Since its official release on July 26, Beijing's customized commercial supplementary medical insurance "Beijing Universal Health Insurance" has handed over a full-month report card.
On August 26, the "Beijing Universal Health Insurance" project team held a mid-term conference on insurance participation, announcing that the number of insured people has exceeded 1.4 million, and on the occasion of the full moon on the line, it will take a convenient "hard core" measure to officially open a special passbook fund payment channel for medical insurance personal accounts, realize one-stop claim settlement within medical insurance, let more Beijing medical insurance participants join and enjoy this guarantee, and enhance the family's ability to resist the risk of medical expenditure.
The representative of the "Beijing Universal Health Insurance" co-insurance body also answered questions that the public was more concerned about, such as the setting of the deductible and the difference between the "Beijing Huibao" product "Beijing Huibao" and the previously launched Beijing Huimin Insurance product.
The "Beijing Universal Health Insurance" deductible is high
On July 26, "Beijing Universal Health Insurance" became a hot topic of public concern as soon as it was launched.
According to Zhang Shi, CEO of Yiduyun, the main operating platform of "Beijing Universal Health Insurance", as of 0:00 on August 25, the number of participants in "Beijing Universal Health Insurance" exceeded 1.4 million. In terms of gender, male insured persons accounted for 47.19%, and female insured people accounted for 52.81%. From the perspective of the insured age, the post-80s and post-60s have become the main force of insurance, accounting for 41.89% of the insured.
It is reported that the "Beijing Inclusive Health Insurance" is jointly guided by the Beijing Municipal Medical Security Bureau and the Beijing Municipal Local Financial Supervision and Administration Bureau, and supervised by the Beijing Supervision Bureau of the China Banking and Insurance Regulatory Commission, which is the only urban customized commercial medical insurance project in Beijing that is reported for implementation in strict accordance with the regulatory requirements, and is a useful supplement to the basic medical insurance in Beijing. Beijing basic medical insurance participants only need to pay 195 yuan a year to obtain medical insurance of up to 3 million yuan inside and outside the medical insurance directory, covering the inpatient + outpatient personal out-of-pocket expenses in the medical insurance directory, the personal self-payment costs of inpatients outside the medical insurance directory, and the high cost of 100 kinds of special drugs at home and abroad.
It is worth noting that since its launch, there have also been many controversies in the market about the "Beijing Universal Health Insurance" product. For example, some people say that the deductible of this product is high, and ordinary diseases cannot be reached at all.
The so-called deductible refers to the threshold of reimbursement of commercial insurance products.
Judging from the product introduction of "Beijing Universal Health Insurance", the liability within the medical insurance, that is, the outpatient and inpatient medical expenses within the medical insurance, the protection plan is linked with the basic medical insurance policy, and the minimum payment standard of the medical insurance for the major illness in Beijing in that year is taken as the deductible; the liability outside the medical insurance, that is, the self-paid part of the inpatient medical expenses outside the medical insurance, is deducted by 20,000 yuan (40,000 yuan for specific pre-existing patients); the special drug liability, that is, the special drug cost compensation guarantee purchased by the domestic hospital outpatient prescription and the special drug designated medical institution purchased by the designated medical institution in Hainan, the deductible is 20,000 yuan respectively.
This also means that the insured's medical expenses can only initiate claims if the insured's medical expenses exceed the above agreed amount.
At the press conference, He Xiaojing, representative of the "Beijing Universal Health Insurance" co-insurance body, said that Beijing Universal Health Insurance mainly solves the risk of family expenditure caused by high medical costs, so the setting of deductibles will not have a negative impact on the family systemic risks caused by serious illnesses and diseases. The supplementary medical insurance of the unit does not conflict with the "Beijing Universal Health Insurance", and the two are allocated at the same time, which can better solve the problem of medical cost burden. Young people should take advantage of the time of good health to apply for insurance as soon as possible, even if a specific disease occurs in the process of continuous insurance, they can still get compensation according to the standards of healthy people.
Multiple models in one city
In fact, this is not the first "Huimin Bao" product in Beijing. Previously, Beijing has also launched two other products, "Chenghuibao" and "Jinghuibao". Among them, the popularity of "JinghuiBao" with a premium of 79 yuan is relatively higher.
When a city has a variety of "Huimin Bao" products, how to choose also makes the people cry out for headaches.
Hao Lianshan, deputy general manager of the Beijing branch of China Pacific Life Insurance Co., Ltd., pointed out that from the perspective of product nature, "Beijing Universal Health Insurance" is an inclusive supplementary medical insurance product customized for Beijing medical insurance participants and closely linked to basic medical insurance, and is an important part of Beijing's multi-level medical security system.
In June this year, the China Banking and Insurance Regulatory Commission issued the Notice on Regulating the Urban Customized Commercial Medical Insurance Business of Insurance Companies, correcting the existing problems in customized supplementary medical insurance, standardizing relevant business behaviors, and improving service quality.
At that time, the relevant person in charge of the Banking and Insurance Regulatory Commission pointed out that the customized medical insurance business has a wide audience, requiring the insurance company to have a sound information system construction, to be able to connect with the medical insurance system and complete one-stop settlement, and at the same time, there are also higher requirements for offline customer consultation, claims and other service capabilities. At present, the business experience and risk control capabilities of some underwriting companies are insufficient, the service level is uneven, and the sustainable service ability is not strong.
Compared with the two products, the two are different in terms of coverage, special drug scope, reimbursement ratio, premium and other items. For example, the price of "Beijing Huibao" is 79 yuan / year / person, and the price of "Beijing Universal Health Insurance" is 195 yuan / year / person.
For these differences, Hao Lianshan explained that from the perspective of the content of the protection, "JinghuiBao" mainly protects hospitalization + 17 types of specific high-value drugs in the medical insurance catalog, while "Beijing Universal Health Insurance" also guarantees the medical responsibility of the out-of-pocket part of the medical insurance, and provides 100 kinds of special drug services, including 75 kinds of international latest drugs.
"Although the deductible of 'Jinghuibao' is lower and the reimbursement ratio is higher, due to the higher reimbursement ratio of basic medical insurance in Beijing, the gap in residents' protection for the expenses in the directory is no longer large." For residents who have not purchased commercial health insurance, 'Beijing Universal Health Insurance' can effectively make up for the pain points of their lack of coverage in terms of off-list expenses and high-value special drugs, and the lack of ability to cope with serious disease risks. Hao Lianshan said.
Hao Lianshan further said that from the perspective of the nature of benefiting the people, the "Beijing Universal Health Insurance" can also be insured and indemnified for people with pre-existing conditions, while the "Beijing Huibao" can only be insured; from the perspective of the participating entities, the "Beijing Huibao" is underwritten by two insurance companies of Beijing Life and AXA Tianping Property and Casualty Insurance, and the "Beijing Universal Health Insurance" is underwritten by five insurance companies such as Chinese Life, which has more reliable support protection in terms of claims services and institutional outlets.