Acute treatment for cerebral infarction is expensive, and subsequent long-term rehabilitation and persistent sequelae often lead to increased living expenses. This frequently results in a financial burden that cannot be fully covered by public health insurance (High-Cost Medical Expense System).
Estimated Insurance Payouts for Cerebral Infarction (as of 2025)
Cerebral infarction (a type of stroke) is often covered by life insurance and medical insurance, allowing for payouts upon hospitalization, surgery, and confirmed diagnosis. However, the amount varies based on the contract details (coverage amount set) and the insurance company, and is not fixed. The table below summarizes general estimates. Always check your insurance policy and contact your insurance provider for the exact amount.
1. In the Case of Medical Insurance (Focus on Hospitalization/Surgery)
Medical insurance typically pays out upon the onset of stroke (hospitalization, surgery, outpatient visits). Private medical insurance supplements the out-of-pocket expenses required by public health insurance.
| Payout Type | Content | Estimated Payout (Per Occurrence) | Notes |
| Hospitalization Benefit | Per day of hospitalization | ¥5,000−¥10,000 daily | Average hospital stay is 21−45 days, totaling ¥100,000−¥500,000. May exceed ¥500,000 if severe and prolonged. |
| Surgical Benefit | Thrombectomy (catheter) procedure, etc. | ¥50,000−¥200,000 (Based on surgical complexity grade) | Endovascular cerebral procedures are often classified as “highly advanced surgery,” leading to higher payouts. |
| Outpatient Benefit | Outpatient rehab post-discharge | ¥2,000−¥5,000 per visit (Max 60 days) | ¥100,000−¥200,000 for recovery phase rehabilitation. |
| Diagnosis Benefit | Confirmed cerebral infarction diagnosis | ¥100,000−¥500,000(Lump sum) | Applicable if the policy includes specific disease coverage. |
Estimated Total Average: ¥200,000−¥1,000,000 overall for cerebral infarction (mild to severe). Advanced medical treatments (t-PA or thrombectomy) are often covered additionally. Caution: It is difficult to enroll in a new policy with a pre-existing condition history; often, reduced underwriting policies (with higher premiums) must be chosen.
2. In the Case of Life Insurance (Focus on Death/Critical Illness)
Life insurance primarily covers death, but with a Critical Illness (CI) rider (Cancer, Myocardial Infarction, Stroke), a lump sum is paid upon confirmed stroke diagnosis. The base coverage applies upon death.
| Payout Type | Content | Estimated Payout | Notes |
| Critical Illness Lump Sum | Stroke diagnosis + sequelae (e.g., hemiplegia) | ¥500,000−¥5,000,000 | Depends on the amount set at contract (e.g., 100% of base death coverage). Full payment upon meeting specified condition (e.g., requiring long-term care level 1). |
| Death Benefit | Death caused by cerebral infarction | ¥10,000,000−¥30,000,000 | Standard contract amount, covering survivors’ financial security. |
| Specific Disease Diagnosis Benefit | Diagnosis (in mild cases) | ¥500,000−¥1,000,000 (10%of base amount) | In products from companies like Nissay, upon diagnosis less severe than the full Critical Illness definition. |
Estimated Total Average: ¥1,000,000−¥3,000,000 for the diagnostic lump sum (for severe sequelae). Death benefits are multi-million scale, but coverage during survival is key. Caution: Stroke is included as a Critical Illness, but mild cases (no sequelae) may not be eligible for the payout. Failure to disclose medical history (non-disclosure) leads to policy cancellation.
3. Overall Key Points and Advice
- Estimated Total Payout (Medical + Life): ¥200,000−¥500,000 for mild cases; ¥1,000,000−¥5,000,000+ for severe cases (with sequelae). Burden is eased when combined with the Public High-Cost Medical Expense System (capped at ¥80,000−¥150,000 monthly).
- Payout Conditions: Confirmed diagnosis, duration of hospitalization, presence of surgery, severity of sequelae (e.g., requiring long-term care certification after 1 year). As of 2025, coverage is also expanding for Tenecteplase (new drug) treatment.
- Payout for Recurrence: Repeated payouts are possible with policies offering multiple coverage, but contract limitations may apply.
- Enrollment and Claim Tips:
- If there is a history of stroke, general insurance enrollment is possible after 5 years of complete recovery.Otherwise, choose a reduced underwriting policy (e.g., Aflac).
- Claims require submission of medical certificates/receipts and take 1-2 months. Seek simulation services from free consultation centers (e.g., Hoken no Madoguchi).
- Combining with Public Coverage: Public health insurance covers 70%, and the High-Cost Medical Expense System caps costs; private insurance covers the remainder.
