically determine the price.
"Insurance companies should conduct reasonable risk assessment and clear analysis and judgment of customized medical insurance business, strengthen professional capacity building, use technology to effectively control unreasonable expenses, enhance operation and management capabilities, improve management service efficiency, and enhance risk control capabilities." The relevant person in charge of the CBI said.
Related Q&A: what are the pre-existing conditions of medical insurance NantongLegal analysis: medical insurance Nantong pre-existing conditions can be insured. The general beneficiary of medical insurance is the past with several diseases, does not affect the insurance, but the subsequent occurrence of insurance liability is not compensated. This all diseases can be compensated, even if the insured before suffering from cancer, the subsequent occurrence of related costs, can also be compensated, does not affect the responsibility of the insurance. It just means that the payout ratio has changed.
Specific allocation changes are shown in no pre-existing conditions before enrollment, deducted in accordance with 70% of the proportion of compensation, medical insurance in / out of the cost, rare diseases, out-of-hospital specific tumors are 1 million can be compensated; pre-existing conditions before enrollment, deducted in accordance with the proportion of 50% of the compensation (out-of-hospital hospitalization costs and out-of-hospital specific tumors medicines).
Legal basis: The Social Insurance Law of the People's Republic of China
Article 2: The State establishes a social insurance system for basic pension insurance, basic medical insurance, industrial injury insurance, unemployment insurance, maternity insurance and other social insurance, and guarantees the right of citizens to obtain material assistance from the State and society in accordance with the law in the event of old age, sickness, industrial injury, unemployment and maternity.
Article 26 The standards of treatment for basic medical insurance for employees, new rural cooperative medical care and basic medical insurance for urban residents shall be implemented in accordance with the provisions of the State.
Article 28 Medical expenses that conform to the basic medical insurance drug catalog, diagnostic and therapeutic items, standards of medical service facilities, as well as those for emergency and rescue shall be paid from the basic medical insurance fund in accordance with the state regulations.