On August 12, Zhang Shi, CEO of YiDuYun,the major operation platform of the Beijing Inclusive Medical Insurance Program, along with Dong Yu, lead of the Program's product team, introduced the features and answered questions related to the program.

Q: How do we understand the "Inclusiveness" of Beijing Inclusive Medical Insurance Program?

A: Beijing Inclusive Medical Insurance Program is available to all active Beijing medical insurance system account holders, regardless of age, occupation, place of household registration, or previous medical history. The program is more inclusive than ordinary commercial insurance plans due to the fact that specific preexisting conditions are both insurable and claimable. Another extraordinary aspect of the program is how insurants with five specific preexisting conditions, (including malignant tumors as well as liver and kidney diseases) can be applied to differentiated claim plans from healthy applicants. Not only that, if they satisfy certain specific conditions, insurant applicants with other diseases including hepatitis B, mammary nodules and uterine fibroids can be compensated in the same way as healthy plan holders. This allows the plan to have a longer reach when it comes to benefiting patients.

Take a male applicant who is 60 years old for example. Ordinary commercial medical insurance could cost over 1,000 yuan a year, whereas Beijing Inclusive Medical Insurance Program utilizes unified insurance for elders or children. In sharp contrast, this insurance only costs 195 yuan a year (less than 0.6 yuan per day), and offers a maximum compensation of 3 million yuan. This is another wonderful example of the inclusiveness of the program.

Q: What are the differences in reimbursement ratio between healthy applicants and those with preexisting conditions?

A: The greatest feature of Beijing Inclusive Medical Insurance Program is that both healthy applicants and those with preexisting conditions can be insured and have access to claims, with only slight differences in the reimbursement ratio and the compensation standard.

For example, any expenditures related to insured serious diseases in excess of the compensation provided will be reimbursed by 80% for healthy applicants and 40% for applicants with preexisting conditions. In the event of situations involving diseases where the applicant has paid out-of-pocket, there is a 20,000 yuan deductible and a 70/30 plan for healthy applicants and a 40,000 yuan deductible and a 35/65 plan for applicants with preexisting conditions. As for 100 types of special drugs produced domestically and overseas, a 20,000 yuan deductible with a 60/40 plan will go to healthy applicants and a 40,000 yuan deductible with a 30/70 plan will go to applicants with preexisting conditions.

To focus on the concept of inclusiveness, Beijing Inclusive Medical Insurance Program also covers and offers claims for diseases that are typically not covered in ordinary commercial insurance plans, such as nodes diagnosed during physical examinations. It is accessible to both healthy applicants and applicants with five specific preexisting conditions who takes differentiated deductibles and reimbursement ratios.

Q: Is there any overlap between the supplementary medical insurance from the employer and Beijing Inclusive Medical Insurance Program?

A: No, they may both be used simultaneously. First, the reimbursed amount of the supplementary medical insurance can be added to the deductible of Beijing Inclusive Medical Insurance Program. Due to limited budgets, the supplementary medical insurance usually covers only outpatient costs and "out-of-pocket (Ⅰ)" costs while excluding "out-of-pocket (Ⅱ)" and "self-supporting" costs, as well as "special support" and "value-added services".

In addition, supplemental medical insurance provided by an employer generally consists of 10,000 to 20,000 yuan in coverage for outpatient service and 50,000 yuan for inpatient service. In contrast, Beijing Inclusive Medical Insurance Program can provide a more reassuring reimbursement of up to 3 million yuan. Therefore, it is better to apply for both supplemental medical insurance and Beijing Inclusive Medical Insurance Program to cover the medical expenses.

Q: How can I be enrolled in the Program? How to file an insurance claim?

A: You can first follow the official WeChat account for Beijing Inclusive Medical Insurance Program (北京普惠健康保, ID: gh_83a5738034b9). You can then enroll yourself in the insurance program by tapping "Apply (参保入口) " and "Personal Enrollment (个人参保)" on the bottom navigation menu.

Beijing Inclusive Medical Insurance Program is closely connected with the medical insurance system, and all reimbursements within the scope of the medical insurance system do not require any additional documentation. The scope of the medical insurance system is in line with that of serious illness insurance. Also, the reimbursement rate of Beijing Inclusive Medical Insurance Program changes along with that of the medical insurance every year. The reimbursement process can be completed at the same time as the settlement of serious illnesses under the basic medical insurance system, which allows for one-stop settlement. As long as the deductible is met, there is no limit to the number of claims that can be reimbursed throughout the year.

     For reimbursement of out-of-pocket expenses covered by the program, you can upload copies of all documentation online via the insurance claim service section of Beijing Inclusive Medical Insurance Program's official WeChat account (Note: the insurance claim channel will be updated after the open enrollment period expires). A specialist will contact you to confirm the documents associated with the claim and proceed to handle the claim as soon as possible.

For special drugs, all insurants can file an insurance claim via the Beijing Inclusive Medical Insurance Program's official WeChat account. There are 19 designated pharmacies located throughout Beijing where insurants are only required to pay the amount they are responsible for in order to pick up their drugs. The list of pharmacies can be found in the "Coverage Introduction (保障介绍)" section of Beijing Inclusive Medical Insurance Program's official WeChat account.

Q: Why a deductible is set for Beijing Inclusive Medical Insurance Program? Can the deductible be further reduced?

A: Most of the medical insurance programs with an insurance amount of over one million yuan in the market as well as other inclusive insurance programs in other cities have deductibles, and Beijing Inclusive Medical Insurance Program is no exception. The only difference is the amount of the deductibles.

   The deductibles are designed for two main reasons. One is to reduce the loss ratio and make the premiums more affordable. This is also the reasoning behind increasing the deductible for people with a specific medical history. Beijing Inclusive Medical Insurance Program is able to cover and pay for people with a specific medical history. Compared with healthy insurants, people with specific medical histories enjoy different services provided by the program which can benefit more people with illnesses. If the deductible is reduced, the premium will be increased. The second reason is the deductible is set at 20,000 to 40,000 yuan, the price which is affordable for most families, to help insurants withstand the risk of major illnesses.

It is important to note that the deductible for Beijing Inclusive Medical Insurance Program is calculated on an annual basis and not on the basis of a single hospitalization. If a participant has multiple outpatient or inpatient visits in a policy year, the deductible will be calculated on an annual basis.

(Note: Content source is from Beijing Daily App.)