Commercial health insurance has gradually become a new demand for the public
In recent years, my country's commercial health insurance has developed rapidly, with increasingly rich product categories and expanding service scope.
Health insurance products mainly include five categories: sickness insurance, medical insurance, medical accident insurance, nursing care insurance and disability income loss insurance.
Data from the China Banking and Insurance Regulatory Commission shows that in 2021, health insurance premium income is 880.36 billion yuan, a year-on-year increase of 7.7%, and compensation expenditure is 408.53 billion yuan, a year-on-year increase of 39.9%, and long-term health insurance risks of 1.3 trillion yuan have accumulated for the insured. The reserve fund has played an active role in meeting the multi-level and diversified health security needs of the people.
critical illness insurance
As early as 2012, the National Development and Reform Commission and other six departments issued the "Guiding Opinions on Carrying out Major Disease Insurance Work for Urban and Rural Residents", which clearly aimed at the situation of urban residents' medical insurance and new rural cooperative insurance (co-insurance) people's heavy burden of serious diseases. market mechanism, establish a critical illness insurance system, and reduce the critical illness burden on urban and rural residents.
In May last year, the China Banking and Insurance Regulatory Commission issued the "Administrative Measures for Insurance Company's Critical Illness Insurance Business for Urban and Rural Residents", which integrated the previously scattered regulatory systems and built a regulatory system covering the entire process and link of critical illness insurance undertaking.
In the interview, the reporter learned that various insurance institutions take advantage of their professional advantages to actively undertake critical illness insurance, give play to the role of the market mechanism, and improve the operational efficiency, service level and quality of critical illness insurance.
As one of the first companies in the industry to carry out critical illness insurance business, China Life's life insurance companies have launched more than 200 critical illness insurance projects, covering more than 350 million urban and rural residents, and accumulative indemnity of about 140 billion yuan.
Among them, in 2021, China Life's critical illness insurance business will pay more than 25 billion yuan in medical expenses for 14 million person-times, becoming an important supplement to basic medical insurance.
Bai Tao, chairman of China Life Group, said that he will continue to work hard to convert various risks faced by the economy, society and the people into insurable risks, broaden the scope of "uncertainty" management, improve risk management capabilities, and continue to innovate in the field of health insurance. Insurance products and services actively cover a wider range of people and regions, enhance economic and social resilience, and help local government departments build a denser people's livelihood security network.
In 2021, China United Property Insurance Co., Ltd. won the bid for the critical illness and critical illness supplementary insurance project for urban and rural residents in Henan Province.
China Property & Casualty Insurance Henan Branch adopts a variety of methods to facilitate the insured people to settle their claims.
The company actively communicated with the medical insurance department to clarify that the reimbursement procedures in the critical illness insurance claim settlement stage are subject to the basic medical reimbursement statement, and patients will not repeat the procedures.
In response to the situation that many patients were transferred to other hospitals for treatment and could not provide timely reimbursement information, China Property & Casualty Insurance took flexible service measures to open a green claim settlement channel for customers under the premise of compliance, and clearly put forward the requirement to complete the claim payment within 5 days.
At present, China Property & Casualty Insurance has accumulated more than 9.5 million insured people in its five underwriting areas in Henan Province, and its service outlets cover all underwriting counties (regions), effectively providing "one-stop" settlement services for insured residents.
At the press conference of the State Council Information Office earlier this year, Guo Shuqing, chairman of the China Banking and Insurance Regulatory Commission, said that serious illness insurance for urban and rural residents has covered 1.22 billion urban and rural residents.
According to the latest data from the China Banking and Insurance Regulatory Commission, the critical illness insurance has paid out more than 60 million person-times, and the proportion of critical illness reimbursement among insured people has increased by 10 to 15 percentage points.
Supplementary Medical Insurance
In recent years, with the improvement of medical level, the demand of residents for medical insurance has also increased.
The rapid development of short-term medical insurance, especially "Huimin Insurance", has enriched the commercial health insurance market and provided more supplementary medical insurance for the majority of residents.
To this end, the General Office of the China Banking and Insurance Regulatory Commission first issued the "Notice on Doing a Good Job in Customer Service for Short-term Health Insurance Business", which further clarified the description of short-term health insurance terms and customer service, and guided all insurance companies to do a good job in product conversion and customer communication. , complaint handling and other work to ensure the smooth and orderly switching of short-term health insurance business.
Subsequently, the "Notice on Regulating the Urban Customized Commercial Medical Insurance Business of Insurance Companies" was issued to encourage the insurance industry to actively participate in the construction of a multi-level medical security system and effectively play the role of the market mechanism.
During the interview, the reporter learned that the current supplementary medical insurance represented by "Huimin Insurance" has the following characteristics: First, it is rich in protection, extending from the basic medical insurance catalog to outside the medical insurance catalog and special drug cost protection; expanding from healthy people To people with pre-existing conditions, reduce the cost burden.
Second, advanced medical insurance is comprehensive, covering drugs for malignant tumors, rare diseases, and innovative treatment plans, improving the accessibility of advanced medical care.
The third is to have a wealth of health management services, whether healthy people, chronically ill people or seriously ill people can enjoy the corresponding health management services.
The fourth is to closely link the serious illness policy.
Supplementary medical insurance can be reimbursed twice after the basic medical insurance and critical illness medical insurance are reimbursed, and the protection is more adequate.
According to incomplete statistics, as of the end of 2021, more than 200 "Huiminbao" products have been launched in 27 provinces, with a total of 140 million people participating in the insurance, and the total premium income has exceeded 14 billion yuan.
As an important reinsurer of "Huimin Insurance", China Life Reinsurance Co., Ltd. undertakes the reinsurance business of nearly half of the products.
Li Qi, assistant to the general manager of China Re Life Insurance, said that China Re Life Insurance will continue to play a professional role in "Huimin Insurance", support the cause of universal medical insurance, and serve the "Healthy China" strategy.
On the one hand, through the support of risk management in the operation process, it will help the long-term stable and sustainable development of "Huiminbao".
On the other hand, if conditions permit, it will help to realize the "one-stop" settlement of basic medical insurance and "Huimin Insurance", solve the problem of "claims and errands", and improve people's sense of gain and satisfaction.
It is worth mentioning that with the gradual expansion of the coverage of commercial health insurance, insurance products targeting new citizen groups and specific groups of people are becoming more and more popular among consumers.
For example, ABC Life has 55 products on sale that support new citizens to apply for insurance and provide insurance protection services. The coverage covers accidents, serious illnesses, medical care and other types of protection responsibilities.
From 2019 to the first quarter of 2022, nearly 476,800 people were insured by ABC Life's new citizen insurance products, and the compensation amount exceeded 113 million yuan.
At the same time, ABC Life plays the role of commercial health insurance, providing new citizens and other customers with a variety of health insurance products and different insurance products including critical illness insurance, personal accident medical insurance, hospitalization medical insurance, group social insurance supplementary medical insurance, etc. The time limit and payment method support flexible choices based on security needs.
In April this year, the Beijing Cancer Prevention and Research Office released the "2021 Beijing Cancer Registration Annual Report", which showed that the age-specific incidence of malignant tumors in Beijing began to rise rapidly from the age of 20 to 24, and the incidence of females was slightly higher than that of males.
Last year, the “Huitabao”, an exclusive protection for women in Beijing, attracted the attention of the majority of female citizens as soon as it was launched.
At the end of June this year, "Hui She Bao" was upgraded to "Love She Bao" and officially launched, and the premium remained unchanged at 89 yuan per person per year. New citizens were opened to participate in the insurance, and protection responsibilities and health services were comprehensively upgraded.
"Love She Insurance" is jointly underwritten by Zhonghui Property Mutual Insurance Co., Ltd. and Beijing Life Insurance Co., Ltd., and Chenxi Health provides special medicine services.
Chen Ziquan, president of the China Maternal and Child Health Association, said that "Love She Bao" provides exclusive protection and health services for cancer, which is conducive to further improving the protection coverage and risk-taking ability of women.
Promote long-term care insurance pilot
In recent years, with the deepening of the aging degree, the declining fertility rate and the miniaturization of families have brought about shortage of caring staff, increasing cost of care, and difficulty in caring for the disabled elderly. The problem of long-term care has evolved from family responsibility in traditional society to Hot topics that are of common concern to all sectors of society.
In September 2020, the National Medical Security Administration and the Ministry of Finance issued the "Guiding Opinions on Expanding the Pilot Program of the Long-Term Care Insurance System", proposing that during the "14th Five-Year Plan" period, basically form a long-term plan that adapts to China's economic development level and aging development trend. The policy framework of the nursing insurance system is to promote the establishment and improvement of a multi-level long-term care security system that meets the diverse needs of the masses.
Judging from the situation of more than 40 cities where pilot projects have been carried out, the vast majority of national-level pilot projects and local independent pilot projects are served by commercial insurance companies, covering a total population of more than 100 million, and has provided more than 700,000 disabled elderly people. guaranteed long-term care services.
In May 2021, the General Office of the China Banking and Insurance Regulatory Commission issued the "Notice on Regulating Insurance Companies' Participation in the Pilot Services of the Long-Term Care Insurance System". , Nursing institution management and other aspects put forward clear requirements.
In 2018, long-term care insurance was piloted in Shijingshan District, Beijing.
Love Life Insurance Co., Ltd. participated in the implementation of the pilot policy throughout the process.
According to Ma Hui, the person in charge of the long-term care project of Love Life, the company has received a total of 18,398 person-times of policy consultation in Shijingshan District, accepted 2,068 person-times of applications, and paid 44.356 million yuan for nursing expenses. , a total of 2,108 people have been trained; in terms of auditing and controlling unreasonable expenditures, a total of 124 people have been audited, saving about 3 million yuan; since the expansion of the pilot, a total of 1,596 disabled elderly and their families have been provided home-based nursing guidance, and home-based nursing care The problems occurred in the nursing process of relatives (housekeeping nurses) were corrected in time; 1,119 elderly people served by designated service institutions were supervised and spot-checked for service quality; they accompanied the institutions to provide services for 300 elderly people, and timely proposed the door-to-door service of the institution. Risk points and problems in the service process.
The person in charge of the relevant departments of the China Banking and Insurance Regulatory Commission said that the commercial health insurance system will be further improved.
The first is to conduct in-depth research on expanding the scope of tax-preferred health insurance products, and make full use of the personal income tax policy for commercial health insurance.
The second is to explore the conversion mechanism between life insurance compensation liability and care payment, and encourage the development of commercial long-term care insurance.
The third is to work with relevant departments to strengthen the research on urban customized medical insurance business, strengthen tracking and retrospection, and provide a basis for further introduction of norms.
Yu Yong