New Benchmark in Integration of Public and Commercial Health Insurance: Launching the Era of Seamless and Instant Claims

Under the vigorous promotion by the state,“Healthy China”Amid the tidal wave of building and deepening reforms in the medical security system, empowered by medical insurance data from the National Healthcare Security Administration, undertaken by Xicheng District, Beijing, and operated by Beijing Jishubao Health Technology Co., Ltd., a state-owned enterprise under Xicheng District“Medical Insurance+Commercial Insurance”The pilot project of the Clearing and Settlement Center has been successfully implemented. This innovative initiative, akin to a stone cast into a calm lake, has sent ripples through the field of medical security. Numerous insurance institutions have responded actively, joining the platform one after another to jointly usher in“Medical Insurance+Commercial Insurance”A New Chapter in Integrated Development.

Among them, Ping An Good Doctor, the flagship member of Ping An Group’s healthcare sector, joined hands with Ping An Technology, Ping An Property & Casualty Insurance, Ping An Health Insurance, and Ping An Pension Insurance to deeply engage in the pilot program and spare no effort in building“Ping An Medical Health Pay”, launching China's first initiative to leverage medical insurance data through“Medical Insurance+Commercial Insurance”The clearing and settlement center’s seamless rapid-reimbursement product has injected new vitality into the optimization and upgrading of China’s healthcare security system.

This innovative initiative aligns closely with the national macro-strategy of building a multi-tiered medical security system. The state has consistently been committed to promoting the complementary relationship between commercial health insurance and basic medical insurance, thereby enhancing the overall effectiveness of medical security. The platform established by the “Medical Insurance + Commercial Insurance” Clearing and Settlement Center serves as a robust bridge, successfully breaking down data barriers between medical insurance and commercial insurance and achieving seamless integration in key areas such as data exchange and expense settlement. Through precise clearing and efficient settlement, every fund from both medical insurance and commercial insurance is utilized with precision, effectively facilitating the implementation of the national medical security strategy and establishing a solid health safeguard for the stable economic and social development of the country.

From a public welfare perspective, the successful implementation of the “Basic Medical Insurance + Commercial Health Insurance” clearing and settlement center has undoubtedly been a timely boon, effectively addressing the pain points and difficulties faced by the public in accessing medical care. In the past, the reimbursement processes for basic medical insurance and commercial health insurance were cumbersome, forcing patients and their families to shuttle back and forth between hospitals and insurance companies, consuming significant time and energy and leaving them physically and mentally exhausted.Today, Ping An Medical Health Pay leverages its unique product advantages and the powerful capabilities of the “Social Medical Insurance + Commercial Insurance” clearing and settlement center to enable one-code direct payment and seamless, rapid claims reimbursement for customers during medical treatment. Patients no longer need to make upfront payments or navigate cumbersome post-treatment claims procedures, as the system automatically handles the clearing and settlement of commercial insurance claims, truly achieving a “zero-perception” claims experience.This convenient and efficient model not only significantly improves claims processing efficiency but also provides patients with an unprecedented healthcare experience, enabling them to devote their full attention to treatment and recovery. It greatly alleviates patients’ financial and psychological burdens, truly embodying the principles of benefiting and serving the public, while markedly enhancing people’s sense of gain and well-being.

For insurance institutions, the “Basic Medical Insurance + Commercial Insurance” Clearing and Settlement Center brings about comprehensive transformation and enhancement. The Center provides insurers with a more scientific and precise basis for risk assessment and product pricing. Its highly efficient settlement process acts as an “accelerator” for claims handling, significantly shortening the claims cycle, reducing operational costs, and improving service quality and customer satisfaction. These positive developments have further invigorated the commercial health insurance market and promoted the healthy and sustainable development of the insurance industry.

As an innovative pioneer in this pilot program, Ping An Healthcare Payment has deeply integrated with the “Basic Medical Insurance + Commercial Health Insurance” clearing and settlement center. Its innovative direct billing feature for commercial health insurance has been thoroughly validated and applied in pilot scenarios, providing a replicable and scalable model for the integrated development of basic medical insurance and commercial health insurance.

Looking ahead, the “Basic Medical Insurance + Commercial Insurance” Clearing and Settlement Center, insurance institutions, and other stakeholders will continue to work together to optimize the functions and services of the clearing and settlement center, persistently explore new models and pathways for the integrated development of basic medical insurance and commercial insurance, enable more people to enjoy more convenient, efficient, and high-quality healthcare security services, and contribute to the building of a “Healthy China.”