When using life or medical insurance for Intracerebral Hemorrhage (a type of stroke), the payout can vary significantly based on your contract details, hospitalization days, whether surgery was performed, and whether death or residual disability occurred. Generally, medical insurance primarily covers hospitalization and surgery, while life insuranceapplies through critical illness riders and death benefits. Public health insurance’s High-Cost Medical Care Benefits system (capping monthly self-pay at approximately ¥80,000) is used concurrently, with private insurance acting as a supplement. The benefit amounts are estimates; please consult your policy or insurance company for actual figures. The average hospital stay is approx. 77–78 days (MHLW data), and the total medical cost (30% co-pay) is approx. ¥700,000 for mild to moderate cases.
1. Medical Insurance Payout Examples (Focus on Hospitalization and Surgery)
Medical insurance typically provides a daily hospitalization benefit of ¥5,000∼¥10,000. A critical illness rider adds a lump-sum payment.
| Case (Bleeding Volume/Severity) | Est. Hospital Stay (Days) | Total Medical Cost (30% Co-pay) | Est. Payout (Daily benefit ¥5,000, Hospitalization ¥10k/Surgery ¥50k) | Notes |
| Mild (10–20 mL, No Surgery) | 2–6 Weeks(14–42 days) | ¥100,000 ∼¥300,000 | Hospitalization: ¥70,000 ∼ ¥210,000 Surgery: None Total: ¥70,000 ∼ ¥210,000 | Focus on short-term stay. Rehab adds +¥10,000s/month. |
| Moderate (30–50 mL, Hemiparesis) | 3–5 Months(90–150 days) | ¥200,000 ∼¥500,000 | Hospitalization: ¥450,000 ∼ ¥750,000 Surgery: ¥50,000 Critical Illness Rider: ¥500,000 (if attached) Total: Approx. ¥1,000,000 | Days extended due to recovery rehab. Rehab adds extra payout of ¥100,000 ∼ ¥200,000 (3 hours/day). |
| Severe(>50 mL, Surgery performed) | 5–10 Months(150–300 days) | Over ¥300,000 ∼¥800,000 | Hospitalization: ¥750,000 ∼ ¥1,500,000 Surgery: ¥100,000 ∼ ¥200,000 (Craniotomy) Critical Illness Rider: ¥1,000,000 Total: ¥1,850,000 ∼ ¥2,700,000 | Endoscopic surgery may increase payout. Ventricular drainage adds ≈ ¥50,000. |
| Cerebellar Hemorrhage(Emergency Surgery) | 2–4 Months(60–120 days) | ¥150,000 ∼¥400,000 | Hospitalization: ¥300,000 ∼ ¥600,000 Surgery: ¥100,000 Total: ¥400,000 ∼ ¥700,000 | High rate of surgery, leading to a thicker payout. |
Calculation Key Points:
- Hospitalization Benefit: Daily amount × Days (e.g., ¥5,000 ×90 days=¥450,000).
- Surgery Benefit: ¥50,000∼¥200,000 for inpatient surgery (Cerebral Hematoma Evacuation is high-cost).
- Critical Illness Lump Sum: ¥500,000∼¥1,000,000 upon stroke diagnosis (depends on rider). Designed to cover average medical costs of ≈¥700,000.
- Rehabilitation Benefit: Equivalent to ≈¥2,450 per unit (20 mins) under insurance. Private insurance may add an extra daily amount of ¥1,000∼¥5,000. Caution: Payouts may be reduced if the waiting period (>90 days) or benefit limit (60 days/per occurrence) is exceeded. There is a risk of denial if the use of anticoagulants was not declared during application.
2. Life Insurance Payout Examples (Focus on Death and Disability)
Life insurance is primarily for death, but critical illness riders or income protection policies often provide hospitalization and income compensation.
| Case | Coverage Type | Estimated Payout (Death benefit ¥5M, Critical Illness Rider ¥500k) | Notes |
| Survival with Sequelae(e.g., Hemiparesis) | Critical Illness Lump Sum + Income Protection Benefit | Critical Illness: ¥500,000 Income Protection: ¥100,000/month ×6 months=¥600,000 Total: ¥1,100,000 | Compensation is 60% of pre-disability salary (max 1.5 years). ¥500,000∼¥3,000,000 may be added based on residual disability grade (1st∼14thgrade). |
| Death(Directly from ICH) | Death Benefit | ¥5,000,000 (Base Coverage) + Critical Illness Rider ¥500,000 Total: ¥5,500,000 | High mortality rate for severe cases like Pontine Hemorrhage. Can be supplemented for funeral costs. |
| Severe Residual Disability(Bedridden) | Severe Disability Lump Sum | Grade 1: ¥3,000,000 Grade 5: ¥1,000,000 Total: ¥1,000,000 ∼¥3,000,000 | Paid based on disability grade (e.g., thalamic pain or quadriparesis). Effective for covering long-term care costs. |
Calculation Key Points:
- Critical Illness Coverage: Lump sum of ¥500,000∼¥1,000,000 upon stroke diagnosis (equivalent to ≈¥300,000 for cancer or ≈¥530,000 for myocardial infarction).
- Income Protection: Compensation for the period unable to work (average 3–6 months). Monthly salary of ¥300,000 may yield a ¥180,000 monthly benefit.
- Death Benefit: Full base contract amount (¥3M∼¥10M). ICH mortality rate is 10–40% (varies by site). Caution: Pre-existing conditions must be declared, which can lead to enrollment restrictions. Joining after onset is difficult; simplified issue policies (e.g., Aflac) may be an option with an additional monthly premium of ¥2,000∼¥5,000.
Overall Financial Burden Reduction Example (Moderate Case, 3-Month Stay)
- Public Burden: High-Cost Medical Care Benefits cap at ≈¥80,000/month → Total medical cost of ¥500,000→Actual self-pay burden ¥240,000.
- Private Insurance Payout: Hospitalization ¥450,000 + Surgery ¥50,000 + Critical Illness ¥500,000=∗∗¥1,000,000.**
- Net Financial Impact: ¥240,000 (burden) – ¥1,000,000 (payout) =∗∗¥760,000 surplus** (Excess benefit). This can cover rehabilitation and living expenses.
Tips for Utilization (2025 Update)
- High-Cost Medical Care Application: Apply for the Certificate of Application for Ceiling Amount in advance to cap the window payment at ≈¥80,000/month.
- Recommended Insurance: Medical insurance like EVER Simple (Aflac, covers stroke). Opt for Critical Illness insurance for the lump sum benefit.
- Consultation: Free consultations are available at insurance agencies (e.g., Hoken no Madoguchi or Money Career). Review your policy beforehand if you have a family history.
