Who can pay for the welfare insurance of RMB 79 and RMB 2 million sweeping across the country?

category:Finance
 Who can pay for the welfare insurance of RMB 79 and RMB 2 million sweeping across the country?


In order to attract more people to join the supplementary insurance and improve the use efficiency of the personal account of medical insurance, Shenzhen, Foshan, Suzhou and other places also support purchasing through the balance of the personal account of medical insurance when carrying out the Huimin insurance. However, whether the local version of the policy can be sustained or not remains to be seen in the official document of the reform of the personal account of the National Medical Insurance Bureau.

Previously, the guidance on establishing and perfecting the outpatient medical insurance system for employees (Draft for advice) published by the state health insurance bureau did not include the purchase of commercial insurance for individual accounts in the scope of use or the scope of non-use. There are two understandings in the industry, one is that there is no prohibition, which means that there is room for it; the other is that after the next step of the medical treatment list, the medical insurance fund including individual account will be used for basic medical insurance, and the new personal account funds can no longer be used for purchasing commercial insurance products.

Huimin insurance swept across the country

The prototype of Huimin insurance is the first supplementary medical insurance for serious and serious diseases launched by Shenzhen Municipal Government in 2015, which is undertaken by Ping an endowment insurance group company. Since then, many cities and insurance companies have successively launched similar projects. Since this year, more and more cities and insurance companies have joined the ranks of Huimin insurance. According to the data, the number of insured persons of Huimin insurance is more than 20 million, and the accumulated premium is more than 1 billion yuan.

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.

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.

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.

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.