官宣9款医疗险覆盖商保创新药后又撤销，复星联合健康保险缘何“悔棋”

市场资讯2025-12-18

来源：北京商报　　多天前，首版《商业健康保险创新药品目录》公布，目录中19种创新药被正式推向了商业健康保险的舞台中央。业内正翘首以待，谁会将目录中的创新药纳入保险保障，成为第一批“吃螃蟹”的保险机构。一则“官宣！复星联合健康保险9款医疗险覆盖商保创新药！”的推文便在保险圈炸开了锅。　　然而，市场情绪的升温尚未持续太久，便出现了异样。12月18日，北京商报记者注意到，这篇承载着行业期待的“官宣...

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Why did Fosun United Health Insurance \"regret\"","themeId":null,"isJumpTheme":false,"ttsUrl":null,"symbols_score_info":{"600196":1.86,"02196":1.86},"content_text":"来源：北京商报\n　　多天前，首版《商业健康保险创新药品目录》公布，目录中19种创新药被正式推向了商业健康保险的舞台中央。业内正翘首以待，谁会将目录中的创新药纳入保险保障，成为第一批“吃螃蟹”的保险机构。一则“官宣！复星联合健康保险9款医疗险覆盖商保创新药！”的推文便在保险圈炸开了锅。\n\n　　然而，市场情绪的升温尚未持续太久，便出现了异样。12月18日，北京商报记者注意到，这篇承载着行业期待的“官宣”文章，在其官方微信公众号上已然不见踪影，只留下“已删除”的提示。一场备受瞩目的“官宣”，在众目睽睽之下上演了“撤回”的戏码。那么，从高调宣布到悄然撤回，这“虚晃一枪”的背后，原因几何？对于整个健康险市场而言，首版商保创新药目录的发布，究竟意味着怎样的机遇与变局？\n　　撤回“官宣”，公司回应\n　　“官宣！复星联合健康保险9款医疗险覆盖商保创新药！”12月18日，北京商报记者了解到，复星联合健康保险的一则公告在行业引起关注。\n　　“此前部分城市的惠民保宣传纳入商保创新药目录中的药，目前终于看到有保险公司官宣自家的中端医疗险、长期医疗险纳入商保创新药目录中的药。”复星联合健康保险的官宣无疑令业内欣喜。\n　　不过，此事却出现了“反转”。北京商报记者查看复星联合健康保险微信公众号，该推文显示已删除。\n　　“根据我们接到的通知，官微推文确实已经撤销。”北京商报记者拨通了复星联合健康保险总公司消费者权益保护专线。对于相关公告删除的原因，相关人员表示，目前还没有商议敲定，所以就撤掉了。\n　　对于是否会再次公告等问题，上述人员告诉记者，到时以实际发布的内容为准。\n　　北京商报记者根据删除的推文了解到，复星联合健康保险表示，对9款保险产品进行药品清单调整，在原有药品清单基础上，根据国家医疗保障局发布的《商业健康保险创新药品目录》，增加创新药品。本次药品清单调整自2026年1月1日起，对复星联合乐健2025中端医疗保险、复星联合乐健2025中端医疗保险（互联网）、复星联合乐健高端住院长期医疗保险（2.0版）等9款保险产品的被保险人生效。\n　　在业内眼中，这一进一退略显突然。对于文章删除原因，众托帮联合创始人兼总经理龙格分析认为，可能相关产品细节、赔付规则或与药企的合作条款尚未最终敲定，出于内部流程严谨性和避免市场误读的考虑，故先撤回，待方案完全确定再公布。龙格同时也表示，医疗险覆盖商保创新药具有积极意义，可以直接减轻患者使用高价创新药的经济负担，激励药企研发，推动健康险从同质化竞争转向价值竞争，完善多层次医疗保障体系。\n　　在中央财经大学副教授刘春生看来，将商保创新药纳入医疗险，能显著提升保险产品的保障价值和竞争力，切实减轻患者的用药负担。此次先公布后撤销的操作，短期内可能引发市场对其内部管理和决策流程的疑问，但若公司能坦诚沟通、尽快敲定并公布最终方案，可将负面影响降至最低。\n　　对接目录仍需解决定价等难题\n　　复星联合健康保险“悔棋”动作的背后，与首次推出的《商业健康保险创新药品目录》不无关联。\n　　12月7日，国家医保局公布了医保目录。与之前七年公布的目录相比，这一次增加了商保创新药目录，这次涉及19种药品，包括治疗肿瘤、罕见病以及阿尔茨海默的药品。它们的共同特点是创新程度高、临床价值大、患者获益显著，且超出基本医保保障范围。在业内人士看来，首个商保创新药目录将提升商业保险的购买率。\n　　创新药支付难一直是我国生物医药产业发展的症结。毫无疑问，商保创新药目录无论是对创新药企还是保险机构，都是一个多方共赢、协同发展的契机。对于保险机构来说，通过聚焦高值创新药，保险产品可更精准对接未被基本医保覆盖的临床需求，提升产品差异化竞争力；加强与医药产业协同。\n　　对于医疗险覆盖商保创新药，刘春生认为，这是健康险发展的必然方向，有助于构建“医保保基本、商保补高端”的格局。但成功关键在于险企能否做好风险管控，实现业务的可持续发展。\n　　然而，机遇的另一面是严峻的挑战。龙格认为，核心问题是缺乏历史数据导致精算定价难，以及高价药带来的赔付率失控风险。因此，险企需要把握机遇，善用“三除外”政策，并积极与药企、医疗机构合作，探索数据共享和风险共担机制，开发更精准的产品与服务。\n　　因此，面对这片新海域，险企需要做足准备。“对险企而言，纳入创新药目录的主要难点在于高昂的药价会推高理赔成本，且缺乏长期数据来精准定价和管控风险；对于险企来说，可以通过开发专属产品实现差异化竞争，并借此与药企合作，积累宝贵的医疗数据，为长远发展奠定基础。”刘春生表示。\n　　增资获批，近年来净利波动\n　　复星联合健康保险成立于2017年1月，为国内第六家获批开业的专业健康险公司。主要股东包括上海复星产业投资有限公司、上海复星医药（集团）股份有限公司（以下简称“复星医药”）、国际金融公司（IFC）等。\n　　该公司开展各类医疗保险、疾病保险、失能收入损失保险、护理保险等业务。\n　　回顾其业绩，可以看到一条清晰的爬坡曲线。业绩层面，2021年，连亏四年的复星联合健康保险扭亏为盈，并开始实现连续盈利。\n　　2021—2024年，该公司分别实现净利润0.20亿元、0.63亿元、0.23亿元、0.42亿元。今年前三季度，该公司净利润0.63亿元。\n　　刘春生表示，保险公司要减少利润波动、实现稳定盈利，核心在于平衡好业务增长与风险控制。关键举措包括，在承保端严格风控，在投资端采取稳健策略保证收益，同时采取持续优化运营成本等举措。\n　　目前，该公司董事长一职待补位。2024年9月，复星联合健康保险公告称，曾明光因个人原因辞去公司董事长职务。2025年三季度偿付能力报告显示，彭玉龙现任复星联合健康保险董事，代为履行董事长职责。\n　　需要关注的是，近年来，复星联合健康保险频频寻求增资，此前多次增资方案未有下文。今年9月，该公司公告称，监管同意该公司增加注册资本3.1641亿元，由6.9444亿元变更为10.1085亿元。\n　　根据相关公告，此次增资不仅获得了大量注册资本，还引入两大国际资本股东。\n　　复星医药此前在公告中提到，本次增资将有利于推动复星集团医药、医疗健康服务等业务与商业保险的合作融通，进一步探索模式创新、加深业务协同。\n　　龙格认为，此次复星联合健康保险增资，可以直接提升公司资本实力和偿付能力，为覆盖创新药等新业务提供风险缓冲，支持规模扩张。引入国际资本还有助于带来管理经验与资源，助力其“保险+医疗”生态布局。\n\n\n海量资讯、精准解读，尽在新浪财经APP\n\n责任编辑：曹睿潼","kind":"news","is_publish_news":true,"is_publish_highlight":false,"is_publish_live":false,"is_publish_wemedia":null,"editions":null,"column":"","sentiment":"-1","news_tag":"","news_rank":0,"symbols":[],"gpt_button":1,"need_auth":false,"code":"91000000","status":"200"},"commentList":[],"isCommentEnd":true,"newsSizeData":{"likeSize":0,"commentSize":0,"repostSize":0,"favoriteSize":0,"likeStatus":false,"favoriteStatus":false},"APP":{"userAgent":"Mozilla/5.0 AppleWebKit/537.36 (KHTML, like Gecko; compatible; ClaudeBot/1.0; +claudebot@anthropic.com)","isDev":false,"isTTM":false,"deviceId":"web-server-community-laohu8-v3","version":"4.35.13","shortVersion":"4.35.13","platform":"web","vendor":"web","appName":"laohu8","isIOS":false,"isAndroid":false,"isTiger":false,"isTHS":false,"isWeiXin":false,"isWeiXinMini":false,"isWeiBo":false,"isQQ":false,"isBaiduSwan":false,"isBaiduBox":false,"isDingTalk":false,"isToutiao":false,"isOnePlus":false,"isHuaWei":false,"isXiaomi":false,"isXiaomiWebView":false,"isOppo":false,"isVivo":false,"isSamsung":false,"isMobile":false},"href":"/m/news/2592906229","isCrawlerRequest":true}