The 10th anniversary of the operation of the major illness insurance, the innovation of the National Life Insurance Seeking the disease is expensive, helping the "healthy China"

With the advancement of the "Healthy China" strategy, my country is gradually building a multi -level medical security system with basic medical security as the main body, medical assistance as the bottom, other forms of insurance protection and commercial health insurance. In September 2021, the General Office of the State Council issued the "Fourteenth Five -Year Plan" National Medical Security Plan, which further clarified the positioning of basic medical insurance "insurance basic", encouraged the development of commercial health insurance products that connect with commercial insurance institutions to develop and basic medical insurance. More Good coverage of basic medical insurance fees that are not paid.

As a state -owned controlling financial insurance company, China Life Insurance Co., Ltd. (hereinafter referred to as "China Life Shou Shou Casualty Company") has been actively integrated into the national situation with the opportunity to undertake the opportunity to undertake urban and rural residents' serious illness insurance. The station promotes the development of health insurance business. Ten years of sharpening, in the process of gradually improving and improving the medical security system, Chinese Life Insurance Corporation has continuously created and improved the demand for the increasing demand for national health medical care services by improving the commercial health insurance security service system.

Based on insurance professional advantages, improve the multi -level social security system

In order to improve the level of people's medical security and reduce the burden of medical treatment, my country has built the top -level design of the "multi -level medical security system", including the "main layer" composed of basic medical insurance, the "bottom layer" composed of medical assistance, and commercial health insurance The "supplementary layer" composed of a variety of guarantees, such as a variety of guarantees, etc., commercial health insurance is an indispensable part of the national medical security system.

In this context, China Life and Life Insurance Company focuses on the pain and difficulties in the field of people's livelihood security, actively connect with the medical insurance system, continuously undertake policy health insurance business such as major illness insurance, supplementary medical insurance, and long -term care insurance. Commercial health insurance business, support the construction of a national multi -level medical security system.

The road of major illness insurance opened up the road of political and business cooperation. In 2012, six ministries and commissions such as the National Development and Reform Commission jointly issued the "Guiding Opinions on Carrying out the Insurance Work of Urban and Rural Residents' Disease Insurance", which clearly put forward the prelude to the establishment of a major illness insurance system and unveiled the implementation of the pilot of major illness insurance. As one of the earliest insurance companies that participated in the implementation of the National Disease Insurance System, China Life Insurance Company supports the promotion of people's livelihood projects in accordance with the principle of "active participation, professional services, independent accounting, and openness and transparency". Medical assistance "multiple guarantees.

In 2012, Qinghai Province took the lead in launching the work of urban and rural residents' serious illness insurance nationwide. As one of the insurance companies, China Life and Life Insurance Company provided nearly 2.3 million urban and rural residents such as Hainan, Huangnan, Guoluo and Xining. , Create a "one -stop" and "integrated" service model. In 2018, China Life and Life Insurance Jinhua Branch hosted the Jinhua Disease Insurance Project as the main contractor. The project cooperated with the local government to implement the "selection and payment premium law" major disease insurance system covering the entire population, unified system, unified treatment, and coordinated policy. The first, the medical insurance governance model of "government guidance, public participation, and social collaboration" was realized. As of the end of June 2022, China Life Insurance Corporation has hosted more than 200 major illness insurance projects across the country, covering nearly 350 million urban and rural residents. Since 2012, it has paid more than 79 million people with a total of more than 79 million yuan and compensated by more than 150 billion yuan.

Supplementary medical insurance builds a multi -medical security system. As a supplementary and extension of basic medical insurance and major illness insurance, supplementary medical insurance is an important part of the multi -level medical security system. Since 2019, in order to solve the actual problems of personal burden, poverty due to illness, poverty, and poverty due to illness, and poverty due to illness, the Zhuhai Municipal Government who have suffered from major illnesses due to large medical expenses and self -funded drugs. Innovate cooperation, jointly launch the "great love" project, encouraged and guided by the government, voluntarily purchased by the insured, and can use medical insurance personal accounts (family support) or cash insured. With the launch of the project, Zhuhai City took the lead in building a five -medical security system for "basic medical insurance + major illness insurance + medical assistance + additional supplementary medical insurance + charity donation", which created the government -led or guidance, basic medical insurance, commercial insurance, commercial insurance New model of social governance with charity donation. As of the end of June 2022, China Life Insurance Corporation has hosted more than 170 supplementary medical insurance projects in 26 provinces (autonomous regions, municipalities), covering more than 58 million people.

Basic medical insurance extension of inclusive health insurance. China Life Insurance Company actively connects the "one city, one strategy" of the local governments "one city, one policy" Huimin version of the medical security needs, and uses the principle of compliance operations, adopts an innovative model of government -business integration, and complementary advantages. Criminal medical expenses. Taking Hangzhou's "West Lake Yilian Insurance" as an example, the project is hosted by the Chinese Life and Life Insurance Hangzhou Branch as the main contractor, focusing on guaranteeing the cost of self -funded drugs, diagnosis and treatment items, malignant tumors, and critical innovative drugs outside the basic medical insurance directory. Some of the rare patients focus on resolving the risk of people's poverty due to illness and returning to poverty due to illness. After the "West Lake Yilian Insurance" was launched in 2021, the number of insureds exceeded 300,000 on the first day, the number of insureds exceeded 1 million in 3 days, and 4.7 million participants in 2021, with an insured rate of 42%. As of the end of June 2022, the urban customized commercial medical insurance of China Life Insurance Company has landed in 21 provinces (autonomous regions, municipalities) in total, with a total of nearly 70 projects, and the number of underwriters in the project exceeds 18 million. Long -term nursing insurance opens a innovative protection field. Establishing a long -term nursing insurance system is an important deployment to actively respond to the aging of the population and improve the social security system. In 2016, the Ministry of Human Resources and Social Affairs issued the "Guiding Opinions on the Pilot of Long -term Nursing Insurance System" and organized a pilot of long -term nursing insurance system. The Chinese Life Insurance Corporation aims to create a long -term care insurance support service system based on corporate resources, relying on corporate resources. Taking the Chengdu project as an example, the full process and grid management of the innovation and practice nursing service of China Life and Life Insurance Company, create a "three real" benchmark for "real, simple and solid", and formulate more than 10 full all of "Guidelines for Hometown Management" The process management specifications are established, and more than 50 professional service teams are established. As of the end of June 2022, China Life Insurance Corporation has hosted more than 60 long -term care insurance projects in 17 provinces (autonomous regions, municipalities), covering nearly 26 million people.

Commercial health insurance helps weaving a multi -guarantee network. The country attaches great importance to the connection and supplementary role of commercial health insurance and social security. China Life Insurance Corporation has resolutely implemented a series of policies for the development of commercial health insurance, returning to insurance protection, promoting the reform of the supply of health insurance products, and increasing product supply. Relying on the professional business advantages of human danger, a health insurance product system has been established, including "national life blessings", "enjoyment of blessing", "Kangning" and "Kangyue" series of product systems for personal customers. Customers' serious illness insurance, long -term care insurance, supplementary medical insurance, family planning insurance, aging insurance, small insurance, employee welfare and other product systems. In response to the preferential tax policy of health insurance, China Life and Life Insurance Company has developed personal tax preferential health insurance products to meet the needs of taxation people's health guarantee. From 2018 to 2021, China Life and Life Insurance Corporation continued to enrich the company's health insurance product system in accordance with customer diversified and differentiated health guarantee needs, and developed more than a hundred types of health insurance products.

China Life Insurance Company has continuously improved the level of health insurance business operation and services, forming a relatively mature product development and underwriting claims risk control system. The service teams of relevant professional background personnel such as information, risk control, etc., the level of intelligence and professional service has been continuously improved.

The scale of health insurance premiums in China Life Insurance Company has increased from more than 42 billion yuan in 2015 at the end of the "Twelfth Five -Year Plan" to more than 120 billion yuan in 2021, with a compound annual increase of more than 19%.

Science and technology empowerment professional operations, expand the scope of management service areas

Driven by the dual promotion of policies and markets, the transformation from "health insurance products" to "health insurance products+health management services" has become the key to leverage the development of the insurance industry from quantitative change to qualitative change. As an important leader of health insurance, insurance companies have strived to develop the core capabilities of their health management services, coordinate the cooperation of various related parties, and guide the joint consumer -centric health service system.

In the process, as the head enterprise in the life insurance industry, China Life and Life Insurance Company continued to strengthen scientific and technological innovation capabilities under the overall strategic layout of China Life Group's "big health", and promoted the "line of national life big health" platform The construction of a health service system for interconnection and interconnection. According to reports, as of the end of June 2022, the "National Life Health" platform has been connected to provide more than 100 health service projects.

While continuously exploring the innovation of the "Insurance Protection+Health Service" model, China Life and Life Insurance Corporation is also committed to the standardization and standardization of medical insurance public services, and cooperates with the reform of the supervision and payment methods of medical insurance funds.

The first is to carry out "one -stop" settlement. In order to solve the problem of "spending money to see a doctor, reimbursement of leg breaking", the Chinese Life Insurance Company will build a comprehensive settlement platform for political and business integration with the information system of basic medical insurance and medical institutions, and innovate the "one -stop" settlement service The model has improved the cosmetic settlement experience of the participating people.

The second is to build a "four -in -one" medical risk management and control system for "intelligent review+institutional inspection+case survey+expert meeting." Over the years, China Life and Life Insurance Corporation has helped medical insurance to continuously improve the management level and use efficiency of medical insurance through participation in medical expenses.

The third is to participate in the reform of DRG and DIP medical insurance payment methods. Since its first participation in the management of the New Rural Cooperative Office in 2003, the China Life and Life Insurance Company has gradually expanded from participating in the basic medical insurance office to medical assistance, poverty alleviation and prevention, poverty alleviation, and DRG/DIP. As of the end of June 2022, China Life Insurance Corporation has run more than 300 health guarantee commissioned management projects. Taking the reform of the DIP payment method of Liaoning Yingkou as an example, the entire process of China Life and Life Insurance Company participated in the provision of fund actuarial, sick payment standards, settlement process renovation, and system platform construction. The local medical insurance department's strengthening of medical expenses assessment has prompted medical institutions to be more inclined to accept and treat patients with difficulties and critical illness. Since the pilot of the reform, the medical insurance hospitalization rate of Yingkou has decreased significantly. Tri life development positioning, boost high -quality development of health insurance

In recent years, as the population aging has accelerated, the people's medical and health demand has become increasingly strong, and commercial health insurance has undoubtedly can make a difference in national strategies such as "healthy China".

However, in recent years, despite the strong support of the government, the active layout of the enterprise, the gradually strengthening the masses' concepts, and the increasingly diverse product form, the protection borne by commercial health insurance is still very limited in the proportion of total medical expenses in China.

As a large state -owned insurance institution, the Chinese Life Life Insurance Corporation takes the mission of "protecting the health of the people and enhancing the well -being of the people's livelihood", actively connects the government's needs, adheres to the principle of combining economic benefits and social value, and promotes the high -quality development of health insurance.

The first is to deeply excavate the market segment and be a guardian of health risks. For the phenomenon of "health insurance health care and non -bid", "non -guaranteed directory in the guarantee", "short -term non -guaranteed long -term", etc. , China Life Insurance Company has developed market segmented market products, paying attention to the construction of core capabilities such as accurate customer acquisition. For example, for health insurance products for specific diseases and special groups such as elderly, children, and maternals; exclusive insurance products for new industries and new business practitioners; cover high -end medical insurance products such as innovative drugs, special -demand medical expenses, overseas medical expenses, etc., Meet the full range of health protection needs of enterprises and personal families.

The second is to improve professional management capabilities and serve medical insurance reforms. At present, insurance companies generally lack the core capabilities of deep integration with the medical service system, refined risk control, and accurately capturing the needs of customers. Strengthening political and business cooperation is undoubtedly an inevitable choice for insurance companies to achieve health insurance operations. China Life Insurance Corporation will continue to improve the professional management capabilities of health insurance, strengthen the core capabilities of health insurance, continue to actively participate in various types of medical insurance services, form in -depth cooperation with the government, and extensively participate in social governance.

The third is to provide all -cycle health services to be promoters of people's health. At this stage, commercial health insurance mainly plays a single role of "payer". Most medical compensation resources are concentrated in the treatment link, and the full health journey coverage of pre -prevention and post -after -management has not been achieved. At the same time, medical insurance settlement is often more passive, and low participation in the formulation and implementation of medical service solutions. Throughout the mature insurance markets such as Europe and the United States, the positioning and roles of health insurance companies have gradually changed from the "passive claims" medical service payment party to health partners of "full -process health management". In order to get rid of the dilemma of limited value creation and insufficient ecological impact, Chinese Life Insurance Company will change from the traditional "single payment party" to the role of "full process management service". Explore health management services for customers' full life cycle.

Looking back on the past 10 years, China Life and Life Insurance Co., Ltd. has given full play to the advantages of the Internet, customers, brands, and comprehensive financial advantages formed by many years, and further transforms the advantages of resources into new kinetic energy and new results in serving the real economy, forming the industry's "head geese" effect Essence

In the next 10 years, it is an important period for my country to promote the construction of "healthy China", and it is also a critical period for deepening the reform of the medical security system and comprehensively building a multi -level medical security system. Under the leadership of the China Life Insurance Company, under the leadership of the China Life Group's "Great Health" strategy, it will give full play to professional advantages, system advantages, outlet advantages, and team advantages, to improve the efficiency of social security system operation, and further give full play to the economic "shock absorber" of insurance economy And the "stabilizer" function of the society, fully serve the construction of the social security system. ⑦

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