Beyond oncology and rare disease medications, treatments for chronic diseases, mental health conditions, out-of-hospital drugs, overseas medications, and original patented drugs are now covered in some regions.

As Huimin Insurance enters its sixth year of nationwide promotion, "special drug coverage" has become a standard feature. Industry estimates indicate that last year, Huimin Insurance contributed approximately 1.8 billion yuan in payments for innovative drugs—a ninefold increase from 2021—despite its modest premium scale of under 20 billion yuan.

However, the reimbursement experience varies among its roughly 150 million annual enrollees. While some received single payouts nearing 800,000 yuan or 30 reimbursements in a year, others—such as chronic disease patients—struggle to meet deductibles despite frequent medical visits. Some face reduced payouts due to pre-existing conditions, while out-of-town patients or new urban residents are excluded entirely.

The dual goals of low premiums and high payout rates, coupled with rising enrollment among seniors and those with pre-existing conditions, have pushed Huimin Insurance toward a "death spiral." To mitigate payout pressures, some programs have raised deductibles or capped high-cost drug reimbursements, inadvertently reducing healthcare benefits. Meanwhile, the recent release of China’s first commercial insurance innovative drug directory has fueled industry hopes for Huimin Insurance to integrate it and expand innovative drug coverage.

Against this backdrop, the "Notice on Promoting High-Quality Development of Urban Commercial Medical Insurance" (the Notice) issued this year by the National Financial Regulatory Administration emphasizes aligning premiums with coverage levels, balancing expansion with sustainability, and avoiding low-price, cutthroat competition. It also mandates timely inclusion of new medical technologies, drugs, and devices.

Recent updates to 2026 Huimin Insurance plans reveal key trends: - **Multi-tiered premiums** are replacing low-cost models as a marketing strategy. - Coverage now extends to **chronic disease treatments, mental health drugs, out-of-hospital medications, overseas drugs, and original patented drugs** alongside oncology and rare disease therapies. - Some regions are easing enrollment and reimbursement for **out-of-town patients**.

**Expanding Special Drug Directories** A 2025 white paper reports that 90% of Huimin Insurance programs include special drug coverage, with 672 drugs listed nationwide in 2024—a 1.8x increase from 2021. While oncology (40%) and rare disease drugs dominate, newer plans are incorporating high-cost chronic disease treatments. For example: - Beijing’s 2026 plan covers 159 drugs, including CAR-T therapy and Alzheimer’s treatments like lecanemab and donanemab. - Shandong’s upgraded "Qilu Bao" lists 3,000 out-of-pocket drugs, 37 innovative therapies, and 15 rare disease medications, plus 50+ original patented drugs via online consultations.

Notably, Shantou has become the first city to link its Huimin Insurance with the national commercial insurance innovative drug directory, offering a 10% higher reimbursement rate for listed drugs.

**Risk-Based Pricing and Tiered Benefits** Balancing affordability and sustainability remains a challenge. The Notice advocates risk-based pricing by age, gender, and health status, rejecting preset payout rates or fund pools. Many 2026 plans now offer **basic and upgraded tiers**, with broader coverage at higher premiums. Examples include: - Hunan’s upgraded plan: 80% reimbursement for 20 out-of-hospital drugs, lower deductibles (10,000 yuan), and 1 million yuan caps. - Shandong’s version: coverage for robotic surgeries and post-hospitalization care.

Age-based pricing (e.g., discounts for minors) and differential payouts for pre-existing conditions are also emerging, though wide gaps may still burden seriously ill patients.

**Inclusivity: New Urban Residents and Out-of-Town Care** To expand enrollment, 2026 plans are adopting strategies like: - Lower deductibles and added benefits (e.g., mental health, fertility treatments). - Broader eligibility, including uninsured migrants (e.g., gig workers in Hangzhou) and out-of-town care reimbursements (e.g., Guangzhou’s "Sui Sui Kang").

With an estimated 50 billion yuan market for insuring those with pre-existing conditions, Huimin Insurance’s 10 billion yuan share highlights room for growth through smarter pricing and expanded access.