继发展改革委等六部委公布《关于开展城乡居民大病保险工作的指导意见》之后，保监会近日召开的城乡居民大病保险工作会传递出的消息称，目前保监会正在制定规范大病保险业务的通知和大病保险示范产品，细化大病保险相关规定，统一和规范服务标准。

The six ministries and commissions such as development and reform commission announced[About urban and rural residents to carry out a serious illness insurance work guiding opinions]after,The China insurance regulatory commission recently held between urban and rural residents of a serious illness insurance work will transfer the news said,At present the China insurance regulatory commission is developing standard serious illness insurance business notice and serious illness insurance demonstration products,Refining a serious illness insurance related regulations,Unity and standardize services.

　　分析认为，保险业要按照“收支平衡、保本微利”的原则开展大病保险，最大程度上让利于民；承办公司要将大病保险列入整体发展规划，做长期服务的打算，确保大病保险制度持续稳定运行。

According to analysis,Insurance according to the"balance/Break-even meager profit"Principle to carry out a serious illness insurance,Maximum benefit to the people;The company will be a serious illness insurance included in the overall development plan,Do long service plan,Ensure that a serious illness insurance system continuous and stable operation.

——大病保险为保险业参与医疗保障体系建设提供新途径 - a serious illness insurance for the insurance industry to participate in medical security system construction to provide new ways

　　根据发展改革委等六部委此前联合发布的《关于开展城乡居民大病保险工作的指导意见》，城乡居民大病保险承办方式为向商业机构购买大病保险，这标志着商业保险机构首次得以在国家政策的鼓励下进军城乡居民大病保险业务领域，从政策环境和制度层面为商业保险机构创造了更大的发展空间。

According to the development and reform commission and so on six ministries jointly issued after the[About urban and rural residents to carry out a serious illness insurance work guiding opinions],Urban and rural residents a serious illness insurance for the way to business institutions to purchase a serious illness insurance,This marks the first commercial insurance institutions in the national policy to under the encouragement of urban and rural residents into a serious illness insurance business areas,The policy environment and system level for commercial insurance institutions to create a larger development space.

　　根据《指导意见》，承办大病保险的商业保险机构通过政府招标选定。符合基本准入条件的商业保险机构自愿参加投标，中标后以保险合同形式承办大病保险，承担经营风险，自负盈亏。商业保险机构承办大病保险的保费收入，按现行规定免征营业税。

According to[Guiding opinions],Undertaking serious illness insurance business insurance institutions through the government tender selected.Conforms to the basic access conditions of commercial insurance institutions voluntarily participate in the bidding,After winning the bid to insurance contract form undertaking serious illness insurance,Assume business risk,Responsible for their own profits and losses.Commercial insurance institutions undertaking serious illness insurance premium income,According to the current regulation shall be exempted from business tax.

　　此外，承办大病保险的商业保险机构必须具备多项基本条件：符合保监会规定的经营健康保险的必备条件；在中国境内经营健康保险专项业务5年以上，具有良好市场信誉；具备完善的服务网络和较强的医疗保险专业能力；配备医学等专业背景的专职工作人员；商业保险机构总部同意分支机构参与当地大病保险业务，并提供业务、财务、信息技术等支持；能够实现大病保险业务单独核算。

In addition,Undertaking serious illness insurance business insurance institutions must have a number of basic conditions:Conform to the provisions of the circ business health insurance the necessary conditions;Operations in China health insurance special business five years,Has a good market reputation;Has perfect service network and strong medical insurance professional ability;Equipped with medical and other professional background full-time staff;Commercial insurance agency headquarters agreed to participate in the local branch of a serious illness insurance business,And provide business/financial/Information technology support;Will be able to realize the serious illness insurance business accounted for separately.

　　开展大病保险是完善多层次医保体系的重要举措，标志着我国医保体系建设从实现“病有所医”向解决“因病致贫、因病返贫”迈出了关键一步。在政府主导的原则下，采取向商业保险机构购买大病保险是重大体制机制创新，也为保险业参与医疗保障体系建设提供了新的途径。

To carry out a serious illness insurance is perfect multi-level medical insurance system important action,Marks the medical insurance system construction in our country from the realization"BingYouSuoYi"To solve"Become financially-difficult/Poverty due to illness"Taking a key step.In the governmental dominant under the principle of,Take to commercial insurance institutions to purchase a serious illness insurance is major system and mechanism innovation,Also for the insurance industry to participate in the construction of medical security system provides a new way.

　　专家认为，保险业开展大病保险可以提高统筹层次，增强抗风险能力，提高服务水平，放大保障效应，加大对医疗机构和医疗费用的制约，有效降低诊疗成本；发挥商业保险机构的专业技术优势、风险管理优势、服务优势和市场化运行机制，形成政府、个人和保险机构共担大病风险，保障水平与经济社会发展水平及财政承受能力相适应的机制。

Experts say,The insurance industry to carry out a serious illness insurance can improve the level of overall planning,Increase its ability to resist risks,Raises the service level,Amplification security effect,Increase of medical institutions and medical cost restriction,Effectively reduce the cost of diagnosis and treatment;Play commercial insurance mechanism of professional and technical advantages/Risk management advantages/Service advantage and market operation mechanism,Form the government/Personal and insurance institutions sharing the risk of a serious illness,Security level and the social economic development level and financial affordability mechanism.

——保险机构把握政策时机积极参与承办大病保险 - insurance institutions to grasp the policy time actively participate in undertaking serious illness insurance

　　事实上，在“新农合”与城镇居民医疗保险陆续推出之后，各地不断探索引入商业保险机构参与医疗风险管理和健康服务，涌现出了多种操作性强的试点经营模式，例如阳光保险的“襄阳模式”、中国人保的“湛江模式”、“太仓模式”等等。

In fact,in"New farmers joint"And urban residents medical treatment insurance after releasing,All continuously explore into commercial insurance agencies to participate in medical risk management and health services,Emerged in a variety of feasible pilot operation mode,For example the sunshine insurance"Xiangyang mode"/The Chinese people can keep"Zhanjiang mode"/"Taicang mode", etc.

　　2009年，襄阳市政府拟在全市实施城镇居民大额医疗费用保险制度，一举中标的阳光保险详细制定了风险管控措施和数据监控模型，与襄阳市医保局“合署办公”，将“六个统一”作为风险管控的核心，即统一征缴、统一政策、统一人员调配、统一系统管理、统一医疗管理、统一支付标准。

In 2009,,Xiangyang city government intends to urban residents in the implementation of large medical expenses insurance system,At one fell swoop the sunshine insurance has formulated the detailed risk control measures and data monitoring model,And xiangyang city medical insurance bureau"Offices office",will"Six unified"As the core of risk control,Namely unified collects pay/Unified policy/Unified personnel assignment/Unified system management/Unified medical management/Unified payment standard.

　　具体做法是，由襄阳当地医保基金筹资每人20元，城镇居民不需再出资便可获得大病保障，只要患病支付合理费用超过3万元，超出部分将由阳光保险按一定的比例支付，公司支付封顶为9万元。

Particular way is,Xiangyang by local medical insurance fund financing 20 yuan per person,Urban residents do not need to obtain the investment guarantee a serious illness,As long as sick pay reasonable costs more than 30000 yuan,Beyond part will by sunshine insurance according to the certain proportion pay,The company pay capped for 90000 yuan.

　　也就是说，患者出院时结算自费部分，然后由定点医疗机构来进行结算，3万元之内的其他部分由社保来承担，3万-9万元部分由保险公司来支付60%-65%。患者不再需要自己先行垫付，然后再跑医保、跑商业保险机构报销，一站式解决了补偿问题。

That is,When released from the hospital patients settlement part at one's own expenses,Then the fixed-point medical institutions for settlement,30000 yuan in other parts of the social security to bear,30000-90000 yuan in part by the insurance company to pay 60% - 65%.Patients will no longer need to reimburse them later,Then run medical insurance/Run business insurance institutions to submit an expense account,"One-stop" work style to solve the compensation.

　　2010年，阳光保险协助襄阳市医保管理部门建立了“二次补偿”机制。也就是说，合理医疗费用结算后，个人支付超过1万元的，保险公司将再次对超出部分补偿30%。目前“襄阳模式”大病保险封顶是9万元，未来有望逐步提高至15万元。同时，“襄阳模式”还启动了盈利的调节机制，将大病保险的保险责任从单纯的大额补充扩充到了意外保障。

In 2010,,Sunshine insurance assist xiangyang city medical insurance management department built"Secondary compensation"mechanism.That is,After the reasonable expenses for medical treatment,The individual pays more than 10000 yuan,The insurance company will exceed 30% again on part of the compensation.At present"Xiangyang mode"A serious illness insurance capped is 90000 yuan,The future is expected to gradually increase to 150000 yuan.At the same time,"Xiangyang mode"Also launched the adjusting mechanism of the profit,Will be a serious illness insurance the insurance liability from the pure big added expansion to the accident security.

　　阳光保险相关负责人指出，大病保险新政为“襄阳模式”进一步夯实基础、不断推广迎来了契机。为此，阳光保险也在制订大病保险新规划，并将研究覆盖面更广的保障方案，以打开参与“新农合”大病保险的新局面。

The sun is pointed out that the relevant person in charge of insurance,A serious illness insurance for the New Deal"Xiangyang mode"Further, laying a solid foundation/Popularize continuously ushered in the opportunity.therefore,Sunshine insurance also in making a serious illness insurance new planning,And will study much broader security scheme,To open up to participate in"New farmers joint"A serious illness insurance of the new situation.

　　中国人保集团董事长吴焰也表示，中国人保将把握政策出台的有利时机，发挥专业和机构网点优势，继续积极参与承办大病保险，推动大病保险健康有序发展。

Chinese people can keep the group chairman WuYan also said,China will hold the insurer policies favorable opportunity,Play professional and outlets of the advantage,Continue to take an active part in undertaking serious illness insurance,A serious illness insurance to promote the healthy and orderly development.

——大病保险政策将细化 “保本微利”成关键 - a serious illness insurance policy will refining "Break-even meager profit"Into key

　　由于大病保险在我国还是一个新生事物，具有参与主体多、涉及领域广、服务链条长、风险管理复杂等特点，这对保险业专业水平、风险控制、服务能力等都提出了很高要求。

Due to a serious illness insurance in our country is still a new thing,Has more than participation main body/Involves wide field/Service chain long/Risk management complex etc,The insurance industry professional level/Risk control/Service ability and so on all put forward high request.

　　为此，保监会主席项俊波指出，要加大产品和服务创新力度，协助政府拟定科学合理的大病保障方案；要完善大病保险运行机制，在产品设计、精算技术、偿付能力管理、资产负债匹配管理和消费者利益保护等方面形成相互配套的机制；要改进和完善服务流程，简化报销手续，提供“一站式”即时结算服务；要积极开发多样化保险产品，进一步扩大商业保险参与医疗保障体系建设的领域和范围。

therefore,The China insurance regulatory commission chairman XiangJunBo pointed out,To increase product and service innovation,Assisting the government out scientific and reasonable serious illness security scheme;To improve a serious illness insurance operation mechanism,In the product design/Actuarial technology/Solvency management/Assets and liabilities match management and the interests of consumers protection form mutual supporting mechanism;To improve and perfect the service process,Simplified to submit an expense account formalities,provide"one-stop"Instant settlement services;To actively the development of diversified insurance products,Further expand the commercial insurance to participate in medical security system of the construction field and scope.

　　目前，保监会正在制定规范大病保险业务的通知和大病保险示范产品，细化大病保险相关规定，统一和规范服务标准。同时，在各地政府依据实际情况制订细则的过程中，或将涉及如何与保险公司确定保障方案、医保基金结余多少、用来购买商业保险的资金占比多大等等问题。

At present,The China insurance regulatory commission is developing standard serious illness insurance business notice and serious illness insurance demonstration products,Refining a serious illness insurance related regulations,Unity and standardize services.At the same time,In the local governments according to the actual situation in the process of formulate rules,Or will involve with insurance company how to determine the security plan/How many medical insurance fund balance/Used to buy commercial insurance funds accounted for more than much and so on questions.

　　连日来，保监会有关负责人在公开场合多次强调，保险业要按照“收支平衡、保本微利”的原则开展大病保险，尽可能提高保障水平，最大程度上让利于民。有业内人士表示，大病保险如何让保险公司实现“保本微利”，避免像交强险那样陷入亏损困局，将决定商业保险机构承办大病保险的深度和广度。如何合理确定各地保费，既让老百姓交得起，又能保证保险公司的积极性，成为各地政府推行这一政策所面临的主要问题。

For the last few days,The China insurance regulatory commission officials has emphasized many times that in public,Insurance according to the"balance/Break-even meager profit"Principle to carry out a serious illness insurance,As far as possible improves the security level,Maximum benefit to the people.The personage inside course of study says,A serious illness insurance how to let insurance companies to achieve"Break-even meager profit",Avoid making like that into loss predicament,Will decide the commercial insurance institutions undertaking serious illness insurance depth and the breadth.How to reasonably determine the premium around,Not only let people pay up,And can guarantee the enthusiasm of the insurance company,As governments around the world to implement this policy is the main problem facing.

　　项俊波表示，保监会将适当减免监管费、保险保障基金，调整大病保险资本要求等降低大病保险运行成本。保险公司开展大病保险要遵循科学定价、审慎定价原则，合理设定利润上限，并建立风险调节基金等方式对盈亏情况进行调剂，超出的利润进入基金池，用于提高保障水平或滚存到下年度。逐步形成合理的利益激励和约束机制，保障大病保险制度可持续运行。

XiangJunBo said,The China insurance regulatory commission will be appropriate reduction supervision fee/Insurance security funds,Adjust a serious illness insurance capital requirements, etc. To reduce serious illness insurance operation cost.The insurance company to carry out a serious illness insurance should follow the scientific pricing/Prudent pricing principle,Reasonable setting profit cap,And establish the risk adjustment funds way for profit and loss situation of dispensing,Beyond profit into the fund pool,To enhance the security level or accumulated until next year.Gradually formed a reasonable interest incentive and restraint mechanism,Ensure a serious illness insurance system sustainable operation.

　　与此同时，监管部门要加强对开展大病保险的组织协调和监管，促进大病保险业务规范发展；严格按照相关标准，从严把好大病保险市场准入关，坚决杜绝随意进出和短期行为。

meanwhile,To strengthen the supervision department to carry out a serious illness insurance organization and coordination and supervision,To promote the development of a serious illness insurance business norms;In strict accordance with the relevant standards,Strictly to give good serious illness insurance market access,Resolutely put an end to random pass in and out and short-term behavior.

　　专家认为，参与大病保险业务的保险公司必须将大病保险列入自身的整体发展规划，要有意愿、有能力进行长期服务。大病保险要引入市场机制，通过竞争降低承办费用和管理成本。承办公司应降低管理成本、合理分摊费用，尽可能提高保障水平，充分发挥大病保险资金的效用。(记者 王文帅 吴雨)

Experts say,A serious illness insurance in the insurance company of business of a serious illness insurance must be listed in their overall development plan,Want to have intend to/Have the ability to carry on the long-term service.A serious illness insurance to introducing market mechanism,Through the competition to reduce the cost and management cost.The company shall reduce the management cost/Reasonable share (in) the cost,As far as possible improves the security level,Give full play to the effectiveness of a serious illness insurance funds.(Reporter WangWenShuai WuYu)