Many cities have customized and launched inclusive commercial medical insurance——
Is "inclusive insurance" worth buying?
Wang Junling Li Xiaoshu
"People's Daily Overseas Edition" (11th edition on August 31, 2021)
No age limit, no household registration, no occupation, and annual premiums less than 200 yuan... Recently, the "Beijing Pratt & Whitney" was jointly designed and developed by five insurance companies: People’s Insurance, China Life, Taikang Insurance, China Pacific Insurance, and Ping An of China. "Health Insurance" has received widespread attention as soon as it was launched.
Data shows that the number of people participating in the insurance has exceeded 1 million in just over ten days from July 26 to August 9.
Since last year, a number of similar supplementary medical insurance products have been launched across the country, mostly by local government departments and commercial insurance companies, such as "Jinhuibao", "Jinhuibao", "Tianyiyongning Insurance", and "Huirongbao". And so on, the main inclusive feature has attracted many consumers to participate in insurance.
What are the characteristics of this type of "inclusive insurance"?
How can customized insurance develop steadily?
Low threshold, high ceiling, wide range
With the development of economy and society, people's health awareness and risk management awareness have been continuously improved.
Recently, Wu Yao, who works in Changji, Xinjiang, intends to continue to buy "Jinhuibao" for his parents who are far away in Shanxi.
"After I graduated, I worked in Xinjiang for almost five or six years. It is far away, and I rarely have the opportunity to go home a year. What I worry about most is the health of my parents. With basic medical insurance, plus this supplementary insurance , There is no need to delay diagnosis and treatment due to the cost. The annual premium of 59 yuan, the threshold is not high." Wu Yao said.
Whether it is "Jinhui Insurance" or "Beijing Inclusive Health Insurance", many insured people have similar ideas to Wu Yao: they don't spend a lot of money, and they are prepared.
Specifically, this type of insurance also embodies the characteristics of inclusiveness in its design.
-Low barriers to participation.
"Inclusive insurance" breaks through many restrictions of traditional commercial insurance. It does not limit the age of household registration, does not require previous health conditions, and the premium standard can be affordable for most people.
For example, the "Beijing Inclusive Health Insurance" clearly covers the five types of specific pre-existing patients, including malignant tumors, liver and kidney diseases, cardiovascular and cerebrovascular diseases, and glucose and lipid metabolism. "Insured and claimable", don’t worry about being denied insurance.
——The upper limit of guarantee is high.
Compared with low premiums, the maximum compensation ceiling of "inclusive insurance" is mostly above one million yuan.
For example, "Jinhuibao" has an annual premium of 59 yuan, which can provide up to 3 million yuan of supplementary medical insurance protection for Shanxi Province basic medical insurance participants; Tianjin's "Jinhuibao" has an annual premium of 68 yuan, including hospitalization medical expenses. Including 1 million yuan of protection and 1 million yuan of specific high-cost medicines, the maximum protection can reach 2 million yuan.
——Wide coverage.
For many insured persons, whether or not insurance can cover more effective drugs in the event of an illness is related to the "fineness" of the insurance product.
At present, most inclusive insurances clearly list the reimbursable drugs in the contract.
For example, Sichuan’s "Hui Rongbao Specific High-Volume Drug List" clearly defines the "dacitinib tablets" and "sintilimab injection" for the treatment of lung cancer, Drugs such as "Ni capsule" are included in the coverage.
According to the relevant person in charge of PICC, products such as "Beijing Inclusive Health Insurance" are urban customized commercial medical insurance, usually under the guidance of the local government, adopting the model of "one city, one policy" to closely link with basic medical insurance in various regions, and open to all local residents. The insured population is a one-year medical insurance product with inclusive nature.
At present, the number of people insured by the "Beijing Inclusive Health Insurance" product has exceeded 1.36 million.
"The biggest advantage of this type of product is that it is cheap, high insured amount, and relaxed insurance conditions, benefiting the elderly and people with illnesses; its disadvantage is that the vast majority of the products are one-year medical insurance, and there is no mandatory agreement to guarantee renewal. It has a mutually integrated and complementary relationship with basic social insurance and traditional commercial insurance." The person in charge said.
Guarantee effect attracts much attention
For "inclusive insurance", are consumers willing to buy it?
"I read the terms of Beijing Inclusive Health Insurance carefully, and I feel that it is more humane than commercial insurance, and it is a kind of benefit!" Qi Hang, who studied at Peking University, said that his parents had already taken the initiative to purchase the local area in Huai'an, Jiangsu. After graduation and participating in social insurance, he also intends to purchase such inclusive insurance.
"It is necessary to invest in your health in advance while you are young and in good health."
However, there are also concerns about the effectiveness and sustainability of inclusive insurance.
Li Xinxin, who works 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 unclear how effective the protection is. For example, is the claim procedure troublesome? How to connect with basic medical insurance and other commercial insurance? How can insurance companies maintain protection capabilities for a long time?" Li Xinxin said.
It is worth noting that "inclusive insurance" is more popular among office workers.
Taking Beijing Inclusive Health Insurance as an example, previously released data showed that among the 1 million insured persons, the proportion of urban employees was as high as 78.37%, and the proportion of urban and rural residents was 20.57%. The demand for medical insurance for employees is even stronger.
In terms of the age of participation, the "post-70s" and "post-80s" are the main force participating in the insurance, accounting for 42.7%.
Zhang Ming, head of Taikang Pension Inclusive Insurance Department, told the author that as of now, Taikang Pension has launched customized urban inclusive insurance projects in more than 20 cities across the country, and has provided urban customized inclusive insurance for more than tens of millions of insured persons. .
In terms of product liability design, small premiums are used to leverage high protection to accurately protect the risks of large medical expenses caused by major diseases; in terms of risk control, whether it is front-end product pricing or back-end claims services, this type of Inclusive insurance needs to be closely integrated with local medical insurance.
"Compared to traditional commercial insurance, inclusive insurance is a product superimposed on basic medical insurance, focusing on the word'inclusive'. For example, most commercial medical insurance requires health notification, and some people who are sick Or sub-healthy people may not meet the insurance requirements, and most inclusive insurance patients with past illnesses can be insured and claimable to achieve real universality; usually, the premium price of commercial medical insurance increases with age, and most inclusive insurance is the average price of young and old , The price is affordable.” Zhang Ming said that with the promotion of such products, in fact higher requirements have been placed on insurance companies, requiring insurance companies to make more efforts in scientific pricing and refined management.
However, "inclusive insurance" does not cover the whole world, and there are still restrictions and thresholds for compensation, and consumers must treat this rationally.
Yu Baorong, a professor at the Health Insurance and Health Economics Research Center of the University of International Business and Economics, said that because of the low premiums, the entire insurance fund pool is relatively limited.
For example, the minimum deductible of Beijing Puhui Health Insurance is 30,400 yuan, and the money under the deductible must be paid by the patient.
Therefore, this type of insurance is more practical for patients suffering from serious illness and high medical expenses.
Promote the sustainable development of inclusive insurance
It is understood that inclusive insurance was first introduced in Shenzhen.
In 2015, the Shenzhen Supplementary Medical Insurance Project for Major and Critical Diseases, which was first promoted by the Shenzhen Municipal Government and underwritten by Ping An Annuity Insurance, began operation, becoming the first city and project of customized commercial medical insurance in a pilot city nationwide.
As of last year, the number of insured persons has reached 7.8 million, covering more than half of the basic medical insurance insured persons in Shenzhen, and the number of beneficiaries of claims has exceeded 100,000. This has become an important guarantee for preventing people from becoming poverty due to illness and returning to poverty due to illness.
The relevant person in charge of inclusive insurance of Ping An Pension Co., Ltd. told the author that the original intention of inclusive insurance was to help the construction of a local multi-level medical security system with commercial insurance and reduce the medical expenses of people with serious diseases.
Compared with traditional commercial insurance and national social insurance, its characteristics are reflected in two aspects: one is to provide customized product protection schemes in accordance with local medical insurance policies to make up for the gap in medical insurance for local residents; Features, launch products suitable for different cities.
"For example, Hainan's'Huiqiongbao' innovative'medical insurance + commercial insurance' mechanism is of positive significance for reducing the burden of medical expenses for Hainan patients, improving the availability of medicines for citizens with high quality, and effectively preventing poverty caused by illness from returning to poverty. ."
However, while inclusive insurance has gained popularity, there have also been competitions to lower prices and exaggerate publicity.
On May 28 this year, the China Banking and Insurance Regulatory Commission issued the "Notice of the General Office of the China Banking and Insurance Regulatory Commission on Regulating the Urban Customized Commercial Medical Insurance Business of Insurance Companies", requiring insurance companies to formulate scientific and reasonable protection plans in accordance with the laws of commercial insurance operations and market principles; Standardize business development, improve management service efficiency and risk control capabilities.
At the same time, the regulatory requirements have been clarified, and violations such as low-price vicious competition and false propaganda will be investigated and dealt with to maintain market order and ensure the smooth operation of business.
In Baorong’s view, inclusive insurance is essentially commercial insurance, a product different from social insurance. Its sustainability depends on the number of people insured, the level of premiums, the size of the benefit package, the scope of benefits, and the level of benefits.
Among them, maintaining a balance between premium income and compensation expenditure is fundamental.
"At present, most of my country'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 positioning, clarify the boundaries, and clarify their responsibilities, so that they can truly become my country's multi-level medical insurance. An effective part of the security system." Yu Baorong said.