Giving full play to the function of reducing the burden of commercial insurance
The commercial supplementary medical insurance in the Guiding Opinions refers to the supplementary medical insurance which is guided and supported by the government, voluntarily participated by the masses, and the insurance company undertakes the insurance liability, which is connected with the social medical insurance and faces all the basic medical insurance participants.
According to the guiding opinions, the following principles should be followed in the work of commercial supplementary medical insurance: first, wide coverage. Commercial supplementary medical insurance is for all employees and urban and rural residents. It is not allowed to set up preconditions such as age, health status, past medical history, occupation type, etc., and the premium is uncoupled from individual disease risk. Take the city divided into districts as the unit and implement the overall planning at the municipal level. Second, treatment can be linked. We should adhere to the position that commercial supplementary medical insurance is an important part of the multi-level medical security system, appropriately reflect the preferential payment for major diseases, and give full play to the function of reducing the burden of commercial insurance echelons.
Third, commercial operation. We should adhere to the principle of encouraging and promoting by the government, assuming sole responsibility for the profits and losses of enterprises, and voluntary participation by the masses. We should establish a scientific, reasonable and stable pricing mechanism, strengthen actuarial science, link the price with insurance liability, dynamically adjust premium, and appropriately introduce competition mechanism.
Scientific selection of undertaking enterprises and products
According to the guiding opinions, the undertaking enterprises and products should be selected scientifically. The municipal medical security departments, together with relevant departments, have selected 2-5 insurance companies with strong service ability and good business reputation as supporting parties, and encourage and guide insurance companies to take the form of joint insurance and co insurance.
The commercial supplementary medical insurance is carried out in cities with districts. The medical security departments of each city, together with the relevant departments and the selected insurance companies, shall jointly agree on the insurance scheme. In principle, each city shall set up an insurance scheme, and multiple optional payment grades can be set.
Strengthen guidance and support for insurance companies. The medical security departments of all cities shall, in accordance with the requirements of the provincial government general offices implementation plan on printing and distributing the Interim Measures for the opening and security management of public data in Zhejiang Province (zhzbh  No. 52) and the provincial big data Bureaus notice on printing and distributing technical specifications for security and desensitization of public data in Zhejiang Province (zhzbf  No. 5) and other documents, before ensuring information security In addition, it provides necessary data support for insurance companies to carry out product design and verification actuary, and improves the accuracy and rationality of commercial supplementary medical insurance.
The relevant departments at all levels should give full play to their respective functional advantages, help insurance companies publicize and introduce commercial supplementary medical insurance through various ways, and strive to increase the proportion of insured persons. Insurance companies should save costs, underwriting claims and other major service links should rely on their own outlets and teams to carry out operations, and continuously improve insurance services.
Diversified fund raising encourages the masses to participate in insurance. Employees who participate in the basic medical insurance are allowed to purchase commercial supplementary medical insurance by using the balance of their personal calendar accounts. Employees personal calendar accounts can purchase commercial supplementary medical insurance for their family members (spouses, children, parents) who participate in the basic medical insurance in the province.
Local governments can integrate commercial supplementary medical insurance for poverty alleviation according to the actual situation.
Employers and urban and rural collective economic organizations are encouraged to purchase commercial supplementary medical insurance for their employees and residents, and the purchase expenses shall be deducted before tax when calculating individual taxable income according to the provisions of commercial health insurance.
We will improve the convenience of commercial supplementary medical insurance for insurance and claim settlement. We should give full play to the advantages of Internet plus and improve the linkage management mode of social medical insurance and commercial supplementary medical insurance. Through the APP of the Zhejiang Li office and the commercial supplementary medical insurance, we will fully implement online insurance and palm insurance, and generate electronic certificates online.
We will comprehensively implement the 3 + n mode of medical insurance settlement, implement the one-stop settlement of compensation payment for basic medical insurance, critical illness insurance, medical assistance and commercial supplementary medical insurance, solve the problem of paying for medical expenses, settling claims and running errands, and effectively enhance the sense of gain and satisfaction of the masses.
Set up special class for commercial supplementary medical insurance
The guiding opinions emphasize the strengthening of organizational guidance. All localities should attach great importance to the work of commercial supplementary medical insurance. They should unify their thinking, improve their understanding and strengthen guidance. Relevant departments should draw up a timetable and roadmap according to their respective functions to ensure the implementation of relevant work of commercial supplementary medical insurance. The municipal medical security departments should set up special classes for commercial supplementary medical insurance together with relevant departments, strengthen organization and coordination, and study and solve relevant problems. All districts and cities shall formulate and promulgate the implementation plan in time according to the guiding opinions and local actual conditions, and implement the participation of commercial supplementary medical insurance and the collection and payment of medical insurance premium of urban and rural residents at the same time, so as to ensure the implementation of commercial supplementary medical insurance next year.
Clear division of responsibilities. Medical security departments at all levels should take the lead in policy design, insurance company selection, data and information support, and one-stop settlement; banking, insurance and supervision departments should strengthen communication and cooperation with medical security departments, supervise and manage the operation of commercial supplementary medical insurance by insurance companies, guide insurance industry associations in various regions, and assist local medical security departments in formulating insurance schemes The financial department should support the insurance subsidy for the poor; the tax department should implement the preferential tax policy of commercial supplementary medical insurance (commercial health insurance); the undertaking company of commercial supplementary medical insurance should strengthen the financial actuary, design products according to the principle of principal and low profit, strengthen publicity and expand the coverage ratio of the masses For example, we should strive to do a good job in claims service, prevent insurance risks, and improve the reputation of commercial supplementary medical insurance. Strengthen risk prevention. At the same time, the relevant functional departments should establish and improve the long-term supervision mechanism to effectively prevent the risks of information and clean government, strengthen the risk warning for the operation of insurance companies, constantly innovate the supervision concept, change the supervision mode, enrich the supervision means, and simultaneously implement the risk prevention and standardized development. Source: editor in charge of economic report in the 21st century: Zhong Qiming_ NF5619