Financial Services Association, April 23 (Reporter Xia Shuyuan) On April 23, the 2024 Shanghai Urban Customized Commercial Supplementary Medical Insurance - Shanghai Huiai Insurance application window officially opened. As of 12:00 noon on the 23rd, the insurance application window had only been open for 2 hours. The number of insured persons had already surpassed one million, 6 hours earlier than the same period last year, and the enthusiasm of Shanghai residents to enroll in insurance was high.

According to reports, the 2024 edition of Shanghai Insurance achieved “one expansion, one advantage, and one increase” on the basis of continuing inclusive properties such as broad coverage and low threshold, but the premium was still 129 yuan. In terms of insured persons, all participants in basic health insurance in Shanghai can enroll in insurance. At the same time, it supports the purchase of personal health insurance account balances. Insured persons can use their personal account balances over the years to enroll in insurance for up to 6 immediate family members (parents, spouses, children).

It is worth noting how the product design and coverage of the 2024 Shanghai Huibao edition have been iteratively upgraded. Who exactly is such a policy guarantee product suitable for, and how far can it go in the future? With these questions in mind, the Financial Services Association looked into it.

The 2024 edition of Shanghai Insurance is iterative and upgraded: the guarantee liability is extended, one excellent, one increase, and the premium is still 129 yuan

In 2024, the premium of Shanghai Huihui Insurance will remain the same. It is still 129 yuan/year, but the guarantee liability has been upgraded. Compared with the 2023 version, the five major guarantee responsibilities of the 2024 Shanghai Insurance Insurance have achieved “one expansion, one excellent, and one increase”.

As soon as it expands, the cost of in-patient self-funded treatment is extended. On the basis of guaranteeing self-funded medicines, consumables, and tests, treatment costs are included in the scope of coverage to further reduce the burden on patients.

The first advantage is deductible optimization. The basic deductible amount was reduced from 16,000 yuan/year in 2023 to 12,000 yuan/year. Customers who have been insured for 2 consecutive years can enjoy a deductible of 11,000 yuan/year, and customers who have been insured for 3 consecutive years and have no claims can enjoy a deductible of 10,000 yuan/year, lowering the claim threshold.

One increase means increasing the variety of specialty drugs at home and abroad. Domestic specific high-value drugs were expanded from 36 to 41 last year, overseas specialty drugs were expanded from 15 to 28 last year, and the number of CAR-T treatment drugs increased from 2 to 3 last year, covering high-incidence diseases among Shanghai residents and expanding the number of beneficiaries.

In addition to upgrading security responsibilities, in 2024, Shanghai HuiInsurance empowers the service model with scientific and technological innovation to further improve the convenience of claims processing and enhance the sense of acquisition for insured persons.

The first is to reduce the financial pressure on patients facing treatment for major illnesses and create a high-speed claims service experience. The 2024 edition of Shanghai Huibao launched the Proton Heavy Ion Hospital Direct Claim Service to solve the pressure on patients to advance funds, up to 300,000 yuan/year/person.

Second, with the collaborative support of the Shanghai Big Data Center and the Shanghai Medical Insurance Center, blockchain technology was applied to upgrade the active claims service. Insured persons can “enjoy it without a claim” after authorizing the launch of the service. After being discharged from the hospital, they can automatically receive compensation without applying without applying if they meet the specific inpatient self-funded medical expenses insurance claim conditions.

Third, two new exclusive health benefits have been added. Insured participants enjoy discounts at their own expense when purchasing drugs at designated offline pharmacies in Shanghai (covering 16 administrative districts in the city, over 2000+ pharmacies) and designated online shopping malls. At the same time, they also enjoy online graphic consultation services from specialists from the top three hospitals to meet customers' daily medical treatment and nighttime service needs.

It is worth mentioning that with the guidance of insurance enrolment policies, the number of people covered by the Shanghai Insurance Plan has been expanded. In 2024, under the guidance of the government, Shanghai Insurance will continue the previous group order form, steadily expand the number of insured enterprises, and continue to promote the level of health protection for new groups of citizens.

According to reports, from now until 24:00 on June 30, participants in Shanghai basic medical insurance (including employee health insurance and residents' health insurance) can apply for insurance through various channels such as Shanghai Huibao's official WeChat account, application, Shanghai Insurance Code, Alipay, and Tencent Microinsurance. The coverage period is from July 1, 2024 to June 30, 2025.

Shanghai Huibao has been in operation for 3 years: more than 20 million people have applied for insurance, and the compensation amount has exceeded 1.6 billion yuan

Since 2020 blossomed and ushered in the first year of real products, Huimin Insurance has gradually expanded horizontally to iterated vertically. Along with the steady expansion of the “basic market”, the market is also gradually shifting from explosive growth to steady progress.

According to reports, Shanghai Insurance is underwritten by the chief insurance company of China Taibao Life Insurance and is jointly underwritten by eight insurance companies: China Life Insurance, Xinhua Life Insurance, Ping An Health, Taiping Financial Insurance, Jianxin Life, BOC Life, and ICBC AXA.

In the past 3 years, based on the principle of “government guidance, commercial operation, and benefit the people”, Shanghai Insurance has accumulated more than 20 million insured people, making it the largest insurance program in the country.

According to Long Ge, deputy director of the Innovation and Risk Management Research Center at the University of Foreign Economics and Trade, since the launch of the Shanghai Huibao Insurance in 2021, the participation rate has stabilized at over 30%. By the 3rd year, more than 4 million insured persons had been insured for 3 consecutive years, and over 7.5 million had been insured for 2 years.

In addition, the structure of the number of people enrolled in Shanghai Insurance for 3 years is generally stable. Individual accounts account for nearly 80% of payments, the average age of insurance is around 48, and over 80% of insured persons apply for insurance for their families.

By the end of March 2024, Shanghai Insurance had completed more than 650,000 cases over 3 years, and the cumulative amount of compensation exceeded 1.6 billion yuan, benefiting hundreds of thousands of families. The maximum beneficiary was 104 years old, the youngest beneficiary was only 3 months old, and the maximum cumulative compensation amount for 3 years for a single person was 2,436 million yuan, effectively reducing the burden of medical expenses for insured persons.

At the same time, the application rate of electronic claims diagnosis and treatment data reached 75%, and the average settlement time was only 2.3 days, effectively improving the customer service experience and providing timely and effective assistance to all types of patients.

Longge said that at present, people's recognition of Huimin Insurance has gradually changed from “icing on the cake” to “blessing in the snow.” Judging from industry exchanges, the total premiums of Shanghai HuiInsurance in the past 3 years have been 2.5 billion yuan, and the compensation amount has exceeded 1.6 billion yuan. The 3-year payout rate is expected to be around 75%, and the operating entities as a whole have shown a marginal profit in capital protection. Furthermore, since there is still room for premium increases, the continuity of its products can be guaranteed.

At the same time, Longge suggested that in addition to the iterative upgrading of the product guarantee plan, the proposal was to increase publicity and promotion efforts for new groups of citizens, increase government subsidies, and deduct the portion not exceeding the 5% standard of employees' wages for enterprises purchasing supplementary medical insurance, such as welfare insurance, according to regulations.