& gt
Hainan Supervision Bureau of China Banking 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 online. Wang (Xinhua News Agency)
There are no age restrictions, no household registration restrictions, no occupational restrictions, and the annual premium is not enough for 200 yuan ... Recently, the "Beijing Pratt & Whitney Health Insurance" 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 widespread attention. The data shows that in just over ten days from July 26th to August 9th, the number of participants has exceeded 1 10,000.
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", "Jin", "Yi Tian Yongningbao" and "Rong Huibao", which focus on universal features and attract many consumers to participate in insurance. What are the characteristics of this kind of "universal insurance"? How to develop customized insurance steadily?
Low threshold, high ceiling, wide range
With the development of economy and society, people's awareness of health and risk management is constantly improving.
Recently, Wu Yao, who works in Changji, Xinjiang, intends to continue to buy "Jinhui Insurance" for his parents in his hometown in Shanxi. "I worked in Xinjiang after graduation for almost five or six years. Being far apart, it is rare to have a chance to go home once a year. What worries me most is my parents' health. With the basic medical insurance and this supplementary insurance, there is no need to delay the diagnosis and treatment because of the cost. The annual premium is not high in 59 yuan. " Wu Yao said.
Whether it is "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 Pratt & Whitney everywhere in its design.
-the threshold for participation in insurance 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 is 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 metabolism diseases, by increasing the deductible and reducing the proportion of compensation, so as to realize "insurability and compensation" without worrying about being refused insurance.
-the upper limit of protection is high. Compared with the low premium, the maximum compensation limit of "including insurance" is mostly more than one million yuan. For example, 59 yuan, the annual premium of "Jin Bao Hui", can provide up to 3 million yuan of supplementary medical insurance for the basic medical insurance in Shanxi Province; The annual premium of "Hui Jin Insurance" in Tianjin is 68 yuan, of which the hospitalization fee is 6,543.8+0,000 yuan, and some high medical expenses are 6,543.8+0,000 yuan, 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 insurance clearly lists the reimbursable drugs in the contract. For example, in the list of some high-priced drugs in Sichuan Huirongbao, drugs such as dakotinib tablets for lung cancer, sindilizumab injection for leukemia, vinacola tablets and nilotinib capsules are clearly included in the scope of protection.
According to the relevant person in charge of PICC China, "Jingpuhui Health Insurance" and other products are customized commercial medical insurance in the city, usually guided by the local government, and closely linked with the basic medical insurance in various places by adopting the mode of "one city, one policy", which is a one-year inclusive medical insurance product for all local insured persons. At present, the number of products insured by "Beijing Pratt & Whitney Health Insurance" has exceeded 1.36 million.
"The biggest advantage of this kind of products is that they are cheap, with high insurance coverage and loose insurance conditions, benefiting the elderly, the weak and the sick; Its disadvantage is that most 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. It is a kind of welfare!" Qi Hang, a student at Peking University, said that his parents had taken the initiative to buy the local "Minhui Insurance" in Huai 'an, Jiangsu Province, and planned to buy this universal insurance after graduating from social security. "It is necessary to invest in health in advance while being young and in good health."
However, some people are worried about the claims effect and sustainability of Pratt & Whitney Insurance. Li Xinxin, who is engaged in the art training industry in Chongqing, said that an insurance company had launched "Yuhuibao" before, but he is still on the sidelines. "This kind of inclusive insurance is a new thing, and its guarantee effect is still uncertain. 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 ability to support for a long time? " Li Xinxin said.
It is worth noting that "inclusive insurance" is more popular with office workers. Taking Beijing Pratt & Whitney Health Insurance as an example, previously published data showed that among 1 10,000 participants, the participation rate of urban workers was as high as 78.37%, and that of urban and rural residents was 20.57%, and the demand for medical insurance for on-the-job workers was even stronger. From the age of participation, "post-70s" and "post-80s" are the main participants, accounting for 42.7%.
Zhang Ming, the 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 1000 million insured persons. In the design of product liability, small premiums are used to incite high protection and accurately protect the risk of large medical expenses caused by serious and serious diseases; 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 linked with local medical insurance. "Compared with traditional commercial insurance, Pratt & Whitney Insurance is a product superimposed on basic medical insurance, with the focus on the word' Pratt & Whitney'. For example, most commercial medical insurance will require health notification, some sick people or sub-healthy people may not meet the insurance requirements, and most patients who have previously had inclusive insurance can apply for insurance claims, thus achieving real popularization; Under normal circumstances, the premium price of commercial medical insurance increases with age. Most inclusive insurances are the average price of Xian Yi, old and young, and the pricing is affordable. " Zhang Ming said that with the promotion of such products, higher requirements are actually put forward for insurance companies, and more efforts need to be made in scientific pricing and refined management.
However, "inclusive insurance" is not all-inclusive, and there are still restrictions and thresholds for compensation. Consumers should treat it rationally. Yu Baorong, a professor at university of international business and economics Health Insurance and Health Economics Research Center, said that due to the low premium, the entire insurance fund pool is relatively limited. For example, the minimum deductible of Beijing Pratt & Whitney Health Insurance is 30,400 yuan, and the money below 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 Pratt & Whitney Insurance was first launched in Shenzhen. In 20 15, the Shenzhen Supplementary Medical Insurance Project for Serious and Extraordinary Diseases initiated by Shenzhen Municipal Government and underwritten by Ping An Endowment 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 insured persons has reached 7.8 million, covering more than half of the insured persons of basic medical insurance in Shenzhen, and the number of people benefiting from claims has exceeded 654.38+10,000, which has become an important guarantee to prevent people from becoming poor or returning to poverty due to illness.
The relevant person in charge of Pratt & Whitney Insurance of Ping An Endowment Insurance Co., Ltd. told the author that the original intention of Pratt & Whitney Insurance is to help the construction of 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: 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; The second is to launch products suitable for different cities according to the urban population structure and regional characteristics. "For example, Hainan Huiqiongbao's innovative medical insurance+commercial insurance mechanism is of positive significance for reducing the burden of medical expenses for Hainan patients, improving the accessibility of high-quality medicines for citizens, and effectively preventing poverty from returning to poverty due to illness."
However, while 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 Commercial Medical Insurance Business of Insurance Companies in Cities, requiring insurance companies to formulate scientific and reasonable protection schemes in accordance with the business 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 to maintain market order and ensure the smooth operation of the business.
In Bao Rong's view, Pratt & Whitney insurance is essentially commercial insurance, which is a product different from social insurance. Its sustainability depends on the number of participants, the level of insurance premium, the scale of welfare plan, the scope and degree of benefit. Among them, maintaining the balance between premium income and compensation expenditure is fundamental. "At present, most inclusive health insurance products in China 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, define the boundaries and clarify their responsibilities, so as to truly become an effective part of China's multi-level medical security system. " Yu Baorong said.