Boao Lecheng Global Special Drug Insurance 2021 Launches with Pre-existing Conditions Covered and Up to RMB 1 Million in Coverage for Just RMB 29
“At that time, the doctor said that only imported drugs could help my father’s condition, but the monthly treatment cost of 40,000 yuan was undoubtedly an astronomical figure for our not-so-well-off family. I felt very pessimistic at the time. Relatives also came to persuade me to give up treatment, but was I really supposed to just stand by and watch him slip away?” said Li Xingyong.
“Later, it suddenly dawned on me that I had previously purchased the Hainan Boao Lecheng Special Drug Insurance. At the time, I paid a premium of just 29 yuan, and now over 300,000 yuan has been reimbursed. After more than ten treatments, the total reimbursement will exceed 400,000 yuan,” said Li Xingyong excitedly. “In just a few months, how could an ordinary family possibly come up with such a large sum? It truly felt like winning the lottery.”
Currently, Li Xingyong’s father’s condition has stabilized, andThe Boao Lecheng Special Drug Insurance, initially purchased for RMB 29, has already processed 16 claims, with total payouts amounting to approximately RMB 386,000.
This is a personal account from an enrollee of the 2020 edition of the Hainan Boao Lecheng Special Drug Insurance.
According to VCBeat, the 2020 edition of the Boao Lecheng Special Drug Insurance in Hainan has helped more than 700,000 patients alleviate the difficulties in accessing and using medications. In August this year, to improve the multi-tiered medical security system of “basic medical insurance + commercial insurance,” effectively extend the benefits of high-quality pharmaceutical resources to more people, and support the construction of a “Healthy China,” the Boao area of the Hainan Free Trade Port once again joined forces with multiple parties to launch the 2021 edition of the Lecheng Global Special Drug Insurance.
The 2021 edition of the Boao Lecheng Special Drug Insurance, now available, offers upgraded coverage without any increase in premium. For just RMB 29 per person annually, Hainan residents can enjoy supplementary medical coverage of up to RMB 1 million for over 100 high-cost specialty drugs from both domestic and international markets that are not included in the national medical insurance catalog, with pre-existing conditions covered. (The China-wide version starts at RMB 39 and is launched on the same day.)
What upgrades were made to the 2021 edition of the Boao Lecheng Special Drug Insurance? What are the eligibility requirements for individuals with pre-existing conditions? What efforts underpinned the launch of the Lecheng Special Drug Insurance? And what is the future potential of this insurance product? To address these questions, VCBeat conducted an exclusive interview with Peng Xuan, CEO of Yuanxin Huibao.
In August last year, guided by the Hainan Provincial Bureau of Banking and Insurance Regulation, the Hainan Provincial Healthcare Security Administration, and other authorities, and leveraging the Overall Plan for the Construction of the Hainan Free Trade Port, the Administrative Bureau of the Boao Lecheng International Medical Tourism Pilot Zone in Hainan Province jointly launched the 2020 Edition of the Boao Lecheng Global Special Drug Insurance in Hainan, in collaboration with Yuanxin Huibao, China Life Property & Casualty Insurance Company Limited, and The People’s Insurance Company (Group) of China Property and Casualty Company Limited.
As the first provincial-level, government-guided inclusive global specialty drug insurance plan,The 2020 edition of the Lecheng Special Drug Insurance attracted significant attention upon its launch, with enrollment surpassing 100,000 policies within just two days of release and ultimately exceeding 1.7 million participants.
The launch of the Hainan and nationwide versions of the Boao Lecheng Global Specialty Drug Insurance has, to some extent, alleviated a series of challenges, including the high cost of domestic medications for malignant tumors and the difficulty in accessing foreign specialty drugs. This enables Chinese residents to effectively access new overseas specialty drugs within China through insurance coverage.
“The superposition and openness of the special policies in the Boao Lecheng International Medical Tourism Pilot Zone are a microcosm of the development of China’s healthcare industry. The launch of the Hainan Free Trade Port Lecheng Global Special Drug Insurance is a concentrated manifestation of integrated institutional innovation, as well as a generous gift from Lecheng to the people of the entire province during the initial phase of the Free Trade Port construction. It allows the people of the province to tangibly experience the sense of gain from early harvests, while also contributing a ‘Lecheng Solution’ to the health of the Chinese people,” stated Gu Gang, Secretary of the Party Committee and Director of the Administrative Bureau of the Boao Lecheng International Medical Tourism Pilot Zone.
“This product has achieved multiple breakthroughs in China’s insurance market,” Peng Xuan told VCBeat.
VCBeat has learned that, as a major public welfare project in Hainan Province benefiting nearly 10 million residents,The 2021 Hainan Edition of the Lecheng Global Special Drug Insurance has undergone multi-faceted upgrades in terms of the number of covered drugs, the eligible population, and health services, while maintaining the annual premium of RMB 29 per person and the sum insured of RMB 1 million.
First, compared with the 70 drugs covered by the 2020 version of the Boao Lecheng Special Drug Insurance, the newly launched special drug insurance covers a larger number of drugs, reaching 100, including 75 overseas special drugs and 25 domestic special drugs not covered by social security. The covered diseases include liver cancer, lung cancer, breast cancer, colorectal cancer, and gastric cancer, which are highly prevalent in Hainan, as well as leukemia, prostate cancer, and lymphoma, among other high-incidence conditions.
Lecheng Global Special Drug Insurance (Hainan Edition): List of 25 Domestic Drugs
Lecheng Global Specialty Drug Insurance (Hainan Version) List of 75 Overseas Medications
Secondly, the coverage is broader: Hainan Province household registration holders, Hainan ID card holders, local basic medical insurance participants in Hainan Province, and their immediate family members are all eligible for enrollment, with no restrictions on age, occupation, or health status.
Finally, the scope of health services has been expanded, with upgrades to eight value-added services: global medication search, patient recruitment, cancer genetic testing, early screening for critical illnesses, direct-access healthcare for proton and heavy ion therapy, online text-and-image consultations, overseas second opinions, and emergency rescue.
Furthermore, it is worth noting that the most significant upgrade in the 2021 edition of the Boao Lecheng Special Drug Insurance, compared to the 2020 edition, is the inclusion of coverage and reimbursement for pre-existing conditions.
“The specific scope of covered conditions corresponds to the indications listed in the drug formulary. For insured individuals with pre-existing conditions, the reimbursement rate for expenses related to specified medications incurred during the policy period, where such expenses are attributable to the pre-existing condition, is 30%.”"Pre-existing conditions can be covered and compensated, which will benefit more Chinese people," said Peng Xuan.
The Boao Lecheng Global Special Drug Insurance has disrupted the traditional pricing basis of commercial health insurance. By integrating medical insurance data, it shifts from relying solely on historical disease incidence rates to incorporating multi-factor data elements. Underwritten jointly by multiple insurers and supported by the Hainan Provincial Healthcare Security Administration, the product features integrated pricing that accounts for various factors, including province-wide claim incidents and special drug utilization rates. Additionally, a commercial insurance payment platform has been introduced to offer patients flexible payment options, such as installment plans.
According to Peng Xuan, the claims process for the 2021 edition of the Boao Lecheng Special Drug Insurance is as follows:
First, if a patient who has purchased the Lecheng Special Drug Insurance is unfortunately diagnosed with cancer, and the diagnosed cancer falls within the coverage scope corresponding to the drug list specified in the product, the patient may submit a claim application via the official WeChat account or at offline service centers during the policy period.
Subsequently, upon receiving the patient’s claim application, the insurance company will initiate the claims review process.Patients whose applications are approved may receive 100% reimbursement for specified medication costs, provided that pre-existing conditions are not involved; in cases where the medications are used to treat pre-existing conditions, they may still receive 30% reimbursement for specified medication costs.
Furthermore,Approved customers may also enjoy additional services such as direct medication claims (where pharmacies deliver medications directly, and patients are only responsible for costs outside the coverage scope) and medication reimbursement (where patients purchase medications themselves and apply for retrospective reimbursement based on the coverage scope). Among these, high-cost deposit advance services are additionally available for specific overseas medications.
Finally, after the patient submits a claim application, a dedicated specialty drug service representative will provide one-on-one follow-up support, regularly monitoring the patient’s medication adherence and assisting throughout the process with the preparation of required claim documentation and guidance on reimbursement procedures.
On the same day that the 2021 Hainan Edition of the Boao Lecheng Special Drug Insurance was launched, the National Edition was also released.
VCBeat has learned that,The 2021 National Edition of the Boao Lecheng Global Special Drug Insurance covers 100 specific drugs, 10 overseas medical devices, and 12 health management services. With annual premiums starting at RMB 39, it is available to individuals of all nationalities residing in mainland China. The eligible age for first-time enrollment ranges from 28 days after birth to 60 years, while renewals are accepted up to age 99. Lower premiums are offered for family policies.
“The 2021 Hainan Edition of the Lecheng Global Specialty Drug Insurance has undergone comprehensive upgrades in terms of the number of covered drugs, beneficiary population, and health services. Notably, the number of covered drugs has increased from 70 last year to 100, including 25 specialty drugs not covered by China’s national social security system and 75 overseas specialty drugs,” said Peng Xuan, adding that the successful launch of the Lecheng Global Specialty Drug Insurance was made possible by the joint efforts of all parties involved.
Among them,What role does Yuanxin Huibao play? What efforts have been made in the design and launch of its products?
Peng Xuan stated that Yuanxin Huibao has long been committed to alleviating the financial burden on the public regarding high-priced oncology drugs and innovative medicines in the field of specialty pharmaceuticals.In 2020, Yuanxin Huibao partnered with the Boao Lecheng Administrative Bureau to jointly establish the “Boao Lecheng International Medical Tourism Pilot Zone Integrated Insurance Service Platform,” aiming to introduce the health insurance industry into Lecheng and “build a customer data center based on insured patients to achieve information sharing, matching, and refined operational management among various institutions.”
During the early design phase of the Boao Lecheng Global Specialty Drug Insurance and in the promotion of its upgraded version, Yuanxin Huibao held multiple negotiations with major pharmaceutical and medical device giants to secure the inclusion of their products within the insurance coverage. For the 2021 edition of the Boao Lecheng Global Specialty Drug Insurance, which features home delivery of medications, direct drug cost reimbursement, and eight newly upgraded value-added services, Yuanxin Huibao will provide professional support.
Furthermore, according to Peng Xuan, Yuanxin Huibao has successively established strategic partnerships with multiple institutions, including Hainan Boao Super Hospital and Hainan Boao Evergrande International Hospital. By linking “medical care–patients–pharmaceuticals–insurance,” it aims to create a closed-loop health protection service ecosystem, providing patients with higher-quality and more efficient medical services.
Meanwhile, it is worth noting that, as pointed out in Ping An Securities’ “Special Research Report on Health Insurance,”In recent years, China’s “Huiminbao” (inclusive supplemental medical insurance) initiatives have proliferated across multiple regions. In 2020, a total of 111 products were launched across 179 prefecture-level cities in 82 areas spanning 23 provinces, attracting over 40 million enrollees and generating more than RMB 5 billion in premium income. Among these offerings, five were national-level products and fourteen were provincial-level products. The combination of an “inclusive model” and policy support has driven explosive growth in this sector.
In an era where specialty drug insurance is experiencing explosive growth, how much room for future expansion remains?
In this regard,Peng Xuan stated that specialty drug insurance is a new type of health insurance that provides cost coverage for specialty drugs not covered by basic medical insurance, with specialty drugs being the core focus of such insurance.
In terms of pharmaceuticals, the range of drugs covered by specialty drug insurance products currently available on the market varies significantly, ranging from a dozen or so to comprehensive coverage of all therapeutic medications both within and outside the national social security formulary, with continuous updates in line with market developments;
Regarding pricing, the varying premium rates for specialty drug insurance—determined by considerations of different customer segments, scenarios, and coverage scopes—are the result of collaborative efforts among insurers, reinsurers, and service providers, including Yuanxin Huibao. Each party leverages its respective strengths in the operation of specialty drug insurance and jointly provides empirical data support during the product design phase.
“The design of future specialty drug insurance should place greater emphasis on expanding accessibility to lower-tier markets, integrating with the aging population trend, and aligning with the public’s healthcare-seeking behaviors, so as to gain broader recognition and support from the populace,” Peng Xuan told VCBeat.