Health Plan Files IPO Prospectus Amid Expansion of Digital Health Services

Health Plan: A Health Plan refers to a standardized, personalized health management service program developed by the healthcare industry for social groups and individuals. It is designed with strong executability and demonstrated effectiveness to prevent and reduce disease incidence, improve the quality of medical care, control healthcare costs, enhance treatment outcomes, and reduce expenditures.

Health Insurance
Abroad, "Health Plan" is often synonymous with "Health Insurance." Health insurance primarily refers to insurance that offsets individual medical expenses. By estimating the overall healthcare and health system expenditures for a specific population, insurance companies can develop a standardized financial framework, such as monthly premiums or payroll taxes, to ensure that the medical benefits stipulated in the insurance agreement are effectively covered. These benefits are administered by a central entity, such as a government agency, a private enterprise, or a non-profit organization. Coverage typically includes insured events, medical costs, disability losses, and accidental injury or death.

Generally, health insurance providers can be clinics, hospitals, physicians, laboratories, or pharmacies. In some countries without comprehensive health coverage, such as the United States, health insurance is typically included in employer-sponsored benefit plans.

In some countries, such as the United Kingdom and Canada, health insurance is provided by the government and regarded as a fundamental right of citizens, forming part of national public services. In fact, among European Union member states, nearly all developed nations with medium-to-high income levels have established government-led universal healthcare systems, achieving the goal of “free access to medical care.” Similar objectives have largely been realized in developed Asian regions such as Japan, South Korea, and Singapore. By contrast, other countries, notably the United States across the Atlantic, lack a healthcare welfare system comparable to Europe’s. Achieving universal health coverage remains challenging, with coverage limited primarily to specific social groups, such as the elderly, people with disabilities, and military personnel. Although former President Obama made sustained efforts to promote universal healthcare in the United States, the fragmentation of various healthcare welfare programs has rendered the organization and establishment of a universal system considerably more complex.



Generally, there are two types of health and medical insurance.
Private Health Insurance — Americans rely heavily on this type of health coverage. According to surveys, 58% of U.S. citizens have such insurance.

Public Health Insurance – This type of insurance is provided by the state but still requires the collection of premiums. In the United States, federal social insurance and Medicaid programs are available to individuals aged 65 and older as well as those with disabilities, funded jointly by the federal government and state governments.

Health Insurance vs. Health Plans
Although health plans are often equated with health insurance, there is a slight distinction between the two. Historically, Health Maintenance Organizations (HMOs) have tended to use the term “health plan,” whereas commercial insurers have preferred the term “health insurance.” A health plan may be a primary care arrangement provided by an HMO or a Point-of-Service (POS) plan. Prepaid health plans typically cover a fixed amount of services, such as $300 for preventive care, a specified number of days of hospital care, a set number of home health visits, or a defined period of hospice care.

There are many different types of health plans available for employers and employees to choose from, including Health Savings Accounts (HSAs) and medical insurance plans with varying levels of deductibles. Let us first introduce a professional concept: the deductible. Also known as an "out-of-pocket amount," a deductible refers to the portion of loss within a specified limit for which the insurer is not liable under the insurance contract. The provision of deductibles is primarily intended to reduce frequent small claims payments, enhance policyholders’ sense of responsibility, prevent avoidable losses, and lower insurers’ operational costs. The inclusion of deductibles is a standard practice among both international and domestic insurance companies.

Some insurance plans have high deductibles. Typically, these plans require employees to pay lower monthly premiums; however, when employees utilize their insurance, the reimbursement amount is lower, resulting in higher out-of-pocket costs for the employee. Such insurance plans are suitable for individuals who rarely visit doctors and have minimal medical needs. Plans with low deductibles are generally more expensive, but they significantly reduce expenses related to medical services and treatments. The recent trend shows employers offering high-deductible health plans to employees, known as consumer-driven healthcare plans. This is because such plans require employees to pay lower premiums while simultaneously reducing the overall cost burden associated with employees' healthcare needs.

In the United States, health insurance policyholders typically choose insurers that have been accredited by renowned quality assurance programs, such as The Joint Commission or the National Committee for Quality Assurance.



Editor: Huang Jia