The release of the new definition of critical illness insurance adds three kinds of critical illness： scientifically dividing the disease level and paying more accurately.

　　After more than two years of repeated argumentation and revision, the new definition of critical illness insurance, which has attracted much attention in the industry, has finally been officially announced. Yesterday, on November 5th, China Insurance Association and China Medical Doctor Association officially released the Standard for the Use of Disease Definition in critical illness insurance (revised edition in 2020). At the same time, China Association of Actuaries issued the Table of Incidence Rate of Major Diseases in China Life Insurance Industry (2020).

　　On the basis of the original definition of critical illness, the new definition of critical illness insurance adds three serious diseases: severe chronic respiratory failure, severe Crohn’s disease and severe ulcerative colitis. At the same time, three kinds of core serious diseases, malignant tumor, acute myocardial infarction and sequelae of stroke, were scientifically classified, and the corresponding definitions of three kinds of mild diseases were added, which expanded the scope of protection.

　　focus

　　The revised contents include three aspects.

　　The definition of mild diseases was introduced for the first time.

　　It is understood that optimizing classification and establishing a classification system for major diseases are the main contents of this new definition of critical illness insurance.

　　The definition of mild diseases is introduced for the first time, and three core diseases, namely malignant tumor, acute myocardial infarction and sequelae of stroke, are divided into two levels according to their severity. The Insurance Association said that through scientific classification, on the one hand, it fully adapts to the development of medical diagnosis and treatment technology, and defines some diseases that used to be serious diseases, but at present, the cost of diagnosis and treatment is low and the prognosis is good, making the compensation standard more scientific and reasonable; On the other hand, it also adapts to the actual development of critical illness insurance market, and formulates clear industry standards for mild diseases that are more common in the market at present, so as to standardize market behavior.

　　At the same time, increase the number of diseases and moderately expand the scope of protection. Based on the evaluation model of major diseases, the degree of major diseases is quantitatively evaluated, and the original definition of 25 major diseases is improved and expanded to 28 severe diseases and 3 mild diseases, and the scope of protection is appropriately expanded.

　　Secondly, this new definition of critical illness insurance also expands the scope of disease definition and optimizes the definition connotation. According to the latest medical progress, the coverage of major organ transplantation, coronary artery bypass grafting, heart valve surgery and aortic surgery has been expanded, and the definitions of diseases such as severe chronic renal failure have been improved and optimized.

　　It is worth noting that this change has further expanded the coverage of the new definition of critical illness insurance. On the basis of the original definition of serious diseases, three serious diseases are added: severe chronic respiratory failure, severe Crohn’s disease and severe ulcerative colitis. At the same time, three kinds of core serious diseases, malignant tumor, acute myocardial infarction and sequelae of stroke, were scientifically classified, and the corresponding definitions of three kinds of mild diseases were added, which expanded the scope of protection.

　　Third, the compensation conditions are more reasonable. According to the latest medical practice, the compensation conditions of some definition items are relaxed. For example, for "heart valve surgery", the limited condition that "the chest must be opened" stipulated in the original definition is cancelled and replaced by "the heart must be opened", which effectively improves the protection rights and interests of consumers.

　　affect

　　Under the premise of the same guarantee responsibility

　　The price of critical illness insurance products decreased slightly.

　　The relevant person in charge of the China Association of Actuaries said that there are many factors affecting the price of critical illness insurance products, including guarantee liability, interest rate, expense rate, and the incidence of critical illness. Different products have different sensitivities to various factors, and the incidence of critical illness is one of the important factors. This revision of the list of serious diseases will affect the incidence of serious diseases of new products in the future, and the curve shape and incidence level have changed to some extent compared with the old specifications.

　　From the perspective of protecting consumers’ interests, this 2020 edition of the list of serious diseases has optimized the risk margin scientifically. From the price point of view, for mainstream critical illness insurance products, if under the premise of the same guarantee responsibility, the price of critical illness insurance products will drop slightly, and for regular critical illness insurance products, the price of some age groups will drop significantly. Generally speaking, the new definition of critical illness insurance makes the price of critical illness insurance products more scientific and reasonable.

　　The relevant person in charge of the China Association of Actuaries said that the next step will be to carry out three major tasks under the guidance of China Banking and Insurance Regulatory Commission: to do a good job in publicity and training, to publicize in various ways, and to publicize and display the project results to the inside and outside of the industry; Use the dynamic adjustment mechanism of critical illness list, further play the role of professional platform, explore the establishment of dynamic analysis and adjustment mechanism of critical illness list, and better serve the development of health insurance.

　　implement

　　Critical illness insurance has provided more than 3,000 products.

　　The replacement of old and new products will be completed by the end of January next year.

　　According to statistics, in the 11 years from 2007 to 2018 alone, critical illness insurance has provided more than 3,000 products to consumers, covering nearly 200 million person-times, paying about 1.8 million person-times and paying more than 100 billion yuan. At present, critical illness insurance accounts for nearly 60% of the total premium of health insurance business.

　　After the implementation of the new definition of critical illness insurance, the supervision also set a deadline for the transition of old and new products. The transition period of the new definition of critical illness insurance is set to January 31, 2021, which means that from the date of publication to January 31, 2021, insurance companies should do a good job in product connection and customer service. After the transition period, insurance companies may not continue to sell critical illness insurance products developed based on the old specifications.

　　This group/reporter Yan Lishuang for the picture/vision china

　　explain

　　About thyroid cancer

　　This revision did not exclude thyroid cancer, but graded it according to the severity of the disease and paid it according to the severity.

　　According to the latest medical practice, it is an important breakthrough in this revision to scientifically classify diseases and reasonably distinguish severe diseases from mild diseases, so as to make the compensation more accurate and reasonable. Some early malignant tumors that were excluded from compensation in the old specification were also included in the new specification "Malignant tumor — — Mild ",such as skin malignant tumor without lymph nodes and distant metastasis except melanoma, prostate cancer with TNM stage T1N0M0 and other diseases. From this perspective, the protection of consumers is more comprehensive.

　　On the upper limit of the proportion of minor compensation

　　The requirements of the new standard for the proportion of insurance amount for three kinds of mild diseases are the important contents of the classification system for major diseases, and the purpose is to set the compensation standard scientifically and reasonably according to the severity of diseases, medical expenses and prognosis. According to the feedback from all walks of life and the calculation of underwriting claims data in the insurance industry, the upper limit of the proportion of the three kinds of mild illness insurance is determined to be 30%. Insurance companies add mild diseases beyond the new standards to their critical illness insurance products, and the corresponding insurance amount shall be set by the insurance companies themselves reasonably.

　　About carcinoma in situ

　　First of all, in the old specification, malignant tumor does not include carcinoma in situ. In this revision, in order to further standardize the concept and scope of malignant tumor, on the basis of referring to the International Statistical Classification of Diseases and Related Health Problems (ICD) of the World Health Organization (WHO), the tumor morphological standard of the Third Edition of the International Classification of Diseases Oncology (ICD-O-3) of the World Health Organization (WHO) was introduced to make the definition more accurate and standardized. However, carcinoma in situ does not belong to the malignant tumor specified in ICD-O-3 tumor morphology standard. At the same time, we have deeply studied and referred to the experience of Britain, Canada, Singapore and other countries (except for carcinoma in situ), so this revision will not include carcinoma in situ for the time being. However, insurance companies can increase the responsibility of cancer in situ protection in critical illness insurance products on the basis of diseases specified in the new regulations, so as to meet the diversified insurance protection needs of consumers.

　　be relevant

　　Coronary stents enter the "thousand yuan era"

　　Xinhua News Agency: Coronary stents that once amounted to 10,000 yuan entered the "thousand yuan era". The reporter learned from the joint procurement office of high-value medical consumables organized by the state that the first batch of centralized procurement of high-value medical consumables in China, starting with coronary stents, produced the quasi-winning results in Tianjin on November 5. Ten products will be selected in this centralized procurement, and the price of coronary stent will drop from about 13,000 yuan to about 700 yuan.

　　It is reported that the coronary stents purchased in this centralized way are made of cobalt-chromium alloy or platinum-chromium alloy, and the drug-carrying type is rapamycin and its derivatives, and the procurement cycle is two years. The mainstream products commonly used in clinical practice in medical institutions are basically selected, covering more than 70% of the intended purchase volume of medical institutions. Compared with 2019, the same product of the same enterprise has an average price reduction of 93%, domestic products have an average price reduction of 92%, and imported products have an average price reduction of 95%. According to the intended purchase volume, it is estimated that the related expenses will be saved by 10.9 billion yuan.

　　The reporter learned that relevant enterprises actively participated in this collection, and a total of 11 enterprises participated in the bidding, involving 26 coronary stent products registered and listed in China. Through competition, 10 products were selected, belonging to 8 Chinese and foreign enterprises. Medical institutions also actively participated in this centralized procurement, with a total of 2,408 medical institutions participating, including 851 medical institutions with annual procurement volume of more than 500. In the first year, the number of intentional purchases reached 1.07 million, which was close to the number of drug-loaded chromium alloy stents purchased in 2019 (1.09 million), accounting for 65% of all material purchases in 2019 (1.65 million).

　　Zhong Dongbo, director of the Department of Drug Price and Bidding and Purchasing of the National Health Insurance Bureau, commented on the results of the national centralized procurement of coronary stents: to benefit the people, to encourage medical institutions and to promote the high-quality development of the pharmaceutical industry.