News

The Health Insurance Act restricts health insurance benefits under certain conditions in cases contrary to the spirit of the health insurance system—for example, if an injury is attributable to a deliberate and illegal action.

Based on the provisions of the Act, the Hitachi Health Insurance Society has established standards on restricting benefits. These standards entered into effect in October 2017.

 

1. Standards on restricting benefits

<Loss of all coverage (not including funeral expenses)>

・ Injuries suffered in accidents attributable to drunk driving or driving under the influence of alcohol or accidents to which legal provisions on dangerous driving leading to death or injury apply

・ Intoxication due to use of illegal drugs

・ Bone fractures sustained by kicking a wall or other item in anger

・ Suicide or attempted suicide (excluding cases attributable to mental disorder)

etc.

 

<Loss or partial loss of coverage>

・ Injuries suffered due to fights or other violence

・ Injuries attributable to extreme intoxication

・ Failure to respond to requests by the Health Insurance Society to submit documentation or notifications

etc.

 

2. Loss or partial loss of certain insurance benefits

Loss or partial loss of coverage for Health Insurance Society’s portion of medical care costs and cash benefits (High-Cost Medical Care Benefits, additional benefits, Injury and Sickness Allowance, etc.)

 

3. Date of application of standards

These standards apply to grounds for claims arising on or after October 1, 2017.