"Two people in my family were hospitalized, and both had Huiminbao, but not a penny was reimbursed."

When asked whether he would renew Huiminbao, netizen A answered like this. The subtext is: not renewing.

It seems to be a very common thing to buy Huiminbao but not get protection. Behind this, it may also be Huiminbao's helpless move.

The nature of universal benefits has led to its extremely wide audience, but in order to avoid losses, Huiminbao has to set a relatively high deductible. In the past, the deductible of some products exceeded 20,000 yuan.

However, most of the 20,000 yuan paid out of pocket in addition to medical insurance reimbursement is for major diseases. This also makes Huiminbao look more like major disease insurance, which has little to do with the market's perception of "benefiting the people".

Of course, there are also Huiminbao with higher compensation rates, but they have fallen into a dilemma of losses, and are in a dilemma: it is difficult to raise prices significantly, but the rights and interests may need to continue to increase.

How to find a balance is still a question that Huiminbao, which has been in existence for 10 years, needs to answer.

▍Provide secondary protection

As a policy insurance for medical insurance participants, Huiminbao is positioned to provide secondary protection after basic medical insurance, and to exist in an intermediate form between traditional social insurance and commercial insurance.

The reason why it became popular quickly at the beginning of its launch is due to four core elements.

First, the insurance threshold is low. General commercial health insurance has different degrees of restrictions on the insured, such as the maximum insured age is 80 years old, and insurance with illness is not allowed. Huiminbao has basically no requirements for the insured age, occupation and health status, so it attracts more groups to participate.

Second, the participation threshold is low and the premium is relatively low. According to the "Research on the Development Model of Huiminbao" released by the China Health Information and Health Medical Big Data Society, about 78% of the products use a uniform rate, and the average premium of such products is only about 77 yuan. Most products are priced between 41 and 80 yuan, and only 11% of the products are priced over 100 yuan.

The per capita price of "million medical insurance" exceeds 500 yuan, and the higher the age, the higher the price. Therefore, "Huiminbao" is more inclusive.

Third, the total insured amount is high. The insured amount of Huiminbao can usually reach 1-3 million yuan, which is close to the insured amount level of some million medical products. At the same time, in addition to routine hospitalization and outpatient special medical responsibilities, most Huiminbao products also provide special medicine cost protection. According to the "Research on the Development Model of "Huiminbao"" released by the China Health Information and Health Medical Big Data Society, nearly 78% of Huiminbao products provide special medicine protection.

Fourth, the government has a high degree of participation. Unlike traditional commercial health insurance, some Huiminbao products are guided or even led by the government, and have close relations with relevant departments such as the local medical insurance bureau, the banking and insurance regulatory bureau, the health and health commission, and the financial bureau.

This factor also makes Huiminbao have a significant KPI indicator drive in the early stage of promotion. For example, employees of insurance companies and other companies all have the task of "attracting new customers", so fission was quickly achieved in the early stage.

However, in the actual operation process, how Huiminbao can "benefit the people" seems to have become a challenge.

▍Ideal and reality

If Huiminbao wants to continue to operate, the core is to balance universal benefits and profitability, with the purpose of capital preservation and small profits, and the compensation rate needs to be maintained at an appropriate level, but this is only an ideal state.

The reality is that if you start from the perspective of product design, you will find that Huiminbao is prone to fall into the dilemma of "death spiral". The core reason is that it does not have too many restrictions on the elderly and those with illnesses. This also leads to the need to increase the "deductible" as much as possible:

In 2021, about 83% of Huiminbao products have a deductible of 20,000 yuan.

But too high a deductible can easily make healthy groups feel uninvolved. You know, paying 20,000 yuan out of pocket outside of medical insurance often means a serious disease. And this is a minority of cases after all.

It is for this reason that most insured people may be unable to pay for the purchase of Huiminbao, and their participation is low. According to estimates, the current compensation rate of Huiminbao in most parts of my country is less than 50%, which is somewhat inconsistent with the original intention of benefiting the people.

Too low a compensation rate will significantly reduce people's enthusiasm for insurance participation and aggravate the problem of adverse selection. For example, the first-year compensation rate of "Zhuhai Love Without Borders" was only 37.3%, and the number of participants decreased significantly in the second year.

If the compensation rate is too high, it is easy to fall into a loss. From the actual situation, a considerable number of Huiminbao have also appeared in a state of not making ends meet.

The core measure of this part of Huiminbao is price increase. According to statistics, the average premium of Huiminbao products in 2021 is 101 yuan, an increase of 44% from 70 yuan in 2020. In 2022, the average price of Huiminbao has reached 123 yuan, of which products above 100 yuan account for 41%.

However, price increases will also discourage a considerable number of groups. Especially after the price increase, the cost performance will be lacking. A Chongqing netizen said, "Huimin Yukuaibao costs 169/year, while I only pay 200/year for Alipay Million Medical Insurance, but the protection is much better than Yukuaibao."

The subtext is, why should I choose Huiminbao?

Due to the particularity of the population, whether it is Huiminbao with an excessively high compensation rate or Huiminbao with an excessively low compensation rate, it is currently in a relatively embarrassing situation.

▍How to find a balance

For Huiminbao, how to find a balance is a difficult problem. From the perspective of exploration, the core is to start from the following three ideas.

First, expand the protection outside the medical insurance catalog. From the perspective of Huiminbao's responsibility design in 2020, it is generally based on "medical responsibility within medical insurance + special drug responsibility", and since 2021, Huiminbao products in many regions have begun to transform into "medical responsibility within medical insurance + medical responsibility outside medical insurance + special drug responsibility" or "medical responsibility outside medical insurance + special drug responsibility".

Second, continue to expand the number of special drugs. Huiminbao's special medicine liability is mainly for special medicines for treating specific diseases (usually malignant tumors, etc.), and the scope of special medicines is defined in the form of a white list. The scope of special medicines for some products also includes overseas innovative drugs that are not listed in China. In recent years, the scope of Huiminbao's product liability has expanded, and increasing the number of special medicines is the most common iteration direction.

Taking Hainan Province's "Lecheng Special Medicine Insurance" as an example, the number of special medicines it covers has expanded from 70 in 2020 to 100 in 2021, among which the number of overseas innovative drugs has increased significantly, and the range of diseases covered has also increased from 35 to 42. At the same time, for people with previous diseases, compensation is allowed at a rate of 30%.

Third, it is to reduce the deductible. This trend of change was evident in 2021-2022. According to Hunan University's "Huiminbao Product Research Blue Book 2022", in 2021, about 83% of Huiminbao products had a deductible of 20,000 yuan, and in 2022, this proportion dropped to 50%, and the proportion of Huiminbao products with a deductible of 15,000 yuan increased from 8% to 20%.

This trend has continued to the present. According to statistics, in 2024, the deductibles of 43.04% of products were adjusted, of which 97% reduced the deductibles.

In other words, the iterative logic of Huiminbao is to increase the scope of protection on the one hand and to increase the sense of gain of the insured group on the other hand.

However, in reality, this is still a big challenge. After all, Huiminbao has not yet achieved a reversal of the insurance participation rate. In short, the total pool is getting smaller; and in the case of limited price increases, increasing benefits may face a substantial increase in the compensation rate, and if you are not careful, you will still fall into a "death spiral" cycle.

Huiminbao has been around for 10 years since its inception in 2015. Although this is not a short period of time, exploration in various places still needs to continue.

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