Wang Xiangnan, deputy director of the insurance and economic development research center of Chinese Academy of Social Sciences, summed up four points to our reporter when talking about the development background of Huimin insurance, including that the self payment part of residents medical expenses is still very high, the phenomenon of returning to poverty due to illness and fear of getting sick is common; cities are creating their own attraction, and medical insurance is an important public service; and the Ministry of health insurance is a major public service The insurance companys million million medical insurance has developed well, but it faces the problems of high cost of customers, high compensation rate, some product design is not close to the needs of the people, and does not consider the regional differences. Huimin insurance combines the credibility of the city government, multi sector resources and commercial insurance technology to improve the level of medical insurance for urban residents.
However, the problems existing in the development process of Huimin insurance, which lacks top-level design, can not be ignored. Our reporter learned from the practice that the China Banking and Insurance Regulatory Commission recently issued the notice on standardizing the urban customized commercial medical insurance business of insurance companies (Draft for comments), which intends to comprehensively standardize the business development of Huimin insurance.
A prairie fire
The so-called universal major commercial supplementary medical insurance is a one-year health insurance product between commercial insurance, basic medical insurance and serious illness insurance. Because of the characteristics of low threshold, low premium and high insurance amount, the so-called Huimin insurance is titled as benefiting the people.
In 2015, led by the Shenzhen medical insurance bureau, Ping An pension exclusively underwrote Chinas first supplementary medical insurance for serious and serious diseases, which is the original prototype of the Huimin insurance. After five years of vigorous promotion by the Shenzhen municipal government, the insured number has reached 7.52 million, accounting for 53% of the total number of insured persons. During this period, it was also the time of the rise of millions of medical insurance. Perhaps it was because of this that there was no splash in the first few years of Huimin insurance in Shenzhen.
However, with the entry of millions of medical insurance for a long time, the market of million medical insurance is facing a reshuffle, and its heat is also cooling down. In 2020, it seems that there is no sign that Huimin insurance will replace the million medical insurance and become a competitive place. There are not only time-honored giant insurance companies, but also a large number of small and medium-sized insurance companies. Of course, there are also Internet traffic giants and emerging insurance technology enterprises. At present, more than 80 kinds of Huimin Bao products have been launched in more than 60 large and medium-sized cities, with more than 20 million insured persons.
The support of the local government is indispensable to the popularity of the people benefit protection. As far as local governments are concerned, it is undoubtedly an innovative and exploratory move to serve the peoples livelihood. It can improve the level of medical insurance benefits of citizens without additional financial expenditure.
Therefore, in Hainan, Shenzhen, Xiamen, Foshan, Zibo, Yiyang and other places, local government departments have platform for the benefit of the people. For example, the names of local governments have appeared successively in the special drug insurance of Nanle City, Xiamen Huimin insurance, Foshan Pingan Buddha medical insurance, Zibo qihuibao and Yiyang Yihui insurance in Hunan Province, and relevant leading cadres attended the conference to show their support. The highest level of support from local governments is Hainan Lecheng special drug insurance, which is covered by three companies such as Guoshou property insurance. The premium can be guaranteed by 1 million insurance amount only for 29 yuan. All the supporting units are heavyweight units, including provincial government, provincial health and Health Commission, provincial bank and insurance regulatory bureau, provincial medical insurance bureau and provincial drug administration. Meanwhile, the deputy governor also attended the speech.
Of course, not all insurance companies and Huimin insurance can obtain the support of government departments, and some Huimin insurance projects are in the naked state. Today, July 17, Changsha Medical Security Bureau issued an announcement to clarify: Recently, some people came to the bureau to inquire whether the star benefit insurance launched by Taikang pension Hunan branch is the Changsha citizens exclusive universal supplementary medical insurance guided by Changsha Medical Security Bureau, and Changsha Medical Security Bureau has not provided any business guidance for the product.
With the support of the local government, Huimin insurance has been selling very hot. Shenzhen Huimin insurance has been running for five years with a total of 7.52 million people. Beijing Huihui insurance has exceeded one million people in less than two weeks. Ningbo Yonghui insurance company has more than 400000 participants in three weeks. The astonishing rate of participation has also made insurance companies blood vessels full of blood.
At the same time, the lack of top-level design of Huimin insurance has gradually exposed related problems. For the problems existing in the development process of Huimin insurance, Wang Xiangnan summed up three points to our reporter. First, the nature of business is not clear. As a policy insurance, commercial insurance, or similar social security business is better, it is still difficult to answer. The products are very inclusive, but some have not fully evaluated the long-term sustainability of supply. Second, some business focus is not prominent enough. Some peoples welfare insurance covers a wide range of fields, but it does not highlight the contents of medical expenses outside the social security catalogue, and does not solve the problems most concerned by patients. Third, there are deviations in publicity. Some over publicize the low price, some weaken the deductible liability, and some have weak perception of insurance products, which have damaged the rights and interests of consumers. Fourth, the positioning of individual businesses is relatively high. In the process of comparison, the high level of security and the lowest possible price have exceeded the stage of economic and social development of the city.
This is true. With the continued popularity of Huimin insurance, many companies even fight a price war in order to seize the market. At present, the lowest one-year insurance price of Huimin insurance is 19 yuan. Most of the premium rates are 49 yuan, 59 yuan and 69 yuan, and the higher one is between 160 yuan and 200 yuan.
In addition, in some cities, there have been a number of Huimin insurance projects launched by different insurance companies, such as Ningbo Yonghui insurance, Gonghui insurance and citizen insurance. The first two are covered by Ping An Property Insurance and Taikang endowment insurance, while the civil insurance is jointly insured by four insurance companies, including Taiping Life insurance. The insurance coverage of the three insurance companies is 2 million yuan, but the premium of Yonghui insurance is 59 yuan. The industrial insurance and civil insurance are divided according to their ages The premium for the age less than 50 years old is 68 yuan, and the premium of 50 years old is 168 yuan. However, the premium for the age of less than 50 years old is 59 yuan, and that of over 50 years old is 139 yuan.
Another example is Xiamen Huimin insurance and luhuibao. The former is underwritten by Ping An pension, while the latter is jointly underwritten by Guoshou property insurance and other three companies. The formers premium is 70 yuan, with an amount of 2.5 million yuan, while the latter is 60 yuan with an amount of 1.5 million yuan.
Low premium, high coverage, disease insurance... As a commercial insurance company, is it really willing to do charity? In fact, it is not. Huimin insurance has set a deductible of 20000-30000, that is to say, after the reimbursement of medical insurance, deduct 20000-30000 of the self paid part first, and then the remaining part can be used for reimbursement of 70% - 80%. Overall, the total hospitalization expenses can only be used if the total hospitalization expenses are more than 50000-70000.
However, according to the statistical bulletin on the development of Chinas health and health undertakings in 2019 issued by the national health and Health Commission, the per capita hospitalization cost in 2019 is 9848.4 yuan, and the average outpatient cost of the hospital is 290.8 yuan.
It can be seen that the setting of high deductible greatly reduces the loss ratio of Huimin insurance. In Chengdu, since the Huirong insurance entered the guarantee period on July 1, according to the July claim settlement briefing of Chengdu Huirong insurance, as of August 3, 1323 claims application materials have been received, of which only 31 claims have met the claim standard. This means that more than 1200 people have bought Huimin insurance, but they cant get reimbursement.
In addition, in the publicity process of Huimin insurance, most of them only emphasize the advantages of low premium, high insurance amount and insurance with illness, but weaken the problems such as deductible liability and hidden worries.
Under the gallop, the various problems existing in the Huimin insurance have been fully observed by the regulatory authorities. Our reporter learned from the practice that recently, the personal insurance Department of the CIRC issued the notice on standardizing the urban customized commercial medical insurance business of insurance companies (Draft for Soliciting Opinions) to all the insurance bureaus, insurance companies and the China Insurance Association (hereinafter referred to as the notice).
First of all, the notice gives the official definition of urban customized commercial medical insurance. And to a certain extent, it affirms the role of Huimin insurance in improving the level of residents security. At the same time, we should adjust its operation principles, that is, insurance companies should follow the commercial insurance business rules, operate in a market-oriented way, formulate a reasonable security scheme, scientifically determine the scope of responsibility, give play to the role of market mechanism, and serve the peoples livelihood.
Specifically, the notice has made the following requirements: the security scheme should reflect the regional characteristics, meet the actual medical security needs of the insured people, encourage the inclusion of medical expenses out of the catalog into the scope of insurance, and meet the multi-level and diversified medical security needs of the insured people; the product design, development and management should strictly abide by the regulatory system, based on the necessary historical data, combined with the local characteristics, in accordance with the local characteristics We should reasonably estimate the size of the insured, calculate the premium and determine the premium rate, scientifically determine the price, and report the protection scheme to the local bancassurance regulatory department before underwriting.
However, the notice also regulates the chaos in the actual operation process. For example, in view of pricing confusion, the notice clearly investigates and punishes the behavior of participating in malicious price competition and illegally paying service charges; in view of the insufficient risk tips, the notice not only requires the insurance company to truthfully and fully inform the key information such as the guarantee period, guarantee liability, liability exemption and claim settlement process, but also clearly requires the establishment of a sound claim return visit We will also investigate and deal with the behavior of exaggerating propaganda, making false promises and misleading consumers. Once found, they will be severely punished if they lack the necessary data base, fail to use the recorded products according to the regulations or fail to report the security scheme in time, delay and cherish the compensation, use improper means to obtain or defraud the medical insurance fund, make false propaganda in the name of the government, disclose the information of the insured or use it for other purposes without authorization. Wang Xiangnan told our reporter that in the early stage of rapid development, new products and new models are generally a bit chaotic, which is due to unclear innovation constraints, optimistic participants and medium supporting measures. With the rapid development of Huimin insurance in various regions, its business form, value and risk composition are relatively clear. At this time, the release of the draft for comments is to prompt all kinds of risks, clarify the regulatory attitude, and promote the Huimin insurance to run a good and long-term good. Editor in charge: Meng Junlian editor in chief: ran Xuedong source: China Times editor in charge: Zhong Qiming_ NF5619
However, the notice also regulates the chaos in the actual operation process. For example, in view of pricing confusion, the notice clearly investigates and punishes the behavior of participating in malicious price competition and illegally paying service charges; in view of the insufficient risk tips, the notice not only requires the insurance company to truthfully and fully inform the key information such as the guarantee period, guarantee liability, liability exemption and claim settlement process, but also clearly requires the establishment of a sound claim return visit We will also investigate and deal with the behavior of exaggerating propaganda, making false promises and misleading consumers. Once found, they will be severely punished if they lack the necessary data base, fail to use the recorded products according to the regulations or fail to report the security scheme in time, delay and cherish the compensation, use improper means to obtain or defraud the medical insurance fund, make false propaganda in the name of the government, disclose the information of the insured or use it for other purposes without authorization.
Editor in charge: Meng Junlian editor in chief: ran Xuedong