COVID-related hospital benefits face stricter eligibility criteria from Japan’s life insurers

The Yomiuri Shimbun

13:57 JST, August 31, 2022

The life insurance industry is preparing to substantially narrow the scope of COVID-19 patients eligible for hospital benefits in medical insurance policies from late September at the earliest, it has been learned.

So far, the benefits have been paid to all patients, including those recuperating at home. The move by life insurers comes as the government is considering relaxing measures such as requests to refrain from going out.

Specifically, the life insurers plan to limit the payment to those who cannot avoid hospitalization or home treatment, including the elderly ages 65 and over, pregnant women, and people on medication. At the same time, the life insurers will establish a system to handle necessary payments even in the event that home care certificates are no longer sent to patients recuperating at home after a review of the total number of infected people.

In private medical insurance policies, life insurers are currently accepting claims for hospital benefits even in cases in which policyholders are recuperating at home as long as they submit home care certificates issued by medical institutions.

The life insurance industry has decided to narrow the scope of those eligible for hospital benefits because, in addition to the rapid increase in the number of infected people, the government will balance pandemic measures with economic activities by, for example, shortening the period of medical treatment and easing restrictions on going out for asymptomatic patients.