What will happen to "hospitalization insurance" in corona home treatment?

September 1st 20:50

In mid-June, my husband (reporter Kanazawa), who was away from home, was infected with the new coronavirus and was recuperating at home.

She had a fever and a sore throat, but luckily she was fine.


When I told my boss about my husband's corona infection, the response was, "It seems that hospitalization insurance is available even for home treatment." So I checked.



And the target of the benefits will change greatly from the end of September.



(Added new information to July 26 article)

Record-breaking home care

Due to the rapid spread of infection due to the “seventh wave,” the number of people receiving medical treatment at home has reached a record high.



Until now, hospitalization benefits have been received according to the contract details of the medical insurance you have subscribed to when you receive medical treatment at home.



Regarding this, on SNS, "My employee received 300,000 yen after taking a three-week break due to a chain reaction from a child," or, "Just in case, I got more than 200,000 yen with corona insurance and life insurance. I'm saved because my husband can't go to work due to heavy contact."



In addition, there are posts such as "It seems that the number of policyholders who go to receive PCR immediately after joining medical insurance that provides hospitalization benefits if they are determined to be positive" and "I will be tested as many times as I want until they become positive". was.

What do I need in order to receive benefits?

According to the Life Insurance Association of which the insurance company is a member, the required documents differ slightly depending on the insurance company, but in principle, in the case of home treatment or accommodation treatment, a positive diagnosis is received from a medical institution and "deemed hospitalization" is done. Proof is required.



“My HER-SYS” is a national system that allows patients to enter their health status on a smartphone or computer.



When you receive medical treatment at home, you can register with the contact from the public health center or medical institution and use it to report your physical condition.

In some cases, hospitalization benefits are paid by filling out a form sent by each insurance company that describes the period of medical treatment, etc. and printing this screenshot.



When the "My HER-SYS" screen is not available, the "Certificate of Accommodation and Home Care" issued by a medical institution or public health center can be used as a substitute. The association has informed each insurance company to respond with an alternative document.

Examples of alternative documents


▽ Documents that show the results of PCR tests and antigen tests conducted at medical institutions, etc. ▽ Medical bills



Prescriptions and dosing instructions for corona treatment drugs


▽ Health follow-up center reception results established by local governments (LINE ▽A copy

of


the emails exchanged between the public health center and the positive person


▽Information from the public health center to the positive person (including points to note about health observation and life support)


▽Results of the testing center conducting the PCR/antigen test (excluding commercially available test kits) )

The association wants you to check the alternative documents handled by each insurance company, as they differ.

About 40 companies that are members of the association paid about 88.97 billion yen in hospitalization benefits for 913,685 cases last fiscal year for home treatment and accommodation treatment.



This fiscal year, in just three months until the end of June, there were 1,867,550 cases for approximately 169,121,210,000 yen.



We have already surpassed last year's numbers and amounts.

Review of payment targets, limited to people at high risk of becoming seriously ill

Under these circumstances, insurance companies have decided to review the payment of hospitalization benefits due to "deemed hospitalization" due to the review of the total number of new corona infected people.



Specifically, the payment will be limited to people with a high risk of becoming seriously ill, such as ▽ elderly people over 65 years old, patients who need hospitalization, pregnant women, and patients who need treatment drugs and oxygen for the new corona. increase.



The operation may differ depending on the insurance company, but it is expected that the target will be reviewed from the end of September at the earliest.

Expert “Changes in social conditions and miscalculations in the background”

Professor Nobuyasu Uemura of Fukuoka University, who is familiar with insurance, believes that it is appropriate to review the coverage of hospitalization insurance in line with the government's review of the total number of patients.

"I think it's a story that expands the interpretation of the insurance agreement and dares to bring the amount paid closer to normal. Corona is an unknown disease, and the initial situation where we don't know what will happen is the social situation. has changed considerably, and I thought that it was necessary to review it.

In addition, it is pointed out that there was a miscalculation on the insurance company side in the background of this time.

"There are two miscalculations for insurance companies. One is that we didn't think that the number of positive people would increase so much. The other is that we didn't expect so many insurance claims for 'deemed hospitalization.'"

On the other hand, regarding the target age of 65 years and over, ``I think it is in accordance with the government's policy, but there is some doubt from the perspective of fairness whether it is reasonable to say that people over 65 years old have a high risk of becoming seriously ill. ' said.



And as confusion is expected in the future, the insurance company is required to provide a polite explanation.

“Customers have a lot of confusing information, so I would like them to keep that in mind. I think there will be a considerable amount of inquiries, so I would like them to provide meticulous responses that convey the latest information as much as possible in a way that is easy to understand.”

When I interviewed the Life Insurance Association, it means that the timing and necessary documents to review the target are different for each company.



It seems that you need to check frequently on the homepage of the insurance company you are joining.



(Reporting reporters: Yukie Kanazawa, Yu Suzuki, Sho Ito, Yuichiro Yano)