In order to attract more people to join supplementary insurance and improve the efficiency of personal accounts for medical insurance, Shenzhen, Foshan, Suzhou and other places support the purchase of personal account balance through medical insurance when carrying out the Huimin insurance. But whether the local policy can be sustained remains to be issued by the official document of the personal account reform of the state health insurance bureau.
Prior to that, the guidance on establishing and improving the outpatient mutual aid security mechanism of employees basic medical insurance (Draft) published by the state medical insurance bureau did not include the purchase of commercial insurance by personal account into the scope that can be used, nor included in the scope that can not be used. The industrys understanding of this can be divided into two types: one is that no prohibition means leaving space; the other is that after the introduction of the next medical insurance treatment list, all the medical insurance funds including personal accounts will be used for basic medical insurance, and the newly added personal account funds can no longer be used to purchase commercial insurance products.
Huimin insurance swept across the country
One of the typical cases is that on October 15, Beijing launched a special inclusive medical insurance, Beijing Huibao. The basic medical insurance personnel in Beijing can receive the highest 2 million yuan insurance guarantee and 18 health services at a unified price of 79 yuan per year, and they are not limited to age, occupation, registered residence and health status. Compared with the millions of medical products sold on the market, the insurance is free from physical examination and illness can also be insured.
The welfare insurance launched by all localities reflects the characteristics of high quality and low price. The price is around 100 yuan, and in some places it is only 40 or 50 yuan. The insured amount is about one million yuan, and the reimbursement rate is also very high, basically more than 70%. Of course, Huimin insurance is not all advantages. Due to the high deductible based on the social security catalog, some people in the industry have estimated that the medical expenses of patients should reach more than 50000, even 80000, in order to reach the minimum payment line of Huimin insurance and trigger compensation.
Compared with commercial insurance, Huimin insurance is also very loose in health notification. Huirong insurance in Sichuan clearly states that medical expenses of past diseases can be compensated without health notification; Beijing Huibao in Beijing stipulates that patients can be insured, but the expenses caused by past diseases and complications of five major diseases such as tumor are not compensated.
Zhu Minglai said that although the list of essential medicines for medical insurance has been adjusted in the past two or three years, a large number of the latest drugs have been included in the medical insurance through negotiation, but there are still two problems. One is that although some drugs are included, they can not be fully reimbursed, and some can only be used in the hospital but not in the outpatient department; second, some drugs with good curative effect have not been negotiated in the negotiation process and become hospitals External medicine, in order to reduce the burden of patients, need to have a supplementary nature of insurance to make up for this deficiency, so the basic medical insurance has a demand for the benefit of the people insurance, which is why the local government is willing to support the Huimin insurance.
With the endorsement of the local government, Huimin insurance has more credibility than the million million medical insurance launched by insurance companies.
Zhu Minglai believes that as a voluntary insurance, the ultimate success of Huimin insurance depends on the number of insured people. The basic medical insurance is participated by all the people. As a supplementary insurance, the Huimin insurance should be full participation, or the coverage rate should be kept at 70% ~ 80%. Only when there are many people can the risks be effectively dispersed and the operation can be guaranteed at such a low price. In case of serious adverse selection, high risk will occur People buy, low-risk do not buy, then it is difficult to maintain in the future.
In the reply to the policy question and answer of Beijing Huibao on whether the price will rise next year, it is mentioned that the project of Beijing Huibao will strive for sustainable and steady development. Next year, the insurance policy and rate will be considered according to the operation and service conditions of this years project, but the premium of this year will not be adjusted for individuals.
The problem now is that this kind of insurance is not compulsory. In some areas, the coverage rate is only 10%, which leads to great potential risks. How to effectively attract more people to participate in the insurance, and how to improve the insurance rate are the problems that must be solved by the Huimin insurance Zhu Ming said.
Can medical insurance individual account pay the bill
Some of the 40 or 50 cities that have introduced the policy of Huimin insurance have proposed to allow the individual account of medical insurance to purchase the insurance.
Feng Pengcheng, deputy general manager of the health insurance division of Taikang Endowment Insurance Co., Ltd., told reporters from the first finance and economics department that Shenzhen, Foshan, Suzhou, Lianyungang and other places also support the purchase of individual account balance when carrying out urban universal health insurance. Through the guidance and support of the government, it is conducive to expand the masses awareness of commercial insurance, improve the awareness of insurance, expand the coverage of insurance, not only greatly reduce the sales cost, improve the security efficiency, but also conducive to the establishment of a multi-level medical security system.
In addition, the individual insurance account with the insured amount of more than 3000 yuan can be used to purchase individual health insurance account in Suzhou. Foshans Pingan Buddha medical insurance stipulates that medical insurance card account can be used to pay.
According to incomplete statistics, Zhejiang Province (11 cities), Shandong Province (16 cities), Fujian Province (9 cities), Yunnan Province (16 cities), Shanghai City, Chongqing City, Jiangsu Province, Suzhou, Yangzhou, Nantong, Changzhou, Wuxi, Shenzhen, Zhongshan, Huizhou, Liaoning Province, Shenyang, Dalian, Fushun, Liaoyang, Panjin, Benxi, Anhui Province, Changsha, Hunan Province, and Guangxi Province, respectively Nanning, Shaanxi Yanan and other 13 provinces and cities have issued documents in succession. Through the selection of shortlisted commercial insurance institutions, the selection of health insurance products, the innovative practice of encouraging employees to purchase commercial health insurance with the balance of individual accounts, a small amount of premium can leverage large amount of security, realize risk pooling among social members, enlarge the security efficiency of the fund, and improve the level of medical compensation.
Zhu Minglai believes that if individual accounts are allowed to purchase Huimin insurance, it should be a good guide. From the experience of local practice in the past two years, no big problems have been found. The policy should be to actively encourage them. It is true that commercial insurance is not mentioned in the personal account reform plan of the National Health Insurance Bureau, but it is also not included in the scope of prohibition. This has become a vacuum zone, and I personally feel that the policy has left space..
At the end of August, the State Medical Insurance Bureau issued the guiding opinions on establishing and improving the outpatient mutual aid security mechanism of employees basic medical insurance (Draft for comments), which proposed that the personal account should be mainly used to pay the self paid expenses of insured employees within the policy scope of designated medical institutions or designated retail pharmacies, and clearly stipulated that individual accounts should not be used for public health expenses Other expenditures that are not covered by the basic medical insurance, such as consumption, sports fitness or health care, are not mentioned in commercial insurance.
During the consultation period, Feng Pengcheng submitted relevant feedback to the National Health Insurance Bureau on the role that commercial insurance should play in the reform of individual medical insurance accounts. He proposed that allowing targeted purchase of commercial health insurance with designated personal accounts not only respected individual selectivity, but also expanded the health protection of the insured person and his family. In the future, whether the individual account of medical insurance can pay for the commercial supplementary medical insurance, including Huimin insurance, remains to be determined by the official documents of outpatient co-ordination and individual account reform. However, some authoritative people in the industry have told the first finance and economics that the current 9% of the medical insurance fee can no longer be increased. The medical insurance fund should be mainly used for basic insurance, not for commercial insurance. Now, the local government has issued the document of purchasing commercial insurance with personal account. However, after the list of medical insurance benefits is issued, it is very likely that the local government will not be able to issue such a policy. Extended reading of EF education response: foreign teachers involved in making pornographic videos of young girls: the iPhone 12 has been terminated and its first day of sale has not decreased. There is a price increase of 1500 yuan to collect the first chip University of Nanjing integrated circuit University. Source: No.1 Financial Editor: Chen Hequn_ NB12679
During the consultation period, Feng Pengcheng submitted relevant feedback to the National Health Insurance Bureau on the role that commercial insurance should play in the reform of individual medical insurance accounts. He proposed that allowing targeted purchase of commercial health insurance with designated personal accounts not only respected individual selectivity, but also expanded the health protection of the insured person and his family.
In the future, whether the individual account of medical insurance can pay for the commercial supplementary medical insurance, including Huimin insurance, remains to be determined by the official documents of outpatient co-ordination and individual account reform. However, some authoritative people in the industry have told the first finance and economics that the current 9% of the medical insurance fee can no longer be increased. The medical insurance fund should be mainly used for basic insurance, not for commercial insurance. Now, the local government has issued the document of purchasing commercial insurance with personal account. However, after the list of medical insurance benefits is issued, it is very likely that the local government will not be able to issue such a policy.