Source: Zhongbao Xinzh
Since 10, domestic city-specific commercial supplementary medical insurance (hereinafter referred to as "Huiminbao") has entered its annual iteration window. Multiple regions have launched their new Huiminbao products for enrollment: Anhui Huiminbao opened pre-registration on 10/1; Shaanxi All-People Health Insurance began enrollment on 10/12; Tianjin Huiminbao started presales on 10/13; Shandong Qilu Bao went live with a new version on 10/14; and Chongqing Yu Kuai Bao will launch enrollment on 10/21.
As a benchmark project for public welfare insurance in China, Chongqing Yu Kuai Bao's operational data over its more than five years reflects the sustainability challenges commonly faced by such programs. According to publicly disclosed figures, as of 2026 and 9, Chongqing Yu Kuai Bao had accumulated over 2550 million insured person-visits, with payouts covering 424 million person-visits and a total payout amount of 27.59 billion yuan.
The project's inclusive nature creates ongoing operational pressure. In 2025, the loss ratio exceeded 100%, reaching 101.36%, with claim payments surpassing premium income and resulting in a deficit where expenses exceed revenue. Based on operational trends, the loss pressure in 2026 is expected to rise further, and the deficit may persist.
Hui Min Bao, with its zero-barrier enrollment, is inherently exposed to adverse selection. If the risk structure remains imbalanced, it can trigger a classic "death spiral": healthy individuals drop out, overall claim ratios rise, products face pressure and increase premiums, which in turn drives more healthy people away. This is the core risk that all Hui Min Bao products cannot avoid in the long term.
01
Multiple regions launch new affordable insurance programs:
Universal coverage faces direct payout pressure
To balance inclusive protection with operational sustainability, new Hui Min Bao products in Anhui, Shaanxi, Tianjin, Shandong, and Chongqing maintain low enrollment barriers—no age limits, no occupation restrictions, and no health declarations. Through refined policy terms, tiered coverage, optimized pricing, and incentive programs, these plans establish a framework to counter adverse selection and ensure manageable risk.
Anhui Huimin Bao 2027 Edition maintains its inclusive positioning for all. Premiums are set at 138 yuan for adults and 100 yuan for minors. A family enrollment discount is also offered: families with three or more members receive a 9.5-fold reduction on adult premiums, while the maximum coverage limit increases to 500 million yuan. To further reduce the financial burden on enrollees, the deductible for non-pre-existing condition coverage has been lowered to 1.7 million yuan. Special discounts apply to high-risk frontline workers such as delivery and courier riders, with deductibles reduced by 2000 yuan and reimbursement rates increased by 5%. To encourage retention of quality enrollees, a continuous enrollment incentive is introduced: users who have been enrolled for two consecutive years without filing any claims will receive an additional 5% increase in their reimbursement rate for covered services in the following year. In terms of drug coverage, the 2027 edition expands the list of covered specialty drugs to 36 types, including multiple new targeted therapies for cancer, thereby strengthening protection against serious illnesses.
Shaanxi All-People Health Insurance 2027 Edition continues the dual-tier pricing structure: Basic Plan at 89 yuan and Upgrade Plan at 169 yuan. Exclusive discounts are available for high-quality renewal members and group policyholders. For users renewing without claims or groups of 50 or more, the Upgrade Plan premium drops to as low as 136 yuan. Core highlights include upgraded coverage for innovative drugs and medical devices. The Upgrade Plan exclusively covers three premium responsibilities: 100 million yuan domestic specialty drug coverage, 50 million yuan overseas specialty drug coverage, and 50 million yuan CAR-T therapy coverage. The specialty drug list now includes innovative medications for common cancers such as lung, liver, breast, and leukemia. Basic benefits have been optimized: the unified hospitalization deductible has been reduced by 2000 yuan, and reimbursement rates for non-pre-existing condition patients' out-of-pocket hospital expenses have increased by 5%. Coverage restrictions have been further relaxed: the Upgrade Plan has completely eliminated negative claim lists, while the Basic Plan's negative list has been streamlined from 25 items to 15 items, significantly expanding coverage scope. Public operational data shows that as of 2026 year 8 month, Shaanxi All-People Health Insurance has served over 545 million insured individuals for four consecutive years, with cumulative payouts reaching 4.52 billion yuan, demonstrating significant results in providing financial protection.
Tianjin Huimin Bao 2026 Edition (Coverage Period: 2026 years, from 10/1/2027 to 9/30/0). Breaking the single-price model, we implement age-based differentiated pricing to align risk with premiums: 17–130 years old at ¥18, 49–140 years old at ¥50, and 150+ years old at ¥440. Total coverage has increased to 50 million yuan. New product benefits include specific inpatient coverage for colorectal cancer and cardiovascular/cerebrovascular critical illnesses, enhancing protection against high-risk conditions. The specialized medication benefit maintains a high level of flexibility, with zero deductibles for 100 high-cost drugs and a maximum payout of 49 million yuan. Additionally, an optional 100 yuan add-on package is available, covering post-surgical inpatient nursing, home rehabilitation services, and up to {20} million yuan in innovative drug coverage under commercial insurance, establishing a tiered system that offers universal basic protection with customizable premium options.
Shandong Qilu Bao 2027 Edition introduces a multi-tiered, differentiated product matrix tailored to the protection needs of diverse populations. Four flagship products are launched: 1. Rural Revitalization Edition: Priced at 19–99 yuan, it focuses on maximum inclusivity and safety nets, covering basic medical risks for low-income and rural groups. 2. Inclusive Livelihood Edition: Priced at 59–169 yuan, it offers balanced and practical coverage aligned with the general public's basic protection needs. 3. Better Life Edition: Starting from 149 yuan, it includes 9 core coverage items, significantly upgrading standard medical protections. 4. Supreme Premium Edition: With a unified retail price of 799 yuan, group policyholders (excluding provincial-level employees) in Jinan City enjoy an exclusive discounted rate of 365 yuan. This edition provides 13 refined coverage items with total coverage exceeding 517 million yuan. Notably, the Supreme Premium Edition pioneers coverage for out-of-pocket expenses related to implantable brain-computer interface surgeries and orthopedic robots, while adding protection for heavy ion radiotherapy costs—achieving full coverage of both proton and heavy ion therapies, two of the world's most advanced radiation treatment technologies. On pharmaceutical coverage, it delivers dual upgrades for specialty drugs and online medications. The number of covered high-cost specialty drugs and innovative medicines has increased to 43 types, fully aligning with the national commercial insurance innovative drug directory. Internet outpatient medication coverage is also expanded, including approximately 3000 generic drugs and over 100 specific originator drugs.
Chongqing Yukuai Bao 2027 Edition retains proven, user-friendly mechanisms such as coverage for pre-existing conditions, family group policy discounts, incentives for continuous enrollment, payment via personal medical insurance accounts, and one-stop settlement, while implementing two core optimizations tailored to specific needs.
First, fully implement age-based pricing to achieve refined risk pricing while upholding the inclusive baseline.
Second, we innovate the tiered reimbursement model. For newly diagnosed cases, after deducting basic medical insurance reimbursements, excluded expenses, and the deductible, inpatient and special outpatient costs are reimbursed on a progressive scale: the inclusive plan covers 25%–55%, while the upgraded plan covers 45%–90%. This ensures that higher medical burdens result in higher reimbursement rates. For pre-existing conditions, fixed-rate reimbursement remains unchanged to maintain coverage stability. Regarding drug coverage, the core list of specialty medications remains stable at 60 types, with an additional 10 innovative drugs for cancer and rare diseases added, including 2 locally approved Class I innovative drugs in Chongqing. Two optional benefits are also retained: internet hospital outpatient care at 30 per person per year, and post-surgical in-hospital nursing services at 50 per person per year, further expanding coverage scenarios.
02
Risk Control Design with Zero Barriers:
Layered terms to mitigate adverse selection
Overall, new products in all five regions uphold the inclusive principle of universal coverage. However, they have universally adopted a refined risk control logic where enrollment is uniform but payouts vary. All measures to prevent adverse selection and manage costs can be categorized into two core systems.
First major system: Pre-screening for risk to optimize the structure of the insurance risk pool.
First, adopt differentiated pricing to stabilize enrollment among healthy individuals using price mechanisms. Tianjin and Chongqing have implemented age-based pricing to better align with risk differences.
Second, layered payouts for pre-existing conditions to differentiate coverage based on risk. For example, Tianjin specifies that non-pre-existing condition out-of-pocket expenses within the medical insurance are reimbursed at 60%, while pre-existing conditions are reimbursed at only 15%.
Third, incentives for continuous coverage: reward healthy members with increased claim payout ratios (for those with no claims) and complimentary value-added services to encourage retention.
Fourth, refined eligibility constraints: Shandong Qilu Bao reduces special drug reimbursement limits for non-local residents and those with insufficient years of medical insurance coverage to prevent high-risk cross-regional insurance arbitrage.
5. Group and family discounts: attract high-quality insured groups through low-priced group plans to optimize the overall risk profile.
Second Major System: Post-cost Control with Dynamic Optimization to Ensure Accountability.
The core lies in dynamic governance of the drug list, stabilizing special medication claim costs through removal and substitution mechanisms. Shandong Qilu Bao establishes clear institutional rules: once a drug is included in the national medical insurance catalog, it is immediately removed from the Huiminbao special medication list to prevent overlapping liability and invalid claims. Chongqing Yukuai Bao employs a "substitution without volume reduction" mechanism, capping the total number of core special medications at 60 to balance drug iteration with cost control.
Notably, high-volatility, high-cost coverage for innovative drugs has become modular and is no longer part of basic inclusive plans. Instead, it is grouped into premium tiers or optional add-ons. High-value responsibilities such as Shaanxi CAR-T therapy and overseas specialty medications are covered only in the 169 yuan upgraded plan. Tianjin's commercial insurance coverage for innovative drugs requires purchasing a separate 49 yuan add-on. In Shandong, coverage for 43 specialty and innovative drugs is included only in the 799 yuan top-tier version, with 17 specifically aligned to the national commercial insurance list for innovative drugs.
03
The balancing act of inclusive insurance:
Balancing between residual liability and actuarial precision
Sustainable exploration of domestic Hui Min Bao relies on precise clause design. Under rigid constraints of policy inclusivity and zero enrollment barriers, it mitigates adverse selection and stabilizes the risk pool through price tiering, differentiated coverage for pre-existing conditions, incentives for continuous enrollment, and dynamic directory adjustments. The core objective is to maintain broad coverage while optimizing the risk structure.
This model involves trade-offs but offers clear insights for the industry.
First, Huiminbao must establish a proactive risk warning system and move beyond single-period loss ratio assessments. Compared to static medical loss ratios per policy period, three dynamic leading indicators—enrollment mix, proportion of pre-existing conditions, and per-capita specialty drug premium-to-claim ratio—are better at predicting "death spiral" risks early on. Relying solely on current loss ratios can lead to underestimating long-term deterioration in the risk pool structure.
Second, modular and institutionalized coverage for innovative drugs is a viable path for Huiminbao. The basic coverage tier maintains low-cost inclusivity and covers routine medical risks, while high-cost, high-volatility responsibilities such as innovative drugs and advanced treatments are allocated to premium tiers or optional add-on packages. A rigid mechanism for iterating the drug formulary should also be established: once an innovative drug enters the national insurance reimbursement list, it is promptly removed from the product's special drug catalog. This prevents benefit overlap and cost waste, reduces claim expenses, and frees up coverage space for the latest innovations. All rules must be disclosed in advance with full transparency to policyholders.
Third, precise cost control is the core barrier to Huiminbao's sustainability. With no flexibility for market-based price adjustments, claim denials, or business exits, pricing is highly rigid. Only through refined operational measures—such as direct payment at designated pharmacies, precise prescription review, strict indication management, and real-world data implementation—can we effectively secure the claims "gate."
Huiminbao possesses quasi-public good attributes. Guided by local governments, it upholds its mission of universal, inclusive protection and cannot arbitrarily deny coverage, sharply raise premiums, or reduce basic benefits. The industry has undergone multiple rounds of natural consolidation. Data shows that as of 2025 year 7 month, 111 out of 313 Huiminbao products nationwide have been discontinued, representing a clearance rate of 35.5%. Even top-tier products have tested pricing rigidity: Shanghai Huibao's annual premium rose from 129 yuan to 130 yuan in 2025, while Qilu Bao's Supreme Premium Edition reached 799 yuan. Overall, however, most clearances involve discontinuing entire product lines; adjusting prices or halting sales individually carries significant policy pressure and reputational costs.
This also means that Huimin Bao will remain in a narrow margin of error, balancing inclusive livelihood commitments with commercial actuarial equilibrium. The clause iterations of the new versions of Huimin Bao in these five regions represent the optimal balance attempt under current constraints.
In the long run, adverse selection is an enduring challenge for inclusive insurance with no one-size-fits-all solution. Whether local Hui Min Bao policies can sustainably avoid the "death spiral" ultimately depends on the stability of renewal rates and the controllability of loss ratios over the next 3 to 5 years. Under the zero-threshold foundation of inclusive coverage, only through continuous fine-tuning of policy terms, routine risk control operations, and institutionalized responsibility optimization can we ensure the long-term sustainability of inclusive protection.
