Insurance companies will review the payment targets for hospitalization benefits that are paid when medical insurance subscribers are infected with the new corona.
Currently, in principle, we are paying everyone, including the so-called "deemed hospitalization" where you are recuperated at home, but from the end of this month at the earliest, we will limit it to those who are at high risk of becoming seriously ill, such as the elderly.
If a medical insurance subscriber is infected with the new coronavirus, even in the case of so-called "deemed hospitalization" where medical insurance subscribers are treated at home or at a hotel, if there are documents that prove medical treatment issued by public health centers and medical institutions, In principle, I have accepted the payment of hospitalization benefits.
Regarding this, on the 1st, the Financial Services Agency asked industry groups to consider the handling of hospitalization benefits due to "deemed hospitalization", including the payment targets, as soon as possible in line with the review of the grasp of the total number of people infected with the new coronavirus. I had a request.
In response to this, insurance companies are reviewing the payment of hospitalization benefits.
Specifically,
▽ elderly people over 65 years old, ▽
patients who need hospitalization,
▽ pregnant women,
and ▽
people who are at high risk of becoming seriously ill, such as patients who need new corona treatment drugs and oxygen,
I am limiting my payments.
The specific operation may differ depending on the insurance company, but it is expected that the target will be reviewed from the end of this month at the earliest.
To receive benefits for “deemed hospitalization”
Regarding hospitalization benefits for medical insurance, the spread of the new coronavirus has put a strain on the medical field, and there have been a series of cases where patients cannot be hospitalized. I am responding to a request for money.
The required documents differ depending on the insurance company, but if a person who received medical treatment at home, etc., wishes to claim hospitalization benefits, the patient himself/herself can enter information such as his/her health condition using a smartphone or computer. You will be asked to take a picture of the screen specified by the company with a smartphone or the like, or submit a "medical certificate" issued by a medical institution or public health center.
However, some public health centers are busy with the task of issuing medical certificates, and there are situations where they are unable to adequately respond to people at high risk of becoming seriously ill.
For this reason, public health centers are calling for the use of a system called “My HER-SYS,” in which patients themselves enter information on their smartphones or computers when issuing medical care certificates.
In addition, as confirmation documents instead of medical treatment certificates, insurance companies provide documents that show the results of PCR tests and antigen tests conducted at medical institutions, emails that show communication with public health centers, and prescriptions for new corona therapeutic drugs. We are planning to create a system that does not burden the medical field, such as by using
Payments to “deemed hospitalization” patients surge
Payments by insurance companies to "deemed hospitalization" patients have surged recently.
According to the Life Insurance Association of Japan, the total number of hospitalization benefits paid by the 42 companies that are members of the association due to the corona crisis by the end of July this year was 3,515,966, of which 93%, or 3,292,091. I was a contractor of "deemed hospitalization".
The number of payments to "deemed hospitalization" patients exceeded 110,000 in October last year, but then decreased, and in January this year it decreased to about 10,000.
However, as the number of claims for the sixth wave of infected people increased, it surged to 400,000 in March, 520,000 in April, 640,000 in May, and 700,000 in June. continued to increase.
Along with this, the amount of insurance payouts paid by insurance companies has also increased sharply, and payments to policyholders of "deemed hospitalization" paid by the end of July due to the corona wreck reached 304,668,530,000 yen.
Until last year, the amount paid was about 10 billion yen even in the most months, but this year it increased to 38 billion yen in March.
It continued to increase to 49.2 billion yen in April, 57.7 billion yen in May, and 62.0 billion yen in June.
In July, it was 39.5 billion yen.
Since the spring of this year, insurance companies have responded by significantly increasing the number of employees in charge of payment of benefits, but due to the number of cases exceeding expectations, the payment procedure may take longer than usual. It means that they are one after another.
Inappropriate cases for the purpose of benefits
The reason for the increase in payments is the increase in the number of infected people, but according to insurance companies, there are cases where inappropriate contracts are suspected to receive hospitalization benefits.
For example, if you have symptoms such as fever, or after finding out that a family member you live with has been infected, you may enroll in an insurance policy that provides high-cost coverage, and cancel it as soon as a negative PCR test is confirmed. to be seen.
Insurance companies are taking measures such as strengthening confirmation work with the person if there is a suspicion that the contract does not match the original purpose of the insurance, such as repeated purchases and cancellations of high-cost medical insurance in a short period of time. .
Expert: “Insurance companies should give careful explanations”
Nobuyasu Uemura, a professor at Fukuoka University who is familiar with the insurance industry, said, ``When the insurance company decided to pay hospitalization benefits even if it was a ``deemed hospitalization,'' we still didn't know what kind of disease the corona was and how serious it was, so it wasn't for society. However, today, even if the symptoms are not severe, if you test positive, you will be able to receive benefits, and some people dare to enroll in insurance to receive benefits. It's coming out," he points out.
He added, ``In the first place, the source of the hospitalization benefits is the insurance premiums paid by the insured, and the balance between those who pay the premiums and those who receive the benefits is broken, and the situation is unfair. So, it should be taken as a story of returning to a normal state."
On the other hand, regarding the future, ``It is irregular to pay benefits for ``deemed hospitalization,'' but it is also irregular to stop doing so. In addition, there is a possibility of confusion in the transitional period of the review, and insurance companies will be required to provide detailed explanations, such as clarifying the terms of payment in advance." .
He also pointed out, ``It is important for insurance policyholders to obtain information such as contacting their insurance company and confirming the content of announcements, so as to know what kind of response is required.'' doing.