Verifying Comparisons:
A Look at Cancer
Insurance
What you should know about cancer, medical care,and cancer insurance

By Mitsunobu Sasaki

Public Interest Incorporated Foundation

Oriental Life Insurance Cultural Development CenterTokyo, Japan

『比較検証、がん保険 知っておくべき「癌」と「医療」と「がん保険」』
英語版出版に寄せて

今般、公益財団法人アシア生命保険振興センター様よりこのような機会を頂戴するという僥倖に、驚いている次第です。
がん保険をはじめ、第三分野商品の資料がなかったため 2015 年に法律家の方々や大学の研究者の方々から要望を受け、「がんとがん保険」（保険毎日新聞社出版）という、第三分野商品に関する業界初めての教科書的解説書を上梓いたしました。その後、一般の消費者の方や保険募集人の方々に向けた解説書も欲しいとの声を頂戴し、理解しやすい内容にアレンジして、「比較検証、がん保険」をまとめた次第です。
保険販売における情報提供義務が強化されたことや、複数社商品を扱う乗合代理店が多くなってきたため、複数社の商品を比較した情報提供を行う機会が多くなったことを意識し、タイトルに「比較検証」と入れました。したがって、保険会社の営業教育の面でも参照していただける内容にしたつもりです。
さて、本書で取り上げたがん保険は、販売件数から見ても日本の保険業界を代表する商品に育っています。さらに、公的医療保険に対する民間保険の補完機能を着実に担ってきた商品と言えます。また、国内の多くの会社からサービスが提供され、これらの商品は第三分野商品と呼ばれている数多くの商品の中でも、その中心的な商品の一つになっています。
一方、がん保険は、がんという疾病だけを保障する商品で究極の特定疾病保障保険とされています。いまや国民の「二人に一人ががんになる時代」であるとされ、がんだけに保障を限定した商品は、安価でサービスを提供することが可能になり、多くの日本国民が抱いているがんへの不安を軽減することに寄与しています。しかし、がんだけを保障するために、商品構成の面で、他の商品と異なり多数の特徴がみられます。また、販売するためには、がん保険の内容のみならず、がんの医療や、患者の療養に関する情報を、正しく消費者へ提供しなければなりません。保険を購入する側も、これらの多くの情報か
ら自分に適合した商品の選択が求められています。すなわち、販売する側、購入する側がともに、がんという疾病のリスクの理解が必要だということでしょう。
現在、保険業界を取り巻く環境の変化を見ても、インシュアテックや、オンラ
イン事務の導入、健康支援的付加的サービスの提供など大きく変わろうとして1

います。しかし、目先の環境が変化しても、保険のリスク移転機能という本質的使命は変わりません。どうやって、保障を提供するのかということより、忘れてはならないのは消費者のリスクの変化を見極め、的確に保障することです。
日本の医療費は、毎年対前年 2-3%水準で進展し、今後も拡大すると予想されています。これは、同時に民間保険の補完市場が着実に拡大することを意味しています。したがって、第三分野商品は保険会社の成長を牽引する商品であり、国民のがんリスクが無くならない限り、がん保険の重要性はゆるぎなく続くと考えます。さらに、大きく発展したアジアの多くの国々でも、日本と同様な商品へのニーズや市場が拡大し、がんへの保障も現実の課題になるはずです。
その際に、本書の英訳が各国における取り組みの一助になることを心より祈っております。
最後に、本書英訳に携わっていただいた公益財団法人アシア生命保険振興センターの皆様に感謝申し上げます。

株式会社保険医学総合研究所
代表取締役 兼 医学博士
佐々木光信

2

On preparing an English-language version of Verifying Comparisons: A
Look at Cancer Insurance What you should know about cancer, medical care,and cancer insurance

I am surprised by the fortuitous circumstances that have seen me obtain thisopportunity from the Oriental Life Insurance Cultural Development Center.
Due to a lack of materials on cancer insurance and other examples of thirdsector products, I received requests from lawyers and university researchers in2015 and consequently published the first textbook-type practical guide to thirdsector products in the industry entitled Cancer and Cancer Insurance (publishedby The Hoken Mainichi Shinbun). Thereafter, I was asked to also produce apractical guide for general consumers and insurance solicitors. In response, I
adapted the contents in a way that allowed them to be more easily understood by
the target audience and managed to put together Verifying Comparisons: A Lookat Cancer Insurance.
Aware that the obligation to provide information in the course of sellinginsurance has become reinforced and that opportunities to provide information
based on a comparison of multiple products have increased due to an increase in
the number of independent agencies handling products offered by multiple
companies, we included “Verifying Comparisons” in the title of this book.
Accordingly, I also sought to make the contents of this book informative in thecontext of the provision of sales education by insurance companies.
Cancer insurance as taken up in this book has grown into a range of productsthat can be said to embody the Japanese insurance industry, even as measured
from the standpoint of the number of policies sold. Indeed, cancer insurance canbe described as a type of product that has steadily incorporated features thatserve to supplement public healthcare insurance with private-sector insurance
coverage. As well, cancer insurance is a core product among the many products
known as third-sector products through which numerous domestic companies
provide services.
On the other hand, cancer insurance is regarded as the ultimate example of a
type of insurance that covers specific diseases, given that it is a product thatcovers only cancer. With the present being an era in which one in two persons
has or will eventually get cancer, products that are limited to providing coveragefor only cancer can enable the provision of services at a reasonable price and3help alleviate the anxiety felt by many Japanese citizens over the prospect ofdealing with cancer. However, cancer insurance has many characteristics thatdiffer from other products in terms of the way products are structured, sincecoverage applies only to cancer. In selling cancer insurance, information
pertaining to not just the contents of cancer insurance itself, but also cancer
treatment and medical care for patients, must be accurately provided toconsumers. Each purchaser of cancer insurance is then asked to assess thisinformation, of which there is a substantial amount, and choose the right productfor himself or herself. In other words, both the sellers and buyers of cancer
insurance are required to understand the risks associated with the disease known
as cancer.
Currently, even in looking at the environment surrounding the insurance
industry, it is apparent that significant changes are afoot, such as in terms of theintroduction of insurtech (insurance technology) and online businesses, and theprovision of additional health-supporting services. Even if the immediate
environment changes, however, the fundamental mission of insurance – namely,
the transference of insurable risks – remains unchanged. The question of how
we ascertain changes in consumer risks and precisely cover such risks
accordingly is something that we cannot afford to forget, even more than thequestion of how coverage is to be provided.
Healthcare costs in Japan are growing at around two to three percent a year
and are expected to continue increasing. The implication of this situation is thatthe market for complementary private-sector insurance will steadily grow at thesame time. Thus, third-sector products constitute growth engines for insurancecompanies, such that the importance of cancer insurance will likely persist
unyieldingly as long as the risk of cancer in the population does not disappear.
In many Asian countries that have developed significantly over the years, thedemand and market for products similar to the ones offered in Japan will also
grow, and the issue of cancer coverage will no doubt become a very real one tobe addressed.
It is my sincere hope that when that time comes, the English translation ofthis book will be of assistance to the implementation of measures and initiatives
in each country.

4

Finally, I would like to express my heartfelt gratitude to everyone at theOriental Life Insurance Cultural Development Center who were involved intranslating this book into English.

Mitsunobu Sasaki
President & Doctor of Medicine
Insurance Medical Research Institute5

IntroductionMore than forty years have passed since cancer insurance was first sold inJapan. During this period of time, cancer has been the leading cause of death andhas accounted for more than 350,000 deaths a year. One in two people will getcancer at some point in his or her life, such that cancer has truly become a diseaseaffecting the entire nation. While there used to be a time when cancer sufferers
and their families would have been treated poorly at the hands of society unlessthey lived in a way that prevented others from knowing that they had cancer, themodern environment surrounding cancer and cancer patients has changed
dramatically. People do not seek to hide their cancer diagnosis as much, andscenes of people unfortunately dying of cancer, people struggling with cancer,
and people beating cancer and returning to the workplace have become par forthe course these days.
The government is also undertaking full-scale efforts to combat cancer, andthe effects of these efforts are emerging, albeit gradually. Nevertheless, theunsurprising reality is that struggling with cancer after one is stricken by thedisease weighs heavily upon the patient and his or her family. There are various
problems with medical care for cancer treatment, such that these problems areindeed emblematic of the problems with medical care in Japan. Given this stateof affairs, many life insurance companies in Japan have come to offer cancer
insurance coverage in Japan. On one side of the coin, you have various types ofguarantees provided by cancer insurance plans; on the other side are some rather
intractable problems concerning efforts to fight cancer and the cancer-fighting
medical care being given to support the fight against cancer. We hereby present
an outline to explain the concepts of cancer, medical care for cancer, and cancer
insurance in order to have them understood by insurance solicitors and especiallyby those who sell cancer insurance plans in a time when medical care for cancer
is undergoing huge changes.
The Insurance Business Act was revised in 2014, at which time thesupervisory guidelines were also overhauled. In the future, it is hoped that there
will be a clarification of standards for comparing and recommending insurance
products, and activities undertaken in the world of insurance sales will also
undergo significant changes. In the second half of this document (Chapter 4),
the author has described the characteristics of different products from his own
perspective in order to get readers to understand these characteristics as
6measures for making comparisons and recommendations with a focus on cancer
insurance products that are currently being sold. Since the advantages anddisadvantages of each product have been explained in a manner that is as easy
to understand as possible, you should try to harness the information presented
herein as a source of reference materials for future sales. In the first half of thisdocument, cancer knowledge and explanations of environmental changes
surrounding medical care for cancer are presented as prerequisites for getting toknow products offered by different companies. Cancer insurance is a special
type of product that provides coverage solely of cancer and is now a part of thesocietal infrastructure supporting medical care for cancer. It is hoped that thisbook can, in however small a way, help solicitors who play a part in fulfilling asocietal mission to sell security to consumers and lighten the burden placed on
cancer patients and their families.

Introduction 7

8

Table of Contents
Introduction ..................................................................................................6
Points to note concerning the handling of this book: Comparative points . 16
Qualifications concerning comparisons ...................................................... 18
Chapter 1: Cancer and the medical treatment environment for cancer ...... 20❖ Selling cancer insurance ........................................................................ 20
1. Products that were available when cancer insurance first began to be
sold ........................................................................................................ 20
2. Subsequent expansion of sales ............................................................. 21❖ What is cancer insurance? ..................................................................... 22❖ Cancer insurance and insurance sales.................................................... 24❖ What is cancer? ..................................................................................... 25
1. Biological characteristics...................................................................... 25
2. Cause-of-death statistics ....................................................................... 27❖ The three major burdens associated with the medical treatment of cancer............................................................................................................... 30❖ Financial burdens assumed by cancer patients ...................................... 32❖ Trends in national healthcare spending ................................................. 34
1. Total healthcare spending ..................................................................... 34
2. Breakdown of healthcare spending and healthcare spending on cancer............................................................................................................... 34
3. Breakdown of the natural increase in national healthcare spending ... 35❖ Spiraling healthcare costs and the high-cost medical treatment benefit
system.................................................................................................... 36❖ Aspects of the public healthcare system that should be known ............. 38❖ Changes in the medical care environment and healthcare system forcancer .................................................................................................... 40

Table of Contents 9❖ The medical treatment of cancer and the main points concerning medical
service fees ............................................................................................ 42

Chapter 2: Cancer insurance and policy conditions................................... 43❖ Defining cancer ..................................................................................... 44❖ Two types of cancer .............................................................................. 46❖ Classification by the WHO.................................................................... 48❖ Intraepithelial neoplasm, carcinoma in situ, and dysplasia ................... 50
1. How do intraepithelial neoplasms differ from malignant neoplasms? 52
2. At what sites do they commonly develop? .......................................... 52
3. What happens if you withhold treatment? ........................................... 53
4. Will a relapse occur? ............................................................................ 53
5. Difference between mucosa and epithelium ........................................ 55
6. What is dysplasia? ................................................................................ 55
7. Relationship among intraepithelial neoplasms, carcinoma in situ
(intraepithelial cancer), and severe dysplasia....................................... 56
8. What is an intramucosal carcinoma?.................................................... 57
9. Problems arising at the time of payment: Why are there some doctors
who describe a tumor that is not a malignant neoplasm as a cancer? . 58
10. Mammary glands and intraepithelial neoplasms ................................. 60
11. Is coverage of intraepithelial neoplasms necessary? ........................... 60❖ Cancer progression and staging ............................................................. 61❖ Confirming a cancer diagnosis .............................................................. 63❖ Difficult benefit decision ....................................................................... 65
1. Whether or not cancer is applicable..................................................... 66
2. Hospitalizations and surgical operations to be undertaken for the direct
purpose of treating cancer .................................................................... 66
3. Other...................................................................................................... 67❖ Specific provisions to prevent adverse selections ................................. 68❖ Disclosure at the time a cancer insurance policy is taken out .............. 69
1. Disclosure specific to cancer insurance .............................................. 69
2. Points to keep in mind .......................................................................... 70
10❖ Examples of inappropriate explanations featured in materials used forthe purpose of solicitation ..................................................................... 71

Chapter 3: Treatment of cancer .................................................................. 74❖ Surgical treatment ................................................................................. 74
1. From an era of improving treatment outcomes to an era of noninvasive treatment options .................................................................... 74
2. From noninvasive treatment options to multimodal personalized
medicine ................................................................................................ 74
3. Various treatment methods ................................................................... 75❖ Radiation therapy .................................................................................. 76❖ Chemotherapy ....................................................................................... 78
1. What is chemotherapy? ........................................................................ 78
2. There are many types of anticancer drugs: .......................................... 78
3. Current state of treatment with anticancer drugs ................................. 78❖ Molecule-targeting drugs ...................................................................... 80
1. What is a molecule-targeting drug? ..................................................... 80
2. Why are molecule-targeting drugs expensive? .................................... 81
3. Financial side effects (toxicity) and cancer insurance ......................... 81❖ New cancer immunotherapy .................................................................. 81❖ A paradigm shift in the treatment of cancer .......................................... 85❖ Palliative care and supportive therapy ................................................... 87❖ At-home care cases and costs ................................................................ 88❖ Complementary alternatives, supplements, and non-standard medicalcare ........................................................................................................ 92
1. Complementary and alternative medical care ...................................... 92
2. Non-standard medical care ................................................................... 92❖ Unapproved drugs and medical treatment not covered by publichealthcare insurance .............................................................................. 93

Chapter 4: Products .................................................................................... 98

Table of Contents 11

I. General statement on products ................................................................ 98❖ Amendment to the Insurance Business Act: Obligation to provide
information ............................................................................................ 98❖ Comparing and recommending products............................................. 100❖ The provision of product information and the online version of thepolicy conditions ................................................................................. 102❖ Benefits and the law ............................................................................ 104❖ Product approval ................................................................................. 106❖ Product development concepts (focal points)...................................... 108❖ Base policy .......................................................................................... 110❖ Coverage period for a product and premiums by sex .......................... 112❖ Rider system and lump-sum payment system ..................................... 114❖ The problem of preferred-risk policies ................................................ 115❖ Coverage that will be desired in the future .......................................... 117

II. Comparison and recommendation standards ....................................... 121❖ Thinking about evaluation standards ................................................... 121❖ Competition through unnecessary aggregation ................................... 123

III. Discussions on product specifications and viewpoints with respect torecommendations ................................................................................ 125❖ Definitions of cancer and the conditions applicable to making adefinitive diagnosis ............................................................................. 125❖ Lump-sum payment for a malignant neoplasm diagnosis ................... 128❖ Multiple payments of lump-sum payments for a diagnosis ................. 130❖ Amount of coverage of intraepithelial neoplasms ............................... 136❖ Hospitalization benefit ........................................................................ 138❖ Surgical operations benefit .................................................................. 141
12❖ Radiation therapy benefit .................................................................... 144❖ Anticancer drugs ................................................................................. 147❖ Advanced medical care coverage ........................................................ 152❖ Hospital visit coverage ........................................................................ 156❖ At-home care and post-discharge medical treatment .......................... 160❖ Coverage according to progression ..................................................... 162❖ Waiver premium provisions ................................................................ 165❖ Incidental services ............................................................................... 169❖ Summary ............................................................................................. 171

IV. Evaluating products that exclusively provide cancer coverage according
to insurance company .......................................................................... 173❖ Basic coverage and evaluations ........................................................... 173❖ Sony Life Insurance (Whole-Life Cancer Insurance) (08) (no dividends)............................................................................................................. 176❖ Himawari Life Insurance (Yuuki no Omamori Cancer Insurance (2010)
Type B II) ............................................................................................ 178❖ Prudential Life Insurance (Cancer Insurance (Business Insurance);
without dividends) ............................................................................... 180❖ ORIX Life Insurance (Believe Cancer Insurance) ............................. 182❖ AXA Life Insurance (Cancer Treatment Insurance (non-refundable
cancellation type)) ............................................................................... 184❖ Anshin Life Insurance (NEO Cancer Treatment Support Insurance;
without dividends) (NEO Cancer Treatment Support Insurance; nonrefundable cancellation type) .............................................................. 186❖ AIG Fuji Life Insurance (Cancer Best Gold Alpha; non-refundable
cancellation-type insurance for the medical treatment of malignant
neoplasms (2014); without dividends) ................................................ 188

Table of Contents 13

❖ Aioi Life Insurance (New Cancer Insurance Alpha; without dividends)............................................................................................................. 190❖ Manulife Life Insurance (Kodawari Cancer Insurance; without
dividends; whole-life cancer insurance that is non-refundable if canceled
during the premium-payment period).................................................. 192❖ AXA Direct Life Insurance (cancer insurance, cancer insurance (wholelife)) ..................................................................................................... 194❖ MetLife Insurance (Guard X, a cancer insurance policy ideally suited tothe times) ............................................................................................. 196❖ Aflac (New Days Cancer Insurance for Survival; without dividends;
non-refundable cancellation type or low cancellation refund type 2014)............................................................................................................. 198❖ Zurich Life Insurance (Premium Whole-Life Cancer Treatment
Insurance; non-refundable cancellation-type cancer treatment insurance)............................................................................................................. 200

Afterword: The roles and societal significance of cancer insurance ........ 203
Policy conditions referred to in this book (confirmed as of March 22, 2016).................................................................................................................. 207

14

Abbreviations of company names are as follows:● Sony Life Insurance Co., Ltd. → Sony Life Insurance● Sompo Himawari Life Insurance Inc. → Himawari Life Insurance● The Prudential Life Insurance Co., Ltd. → Prudential Life Insurance● ORIX Life Insurance Corporation → ORIX Life Insurance● AXA Life Insurance Co., Ltd. → AXA Life Insurance● Zurich Insurance Company Ltd., Japan Branch → Zurich Life Insurance● Tokio Marine & Nichido Anshin Life Insurance Co., Ltd. → Anshin Life Insurance● AIG Fuji Life Insurance Company, Limited → Fuji Life Insurance● Mitsui Sumitomo Aioi Life Insurance Co., Ltd. → Aioi Life Insurance● Manulife Life Insurance Company → Manulife Life Insurance● AXA Direct Life Insurance Co., Ltd. → AXA Direct Life Insurance● MetLife Insurance K.K. → MetLife Insurance● Aflac Life Insurance Japan, Ltd. → Aflac*The order in which companies are herein listed is based on the order in which they
appear in Insurance – Life Insurance Statistics Issue (Hoken Kenkyujo, Inc.).
*Company names may be further abbreviated in figures and tables throughout thisdocument.
*Insurance policy conditions that have been compared in this document are current as ofthe end of March 2016. Policy conditions mentioned in this document are included at theend of this document.
*Figures for which no source has been specifically identified have all been created by theauthor. Copyright therefore belongs to the Insurance Medicine Research Institute, Inc.
*Cancer is written in different ways in the Japanese-language version of this document.
The name of a specific illness, such as “stomach cancer” or “breast cancer,” is writtenwith the Chinese character for “cancer.” General expressions, such as “anticancer drug”
and “cancer treatment,” are written with the Japanese hiragana characters for “cancer.”
Product names and other terms for which cancer is written with the Japanese katakana
characters for “cancer” are written accordingly with the Japanese katakana characters for“cancer.”Table of Contents 15

□ Points to note concerning the handling of this book: Comparative points
I presented comparative points for products in the second half of thisdocument in my own way in order to allow them to be used for reference
purposes by solicitors who may be uncertain as to what points should be thefocus of their attention. While you must provide an explanation of the clear
standards for introducing products if similar products offered by multiple
companies are to be introduced to customers, you should keep in mind that a
consumer perspective that is not biased towards the incurrence of commissions
will be needed.
Please note that this book does not purport to provide any explanation
whatsoever on the quality of the rate of return with respect to insurance
premiums, commissions, and surrender values.
In essence, it all comes down to having the client purchase products withpeace of mind.
1. How to approach product comparisons● Has the necessary coverage been essentially added?
● Has the aforementioned coverage been presented to consumers in an easyto-understand manner?
● Has the product in question been created at a level that can be understoodby both solicitors and consumers regardless of whether it deals withmedically-appropriate procedures?
● Is the product one for which there are few problems encountered at thetime of payment and one whose policy conditions are clear?
● Is the product one that expands the scope of business with policyholders?
● Does the product help protect consumers?
2. Products that will not be recommended● Any product that contravenes the preceding paragraph● Any product that is too unconventional (subject to careful consideration
if the product is a first for the country or an industry)● When coverage is excessive despite the fact that the product in questionis new● Expansion of total coverage for which neither medical appropriatenessnor the appropriateness of premiums can be confirmed
16

●

Any product that limits the scope of business with policyholders

3. Examples of non-recommendation
In looking at a given benefit, there is generally no significance behind slightvariations in the total amount received. However, there are benefits that would
be problematic if certain coverage were lacking.
Let us say for some particular illnesses or injuries, 999 out of 1,000 patients
paid out-of-pocket expenses of five million yen or less and that the remaining
one out of 1,000 patients paid out-of-pocket expenses of ten million yen. You
would likely say that there is no need to develop a product that pays out 10
million yen in such a scenario. There is no point in developing such a productand promoting it by making it known that total coverage has been accordingly
increased. It is important to note that you have a responsibility to explain
appropriateness and validity on an aggregate basis.
This topic is also connected to an approach to selling riders that coverscratches*.
There may be some criticism on the part of readers as to whether suchthinking is good or bad. Thus, I would like to continue receiving such feedback
and upgrade the standards for making comparative proposals.
*We have prepared a rider for scratches. Since a simple scratch can sometimes lead to a serious illness,
you should enroll yourself in a policy for serious injuries. While the insurance payout is one million
yen, the premiums are very low. I urge you to take a look at signing up for this option. There are actual
examples in which similar approaches to selling policies are taken. You might think that consumers
would not take the bait since they know the risks associated with scratches. However, it can be adifferent story when it comes to unknown risks...

17

Qualifications concerning comparisons
Since standards for making comparative proposals are summarized in thisbook, there are likely people who are naturally skeptical or concerned as towhether the author is up to the task of making such proposals and as to whether
this book can be trusted. Thus, I will explain the relationship between the author,
who is a medical doctor, and medical care for cancer, cancer insurance, andinsurance sales.
The author has been involved in the treatment of many acute-stage cancer
patients as a clinical physician and has seen patients suffering from the side
effects of anticancer drugs and enduring pain after undergoing laparotomy
operations. Each person’s course of medical treatment also varies, such thatsome are transferred to a different hospital after receiving acute-stage treatment,
while others return home to lead different lives. These days, home services havebeen enhanced thanks to long-term care insurance. However, not all cancer
patients can take advantage of these services. In order to better understandsettings where nursing care is provided as well as home care and other examplesof nursing care services, the author also obtained qualifications as a long-termcare support specialist and has obtained feedback concerning the actual state of
at-home care and medical treatment received in facilities from long-term care
workers active in the field. In addition, people are tormented by anxiety just by
feeling subjective symptoms or by receiving indications of abnormality during
a cancer screening before they receive a diagnosis of cancer. Anxiety about
cancer takes the form of anxiety over the prospect of not being able to engage indaily life as before due to the need to struggle with illness or adapt to changes in
the working environment, anxiety over a loss of income and the incurrence oftreatment costs, and the biggest source of anxiety of all – unexpected death. The
author also involved himself in a consultation business for cancer patients inorder to help eliminate such anxieties as much as possible. I learned about allsorts of topics through direct experience with medical care for cancer.
Interacting with patients as a doctor and helping advise patients are ways inwhich support can be provided to individuals. What can be accomplished by one
person on his or her own is limited.
However, the provision of services through cancer insurance is different.
While the provision of services is limited in form to cash benefits, these services
can alleviate the anxiety felt by so many people and help with treatment. The
extent of this help is orders of magnitude greater than what can be accomplished18

by a single medical practitioner. Cancer insurance will play an important role inshaping the infrastructure of medical care for cancer in the years to come. Indeed,this role is set to grow in the future. Whether you are a solicitor or a customer,
you should be able to understand the benefits of enrolling in a cancer insurance
plan to the extent that you know what the medical treatment of cancer entails.
However, cancer insurance cannot be taken out once a diagnosis of cancer has
been received. The utility of insurance obtainable by enrolling in a cancer
insurance plan can be likened to vaccination for disease control purposes. This
type of insurance should be obtained while you are young and healthy enoughthat you are not yet truly mindful of what cancer represents as a disease that
could actually affect you someday. Accordingly, the quality of cancer insurance
as a high-quality form of inoculation is called into question. For this reason,
benchmarks for making comparative recommendations of insurance products
will become necessary.
Just as I was involved in the medical treatment of cancer patients, I was also
involved for many years in the development of products after I joined aninsurance company, where I was also placed in charge of arranging insurance
payments, underwriting policies, and dealing with complaints concerning
payments (by visiting complainants’ homes and medical institutions). I have alsosought to be intimately aware of the difficulties faced by solicitors by obtaining
many opportunities to receive feedback directly from solicitors through sales
education programs and lectures delivered at agencies and fully understanding
the competitive situation faced by insurance companies in the field of sales. In
recent years, I have also been fielding numerous questions from financial
planners and their assessments of insurance products.
Irrespective of whatever criticisms might arise, I thereby compiled this bookin accordance with my aforementioned experiences.

19

Chapter 1: Cancer and the medical treatment environment for cancer❖ Selling cancer insurance
1. Products that were available when cancer insurance first began to be
sold
In 1974, Aflac sold cancer insurance for the first time in Japan. Since youwere only eligible back then to receive benefits under these plans if you became
hospitalized due to cancer, they were considered a type of medical insurance
specifically tailored for cancer (Table 1).
Table 1. Comparing the specifications of products initially sold by Aflac andproducts sold by Aflac today
Name of benefit
Hospitalization benefit
Outpatient benefit
Diagnosis benefit
Multiple diagnosis benefit payments
Surgical treatment benefit
Radiation therapy benefit
Anticancer drug therapy benefit
Advanced cancer treatment benefit
Lump‐sum payment for advanced cancer treatment

Cancer insurance (1974)

Days (2016)

○

○
○
○
○
○
○
○
○
○

Japan at the time was a society in which doctors tended to avoid telling cancer
patients the name of whatever disease was afflicting them (rate of notification
was about ten percent). Indeed, it was a time when people were much more
inclined to refrain from sharing the fact that a family member had cancer withanyone else. Thus, it is very easy to imagine how much energy was expended intrying to sell cancer insurance. Cancer insurance, however, eventually came toaccommodate the needs of Japanese users, and sales of cancer insurance rose
rapidly (Table 2). These days, more than 300 billion yen in benefits is paid out
per year by just one company – Aflac – and the amount that has been
cumulatively paid out to date has exceeded 6 trillion yen (Figure 1).

20

Table 2. Number of cancer insurance policies sold by Aflac
Fiscal year
1975
End of 1989
End of 2014

Number of policies
30,000More than 10 million
More than 15 million

First sold in 1974
Source: Annual report ([Table 1], [Table 2])

Fig. 1. Changes in the number of policies payable by fiscal year for Aflac

Source: News release dated August 27, 2015

2. Subsequent expansion of sales
Aflac was soon joined by other companies in the field of cancer insurance,
but the exercise of discretionary administrative powers by the Ministry of
Finance at the time limited the sale of medical insurance and cancer insurance
to small- to medium-sized and foreign-affiliated life insurance companies. Since
major life insurance companies operated under a sales agent channel, sales weredemarcated by having such insurance sold as a rider in an insurance policy
payable at death or by selling insurance covering three major diseases with adeath benefit. Subsequently, the Japanese version of the Financial Big Bang
paved the way to allow medical insurance and cancer insurance to be sold byChapter 1 21

both major life insurance companies and nonlife insurance companies. In 2007,
it became possible for such insurance policies to be sold by banks as well. Sales
channels have definitely grown, such that we see that cancer insurance is evensold these days by online-only insurance companies.
There are now sixteen companies that sell over 3,000 new cancer insurance
policies a year in this country (Statistics of Insurance, 2014).

❖ What is cancer insurance?
Products that provide coverage of diseases limited in scope to cancer andother specific conditions are referred to as specified disease insurance. Whilevarious types of products are currently being sold, there are two broad categories
of such products: cancer insurance and insurance covering three major diseases.
Cancer insurance began to be sold in 1974 by Aflac, while the latter is sold as a
product common throughout the life insurance sector as a product that provides
coverage against cancer, acute myocardial infarctions (medical name for heart
attacks), and cerebral hemorrhages (strokes). While different companies now
provide services to consumers by arranging features in various ways within eachof the above categories, coverage against cancer is always included (Table 3).
Table 3. Various insurance products providing coverage against specified
diseases
Cancer insurance
Insurance covering three major diseases
Rider covering lifestyle‐related diseases
Waiver premium benefit
Group credit life debt relief coverage

While these two categories of products vary in numerous ways, the basic
conceptual differences are the parts that are indicated in Table 4. In contrast toother products and insurance covering three major diseases, cancer insurance iscapable of providing many people with coverage at moderate cost by providing
coverage against only cancer. Cancer insurance is a product that is hugely
22

advantageous to consumers in that it provides coverage against cancer, a disease
that affects the entire nation and that imposes a substantial burden on patientsand their families while the disease is being fought, for low premium amounts.
Some people might argue that medical insurance is not necessary if you haveenough savings, but the necessity of insurance should be apparent if you knew
the actual state of medical care involved. At the same time, there are various
product attributes and points to keep in mind as concerns contract management
and solicitation given that coverage against cancer alone is to be provided (Table
5).
Details are outlined in other chapters of this book, but it should also be notedthat the term cancer differs from company to company in terms of the scope of
diseases that are covered. Base cancer insurance policies are broadly divided into
products for which lump-sum cancer diagnosis payments or hospital admission
benefits are offered in the base policy and products for which coverage against
other forms of cancer treatment (such as those involving anticancer drugs andradiation) are offered in the base policy.

What is covered
Benefit type

Table 4. Conceptual differences
Insurance covering three major
Cancer insurance
diseases
Cost of treatment
Coverage against major diseases
Rider system
Lump‐sum payment system

Table 5. Characteristics and special attributes of products providing coverageagainst cancer only
Can provide coverage to many people at low prices
Can provide coverage in line with the actual state of medicine by adding policy
ridersCharacteristics are found in contract management and solicitation practices,since coverage is provided against a single disease
Specialized knowledge about cancer needs to be possessed by the insurancecompany and sales agents

Chapter 1 23

❖ Cancer insurance and insurance sales
Cancer insurance is a special kind of product. In other words, it is the ultimate
insurance product providing coverage against a specified disease in that itprovides coverage against only cancer for the product of third-sector products.
Cancer insurance is a special type of insurance for which substantial study isrequired. Even someone who has been involved for many years in the selling of
insurance will have to continue to study cancer. There are probably many people
who might be wondering what they need to study and the extent to which such
topics need to be studied. When it comes to solicitors in direct charge of selling
cancer insurance, there are serious questions as to the extent to which insurancecompany employees who explain products understand and study cancer.
However, the medical care for cancer that is covered by cancer insurance istied to virtually all issues of a medical nature in Japan. Thus, the selling of cancer
insurance is linked to the selling of medical insurance. This is because
everything concerning this topic pertains to the selling of cancer insurance in apractical sense.
By studying the following points through the lens of cancer insurance, you
should be able to realize the importance of the selling of not just cancer insurance
but also third-sector products:
General medical treatment matters;Primary treatment matters;
The burden assumed by patients;
Various systems of medical care;
Impediments suffered by persons attempting to lead lives in society
as patients.

24

The problem of medical care for cancer
exemplifies problems with healthcare in
Japan.
What is learned from studying theselling of cancer insurance should beapplicable to the selling of other third‐
sector products.

❖ What is cancer?
1. Biological characteristics
While the definition of the word cancer in the term cancer insurance is
explained in a separate chapter due to its importance, it should be noted here thatthe term when used in a medical context simply means malignant neoplasm(malignant growth). Consumers also regard the term cancer as meaningmalignant growth. In Japan, it is well-known that 350,000 people die because ofChapter 1 25

malignant growths every year. Why do so many people die of cancer? To answer
this question, we need to understand the biological characteristics of this disease.
The disease known as cancer is manifested in tumors. The human bodycomprises about 60 trillion cells. A tumor is generated when the mechanism
controlling the proliferation and division of cells begins to operate abnormally,
and the state of equilibrium with the mechanism that suppresses and prevents
the arbitrary proliferation of cells is corrupted. When this abnormality crosses
over into the DNA sequence in cells, you have either the cells of the tumor
invading surrounding cells or metastasis occurring in organs other than that of
the affected site (Fig. 2). A single abnormal cell measuring a few micrometers
to several tens of micrometers across can affect the life of a person who is 60
trillion times as large. These biological characteristics characterize malignant
growths capable of causing the deaths of many people, as important organs that
normally work to sustain life become dysfunctional (Table 6) (Table 7).
Fig. 2. Proliferation of cells

Cancer growth undergoes acceleration ⇔ Equilibrium in the mechanism
controlling the growth of cancer (brake) breaks down
Tumor growth + genetic abnormalities
Biological characteristics of malignant neoplasm (invasion and metastasis)
Table 6. Biological characteristics
1. Proliferates as if seeping into surrounding tissue
2. Boundary between the tumor and surrounding tissue isunclearInvasion
3. Displaces surrounding organs
4. Leads to metastasis once the cancer spreads to sites withblood or lymphatic vessels
1. Proliferates upon spreading from primary organs toremotely‐situated organs
Metastasis 2. Grows through blood and lymphatic vessels
3. Sometimes metastasizes to a different site on the sameorgan as the primary organ
26

Table 7. Impact of metastasis and invasion
1. Even after treatment, relapse can occur due to the presence of residual
cancerous tissue
2. Subsequent complications can affect normal (healthy) surrounding
tissue (aphasia, paralysis, radiation damage)
3. Physical symptoms caused by important organs no longer functioning
properly
4. Progression leads to dysfunction and ultimately death
In 2004, fossilized dinosaur bones housed at the Smithsonian Institution in
the United States were x-rayed. Scans revealed signs that bones had been eaten
away by the invasion and metastasis of cancer cells. The abnormal state of cells
measuring just a few micrometers across was shown to have had a life-and-death
impact on giant dinosaurs. We came to understand that cancer was alreadyaffecting organisms on earth in prehistoric times.
2. Cause-of-death statistics
Cancer (a term meaning malignant neoplasm in this book unless otherwise
noted) was the leading cause of death among Japanese people in 1981. The socalled ‘three major diseases’ – consisting of cancer as well as heart disease andcerebrovascular disease – were consistently ranked as the three most fatal causesof death for many years until 2011, when cerebrovascular disease, displaced bythird-ranked pneumonia, dropped one rank to become the fourth leading causeof death in the country (Table 8).
Despite this change, cancer accounts more than 350,000 deaths a year, andall three major diseases combine to account for more than fifty percent (of alldeaths). While accurate records of deaths had been maintained with deathcertificates, statistics concerning the occurrence of cancer remained inadequate.
In January 2016, a national registry of cancer was finally begun by law. We
should now see a more complete picture of cancer patients formed with thedevelopment of accurate data. Since statutory cancer registries are not limited tocases of malignant neoplasm, and since cancer is not always written the sameway in the conditions stipulated in insurance policies, care needs to be taken

Chapter 1 27

whenever explanations are given during the solicitation process1.
Table 8. Ranking the causes of death and changes in this ranking from one
year to the next
Cause of death

2011

2010

Cancer

357,305 (first)

353,499 (first)

Heart disease194,926 (second)

189,360 (second)

Cerebrovascular disease

123,867 (fourth)

123,461 (third)

Pneumonia

124,749 (third)

118,888 (fourth)

Accident

59,416 (fifth)

40,732 (fifth)

Suicide28,896 (sixth)

29,554 (sixth)

363,907341,518

1,253,066

1,197,012

Other causes
Total
Source: National Vital Statistics

Just as we saw in the way the ranking of the leading causes of death in Japanchanged, the numbers of deaths and incidence rates (estimates) for cancers bysite have also gone up and down (Fig. 3). Rates of stomach cancer and cervicalcancer, which ranked high in 1981 decreased while deaths from lung cancer went
up. These trends in the occurrence of cancers by site are believed to have been
substantially affected by lifestyle factors (Table 9). While the impact of cigarettesmoking in particular is well-known, we are also well aware these days of therisk of getting occupational cancers, of which concentrated occurrences incertain places of business have been reported by mass media outlets (Table 10).
Cancer measures that take such lifestyle factors into account are known asprimary cancer prevention measures, and cancer screenings are known assecondary cancer prevention measures (Table 11). Cancer measures that are
carried out as public health measures focus on cancers that occur at highmortality sites and cancers with high incidence rates (Table 12).
1
The names of diseases other than malignant neoplasm that are required to be reported as cancers under
the law governing the National Cancer Registry consist of certain examples of intraepithelial neoplasm,
brain tumors, gastrointestinal stromal tumors, and ovarian tumors pursuant to Article 1 of the
Enforcement Order for the Act on Promoting Cancer Registries; it has been determined that standards
shall comply with the International Classification of Diseases for Oncology (revised in 2012).

28

Fig. 3. Changes in the number of deaths by site

Source: Reproduced from the official website for National Vital Statistics as compiled by the Ministryof Health, Labour and Welfare

Table 9. Lifestyles and carcinogenesis
Gastric cancer

Reduction of salt intake through decreased consumption of salted
products attributed to the spread of refrigerators and improved
logistics

Cervical cancer

Spread of home bathing facilities

Table 10. Occupational cancers that have drawn attention through coverageby news media
2012: Outbreak of bile duct cancer among employees of a printing office
2014: Supreme Court decision in a lawsuit on asbestos damage and on recognizing
industrial accidents
2016: Outbreak of bladder cancer among employees at a chemical plant in Fukui

Table 11. Primary, secondary, and tertiary cancer‐prevention measures
Primary prevention

Lifestyle to prevent cancer

Secondary prevention

Cancer screening

Tertiary prevention

Aggressive treatment

Chapter 1 29

Table 12. Cancer screenings at five different sites as recommended by thegovernment
Lung cancer
Gastric cancer
Large intestine
Breast cancer
Cervical cancer

Chest x‐ray once a year for persons 40 years of age and older;smokers also undergo sputum cytology
Gastric x‐ray examination once a year for persons 40 years of age
and older
Fecal occult blood test once a year for persons 40 years of age andolder
Examination by touch and mammography once every two years
for persons 40 years of age and older (x‐ray examination)
Cytological examination of the cervix once every two years for
persons 20 years of age and older

Insurance companies selling insurance policies payable at death are naturallyinterested in the numbers of deaths that affect rates of mortality and must predict
which site-specific cancers will see an increase or decrease in the numbers ofdeaths in the future. On the other hand, since cancer insurance is a type of
insurance that essentially allows benefits to be received while the insured is still
alive, insurance companies are more interested in cancer case numbers than in
the numbers of deaths. While it goes without saying that there is a high level ofinterest in the impact that smoking and other lifestyle factors have on incidence
and on trends in this regard, the sex of each individual is regarded as being
especially important. Since sex greatly affects rates of cancer incidence, somecompanies have adopted cancer insurance premiums that differ between men
and women.

❖ The three major burdens associated with the medical treatment ofcancerWhen a person gets cancer, he or she and his or her family will suddenly findthemselves assuming substantial burdens due to various environmental changes.
There are three broad categories of burdens (Table 13). The extent to which theseburdens are felt largely depends not just on the difference in treatment approachthat arises based on the cancer site and extent to which the cancer has developed,
but also on circumstances prevailing to that point in time inside and outside thehome in which the patient lives. Physical burdens are alleviated by receiving
30

treatment at a medical institution, but many patients typically suffer frompsychological burdens for a while after being told that they have cancer, suchthat the pattern shown in Fig. 4 is known to occur. Severe psychologicalsymptoms are sometimes seen such that some patients are diagnosed withdepression. In recent years, support activities have gradually taken root, such as
through the efforts of liaison 2 teams and the support provided by hospitalconsultation offices and various patient associations.
Table 13. Burdens assumed by patients
Physical (bodily) burdens
Psychological burdens
Financial burdens (treatment costs, costs of living, and employment issues)

Fig. 4. Psychological burdens: What happens after bad news is delivered
Bad news (name of disease revealed,
progression, remaining life expectancy)

Some patients

Period of shock(one week after bad news given)
Depression
Period of feeling insecure and depression(1‐2 weeks)

Maladjustment

Period of adjustment (1‐2 weeks)

While private insurance plans cannot directly deal with these burdens, private
insurance is effective for addressing financial burdens. Table 14 shows thatnearly 70 percent of respondents in a survey administered to cancer patients
perceive the weight of financial burdens. Cancer insurance focuses on this area
and on covering the cost of treatment during the acute stage of one’s illness.
These days, the rising costs of medical care for cancer threaten the finances ofpatients’ families, such that some patients choose to forgo optimal treatment
2
Liaison refers to medical care provided by a team of doctors, nurses, and psychological counselors in
response to psychological problems suffered by patients.

Chapter 1 31

procedures due to an inability to pay costs even with the application of public
insurance options.
Some families in which both spouses are young and working suffer fromsignificant disruptions to life plans that are caused when one spouse is forced tofight cancer.

Table 14. 2011 survey: Financial and other types of burden rates
Financial difficulties (69%)

Social burdens (60%)

Burden of paying medical care expenses
Depletion of savings
Decrease in income
Loss of employment
Loss of hobbies and purpose in life
Hassle of regular visits to see a doctor

Source: Health and Labor Sciences Research Grant research report by research representative Nobuo
Koinuma, March 2012

❖ Financial burdens assumed by cancer patients
Professor Nobuo Koinuma of the Department of Health Administration and
Policy of the Graduate School of Medicine at Tohoku University was engaged
in a research project (investigation) at the Ministry of Health, Labour andWelfare on the “out-of-pocket expenses paid by cancer patients.” In contrast to
surveys carried out independently by insurance companies, this research project
was officially conducted with costs paid for by the national government. (Whilesome data results have also been obtained by private-sector companies, thesecannot be evaluated in terms of reliability due to the existence of author bias inthese cases.) Results obtained from a report for 2010 are summarized andpresented in Tables 15 and 16.
This investigation was continuously conducted over a period of several years.
While the data for each year as presented in the tables do not capture the full
picture of the financial burden suffered by patients, we see that patients pay, on
average, 1.01 million yen on an out-of-pocket basis when dealing with cancer.
The amount paid by the patient can be divided into direct costs relating to the
medical treatment he or she receives and indirect costs. In addition, the actual
amount paid by a patient will vary due to costs reimbursed through the use of32

the high-cost medical treatment benefit system and to benefits received fromprivate-sector sources. Indirect costs include insurance premiums paid to private
insurance companies. We see that 44.8 percent of patients who were actuallyable to receive private insurance benefits were able to have most of their out-ofpocket expenses covered by these benefits.
According to the report, medical treatment costs an average of 1.36 million
yen for patients who have been hospitalized. Out-of-pocket expenses, exclusiveof private insurance premiums, are broken down as follows: inpatient medicalcare accounts for 47.5 percent of costs, outpatient medical treatments accountfor 16.4 percent of costs, and transportation expenses and other costs account for36.1 percent of costs. The extent to which benefits paid out by private insurance
plans (averaging 100,000 yen) are helpful is clear. It might also be a good idea
to have a certain amount of benefits for visiting the doctor or hospital guaranteed.
Table 15. 2009 survey: Out‐of‐pocket payment breakdown (units x 10,000
yen; excluding patients undergoing particle beam treatment)

Average out‐of‐pocket payment
amount (applicable average)
Direct costs
Hospitalization expenses
Outpatient expenses
Transportation expenses
Indirect costs
Health foods and folk remedies
Private insurance premiums
Other
Reimbursements and benefits
Private insurance benefits
High‐cost medical treatment
spending
Refund of medical care expenses

After diagnosis

7 years after survivor
diagnosis

101.1

29.9

52.5 (74.4 percent ofeligible persons)
18.1
4.5

27.5 (44.2 percent ofeligible persons)21.8 (56.8 percent ofeligible persons)25.5 (85.0 percent ofeligible persons)
13.6
62.4
101.1 (44.8 percent ofeligible persons)28.5 (52.7 percent ofeligible persons)
8.8

11.6 (6.6 percent ofeligible persons)
15.6 (54.5 percent ofeligible persons)
13.5
73.4 (14.9 percent ofeligible persons)15.2 (13.1 percent ofeligible persons)

Source: Health and Labor Sciences Research Grant research report by research representative Nobuo
Koinuma, 2010

Table 16 outlines amounts paid by site and clearly reveals that the assumption
Chapter 1 33

of costs differs from site to site.
Table 16. 2009 survey: Out‐of‐pocket amounts per year by site (excluding
patients undergoing particle beam treatment)

Annual out‐of‐pocket
amountReimbursed
amountGastric
cancer766
thousandyen
501
thousandyen

Colorectal
cancer974
thousandyen
706
thousandyen

Lungcancer
1.02
millionyen
672
thousandyen

Breastcancer
770
thousandyen
482
thousandyen

Uterinecancer900
thousandyen
733
thousandyen

Prostate
cancer753
thousandyen
261
thousandyen

Source: Health and Labor Sciences Research Grant research report by research representative Nobuo
Koinuma, 2010

❖ Trends in national healthcare spending
1. Total healthcare spending
Total healthcare spending in 2014 exceeded 40 trillion yen (Table 17). The
table reveals that this figure continues to rise each year. While the rate of growth
in total healthcare spending fluctuates slightly due to revisions in medical service
fees and changes in the medical care system, spending has been generally
increasing by two to three percent on a year-on-year basis.
Table 17. Changes in healthcare spending (unit: trillions of yen)
FY201036.6

FY201137.8

FY201238.4

FY201339.3

FY201440.0

Source: FY2014 Trends in National Healthcare Spending(http://www.mhlw.go.jp/topics/medias/year/14/dl/iryouhi_data.pdf)

2. Breakdown of healthcare spending and healthcare spending on cancer
Healthcare spending per citizen per year increases with age and tends to behigher for women than for men (Table 18). The data show that there is a serious
problem in that healthcare spending rises even as income goes down. Healthcare
spending on cancer and other forms of neoplasm is second in magnitude tocardiovascular diseases (Table 19).

34

Table 18. Annual healthcare spending per capita (unit: thousands of yen)Age bracket
0 〜14

Male
160.8

Female137.7

15 〜44

101.3

127.9

45 〜6465 and older
All age brackets

297.4

257.3

772.0
310.6

688.8
318.6

Table 19. FY2013 Top 5 medical examination and medical treatment costs byinjury and disease classification

Total
Diseases of the circulatory
systemNeoplasms
Musculoskeletal and connective
tissueDiseases of the respiratory
systemExternal causes
OthersEstimated amount(x 100 million yen)
287,447

Percentage of total
(%)
100.0

58,81720.5

38,85013.5

22,422

7.8

21,211

7.4

20,466125,682

7.1
43.7

Source: http://www.mhlw.go.jp/toukei/saikin/hw/k-iryohi/13/index.htm (Tables 18, 19)

3. Breakdown of the natural increase in national healthcare spending
Regardless of economic conditions, national healthcare spending continues
to rise every year. This is referred to as a natural increase and is equal to about
a 2-3 percent annual growth rate, the breakdown of which is shown in Table 20.
In looking at this table, we see that the impact of aging is at odds with otherfactors in some fiscal years, while other factors is greater in other fiscal years.
The other factor believed to have the biggest impact in terms of causing
healthcare spending to go up is the development of medical technologies. The
spread of advanced medical technologies is driving sharp increases in healthcare
spending.
Where patients receive treatment on an inpatient basis or where advanced
medical technologies are used for cancer patients and other sufferers of severe
illnesses, unit costs of healthcare spending will rise and the impact will be greater.

Chapter 1 35

Table 20. Breakdown of the natural increase in healthcare spending(i) Growth rate ofhealthcare spending(ii) Impact of aging(iii) Other factors

FY2005

FY2007

FY2009FY2011FY2013

3.20%

3.00%

3.40%

3.10%

2.20%

1.80%
1.30%

1.50%
1.50%

1.40%
2.20%

1.20%
2.10%

1.30%
1.10%

(Due to population increase and revisions to medical service fees, the sum of ሺiiሻ and ሺiiiሻ does notequal ሺiሻ.)Source: Produced based on Fiscal Administration Subcommittee materials dated April 27, 2015. Other
factors is net of the impact of population changes and aging and primarily reflects the impact of medical
advancements.

❖ Spiraling healthcare costs and the high-cost medical treatment benefit
systemAs noted in the explanation of national healthcare spending, unit healthcare
costs are becoming high due to the spread of advanced medical technologies(Table 21). Fortunately, there is a medical care environment in place that allows
people in Japan to avoid bankruptcy due to medical care expenses, thanks to theexistence of a safety net known as the high-cost medical treatment benefit system,
which is applicable to costs covered by insurance. In other words, a system thatenables medical care to be obtained on an equitable basis functions in a way thatprevents economic disparities from growing in the area of healthcare. However,total high-cost medical treatment spending is rapidly rising these days in
response to spiraling healthcare costs. The Ministry of Health, Labour andWelfare has also described the current state of the increase in the unit cost of
hospitalization based on data as provided for in Fig. 5.
On the other hand, the capping of income standards applicable to high-cost
medical treatment spending has always been discussed in connection with thereformation of the healthcare system. This cap was raised during the Koizumi
administration and later revised by the Abe administration. In other words, thesafety net is vulnerable in a functional sense.
Moreover, it is expected that uninsured costs to which the high-cost medical
treatment benefit system does not apply (such as medical expenses combinedwith treatment outside the insurance coverage and statutory burdens) will
increase in the future.

36

Table 21. Current situation with respect to spiraling healthcare costs● Economic disparities in healthcare have become a reality.
● The amount paid on an out‐of‐pocket basis by patients will rise due to reforms affecting
high‐cost medical treatment spending.
● The burden of paying for care not covered by insurance will increase.
● Healthcare spending is spiraling for reasons relating to anticancer drugs.

Fig. 5. Growth in high‐cost medical treatment spending

Exponential changes in national healthcare spending
and high‐cost medical treatment spending

Source: Materials provided by the Medical Insurance Committee, Social Security Council (October 12,
2011)

The biggest cause of the increase in the financial burden on cancer patientsis the development of medical technologies for cancer. Medical care is becoming
personalized (customized for each patient), thereby resulting in sharply rising
prices of anticancer drugs. While we will be looking more closely at changes inthe environment surrounding anticancer drugs in a separate chapter, it should be
noted that a questionnaire survey administered to doctors revealed that 1.5
hospitalized patients and 1.6 outpatient patients per month either change or
Chapter 1 37

discontinue treatment due to financial reasons and that this is caused by new
anticancer drugs that are in use these days (Health and Labor Sciences Research
Grant research report by research representative Nobuo Koinuma, 2012).
❖ Aspects of the public healthcare system that should be known
In 1961, universal health insurance coverage became institutionalized inJapan. The contents of the program were enhanced to bring to a completion of
the development of a public healthcare insurance system in 1973. In other words,
a framework for healthcare financing and the equitable provision of medical
services to the people was completed to mark the attainment of UHC3 goals in amanner recognized by the global community.
While private insurance has been functioning to support public insurance on
the outer fringes of the public healthcare insurance system, the role of private
insurance may very well change amid the various initiatives to reform thehealthcare system that are currently underway. Accordingly, an outline ofJapan’s healthcare system needs to be properly understood.
The framework of Japan’s healthcare system is as described below:4
1. Healthcare is primarily funded by the social insurance system (funded
entirely by taxation in some countries).
● In addition, a portion of costs is assumed by patients and the rest iscovered by the public.
● Public healthcare insurance can be broadly divided into two systems:
insurance for employees and national health insurance.
2. Many healthcare institutions are privately run (but on a non-profit basis);
medical services have been provided through such institutions.
● Can be freely established and are accessible to the public without
limitations.
3. In principle, services under the public healthcare insurance system consistof in-kind medical benefits (Table 22).
4. Patients pay a fixed rate and a high-cost medical treatment benefit system
Universal health coverage (UHC) refers to the ability of all persons to receive basic health services
corresponding to a guaranteed level of quality whenever needed, from birth until death, at a level of costthat can be borne.
4 Re-Questioning Medical Policy, Kenji Shimazaki (Chikuma Shobo, November 2015)338

is in place to cover high-cost services.
5. An administrative system functions to control service fees charged byhealthcare institutions.
● Medical service fees schedule, drug price standards, and specificmedical materials standards● System of receipt billing and receipt screening in exchange for in-kindbenefits
6. The use of both insured and uninsured types of medical treatment whenusing the public healthcare insurance system is not allowed, except where
the uninsured concomitant medical treatment benefit system applies.
Table 22. Key in‐kind public medical insurance benefits
Breakdown of in‐kind benefits
Examinations
Drug benefits
Provision of insured medical materials
Inpatient medical treatment
Meals while hospitalized

Required medical care

Contents

Surgical sutures, catheters, and more
Nursing care
Meals and medical treatment expenses
while hospitalized
Living and medical treatment expenses
while hospitalized
Screenings, surgical operations,rehabilitation, and more

Note: It goes without saying that there are some cash benefits as well (such as a lump-sum payment forchildbirth).

You will need to always think about the positioning of private insurance
while grasping these basic matters. This is especially important in dealing withthird-sector products.
However, points that are important when engaging in dialogue with clientsare the characteristics set forth in Table 23.
Table 23. Characteristics of a public healthcare insurance system that areimportant to consumers
 Free access (degree of freedom) Certain level of in‐kind benefits (equitable) Medical treatment fees at official prices (equality)
Note: Changes to this system, such as those that would increase the statutory burden of paying for
selected medical treatment expenses and those that would put limits on free access, are being
contemplated.
Chapter 1 39

❖ Changes in the medical care environment and healthcare system forcancerVarious healthcare system reviews are currently underway. These reviews
will not be examined in detail herein since that is not the purpose of this book,but if you are interested in pursuing this topic further, you should seek out the
many written works that have been published to date and study them on yourown.
Since medical care environments corresponding to cancer are highly varied,
items are presented in Table 24 according to the timing of medical treatment
provided to patients. Although Table 24 is presently applicable, it is expectedthat the contents of this table will rapidly change over time.
The presented items continue to be discussed through various policy
discussions and by councils of experts. The public healthcare insurance systemthrough which UHC as mentioned in the previous section was attained (page 38)
was set up during the period of high economic growth. An urgent and broadranging review is currently underway ahead of the 2025 Problem 5 . The
population structure and longevity risk are also having a huge impact on reviewsof the healthcare system.
Regardless of the pros and cons of these policy discussions, private insurancecompanies need to determine what the impact will be on actual downstream
settings where medical treatment is provided and what specific burdens areplaced on patients and their families. Policy discussions are complicated, andyou need to be constantly exposed to pertinent information in order to assess
trends concerning different discussions with a broad view of the whole. Of
course, better insurance cannot be developed with just policy discussions. It isalso important to obtain feedback from people working in places where
healthcare is provided and from patients themselves.

The 2025 Problem refers to the problem caused by baby boomers in Japan, consisting of those who
were born between 1947 and 1949, turning 75 years old or older in 2025. A significant increase insocial security costs for healthcare and long-term care and a shortage of care facilities and care workers
are expected to occur.

540

Table 24. Discussions relating to the medical treatment of cancer patients<Assumed by patients on an out‐of‐pocket basis>
1. Discussion on reviewing the high‐cost medical treatment benefit system
2. Discussion on expanding the use of insured and uninsured types of medical
treatment
3. Payment of fixed amounts when undergoing check‐ups (partial increase of thestatutory burden of paying for selected medical treatment procedures)
4. Discussion on revising deductions for medical care expenses in connection withefforts to promote self‐medication
5. Review of drug costs (including the promotion of generic drugs and restrictions onpharmacies right outside a doctor’s office or hospital)<personal medical treatment>
1. Discussion on efforts to curtail visits to doctors and insurance exemptions
2. Development of an environment for the use of unapproved drugs and the expansionof the use of insured and uninsured types of medical treatment
・Patient‐requested medical treatment
・Adoption of a Japanese version of the CU system (expanded clinical trials)
3. Revising the system of specialist doctors and establishing a new system of specialist
doctors
4. Development of cutting‐edge medical care and the promotion of clinicalapplications<Provision of medical care>
1. Acute phase
・Development of and progress with respect to cancer treatment organizations insecondary medical zones
2. After the acute phase・Lack of medical treatment facilities for patients for whom cancer patient
rehabilitation costs are calculated and a lack of a system for reporting hospital
bed functions and hospital beds for use during the recovery phase
3. At‐home care・Promotion of a comprehensive community care system and disparities in
effectiveness by region
・Promotion of the concept of “5 diseases and 5 projects”
・Enhancement of disease linkages and coordination with local clinics and hospitals
・Establishment and effect of family doctors, family pharmacies, and healthinformation‐providing pharmacies
・The use of nursing‐care services by patients under the age of forty‐five years is tobe paid on an out‐of‐pocket basis.
・Reviewing the long‐term care insurance system and discussion on reviewing theprovision of services corresponding to nursing care level 2 or below
・Reviewing the shift from a fixed rate for out‐of‐pocket payments of nursing careexpenses to out‐of‐pocket payments based on income*Individual themes that cannot be included in this table have been discussed by many administrative
agencies.

Chapter 1 41

❖ The medical treatment of cancer and the main points concerning
medical service fees
Various medical service fees are calculated in connection with the medical
treatment of cancer. Typical examples are presented here.
Table 25. Items relating to the basic hospitalization rate
A226‐2 Addition of palliative care (per day) 400 points
A226‐3 Addition of palliative care at a medical clinic with beds (per day) 150 points
A232 Addition of core center for cancers (first day of hospitalization)
1. Addition of linked core center for the medical treatment of cancer
a. Linked core center for the medical treatment of cancer 500 points
b. Local center for the medical treatment of cancer 300 points
2. Addition of core center for pediatric cancers 750 points
A310 Palliative care ward admission fee (per day)
1. Period of up to 30 days 4,926 points
2. Period of between 31 days and up to 60 days 4,400 points
3. Period of 61 days or more 3,300 points

Table 26. Items relating to medical management
B001 Specific disease treatment management fee
22. Cancer pain relief guidance management fee
1. Provided by insurance doctor trained in connection with palliative care
2. Any case not coming under 1 100 points
23. Cancer patient guidance management fee
1. A doctor discusses medical treatment policy and other matters in collaboration with nurses
and the contents thereof are provided in writing 500 points
2. A doctor or nurse conducts an interview to alleviate psychological anxiety 200 points
3. A doctor or pharmacist provides a written explanation of the necessity of administering or
injecting an anti‐malignant tumor agent 200 points
4.24 Outpatient palliative care management fee 300 points
B001‐2‐8 Outpatient radiation therapy fee 292 points
B001‐7 Lymphedema guidance management fee 100 points
B005‐6 Cancer treatment coordination plan formulation fee
1. Cancer treatment coordination plan formulation fee 1 750 points
2. Cancer treatment coordination plan formulation fee 2 300 points
B005‐6‐2 Cancer treatment coordination guidance fee 300 points
B005‐6‐3 Cancer treatment coordination management fee
1. Linked core center for the medical treatment of cancer 500 points
2. Local center for the medical treatment of cancer 300 points
3. Core center for pediatric cancers 750 points
B005‐6‐4 Fee for provision of at‐home coordination guidance to a cancer patient on an outpatientbasis 500 points
B010 Medical treatment information provision fee (II) 500 points

42

Table 27. Items relating to at‐home care
C000 Fee for house call 720 points; Addition for a nighttime house call, emergency house call, orother type of house call 2,700 points‐325 points
C001 Home patient visiting care fee (per day)
1. Case not involving a resident of the same building 833 points
2. Case involving a resident of the same building 203 points
6. Addition of home terminal care for a patient who died at home 5,000 points‐3,000 points
C002 Fee for comprehensive medical management provided during the administration of at‐homecare (once a month)
At‐home care support clinic or at‐home care support center 5,400 points‐660 points
Other 3,450 points‐510 points
C003 General at‐home cancer medical treatment fee (per day)At‐home care support clinic or at‐home care support center 2,000 points‐1,495 points
C005 Fee for the provision of home‐visit nursing and guidance services to an at‐home patient (perday)
1. Provided by a public health nurse, midwife, or nurse (except in the case of 3)a. Up to third day in the same week 580 points
b. Fourth and subsequent days in the same week 680 points
2. Provided by an assistant nurse
a. Up to third day in the same week 530 points
b. Fourth and subsequent days in the same week 630 points
3. Provided by a nurse who has received specialized training in palliative care or bedsore care forpatients with malignant tumors 1,285 points
C008 Fee for the provision of drug management guidance to an at‐home patient on a visiting basis
1. Case not involving a resident of the same building 650 points
2. Case involving a resident of the same building 300 points
C108 At‐home malignant tumor patient guidance and management fee 1,500 points
C108‐2 At‐home malignant tumor patient co‐guidance and management fee 1,500 points
Source: Extracted from Notification no. 52 as issued by the Ministry of Health, Labour and Welfare on
March 4, 2016

In the future, at-home care will be centered on home-care support clinics.
Hospitals where acute phase care is received will continue to provide treatmentin the community in accordance with cancer treatment coordination plans ascommunity-based critical path institutions.
Note: Points for medical service fees, such as surgical operation fees, treatment fees, and examination
fees, have been omitted.
Note: See Chapter 3 (At-home care cases and costs) (page 88) for more information on specific at-homecare costs.

Chapter 1 43

Chapter 2: Cancer insurance and policy conditions❖ Defining cancer
In contrast to statutory benefits like those provided through public insurance
schemes, private insurance is characterized by the conclusion of individual
agreements in accordance with insurance policies and their conditions and by
the provision of services in accordance with the contents of these agreements.
Leaving aside individual coverage amounts and whatever daily coverageamount is provided, the details of incidents to which coverage applies under acancer insurance policy are fully stated in the policy conditions. Unlike clients,
solicitors must understand, in their role as insurance professionals, the policy
conditions of products they compare and recommend. Aspects relating tocontractual paperwork are largely uniform from insurance company to insurancecompany, such that no significant differences can be found across the industry.
Since checks are also strictly conducted through examinations performed by the
Financial Services Agency, there should not be many points of comparison thatreveal a disparity among companies. If we were required to indicate someexamples of differences along these lines, we might mention the policy inception
date, the possibility of reviving a policy, and the period during which a suicide
exemption would apply.
However, insured events relating to benefits and the conditions applicable todifferent benefits cannot be properly understood for any given product unless
you fully read the main text of the policy conditions, appendices, comments, andsupplementary provisions. Even more troublesome is the fact that the provisionof third-sector insurance is closely tied to medicine, such that many medical
terms and descriptions are included in the conditions set forth in such insurance
policies. The conditions of cancer insurance policies in particular contain themost medical terms and descriptions; some policies of this type are very difficult
to understand.
As more products are produced for the market and as medical accuracy ishoned in writing the policy conditions for these products, the policy conditions
for these products become more complicated, such that consumers as well as
insurance solicitors will become increasingly incapable of understanding what
they mean. However, medicine can be unclear and ambiguous at times. The
inclusion of medical terms and descriptions is unavoidable to an extent, if you
44wish to provide trouble-free benefits through an insurance product. Ultimately,
the striking of a balance is important.
In order to understand cancer insurance, the first step is to define the term
cancer. In particular, this entails defining malignancy and intraepithelial
neoplasm (Fig. 6). Let us take a closer look at this matter on the following page.
Fig. 6. Definitions are important
The need for coverage differs depending on whether a neoplasm is malignant or not

Chapter 2 45

❖ Two types of cancer
The term cancer is used not just by doctors but also by regular people. In theworld of medicine, the term cancer means a malignant neoplasm in every
country around the world. It is important to note that the term does notencompass precancerous lesions or intraepithelial neoplasms.
If you were to refer to an intraepithelial neoplasm as a cancer, the following
problems would arise:● You would cause patients to become overly anxious;● You would induce an excessive course of treatment to be undertaken.
The World Health Organization (WHO) has also explicitly alluded to suchconcerns in textbooks on the large intestine.
Japan is also a member of the WHO. Accordingly, the term cancer should be
used as carefully as possible.
Likewise, while a doctor might, in fulfilling his or her responsibility as adoctor in explaining medical treatment to a patient, describe an intraepithelial
neoplasm as being an “early-stage cancer,” it would not be appropriate to takethis approach in materials and explanations utilized for the solicitation of
insurance. Taking this approach would be problematic in that it could cause
consumers to mistakenly believe that products offered by other companies do
not cover early-onset stage-one malignant neoplasms. In this way, the proper useof terms is an element in determining whether a product should be recommended
based on comparisons with other products.
If you take a look at cancer insurance upon understanding the above
premises, you will see that product names and policy conditions are naturally
replete with the term cancer. The problem, however, becomes apparent when
you carefully examine the policy conditions and see that there are two types ofdefinitions of cancer in the provision that sets forth a definition of cancer:● Cancer means a malignant neoplasm.
● Cancer means a malignant neoplasm or intraepithelial neoplasm.
The former is the definition that aligns with conventional medical thinking
around the world, but the latter utilizes a version of the term cancer that has beencoined for the conditions set forth in certain policies. Of course, the latter is aterm that, despite having been approved by the Financial Services Agency,
contradicts the WHO’s position. The technical issue with those who draft policy
conditions in a way that conflates malignant neoplasm with intraepithelial46neoplasm through the use of a coined term is not an essential matter. The fact isthat this coined term causes solicitors to mistakenly believe that intraepithelial
neoplasm is a serious disease that needs to be treated in a serious manner, which
in turn causes consumers to regard intraepithelial neoplasm in the same way.
This could be criticized as an approach to sales based on the presentation of a
scenario involving scratches. (See the section on points to keep in mind
concerning the handling of this book.)

Medically speaking, cancer is a term thatrefers to a malignant neoplasm.
A failure to engage in selling in a way thatavoids conflating carcinoma in situ withcancer is problematic.
Solicitation that is carried out in a waythat fuels consumer anxiety is strictly
prohibited.
This is because such an approach could
cause excessive anxiety to patients andhave adverse effects in terms of excessivemodes of treatment.

Chapter 2 47

❖ Classification by the WHO
A neoplasm is also known as a tumor, of which there is a great variety. A
uterine myoma (fibroid) is an example of a tumor. Thus, there are certain criteriathat need to be satisfied for a tumor to be considered a cancer for which benefits
can be provided through cancer insurance. Provisions defining cancer can beseen in the conditions set forth in a cancer insurance policy, and the criteria inquestion would be specifically outlined in a separate table. Take a look at what
is set forth in a separate table of criteria.
Take a look at Table 28. While there are several difficult terms presented
here in this table, the following is included: “‘compliant with the International
Statistical Classification of Diseases and Related Health Problems 10th Revision(ICD-10) (2003 version),’ as compiled by the Statistics and Information
Department under the authority of the Minister's Secretariat at the Ministry of
Health, Labour and Welfare.” In other words, the WHO’s ICD-10 classification
is being used to constitute the criteria in question6.
Table 28. Section 1 of the Appendix in connection
with the definition of cancer (ICD‐10)
Cancers for which coverage is provided shall consist of “malignant neoplasms,” whichshall be as defined below.
A malignant neoplasm shall consist of the following in the categories specified in
Notification no. 176 as issued by the Ministry of Internal Affairs and Communications on
March 23, 2009; the contents of these categories shall be compliant with “theInternational Statistical Classification of Diseases and Related Health Problems 10th
Revision (ICD‐10) (2003 version),’ as compiled by the Statistics and Information
Department under the authority of the Minister's Secretariat at the Ministry of Health,Labour and Welfare.
Source: Rearranged and reprinted by the author based on contents typically found in the conditions set
forth in insurance policies offered by different companies.

Take a look at Table 29. The following is included: “‘International
Classification of Diseases for Oncology, third edition,’ as compiled by theStatistics and Information Department under the authority of the Minister's
Secretariat at the Ministry of Health, Labour and Welfare.” In this case as well,
6

ICO-10 will be amended to ICO-11 in 2022.

48

the WHO’s ICD-O-3 classification is being used to constitute the criteria inquestion.
Table 29. Section 2 of the Appendix in connection
with the definition of cancer (ICD‐O)
In Section 1 hereof, malignant neoplasms are neoplasms whose morphology codes are
expressly set to malignant and neoplasms for which a fifth‐digit code indicating themorphology thereof has been assigned as part of a morphology code included in “theInternational Classification of Diseases for Oncology, third edition,’ as compiled by theStatistics and Information Department under the authority of the Minister's Secretariat
at the Ministry of Health, Labour and Welfare.
Source: Rearranged and reprinted by the author based on contents typically found in the conditions set
forth in insurance policies offered by different companies.

In this way, two sets of WHO classification are being used at a fundamental
level. By using these two sets of classification, tumors for which benefits will be
provided can be determined by identifying either a malignant neoplasm or
intraepithelial neoplasm, and payments can be properly clarified accordingly.
While tumors can be broadly divided into four types, including benign tumors,
the types of tumors that are relevant as far as cancer insurance is concerned aremalignant neoplasms and intraepithelial neoplasms (Table 30).
Table 30. Four types of neoplasms (tumors) and morphology codes(/0, /1, /2, /3, /6, /9)・Benign neoplasm
・Neoplasm of unknown properties
・Intraepithelial neoplasm
・Malignant neoplasm

/0
/1
/2
/3, /6, /9

Source: International Classification of Diseases for Oncology

In the policy conditions put forth these days by different companies, both
ICD-10 and ICD-O are explicitly referred to as shown in Tables 28 and 29.
Previously, however, many products featured policy conditions for which only
the medically ambiguous definition corresponding to ICD-10 was used. Thanks
to this state of ambiguity, there were concerns that problems might arise at thetime of payment (Fig. 7).

Chapter 2 49

Fig. 7. Two types of policy conditions
Type 1: Combined policy
conditions

Type 2: ICD‐10 only

❖ Intraepithelial neoplasm, carcinoma in situ, and dysplasia
The definitions of malignant neoplasm and intraepithelial neoplasm arestated in policy conditions. (See Classification by the WHO and Tables 28 and
29 on page 48-49.)
While there are products for which cancer includes tumors in the epithelium,
there are even some solicitors selling cancer insurance who are under the
impression that the medical risks associated with malignant neoplasms areequivalent to those associated with intraepithelial neoplasms. If insurance is soldbased on such an understanding, many consumers with utterly no interest in
intraepithelial neoplasms will believe the mistaken explanations given bysolicitors with a poor grasp of the proper definitions to be used. (This is anapproach to sales based on the presentation of a scenario involving scratches.
See the section on points to keep in mind concerning the handling of this book.)
A solicitor will, at a minimum, need to understand the following points:● The difference between epithelium and mucosa● The difference between malignant neoplasm and intraepithelial
neoplasm● The difference between intraepithelial neoplasm and carcinoma in situ
● What dysplasia is
Without a medical understanding of the above points, there is no way toprovide an accurate explanation of coverage matters. These points do notconstitute knowledge that needs to be understood only by employees belonging
to the claims department of an insurance company. Unless this situation
improves, products will be sold by solicitors who fail to understand what they
are selling.
It is safe to assume that no solicitor with an insurance firm selling automobile
insurance by saying something like “This policy is great since it includes
50

roadside service” is unaware of the meaning of roadside service.
Thus, the provision to solicitors of sales education that includes medical
matters is essential. Unfortunately, however, an examination of each company’s
official website, pamphlets, and bookmarks reveals that most companies fail toexplain or provide illustrations of intraepithelial neoplasms.

Do you know: The difference between epithelium
and mucosa
 The difference between malignant
neoplasm and intraepithelial
neoplasm
 The difference between
intraepithelial neoplasm andcarcinoma in situ
 What dysplasia is?

Sales education will henceforth beimportant!!
There are no explanations or relevant
illustrations on your official website orin your bookmarks and pamphlets.
Since clients are not experts when it
comes to medical matters, illustrations
are essential!

Chapter 2 51

I will now devote some space in this book to an explanation of malignant
neoplasms and intraepithelial neoplasms.
The point I wish to emphasize here is that an intraepithelial neoplasm iscompletely different from a malignant neoplasm, as has been explained in theclassification system set forth by the WHO. This difference turns on the presenceor absence of penetration beyond the basal membrane (a different standard
applies only to the large intestine). If there is no penetration beyond the basal
membrane, there is no risk to life, treatment is simple, and whatever burdens are
imposed by and for medical treatment on the patient are minimal.
1. How do intraepithelial neoplasms differ from malignant neoplasms?
● They differ in terms of how they are classified by the WHO.
● Their biological characteristics differ such that there is no invasion whenit comes to intraepithelial neoplasms. Once there is invasion, the tumor
is classified as a malignant neoplasm.
● After the lesion is detected, the risk of death is very low, as the lesion
would be removed and not left untreated.
● With respect to the burden of medical treatment, an intraepithelial
neoplasm can normally be treated relatively easily, with no long-term
need to receive medical attention afterwards.
These are examples of how intraepithelial neoplasms differ significantly
from malignant neoplasms (Table 31).
Table 31. Differences between malignant neoplasms andintraepithelial neoplasms
Malignant neoplasms
ICD‐O morphology code /3
With invasion andmetastasis

Intraepithelial neoplasms
ICD‐O morphology code /2
No invasion and nometastasis

Risk to life

Yes

No

Treatment burden

Significant

Typically low but depends
on site affected

WHO classification
Biological characteristics

2. At what sites do they commonly develop?
Examples of sites where they commonly develop are the large intestine,cervix, bladder, and mammary gland (Table 32).

52

Table 32. Number of affected persons nationwide by major site (estimates)2010 Center for Cancer Control and Information Services
Excludingintraepithelial
neoplasms
805,236

Includingintraepithelial
neoplasms
869,687

Esophagus

21,427

23,112

1,685

Large intestine

118,997

143,708

24,711

Lung

107,241

107,355

114

Skin

14,86318,3193,456

Breast68,071

76,041

7,970

Cervix23,36740,48017,113

Bladder

19,21928,621

9,402

Total for male andfemale patients
All sites

Intraepithelial
neoplasms
64,451

Source: Produced by the author based on sections 4 and 27 of Table 2, Monitoring of Cancer Incidence
in Japan 2010 Report
Note: All intraepithelial neoplasms in the uterus were registered as affecting the cervix; there were
10,737 patients with malignant neoplasm of the cervix.

3. What happens if you withhold treatment?
An intraepithelial neoplasm is typically removed upon detection. Thus, thenatural course of the disease in cases where treatment is not provided is notaccurately known. It is believed that some cases will result in invasion, somecases will see the tumor naturally heal, and some cases will see no change occur(Fig. 8). While they may be based on old data, there are reports that suggest thatapproximately 12 percent of cases result in invasion.
4. Will a relapse occur?
If the tumor is fully removed, there will be no relapse (recurrence). Since themammary ducts of the mammary tissue are complex and thus susceptible torecurrence, the mammary glands are sometimes fully resected (Fig. 9).

Chapter 2 53

Fig. 8. The natural course of the disease in cases where treatment
for an intraepithelial neoplasm is not provided(not many cases of progression to invasive cancer)

Source: Produced by the author based on OstorAG, Int. J. Gynecology Pathol. 1993:12:186-192
Note: Since intraepithelial neoplasms are treated, it is not possible to observe the natural course of
their development.

Fig. 9 Differences in terms of relapse54

5. Difference between mucosa and epithelium
Take a look at Fig. 10. A part of the mucosa (mucous membrane) is theepithelium. These terms were often presented in a conflated manner inpamphlets and other materials used to sell products to potential clients.
Fig. 10. Digestive tract tissue (There are multiple types of epithelia;
the structure of the mucous membrane also differs from organ to organ.)Note: Cancer can be divided into carcinoma if it first occurs in the epithelium and sarcoma if it firstoccurs outside of the epithelium as shown in the figure. Both carcinoma and sarcoma are malignant
neoplasms.

6. What is dysplasia?
Dysplasia is a term used to establish a professional finding as to the presenceof pathological tissue when a lesion is observed with a microscope.
You might see cellular atypicality (features that look different from what theynormally look like) or a structural atypicality (atypicality in the structure of thetissue where the cells in question have aggregated) in the cells, but there will be
no invasion crossing the basal membrane.
Depending on the degree of the atypicality in question, the dysplasia would
Chapter 2 55

be classified as anything from mild to advanced; regardless of the classification,
the finding thereof would apply within the epithelium.
A moderate or severe form of dysplasia could conceivably be a precancerous
lesion. A mild form of dysplasia may be seen in some cases as a type of change
not constituting a tumor.
An explanation regarding dysplasia is hereby reprinted in Table 33 from a
glossary published by a specialized society.

Table 33. Explanation of the term dysplasia(Japan Society of Clinical Oncology, Glossary 2011)
Confined to the epithelium, dysplasia is a proliferative lesion that exhibits cellularatypicality and structural atypicality but does not destroy the basal membrane. In
general, the nucleus is enlarged and deeply stained, the nucleolus is distinctive, thenucleus‐cytoplasm ratio is large, and a dedifferentiation tendency is exhibited. While
dysplasia is literally equivalent to a finding of carcinoma in situ, its atypicality is mild,
such that a determination of cancer is assumed to be impossible to make. Cellular andstructural atypicality can also be seen in degenerative, reactive, and regenerative
lesions, and care needs to be taken in properly identifying these lesions. Dysplasia
exhibiting moderate or advanced atypicality is deemed to be a precancerous lesion. The
term dysplastic state is often used to describe squamous cell lesions and has also cometo be used more recently to describe adenomatous lesions and the preleukemic state.
Neoplastic lesions are referred to as intraepithelial neoplasia. In particular, high‐grade
intraepithelial neoplasia is an alternative term describing the precancerous state of themucosal epithelium applicable to the squamous epithelium, while low‐grade
intraepithelial neoplasia is a term describing a non‐precancerous state of the mucosal
epithelium applicable to the squamous epithelium.
Whereas adenomas are single‐cloned neoplastic lesions, a dysplasia is not necessarily
neoplastic, which means that they should not be confused with one another. The
definition of dysplasia may differ from organ to organ and in accordance with thepathology. For example, in Europe, dysplasia encompasses adenomas of the colon andadenoma cancer, and degenerative atypical cells in the liver are known as dysplastic
cells.

7. Relationship among intraepithelial neoplasms, carcinoma in situ
(intraepithelial cancer), and severe dysplasia
According to ICD-10, intraepithelial neoplasm = carcinoma in situ + severe
dysplasia (Fig. 11).
The same rules apply to organs other than the cervix.
Since the level of precision when it came to distinguishing between
carcinoma in situ and severe dysplasia was not originally very high, severe
dysplasia and carcinoma in situ are collectively referred to as intraepithelial
56neoplasm.
*This is a notion that primarily applies to organs in which the cellular layers of the epithelium overlap
one another.

On the other hand, there are some organs, like the stomach and the large
intestine, in which the epithelial cells do not overlap. Illustrative errors
concerning this point have been seen on the websites of insurance companies in
the past.
*There are apparently companies that refer the classification of carcinoma in situ or severe dysplasia toa medical institution for the purpose of paying benefits even though the pathological finding as
indicated in writing on a medical certificate corresponds to an intraepithelial neoplasm. This may beconsidered a problematic approach that ignores the medical background noted above.

Fig. 11. Schematic diagram of a cervical lesion*Note (important): While this sort of schematic diagram might appear on bookmarks and in materials
used for the purpose of solicitation, you should keep in mind that types of epithelium differ for thestomach and large intestine. Erroneous illustrations abound!

8. What is an intramucosal carcinoma?
Take a look at Fig. 12. Intraepithelial neoplasm and intramucosal carcinoma
are different.
● Intraepithelial neoplasm = has not invaded beyond the basal membrane● Intramucosal carcinoma = has not invaded beyond the muscularis
Chapter 2 57

propria; neoplastic cells remain in the mucosal layer*Intramucosal carcinoma of the stomach is a malignant neoplasm.
Intramucosal carcinoma of the large intestine is classified on an exceptional basis as an intraepithelial
neoplasm!!
Intramucosal carcinoma of the large intestine comes under early-stage colorectal cancer underJapan’s own arrangement. For this reason, payment problems can be seen from time to time.
*“Intramucosal carcinoma is an intraepithelial neoplasm. Therefore, the payment of benefits formalignant neoplasms does not apply to intramucosal carcinomas.” This erroneous explanation can beseen printed on bookmarks and in materials used for insurance solicitation purposes!!

Fig. 12. Intramucosal carcinoma

9. Problems arising at the time of payment: Why are there some doctors
who describe a tumor that is not a malignant neoplasm as a cancer?
There are cases in which a policyholder submits a claim for payment ofmoney equivalent to the benefit for a malignant neoplasm after being told by hisor her doctor that he or she has cancer but in which further examination reveals
that the policyholder actually has an intraepithelial neoplasm.
● Doctor describes a precancerous lesion as an example of cancer● Doctor regards an intraepithelial neoplasm as a pre-invasive cancer
58

●
●

Because intraepithelial neoplasms are included in the scope of earlystage colorectal cancers under Japanese rules
Because intraepithelial neoplastic noninvasive mammary ductal
carcinomas are included in the scope of malignant neoplasms underJapan’s unique protocols for treating breast cancer

Cases in which a tumor not constituting a malignant neoplasm is neverthelessdescribed by a doctor as a malignant neoplasm for these sorts of reasons can befound.

It’s early‐stage colorectal cancer.
I’ve explained that it’s cancer so I’masking that you process the claim.

With thepatient’s
insurance
policy, we
won’t payunless it’s amalignantneoplasm.

*Intraepithelial neoplasm of the large intestine, which is classified in this example as early-stage
colorectal cancer, is treated with a relatively simple procedure known as a polypectomy, which involves
the use of a colorectal camera. There is little physical or financial burden imposed on the patient. The
problem comes from describing the condition in this scenario as a cancer. (See the protocol on treatingcolorectal cancer.)
Chapter 2 59

10. Mammary glands and intraepithelial neoplasms
A typical example of an intraepithelial neoplasm of the mammary gland isnoninvasive mammary ductal carcinoma, which is detected at rates of about 10
to 20 percent of all tumors of the mammary gland. Previously, the breast would
have been totally removed out of a belief that such tumors frequently emergedat several places in the mammary glands. More recently, however, breastconserving surgical operations have come to be performed instead (Table 34).
These days, such tumors are discovered while they are still small, thanks to theuse of mammography. Noninvasive mammary ductal carcinoma carries no riskof death, since there is no invasion beyond the basal membrane. On the other
hand, recurrence will happen when mammary ducts of a complex morphology
have not been resected.
Table 34. Treatment of an intraepithelial neoplasm of the mammary gland
Total mastectomy + hormonal drugs
Breast‐conserving surgical operation + radiation therapy + hormonal drugs

This has ended up being a rather long explanation to get you to understandthe concept of intraepithelial neoplasms. While this still cannot be described as
being a sufficient explanation, I hope that you will endeavor to deepen your own
level of understanding.
Solicitors should understand the following two points.
1.
2.

Since the burden placed on patients will differ from that associated with malignant
neoplasms, you must explain to each client that the need for insurance varies. (Anyexplanation purporting to say the opposite is strictly prohibited!)
After considering the above, you should think about the necessity of providing
coverage of intraepithelial neoplasms in your role as a solicitor.

11. Is coverage of intraepithelial neoplasms necessary?
If you believed that malignant neoplasms and intraepithelial neoplasms
carried the same level of risk, the extent to which intraepithelial neoplasms arecovered would constitute a standard for making comparative recommendations.
In the unlikely event that you believed that intraepithelial neoplasms could
be sufficiently covered by a women’s disease rider or medical insurance policy,
the extent to which intraepithelial neoplasms are covered would not constitute a
standard for making comparative recommendations.
60

The capabilities of insurance solicitors are being tested.
It is problematic if you are convinced by whatever unilateralexplanations are given to you by insurance companies.
Think for yourself.

What kind of coverage do you, as the client, need?

❖ Cancer progression and staging
The Union for International Cancer Control (UICC) produced and publishedthe TNM classification (staging) system as a system for indicating the
progression of a solid tumor (Table 35) (Fig. 13). Having previously undergone
six revisions, the seventh edition is the edition that is currently in effect. With
the conventional approach to treatment, standard treatment methods determinedaccording to organ and according to progression are recommended. Thesemethods have been disseminated to clinicians as a set of medical treatment
guidelines.
Table 35. The three factors that are considered in the TNM classification
system
T factor: Classification determined by tumor size and depth of invasion by site
N factor: Classification determined by metastasis to lymph nodes and the spread and extent
thereofM factor: Diagnosis of metastasis to distant parts of the body and the spread and extent
thereof

Chapter 2 61

Fig. 13. Illustration of the TNM classification system

Generally speaking, solid tumors are ranked into four stages according toprogression. Stage IV means that the cancer has metastasized to distant parts ofthe body beyond local sites, while stage I describes the localized existence of amalignant neoplasm at the site where it first emerged.
Stage I → Stage II → Stage III → Stage IV(early <…………………..……> advanced)
There are also differences among the various editions of the classification
system. Strictly speaking, the same edition of the TNM classification system canbe modified with the use of one of three prefixes: c, p, and s.
The TNM classification system can conceivably be used as an alternative
way to describe the severity (progression) of cancer for serious cancers for which
insurance coverage is needed. However, you must understand that the
progression of cancer differs from the severity of cancer in terms of the need forcoverage (Table 36). As the severity of a cancer suffered by a patient is ongoing,stage-linked benefits based simply on progression in accordance with the TNM
classification system should be carefully considered. (It is self-evident that apatient with a heavy burden will need to receive coverage that is generous.)
In addition, progression, which relates to the rate of survival, can be tied to a
notification of life expectancy. A notification that you have cancer is different
from a notification of life expectancy. Even if the cancer notification rate isalmost 100 percent, notifications of life expectancy will not always correspond62

to the same rate. In other words, even if you have been notified that you havecancer, you might not have been told the extent to which your condition has
progressed.
Table 36. Points to keep in mind when using the TNM classification system todesign an insurance product・There is some discrepancy between the TNM classification system and the cancer
treatment protocols.
・There are three types of TNM classification systems.
・The TNM assessment made at the time of the initial diagnostic testing is subject tochange.
・There are no standards for diagnosis applicable to any of the factors comprising theTNM classification system: T, N, M.
・The TNM classification system relates to the necessity of treatment and the methodby which treatment is to be provided and differs from the system by which severity isassessed in determining that there is a condition of need for long‐term care exclusiveof end‐of‐life care.
・Progression according to the TNM classification system is linked to the survival rate
and notifications of life expectancy.
・There is a discrepancy between the cancer notification rate and the cancer
progression notification rate.
Note: Various issues have been pointed out with respect to the use of the TNM classification system.
The TNM classification system is an artificial standard for classifying tumors in accordance withdifferences in survival rate and was created by the American Cancer Society, a substantial operating
member of the UICC.

❖ Confirming a cancer diagnosis
As explained earlier, the definitions of malignant neoplasm andintraepithelial neoplasm and the WHO’s classification standards are
exceedingly important elements affecting the conditions set forth in a cancer
insurance policy.
In order to medically examine a patient and confirm a diagnosis of cancer,
numerous types of tests are conducted (Table 37). It goes without saying that thequestion of which test results are to be given the most weight in making adiagnosis of cancer is a topic of importance in the area of clinical medicine.
A look at policy conditions reveals that many cancer insurance policies
stipulate that benefits are to be provided subject to the condition that a cancer
Chapter 2 63

diagnosis made after a policy comes into effect is confirmed. What is important
here is to figure out what is meant by “confirmation of diagnosis.” Just as thenotion that “cancer is a term referring to a malignant neoplasm” is one for whicha universal medical consensus has been reached, a universal medical consensus
has been reached for the idea that “confirmation of a diagnosis of cancer is afinding as to the presence of pathological tissue (histopathological finding).”
This is because there are no tests at the moment that are capable of scientificallyoffering a level of diagnostic accuracy capable of outperforming methods ofreaching diagnoses that indicate the presence of pathological tissue. If other tests
are utilized to confirm a diagnosis, differences will arise between healthcare
institutions and doctors in terms of the quality of diagnoses that are reached.
Table 37. Various types of tests and findings
●
●
●
●
●
●
●
●
●

Findings from a medical examination by interview (history taking)Findings from a physical medical examination
Blood test
Simple x‐ray
UltrasoundHighly accurate imaging (CT, MRI)PET scanCytological testing
Histopathological testing ⇔ confirmed diagnosis

Thus, the conditions set forth in insurance policies should also be madeconsistent with standard medical views on this matter.
If you fail to give greater weight to histopathological findings and simply
accept the results of other tests, there will be an inconsistency with respect to thepayment of benefits, and the problem of a lack of fairness among policyholders
will emerge.
Of course, there are also cases in which a histopathological finding cannot be
obtained. This might happen for persons who already have terminal cancer at thetime of their first visit to a doctor or for persons for whom a tissue examination
cannot be performed, such as where a tumor is situated in the brain or pancreas.
Thus, while you should give weight to a pathological examination finding when
confirming a diagnosis, a medical reason for an inability to obtain such a findingis important in such cases. It would be problematic if you were to make aninsurance claim based on a diagnosis of colorectal cancer arrived at because thepatient happened to produce some bloody stool.
64

We expect to see the arrival of an age in which you can conduct molecularbiological testing in addition to testing for the presence of pathological tissue.
Such testing would include testing for the presence of various types of tumor
markers and genetic testing. No doubt the conditions set forth in cancer
insurance policies will eventually need to be revised in line with medical
advancements of this sort.

Payment‐related issues will arise
with policies that include
conditions that allow for the useof diagnoses arrived at with othertesting options!

The confirmation of a diagnosis with ahistopathological finding is an idea for which auniversal medical consensus has been reached!
If a diagnosis is accepted based on testing that
does not consist of a test for the presence of
pathological tissue, a medical explanation for
the inability to conduct pathological testing will
be important.

❖ Difficult benefit decision
Unlike what might be seen with other insurance products, only an insured
person with cancer will be eligible to receive a benefit payable under a cancer
insurance policy. For this reason, a difficult benefit decision is required to be
made. This decision turns on the ability to distinguish between cancer anddiseases that are not cancer (Fig. 14).
Chapter 2 65

Fig. 14. Difficult benefits determination 1: cancer or not,cancer treatment or not

1. Whether or not cancer is applicable
When it comes to determining whether or not an illness constitutes cancer, it
should be noted that cancer is defined in the conditions set forth in a cancer
insurance policy. Thus, a determination must be made as to whether the name ofa disease for which a claim is made constitutes cancer as stipulated in the policy
conditions.
Example ሺiሻ: I haven’t undergone pathological testing, but my doctor has
told me that I have cancer, so please pay me.
Example ሺiiሻ: I have what is known as a malignant meningioma*, so please
pay me.
In either of the above examples, no benefit is payable without the satisfactionof other conditions.
*Some types of malignant meningioma consist of tumors that are notmalignant neoplasms.
2. Hospitalizations and surgical operations to be undertaken for the direct
purpose of treating cancer
Let us say that you are treated for cancer and find yourself getting better andthat you then suffer a stroke the day before your scheduled release from hospital.
You will consequently be required to remain hospitalized to get treated for yoursetback. In such a case, you will not receive any benefit money for the portionof your stay in the hospital that is attributed to the stroke. The conditions forreceiving a hospitalization benefit will be stated in the policy conditions in termsof “hospitalization for the (direct) purpose of receiving treatment for cancer.” Insuch an example in which a stroke is suffered (example ሺiiiሻ), it is relatively easy66to make a determination on this point. In the real world, however, examples inwhich it is difficult to distinguish between hospitalization for cancer andhospitalization for any other reason abound.
Example ሺiiiሻ: After the patient underwent a surgical operation for livercancer, his hepatic cirrhosis, which was linked to his liver cancer, worsened toprolong his stay in the hospital.
3. OtherIn addition to the issue of determining whether a given condition can betreated as a cancer or not in the context of cancer insurance, problems are also
encountered in making a determination with respect to the applicability ofsurgical operations for cancer and the benefit multiplier. A determination isrequired as to whether radical surgical cancer operation, other surgical cancer
operation, or surgical operation with the use of fiber-optics or catheters should
apply (Fig. 15).
For example, some insurance policies offer different amounts of benefit
payments depending on which surgical operation is applicable in such cases as
when gastric cancer is removed with a stomach camera. If a supplementary
explanation of the benchmarks for making a determination were included in thefootnotes of the policy conditions, there would be no problems down the road.
The quality of a given product is a function of the attention paid to such details.
Fig. 15. Difficult benefits determination 2: Surgical operations for gastriccancer based on the use of a stomach camera*An insurance policy with conditions setting forth definitions of such terms as radical surgicaloperation is a high-quality product.

Chapter 2 67

❖ Specific provisions to prevent adverse selections
Cancer insurance is fundamentally based on the idea that the payment ofbenefits is premised on the confirmation of a cancer diagnosis for the first time
at some point after the policy takes effect. Thus, someone who has been
diagnosed with cancer even once in his or her life will not be entitled to take out
cancer insurance. Some persons who are at risk of getting cancer have been seen
making an adverse selection by attempting to take out cancer insurance. There
are three types of provisions found in the policy conditions that are designed toprevent this from happening.
(i) Obligation to disclose(ii) Waiting period (commencement of coverage is delayed by ninety daysor three months)(iii) Invalidation provision (contract is invalidated if a diagnosis of cancer
is confirmed before the policy takes effect)
Each of these provisions is effective at preventing a different type of adverse
selection as specifically outlined in Table 38.
Table 38. Provisions for the prevention of adverse selections
Provision

Type ofadverseselection

General provision
Obligation to disclose
Person who takes out apolicy while concealing
the fact that there has
been an indication ofabnormality revealed
in a checkup and thefact that he or she isundergoing
examinations at ahealthcare institution.

Provision specific to cancer insurance policies(*)
Waiting period
Invalidation provision
Person who takes out
a cancer insurance
policy without
undergoing an
examination at ahealthcare institution
despite having
subjective symptoms.

Person who takes out
a policy while
concealing a medical
history of cancer.

Source: Produced by the author; *Even some insurance policies covering the three major diseases
contain provisions that provide for a waiting period applicable to certain malignant neoplasms.

(i) Obligation to disclose
If you receive an indication of abnormality in the wake of a checkup andundergo an examination, it is possible that the insurance agreement will becanceled at the time you submit a claim for benefit payments on the grounds thatyou violated your obligation to disclose.
68

(ii) Waiting period
If you have subjective symptoms, you might decide to apply for cancer
insurance before seeing a doctor. In such a case, you would not be subject to the
obligation to disclose, since you would not have received a diagnosis at this time.
A waiting period would be instituted to prevent this kind of an adverse selection
risk.
(iii) Invalidation provision
If you receive a definitive diagnosis of cancer before your insurance policy
takes effect irrespective of whether you knew or not, your contract will be
invalidated. The way you will be reimbursed for the insurance premiums thathave been paid to date depends on whether or not you knew about your diagnosis
as outlined in Table 39.
Table 39. Operation of the invalidation provision
If the insured knew
In general, the provisions of the policy
conditions call for the application of theinvalidation provision over the provisionthat applies in the event of noncompliancewith the obligation to disclose.
Insurance premiums are not reimbursed.
(These days, some companies reimburse
an amount equivalent to the cancellation
refund.)If the insured did not know

An amount equivalent to the amount of
insurance premiums already paid isreimbursed.

❖ Disclosure at the time a cancer insurance policy is taken out
1. Disclosure specific to cancer insurance
Cancer insurance is a product that is invalidated if a diagnosis of cancer isconfirmed before the policy takes effect, irrespective of whether the insured
person knows that he or she has cancer. Thus, a disclosure form to be submitted
when taking out a policy requires the inclusion of questions unique to cancer
insurance.
Have you ever previously gotten cancer?
While someone who does not know the answer to this question cannot be
prevented from taking out a policy, this question can prevent a meaningless
contract from being concluded and the invalidation of the contract after a policy
takes effect for anyone who knows that he or she has previously gotten cancer.
Chapter 2 69

Since a disclosure form outlining a history of injuries and illnesses over theprevious five years or so will be requested with normal insurance products, thenature of the disclosure that is required for cancer insurance can, by comparison,be described as being highly unique indeed (Fig. 16).
Fig. 16. Disclosure question paired with the invalidation provision

2. Points to keep in mind
It is also important to be aware of the names of diseases to know whether
your own medical history includes any conditions that might come under theterm cancer. To prevent applicants from providing incorrect answers,
supplementary explanations are necessary. For example, you should remind
applicants of the fact that cancer includes leukemia and sarcoma (Tables 40 and
41).
Special attention needs to be paid for products that have an invalidation
provision for intraepithelial neoplasms. It is expected that there are many people
who are not aware of the names of diseases.
Table 40. Some names of diseases that applicants might not be aware arenames of cancers
GIST
Carcinoid
Myelodysplastic syndrome
ThymomaMultiple myeloma

70

Table 41. Names of diseases corresponding to intraepithelial neoplasms of thecervixSevere dysplasia
CIN III, SIN III, HSIN, HSIL
Note: Although the handling of moderate dysplasia, CIN II, and SIN II differs fromcompany to company, it is the current opinion of the WHO that these conditions areincluded in the scope of intraepithelial neoplasms.

It is my belief as the author of this book that the downside behind theprovision of excessive coverage of intraepithelial neoplasms is the existence ofan invalidation provision for intraepithelial neoplasms.
❖ Examples of inappropriate explanations featured in materials used forthe purpose of solicitation
While intraepithelial neoplasms need to be explained to clients since
intraepithelial neoplasms are covered by cancer insurance policies, telling aclient that an explanation is provided in appendices attached to the policy
conditions can be described as a flagrant failure to carry out this requirement to
explain. Accurate, easy-to-understand explanations and illustrations ought to be
included in materials used for the purpose of solicitation and on bookmarks.
Although this matter may be low priority given that it is hardly touched upon inmagazines and other media that evaluate insurance products, the provision of
information relating to malignant neoplasms and intraepithelial neoplasms
through materials used for the purpose of solicitation (such as bookmarks) is
important.
● Information is not being provided● Provided information is incorrect● Provided information is not medically reliable
These scenarios may be evidence of the fact that medical oversight isinsufficient on the part of some companies, even though they may be selling
third-sector products that are deeply tied to medical care. Such circumstances
could be used to assess not just product evaluations and proposals to be describedlater but also evaluations and proposals of the companies that sell these products.
I hereby present several examples of inappropriateness included in materials
used for the purpose of solicitation and posted to official websites in the industry(both those that have been corrected and those that continue to be used in this
Chapter 2 71

state).
(1) Misunderstanding of intraepithelial neoplasms
Intramucosal carcinoma is carcinoma in situ.
Intramucosal carcinoma of the stomach is, in principle, a malignant
neoplasm, thus making this statement incorrect.
(2) Incorrect explanation of mucous membrane
Carcinoma in situ refers to the state in which the cancer in question has notgone beyond the uppermost epithelial layer of the mucous membrane,
which means that the basal membrane constituting the lowest layer of themucous membrane has not yet been destroyed.
Since the lowest layer of the mucous membrane is not the basal membrane,
this statement is incorrect.

(3) Incorrect illustrations and conflations of tissue structure corresponding to themucous membrane found in the stomach and large intestine and the mucous
membrane found in the cervix

72This is an inappropriate illustration of the mucous membrane of the stomach(since the gastric epithelium is a single-layer columnar epithelium). It might
have been better to explain with a focus on the cervix instead.
(4) Inappropriate use of medical terms in the policy conditions
The appendix attached to the policy conditions states that “malignant
neoplasm refers to any (medical) malignant neoplasm or (medical)
intraepithelial neoplasm”.
Malignant neoplasm as a coined term is conflated with malignant neoplasm
as a medical term.
Malignant neoplasm as a coined term should not be used.
(5) Inappropriate catchphrases that induce a misrepresentation of products
provided by other companies
Materials used for the purpose of solicitation indicate that “Early‐stage
cancers are covered.”
While this is a catchphrase that emphasizes the provision of additional
coverage of intraepithelial neoplasms by the company, it could potentially lead
consumers to mistakenly believe that cancer insurance policies that do not coverstage I malignant neoplasms are sold by other companies instead. Perhaps an
appropriate expression in this case is to say, “We also cover certain precancerous
lesions.”
If this sort of expression were to be used, however, a medical explanation of
precancerous lesion would be necessary. Ultimately, a company can only state“We also cover intraepithelial neoplasms.”

Chapter 2 73

Chapter 3: Treatment of cancer❖ Surgical treatment
A specialist in surgical treatment spoke of the changes in surgical treatment
at a cancer-related conference as follows:
1. From an era of improving treatment outcomes to an era of non-invasive
treatment options
A representative type of surgical treatment is the surgical operation. When it
comes to treating solid cancers, surgical operations were the main option at one
time. As improvements in and the optimization of the scope of and skills used inoperations were being researched in the pursuit of radical outcomes, thedirection of surgical treatment underwent a massive shift towards the conductingof noninvasive (treatment options that are neither painful nor agonizing) orfunction-preserving surgical operations as a way to help safeguard quality of life
subsequent to treatment by having patients go through a stage for improving
treatment outcomes (Fig. 17). Endoscopic surgical operations as well as
surgical operations performed under an endoscope, which include procedures
based on the use of laparoscopes and thoracoscopes, became popular. Robotassisted surgical operations to which principles of medical engineering havebeen applied also came to be introduced (Table 43).
2. From noninvasive treatment options to multimodal personalized
medicine
At the same time, we have seen a shift from an approach based on surgicaloperations alone to the incorporation of multimodal treatment options combining
radiation therapy and anticancer-drug-based treatment (Table 43) into the rosterof options made available for each site in the body thanks to recent
advancements in radiation therapy and the advent of new anticancer drugs.
For relatively small tumors, surgical resection or excision is still the maincourse of treatment that is followed, but a combined approach to treatment
involving the use of anticancer drugs in the event that the removed tumor
undergoes genetic screening that reveals a high risk of potential metastasis orrelapse has come to be used for breast cancer and other such conditions. In otherwords, we are seeing a shift in treatment approach from the provision of74

treatment according to site and the progression of the malignant neoplasm(stage) to the provision of personalized treatment.
3. Various treatment methods
Treatment procedures and techniques are also diversifying, as we can see inthe performance of hepatic embolization and other forms of intravascularsurgical operations and application of radio-wave coagulation to treat livercancer.
Fig. 17. Changes in surgical treatment methods

Table 42. Treatment diversification and noninvasive treatment
Surgical operations performed under an endoscope: EMR, ESD, surgical operations
performed under a laparoscope, surgical operations performed under a thoracoscope,
robot‐assisted surgical operations
Intravascular surgical operations: Embolization
Others: Radio‐wave coagulation, laser operations

Table 43. Multimodal treatment
In inoperable cases of colorectal cancer and gastric cancer, the tumor is shrunk throughchemotherapy before a surgical operation is undertaken.
A laparoscope is used to determine whether or not intra‐abdominal metastasis has
occurred; if metastasis has occurred, anticancer drugs are administered before a surgicaloperation.
These and other examples of proactive treatment based on the use of surgicaloperations and other treatment methods are collectively known as multimodal
treatment.

Chapter 3 75

❖ Radiation therapy
In recent years, radiation technology for medical use has advanced
significantly, and patients now expect considerably positive outcomes from theuse of radiation therapy. The media has even highlighted cases in which
prominent figures known to television audiences had chosen to receive radiation
therapy on the grounds that functional preservation is possible when treatinghead and neck cancer and laryngeal cancer. Without the availability of radiation
therapy technology, the daily lives of many patients would likely havedeteriorated significantly and become highly stressful. In the past, patientswould typically be transferred to the radiology department by the surgicaldepartment in inoperable cases and cases of recurrence, such that radiation
therapy was not a primary course of action to take in the treatment of cancer.
These days, however, twenty-five percent of patients receive radiation therapy
as cancer treatment undergoes a far-reaching transformation.
With advancements in radiation therapy equipment, new types of therapy
equipment are being constantly introduced (Table 44). With radiation therapy,
aftereffects can be seen due to side effects (adverse phenomena) caused by theirradiation of normal non-tumor tissue, and it is known that the quality of life
after treatment can deteriorate. Thus, advancements in radiation therapy trace ahistory of the development of irradiation equipment and improvements toirradiation technology carried out in an effort to treat tumors more efficiently
and minimize aftereffects.
Table 44. Major examples of radiation therapy
External‐beam radiation

Interstitial irradiation

Linear particle accelerator
High‐precision radiation therapy (IMRT, IGRT), motion‐
tracking radiation therapy
Particle beam therapy
Stereotactic radiation therapy (cyber knives, gamma knives)
Brachytherapy

In addition, equipment for treating cancers not with radiation but withparticle beams, with which you might be familiar, is another example of a new
type of treatment device. Particle beams have garnered attention as an expensive
option for providing medical care, as recognized in the field of advanced medical
care.
76

In the meantime, radiation-based treatment technology has advanced. In
particular, huge strides have been made in high-precision radiation therapy interms of targeting just the tumor and minimizing the amount of radiation directed
at surrounding normal issue. A tumor is not a nicely-shaped sphere but rather amalformed lesion. The irradiation method that corresponds to the shape of sucha tumor is what is known as high-precision radiation therapy and can be
described as a three-dimensional type of irradiation method. It became eligible
for insurance coverage ahead of the use of particle beams and can be used as amuch cheaper treatment option than particle beams. In recent years, thetechnology has advanced even further. Motion-tracking radiation therapy
equipment to facilitate four-dimensional irradiation has also been introduced toenable irradiation that is tailored to the movements of the body during theirradiation process (since respiratory movements during treatment are
unavoidable).
In addition, such treatment devices as gamma knives and cyber knives havealso come to be used as devices for carrying out stereotactic radiation therapy totarget lesions with a high degree of precision.
Radiation technology, as explained in this section, consists of external-beamradiation therapy administered from outside the body. However, interstitial
irradiation (brachytherapy), for which a radioactive material is implanted into
the lesion or surrounding tissue to allow for irradiation from within the tissue, isalso employed for prostate cancer, tongue cancer, and uterine cancer, and atother sites.
Moreover, the use of radiation is also being promoted for carcinomatous pain
caused by bone metastasis. While radiation therapy used to be regarded as atreatment method employed in lieu of surgical operations undertaken with theaim of curing cancer, it also came to be used to alleviate symptoms, such thatthe scope of its use in therapy is expanding.
In the past, private life insurance products that provided for the payment ofbenefits as part of the surgical operations benefit in the event that the amount ofradiation from external-beam radiation administered in a normal manner was atleast fifty grays (Gy) were standard. These products, however, are no longeraligned with the current state of progress in terms of treatment methods. When
benefits were paid as part of the surgical operations benefit, there was also a
problem in that poicyholders found it difficult to know whether the product inquestion provided additional benefit payments for radiation or not.
Chapter 3 77

❖ Chemotherapy
1. What is chemotherapy?
A specialist would define chemotherapy as “a form of therapy that uses
chemicals to suppress the growth of or kill pathogenic microorganisms or
malignant tumor cells residing in host cells and that is generally used often in
the treatment of malignant tumors.” Chemicals used include not just anticancer
drugs but also antibiotic drugs for bacteria.
2. There are many types of anticancer drugs:
ሺiሻ Conventional cytotoxic anticancer drugs (cytocidal anticancer drugs)･Conventional cytotoxic anticancer drugs impair the cell division cycle andare also toxic to healthy cells that divide and proliferate.
ሺiiሻ Molecule-targeting drugs･ Molecule-targeting drugs are at the forefront of new anticancer drugs,
exhibit side effects that have never before been seen, and are extremely
expensive.
･Molecule-targeting drugs are at the center of personalized medicine throughtheir use in genetic testing and other forms of companion diagnostics (diagnostic
testing to confirm in advance the therapeutic effects of an anticancer drug to beadministered).
3. Current state of treatment with anticancer drugs
With the advent of molecule-targeting drugs, chemotherapy-based treatment
is undergoing significant changes and is expected to take center stage in theevolution of cancer treatment in the years to come (see A paradigm shift in thetreatment of cancer on page 85 ).
Currently, treatment with anticancer drugs is essential for patients withadvanced forms of cancer, and progress is also being made with supportive
therapy designed to suppress side effects (see page 87 for a section on palliative
care and supportive therapy). Due in part to the impact of this progress,
outpatient chemotherapy, which entails the administration of anticancer drugs
on an outpatient basis, is also becoming widespread. Half of all patients
receiving anticancer drug therapy are already receiving such treatment byregularly visiting hospitals or clinics.
The biggest problem is that anticancer drugs have become very expensive.
78

Indeed, even very expensive oral drugs have emerged. This problem isemblematic of the problems with economic disparities in healthcare (Fig. 18).
Table 45. Options when it comes to medical care for cancer
Early‐stage cancer
Surgical operation
Radiation
Chemotherapy
Palliative care and supportive therapy

Advanced cancer
Chemotherapy
Palliative care and supportive therapy

Table 46. Comparing treatment options
Early‐stage cancer
Surgical operation and radiation therapy
Topical treatment
Local side effects
Treatment is generally short‐term

Advanced cancer
Chemotherapy
Whole‐body medical care in many cases
Systemic side effects
Long‐term treatment

Fig. 18. Environment in which anticancer drug treatment is provided

Chapter 3 79

❖ Molecule-targeting drugs
With the emergence of molecule-targeting drugs, cancer treatment has
undergone significant changes. Allow me to briefly describe molecule-targeting
drugs.
1. What is a molecule-targeting drug?
In contrast to cytotoxic anticancer drugs (conventional anticancer drugs),
molecule-targeting drugs are drugs used to treat cancer by targeting molecularlevel abnormalities specifically tied to cancer cells. Drugs that inhibit theneogenesis of blood vessels by targeting molecules that determine cancer
characteristics, such as in terms of cancer growth, invasion, and metastasis (Fig.
19), have also been created. Points of comparison with conventional anticancer
drugs are summarized in Table 47.
Fig. 19. Target points for molecule‐targeting drugs

Table 47
Molecule‐targeting drugs
Molecules that are characteristic of cancer
are targetedSpecial side effects
Personalized administration (mainly bygene or biomarker)
Expensive

80

Conventional anticancer drugs
Act on DNA and RNA in the process of
nuclear division
Typical side effects
Administration by tissue type by site

2. Why are molecule-targeting drugs expensive?
New drugs released in recent years are extremely expensive. While simple
comparisons cannot be made due to the existence of various regimens*, acomparison with conventional anticancer drugs reveals that the price of one
bottle of injectable solution or one tablet or pill of medicine for internal use iseight to nine times higher than that of conventional equivalents. Since these
consist almost entirely of therapeutic drugs customized in line with thecharacteristics of each patient, they are not meant to be administered to all
patients, which means that drug prices will inevitably rise.
*According to the Department of Pharmacy at the National Cancer Center
Hospital, a regimen means “a chronological treatment plan for the administrationof anticancer drugs, intravenous fluids, and supportive therapy drugs (such as
antiemetic drugs).”
3. Financial side effects (toxicity) and cancer insurance
The duration of chemotherapy is sometimes extended. In addition to thephysical side effects, there are also financial side effects that come from theimposition of a high cost burden, which can also in turn affect treatment options
available to clinicians. Private insurance can be useful for dealing with suchfinancial side effects (Table 48).
Table 48. Financial toxicity of anticancer drugs
Contents of side effects
Physical side effects
Financial side effects (financial toxicity)

How to deal with side effects
Supportive therapy
Cancer insurance❖ New cancer immunotherapy
Garnering significant interest these days is the notion of cancer
immunotherapy (Fig. 20). In the past, much of what this entailed was cellularimmunotherapy, which was offered by private practices in the community as a
medical treatment option not covered by public healthcare insurance and may
have been a bit specialized. The therapy primarily consisted of a type oftreatment known as activated lymphocyte injection therapy, which belongs to
the category of treatment referred to as nonspecific immunotherapy. Suffice it toChapter 3 81

say, it is difficult to assess the effect of immunotherapy in the same way that
normal anticancer drugs are evaluated. Suppression of the progression ofmalignant neoplasms has become the main goal of treatment, although when
surgical treatment, medical treatment, and all other treatment options are nolonger effective and the attending physician is ready to throw in the towel, somepatients, as a last resort, visit a private practice where cancer immunotherapy isoffered and receive medical treatment not covered by public healthcare
insurance. At the clinic with the longest history in this field, a course of six
treatments over a three-month period costs about 1.3 million yen.
Fig. 20. Immunotherapy for cancer

Recently, however, there have been medical breakthroughs in the world of
immunotherapy that have yielded confirmed outcomes comparable to the use of
normal anticancer drugs. Types of immunotherapy that have recently shown
some promise include the following (Table 49):
 Cell therapy designed to reinforce the aggressiveness of immune cells
that exhibit cytocidal effects;
 Treatment to release the mechanism by which cancer immunity issuppressed;
 Peptide vaccine therapy.
In recent years, Nivolumab, the world’s first drug of its kind, was approvedfor post-drug development insurance coverage in Japan and has been used inclinical practice. The attainment of a therapeutic effect through the combinationof the drug with monotherapy or other forms of immunotherapy, or withchemotherapy, has been confirmed. Indeed, the drug represents a great leap
forward in the world of immunotherapy, and oncology specialists are also paying
attention. At last, it can be said in a truly meaningful sense that a fourth type oftherapy for cancer has emerged on the scene.

82

Table 49. Recent cancer immunotherapy(i) Strengthening immunity
・Cancer vaccine therapy
Therapy that works by increasing immune cells that recognize cancer cellmarkers
・Adoptive immunotherapy with T lymphocytes
Immune cells that attack cancer are increased through genetic modification
techniques(ii) Releasing the mechanism by which immunity is suppressed
・Immune checkpoint inhibitors
Currently the hottest form of immunotherapy

However, both clinicians and pharmaceutical manufacturers are concerned
about soaring drug prices. Nivolumab and a similar drug known as Ipilimumab
are extremely expensive. It is expected that new drugs yet to be developed will
also be expensive (Table 50).
Table 50. Drug prices
Opdivo (generic name: Nivolumab)
Intravenous dose of 3 mg/kg (body weight)
20 mg 1 bottle drug price 150,200 yen
for malignant melanoma that cannot beradically excised, to be administered at two‐
100 mg 1 bottle drug price 729,849 yen
week intervals
Yervoy (generic name: Ipilimumab)
Dose of 3 mg/kg (body weight) for malignant
melanoma that cannot be radically excised,
50 mg 1 bottle drug price 485,342 yen
to be administered four times at three‐weekintervals
Source: Drug price standards and attachments for each drug
*Drug prices have been lowered to a quarter of prices as listed as of June 2020.

In the future, we believe that the time will come when private insurancecompanies will consider developing products that cover treatment costs,
including the costs of cellular immunotherapy, as overall progress in the area of
immunotherapy continues apace. However, we must figure out whether
coverage will apply to the framework of immunotherapy or whether coverage
will come within the scope of treatment involving the use of anticancer drugs(Fig. 21).
Incidentally, a vaccine developed by Maruyama is a paid clinical trial drug
Chapter 3 83

that patients must pay for on an out-of-pocket basis, despite the fact that its use
is part of a trial (Table 51). Many companies define the drugs for which an
anticancer drug treatment benefit can be received as approved drugs or drugs
covered by insurance, which means that the Maruyama vaccine would not
qualify for the receipt of this benefit (though the actual operations of individualcompanies were not investigated with respect to this point). Among products
surveyed for this book, only Himawari Life Insurance’s cancer insurance policy
expressly indicates that cellular immunotherapy is included within the scope ofcoverage applicable to anticancer drugs. The definition set forth in the conditionsof this policy is excerpted in Table 52.
Fig. 21. Division between anticancer drugs and immunotherapy

Table 51. Drug approval and drug costs
paid by patients on an out‐of‐pocket basis
Use of unapproved drugs for
medical treatment not covered bypublic healthcare insurance
Unapproved
drugs

Approveddrugs

Common clinical trial drugs
Expanded clinical trial drugs andclass B advanced medical care
Use in patient‐requested medical
treatment
After pharmaceutical approval andbefore being covered by insurance
After being covered by insurance

Paid for by patient
Paid for by pharmaceuticalcompany (exception: Maruyama
vaccine)Paid for by patient or
pharmaceutical company(*1)
Paid for by patient or
pharmaceutical company
Paid for by patient
Statutory burden

Note 1: [Important] Costs pertaining to advanced medical care is not necessarily equivalent in amountto the amount to be paid by the patient on an out-of-pocket basis!

84

Table 52. Cancer outpatient treatment benefit‐ Comment 3 of Appendix Table 7
Chemotherapy means a therapy undertaken for the purpose of destroying cancer or
suppressing the development and proliferation of cancer through the administration of
a drug for which cancer is defined as the disease that is susceptible to treatment by the
drug (includes cellular immunotherapy and vaccine therapy).
Source: Himawari Life Insurance, Yuuki no Omamori cancer insurance policy (2010), policy conditions
dated April 2015

❖ A paradigm shift in the treatment of cancer
Recent cancer treatment-related academic societies have changed
significantly over the course of just a few years. Audiences are filling up venues
where announcements on drug therapies are being made as if there has been achanging of the guard in terms of what the primary focus is in the treatment ofcancer. Whereas announcements concerning immunotherapy research projects
used to be made to sparse crowds, they are now so popular with medical officialsthat the venues in which they are hosted can no longer accommodate everyone
who shows up to attend.
Against this backdrop can be found the spread of anticancer drugs and theemergence of immunotherapy as drivers of personalized medical care as madepossible by developments in genetic testing technology. While the importanceof the treatment of localized tumors by way of the use of surgical treatment
options and radiation therapy options remains unchanged even today, treatmentrelated thinking is likely to change from the ground up, including with respect
to how anticancer drug therapy will henceforth be selected even for dealing withearly-stage cancer.
For each site, guidelines for the medical treatment of malignant neoplasms
have been released and are used as a bible for the provision of treatment by
medical practitioners. Nevertheless, treatment methods are essentially put
together in accordance with the cancer site and the progression of the cancer(stage). Even at present, however, we can see signs of change in this frameworkof treatment. It has gotten to the point where declarations have been made by
key figures in the treatment of breast cancer to the effect that the era of treatment
by stage has come to an end. A multimodal approach to treatment of even earlystage cancers is necessary, and treatment of even advanced cancers that had
Chapter 3 85

previously been considered lost causes are proceeding. These points can be
described as evidence of the fact that a paradigm shift in the treatment of cancer
is indeed underway (Fig. 22).
Fig. 22. Paradigm shift in treatment

Doctor, is it true that treatment
comes to an end when thetumor is no more than acentimeter in diameter andthere is no metastasis detected
in axillary lymph nodes?

86

Breast cancer studies revealthat tumors can metastasize
rather easily.
Just in case, we should treat
it with anticancer drugs.

❖ Palliative care and supportive therapy
The Cancer Control Act (Basic Act) came into effect on April 1, 2007.
Paragraph (1) of Article 9 of the Basic Act sets forth the formulation of a Basic
Plan to Promote Cancer Control Programs (Basic Plan) and stipulates that thisplan would be reviewed every five years.
While a Basic Plan was formulated in 2007 and later in 2012, the plan
published in June 2007 identified “provision of palliative care from the outset oftreatment” as being the second-most-important issue to be engaged in on apriority basis as follows: “development of a system for providing total palliative
care, including not just care that addresses physical pain but also mental carethat addresses psychological pain in accordance with each cancer patient’s
situation” and “development of a system for appropriately providing at-homemedical care and long-term nursing care, in order to maintain and improve eachcancer patient’s course of medical treatment at home” (Table 53).
Table 53. Cancer control and palliative care
April 2007: Cancer Control Act
June 2007: Basic Plan to Promote Cancer Control Programs
Important issue to be engaged in on a priority basis: Provision of palliative
care from the outset of treatment

The term palliative care as used to date is synonymous in the minds of somewith the term terminal care. For this reason, the alternative term supportive
therapy has also come to be used. Palliative care or supportive therapy means
therapy and care provided to improve a patient’s quality of life and is a broadconcept that encompasses not just physical care but psychological and spiritual
aspects as well (Table 54). At the same time, supportive therapy as an actual
expression is often used as a term that means treatment to suppress side effects
that occur subsequent to the provision of anticancer drug therapy or treatment ofcancer-related pain (Table 55).

Chapter 3 87

Table 54. Palliative care and supportive therapy
Development of a system for providing total palliative care, including not just care that
addresses physical pain but also mental care that addresses psychological pain in
accordance with each cancer patient’s situation

Table 55. General supportive therapy
Treatment for relief from cancer pain
Treatment to deal with the side effects of anticancer drugs (antiemetic drugs,
prevention of leukopenia)

If we were to consider providing palliative care from the outset of medical
treatment, as it is called for in the Basic Plan, rather than only at the terminal
stage of cancer, then it would appear that we need to carefully consider the useof the term palliative care in the names of products providing benefits tied toterminal care. In addition, we need to look into using the term supportive carein the names of private insurance products for only the provision of the treatmentof pain and treatment of side effects arising from the use of drugs.
While these points are perhaps of trivial importance, we should think about
the provision of private insurance services that are aligned with the Basic Plan
while taking into consideration the proper usage of terms.

❖ At-home care cases and costs
While you can imagine that some cancer patients might leave the hospitalwhile they are still suffering from symptoms and thereafter receive at-home careor terminal care at home, I have provided some illustrative examples in case you
might be having a hard time imagining what such scenarios entail. Medical careexpenses and out-of-pocket expenses will be incurred in these examples (Table
56).

88

Table 56. Costs of admission to a palliative care ward and at‐home care in an
at‐home case involving a sixty‐four‐year‐old individual from April 2016
<At‐home care support center>
Palliative care ward admission fee (up to 30 days)
Initial addition for an emergency admission
Nursing care support coordination guidance fee
Home‐visit medical treatment fee for at‐home patients
General management fee for at‐home medical care
Addition for comprehensive clinics and centers forthe provision of at‐home palliative care
At‐home malignant tumor patient guidance andmanagement fee
Home‐visit nursing instructions fee
Post‐discharge home‐visit guidance fee
Addition for home‐visit nursing care accompaniment<Home‐visit nursing station>
Basic medical treatment expenses for home‐visit
nursing care I(Amount up to third day in the same week)(Amount for fourth and subsequent days in the same
week)Management and medical treatment expenses forfunctionally enhanced home‐visit nursing care I
Addition for arranging twenty‐four‐hour handling
Addition for special management

4,926 × 7 days
200 points x 7 days
400 points
833 points x 6 times a month
5,000 points x 1 time a month
400 points
1,500 points x 1 time a month
300 points
580 points x 3 times
20 points
Subtotal 50,240 points

5,550 yen x 9 times per month
6,550 yen x 3 times per month

12,400 yen (first day) + 2,980 yen x 11 times
5,400 yen
5,000 yen
Subtotal 125,180 yen(Per month) Total 627,580 yen
Amount paid on out‐of‐pocket basis
83,706 yen(104,568 yen or paid by the high‐cost medical
treatment benefit system)* In addition, medication, materials, andother items
Source: Case studies and tables have been reprinted from page 52 of Social Security Weekly No. 2863,
February 22, 2016

[Home case] Sixty-four-year-old man receives at-home care for end-stage livercancer
 Discharged after being temporarily hospitalized in the palliative careward due to a sudden worsening of symptoms;
 Receives regular visits for medical treatment two days a week by at-homecare support center workers experienced in making emergency housecalls and providing nursing care; Receives home-visit nursing care provided by workers dispatched from
Chapter 3 89

a home-visiting nursing station four days a week; Patient who pays thirty percent of fees on an out-of-pocket basis.
[Various additions to facilitate coordination between at-home care and inpatientcare] Initial addition for emergency admission to a palliative care ward
By having a medical fees examination agency evaluate the emergency
admission of a patient receiving at-home care to a palliative care ward, thepatient will be able to receive enhanced palliative care in a palliative careward whenever his or her symptoms worsen.
 Post-discharge home-visit guidance fee and addition for home-visit nursing
care accompaniment
By evaluating home-visit guidance provided by a hospital immediately
after a patient is discharged, the transitioning of the patient from inpatientcare to at-home care can be facilitated.
 Nursing care support coordination guidance fee
By evaluating coordination with nursing care support specialists duringhospitalization, the use of nursing care services after the patient is discharged
will be facilitated.
 General management fee for at-home medical care and general management
fee for medical care when moving into a facility
By evaluating critically ill patients, enhanced at-home care can bereceived.
 Addition for comprehensive clinics and centers for the provision of at-homepalliative careBy evaluating medical institutions with sufficient experience in providing
palliative care, at-home palliative care can be received with peace of mind
from medical institutions with a proven track record.
Have you managed to paint a picture of how at-home care expenses are paid
for in your mind? Various complicated additions are tallied. These include
additions established as part of a set of revisions to medical service fees in fiscal
year 2016 and medical treatment expenses for home-visit nursing care that wererevised at the same time (Ins. Ann. 0304 No. 12). Fundamentally speaking, we
will see terminal care for cancer provided to a greater extent in communities, as
patients are repeatedly admitted to at-home care support centers and receive at90

home care at home as part of a comprehensive system of community-based carethat differs from the care provided by large hospitals dedicated to the provisionof acute-stage treatment (Fig. 23).
Fig. 23. Structural outline of at‐home careIf you are sixty-five years of age or older, you can also use long-term nursing
care services as a primary insured person covered by long-term care insurance,in addition to medical care services listed in the table.
Furthermore, if you have a physical disability due to cancer or as anaftereffect arising after treatment, you might also be entitled to receive various
welfare services.
Long-term care insurance consists of the following:
40 years of age orolder and under
64 years of age
65 years of age or
older

Non‐end‐stage cancer
Where you have been certified as
needing long‐term care and are
suffering from end‐stage cancer
Where you have been certified as
needing long‐term care, even if thereason is unrelated to cancer

Not covered by long‐term‐care insurance
Covered by long‐term‐careinsurance
Covered by long‐term‐careinsurance

Not all cancer patients can receive long-term nursing care services.
Chapter 3 91

❖ Complementary alternatives, supplements, and non-standard medicalcare
1. Complementary and alternative medical care
After getting cancer, many patients and survivors receive complementary andalternative medical care, which includes folk remedies. Much of this type of careconsists of supplements taken orally, but the actual situation with respect to this
topic is not fully understood. While a study has been conducted by the National
Hospital Organization Shikoku Cancer Center, it is outdated and contains norecent data.
The definition of complementary and alternative medical care is as set forthin Table 57. The Japanese Society for Complementary and Alternative Medicine
has been established as an active academic society operating in this field.
In particular, there are concerns over the safety of supplements and otheritems ingested into the body and any possible adverse effects on cancer treatment
being received by a patient. The reference source trusted most by the author is a
website featuring information on the safety and efficacy of health foods as
maintained by the National Institute of Health and Nutrition (Table 58).
However, Japan lags behind other countries in terms of national initiatives inthis field.
Table 57. Defining complementary and alternative medical care
A collective term for medical and healthcare systems that have not been scientificallyvalidated or clinically applied in the field of modern Western medicine.

Table 58. Reference sites relating to complementary and alternative medical
careJapanese Society for Complementary and Alternative Medicine (http://www.jcam‐
net.jp/)National Institute of Health and Nutrition (http://www0.nih.go.jp/eiken/)
Information on the safety and efficacy of health foods (https://hfnet.nih.go.jp/)

2. Non-standard medical care
Cancer patients are beset by a host of concerns and often desperately seekout various therapies. While dubious forms of non-standard medical careprovided by exploiting the insecurities of patients are rampant, the harm to healthcannot be prevented, since we are unable to ascertain the actual situation, which92

involves medical treatment that is not covered by public healthcare insurance,
and are unable to monitor medical care that is not governed by the Medical
Practitioners Act or the Pharmaceutical Affairs Act (Table 59). Because thissituation exists, there is concern that the harm caused to health will expand
further if we were to proceed with completely lifting the ban on the use of
insured and uninsured types of medical treatment.
Table 59. Reported cases of non‐standard medical treatment
Various types of medical care referred to as immunotherapy
An immunotherapy clinic established by a former medical school professor ran into
problems when it attracted clients by setting up a website suggesting that the clinic had
been recognized as legitimate by the Japan Society of Clinical Oncology for its provisionof non‐standard treatment options.
Uproar over homeopathy
The Science Council of Japan stated that it condemns the gratuitous provision of
homeopathic care, for which it was claimed that a certain candy could cure diseases in amanner that disregarded science.
Particulars concerning the endorsement of Agaricus
While many cancer patients used to take a health food known as Agaricus as asupplement, this product fell out of favor with the public when the publisher of a booksuggesting that Agaricus was effective in fighting cancer and the honorary professor of
Tokai University who had written this book were investigated for violating thePharmaceutical Affairs Act.

❖ Unapproved drugs and medical treatment not covered by publichealthcare insurance
The main fields in which medical treatment not covered by public healthcare
insurance is provided are as listed in Table 60. These fields are not very large inJapan, a country with a highly-developed system of public healthcare insurance.
In 2015, the year known as the first year of preemptive medicine, the medical
community and the government both declared that they would focus on
personalized preventive medicine. Preventive medicine, however, lies in therealm of medical treatment that is paid for on an out-of-pocket basis, since it
fundamentally is not covered by the public insurance scheme. Medical treatment
not covered by public healthcare insurance is expected to grow in the future(Table 61).
Chapter 3 93

Table 60. Three major fields in which medical treatment not covered by publichealthcare insurance is currently provided
Cosmetic surgery (including breast reconstruction)
Unapproved drugs
Cancer cellular immunotherapy

On the other hand, it is also expected that the realm of medical treatment notcovered by public healthcare insurance in connection with unapproved drugs
will shrink in the short term. Unapproved anticancer drugs are used, because
there has been an expansion of medical treatment options covered by theuninsured concomitant medical treatment benefit system (such as evaluatedmedical treatment, patient-requested medical treatment, and the expanded
treatment system). In addition, since insurance came to cover implant-type
breast reconstructive surgical operations performed after surgical operations forbreast cancer, fewer cases involving breast reconstruction as a type of medical
treatment not covered by insurance arose (Table 61).
While we cannot predict the extent to which medical treatment options notcovered by public healthcare insurance will increase or decrease, the types of
medical treatment not covered by public healthcare insurance that we expect will
become more popular in the future include the preservation of reproductive cells
in connection with cancer treatment and, as a representative example ofpreemptive medicine, preventive mastectomies performed in accordance withgenetic cancer tests of the sort that Angelina Jolie underwent (Table 61).
Table 61. Cancer‐related trends in medical treatment options not covered bypublic healthcare insurance
Shrinkage factors
・The environment in which unapproved drugs can be used has been enhanced.
・Implant‐type breast reconstruction surgical operations are now covered by insurance.
Expansion factors
・Genetic testing‐based cancer‐related preventive medical care practiced as an example
of preemptive medicine (e.g. mastectomy by Angelina Jolie)
・Preservation of reproductive cells in connection with cancer treatment

The coverage by private insurance companies of medical treatment options
not covered by public healthcare insurance is criticized by some as “an act thatflies in the face of treatment covered by health insurance,” “an effort to diminish
the public insurance system and expand operations through privatization,” and94

“an effort to establish an American-style healthcare system” (Table 62). Thus,
care must be taken when introducing products that cover medical treatment
options not covered by public healthcare insurance. This is because we canassume that the consensus of the general public is oriented towards themaintenance of the public healthcare insurance system.
Table 62. Criticism of the selling by private insurance companies of
products covering medical treatment options not coveredby public healthcare insurance
An act that flies in the face of treatment covered by health insurance
An effort to diminish the public insurance system and expand operations throughprivatization
An effort to establish an American‐style healthcare system

In contrast to completely unregulated medical treatment options not coveredby public healthcare insurance, we believe that the publicly-managed use of
insured and uninsured types of medical treatment, such as advanced medical careand patient-requested medical care, and the attendant out-of-pocket payment ofcosts by patients, will surely expand. Thus, we will need to properly sort out therelationship between the use of insured and uninsured types of medical treatment
and private insurance. Concerns regarding private insurance services in thisregard are as outlined below.
They impede the fostering of the awareness of medical costs on the partof patients;
Healthcare costs will remain high;
They hinder an insurance coverage mindset on the part of medical
equipment and pharmaceutical manufacturers;
Excessive and overlapping benefits.

Since particle beam therapy, which costs as much as three million yen persession, had been considered advanced medical care, insurance companies
emphasized this point and touted the utility of advanced medical care riders as
products that can cover high-cost medical treatment options not covered bypublic healthcare insurance. For this reason, companies have been paying
attention to developments regarding the coverage of particle beam therapy by
the public healthcare insurance system. I fretted that the limits and contradictions
Chapter 3 95

associated with the provision of private insurance services would become
exposed if the extension of coverage by the public healthcare insurance systemwere to lead to a loss of additional points and force policyholders who had been
told that particle beam therapy could be received on a fully-covered basis if they
took out insurance for this purpose to instead pay for thirty percent of the costsof particle beam therapy (approximately 900,000 yen). However, this would
cause the private insurance sector to be criticized for seeking to keep medical
costs high.

96Chapter 3 97

Chapter 4: Products
I. General statement on products❖ Amendment to the Insurance Business Act: Obligation to provide
information
In response to major changes in the business environment surrounding
insurance companies, the Insurance Business Act came into effect as revised on
May 29, 2016, in order to put into effect new solicitation rules. This act wasamended due in part to the greater complexity of insurance products, adiversification of sales channels, and the emergence of independent agencies.
The new Insurance Business Act includes measures to ensure the reliability of
insurance, including by way of the establishment of basic rules governing
insurance solicitation and the development of rules applicable to insurance
solicitors.
Accordingly, insurance solicitation is also required to be carried out in amanner that complies with new laws and the Financial Services Agency’s
supervisory guidelines.
As you might already be aware, the amendments in question are importantfor mandating the ascertainment of intent (Article 294-2 of the Insurance
Business Act) and mandating the provision of information (Article 294 of the
Insurance Business Act). To verify the intent of a client, the provision of
appropriate information is necessary. The text of the revised statute is aspresented in Table 63, and a mandate to provide information was added to
Article 294 of the Act.
An explanation of the specific contents of information to be provided has
been publicly disclosed in an answer to question three of a set of questions andanswers exchanged with the Life Insurance Association of Japan. This
explanation is cited in Table 64. For cancer insurance, the provision of thefollowing information as indicated in the answer is important:(1) Conditions applicable to the payment of insurance claims, the insurance
period, the amount of insurance coverage, and more;(2) The contents of the obligation to disclose, the policy inception date,
information concerning the lapsing of the policy, information
concerning a safety net, and more.
98

Table 63. Adding an obligation to provide information to the amended
Insurance Business Act
The title of Article 294 shall be changed to “(Provision of information)”, the same article shall beread as paragraph (3) of the same article, and the following two paragraphs shall be added to thesame article as paragraphs (1) and (2). Any insurance company, etc., foreign insurance company,
etc., officer (excluding insurance solicitor) thereof, insurance solicitor or broker, or officer or
employee thereof must disclose the contents of an insurance policy and any other information
helpful to the policyholder etc., pursuant to provisions as set forth by a Cabinet Office Ordinance, inorder to aid in protecting the policyholder etc. in connection with the conclusion of an insurance
policy, insurance solicitation, any action to induce an individual to take out an insurance policy
pertaining to group insurance […] for which a policy has been concluded or insurance solicitation
has been undertaken thereby, or any other action undertaken to have the policyholder etc. take out
the given insurance policy […]. Provided, however, that this provision shall not apply where a
Cabinet Office Ordinance specifies that there is no risk of a lack of protection afforded to thepolicyholder etc.

Table 64. Q&A with the Life Insurance Association of Japan<② Questions regarding the obligation to provide information>
Q3. What kind of rule is the one that mandates the provision of information wheneverinsurance solicitation activities are being undertaken?
A. The mandate to provide information requires the provision, by an insurance solicitor,
etc., at the time he or she engages in insurance solicitation actions, of information
required by a policyholder or insured person to assess the advisability of concluding
or taking out an insurance policy. Specifically, the following matters are required to
be provided.
(1) Information required to enable the client to understand the contents of theinsurance product (such as the conditions applicable to the payment of insurance
claims, the insurance period, and the amount of insurance coverage);(2) Information to be brought to the attention of the client (such as the contents of
the obligation to disclose, scheduled point in time at which the policy will begin totake effect, information concerning the lapsing of the policy, and information
concerning a safety net);(3) Other information that should be helpful to the policyholder etc. (such as
information concerning a roadside service or other key supplementary services and a
direct payment service).
Q4. What will change as a result of the introduction of a mandate to provide
information?
A. The requirement to provide certain information coming within the scope of a “policy
outline” or “information to which attention should be drawn,” which was previously
set forth in the supervisory guidelines, is now stipulated as a statutory obligation. In
addition, the scope of matters subject to a penalty for non‐disclosure as provided forin item (i) of paragraph (1) of Article 300 of the Act used to be limited to “importantmatters affecting the judgment of the policyholder or insured person.”

Products will be explained beginning in the section below. The points to be
Chapter 4 99

covered will discuss standards relating to the payment of claims and the medical
interpretation of the policy conditions in accordance with the conditions set forthby each company. These are aspects of the provision of information with respect
to products that had not been examined in detail until now.
❖ Comparing and recommending products
The Financial Services Agency’s supervisory guidelines have mandated, inconnection with the provision of information whenever insurance products
offered by multiple companies are handled, the provision of information relating
to reasons for presenting and recommending a list of comparable products thatare handled and specific products (Table 65). In short, an independent agency
wishing to compare and sell products offered by different companies needs toprovide and explain the grounds for making a recommendation. While it is easy
to state this in writing, it is in fact difficult to specifically define the standards
for comparing products.
In any case, supervision applies to the question of whether “you have
explained the objective standards and reasons in question, including with respect
to product characteristics and insurance premium levels” in accordance withwhat the client wants. While the extent to which the precise management of
explanations of reasons will be necessary will likely become clear in the courseof providing practical guidance in the future, comparisons, at least in terms of
information set forth in (1) and (2) of the answer to Q3 in Table 64, whichcorresponds to “Amendment to the Insurance Business Act: Obligation toprovide information” (page 99), which appears in the previous section on theneed to provide information pursuant to the amended statute, will be examined.
While the daily hospitalization amount, lump-sum payment amount, coverage
period, number of times benefits are to be paid, and other such examples ofobjective information can be easily understood, the work that is performed toprofessionally peruse the policy conditions, refer to medical interpretations ofambiguous parts, and make comparisons accordingly appears to be quite difficult.

100

Table 65. Q&A with the Life Insurance Association of Japan
Q7. If an insurance solicitor with two or more affiliated insurance companies were to sell products by comparing
and recommending them, what kind of information provision approach is required to be taken?
A. Supervisory Guidelines II‐4‐2‐9(5) stipulate as follows. For an insurance solicitor with two (2) or more affiliatedinsurance companies (which means an insurance solicitor with two (2) or more affiliated insurance companies
as prescribed in item (iv) of paragraph (3) of Article 227‐2 of the Regulations and item (ii) of paragraph (1) of
Article 234‐21‐2 of the Regulations; the same hereinafter in Q&A 7 below), explanations of the reasons forrecommending enrollment in an insurance policy, as specified in item (iv) of paragraph (3) of Article 227‐2 ofthe Regulations and item (ii) of paragraph (1) of Article 234‐21‐2 of the Regulations, and whether measures toensure the sound and appropriate operations of business by an insurance solicitor with two (2) or moreaffiliated insurance companies have been taken shall be confirmed while taking the following points into
account. (1) Has an outline of comparable products in line with the client’s intention as selected from amongproducts handled by an insurance solicitor with two (2) or more affiliated insurance companies (whereapplicable, products that have been narrowed down according to the type of insurance, contents of coverage(compensation), and other product attributes in accordance with the intention of the client as ascertained by
the insurance solicitor) been expressly presented, and have the contents of these products been explained as
requested by the client? (2) Have the reasons for making a presentation or recommendation been explained inan easy‐to‐understand manner to the client whenever a specific product has been presented orrecommended? In particular, if products have been presented or recommended after they had been further
narrowed down from among handled products that match the intentions of the client as determined by aninsurance solicitor with two (2) or more affiliated insurance companies, have the objective standards andreasons with respect to product attributes, premium levels, and other considerations been properly explained?
Note 1: Make sure you refrain from narrowing down, presenting, or recommending products in a way that, forexample, effectively induces clients to go with products that earn the insurance agency high commissions,even as superficial efforts are made to seemingly explain the reasons for recommending certain products in an
objective manner. Note 2: If, for example, you compare a product you are recommending with other products
as a way to highlight the superiority of the product you are recommending, you should keep in mind that you
need to not just accurately present a complete picture and the attributes of each of the other products but
also comprehensively indicate matters required, to allow the client to accurately assess the contents of theinsurance policies in question, such as by explaining the basis for the superiority of the product you arerecommending (see item (vi) of paragraph (1) of Article 300 of the Act, II‐4‐2‐2(9) ②). (3) Irrespective of (1)and (2) above, if a narrowed down or specific product is to be presented or recommended to a client in amanner not based on product characteristics, insurance premium levels, or other objective standards orreasons, have the applicable standards or reasons (such as a capital relationship with a specific insurancecompany or other reason tied to administrative procedures or management policies) been explained? (Note)
Where fairness and neutrality among insurance companies is mentioned, endeavor to ensure that the capital
relationship with a specific insurance company, commission level, or situation with respect to administrative
procedures or management policies is not taken into account as a standard or reason applicable to thenarrowing down, presentation, or recommendation of a product. (4) Have arrangements to check and verify
the state of the implementation of measures to periodically and whenever necessary present and recommend
products and present the standpoint of the insurance agency in an appropriate manner in accordance with (1)through (3) above, as set forth in internal regulations, been made?
Q8. If a specific product is recommended in a manner not in accordance with product attributes and otherobjective standards, what kinds of information will need to be provided?
A. If products are narrowed down, or a specific product is presented or recommended to a client, in a manner notin accordance with product attributes, insurance premium level, and other objective standards or reasons, theapplicable standards or reasons (such as a capital relationship with a specific insurance company or otherreason tied to administrative procedures or management policies) need to be explained. For example, if the
products of a specific insurance company are to be presented by an agency affiliated with the specificinsurance company, it would be sufficient for the given agency to explain that it is an agency affiliated with thespecific insurance company.

Even if products are similar, their details may differ if they are offered bydifferent companies, which makes it difficult to simply compare insurance
premium amounts. At this time, most companies fail to disclose even a
Chapter 4 101

breakdown of insurance premiums. If neither the calculation method used to set
insurance premiums nor the underlying data are disclosed, the current situation
is such that we can only make simple comparisons of insurance premiums. The
supervisory guidelines indicate that products should not be recommended on thebasis of the size of service fees. From the perspective of clients, however, theproblem of service fees not being disclosed has not yet been resolved, whichmeans that there appears to be unfinished work concerning efforts to amend theInsurance Business Act.
❖ The provision of product information and the online version of thepolicy conditions
I assume that readers who are insurance professionals would find it easy tocompare the daily amount of benefits and the number of times benefits are paidout in accordance with objective standards, as alluded to in the preceding section(Comparing and recommending products, page 100). Yet, a product cannot be
fully explained with the contents of materials used for the purpose of solicitation
or a document containing a descriptive summary of the product as issued by the
insurance company.
A product explanation is highly predicated on the conditions set forth in apolicy being properly understood. A detailed understanding cannot be achieved
with just the materials used for solicitation or a guidebook designed to encourage
clients to take out a policy. You must carefully read the conditions set forth in
the policies of products being compared, in order to compare and recommend
insurance products.
Of course, there are probably very few customers who will fully read thepolicy conditions when they apply for insurance. No matter how much you try
to improve materials describing material matters, any effort to create a perfect
document will ultimately lead you to the policy conditions themselves.
Even if a client says something like “The policy conditions are not supposed
to be read since we are talking about a contract of adhesion,” the policy
conditions are required for any professional who wishes to assess the quality ofa product and then explain the product to customers. In particular, how many
policyholders carefully place their received copy of the policy conditions safely
in storage for the rest of their lives? The policy conditions will be needed whena contractual question or problem arises (Table 66).
102

Leaving aside the question of whether a product is good or bad, the provisionof the policy conditions in a way that allows them to be read at any time is thefirst step to fulfilling the obligation to provide information. The attitude ofcompanies that have failed to post the policy conditions online to enable them tobe printed by clients after the amended Insurance Business Act came into force
is a problem. In writing this book, I found that there were still companies selling
cancer insurance that had not yet released policy conditions online (Table 67).
This is a situation I hope to see rectified.
Table 66. Necessity of carefully reading the policy conditions
Disadvantageous information could be hidden in the policy conditions.
The policy conditions constitute the insurance product itself (conditions applicable toand the scope of benefits).
A product is understood by first reading the policy conditions.
The provisions as provided for in the conditions set forth in different policies
Information on policy exclusions

Table 67. Companies that have not yet disclosed policy conditions online (asof February 20, 2016)
Guard X as offered by MetLife Insurance
Kodawari Cancer Insurance as offered by Manulife Life Insurance
Premium Whole‐Life Cancer Treatment Insurance as offered by Zurich Life Insurance
Note: The number of cancer insurance policies was reported in a table of new policies on page 69 of theStatistics of Insurance for fiscal year 2014; these are companies that were confirmed through an online
investigation to have sold stand-alone products offering cancer coverage.

Ensure that policy conditions are disclosed online
and that products are evaluated.

Chapter 4 103

❖ Benefits and the law
The scope of benefits that can be commercialized as third-sector insurance
policies is determined by law. Table 68 indicates that only cash benefits areallowed with insurance. Article 2 of the Insurance Business Act in Table 69
recognizes human injuries and illnesses and allows for related benefits. What is
important to note here is that third-sector insurance basically offers benefits
premised on injuries and illnesses. Everything else is prescribed by Cabinet
Office Ordinances. Articles 4 and 5 of the Regulations for the Enforcement of
the Insurance Business Act indicate that procedures not clearly included ininjuries and illnesses, such as childbirth, senility, nursing care, and the donationof bone marrow, are governed by Cabinet Office Ordinances (Table 70). In otherwords, Cabinet Office Ordinances apply to situations that cannot be clearly
determined as constituting a human injury or illness or to conditions that clearly
differ from injuries and illnesses.
An amendment to the law to extend coverage to the treatment of infertility
not known to be attributable to an injury or illness is being debated (as of March
2016). At this time, the law also disallows benefits for preventive medical careadministered before an illness arises.
Table 68. Insurance Act
Article 2(i) Insurance policy: A contract, whether it is called an insurance contract or a mutual
aid contract or referred to by any other name, under which one of the parties promises
to provide property (limited to the payment of money in the case of life insurance policies
and fixed amount accident and health insurance policies; hereinafter referred to as an"insurance proceeds payment") on the condition of the occurrence of a certain event, andthe other party promises to pay insurance premiums (including mutual aid premiums; thesame shall apply hereinafter) according to the likelihood of such event occurring;(iv) Insured: A person specified in (a) to (c) below according to the categories of insurance
policies listed in (a) to (c) respectively:(a) and (b) [omitted](c) Fixed amount accident and health insurance policy: A policy under which an insurer is
to make an insurance proceeds payment to a person upon that person sustaining an injury
or illness (hereinafter referred to as “injury or illness”)

104

Table 69. Items (i) and (ii) of paragraph (4) of Article 3 of the Insurance
Business Act(i) Insurance for which premiums are received under a contract to pay fixed insurance
proceeds in connection with the survival or death of individuals (including the physicalstate of an individual whom a doctor has diagnosed as having no longer than a certain
period of time left to live; hereinafter, the same shall apply in this paragraph and thefollowing paragraph) (excluding that pertaining only to death, as under the following
sub‐item (c)).
(ii) Insurance for which insurance premiums are received under a contract to pay fixed
insurance proceeds in connection with the following events or to compensate fordamage to the individual caused by such events:(a) That an individual has contracted a disease;(b) An individual's condition that was caused by an injury or disease;(c) An individual's death that was directly caused by an injury;(d) Cases specified by Cabinet Office Ordinance as those similar to what is listed in (a)or (b) (excluding the death of an individual); and(e) Treatment (including those specified by Cabinet Office Ordinance as procedures
similar to treatment) concerning those listed in (a), (b), or (d).

Table 70. Regulations for the Enforcement of the Insurance Business Act
Article 4 The causes to be specified by Cabinet Office Ordinance:(i) Parturition and state of a human body caused by a parturition;(ii) State of a human body requiring fertility treatment;(iii) State of a human body requiring constant nursing care as a direct result of senility;and(iv) Donation of bone marrow and the state of a human body caused by a donation ofbone barrow.
Article 5 The activities to be specified by Cabinet Office Ordinance:(i) Midwifery performed by a midwife as provided for in Article 3 (Definitions) of the
Act on Public Health Nurses, Midwives, and Nurses (Act No. 203 of 1948);(ii) Therapies performed by a judo therapist as provided for in Article 2 (Definitions) of
the Judo Therapists Act (Act No. 19 of 1970);(iii) Therapies to be performed by a massage and finger pressure therapist, acupuncture
therapist, or moxacauterization therapist as provided for in the Act on Practitioners of
Massage, Finger Pressure, Acupuncture, Moxacauterization, Etc. (Act No. 217 of 1947)(limited to therapies performed in accordance with instructions issued by medical
doctors).

Chapter 4 105

❖ Product approval
When you sell a new insurance policy, you must obtain the approval of the
Financial Services Agency. Primarily subject to an examination for approval is
the contents of the product (policy conditions) and the calculation of insurance
premiums. Even an insurance policy that has been sold for some time will need
to be submitted for approval again if the insurance company revises the premiumor policy conditions.
Insurance policies are products that policyholders are tied to for a long time.
They are also highly specialized and complicated and characterized by a huge
gap in terms of the volume of information held by customers on the one handand insurance companies on the other hand. Since contents that are unfavorable
to consumers or defects in a product can give rise to significant problems,
examinations relating to the approval of insurance products as conducted by thecompetent supervisory authority are carefully and strictly performed (Table 71).
Table 71. Basis for a product examination: Policyholder protection andproduct defect check
Long‐term nature of the product
Information asymmetry as between the insurance company and consumers
Special nature and complexity of the product

The system through which new products are examined by the Financial
Services Agency is related to the licensing of a company that allows it to engage
in an insurance business. In order to obtain a license, you must submit documents
prescribed by law to an examination of the contents of these documents and havethese documents approved. These documents are referred to as basic documents.
There are four types of basic documents, including the articles ofincorporation. In examining a product, the basic documents outlined in Table 72
are to be examined. You might think that this table contains a number of difficult
words. All of these documents must be newly approved if they need to be
rewritten to sell a new product. While burdensome, this process cannot be
avoided.
It is sufficient for general purposes for you to understand that an actual
examination entails a face-to-face discussion between officials with the
Financial Services Agency and representatives of the insurance company and a106

review of documents pertaining to policy conditions and the insurance premiums
for the product in question.
Table 72. Basic documents subject to examination
Statement of Business Procedures
General Policy Conditions
Statement of the Methods According to Which Insurance Premiums and Policy Reserves
Are Calculated

The number one reason why the government
conducts checks is the protection of consumers.
Insurance products are specialized,
long‐term agreements.
Many consumers fail to read the policy
conditions.

Chapter 4 107

❖ Product development concepts (focal points)
While it may seem that a huge variety of third-sector products are available,
you will realize that product frameworks (focal points) are rather limited in
number once you sort out these products. This is something that insurancecompanies themselves do not understand, such that some insurance companies
do not maintain a consistent philosophy when it comes to the provision of
products. In other words, an understanding of the underwriting risk structure
constituting the bedrock of insurance sales is critical.
(1) If the focus is on illnesses and diseases
Handicap coverage, including with respect to the cause of an illness ordisease, the treatment of an illness or disease, and the aftereffects of an illness
or disease ⇒ Comprehensive coverage applicable to illnesses and diseases(cancer insurance has been primarily developed in this area)(2) If the focus is on medical care (a more comprehensive focal point than(1))
Prevention (health), treatment (medical care), recovery from disability(welfare) ⇒ Comprehensive coverage applicable to the maintenance of health(health in the broad sense of the term)(3) If the focus is on the social security (insurance) system
Pension, employment, nursing care, medical care ⇒ Comprehensive
coverage applicable to a life of security(4) If the focus is on personal lifestyles
Marriage, childcare education, employment, and old age ⇒ Rich lifestylesupportIn addition, product focal points are determined by subjecting targets for theacquisition of insurance to segmentation by, among other variables, sex, age
bracket, household composition, and job type (Fig. 24).
Distinguishing features of insurance companies and insurance products aredefined by figuring out how concepts for third-sector products are to be refined
through integration with first-sector products. The positioning of basic focal
points for the development of products is also important in thinking about
aspects of linkages with existing products and sales education.

108

Fig. 24. Product development focal points

Chapter 4 109

❖ Base policy
An insurance product consists of a base policy and riders, but the base policy
constitutes the framework of the product and can also be described as the faceof the product.
If you look at the structures of base policies and riders, you can discern theconcept according to which a given product is sold.
These days, there are three main types of base policies for cancer insurance
products, as follows:
Type (1)Type (2)Type (3)Both a lump‐sum payment for a cancer diagnosis and a hospitalization
benefit are offered in the base policy
Either a lump‐sum payment for a cancer diagnosis or a hospitalization
benefit is offered in the base policy
Neither a lump‐sum payment for a cancer diagnosis nor a hospitalization
benefit is offered in the base policy

Elements for which coverage is highly required by many consumers and forwhich the provision of coverage on an ongoing basis without modification overa long period of time is needed are normally included in the base policy.
Accordingly, hospitalization coverage comes within the scope of the base policy
in a healthcare insurance plan, such that hospitalization coverage has thus far
never been provided in a rider. With cancer insurance, standard products can be
described as being normally structured to correspond to either Type (1) or Type(2) above.
However, if you were to analyze the products offered by each company, you
would see that there are many Type (3) products available on the market. Manyof these insurance products are structured in such a way that the base policy
provides for anticancer drug therapy benefits and radiation therapy benefits,
while a rider provides for a lump-sum payment for a cancer diagnosis or ahospitalization benefit. Many insurance products of this type are provided bycompanies who have not previously sold cancer insurance as part of their main
lineup of products or by companies that entered the cancer insurance market late(Fig. 25). These companies have apparently adopted a Type (3) structure for
products for which the contents of the base policy and rider are inverted, in order
to allow them to offer customers who have already taken out a medical insurance
or cancer insurance policy or an insurance policy covering three major diseases
a way to purchase an additional insurance product (Fig. 26). Since various
110problems might arise if comprehensive coverage were to be provided acrossmultiple policies, the provision of an explanation of the risks relating to this pointat the time insurance is proposed to a customer is important.
Fig. 25. Base policy and riders

Fig. 26. Type (3) product strategy

Chapter 4 111

❖ Coverage period for a product and premiums by sex
I am sometimes asked to explain why the insurance period for a base policy
differs from the insurance period for a rider. In other words, what are the reasonsfor the existence of whole-life coverage and fixed-term coverage? There are also
products that consist of a base policy that provides whole-life coverage and arider that provides coverage for a fixed term. The reasons why coverage must be
sold on a whole-life or fixed-term basis, the basis for designing products indifferent ways, and the advantages and disadvantages of these differences for
consumers are presented in Table 73. Ultimately, the differences come down to
the fact that whole-life products are products for which premiums are not revised,and fixed-term products are products for which premiums are revised each time
the product is renewed. Since the incidence rate for diseases and illnesses rises
with age, the component from which the component corresponding to this point
is deducted is evaluated as shown in Table 73. In particular, some products
provided through riders consist of fixed-term products. However, a prediction as
to whether the probability of an insured event occurring in the future will
decrease or increase will be important for a rider for which premiums determinedaccording to sex and age have not been adopted. For example, if amounts to be
paid for advanced medical care, a field that is expected to grow in the future, areprojected to increase, you should choose to go with lifetime coverage inanticipation of higher future premiums. If there will be fewer facilities where
patients can be hospitalized, you should expect that premiums for thiscomponent will decline, and you should then choose to go with a fixed-term rider
in connection with hospitalization coverage. It will come to be necessary to makesuch determinations based on different considerations.
Some insurance companies charge insurance premiums according to sex andothers do not. In fact, insurance premiums by sex are becoming increasingly
banned in Europe on the grounds that such a practice is discriminatory. In Japan,
however, this point is not especially problematic. While companies consider theeffort to differentiate premiums on the basis of sex to be an administrative hassle,
the fact that the incidence of cancer is lower for women than it is for men means
that, as far as cancer insurance alone is concerned, there is an advantage in thatenrollment at more affordable premium rates is possible for certain individuals.
An evaluation of this point is summarized in Table 74.

112

Table 73. Comparing differences in coverage period

Whole‐lifetype
insurance
products

Fixed‐term
type
insurance
products

Reason for insurancecompany
If the incidence rate of an
insured event is expected
to decline in a stablemanner, there is a profit‐
related advantage in thatwhole‐life type insurance
products will generate
incidence gains.
Difficult to predict the
future incidence of
insured events for which
benefits are to be paid
Possible that theincidence rate of an
insured event will
increase in the future
Even if the incidence rate
is projected to decline in
the future, a policy can beextended by lowering theshort‐term premium rate.

Advantages for
consumer

Disadvantages for
consumers

Premiums will notchangeIf the incidence
rate declines, theconsumer will end
up paying higher
premiums

Short‐term premiums
will be cheaper
If the incidence rateof an insured event
declines in the future,
the premium at thetime of renewal will
be renderedfavorable.

Possible thatpremiums will go
up in the future

Table 74. Insurance premiums by sex
Insurance company

Males

By sexSignificant administrative
burdenCan acquire a substantial
number of female clients

High premiums

Same rates
for men andwomen

Administrative burden is
low.
Sales to the market
segment consisting ofmale clients can be
expanded.

Premiums are low,
thereby giving
clients a sense thata given policy isgood value formoney.

Females
Premiums are low,
thereby giving
clients a sense thata given policy isgood value formoney.
With higher
premiums, clientsare dissatisfied withhaving to pay
premium rates on
par with premium
rates paid by men.

Chapter 4 113

❖ Rider system and lump-sum payment system
Cancer insurance corresponding to the lump-sum payment system has
become popular, as a result of which focus was once again directed towards thesignificance of the lump-sum payment system and the rider system. Originally,cancer coverage was added to lump-sum payment-type insurance policies
covering three major diseases. In referencing this background, the lump-sum
payment system can be said to have been used for products with a focus on the
coverage of serious illnesses and diseases (Table 75). On the other hand, giventhat acute-stage treatment costs are covered as an original concept behind theexistence of cancer insurance, coverage will be provided through riders tailoredto treatment required to medically treat cancer. At first glance, it may seem as if
the lump-sum payment system is easy to recommend, but you will be asked to
explain the amount needed for a lump-sum payment.
Cancer insurance corresponding to the rider system is designed to make iteasy for even insurance solicitors with little medical knowledge to put together
costs required for cancer treatment and explain to clients the coverage that isrequired. Whereas you will be presenting a certain fixed amount of benefits withthe lump-sum payment type of policy, an amount of up to around two million to
three million yen will be approximately equivalent to the lump-sum payment fora diagnosis of cancer made with a normal cancer insurance policy. You can thus
explain to the effect that, if an insured person were to get cancer, Japanese
research data suggests that an average of around one million yen over a courseof a year will be needed as short-term funds. I believe that it would be difficult
to provide an explanation to justify a lump-sum payment for a hefty amount ofcoverage exceeding this level. Providing an explanation that is tied to areasonable amount is easier with the rider system, as it is closer to providing
coverage matched to actual losses incurred. In fact, I remember hearing fromothers during my days working in insurance sales of solicitors who would
recommend products that provided lump-sum payments since it meant that theywould not have to provide explanations concerning multiple types of riders.
Ideally, you should understand the product concepts associated with both therider system and the lump-sum payment system and appropriately provide toclients explanations of product attributes corresponding to each type of system.

114

Table 75. Comparing lump‐sum payment‐type and rider‐type cancer insurance
policies
Basic concept
Product
explanation

Required amountof coverage

Lump sum payment
Coverage of major diseases andillnesses
Product explanation similar tothat which is applicable to thecoverage of three majordiseases
Amount required to covermajor diseases and illnesses will
be presented.

Rider
Coverage of treatment costs
If each rider is explained, thecontents of treatment will be
automatically explained.
Standard amount of required
coverage is set for riders; riders
are put together toapproximate coverage of actual
loss❖ The problem of preferred-risk policies
In recent years, the use of Big Data has exploded. Insurance companies arealso inclined to analyze various policies and use the results of these studies topromote the management of the health of insured persons. Insurance companies
underwrite huge numbers of policies and have mechanisms that allow them totrack these policies, which means that it is possible that they have alreadydeveloped an environment to facilitate the use of Big Data. Unfortunately,
however, the quality of health-related information that is usable for analytical
purposes is a problem, as it has been pointed out for a long time. In particular,
the reliability of such information as scientific data has been a constant issue.
The author also focused fully on this problem and proceeded to analyze theeffects of medical check-ups administered to over a million insured persons in2000 for the first time in Japan. The results of this analysis were even mentioned
in four major newspapers. Insurance companies responded by changing their
protocols by replacing doctor’s examinations, which had been necessary
whenever a client wished to take out an insurance policy, with the submission ofdata from a medical checkup (entailing the handling of a notice of the results ofa medical checkup in each case).

Chapter 4 115

Comparison of mortality according to whether an individual has undergone a medical
checkup or not (%)(Mortality of persons who have not undergone a medical checkup set to base 100)
Persons who have not
Persons who haveundergone a medical checkup
undergone a medical checkup
Male
100
62.3
Female100
67.9

While this may be something that some companies do not want to hear, I am
personally concerned to see that the notion that companies might want to use
Big Data in the development of preferred-risk policies is one that is likely toemerge (Fig. 27). While I believe that risk segmentation with respect to firstsector products is a sign of the times, I encourage insurance companies to firstturn their attention to areas outside the insurance industry when they wish toconsider adopting preferred-risk policies for cancer insurance and other types ofthird-sector products.
Fig. 27. Use of Big Data

Main concerns regarding preferred-risk policies
 Criticisms that go to the role of third-sector products (role of private
insurance companies)
 Increased public concern about whether genetic testing will eventually be
used in the future Impact on the simple disclosure form-based system for taking out
insurance
 Will products or special conditions for persons not coming within thescope of preferred risks be made available?
116Some insurance companies are already selling third-sector preferred-risk
insurance policies. (The first of these companies no longer offers preferred-risk
insurance policies.) I have never seen a television commercial touting theavailability of policies (naturally for higher premiums) to persons unable to takeout a preferred-risk insurance policy. Such insurance companies will be
criticized for cherry-picking their clientele. For insurance policies payable atdeath, special conditions have traditionally been disseminated so that problems
could be avoided by allowing persons whose health was of some concern to takeout insurance through the imposition of additional conditions or conditions
resulting in a curtailment of benefits. Third-sector insurance products, however,are frequently based on the use of disclosure forms and therefore cannot
accommodate such persons by adding special conditions.
Given the social role that private insurance should fulfill in the future, theintroduction of discounted insurance for health is problematic in that it could
lead to social unrest attributed to insurance and genetic disparities. While somemight argue that we are overthinking this matter, there are already companies
that clearly stipulate in the policy conditions that they will make risk selections
based on genetic factors. Such policy conditions are at odds enough with global
trends that criticisms of the insurance industry are being amplified as a result.

❖ Coverage that will be desired in the future
While we will take a look at products that are currently available beginningin the next section, let us think about products whose availability is limited orthat are not available in this section.
ሺiሻ Cancer insurance policies that can be taken out by persons with healthimpairments (Fig. 28)
Measures to improve cancer screening rates are included in the Basic Plan toPromote Cancer Control Programs. A program for screening five sites iscurrently being promoted. As a result, there are people who have had
abnormalities identified through screenings that then led to the discovery ofcancer and persons who have undergone follow-up examinations. Normally,
these persons would not be able to take out cancer insurance. The promotion of
screenings has ironically led to an increase in the number of persons who are
Chapter 4 117

unable to take out cancer insurance. Cancer insurance for which underwriting
criteria have been relaxed to enable even persons undergoing follow-up
examinations to take out such policies is being demanded by society. Of course,
this includes insurance policies that can be taken out not just by persons forwhom an abnormality has been identified through a cancer screening but also by
persons with a disease or illness that is associated with a high cancer incidence
rate.
Fig. 28. Substandard insurance needs of persons with health impairments

ሺiiሻ Cancer insurance for affected individuals (Fig. 29)
The promotion of cancer screening is also contributing to the early detectionof cancer. Many patients can survive for a long time if they receive appropriate
treatment, thereby allowing them to return to society as cancer survivors. Since
treatment methods and outcomes are both improving, it is believed that the ranks
of cancer survivors are growing. You would expect that such persons would havea good understanding of the benefits of cancer insurance through theirexperience in undergoing medical treatment for cancer. A patient may have beena cancer insurance policyholder in the past, but that product might not have beenable to be used for any modern forms of cancer treatment. Expectations are highfor the availability of cancer insurance policies for cancer patients that can betaken out by survivors and that can allow benefits to be obtained in a way thatkeeps pace with the latest developments in the world of medicine.
(Such policies are already being sold by some companies but not in any
widespread manner.)118

Fig. 29. Cancer insurance needs of persons with cancer

ሺiiiሻ Income-protection insurance
Of course, employment risks are substantially affected by such external
factors as the economic environment and the workplace of the individual, but
health-related issues are also involved to a significant degree. The inability towork due to an illness affecting the spouse in a household in which both thehusband and wife are gainfully employed is not just a problem that affects thepatient but also a household problem in that the ability of the family as a wholeto earn money can be diminished.
It is known that unforeseen accidents, mental illnesses, and malignant
neoplasms are health-related issues that can cause a loss of employment,
voluntary or otherwise. Income-protection insurance is a low-priority productrelative to insurance payable at death, medical insurance, and cancer insurance
and the like, but, given that the medical treatment of cancer is a major cause ofunemployment, the addition to cancer insurance policies of a feature that could
protect one’s income is something that should be demanded by society. While itgoes without saying that some people believe that income protection should be
provided as a separate type of coverage offered on a standalone basis, it should
also be conceivably added to cancer insurance at the present time when thepriority attached to policies taken out by people is low. It may indeed be possible
to promote this idea to the employees of corporate clients.
We hope that we will see products that go beyond providing coverage ofdirect treatment costs become accepted by consumers through a focus on thedevelopment of various kinds of products in addition to just insurance for theprotection of income. It might even be good to continue taking a scrap-and-build
Chapter 4 119

approach to products required by consumers through trial and error to someextent. (Products to which income protection features have been added are
already available. Some companies have also stopped selling such policies.)
Table 76. Survivorship and the financial burdens of surviving cancer
Employment and income issues
Dismissal of workers, business closure, voluntary retirement

Rate
24%

Decrease in earnings by persons with regular income
Income reduction rate

67%
36%

Source: Excerpted from materials issued by the Cancer Control Promotion Council,
November 2, 2011

We’re both working, but
if either of us getscancer and can nolonger work, we’re introuble!

120

You’re right about that.
I wonder how we can protect our
income…
We’ve got unemployment
insurance and disability pensions,but are those enough?

II. Comparison and recommendation standards❖ Thinking about evaluation standards
This part, if we were to analogize it to the construction of apartment buildings,
is the part that corresponds to thinking about the process of certifying a building.
Viewpoints with respect to standards
1. Is the necessary coverage incorporated into the standards?
2. Are the standards medically valid, and are they easy to understand orcomplicated?
3. Are the policy conditions clear and drafted in a way that problems will
be prevented from arising at the time of payment?
4. Is the superiority of pointless aggregation standards being exaggerated?
5. Is there any concern over overlapping or excessive benefits (a way toincrease commissions by raising the unit cost of products)?
Basic policies
Free design-type products and partial cancer coverage (such as that whichmight be provided by a medical insurance policy rider through which cancer
coverage is provided) are not dealt with in this book.
Specific evaluation points
Specific evaluation points have been summarized in Table 77. The threebasic types of base policies (see page 110 for the section on base policies) arenot evaluated in this section, since they are subject to the policies of eachcompany. In addition, aggregation and other such matters will not be evaluatedin this section but will be touched upon in discussions on the specifications ofeach product.

Chapter 4 121

Table 77. Evaluation points
1) Coverage performance: Whether the basic framework of cancer insurance has been properly
established and the sufficiency thereof (base policy and riders taken together)(1) Whether there are diagnosis‐related benefits
・Initial lump‐sum payment (can be replaced even with a separate product providing
coverage of the three major diseases)
・Multiple payments
・Exemption from having to pay insurance premiums upon receiving a cancer diagnosis(equivalent to a diminishing lump‐sum payment benefit for a diagnosis)
・Coverage of severe conditions(2) Whether there are medical treatment‐related benefits
・Hospitalization
・Hospital visits
・At‐home medical treatment
・Long‐term medical treatment(3) Whether there are treatment‐related matters・Three major cancer treatment options (surgical treatment, radiation therapy, andanticancer drug therapy)(4) Whether there is an exemption from having to pay premiums for physical disability insurance2) Points concerning the policy conditions(1) Cancer definition and the medical validity of a diagnosis
・Cancer definition: Whether the use of ICD‐10 or ICD‐O is appropriate
・Whether the policy conditions can accommodate future changes in the WHO standards(2) Medical validity of the standards for confirming a diagnosis of cancer
・Whether the policy conditions prioritize histopathological findings
・Appropriate use of terminology
Misuse of cancer and malignant neoplasm
Cancer pain, early‐stage cancer(3) Standards applicable to multiple payments of lump‐sum payments for a cancer diagnosis
・Ease of understanding
・Medical validity(4) Validity of the definition of the three major treatment options and the definition of the scopeof benefits
・Surgical operations (public insurance linkage, older types of surgical operations‐related
policy conditions, benefits for some specific surgical options)・Radiation (50 gray (Gy) regulations)・Chemotherapy
Definition of anticancer drugs
Scope of benefits (drugs covered by insurance, drugs for which pharmaceutical approvalhas been obtained, and unapproved drugs)(5) Clarification of the standards applicable to the payment of different types of medical
treatment benefits
3) Whether coverage is being provided through overlapping benefits (excessive benefits and theexcessive assumption of benefits)
・Possibility of overlapping benefits, such as through severe‐level coverage and treatment
benefits122❖ Competition through unnecessary aggregation
In some cases, there is competition to expand through aggregation based ona paucity of scientific evidence.
Since it is easier to recommend a product in comparison ads when the productoffers a broad range of coverage, the standards for aggregation options that are
believed to be medically unnecessary will expand. It is problematic in that thisresults in efforts to draw the attention of consumers away from the truth behind
the acquisition of unnecessary coverage and the selection of products.
Products that offer unlimited whole-life coverage with no limits in terms ofthe number of times benefits are paid and the amount of benefits paid placed on
the coverage of new risks that a company has never previously handled areavailable, but I wonder with concern how products offering such excessive
coverage can be sold. The provision of the excessive coverage of risks that acompany has never previously handled will ultimately lead to one unavoidable
result: the foisting of unnecessary premiums on the policyholder. You should befully aware of this point and consider whether or not such products will berecommended for sale.
By surveying not just cancer insurance but third-sector products in general,competition over various forms of aggregation can be discerned. In other words,
we are talking about the following: Aggregate amount for advanced medical care
 Aggregate number of days of hospitalization for any of the three majordiseases Benefit period and number of days of benefit payments corresponding
to hospital visit benefit payments
 Number of illnesses and diseases included in coverage of lifestylerelated diseases
 Number of months of benefit payments corresponding to anticancer
drug coverage
While some companies have set the aggregate amount of advanced medicalcare costs that they cover to twenty million yen, just how is it that they are
explaining the necessity of this amount to consumers? This is something that I,
even in my role as a doctor, cannot wrap my head around.
Coverage of hospitalization for cancer has long constituted coverage without
any aggregate limits. On the other hand, a number of companies have recently
Chapter 4 123

expanded hospitalization for myocardial infarctions and strokes so that they are
not subject to aggregate limits, for the stated purpose of strengthening coverageof the three major diseases. However, while the Ministry of Health, Labour andWelfare has also certified diseases for which long-term hospitalization has been
deemed necessary (specific excluded diseases), malignant neoplasms arerecognized, while both myocardial infarctions and strokes are not.
While the concept of covering high blood pressure and other forms oflifestyle-related diseases may be medically questionable, I will not pursue thismatter any further in this book.
As mentioned above, the selling of coverage that cannot be medicallygrasped in order to accomplish nothing more than differentiation to prevail overthe competition is problematic. When recommending products, the evaluation ofthis point should be carefully undertaken.
The number of months of anticancer drug treatment benefits payable was
newly brought into the picture as a focus of aggregation competition in relation
to cancer insurance. Competition revolved around three types of coverage: five
years (sixty times), ten years (120 times), and unlimited. As expected, you willneed to carefully consider whether insurance premiums are in line with the
expansiveness of coverage.
For future insurance proposals to be made, it will be meaningless to compare
the simple number of benefit payments to be made, the number of days, months,
or years in question, and the amount of benefits payments that will be payable.
The competition for superiority will turn on whether or not you can explain thevalidity of the rationale for such coverage (Fig. 30).
Fig. 30. Competing on the basis of aggregation that can be perceived as being
excessive, which is what can happen when you try to differentiate yourself
from other companies and achieve superiority

124III. Discussions on product specifications and viewpoints with respect torecommendations*Insurance products stated in this book are products as of 2016; these have been updated sincethen by their respective companies.

❖ Definitions of cancer and the conditions applicable to making adefinitive diagnosis
Let us first look at the definitions of cancer and the conditions for making adefinitive diagnosis as stipulated in provisions upon which all coverage ispredicated. These are the most important parts for not just the payment ofbenefits but also as standards for exercising provisions on invalidity andactivating a waiting period. In other words, these are the most important productpoints for ensuring that correct payments are made and for ensuring that correct
medical explanations are issued.
(i) Comparative points◇ The use of the WHO’s classification standards and the disclosure of any
new standards▷ Use both ICD-10 and ICD-O or use just ICD-10▷ Whether the policy conditions are in accordance with the latest
standards◇ Whether the policy conditions stipulate that the confirmation of adiagnosis requires or prioritizes a histopathological finding
Type A
Type B
Type C

Diagnosis based on a histopathological finding is accepted as apriority condition
Accepted based on a histopathological finding or the result of othertestingDiagnosis of malignant neoplasm made for the first time since thepolicy went into effect◇ How to use terms consisting of cancer and malignant neoplasm

Chapter 4 125

(ii) Evaluation(ii-i) Regarding the use of both ICD-10 and ICD-O
Products with policy conditions based on the use of both the ICD-10
and ICD-O standards are recommended, as they clarify payments formalignant and intraepithelial neoplasms and accordingly give rise to few
problems at the time of payment.
Since medicine is always making progress, it can be argued that policy
conditions based on the use of the latest classification standards are
preferred.
(ii-ii) Regarding a histopathological finding in confirming a diagnosis
Products with policy conditions set forth in a way that treats adiagnosis based on a histopathological finding as a priority condition arerecommended as products that give rise to few problems at the time of
payment.
(ii-iii) Regarding medical validity in connection with the use of terms
consisting of cancer and malignant neoplasm
While the use of the term cancer as a coined term in policy conditions
is permitted, the use of the medical term malignant neoplasm as a coined
word is problematic and should be immediately corrected. Policy
conditions set forth in a way that states “Malignant neoplasms include
intraepithelial neoplasms” in an appendix or schedule in which cancer isdefined is, as might be expected, indeed problematic.

126

Company name
(Product name)Sony Life Insurance(Cancer Insurance)
Himawari Life Insurance(Yuuki no Omamori
Cancer Insurance)
Prudential(Cancer Insurance for
Business Clients)
ORIX Life Insurance(Believe Cancer
Insurance)
AXA Life Insurance(Cancer Treatment
Insurance)
Anshin Life Insurance(NEO Cancer Treatment
Support Insurance)

AIG Fuji Life Insurance(Best Gold Alpha)Aioi Life Insurance(New Cancer Insurance
Alpha)
Manulife Life Insurance(Kodawari Cancer
Insurance)
AXA Direct Life
Insurance(Whole‐Life Cancer)
MetLife Insurance(Guard X)

Aflac(Days Cancer Insurance)
Zurich Life Insurance(Whole‐Life Cancer
Treatment Insurance)

Definition of cancer
Provisions that include intraepithelial neoplasms in thescope of malignant neoplasms
Both ICD‐10 and ICD‐O are used.
Provisions that include intraepithelial neoplasms in thescope of malignant neoplasms
Both ICD‐10 and ICD‐O are used.
Provisions that include intraepithelial neoplasm as a typeof malignant neoplasm
ICD‐10 only
Provisions that include intraepithelial neoplasm as a typeof malignant neoplasm
ICD‐10 only
Malignant neoplasms and intraepithelial neoplasms aretreated as separate terms (where cancer = malignant
neoplasms).
Both ICD‐10 and ICD‐O are used.
Malignant neoplasms and intraepithelial neoplasms aretreated as separate terms (where cancer = malignant
neoplasms + intraepithelial neoplasms).
Both ICD‐10 and ICD‐O are used.
Malignant neoplasms and intraepithelial neoplasms aretreated as separate terms (the term cancer has been
removed from the conditions set forth in the basepolicy).
Both ICD‐10 and ICD‐O are used.
Malignant neoplasms and intraepithelial neoplasms aretreated as separate terms (where cancer = malignant
neoplasms + intraepithelial neoplasms).
Both ICD‐10 and ICD‐O are used.
Malignant neoplasms and intraepithelial neoplasms aretreated as separate terms (where cancer = malignant
neoplasms + intraepithelial neoplasms).
Both ICD‐10 and ICD‐O are used.
Malignant neoplasms and intraepithelial neoplasms aretreated as separate terms (where cancer = malignant
neoplasms + intraepithelial neoplasms).
Both ICD‐10 and ICD‐O are used.
Malignant neoplasms and intraepithelial neoplasms aretreated as separate terms (where cancer = malignant
neoplasms + intraepithelial neoplasms).
Both ICD‐10 and ICD‐O are used.
Malignant neoplasms and intraepithelial neoplasms aretreated as separate terms (where cancer = malignant
neoplasms).
Both ICD‐10 and ICD‐O are used (latest version).
Malignant neoplasms and intraepithelial neoplasms aretreated as separate terms (where cancer = malignant
neoplasms + intraepithelial neoplasms).
Both ICD‐10 and ICD‐O are used.

Conditions for confirming acancer diagnosis
According to type as listed
on page 125

Type B

Type A

Type B

Type A

Type A

Type A

Type A

Type AMix of Type C inbase policies andType B in riders

Type A

Type A

Type A

Type AThe order in which companies are listed here is based on the order in which they are listed in Insurance– Life Insurance Statistics (Hoken Kenkyujo Inc.).
Chapter 4 127

❖ Lump-sum payment for a malignant neoplasm diagnosis
Some products provide a lump-sum payment of benefits when the insured
person obtains a diagnosis of cancer. Coverage is added in the base policy or arider. Pertinent points in comparing products offered by different companies
shall be explained.
Products that provide a lump-sum payment for not just the fulfillment of asimple condition by way of the confirmation of a diagnosis but also thefulfillment of a condition by way of an initial hospitalization or treatment (initial
treatment-linked benefit) are also included.
(i) Comparative points◇ Benefit types:
Type 1
Type 2Type 3

Benefit paid upon the confirmation of a cancer diagnosis
Benefit paid upon the confirmation of a cancer diagnosis or the occurrenceof a particular event, such as hospitalization or treatment
Benefit paid not just upon the confirmation of a cancer diagnosis but also
upon the fulfillment of conditions in terms of site or degree of progression(ii) Evaluation(ii-i) Products lacking a lump-sum payment for a diagnosis
For products for which lump-sum payments have not been added, a study
done by the Ministry of Health, Labour and Welfare looked at the amount ofout-of-pocket expenses paid for by patients and revealed that such products
provide insufficient coverage when it comes to cancer treatment costs. However,
it is believed that clients who have taken out a separate policy for the three majordiseases can combine benefits from the former with lump-sum payments fromthe latter to obtain sufficient coverage and avoid problems of this nature.
(ii-ii) Types 1 and 2
Coverage is broad with Type 1. In particular, if benefits will be received even
without hospitalization or a surgical operation, the insured person will receive
an early benefit payment upon the confirmation of a diagnosis. In contrast, aType 2 product is tied to an event, such as hospitalization, which means that sucha product is linked with the assumption of actual costs. In one sense, a Type 2
product is more rational and can be described as providing coverage more in linewith expenses that are actually incurred. Insurance premiums are considered tobe accordingly lower for Type 2 products.
128

(ii-iii) Diagnosis of malignant neoplasm
Since the condition for paying a lump-sum payment is “diagnosed as having
malignant neoplasm for the first time since the policy came into effect” inaccordance with a Type C product (page 125), a determination of when thepatient got cancer needs to be made in contrast to the determination of theexistence of a malignant neoplasm that is required for a Type A or Type B
product. It is believed that it is very difficult in reality for a doctor to accurately
make such a diagnosis. Without a precise understanding of what it means to getcancer, there is concern that insurance companies might engage in arbitrary
operations with respect to this question. Thus, this type of product cannot berecommended.
Company name
(Product name)

Whether lump‐sum payment
is provided (see note)Sony Life Insurance(Cancer Insurance)
Himawari Life Insurance(Yuuki no Omamori Cancer Insurance)
Prudential(Cancer Insurance for Business Clients)
ORIX Life Insurance(Believe Cancer Insurance)

Lump‐sum payment
provided, once
Lump‐sum payments
provided, multiple times
Lump‐sum payment
provided, once
Lump‐sum payments
provided, multiple times

AXA Life Insurance(Cancer Treatment Insurance)

No lump‐sum payments
provided

Type of benefit anddiagnosis
According to type as
listed on page 128

Type 1
Type 1
Type 1
Type 2
No lump‐sum
payments
providedAnshin Life Insurance(NEO Cancer Treatment Support Insurance)
AIG Fuji Life Insurance(Best Gold Alpha)Aioi Life Insurance(New Cancer Insurance Alpha)
Manulife Life Insurance(Kodawari Cancer Insurance)
AXA Direct Life Insurance(Whole‐Life Cancer)

Lump‐sum payments
Type 1provided, multiple times
Lump‐sum payments
Type 1provided, multiple times
Lump‐sum payments
Type 1provided, multiple times
Lump‐sum payments
Type 3
provided, multiple times
Lump‐sum payment
Type 1provided, once
Lump‐sum payment
MetLife Insurance
provided; in principle, once
Type 2 + Type 3(Guard X)
Special provisions providing
for multiple payments exist.
Aflac
Lump‐sum payments
Type 1(Days Cancer Insurance)
provided, multiple times
Zurich Life Insurance
Lump‐sum payments
Type 1(Whole‐Life Cancer Treatment Insurance)
provided, multiple times
Note: Type of lump-sum payment benefit (normally diagnosis benefit payment, initial treatment-linked
benefit)
Chapter 4 129❖ Multiple payments of lump-sum payments for a diagnosis
Several companies sell products through which multiple payments of lumpsum benefit amounts for a diagnosis are made if certain conditions are met after
a lump-sum payment for a diagnosis is made. This can be thought of as coverageintended to deal with long-term medical treatment costs and patients sufferingfrom serious conditions. Conditions applicable to payment have been excerpted
from the conditions set forth in policies offered by major companies.
Himawari Life Insurance
When the insured person is newly diagnosed as having cancer on or after the day after
the date on which two (2) years have passed after the last day on which there werepreviously grounds for paying the cancer diagnosis benefit payment as reckoned
therefrom (including any recurring or metastasizing cancer).
Provided, however, that, in the event of recurrence, the insured person would need tohave been in a state in which a cancer whose diagnosis had been previously confirmed
could no longer be detected as a result of treatment (hereinafter referred to as “cured
or in remission”), and a diagnosis of recurrence would need to have been subsequently
confirmed.

ORIX Life Insurance
The payment of a cancer treatment benefit payment shall be handled as follows:(1) Where grounds for the payment of a cancer treatment benefit payment arise within
two (2) years of the last day on which there were previously grounds for paying the cancer
treatment benefit payment as received by the insured person as reckoned therefrom, theCompany shall not pay the cancer treatment benefit payment, notwithstanding theprovisions of paragraph (1) hereof.
(2) Where hospitalization as prescribed in item (iii) of the preceding paragraph is
ongoing on the day after the date on which two (2) years have passed after the last day
on which there were previously grounds for paying the cancer treatment benefit payment
as received by the insured person as reckoned therefrom, grounds for the payment of thecancer treatment benefit payment shall be deemed to have newly arisen on that date,
and the Company shall therefore pay the cancer treatment benefit payment.

130

Anshin Life Insurance (cancer diagnosis rider)・When the insured person is in a state in which a malignant neoplasm whose diagnosis
has already been confirmed can no longer be detected as a result of treatment(hereinafter referred to as “cured or in remission”), and a diagnosis of the recurrence ofthe malignant neoplasm is confirmed for the first time thereafter;
・When a malignant neoplasm whose diagnosis has already been confirmed isdefinitively diagnosed as having metastasized to another organ; provided, however, that
this is exclusive of any case in which cancer has already occurred in the organ inquestion prior to the metastasis of the malignant neoplasm;
・When a malignant neoplasm is definitively diagnosed as having newly occurred withno connection to a malignant neoplasm that has already been definitively diagnosed.
* Up to once every two (2) years; provided, however, that this shall be no more thanonce for an intraepithelial neoplasm* Where any of (i) to (iii) below applies after grounds for the payment of a diagnosis
benefit payment arises within two (2) years of the last time there was a day on which
there were grounds for paying the diagnosis benefit payment as reckoned therefrom,grounds for the payment of a new diagnosis benefit payment shall be deemed to have
newly arisen on the date on which any of ① to ③ below applies, and the diagnosis
benefit payment shall be accordingly paid.
(i) When the insured person is admitted to a hospital or clinic for the direct purpose ofreceiving cancer treatment on the day after the date on which two (2) years have passed
after the last time there was a day on which there were grounds for paying the diagnosis
benefit payment as reckoned therefrom;(ii) When the hospitalization of the insured person in a hospital or clinic for the direct
purpose of receiving cancer treatment commences during the insurance period, on orafter the day following the date on which two (2) years have passed;
When the insured person visits a hospital or clinic for the direct purpose of receiving
cancer treatment during the insurance period, on or after the day following the date on
which two (2) years have passed.

AIG Fuji Life Insurance
When the insured person is first admitted to or visits a hospital or clinic for the purposeof treating a malignant neoplasm whose diagnosis has been confirmed during theinsurance period at some point on or after the policy inception date and on or after the
day following the date on which two (2) years have passed after the last time there wasa day on which there were grounds for paying the malignant neoplasm benefit payment
as reckoned therefrom;*Where hospitalization for the purpose of treating a malignant neoplasm is ongoing on
the day following the date on which two (2) years have passed after the last time there
was a day on which there were grounds for paying the malignant neoplasm benefit
payment as reckoned therefrom, the insured person shall be deemed to have been
admitted on that day, and the malignant neoplasm diagnosis benefit payment shall beaccordingly paid.

Chapter 4 131

Aioi Life Insurance
When the insured person is admitted due to circumstances directly attributable tocancer that has been definitively diagnosed on or after the policy inception date insofar
as cancer benefit payments are concerned and on or after the day after the date on
which a diagnosis of cancer is confirmed for the first time at some point on or after thepolicy inception date insofar as cancer benefit payments are concerned*No payment will be made if grounds for paying the cancer diagnosis benefit payment
arise within two (2) years of the date on which the final hospitalization for which thecancer diagnosis benefit payment is to be paid commences (or, where the cancer
diagnosis benefit payment is to be paid upon the confirmation of a cancer diagnosis forthe first time on or after the policy inception date insofar as cancer benefit payments
are concerned, the date on which a diagnosis is confirmed or, where the cancer
diagnosis benefit payment is to be paid pursuant to the provisions of the following
paragraph, the date on which a paid hospitalization is deemed to have commenced) as
reckoned therefrom.
*Where continuous hospitalization corresponding to grounds for paying the cancer
hospitalization benefit payment as provided for in the base policy is ongoing on the day
following the date on which two (2) years have passed after the date on which the final
hospitalization for which the cancer diagnosis benefit payment is to be paid commences
as reckoned therefrom, hospitalization shall be deemed to have commenced on thatday, and the cancer diagnosis benefit payment shall be accordingly paid.

Manulife Life Insurance (malignant neoplasm diagnosis benefit)
When hospitalization for the purpose of treating a malignant neoplasm that has been
definitively diagnosed commences on or after the day following the date on which two(2) years have passed after the date on which the malignant neoplasm was definitively
diagnosed for the first time as reckoned therefrom*Where hospitalization for the purpose of treating a malignant neoplasm is ongoing on
the day following the date on which two (2) years have passed after the date on which
grounds for paying the malignant neoplasm diagnosis benefit payment arose, it shall bedeemed that grounds for payment arose on that date, and the malignant neoplasm
diagnosis benefit payment shall be accordingly paid.
*Where grounds for paying the malignant neoplasm diagnosis benefit payment arise
within two (2) years of the date on which the final hospitalization for which themalignant neoplasm diagnosis benefit payment will be paid commences as reckoned
therefrom, the malignant neoplasm diagnosis benefit payment shall not be paid.

132

MetLife Insurance
Where grounds for paying the malignant neoplasm treatment benefit payment apply tothe insured person within one (1) year of the final date on which there were grounds forpaying the malignant neoplasm treatment benefit payment and for which the malignant
neoplasm treatment benefit was to be paid as reckoned therefrom, the malignant
neoplasm treatment benefit payment shall not be paid, notwithstanding the provisionsof the preceding paragraph (*Conversely, provisions stipulate that this benefit payment
shall be paid if more than one (1) year has passed.)

Aflac
When (a) and (b) below apply on or after the day following the date on which two (2)years have passed after the first day of the month in which falls the day on which
grounds for paying the rider‐stipulated diagnosis benefit payment due to a precedingcancer arose as reckoned therefrom:(a) A diagnosis of cancer is confirmed;(b) The insured person is admitted for the direct purpose of treating cancer.

Zurich Life Insurance
When the insured person is hospitalized for the direct purpose of treating cancer on orafter the day following the date on which two (2) years have passed after the previous
date on which grounds for paying the cancer diagnosis benefit payment arose as
reckoned therefrom.

(i) Comparative points◇ Payment conditions▷ Simplicity of benefit conditions, convenience of conducting a payment
review▷ Medical validity▷ Payment interval (one year, two years)
There are also products with complicated conditions due to the fact that
medical determinations are added to the mix. In order to recommend products,
however, an understanding of such components is very important. Simply statingthat a client will be paid multiple times does not amount to a proper comparison.
(ii) Evaluation
 Difficulty level of the policy conditions (difficulty of medical standards)
It goes without saying that the inclusion in policy conditions of standards thatare difficult for even attending physicians to medically evaluate, such as
standards with respect to “recurrence or remission,” is difficult for consumers to
Chapter 4 133

understand.
A product with a standard for paying benefits upon the occurrence of an event
consisting of hospitalization or the paying of a visit to the hospital in order toobtain treatment for cancer that has been confirmed to exist after two years is
associated with grounds for payment that are easy for consumers to grasp.
Consequently, it is believed that payment problems rarely occur wheneverclaims are submitted.
(ii-i) Multiple payments of intraepithelial neoplasm diagnosis benefits
An intraepithelial neoplasm can be easily treated and carries no risk of having
to undergo long-term medical treatment or suffering death. Therefore, the very
concept of a product that provides benefits multiple times is problematic. Even
if intraepithelial neoplasms are not eligible for payment, such products are notconsidered to be medically disadvantageous from a sales point of view.
(ii-ii) Payment interval
Only MetLife’s Guard X provides for a payment interval of one year, while
many other companies set their payment interval to two years. Perhaps MetLife
chose to go with a payment interval of one year, since payments cover treatment
costs on a lump-sum basis. In addition, diagnosis benefit payments are provided
through riders. For this reason, policy portfolios appear to have become quite
complicated.

134

Company name
(Product name)

Payment interval

Comment

Himawari Life
Insurance(Yuuki no Omamori
Cancer Insurance)

Payment interval of two years; base policy
No limit on the number of payments
Intraepithelial neoplasms are also eligible
for payment.

The medical evaluation as to whether acancer has been cured or is in remission
is difficult to perform (the problem ofdetermining whether a cancer has been
cured or is in remission); there is concernthat hospital visits will be avoided until
the second year to delay the detection ofrecurrence.

ORIX Life Insurance(Believe Cancer
Insurance)

Payment interval of two years; base policy
Intraepithelial neoplasms are also eligible
for payment.

Payment conditions are simple and easy
to understand.

Payment interval of two years; base policy
No limit on the number of payments
Intraepithelial neoplasms are not eligible
for payment.

The policy conditions are difficult tounderstand; it is questionable as towhether there is a need for conditions todetermine whether a cancer is inremission and whether there is a needfor grounds for payment.
There is the problem of determining
whether a cancer has been cured or is inremissionAnshin Life
Insurance(NEO Cancer
Treatment Support
Insurance)

AIG Fuji Life
Insurance(Best Gold Alpha)Aioi Life Insurance(New Cancer
Insurance Alpha)
Manulife Life
Insurance(Kodawari Cancer
Insurance)
MetLife Insurance(Guard X)

Aflac(Days Cancer
Insurance)
Zurich Life
Insurance(Whole‐Life Cancer
Treatment
Insurance)

Payment interval of two years; base policy
No limit on the number of payments
Diagnosis benefit payments for
intraepithelial neoplasms are provided forin a rider.
Payment interval of two years; rider
No limit on the number of payments
Intraepithelial neoplasms are also eligible
for payment.
Payment interval of two years; base policy
No limit on the number of payments
Intraepithelial neoplasms are also eligible
for payment (half amount).
Payment interval of one year
Upper limit on the number of payments offive or ten
Intraepithelial neoplasms are also eligible
for payment.
Payment interval of two years; rider
No limit on the number of payments
Intraepithelial neoplasms are also eligible
for payment (1/10).
Payment interval of two years; rider
No limit on the number of payments
Intraepithelial neoplasms are also eligible
for payment.

Payment conditions are simple and easy
to understand.

Payment conditions are simple and easy
to understand.
While benefits for stage III and stage IV
cancer are separately provided, they
overlap with treatment benefits to giverise to a medically complicated situation.
Payment standards applicable to theoriginal treatment benefit payments areslightly complicated.

Payment conditions are simple and easy
to understand.

Payment conditions are simple and easy
to understand.

Chapter 4 135

❖ Amount of coverage of intraepithelial neoplasms
You should assess the necessity of covering intraepithelial neoplasms by
sufficiently understanding the explanation of intraepithelial neoplasms given in
Chapter 2. In my personal opinion, I believe that you will be adequately covered
if you have taken out medical insurance. If anything, coverage of intraepithelial
neoplasms could render a product more complicated.
(i) Comparative points◇Whether the lump-sum payment for a diagnosis is the same amount as fora malignant neoplasm◇Whether multiple payments of a diagnosis benefit apply◇Whether benefit payments for hospitalization or surgical operations apply◇Whether or not there are invalidation provisions(ii) Evaluation
The existence of invalidation provisions applicable to intraepithelial
neoplasms is more important as a recommendation standard than the extent towhich intraepithelial neoplasms are covered. If there are no invalidation
provisions, then it should be fine to recommend a product that provides suchcoverage.
The significance of cancer invalidation provisions in cancer insurance
policies is explained in my book Cancer and Cancer Insurance (The Hoken
Mainichi Shimbun Co., Ltd., 2015). Malignant neoplasms and intraepithelial
neoplasms constitute biologically different states and also differ completely interms of determinations made for a doctor’s disclosure. It is possible that anindividual who has previously been notified of an abnormality as revealed in acancer screening or who has had a polyp removed from his or her digestive tract
may have had an intraepithelial neoplasm without having received a detailed
explanation from his or her doctor. For this reason, if a policy has invalidation
provisions relating to intraepithelial neoplasms, it will be more unstable in thesense that the policyholder will not be certain when he or she will be able toobtain coverage with peace of mind. This is a huge problem for consumers. This
problem is even greater since intraepithelial neoplasms are now expanding inscope from severe dysplasia to moderate dysplasia. In addition to whether or notcoverage is provided, you must explain disadvantageous elements as material
136matters.
If you can get people to deepen their medical understanding of intraepithelial
neoplasms, you should be able to get them to realize that other comparative
points do not merit being treated as points for recommending a product.
Whether alump‐sumpayment fora diagnosis isprovidedBenefitamount(*)

Whether
multiplepayments
are made

Base policySameamountNo

Base policySameamountYes

Base policy, sameamountYes

Base policySameamountYes

Base policy, sameamountYes

Base policySameamountYes

Base policy, sameamount

Yes

No

None

No

Rider, same amountNo

Base policySameamountNo

Base policy, sameamountYes

Rider

Half theamountYes

Rider, same amount

Yes

Rider

Same
amountYes

Base policy, sameamountYes

Base policy

Unknown

Yes

Rider, same amountYes

AXA Direct Life Insurance(Whole‐Life Cancer)

Base policySameamountNo

MetLife Insurance(Guard X)

Rider

Half theamountYes

Aflac(Days Cancer Insurance)

Base policy

1/10

Yes

Zurich Life Insurance(Whole‐Life Cancer
Treatment Insurance)

Rider

Same
amountYes

Company name
(Product name)Sony Life Insurance(Cancer Insurance)
Himawari Life Insurance(Yuuki no Omamori
Cancer Insurance)
Prudential Life Insurance(Cancer Insurance for
Business Clients)
ORIX Life Insurance(Believe Cancer
Insurance)
AXA Life Insurance(Cancer Treatment
Insurance)
Anshin Life Insurance(NEO Cancer Treatment
Support Insurance)
AIG Fuji Life Insurance(Best Gold Alpha)Aioi Life Insurance(New Cancer Insurance
Alpha)
Manulife Life Insurance(Kodawari Cancer
Insurance)

Whether
hospitalization or
surgical operations arecovered and thebenefit amountBase policy, sameamountWhether
there areinvalidation
provisions(*)
Yes

Hospitalization in basepolicy, same amount
Surgical operations inrider, same amount
Hospitalization inrider, same amount
Surgical operations inbase policy, half theamountHospitalization in basepolicy, same amount
Surgical operations inrider, same amount

Yes

Rider, same amount

Yes

Yes

No

*The benefit amount compares the benefit amount received with the benefit amount received for
malignant neoplasms.
*Invalidation provisions refers to provisions for invalidation through a definitive diagnosis of an
intraepithelial neoplasm before a policy begins to take effect.
Chapter 4 137

❖ Hospitalization benefit
Some companies provide daily benefits where an insured person is
hospitalized for a cancer that has been definitively diagnosed after the policy has
started to take effect through a base policy, while others provide such benefits
through a rider. The definition of the insured event – in other words, theconditions applicable to the benefit in question – is more or less the same for all
insurance companies, and there are no limits as well when it comes toaggregation.
(i) Comparative points(i-i) Benefits-related policy conditions concerning a cancer diagnosis madeduring hospitalization for another disease or illness or the onset of anotherdisease or illness during the medical treatment of cancer
The pertinent point is whether or not differentiation from
hospitalization for any other disease or an injury, a common source ofproblems when benefits are being paid, is expressly addressed in thepolicy conditions. Whether or not the following supplementary rules exist
should be determined.
A: Supplementary rules where hospitalization for cancer is extended due toanother disease or an injury while hospitalization for cancer is ongoing
B: If a diagnosis of cancer is confirmed during hospitalization for anotherdisease or an injury, supplementary rules governing whether or notbenefits for pre-diagnosis treatment shall be paid
C: If a diagnosis of cancer is confirmed during hospitalization for anotherdisease or an injury, supplementary rules governing the handling of postdiagnosis hospitalization(i-ii) Whether there is priority coverage for a short-term hospitalization
Whether there is coverage consisting of an additional daily amountduring a short-term hospitalization of up to five days in length(i-iii) Two types of definitions of the insured event in question can be found;
there is a difference in terms of whether or not the term “direct” is used:
Hospitalization for the direct purpose of treating cancer
Hospitalization for the purpose of treating cancer(ii) Evaluation(ii-i)Is coverage in terms of a hospitalization benefit payment included in the138base policy?
Since this question is a matter of product strategy as adopted by eachcompany, it is not possible to make a categorical statement as to which is
better, but consumers probably expect there to be coverage of hospitalization
for cancer when they take out a cancer insurance policy.
(ii-ii) Necessity of expanding the coverage of short-term hospitalizations
While the addition of a feature consisting of priority coverage of shortterm hospitalizations as seen with medical insurance policies isconceivable in the future, the need to expand coverage of short-term
hospitalizations is probably not great if coverage of the three major cancer
treatment options has been added.
(ii-iii) Clarifying payments
The stipulation of supplementary rules A, B, and C is important. In
particular, the inclusion of rule A or C is probably a standard forrecommendation. If the definition of an insured event also includes theterm direct, few problems relating to payments will likely arise.

Chapter 4 139

Company name
(Product name)

Himawari Life Insurance(Yuuki no Omamori Cancer
Insurance)

Requirements for receiving a hospitalization
benefitBase policy
Hospitalization for the direct purpose oftreating cancer
Base policy
Hospitalization for the direct purpose oftreating cancer

Prudential Life Insurance(Cancer Insurance for Business
Clients)

Base policy
Hospitalization for the direct purpose oftreating cancer

Sony Life Insurance(Cancer Insurance)

ORIX Life Insurance(Believe Cancer Insurance)
AXA Life Insurance(Cancer Treatment Insurance)
Anshin Life Insurance(NEO Cancer Treatment
Support Insurance)
AIG Fuji Life Insurance(Best Gold Alpha)Aioi Life Insurance(New Cancer Insurance Alpha)

Manulife Life Insurance(Kodawari Cancer Insurance)
AXA Direct Life Insurance(Whole‐Life Cancer)
MetLife Insurance(Guard X)
Aflac(Days Cancer Insurance)
Zurich Life Insurance(Whole‐Life Cancer Treatment
Insurance)

140

Base policy
Hospitalization for the direct purpose oftreating cancer
Rider
Hospitalization for the direct purpose oftreating cancer
Base policy
Hospitalization for the direct purpose oftreating cancer
Rider
Hospitalization for the direct purpose oftreating cancer
Base policy
Hospitalization for the purpose of treating
cancerPriority coverage of short‐term hospitalization
available
Rider
Hospitalization for the purpose of treating
cancerBase policy
Hospitalization for the direct purpose oftreating cancer
Rider
Hospitalization for the purpose of treating
cancerLong‐term hospitalization payments available
Base policy
Hospitalization for the direct purpose oftreating cancer
Rider
Hospitalization for the direct purpose oftreating cancer

Whether supplementaryrules apply
Supp. Rules A, B available

No supp. rules
Supp. Rules A, B, C available
With rules governing
deemed admission to at‐home hospiceSupp. Rule B available

Supp. Rules A, C available

Supp. Rule A available

No supp. rules

Supp. Rules A, C available

Supp. Rule C available

Supp. Rules A, C available

Supp. Rule C available

Supp. Rule B available

Supp. Rule C available❖ Surgical operations benefit
Many companies provide a surgical operations benefit for surgical operations
performed for the purpose of treating cancer.
The surgical operations benefit used to be a problem back when there were
frequent cases of non-payment under medical insurance policies. In the case ofcancer insurance, however, simpler products might tend to be recommended if
you are to keep problems from potentially arising at the time of payment in mind,
since payment-related determinations will need to be made with respect to thefollowing: whether or not the surgical operation corresponds to cancer, whether
or not the surgical operation is performed for the purpose of treating cancer, andwhether the surgical operation constitutes a radical surgical operation or anothertype of surgical operation for treating a malignant neoplasm (where the policy
provides a graded benefit). In a nutshell, if lump-sum payments for a cancer
diagnosis are substantial, then you should be satisfied with a surgical operations
benefit payment of a fixed amount.
(i) Comparative points◇ Whether a public insurance-linked system or limited enumeration systemapplies◇ If a public insurance-linked system applies, whether bone marrow or stem
cell transplantation is eligible for the surgical operations benefit◇ Whether the surgical operations benefit is a graded benefit (whereby therate varies according to surgical operation)◇ Whether there is a supplementary explanation of radical surgicaloperations if a limited enumeration system applies(ii) Evaluation(ii-i) Benefit amountIf the policy provides benefit payments consisting of lump-sum
payments for a cancer diagnosis, high amounts of a surgical operations
benefit will not be required if you consider the fact that the high-cost
medical treatment benefit system can also be used for insurance-covered
surgical operations.
(ii-ii) Problems arising at the time of payment
Public insurance-linked products providing fixed-amount benefits will
Chapter 4 141

likely be recommended if you consider the possibility of errors in termsof non-payment or benefit amount. If a limited enumeration systemapplies, policies with a supplementary explanation of radical surgicaloperations will likely give rise to fewer problems.
(ii-iii) Generous benefit payments for serious surgical operations
While the benefit amount will be higher for, for example, open-chest
surgical operations to give the impression that coverage has beenenhanced, this sort of scenario will in fact give rise to more payment
problems. Therefore, since an explanation concerning open-chest surgicaloperations will be needed in such a situation, the contents of coverage
should ideally be as simple as possible.

142

Company name
(Product name)

Type of surgical operations
benefitSony Life Insurance(Cancer Insurance)

Base policy, limited enumeration
system, 4 types (3 benefit
amount tiers)

Himawari Life Insurance(Yuuki no Omamori Cancer
Insurance)

Base policy, limited enumeration
system, 5 types (3 benefit
amount tiers)

Prudential Life Insurance(Cancer Diagnosis Insurance)

Base policy, limited enumeration
system, 4 types (3 benefit
amount tiers)

ORIX Life Insurance(Believe Cancer Insurance)

Base policy, limited enumeration
system, 5 types

AXA Life Insurance(Cancer Treatment Insurance)

Base policy, public insurance‐
linked system (flat rate)
For some surgical operations, anadditional support benefit
payment is provided.

Anshin Life Insurance(NEO Cancer Treatment
Support Insurance)

Rider, limited enumeration
system, 5 types (flat rate)

AIG Fuji Life Insurance(Best Gold Alpha)

Rider, limited enumeration
system, 5 types (flat rate)

Aioi Life Insurance(New Cancer Insurance Alpha)Base policy, limited enumeration
system, 5 types (flat rate)

Manulife Life Insurance(Kodawari Cancer Insurance)

Rider, public insurance‐linked
system (flat rate)

AXA Direct Life Insurance(Whole‐Life Cancer)

Rider, limited enumeration
system, 4 types (flat rate)

MetLife Insurance(Guard X)
Aflac(Days Cancer Insurance)
Zurich Life Insurance(Whole‐Life Cancer Treatment
Insurance)

Supplementary explanation of radical
surgical operations and whether bonemarrow transplantation is eligible
There is a supplementary explanation ofradical surgical operations.
Allogenic bone marrow transplantation iseligible.
There is a supplementary explanation ofradical surgical operations.
Allogenic bone marrow transplantation iseligible.
There is a supplementary explanation ofradical surgical operations.
Allogenic bone marrow transplantation iseligible.
There is a supplementary explanation ofradical surgical operations.
Allogenic bone marrow transplantation iseligible.
Allogenic bone marrow transplantation iseligible.

Base policy, public insurance‐
linked system
Incorporated into the cancer
treatment benefit payment
Rider, public insurance‐linked
system (flat rate)

No supplementary explanation of radical
surgical operations
Allogenic bone marrow transplantation iseligible.
No explanation of radical surgicaloperations
Allogenic bone marrow transplantation iseligible.
There is a supplementary explanation ofradical surgical operations.
Allogenic bone marrow transplantation iseligible.
Allogenic bone marrow transplantation iseligible.
No supplementary explanation of radical
surgical operations
Allogenic bone marrow transplantation iseligible.
One‐time surgical operations benefit
payment for an intraepithelial neoplasm
Includes elements of surgicaloperations/radiation therapy/anticancer
drug treatment benefit payments andthe lump‐sum payment for a diagnosis
Allogenic bone marrow transplantation iseligible with a radiation therapy benefit.

Rider, public insurance‐linked
system (flat rate)

Allogenic bone marrow transplantation iseligible.

Chapter 4 143

❖ Radiation therapy benefit
Radiation therapy is progressing and growing in terms of treatment methods,
treatment equipment, and treatment adaptation. More than 200,000 people a year
and more than twenty-five percent of all cancer patients already receive radiation
therapy. While treatment based on the use of particle beams or heavy particle
beams can also be described as a type of radiation therapy, it is covered byadvanced medical care riders (benefit payments), since it is administered as aform of advanced medical care*. Since treatment, except in special cases, will
cost between several tens of thousands of yen to several hundreds of thousandsof yen, coverage does not have to be especially extensive to deal with out-ofpocket expenses. Radiation therapy is a typical example of a cancer-specific typeof treatment, and a radiation therapy benefit is a type of benefit that is typicallymade available as part of the services that are provided by cancer insurance
policies.
With the radiation therapy benefit, provisions exempting treatment involving
less than 50 Gray (Gy) of radiation from coverage had long been a very serious
matter in the area of radiation therapy. I even remember the Life Insurance
Association of Japan once received a request to abolish such exemption
provisions from a specialized society for radiation. Thus, the abolishment ofsuch provisions is an important part of the points to be considered whenrecommending products.
*While certain types of particle beam therapy became eligible for public healthcare insurance coveragein April 2016, many particle beam therapy options continue to be performed as examples of advanced
medical care. However, they need to be performed in accordance with standards set forth by theJapanese Society for Radiation Oncology.

(i) Comparative points(i-i) Whether the product has been designed in such a way that it is easy tounderstand if coverage in terms of a benefit payment can be obtained if
the insured person undergoes radiation therapy
・Conventional type where a benefit for radiation therapy is provided aspart of four or five different types of surgical operations benefits
・ Type where a benefit is provided through a linkage with surgicaloperations covered by public healthcare insurance(i-ii) Whether there are provisions exempting treatment involving less than144

50 Gray (Gy) of radiation from the provision of this benefit(ii) Evaluation(ii-i) Whether the benefit is provided as an independent benefit payment orotherwise in an equivalent form
A product that explicitly states that coverage consisting of
independent benefit payments is provided is probably better. A type thatis linked to public healthcare insurance corresponds to such a product.
(ii-ii) Provisions exempting treatment involving less than 50 Gray (Gy) ofradiation from the provision of this benefit
This is the biggest point to consider in promoting a product and is apoint to be taken into account when recommending a product. Products
without exemption provisions are recommended.

Chapter 4 145

Company name
(Product name)Sony Life Insurance(Cancer Insurance)
Himawari Life Insurance(Yuuki no Omamori Cancer
Insurance)
Prudential(Cancer Diagnosis Insurance)
ORIX Life Insurance(Believe Cancer Insurance)
AXA Life Insurance(Cancer Treatment Insurance)
Anshin Life Insurance(NEO Cancer Treatment Support
Insurance)
AIG Fuji Life Insurance(Best Gold Alpha)Aioi Life Insurance(New Cancer Insurance Alpha)
Manulife Life Insurance(Kodawari Cancer Insurance)
AXA Direct Life Insurance(Whole‐Life Cancer)
MetLife Insurance(Guard X)
Aflac(Days Cancer Insurance)
Zurich Life Insurance(Whole‐Life Cancer Treatment
Insurance)

146

Type of radiation therapy benefit
Benefit is provided for radiation therapy
performed as part of a limited list of surgicaloperations.
Benefit is provided for radiation therapy
performed as part of a limited list of surgicaloperations.
Benefit is provided for radiation therapy
performed as part of a limited list of surgicaloperations.
Benefit is provided for radiation therapy
performed as part of a limited list of surgicaloperations.
Linked to public insurance
Benefit is provided for radiation therapy
performed as part of a limited list of surgicaloperations.
Benefit is provided for radiation therapy
performed as part of a limited list of surgicaloperations.
Benefit is provided for radiation therapy
performed as part of a limited list of surgicaloperations.
Linked to public insurance
Benefit is provided for radiation therapy
performed as part of a limited list of surgicaloperations.
Base policy; benefit is provided as a cancer
treatment benefit payment subject toconditions that bring elements of diagnosis andtreatment together; linked to public insurance

Provisions
50 Gy provisions apply;
once every 60 days
50 Gy provisions apply;
once every 60 days
50 Gy provisions apply;
once every 60 days
50 Gy provisions apply;
once every 60 days
No 50 Gy provisions;once every 60 days
No 50 Gy provisions;once every 60 days
50 Gy provisions apply;
once every 60 days
No 50 Gy provisions;once every 60 days
No 50 Gy provisions;once every 60 days
50 Gy provisions apply;
once every 60 days

No 50 Gy provisions

Linked to public insurance

No 50 Gy provisions;once every 60 days

Linked to public insurance

No 50 Gy provisions;once every 60 days❖ Anticancer drugs
Just as the addition of advanced medical care coverage has come to be parfor the course with medical insurance policies, the time has come when theprovision of anticancer drug coverage is the norm in the field of cancer insurance.
(i) Comparative points(i-i) Whether the benefit is provided(i-ii) Scope of drugs for which the benefit is provided
・Whether the benefit applies only to drugs covered by public healthcare
insurance
・ Whether drugs that have received pharmaceutical approval are also
covered by the benefit (in which case the benefit would be applicable toa greater extent than where the benefit applies only to drugs covered bypublic healthcare insurance)
・Whether the benefit is provided for unapproved drugs (out-of-pocket
medical expenses)(i-iii) Definition of anticancer drug
・Whether the Japanese standard product classification system or systemof classification standards set forth by the WHO applies (the benefit
would be applicable to a greater extent if the WHO standards apply)(i-iv) Methods of administration
・Whether the benefit applies if the drug is administered to a hospitalized
insured person or an insured person on an outpatient basis
・Whether orally administered drugs are also covered(i-v) Benefit limits and exemptions
・While the type of benefit that provides benefit payments of a monthly
amount is typical, coverage for up to sixty or 120 months in total can beseen.
・Some products provide a separate benefit or do not provide any benefit
for hormone-based drugs.
(ii) Evaluation(ii-i) Maximum benefit
While some anticancer drugs are administered over an extended
Chapter 4 147

period of time, these are highly varied and consist of everything fromdrugs that are continuously used every day on a long-term basis to drugs
that are injected as part of a standard prescribed treatment regimen (see *on page 81). A majority of patients undergoing chemotherapy areadministered drugs on an outpatient basis, according to research
conducted by the Ministry of Health, Labour and Welfare. Single-dose
administration is common and corresponds primarily to hormone-based
drugs. Thus, the maximum number of months for which the benefit isprovided is at least sixty. Endocrine drugs are often administered longterm. At the same time, this option is cheaper than other drugs.
(ii-ii)Scope of the benefit
This is an important point: products that provide the benefit for all
drugs that have received pharmaceutical approval are better than thosethat provide the benefit for only drugs that are covered by publichealthcare insurance. In addition, it would be problematic if a productwere not one that also covered drugs that might be released in the future.
According to the table…
(ii-iii) Benefit for hormone-based drugs
Hormone-based drugs are also important as drugs used for treating
cancer. Products that provide a benefit for this type of drug arerecommended.
(ii-iv) Oral drugs
These days, anticancer drugs taken orally have also become more
expensive. Thus, products that also provide a benefit for oral drugs arerecommended.
(ii-v) Other
There are also products that provide a separate benefit payment for
drugs that mitigate side effects and therapeutic agents that act to reduce
pain. Even though such drugs and agents do not constitute anticancer
drugs, it might be helpful to take this point into account when determining
whether or not a given product should be recommended.

148

Company name
(Product name)Chemotherapy benefit provisions

Scope of the benefit and other points

Sony Life Insurance(Cancer Insurance)

Rider; main text of the policy
conditions refers to drugs that arecovered by public insurance; theappendix refers to drugs for whichpharmaceutical approval has beenobtained, which means that there isan inconsistency within this policy

Monthly benefit amount; up to 120 months
in total
Japanese standard product classification
system and limited list of drugs

Himawari Life Insurance(Yuuki no Omamori Cancer
Insurance)

Base policy; benefit provided as an
outpatient treatment benefit
payment where chemotherapy is
performed on an outpatient basis

Daily benefit amount; up to 120 days within
one year after a definitive diagnosis
No public standard (also applies to pain‐
relief treatment)
Includes cellular immunotherapy andvaccine therapy

Prudential(Cancer Diagnosis Insurance)

None

ORIX Life Insurance(Believe Cancer Insurance)

Rider; benefit provided as a cancer
hospital visit benefit payment on
the day the insured person visits
the hospital to receive treatment
based on the use of anticancer
drugs
Drugs that are covered by public
insurance

AXA Life Insurance(Cancer Treatment Insurance)

Base policy; drugs that are coveredby public insurance

Anshin Life Insurance(NEO Cancer Treatment Support
Insurance)
AIG Fuji Life Insurance(Best Gold Alpha)Aioi Life Insurance(New Cancer Insurance Alpha)

Rider; drugs for whichpharmaceutical approval has beenobtained

Manulife Life Insurance(Kodawari Cancer Insurance)
AXA Direct Life Insurance(Whole‐Life Cancer)
MetLife Insurance(Guard X)

Aflac(Days Cancer Insurance)

Zurich Life Insurance(Whole‐Life Cancer Treatment
Insurance)

Daily benefit amount; up to 60 days within
one year after hospital discharge
Japanese standard product classification
system; oral administration excluded;
hormone‐based drugs are not eligible
Monthly benefit amount; up to 60 months
in total; Japanese standard productclassification 8742; not applicable tohormone‐based drugs
Monthly benefit amount; up to 60 months
in total; WHO standards; applicable tohormone‐based drugs

None
None
Rider; drugs that are covered bypublic insurance

Monthly benefit amount; up to 60 times intotal; WHO standards; applicable tohormone‐based drugs; palliative carebenefit payments separately available

None
Benefit provided as a benefit
payment for the treatment ofmalignant neoplasms
Drugs for which pharmaceutical
approval has been obtained
Rider; drugs for whichpharmaceutical approval has beenobtained

Base policy; drugs that are coveredby insurance

Annual benefit amount (once per year);
WHO standards; applicable to hormone‐based drugs through a separate rider
Monthly benefit amount; up to 60 months
in total (up to 120 months for hormone‐based drugs); WHO standards
Monthly benefit amount; unlimited; WHOstandards; applicable to hormone‐baseddrugs
Conditions as stipulated in the policy as
pertains to applicability to anticancer drugs
are complicated.

※Drug costs and prescription fees are calculated according to the medical service fees schedule for
insurance-covered drugs; they are not calculated for drugs used in clinical trials and are generally
assumed by pharmaceutical manufacturers (see Table 52 of the section on “New cancer
immunotherapy” in Chapter 3).

Chapter 4 149

The environment surrounding treatment based on the use of anticancer drugs
is presently undergoing significant changes concerning two different points.
With respect to the first point, it should be noted that cancer treatment used
to primarily entail the performance of surgical operations. Treatment based on
the use of anticancer drugs now plays such a central role in the treatment ofcancer that it can be said to have displaced surgical operations as the leading
treatment option for cancer. It is also the driving force behind the emergence of
personalized medical care in the form of treatment tailored to each individual
patient. With respect to the second point, it should be noted that anticancer drugs
are becoming more expensive and accordingly imposing a greater financial
burden on patients.
The rising cost of anticancer drugs is negatively affecting not just patients
but also doctors who treat patients. This is because optimal therapeutic drugs
cannot be administered in some cases depending on the patient’s financial status.
In very unfortunate situations, the patient might even suffer from a
discontinuation of treatment. This is a big problem in the medical setting. Even
experts in treatment based on the use of anticancer drugs have high expectations
that treatment based on the use of anticancer drugs will be covered by private
insurance companies. In making comparisons and putting forth
recommendations, this point needs to be properly understood. While you could
argue that a lack of coverage is problematic, the quality of coverage is likewise
important. What is important is to ensure that there is little difference between
anticancer drugs as understood by patients and anticancer drugs as covered in
the policy conditions.

150

Are interferons ananti‐cancer drug?
What will happen toher cancer insurance
benefit payments??

I'm going to treat yourmother’s kidney cancer
with interferons.

Chapter 4 151

❖ Advanced medical care coverage
Advanced medical care is a type of evaluated medical treatment that allows
a patient to receive medical treatment with the technical fees component (inprinciple) borne by the patient in accordance with the publicly managed use of
insured and uninsured types of medical treatment (public insurance -inapplicable
medical treatment system to which the uninsured concomitant medical treatment
benefit system applies). It is important that you are able to explain to clients why
this system exists. It is inadequate to simply say something like, “Particle beam
therapy costs around three million yen. You can afford this with advanced
medical care benefit payments.”
The track record thus far with respect to advanced medical care is such thatmost benefit payments are made for particle beam therapy. The total amountspent on advanced medical care is a small percentage of total healthcare
spending by the population. We will need to assess future trends to determine
whether or not the system will be enhanced. In recommending products, it is also
important that we look at the impact of being able to conclude only one policy
with a given company.
(i) Comparative points◇ Whether or not actual losses are to be compensated (Table 78), (Table 79)
Type A1
Type A2Type B

Assumption of costs pertaining to advanced medical care (technical fees)
Benefit for portion of costs pertaining to advanced medical care (technicalfees) borne by the patient (true actual losses)
Type other than for coverage of actual losses (not currently available
among products compared at this time)◇ Whole-life or fixed-term coverage
Advanced medical care is expected to expand, which means that benefits
should increase in the future. Monthly insurance premiums are low and markup percentages are currently high, but premiums will likely rise down the line.
Thus, whole-life coverage is advantageous if you only focus on advanced
medical care.
◇ Whether advanced medical care for non-cancer diseases or illnesses is also
covered152

Type 1

Cancer only (all products compared at this time are of this type)Type 2Diseases and illnesses other than cancer are also covered.

◇ Other additional benefits
Some companies provide an additional fixed-amount benefit to covertransportation costs incurred to receive medical treatment nominally under alump-sum payment for advanced medical care.
Table 78. Whether the policy conditions are defective (Why would a productlike this be approved?)
Forgive me for being blunt but I believe that Type A1 products are imperfect products.
For consumers, Type A1 products are definitively a great deal. However, the policy
conditions are defective. This is because the technical fees for advanced medical careare not all borne by patients and because the costs of unapproved drugs and medical
devices are assumed by manufacturers.
For example…
Even if a patient were to receive medical treatment in the form of advanced medicalcare based on the use of an unapproved drug costing 2.5 million yen, there are manycases in which 2 million yen of this amount would be paid by the manufacturer and not
paid by the patient. With Type A1 products, however, policy conditions provide forbenefit payments totaling 2.5 million yen to the insured person (beneficiary).
I believe that this is also problematic for the approval review process.

Table 79. Assumption of the costs of advanced medical care
Pattern 1
Costs not covered by a benefit (costs pertaining to advanced medical care) ≠ paid by
patient on out‐of‐pocket basis
Pattern 2
Costs not covered by a benefit (costs pertaining to advanced medical care) = paid by
patient on out‐of‐pocket basis(ii) Evaluation
While you would receive overlapping benefits if you were already enrolled
in a policy providing advanced medical care coverage as offered by anothercompany, there are also cases in which archaic advanced medical care riders
exist, such that you might want to recommend advanced medical care benefit
payments that have been added to a cancer insurance policy if the client wishes
to choose a new option for covering actual losses.
(ii-i) Which is better: coverage of actual losses or another type of product?
Compared products all covered actual losses. The issue is that acomparative explanation as to whether a product pays for technical fees
Chapter 4 153

or pays actual costs included in technical fees is required.
(ii-ii) Advanced medical care benefit under a medical insurance policy oradvanced medical care benefit under a cancer insurance policy
If we have to think in terms of an adverse selection, we will need totake into account the existence of a ninety-day waiting period. However,
it is important that you properly explain this part, since this is a point thatdiffers from an advanced medical care rider that can be added to a medical
insurance policy as outlined in Table 78 (page 153).
(ii-iii) Which is better: whole-life coverage or fixed-term coverage?
While whole-life coverage is advantageous in that premiums can beprojected, coverage is often added through riders, which means that you
must think about coverage as it relates to the base policy. It is probably
difficult to compare whole-life coverage with fixed-term coverage withjust the advanced medical care benefit.
(ii-iv) Aggregate limit
While differences in terms of aggregate limit can be seen, I have neverheard of a case in which the insurance company itself provides a clear
explanation as to whether the assumption of costs exceeding ten million
yen is necessary in order to receive advanced medical care. As the authorof this book, I believe that it would be acceptable to not treat this point as
an important one for evaluation purposes.
(ii-v) Additional benefits (condolence money and transportation expense aid)
Since advanced medical care required by a patient is sometimes
unavailable at a nearby hospital, transportation and accommodation costs
are incurred in some cases. Since these do not constitute absolutely
necessary benefit payment options, their selection depends simply on thepreference of each consumer. I do not believe that such benefit payment
options are important enough to be considered a point for comparing andrecommending products.
(iii) Rule to remember
Unlike other benefit payments, the advanced medical care benefit is subject
to a one-policy-per-company sales rule. While cancer insurance is cheap if you
compare advanced medical care coverage added to cancer insurance withmedical insurance or other products, coverage is limited to advanced medicalcare for cancer only (Table 80).

154

Table 80. Comparing medical insurance with cancer insurance in terms ofadvanced medical care benefit payments given the rule that only one policy
can be taken out with a given company
Waiting
periodApplicable toInsurance premiums

Advanced medical care benefit
payments provided by cancer
insurance policies

Cancer only

90 days(3 months)

Low

Medical insurance and otherpolicies providing advanced
medical care benefit payments

Also applies tonon‐cancer
diseases andillnesses

None

While higher than for advanced
medical care covered by cancer
insurance, premiums would bearound 200 yen per month.

Company name
(Product name)Sony Life Insurance(Cancer Insurance)
Himawari Life Insurance(Yuuki no Omamori Cancer
Insurance)
Prudential Life Insurance(Cancer Diagnosis Insurance,
Cancer Hospitalization Rider)
ORIX Life Insurance(Believe Cancer Insurance)
AXA Life Insurance(Cancer Treatment Insurance)
Anshin Life Insurance(NEO Cancer Treatment
Support Insurance)
AIG Fuji Life Insurance(Best Gold Alpha)

Whether the benefit isprovided; coverage
periodRider; Type A1, Type 1

90‐day waiting period; up to 10 million yen in
total

Rider; Type A1, whole‐life

90‐day waiting period; up to 10 million yen in
total

Rider; Type A2
Rider; Type A1, whole‐life
Rider; Type A2, fixed‐term
Rider; Type A1; whole‐
life; fixed‐term
Rider; Type A1; whole‐life

Aioi Life Insurance(New Cancer Insurance Alpha)

Rider; Type A2

Manulife Life Insurance(Kodawari Cancer Insurance)

Rider; Type A1; fixed‐term(renew every 10 years; up
to 90 years of age)

AXA Direct Life Insurance(Whole‐Life Cancer)
MetLife Insurance(Guard X)

Scope of benefit and other points

Rider; Type A2; fixed‐term(renew every 10 years; up
to 80 years of age)
Rider; Type A1; fixed‐term(renew every 10 years; noupper age limit)

Aflac(Days Cancer Insurance)

Rider; Type A2; fixed‐term(renew every 10 years)

Zurich Life Insurance(Whole‐Life Cancer Treatment
Insurance)

Rider; Type A1; whole‐life

Up to 10 million yen in total (general‐purpose
rider; unknown whether it can be added tocancer insurance)
90‐day waiting period; up to 20 million yen in
total
Up to 10 million yen per time; up to 20 million
yen in total; lump‐sum payment for advanced
medical care available
90‐day waiting period; up to 20 million yen intotal
90‐day waiting period; up to 20 million yen intotal
90‐day waiting period; benefit of up to 20
million yen for transportation andaccommodation costs in total available
90‐day waiting period; up to 20 million yen in
total
Condolatory benefit payments available (50,000
yen per time)
90‐day waiting period; up to 5 million yen intotal
90‐day waiting period; up to 20 million yen in
total; assistance benefit payment available up to
20% of technical fees
3‐month waiting period; up to 20 million yen in
total
Lump‐sum payment for advanced medical careavailable (up to once per year)
Up to 20 million yen in total
Advanced medical care assistance benefit
payment (150,000 yen)

※A1: Benefit for costs pertaining to advanced medical care; A2: benefit for costs pertaining to advanced medical care where such costs
are assumed by the patient

Chapter 4 155❖ Hospital visit coverage
The length of hospitalization is shortening. In addition to advancements inmedical technology, this is due to the impact of policy inducements designed toincrease medical service fees earned by medical institutions whenever treatment
can be completed with shorter-term hospitalizations. As shown in Table 81,
hospital visit coverage will become increasingly important if we take the medicalcare environment of the future into account. However, a reassessment of
payments previously conducted by the insurance industry revealed that hospital
visit benefit payments were often not made or claimed. Some companies thatused to provide coverage in the form of hospital visit benefits no longer offeredthis coverage. In addition, some companies revised the contents of their products
to provide a benefit in the form of a lump-sum fixed payment amount at the timeof discharge as a way to nominally cover hospital visits or provide a benefit for
post-discharge medical treatment.
Since premiums are affordable and mark-up percentages are high with
benefit payments that are linked to the actual number of days an insured person
visits the hospital, it would be worth it for a consumer taking out a new cancer
insurance policy to look into obtaining this coverage.
(i) Comparative points
The framework of this benefit is essentially the daily benefit amount that istied to the day of a visit to the hospital.
◇ Whether or not house visits are included◇ Benefit types(i-i) Daily amount type or fixed-amount benefit on discharge (Table 82)
Type 1 provides a daily benefit amount linked to medical actions
performed during a hospital visit
Type 2 provides a lump-sum benefit payment as a way to nominallyprovide a hospital visit benefit at the time of discharge(i-ii) Admission-linked benefit (page 155)
Type A1 provides coverage that is limited to the post-discharge period
Type A2 covers even hospital visits made prior to hospitalization
Type B covers hospital visits for the purpose of receiving treatment even
without hospitalization

156

Table 81. Reasons why you might need to have your hospital visits covered● The length of hospitalization is shortening due to the impact of the healthcare system(medical service fees).
● You might not necessarily be discharged because you have been completely cured.
(There are also national statistics on this point.)
According to DPC hospital statistics, more than 20% of patients cannot bedischarged in a healed or improved state (data inclusive of all diseases andillnesses: results of a survey on discharged patients pertaining to an assessment of
the impact of DPC adoption in fiscal year 2014).
● There is a shortage of hospitals that provide post‐discharge cancer rehabilitation
services.
● While there are no clear data tracking the shift in treatment from hospitalization toout‐patient services, we can see that testing performed before and after treatment hascome to be carried out on an outpatient basis. (There are also national statistics on thispoint.)● In the future, we will consider expanding the statutory burden (such as in terms of
insurance exemptions and the assumption of a fixed amount at the time of each visit).
● Anticancer drugs are administered to a majority of patients on an outpatient basis(study conducted by the Ministry of Health and Welfare).

Table 82. Benefit types
Type 1
Type 2Type 1+2
No hospital visit
coverage

Himawari Life Insurance, Anshin Life Insurance, Aioi Life Insurance,
Manulife Life Insurance, MetLife Insurance, Aflac
Sony Life Insurance, AXA Direct
ORIX Life Insurance
Prudential, AXA Life Insurance, Fuji Life Insurance(ii) Evaluation(ii-i) Whether there is a benefit and the benefit types
There are many benefit types (A1, A2) covering hospitalization-linked
outpatient-based hospital visits. While the burden of benefit
administration will increase, Type A2 or Type B, which covers hospital
visits after a cancer diagnosis is confirmed even if the insured person is
not hospitalized, is in line with the actual situation surrounding cancer
treatment.
While there are differences in the maximum number of aggregate
benefit days, they are not sufficient to become a standard forrecommending products. Rather than focusing on just the coverage
provided by the hospital visit benefit, it might be good to determine thenecessity of this coverage in relation to other types of coverage. (For
Chapter 4 157

example, with anticancer drug coverage added, outpatient-based hospital
visits are covered as part of the coverage provided by a given policy.)
Since various statutory burdens are expected to expand in the future, itwill be necessary to reinforce coverage provided with the hospital visit
benefit.
(ii-ii) Whether there is a lump-sum payment to be paid on discharge
There are products that, in lieu of a hospital visit benefit, add coveragethat provides for the payment of a fixed lump-sum amount if the insured
person survives and is discharged after he or she has been admitted to thehospital under certain conditions. While post-discharge medical treatment
as a term does not explicitly include hospital visits, post-discharge
coverage in the form of a fixed benefit amount deliberately comparable
to hospital visit benefit payments is provided. Naturally, theadministration of benefits by an insurance company is easier than it iswith daily benefit amounts provided in line with hospital visit dates.
When making comparisons with the hospital visit benefit, you will needto compare in a way that includes conditions applicable to lump-sum
benefit payments made at the time of discharge.
Both hospital visit benefit payments and lump-sum amounts at thetime of discharge are provided by products offered by ORIX Life
Insurance. It is believed that companies that do not offer a hospital visit
benefit instead offer a lump-sum benefit amount at the time of discharge
as a way of raising the appeal of their products.
(ii-iii) Overlapping other coverage
AXA Life Insurance in effect provides coverage in terms of hospital
visit benefit payments with other benefit payments (including benefit
payments for surgical operations, radiation, and chemotherapy) eventhough it does not provide coverage that the company refers to as hospital
visit benefit payments.
Verify the adequacy of substantial coverage in totality with respect tosuch coverage and the coverage provided through the hospital visit benefit.

158Company name
(Product name)Sony Life Insurance(Cancer Insurance)

Hospital visit benefit
payment type; scope of
benefit
None (post‐discharge
medical treatment benefit
payments available)

Himawari Life Insurance(Yuuki no Omamori Cancer
Insurance)

Base policy; Type B

Prudential Life Insurance(Cancer Diagnosis
Insurance)

None

ORIX Life Insurance(Believe Cancer Insurance)

Rider; Types A1, B

AXA Life Insurance(Cancer Treatment
Insurance)
Anshin Life Insurance(NEO Cancer Treatment
Support Insurance)
AIG Fuji Life Insurance(Best Gold Alpha)Conditions and other points

1 year after applicable date ofdiagnosis benefit payment; 120 days;
extended for 1 year in accordance withcertain conditions

A1: 1 year after discharge; up to 60
days within period
B:

None (hospital visits forpalliative medical
treatment covered)
Rider; Type A2

Up to 45 days within 60 days prior tohospitalization and 180 days after
discharge; maximum 730 days in total

None

Aioi Life Insurance(New Cancer Insurance
Alpha)

Rider; Type B (at‐homecare rider available)

5 years after confirmation of diagnosis;
no maximum number of days
There are provisions for providing thebenefit even after 5 years have passed
if certain conditions are met.

Manulife Life Insurance(Kodawari Cancer
Insurance)

Rider; Type A1

Up to 60 days within 365 days after
discharge

AXA Direct Life Insurance(Whole‐Life Cancer)

None (post‐discharge
medical treatment rider
available)

MetLife Insurance(Guard X)

Base policy; Type B

Hospital visits after the confirmation ofdiagnosis; up to 60 days per year
A1: 365 days after discharge; noAflacmaximum number of days
Base policy; Types A1, B(Days Cancer Insurance)
B: No period limitation; no aggregate
limitation
Zurich Life Insurance
Up to 120 days within 60 days prior to(Whole‐Life Cancer
Rider; Type A2
hospitalization and 365 days after
Treatment Insurance)
discharge* A1: Hospital visits subsequent to being discharged after being hospitalized for treatment; A2: hospital
visits prior to being hospitalized for treatment and subsequent to being discharged; B: hospital visits
for treatment* All companies that provide a hospital visit benefit include house calls in the scope of hospital visits.

Chapter 4 159

❖ At-home care and post-discharge medical treatment
The number of days of hospitalization is statistically declining, a fact that
may account for the existence of people whose acute-stage treatment has been
completed but who have no choice but to be discharged even though they are not
yet healed or otherwise better (see Table 81 of “Hospital visit coverage” on page157). Such patients will likely receive at-home care as part of a comprehensive
system of community-based care.
The current benefit types are types through which benefit payments are paid
as a way to nominally cover at-home care and post-discharge medical treatment
received by an insured person after he or she is discharged for surviving after
hospitalization, in accordance with certain conditions predicated on theoccurrence of an insured event corresponding to a cancer hospitalization benefit
payment. In some cases, the benefit will overlap hospital visit benefit paymentsor, conversely, a benefit payment will be provided in lieu of a hospital visit
benefit payment because payment administration is easier for a lump-sum
payment at the time of discharge than it is for the hospital visit benefit (see thehospital visit coverage section on page 156).
(i) Comparative points
While there are no points that especially need to be compared, the length of
the hospitalization period up to discharge, which is a condition for an insured
event, is one that I will mention if one must be stated here.
(ii)Evaluation
With respect to benefit payment options being sold these days, it should be
noted that hospitalization and discharge upon survival are requirements for an
insured event and that the products in question are not products linked to a stateof home care (some pain-relief benefit options are sold), which means that thereason for the existence of such products can be perceived only in terms of suchproducts as an alternative to the hospital visit benefit or as an additional feature.
The provision of proper benefit payments for at-home care for cancer should beseen as something that will now get underway rather than as a work in progress.
We should expect to see an at-home care environment developed in the future
through the promotion of a comprehensive system of community-based care. At
this stage, I get the sense that there is no need to discuss the pros and cons of160such benefit payments or make comparisons and recommendations concerning
such benefit payments.
Company name
(Product name)Sony Life Insurance(Cancer Insurance)
Himawari Life Insurance(Yuuki no Omamori Cancer
Insurance)
Prudential Life Insurance(Cancer Insurance for
Business Clients)
ORIX Life Insurance(Believe Cancer Insurance)
AXA Life Insurance(Cancer Treatment
Insurance)
Anshin Life Insurance(NEO Cancer Treatment
Support Insurance)
AIG Fuji Life Insurance(Best Gold Alpha)

Whether there is alump‐sum payment at
the time of discharge
Base policy; post‐
discharge medical
treatment benefit
payments

When the insured person is discharged
after a reason for paying a cancer
hospitalization benefit payment applies

None

None
Base policy; lump‐sum
payment at the timeof cancer discharge

Upon discharge after hospitalization for
10 or more days

None

None
None

Aioi Life Insurance(New Cancer Insurance
Alpha)

Rider; benefit
payments for at‐homecareManulife Life Insurance(Kodawari Cancer Insurance)

None

AXA Direct Life Insurance(Whole‐Life Cancer)

Rider; payment forpost‐discharge
medical treatment ofcancer

MetLife Insurance(Guard X)
Aflac(Days Cancer Insurance)
Zurich Life Insurance(Whole‐Life Cancer
Treatment Insurance)

Other points

When the insured person survives and isdischarged after a hospitalization of 20
or more days after a reason for paying acancer hospitalization benefit payment
applies
Cancer palliative medical treatment
rider available
When the insured person is discharged
after a reason for paying a cancer
hospitalization benefit payment applies

None
None
None

Chapter 4 161

❖ Coverage according to progression
These days, products that pay substantial amounts of benefit payments formalignant neoplasms that give rise to especially severe medical conditions arebeing developed. Constituting a system for indicating the progression of amalignant neoplasm, the TNM classification system produced by the UICC
(page 61-62) is being used as a standard for solid cancers.
Since data possessed by the Ministry of Health, Labour and Welfare also
reveal that medical treatment costs incurred by patients rise with the degree ofprogression (Table 83), the concept of providing generous coverage to those
whose cancer is progressively worsening is not wrong.
Nevertheless, problems with severity coverage by stage are as outlined in (iii) to (ii-iv) below.
(ii-i) Difference between cancer disclosure and notice of remaining life
While the rate of cancer disclosure has risen, doctors often refrainfrom notifying patients of the amount of life they have left. Indeed,
aspects of notification with respect to both types of information arecompletely different. It would be problematic to link insurance companyprovided benefits tied to the degree of progression to a notification of theamount of life remaining. A problem equivalent to the problem that apatient without the knowledge of having cancer discovers he/she actually
has cancer through receiving a benefit will emerge.
(ii-ii) Continuity of the severity of cancer
While the severity of an illness is continuous, the degree ofprogression as set forth by the UICC-produced TNM classification
system remains a man-made standard. Classification is not based on thenecessity or quantity of medical resources. Rather, this system is astandard for classifying tumors in such a way that a difference in survival
curves can be recognized if progression has been classified. Thus, theprovision of a tiered graded benefit based on the use of this standard leads
to complaints at a certain level. In addition, it invites after-the-fact moral
hazards, including by way of the imposition of arbitrary pressure on
certifying parties. In particular, huge problems can arise if the differencein tiered benefits is large. There is no denying the possibility that aproblem engulfing the medical community could arise. This differs in afundamental way from the problem of stipulating different benefit
162

payments depending on whether you are dealing with an intraepithelial
neoplasm or a malignant neoplasm.
(ii-iii) Diagnostic standards for classifying progression
Whereas a definitive diagnosis of cancer is made on the basis of ahistopathological finding, there unfortunately exists no objective
diagnostic standard relating to the stage of a disease. Furthermore, there
are no definitions set forth by policy conditions relating to this point.
(ii-iv)Problem of overlapping benefits with severity coverage
One might wonder why medical treatment costs are higher for those
whose condition has progressed, but this is essentially a function of thenumber of days of hospitalization and the cost of medical treatment. Thus,
it is problematic that coverage is weighted in accordance with degree ofprogression and that benefit payments according to treatment type overlap
one another.
Table 83. 2011 survey: Burden on patients by stage of disease affecting the
subjects of drug therapy
Out‐of‐pocket
expenses
Length of
hospitalization
per year
Number of
hospital visits

Stage I

Stage II

Stage III

Stage IV

610,000 yen

683,000 yen

982,000 yen

1,284,000 yen

20.6 days

23.3 days

37.1 days

44.3 days

14.2

18.9

2.4

24.9

Source: Health and Labor Sciences Research Grant research report by research representative Nobuo
Koinuma, March 2012

Fig. 31. Costs by degree of progression

Chapter 4 163

Fig. 32. Overlapping benefits

From the perspective of consumers, such policies will become expensive.
For this reason, an explanation as to why costs other than medical treatment
costs incurred for the direct performance of treatment rise in accordance withthe degree of progression must be given when such products are sold.
Since there are problems as exemplified in (ii-i) through (ii-iv) on page 162163, sales education to enable an explanation of the necessity of severity
coverage to be given while overlapping benefits are avoided is important. The
necessity of generous coverage for any patient dealing with a severe conditionis self-evident.
Currently, policies sold by companies that have adopted a system todetermine whether it is proper to pay benefit payments and that have introduced
graded benefit payment amounts while utilizing the TNM classification system
to select patients dealing with a severe condition consist of Guard X as sold by
MetLife Insurance and Kodawari Cancer Insurance as sold by Manulife Life
Insurance.

164❖ Waiver premium provisions
The ability to pay insurance premiums varies greatly depending on the stateof asset ownership and income. In addition, the significance of exemption
provisions also differs according to insurance product. Even though coveragecan enable recovery from an actual illness or injury, the fact that you may not beable to properly enjoy what insurance is designed to provide as a result of being
rendered incapable of working is a serious matter. Thus, the value of becoming
exempt from paying premiums should be very apparent. While exemption
provisions differ directly from benefit payment provisions corresponding totreatment, they are taken up as important components in any given product. A
number of companies also sell policies that exempt policyholders from having
to pay premiums in the event that they get cancer. This is a product feature thatcomprises a part of the coverage that is uniquely provided by cancer insurance
policies.
With insurance premium payment exemption provisions, the benefit received
is allocated to the payment of insurance premiums after an insured event occurs.
In a manner of speaking, the benefit payment, whose purpose of use is limited,is proportional to the remaining period of insurance premiums owing, whichmeans that the product in question is one with a lump-sum payment the amountof which declines over time. Since such a product would be one with insurance
premiums that are accordingly high, you will ultimately need to compare theadditional coverage offered with the balance of insurance premiums owing.
The option to take advantage of payment-exempted insurance premiums for
low-incidence cases of physical disability, such as states of severe disability thecoverage of which has been added to many insurance products, is provided at
low cost to clients as a matter of course.
Those who are granted an exemption from having to pay insurance premiums
are people with an injury or illness and naturally, people who wish to use various
types of insurance services. However, there is concern over the possibility thatcertain insurance features tied to a policyholder might be severed through theaffairs pertaining to the receipt of insurance premiums. Consequently, there isalso concern over the possibility that various types of claims might fail to be
made. Thus, the state of company-specific initiatives for following up on
policyholders after exemption provisions are exercised will also constitute a
standard for comparing and recommending policies. (Since there is a similar
Chapter 4 165

problem with respect to the coverage period after all premiums have been paid
for a paid-up policy at maturity, this is not a problem that is limited to paymentexemption provisions.)

Company name
(Product name)Sony Life Insurance(Cancer Insurance)
Himawari Life Insurance(Yuuki no Omamori Cancer
Insurance)
Prudential Life Insurance(Cancer Diagnosis Insurance)
ORIX Life Insurance(Believe Cancer Insurance)
AXA Life Insurance(Cancer Treatment Insurance)
Anshin Life Insurance(NEO Cancer Treatment
Support Insurance)
AIG Fuji Life Insurance(Best Gold Alpha)Aioi Life Insurance(New Cancer Insurance Alpha)
Manulife Life Insurance(Kodawari Cancer Insurance)
AXA Direct Life Insurance(Whole‐Life Cancer)
MetLife Insurance(Guard X)
Aflac(Days Cancer Insurance)
Zurich Life Insurance(Whole‐Life Cancer Treatment
Insurance)

Payment
exemption for amalignantneoplasm(malignant
neoplasm P
exemption)

Payment
exemption fora physicaldisability(physical
disability P
exemption)

Yes*

Available

No

Available

No

Available

No

Available

No

Available

Available

Available

Available

Available

No

Available

Available

Available

No

Available

Available

No

No

No

Available

Available

Other*Payment exemption for
the three major diseases(skin cancer is eligible)

With specific disability
exclusion conditions(i) Comparative points◇ Whether there are insurance premium payment exemption provisions
 Whether there are physical disability provisions
 Whether there are exemption provisions based on the confirmation ofa cancer diagnosis
166◇ How each company follows up on each policyholder to whom exemption
provisions apply(ii) Evaluation(ii-i) Whether exemption provisions are necessary
Exemption provisions are provisions that are attractive to patients,
since they no longer have to pay insurance premiums.
Products with provisions that allow for coverage to be obtained
cheaply are recommended.
Companies that do not offer payment exemption provisions need tofollow up on policyholders to ensure that policies do not lapse. Since
policy administration and follow-up arrangements are invisible, however,they are unfortunately not taken into account when evaluating andrecommending products. Nevertheless, gathering information on thispoint is still important for solicitors.
(ii-ii) Whether exemption provisions for malignant neoplasms are necessary
When you get cancer, you will be faced with serious issues in termsof a reduction in income, a loss of employment, or otherwise adiminishment in earning power. Since it is difficult to continue paying
insurance premiums while you are battling cancer, a patient will surely
benefit from being exempt from having to pay insurance premiums uponreceiving a definitive diagnosis of a malignant neoplasm. However, thereis the problem of insurance premiums rising in order to obtain thiscoverage. Since this coverage is equivalent to having a lump-sum
payment for diagnosis in excess of a million yen added in connection withthe provision of whole-life coverage, you will need to determine whether
you can recommend certain policies after making sure that this point isclearly understood by the consumer.
In the event of a policy for which insurance premiums are paid forthrough payroll deductions, the way in which an unknown cancer statusis handled is a problem. There have been cases in which a patient came toknow that he or she had cancer when his or her premium deductions
ceased.
Since this is a sensitive matter, the administrative procedures of acompany that provides products should be verified (where the designatedChapter 4 167

proxy claimant submits a confirmation of a cancer diagnosis or request
for a payment exemption or otherwise asks to discuss payroll deductions
due to a problem of uncertainty with respect to a patient’s cancer status).
Of course, a system for following up on a policyholder after he or she
becomes exempt from having to pay insurance premiums and forfollowing up on a policyholder whose policy has been prevented frombecoming invalidated is necessary.

While it might be nice to not have to pay
insurance premiums anymore if I were to getcancer, the problem is by how much will
insurance premiums have to rise for me toobtain this coverage?

168

❖ Incidental services
In-kind services known as policyholder services are provided by insurancecompanies separately from insurance benefits. While there are services that arelimited to specific insurance policies and services that are not, such services arehighly varied and include everything from zoo admission discount coupons todiscount services for finding doctors who can conduct thorough medical checkups.
As shown in Table 86, incidental services differ from insurance benefits.
Since they also constitute product extras as set forth in the statute known as the
Act Against Unjustifiable Premiums and Misleading Presentations, high-costservices cannot be provided.
If we limit our focus to cancer insurance, we see that incidental services
currently being provided include “the provision of various types of informationon the medical treatment of cancer,” “the referral of a doctor who can provide acancer-related second opinion,” and “cancer screening service.” Among suchservices, consultation services relating to the medical treatment of cancer andservices that can refer policyholders to doctors capable of providing a second
opinion are utilized to a considerable degree.
However, companies that provide such services are limited in number, andthere is a sense that, even though insurance companies differ, the fact that thecompanies to whom incidental services are outsourced are all the same does notaffect the standard for comparing and recommending policies. Nevertheless,consultation services with counseling functions provided for cancer patients by
Houken Corp. have been assessed by various parties, including by way of areport on business contents and business track records issued by the Japan
Psycho-Oncology Society*6.
Some customers believe that such incidental services are equivalent toinsurance benefits. Even though we are talking about incidental services,management of the quality of such services is still important. While a company
will provide incidental services because a failure to do so will cause it to becompared unfavorably with other companies, the substantial utilization of suchservices by clients will result in mounting costs. For this reason, some companies
6

Some companies provide incidental services that allow clients seeking psychological counselingservices or a second opinion to interview a doctor.
Chapter 4 169

only engage in efforts in this area in a passive manner. This is just a personal
impression on my part, but a look at the official websites of different companies
reveals that some companies appear to deliberately obfuscate the way in which
their incidental services are described.
Table 86. Comparing insurance benefits and incidental services
Insurance benefits
Cost burden

Insurance premiums

Service type
Upper limit
Supervisory authority

Cash
Policy provisions
Financial Services Agency

Relevant statutes

Insurance Act, Insurance
Business Act, others

Incidental services
Business expenses incurredby the insurance company
In‐kind
Within statutory scope
Consumer Affairs Agency
Act Against Unjustifiable
Premiums and Misleading
Presentations

What kind of treatment isideal?
I don’t really want toundergo a surgical operation
With whom might I
be able to talk about
this matter?

This is the ○○ Insurance
Company calling.
We offer an excellent packageof incidental services!

170❖ Summary
There are various aspects of the medical treatment of cancer for eachindividual, and the risks vary from one person to the next. Thus, a wide range of
products will surely continue to be developed. While this book deviates from an
examination of specific product specifications, some companies have alreadybegun to provide services in terms of cancer coverage by site, coverage of
supportive therapies positioned around the provision of anticancer drug coverage,
and more.
I expect to see various products continue to be developed in the future,including the following: Products that are focused on prevention;
 Products that are focused on providing more finely-textured services forthe provision of treatment coverage;
 Products that are focused on societal reintegration and disability
coverage; and Products that are focused on functions that supplement the social
insurance system.
In any case, the following points are important: That basic coverage is properly provided; That the product is easy to understand; That the policy condition setting forth the benefit conditions are clear,to prevent payment problems from occurring; That the product has been designed on the assumption that there will beadvancements in medicine; That sales education (including education with respect to medicine,
nursing care, and social insurance) is substantial;
 That, since fixed-rate products always give rise to coverage that is either
excessive or lacking, attention needs to be paid to the easy growth ofaggregation undertaken to offset shortfalls.
You should personally check out products to be recommended without
making determinations only on the basis of an insurance company’s
explanations and product overview.
Important points:
 Make sure to confirm product points with the policy conditions
Chapter 4 171

(unfavorable information and favorable information should be includedin the policy conditions); Be careful about any claims to be Japan’s first… or Ranked number one
for…;
 Do not treat a given point as a point of recommendation if the superiorityof the aggregation standard cannot be medically explained; Consider whether you can confidently describe the product as one thatthe client really needs.

I’ve figured out what’s
important!
I’ll personally verify the points
to be recommended.

172

IV. Evaluating products that exclusively provide cancer coverage
according to insurance company❖ Basic coverage and evaluations
This book was not written to rank the products of different companies. It
contains standards-based information to highlight the advantages of cancer
insurance for customers and to help readers figure out which points should betaken into account when evaluating products.
Allow me to diagrammatically illustrate coverage that I believe is useful inthis book. Since the risks that should be underwritten by insurance change withthe times, however, the contents of this book will invariably need to be updatedwith the passage of time.
Basic coverage features(i) Lump-sum payment coverage
Coverage of malignant neoplasms
Lump‐sum payment for the confirmation of a diagnosis (lump‐sum
payment upon the commencement of treatment after a diagnosis ofcancer is confirmed)
1 million to 2 million yen according to research data provided by the
Ministry of Health, Labour and Welfare
Definition of malignant
neoplasm:

Requirements for theconfirmation of a diagnosis:

ICD-10 and ICD-O are utilized; if possible,
provisions governing handling in the eventthat a new classification system is enacted
should be substantial.
The finding of a pathological examination
should be prioritized; biopsy handling isclear.

(ii) Hospitalization coverage
Coverage of malignant neoplasms
Hospitalization coverage (coverage without any aggregate limits)
The relationship between the benefit and hospitalization for other illnesses or
Chapter 4 173

injuries is clear, easy to understand, and expressly set forth in supplementaryrules stipulated in the policy conditions.
(iii) Coverage of the three major treatment options (surgical operations, radiation,
and anticancer drug treatment)
Coverage of malignant neoplasms
Coverage of the three major treatment options
Surgical operations:Radiation:

Anticancer drugs:

In the case of not a public insurance-linked benefit but
a limited enumeration system, radical surgeries andother forms of surgical operations will need to be
explained.
Coverage is independent (encompassed inconventional policy conditions governing surgicaloperations).
Standards indicating the scope of the benefit are clear;drugs granted pharmaceutical approval are also
eligible; whether there is a benefit for hormone-based
drugs is clear; policies offering a broader scope of thebenefit are better. What would be best is a policy thatcombines both the WHO standards and the domestic
standards, though no such policy has been adopted yet
by a company in the industry.

(iv) Advanced medical care
Advanced medical care
Basic coverage should consist of the coverage of actual losses. A benefit equal
to the actual amount paid by the insured person on an out-of-pocket basis is
more appropriate than a benefit equal to the technical fee associated withadvanced medical care.
(v) Coverage of long-term medical treatment
Coverage consisting of multiple lump‐sum payments
Payment conditions are easy to understand; coverage is not medicallycomplicated and essentially encompasses the coverage of severe or advanced174cancers.
(vi) Exemption from having to pay personal injury insurance premiums
Exemption from having to pay personal injury insurance premiums
Even with the addition of exemption provisions, the added value is high forpolicyholders if the impact on insurance premiums is small, in which case theprovision of coverage makes sense.
Incidental coverage functions(vii) Hospital visit coverage
Hospital visit coverage for malignant neoplasms
This type of coverage should be enhanced in the future, since the length of
hospitalization in terms of the number of days will decrease and various typesof statutory burdens will increase.
(viii) Exemption from having to pay malignant neoplasm insurance premiums
Exemption from having to pay malignant neoplasm insurance premiums
While this type of coverage is nice if it is available, it is equivalent to coverage
added to a lump-sum payment for a diagnosis (diminishing lump-sum
payment benefit for a diagnosis of cancer), which means that striking abalance with insurance premiums is important.
(ix) Coverage of intraepithelial neoplasms
Coverage of intraepithelial neoplasms (hospitalization, hospital visits,
surgical operations)This is coverage that has been decoupled from malignant neoplasms to theextent that it does not become excessive.
There are no invalidation provisions for intraepithelial neoplasms (sufficient
if benefits for hospitalization, hospital visits, and surgical operations havebeen added).

Chapter 4 175

❖ Sony Life Insurance(Whole-Life Cancer Insurance) (08) (no dividends)

BasepolicyRidersCancer diagnosis benefit payment (Type A daily amount x 100;
Type B daily amount x 0); once only
Cancer hospitalization benefit payments
Waiting
Cancer surgical operation benefit payments (4 types of limited
periodenumeration; including radiation therapy)
Post‐discharge medical treatment benefit payments
Cancer death benefit payment
Death benefit payment (death for a reason other than cancer)
Anticancer drugs
Waiting
Benefit payment rider for the diagnosis of a specific disease
period(cancer) *Only Type B can be added
Benefit payment rider for the diagnosis of a specific disease (stroke, acute
myocardial infarction) *Only Type B can be added
Waiting
Advanced medical care rider (cancer)
periodAdvanced medical care rider (non‐cancer)
Waiting Insurance premium payment exemption rider (cancer; excludes
periodcarcinoma in situ and skin cancer)
Insurance premium payment exemption rider (stroke, acute myocardial
infarction)
Insurance premium payment exemption rider (physical disability)*Whole-life coverage is provided under the base policy.

Basic coverage
When it comes to basic coverage, enhanced coverage is provided by combining a basepolicy and riders. Provisions to exempt the policyholder from paying insurance premiums
have been enhanced.

Other coverage
Advanced medical care is characterized by the inclusion of advanced medical care forconditions other than cancer.

176

Clarity for consumers(Is it easy for consumers to understand product composition, product labels,
and added coverage functions?)
While the product has been basically designed to be easy to understand, it may be difficult
to understand the fact that radiation therapy is included in the scope of benefit payments
for surgical operations. On the other hand, this is a product that is easy to understand,since multiple payments of diagnosis benefit payments are not provided.

Policy conditions with respect to the definition of cancer and the confirmationof a diagnosis
The way in which terms relating to malignant neoplasms are used in the appendix needs
to be improved.
Conditions for confirming a diagnosis need to be investigated.

Policy conditions with respect to matters not concerning definitions

GeneralThe policy is easy to understand and its basic framework is solid. It can likely be improved
if it were to offer multiple payments of the diagnosis benefit payment or instead, somekind of coverage to persons receiving long‐term medical treatment.

Chapter 4 177

❖ Himawari Life Insurance(Yuuki no Omamori Cancer Insurance (2010) Type B II)

Base policy

RidersCancer diagnosis benefit payments (multiple times after thepassage of 2 years)
Cancer hospitalization benefit payments
Cancer surgical operation benefit payments (5 types of limited
Waiting enumeration; including radiation therapy)
periodCancer outpatient treatment benefit payments (outpatient
treatment accompanying measures taken by doctors during theoutpatient treatment period; up to 120 days during the 1‐year
outpatient treatment period after payment of the diagnosis
benefit payment; extended 1 year later)
Death benefit payment (death for a reason other than cancer); can be
added if the policy is a fixed‐term typePhysical disability P exemption*
Waiting Cancer death rider; living needs rider is available
periodAdvanced medical care rider (cancer)

Whole-life type and fixed-term type (renewed up to 90 years of age)
* A P exemption exempts the policyholder from having to pay insurance premiums for a life insurance
policy if the insured person is in heavy need of long-term nursing care or if certain conditions areotherwise satisfied.

Basic coverage
The product is clean, with a base policy boasting a solid framework. Coverage of the threemajor treatment options will likely need to be improved in the future.

Other coverage

Clarity for consumers
With few riders, the product is centered around its base policy and is easy to understand.

Policy conditions with respect to the definition of cancer and the confirmationof a diagnosis
The way in which terms relating to malignant neoplasms are used in the appendix needs
to be improved.
178

Policy conditions with respect to matters not concerning definitions
With measures taken by doctors and other requirements concerning outpatient
treatment included in the policy conditions, there is concern over the possibility that aninterpretation of the policy conditions could become a problem when conducting
payment reviews.

GeneralWhile some believe that the diagnosis benefit payments cover everything, a better
product in terms of the coverage of cancer treatment costs could be developed byseparately adding coverage of the three major treatment options.

Chapter 4 179

❖ Prudential Life Insurance(Cancer Insurance (Business Insurance); without dividends)

Base policy

RidersCancer death/severe disability insurance money
Cancer hospitalization benefit payments; at‐home hospice caretreated as deemed hospitalization
Waiting Cancer surgical operation benefit payments (4 types of limited
periodenumeration; including radiation therapy)
Cancer treatment benefit payments* (daily amount x 100);
multiple times after the passage of 2 years from the date on
which the preceding hospitalization commenced
Death benefit payment (death for a reason other than cancer); can be
added if the policy is a fixed‐term typePhysical disability P exemption (reason other than cancer)
Waiting Cancer death rider; living needs rider is available
periodAdvanced medical care rider (cancer)

Whole-life coverage is provided under the base policy.
*Insured event for cancer treatment benefit payments: When hospitalization for the direct purpose oftreating definitively diagnosed cancer commences.

Basic coverage
The base policy is solid in terms of its basic framework.
While the functions for the provision of basic coverage are not yet sufficient, it may be
simply the case that coverage has not been augmented, since the product is one that is
exclusively geared towards the provision of business insurance.

Other coverage
This product is notable for treating at‐home hospice care as deemed hospitalization.

Clarity for consumers(Is it easy for consumers to understand product composition, product labels,
and added coverage functions?)
The fact that one type of radiation therapy is included in the scope of benefit payments
for surgical operations may be difficult for consumers to understand.
Since benefit payments for surgical operations other than benefit payments for treatment
are included in the base policy, the contents of coverage cannot be discerned just bylooking at the labels accorded to the product. As for benefit payments for treatment, a(first‐time) lump‐sum payment at the time of hospitalization for treatment would beappropriate.

180Policy conditions (1): Definition of cancer and the confirmation of a diagnosis
Histopathological findings are not prioritized in connection with the confirmation of acancer diagnosis.
The way in which terms relating to malignant neoplasms are used in the appendix needs
to be improved.

Policy conditions (2): Other matters
The relationship between hospitalization for other illnesses or injuries and cancer
hospitalization benefit payments is encoded in supplementary rules more clearly than by
any other company in the industry.

GeneralWhile the three major treatment options may be covered by treatment benefit payments,
outpatient‐based chemotherapy and chemotherapy administered orally during hospital
visits have also become expensive. Coverage of anticancer drug costs will likely become
necessary. This point might be inevitable in the context of business insurance.

Chapter 4 181

❖ ORIX Life Insurance(Believe Cancer Insurance)

Base policy

RidersCancer first‐time diagnosis lump‐sum payment
Cancer hospitalization benefit payments
Cancer surgical operation benefit payments (5 types of limited
Waiting
enumeration; including radiation therapy)
periodCancer discharge lump‐sum payment
Cancer treatment benefit payments* (daily amount x 50);
multiple times after the passage of 2 years
Physical disability P exemption
Cancer hospital visit rider (prescribed hospital visits for the
Waiting purpose of receiving treatment; up to 60 days within 1 year
after discharge)
periodCancer advanced medical care rider (cancer)

Whole-life coverage is provided under the base policy.
*Insured event for cancer treatment benefit payments: When hospitalization for the purpose of treating
definitivly diagnosed cancer commences.

Basic coverage
The base policy is solid in terms of its basic framework.
The functions for the provision of basic coverage are not yet sufficient.

Other coverage

Clarity for consumers(Is it easy to understand the product structure, product title, and added security
function?)
While the composition of the product is easy to understand, the fact that radiation
therapy is included in the benefit payments for surgical operations is difficult to grasp.
Since benefit payments for surgical operations other than the benefit payments fortreatment are included in the base policy, the contents of coverage cannot be discerned
at a mere glance of the product labels. As for the label accorded to benefit payments fortreatment, a (first time) lump‐sum payment at the time of hospitalization for treatment
would be appropriate.

182

Policy conditions with respect to the definition of cancer and the confirmationof a diagnosis
The way in which terms relating to malignant neoplasms are used in the appendix
attached to the policy conditions needs to be improved.

Policy conditions with respect to matters not concerning definitions
Radical surgical operations, as a term relating to the benefit for surgical operations andfor which payment problems could easily occur, is properly explained.

GeneralSince the coverage of anticancer drugs is limited to cases in which parenteral anticancer
drug treatment is received on an outpatient basis, it would be good to further enhance
this coverage.
If creative thinking could be applied to the benefit payments for surgical operations suchthat radiation therapy would instead be covered under a different label, the productwould be easier to understand.

Chapter 4 183

❖ AXA Life Insurance(Cancer Treatment Insurance (non-refundable cancellation type))

Base policy

RidersCancer surgical operation benefit payments
Cancer specific surgical operation support benefit payments
Cancer radiation treatment benefit payments
Waiting
Chemotherapy benefit payments (linked to public insurance)
periodPalliative medical treatment benefit payments (hospitalization
with additional costs for cancer pain treatment or palliativecare)
Physical disability P exemption
Cancer hospitalization rider
Surgical operation benefit payments in an intraepithelial
neoplasm treatment benefit rider
Radiation therapy benefit payments in an intraepithelial
Waiting
neoplasm treatment benefit rider
periodAdvanced medical care benefit payments in a cancer advanced
medical care rider (for costs assumed by the patient)
Lump‐sum payments for advanced medical care in a cancer
advanced medical care rider

Whole-life coverage is provided under the base policy.

Basic coverage
Basic coverage consists of Type 3 coverage as explained on the base policy page. Even
when we expand our focus to include the riders, we see that the specifications of thepolicy are designed to provide pure coverage of treatment. The product is composed insuch a way that those who have obtained lump‐sum payment coverage by taking out
cancer insurance policies with other companies or who have taken out an insurance policy
covering the three major diseases or a medical insurance policy will be compensated forany inadequate coverage of treatment costs. In this sense, the policy of the company isclear. Lump‐sum payments associated with a high degree of freedom are omitted fromthe scope of basic coverage.

Other coverage
The fact that coverage of supportive therapy referred to in terms of palliative medical
treatment has been added can be treated as a point of recommendation.
The fact that there are no invalidation provisions tied to intraepithelial neoplasms canalso be treated as a point of recommendation.
The reasons for selecting surgical operations eligible for support benefit payments for
specific surgical operations are not clear.

184

Clarity for consumers(Is it easy for consumers to understand product composition, product labels,
and added coverage functions?)
The contents of what is being covered are easy to understand, as also reflected in thelabels accorded to different benefits.
Product composition is distinctive.

Policy conditions with respect to the definition of cancer and the confirmationof a diagnosis
There are no problems with the definitions of malignant neoplasm, intraepithelial
neoplasm, or cancer or with the way in which terms are used.

Policy conditions with respect to matters not concerning definitions
There is a sense that the policy conditions were drafted with a deliberate effort to ensurethat no payment problems would be encountered.

GeneralThis is an easy‐to‐understand, well‐thought‐out product. An explanation will need to begiven to ensure that there is no discrepancy between points that are intended by thecompany, such as in terms of the lack of a lump‐sum benefit for a cancer diagnosis andthe distinctive way in which the base policy is constituted, and what consumers might belooking for in a cancer insurance policy. An explanation of risks relating to the selling ofbase policy elements to supplement other products is also pertinent. The fact that nobenefit for hormone‐based drugs as an aspect of chemotherapy is provided needs to beinvestigated, but the product is, generally speaking, one that features inner workings not
visible to the outside that are quite solid and proper.

Chapter 4 185

❖ Anshin Life Insurance(NEO Cancer Treatment Support Insurance; without dividends)(NEO Cancer Treatment Support Insurance; non-refundable
cancellation type)
Benefit payments for a diagnosis; multiple times (first time
only for an intraepithelial neoplasm)
Hospitalization benefit payments
Physical disability P exemption
Waiting Special rules governing the insurance premium payment
periodexemption for malignant neoplasms
Malignant neoplasms first‐time diagnosis rider
Cancer hospital visit rider (between 60 days prior tohospitalization and 180 days after discharge)
Waiting
Cancer surgical operation rider (5 types of limited
periodenumeration; including radiation therapy)
Anticancer drug treatment rider
Cancer advanced medical care rider
Waiting
periodBase policy

RidersWhole-life coverage is provided under the base policy; anticancer drug treatment coverage is provided
for a fixed term of 10 years.

Basic coverage
When it comes to basic coverage, enhanced coverage is provided by combining a basepolicy and riders.
With no insurance premium payment exemption for a physical disability, the product isnotable for the addition of exemption provisions for malignant neoplasms.

Other coverage

Clarity for consumers(Is it easy for consumers to understand product composition, product labels,
and added coverage functions?)
Matters relating to product composition and product labeling are all easy to understand.
However, the fact that one type of radiation therapy is included in the scope of benefit
payments for surgical operations may be difficult for consumers to understand.

186

Policy conditions with respect to the definition of cancer and the confirmationof a diagnosis
There are no problems other than the issue concerning the use of the term cancer as acoined term.

Policy conditions with respect to matters not concerning definitions
Supplementary rules governing multiple payments of diagnosis benefit payments arecomplicated.

GeneralThe contents of coverage have been enhanced. There are likely no problems.
If possible, it would be better if the payment reasons for multiple payments of thediagnosis benefit payments were made easier to understand.

Chapter 4 187

❖ AIG Fuji Life Insurance(Cancer Best Gold Alpha; non-refundable cancellation-type insurance
for the medical treatment of malignant neoplasms (2014); without
dividends)

Base policy

RidersBenefit payments for a diagnosis of a malignant neoplasm
Supplementary rules governing benefit payments for the non‐occurrence of malignant neoplasm events
Death benefit payment
Physical disability P exemption
Intraepithelial neoplasm diagnosis benefit rider
Lump‐sum payment for a first‐time diagnosis of a malignant
neoplasm
Hospitalization benefit payments in a cancer hospitalization andsurgical operation rider
Waiting
Surgical operation benefit payments in a cancer hospitalization
periodand surgical operation rider (5 types of limited enumeration;
including radiation therapy)
Cancer advanced medical care rider
Cancer death coverage rider
Living needs rider (where needs stem from cancer)
Waiting
periodWhole-life coverage is provided under the base policy.

Basic coverage
This is a product for which focus has been placed on lump‐sum payments for a diagnosis.
The addition of radiation and anticancer drug coverage is probably needed in terms ofbasic coverage.

Other coverage

Clarity for consumers(Is it easy for consumers to understand product composition, product labels,
and added coverage functions?)
Matters relating to product composition and the contents of coverage are easy tounderstand. However, the fact that one type of radiation therapy is included in the scopeof benefit payments for surgical operations may be difficult for consumers to understand.

188

Policy conditions with respect to the definition of cancer and the confirmationof a diagnosis
The fact that the term cancer has been removed from the policy conditions for the basepolicy can be treated as a point of recommendation.

Policy conditions with respect to matters not concerning definitions
There are no particular issues.

GeneralThe very thinking behind the composition of a product that provides coverage byintegrating specifications through riders differs from the thinking behind the compositionof a product that provides coverage with lump‐sum payments for a diagnosis; this makes
it hard in this case to compare the product with those offered by other companies. If
lump‐sum payment benefits overlap, solicitors would be required to explain the medical
appropriateness of the amounts in question, such that sales education is important even
where a policy with riders is not being sold. In addition, product composition might need
to be further studied with respect to the coverage of treatment costs expected of cancer
insurance policies by consumers.

Chapter 4 189

❖ Aioi Life Insurance(New Cancer Insurance Alpha; without dividends)

Base policy

RidersCancer hospitalization benefit payments
Cancer surgical operation benefit payments (5 types of limited
enumeration; including radiation therapy)
Death benefit payment
Physical disability P exemption
Cancer diagnosis benefit rider (alpha)
Cancer treatment hospital visit benefit rider
At‐home care benefit rider (alpha)
Cancer death insurance money and insurance money for a
Waiting severe disability due to cancer in a cancer death coverage rider
period(alpha)Death insurance money (death for a reason other than cancer)
in a cancer death coverage rider (alpha)
Cancer advanced medical care rider (alpha) (benefit coveringtransportation and accommodation costs is available)
Waiting
periodWhole-life coverage is provided under the base policy.

Basic coverage
When it comes to basic coverage, enhanced coverage of matters other than anticancer
drugs is provided by combining a base policy and riders.

Other coverage
This product is distinctive for having added short‐term hospitalization coverage to thescope of hospitalization coverage.
Also distinctive is the fact that a benefit covering transportation and accommodation
expenses has been added with a rider for advanced medical care.

Clarity for consumers(Is it easy for consumers to understand product composition, product labels,
and added coverage functions?)
Matters relating to product composition and product labeling are all easy to understand.
However, the fact that one type of radiation therapy is included in the scope of benefit
payments for surgical operations may be difficult for consumers to understand.

190

Policy conditions with respect to the definition of cancer and the confirmationof a diagnosis
There are no problems other than the issue concerning the use of the term cancer as acoined term.

Policy conditions with respect to matters not concerning definitions
The ease with which payment review determinations can be made, such as with respect
to supplementary rules governing hospitalization benefit payments and explanations ofradical surgical operations, has been taken into account.

GeneralThis is an easy‐to‐understand product for which an appropriate balance has been struck.
Basic coverage would not be problematic if coverage of anticancer drugs were improved.

Chapter 4 191

❖ Manulife Life Insurance(Kodawari Cancer Insurance; without dividends; whole-life cancer
insurance that is non-refundable if canceled during the premiumpayment period)

Base policy

RidersCancer diagnosis benefit payments (malignant neoplasm
benefit payments); once every 2 years; multiple times
Cancer diagnosis benefit payment (severe stage; specific
Waiting cancers); once only
periodIntraepithelial neoplasm diagnosis benefit payments; once
every 2 years; multiple times
Cancer surmounting support benefit payments
Physical disability P exemption
Cancer hospitalization rider
Cancer hospital visit rider
Cancer surgical operation and radiation therapy rider (linked to
public insurance)
Anticancer drug treatment rider
Waiting Cancer palliative medical treatment rider
periodAdvanced medical care benefit payments in a cancer advanced
medical care rider
Condolatory benefit payments in a cancer advanced medicalcare rider
Malignant neoplasm insurance premium payment exemption
rider

Whole-life coverage is provided under the base policy; the rider for advanced medical care is effective
for a fixed term of 10 years.

Basic coverage
When it comes to basic coverage, enhanced coverage is provided by combining a basepolicy and riders.
Provisions to exempt the policyholder from paying insurance premiums have beenenhanced.

Other coverage
The product is notable for the fact that coverage of severe‐stage and specific cancers has
been added.

192

Clarity for consumers(Is it easy for consumers to understand product composition, product labels,
and added coverage functions?)
The framework of benefits designed to provide coverage of Stage III and Stage IV cancers
is quite complex.

Policy conditions with respect to the definition of cancer and the confirmationof a diagnosis
Stipulations pertaining to the confirmation of a cancer diagnosis are inconsistently
presented in the base policy and riders. The conditions relating to benefit reasons as set
forth in the base policy state that there needs to be a diagnosis of cancer for the first time
subsequent to the policy coming into effect; two diagnoses are thus required: aconfirmation of a cancer diagnosis and a diagnosis that establishes that the insured
person has gotten cancer for the first time. The event by which the insured person getscancer is neither defined nor subject to any supplementary rules. This sort of diagnosis isbelieved to be medically difficult to obtain. The precise time at which a tumor emerged ina patient is something that a doctor cannot establish or prove.

Policy conditions with respect to matters not concerning definitions
The confirmation of a diagnosis of Stage III or Stage IV cancer is ambiguous. I have theimpression that the policy conditions are problematic in terms of the risk that an after‐the‐fact moral hazard might arise. In addition, there is also a conflation of reasons forbenefits set forth in the riders; “purpose of treatment,” “purpose of treatment,” and“direct purpose of treatment” are all stated.

General
Medical education concerning intraepithelial neoplasms is difficult to provide, and it isexpected that medical education on the degree of progression is difficult to provide.
Various issues can also be discerned, including the following: the degree of progression
does not always match the degree of severity to which necessity is linked; thedetermination of a notification of the degree of progression, which is linked to thenotification of the amount of life remaining, must be made very carefully; and there mustnot be benefits that overlap costs incurred for the treatment of other conditions.
Lacking a definition of the act of getting cancer, the product also calls for medical
operations tied to the act of getting cancer that are difficult to perform.

Chapter 4 193

❖ AXA Direct Life Insurance(cancer insurance, cancer insurance (whole-life))

Base policy

Riders

Waiting Cancer diagnosis benefit payments
periodCancer hospitalization benefit payments
Physical disability P exemption
Cancer surgical operation rider
Waiting
Cancer post‐discharge medical treatment rider
periodCancer advanced medical care rider
Rider providing benefit payments for the non‐occurrence of cancer

Whole-life coverage is provided under the base policy (the rider for advanced medical care is effective
for a fixed term of 10 years).

Basic coverage
As the product can only be purchased online, coverage of core parts is simple and does
not require a complicated payment review process.

Other coverage

Clarity for consumers(Is it easy for consumers to understand product composition, product labels,
and added coverage functions?)
As the product can be purchased only online, the product is exceedingly easy tounderstand and simple.

Policy conditions with respect to the definition of cancer and the confirmationof a diagnosis
There are no problems other than the issue concerning the use of the term cancer as acoined term.

Policy conditions with respect to matters not concerning definitions
There are no particular issues

194General
While coverage of the three major treatment options and of severe or long‐term medical
treatment procedures is less adequate than it is with products provided by othercompanies, the product composition is satisfactory in light of the fact that the product issold on an online basis.

Chapter 4 195

❖ MetLife Insurance(Guard X, a cancer insurance policy ideally suited to the times)

Base policy

Waiting
periodRiders

Waiting
periodMalignant neoplasm treatment benefit payments (public
insurance‐linked surgical operations, radiation therapy, andanticancer drug treatment)(Highest progression degree diagnosis + hospitalization/hospital
visits)Intraepithelial neoplasm treatment benefit payments (public
insurance‐linked surgical operations, radiation therapy, andanticancer drug treatment)
Malignant neoplasm diagnosis benefit payments in a cancer
diagnosis benefit rider
Intraepithelial diagnosis benefit payments in a cancer diagnosis
benefit rider
Cancer hospitalization benefit payments in a cancer
hospitalization benefit rider
Cancer long‐term hospitalization benefit payments in a cancer
hospitalization benefit rider
Cancer hospital visit support benefit rider
Hormone‐based drug treatment benefit rider
Advanced medical care benefit payments in a cancer advanced
medical care rider
Advanced medical care support benefit payments in a cancer
advanced medical care rider
Cancer insurance premium payment exemption rider

Whole-life coverage is provided under the base policy; the rider for advanced medical care is effective
for a fixed term of 10 years.

Basic coverage
When it comes to basic coverage, enhanced coverage is provided by combining a basepolicy and riders.
Basic coverage consists of Type 3 coverage as explained on the base policy page.
Coverage of the three major treatment options is integrated under treatment benefit
payments.
Treatment benefit payments are paid multiple times, with a minimum interval of 1 year
between payments if treatment is undertaken.

196

Other coverage
This product is notable for providing coverage of hospitalization and hospital visits for thehighest progression degree through benefit payments even where treatment is notundertaken.

Clarity for consumers(Is it easy for consumers to understand product composition, product labels,
and added coverage functions?)
Coverage is slightly complicated, since coverage for untreated patients whose condition
is progressing is included in the scope of a benefit labeled as providing treatment benefit
payments.

Policy conditions with respect to the definition of cancer and the confirmationof a diagnosis
There are no problems other than the issue concerning the use of the term cancer as acoined term.

Policy conditions with respect to matters not concerning definitions
There are no particular issues.

General
Medical education concerning intraepithelial neoplasms is difficult to provide, and it isexpected that medical education on the degree of progression is difficult to provide. There
are various issues, including with respect to the fact that the determination of a
notification of the degree of progression, which is linked to the notification of the amountof life remaining, must be made very carefully. It is also possible that the occurrence of an
insured event relating to the degree of progression will be something that cannot berecognized by the beneficiary, policyholder, or insured person in a given case.
An explanation will need to be given to ensure that there is no discrepancy between
points that are intended by the company, such as in terms of the distinctive way in which
the base policy is constituted, and what consumers might be looking for in a cancer
insurance policy. An explanation of risks relating to the selling of base policy elements to
supplement other products is also pertinent.

Chapter 4 197

❖ Aflac(New Days Cancer Insurance for Survival; without dividends; nonrefundable cancellation type or low cancellation refund type 2014)

Base policy

Waiting
periodRiders

Waiting
periodCancer diagnosis benefit payments (1/10 for intraepithelial
neoplasms)
Cancer hospitalization benefit payments
Cancer hospital visit benefit payments
Anticancer drug treatment rider
Surgical operation and radiation therapy rider
Rider providing multiple payments of diagnosis benefit
payments
Cancer advanced medical care benefit payments in an advanced
medical care rider
Cancer advanced medical care lump‐sum payments in anadvanced medical care rider

Whole-life coverage is provided under the base policy (the rider for advanced medical care and rider for
anticancer drug treatment are effective for a fixed term of 10 years).

Basic coverage
The framework of the product is solid.

Other coverage
There are no insurance premium payment exemption provisions.

Clarity for consumers(Is it easy for consumers to understand product composition, product labels,
and added coverage functions?)
The product composition and labeling are simple and easy to understand, and the
addition of coverage functions is also easy to grasp.

Policy conditions with respect to the definition of cancer and the confirmationof a diagnosis
There are no problems. Operations upon the issuance of a new WHO classification system
also constitute a standard that can be applied in a manner more in line with the latest in
medical science.

198

Policy conditions with respect to matters not concerning definitions
While supplementary rules on hospitalization benefit payments are inadequate, there areotherwise no problems.

GeneralWhile the lack of coverage in terms of an insurance premium payment exemption willneed to be investigated in the future, coverage contents and product composition areotherwise fundamentally acceptable.

Chapter 4 199

❖ Zurich Life Insurance(Premium Whole-Life Cancer Treatment Insurance; non-refundable
cancellation-type cancer treatment insurance)

Base policy

RidersRadiation therapy benefit payments
Anticancer drug and hormone‐based drug treatment benefit
payments
Physical disability P exemption
Cancer diagnosis rider (multiple times, provided that theinsured person is hospitalized after 2 years)
Cancer hospitalization rider
Cancer hospital visit rider (for a certain period before and after
hospitalization; up to 120 days total after discharge)
Cancer surgical operation rider (linked to public insurance)
Cancer palliative medical treatment rider (hospitalization with
Waiting
additional costs for cancer pain treatment or palliative care)periodPost‐cancer diagnosis stress‐related illness rider
Advanced medical care benefit payments in a cancer advanced
medical care rider
Advanced medical care support benefit payments in a cancer
advanced medical care rider
Malignant neoplasm insurance premium payment exemption
rider
Waiting
periodWhole-life coverage is provided under the base policy.

Basic coverage
Basic coverage consists of Type 3 coverage as explained on the base policy page. When it
comes to basic coverage, enhanced coverage is provided by combining a base policy andriders. Insurance premium payment exemption provisions are offered.

Other coverage
The fact that coverage of supportive therapy referred to in terms of palliative medical
treatment has been added can be treated as a point of recommendation.
While the inclusion of a rider covering stress‐related illnesses suffered subsequent to adiagnosis of cancer is distinctive, the appropriateness of eligible illnesses is medicallyproblematic such that, if anything, one is likely to question the necessity of this coverage.
While psychological stress can be suffered after a diagnosis of cancer is received, whether
monetary coverage relating to this point is needed or not is not understood.

200

Clarity for consumers(Is it easy for consumers to understand product composition, product labels,
and added coverage functions?)
The contents of what is being covered are easy to understand, as also reflected in thelabels accorded to different benefits.
Since product composition is distinctive, an explanation on this point is abundantly
necessary.

Policy conditions with respect to the definition of cancer and the confirmationof a diagnosis
There are no problems other than the issue concerning the use of the term cancer as acoined term.

Policy conditions with respect to matters not concerning definitions
Supplementary rules governing anticancer drug treatment benefit reasons arecomplicated.

GeneralThe product is well‐balanced in terms of offering a package of basic coverage options
when the base policy and riders are included.
Policy conditions are written in a way that problems are generally not encountered at thetime of payment.
An adequate explanation will need to be given to ensure that there is no discrepancy
between points that are intended by the company in terms of the way in which the basepolicy is constituted and what consumers might be looking for in a cancer insurance policy.
An explanation of risks relating to the selling of base policy elements to supplement otherproducts is also pertinent.

Chapter 4 201

Ultimately, even on comparing products offered by multiple companies, we
see that there is a limit to the number of types of coverage required for the
medical treatment of cancer. For the most part, it appears as if companies are
doing nothing more than trying to nominally differentiate their products bycombining and linking together these types of coverage.
Thus, the following points are important ones for comparing andrecommending products:
 Is the composition of the product easy to understand, and can coverage
be described as being neither excessive nor inadequate?
 Are there clear provisions, supplementary rules, notes, and explanationsof terms that can prevent problems from occurring at the time of
payment included in the detailed parts of the policy conditions that are
typically not read by consumers?
 Are there mechanisms designed to help increase the number ofpolicyholders (devising special conditions)?
 Are there disadvantageous provisions in the form of invalidation
provisions for intraepithelial neoplasms that are also medicallyproblematic?
As I come close to the point at which I will conclude this book, I recognize
even more that I was not mistaken in my initial assessment of the breadth ofcoverage, aggregate values, and most other points as points that are not worth
focusing on when comparing and recommending products. I will also finish
comparing products by reiterating the fact that I did not engage in a comparative
exercise of points from the standpoint of sales policies, examples of which are
as follows: Competition over sales insurance premiums or competition overcommission amounts;
 Securing administrative expenses and securing commissions to be paid
to solicitors by raising the unit prices of products;
 Efforts to make it harder to compare insurance premiums by slightly
expanding the range of specifications; Efforts to make it easier to sell supplementary coverage by modifying
the product composition of base policies.
I chose to take this approach since, from the standpoint of consumers, thesepoints have no impact on the selection of coverage, except insofar as they affectinsurance premiums.
202Afterword: The roles and societal significance of cancer insurance
More than half a century has passed since the establishment of the publichealthcare insurance system in Japan. Waves of change permeating theenvironment in which medical care is administered – including change in termsof institutional fatigue, the tightening of healthcare finances, and the impending
arrival of the 2025 Problem amid changes in population demographics – aregreater now than ever before. It is in this context that private insurance, which
has been complementing the public healthcare insurance system to date, isshowing signs that its role too is gradually changing. Expectations for private
insurance on the part of both the medical community and the general public will
surely rise.
Cancer insurance has already formed the core of the infrastructure throughwhich medical care for cancer is provided. This too is the result of the daily sales
efforts carried out by all insurance solicitors. Medical care for cancer as
facilitated by cancer insurance is undergoing change from one day to the next.
As the public healthcare insurance system, which has been providing ample,
substantial healthcare services up to now, shrinks, the role of private insurance
can be expected to grow to encompass functions that partially supplement publichealthcare insurance. (For more information, see the July 2016 issue of Journalof Life Insurance Management.) However, consumers’ household budgets aretight, such that there is a limit to the total amount of spending a household canaccommodate, regardless of whether money is spent on social insurance
premiums or private insurance premiums. Insurance is an expensive, long-term
purchase. Thus, it is more necessary than ever before to provide and sell highquality products (products that offer proper risk-transferring functions and onpoint risk coverage) and coverage that is not inefficient. It is the role of solicitors
to engage in self-examining behavior every day to determine whether or not they
have managed to truly sell peace of mind to clients through the products theysell. Of course, it goes without saying that, in addition to the selling of insurance,
the act of following up on clients after policies have been signed is important.
In making comparisons with the numbers of policies sold per year, we seethat it is reasonable to suggest that medical insurance and cancer insurance are
typical examples of third-sector products. While the positioning of each type of
product differs, the issues being confronted by medical care for cancer epitomize
the issues with Japanese healthcare and are looming as problems that we must
Afterword 203

address with respect to both types of insurance. Thus, if we can provide
appropriate cancer-targeting coverage, it may be possible to describe theprovision of other third-sector products as an extension of such coverage. In
surveying the changes affecting the medical care environment and discerning
trends in terms of these changes, I am convinced that the provision and sellingof insurance that is tied to the future will be expected by and draw the attentionof consumers.
Insurance is not the sort of product that is designed to deliver somethingtangible to someone who wishes to immediately use it. The phenomenon known
as the innovator’s dilemma does not apply to the life insurance sector. This isbecause it is easy to copy and sell both good products and other products. In thecancer insurance market, there are few opportunities to overwhelm otherproducts and dominate the market even if a company enters the game late. At
best, a company can swap out elements of the specifications of a base policy andseek to provide a product that it hopes can be sold to supplement coverage
provided to the clients of other companies. At the end of the day, you will be
unable to ascertain significant differences upon comparing, at a glance, products
offered by different companies. However, actually analyzing policy conditions
in detail will reveal substantive differences among products. Even if the process
is slow and gradual, I would like to see progress made in providing products thatare rated highly in terms of quality in the details. The essence of what consumers
expect from solicitors is probably the provision of information on this point. The
grounded provision of information of this sort is in contrast to the strategy one
sees normally applied to television commercials and other types of ads for
insurance.
The standards for comparison in this book differ from the conventionaltargets of comparison, such as the breadth of ostensible coverage and the simply
presented low levels of gross premiums. If anything, I have steered clear ofgiving weight to such targets. I set out to explain the results of comparisons froma standpoint of determining the quality of products that are truly needed byconsumers. While it is likely that there will be parts that are criticized by many
readers, I have summarized this book in accordance with my experiences to date.
I anticipate that sales functions will eventually become excluded from thescope of functions performed by insurance companies, such that insurancecompanies will be left to provide products after the selling of insurance is
outsourced. In addition to human insurance sales channels, means of selling204

insurance based on the application of artificial intelligence will also surely be
developed. While comparative information like that which has been presented
in this book is expected to inundate the public realm, I would be happy if I wereto successfully outline, even in the sense of blazing a trail for the industry, thedirection in which a single recommendation standard should be applied.
Lastly, no matter how much the environment surrounding medical care forcancer changes and no matter how much the insurance industry changes, there
is an aspect of insurance that will not change. I am talking about the essentialfunction of insurance. In other words, insurance functions by transferring risks
that affect policyholders. Within this framework, what will change are the types
and qualitative nature of risks. For example, as anticancer drugs become more
expensive, insurance services corresponding to this rise in prices are provided.
Most consumers are probably still unaware of the rising prices of medical
pharmaceuticals. Nevertheless, there are risks affecting consumers. The age inwhich we live demands that the insurance industry quickly ascertain these risks,
explain together with solicitors the risks that are faced, and provide high-quality
products to clients. In other words, the ability to develop products is nothing
more than the ability to assess risks.
A scholar stated the following in a book that was recently published: “Whatis most important when it comes to insurance is the selling of peace of mind.”This might seem to be something that is obvious but you will be reminded of theimplications of this statement even when you just compare cancer insurance
policies. It goes without saying that we should refrain from providing excessive
coverage and overstating fears by exaggerating the risks that might be faced.
While you might still receive all sorts of explanations from each insurancecompany as to the superiority of the products they offer, the government will
also strongly require that solicitors provide explanations from the standpoint ofconsumers and issue points of guidance towards this end. Since there are nostandards for comparing and recommending products, however, any decision torefrain from making comparisons will end up running counter to the need to act
from the standpoint of consumers.
While I continue to cultivate a relationship with several insurance companies,
I am not qualified to solicit, which means that I do not find myself entangled ina conflict of interest. I hope that you understand that I described products offeredby Aflac, where I once worked for an extended period of time, and also included
statements that were critical of these same products. Chapter 4, which carries
Afterword 205

descriptions of various products, was written based fully on objective facts withrespect to comparative points. You can see from my commentary on productspecifications that no product of any company was described as being perfect,
and that, consequently, I recommended no product of any individual company.
It would be sufficient if readers of this book were to simply check points ofcomparison and points of evaluation as explained by me and think about theirown evaluation standards. In this sense, my goal is not to influence theconclusion each reader will arrive at but to position this book as a source ofviewpoints for thinking about pertinent matters.
I wrote this book fully prepared to receive considerable criticism forindividual parts of my explanations and for my own way of thinking about issues.
However, I believe that the proper orientation of product development and theestablishment of a proper sales narrative should be influenced not just byindependent agencies that compare, recommend, and sell products but also
eventually by companies that can only sell proprietary products and that operate
under a sales staff system.
Finally, I was able to reexamine what kinds of coverage are needed byconsumers while thinking about solicitors who must listen daily to feedback
from consumers and feedback from cancer patients and family members
whenever claims are submitted, thinking about patients actually suffering from
illnesses and their family members, and thinking about all those who provide
medical care and nursing care services while battling hard within the constraints
imposed by healthcare institutions and the various healthcare and nursing-caresystems that are linked to healthcare and nursing care at a community level. I
would like to sincerely thank the Hoken Mainichi Shimbun Company for givingme the opportunity to carry out these tasks.

206

Policy conditions referred to in this book (confirmed as of March 22, 2016)

Company nameSony Life
Insurance
Himawari Life
Insurance
Prudential Life
Insurance

ORIX Life
Insurance

AXA Life
Insurance
Anshin Life
Insurance

AIG Fuji Life
Insurance

Aioi Life Insurance

Manulife Life
Insurance

AXA Direct Life
Insurance

MetLife Insurance

Brand name and product name (top)Policy conditions management number or policy conditions booklet printing
management number (bottom)
Whole‐life cancer insurance (08) (without dividends)
November 2, 2015
Yuuki no Omamori
Cancer insurance (2010) Type BII
April 2015
HL‐P‐B2‐14‐02115 (April 2, 2015)
Cancer insurance (for business insurance); without dividends
November 2015
Registered November 24, 2015; Pru ‐ 2015‐02‐0014
Believe Cancer Insurance
New cancer insurance without dividends (2010); cancer advanced medical carerider
30VI09ORIX2015‐C‐025; created in March 2015
Cancer Treatment Insurance (non‐refundable cancellation type)
November 2015
Form No.0T0795 (3.2) AXA‐A1‐1510‐1641/9W2 2015.11.06
NEO Cancer Treatment Support Insurance; without dividends
NEO Cancer Treatment Support Insurance; non‐refundable cancellation type
Newly established in July 2015
Fund 1412‐KR06‐033 D79‐12110 New 201504
Cancer Best Gold AlphaNon‐refundable cancelation type insurance for the medical treatment ofmalignant neoplasms (2014); without dividends
Revised in April 2015; W2043
Reg. No. AFL14D072 W2043 (55,000 (1) 116.6) TF
New Cancer Insurance Alpha; without dividends
August 2015
[MS] B2129 [AD] 92‐129 40,000 2015.05.28 (Rev. 1) 61
Reg. 2015‐A‐202 (July 1, 2015)
Kodawari Cancer Insurance
Without dividends; whole‐life cancer insurance that is non‐refundable ifcanceled during the premium‐payment period
Created in January 2016
MLJ (Co.) 15110224‐386701 (16‐01.45c) Ⓣ
Whole‐Life Cancer Insurance
Cancer insurance (whole‐life type)
September 2015
Form No. AX‐15‐010 (1) 2015.09.16
Guard X Modern Cancer Insurance
Whole‐life cancer treatment insurance
September 2015 ver. 3
Fund 1506‐0012 B005‐24 (03) (15.9) Y1207DI‐DNP

Afterword 207

Company name

Aflac

Zurich Life
Insurance

208

Brand name and product name (top)Policy conditions management number or policy conditions booklet printing
management number (bottom)
New Days Cancer Insurance for Survival
Without dividends; cancer insurance (no refund or low refund amount uponcancellation 2014)
Fund 778192 (00) TO.14.08.40A (new) AF Co. 2‐2014‐0032 June 26
Premium Whole‐Life Cancer Treatment Insurance
Non‐refundable cancellation‐type whole‐life cancer treatment insurance
Rev. April 2015 WC142
Fund 15003

[Biographical outline of the author]

Mitsunobu Sasaki (President, Insurance Medicine Research Institute Inc.)
After graduating from the Keio University School of Medicine, Sasaki obtained a degree in bladder cancer research andreceived the Sanshikai Award.
After working for a medical institution, he became the head of Chiyoda Mutual Life Insurance Company’s medical
research section and the director of the company’s medical division. He became the head of the American Family Life
Assurance Company’s medical division and assumed the post of chief medical director in 2001 before he eventuallychose to work for himself, which he has been doing since.
For over three decades, Sasaki has been engaged in risk-selection (insurance underwriting and insurance payments)
activities and product-development work with a focus on insurance medicine and has been giving lectures on theprovision of information to financial planners and on matters concerning insurance medicine and sales education.
Sasaki has conducted research activities with a focus on the relationship between medical advancements and life
insurance, the healthcare and long-term care insurance systems, and private insurance and has produced a considerable
volume of research results, including in the form of papers published in this field. His work to introduce a risk-selection
method based on the use of videophone technology to the insurance sector has been picked up by the Financial Times
economic journal, NHK Close-Up Gendai, and other media outlets.
In addition to serving as a member of the governing board of the Association of Insurance Medicine of Japan and amember of the Life Insurance Association of Japan’s Medical Affairs Subcommittee, Sasaki is currently an editorial
writer for the Insurance Journal.
Sasaki is a medical doctor, Doctor of Medicine, certified long-term care support specialist, certified physician with the
Association of Life Insurance Medicine of Japan, and certified industrial physician with the Japan Medical Association
and belongs to, among other academic organizations, the Japan Society of Clinical Oncology, the Japanese Urological
Association, the Japanese Society of Insurance Science, the Association of Insurance Medicine of Japan, and the Japan
Association for Bioethics.
[Major papers and articles]
1.
The significance of medical checkups (homework report of the Association of Life Insurance Medicine ofJapan; published in four major newspapers)
2.
Life insurance risk selection (Insurance Science Magazine; paper for a lecture presentation made at a
symposium held at Komazawa University)
3.
Bioethics and the insurance business (Journal of the Association of Life Insurance Medicine of Japan; reporton initiatives concerning genetic problems in the area of life insurance)
4.
Gender dysphoria and sex change procedures (Journal of the Institute of Life Insurance Management;
editorial on the impact of an exceptional measures statute concerning sex change procedures on the life
insurance business)
5.
Fetal status and the scope of coverage (Journal of the Association of Life Insurance Medicine of Japan;
explanation of issues concerning fetal treatment and life insurance)
6.
Higher-order brain dysfunction and coverage trends (Journal of the Institute of Life InsuranceManagement; pointing out that coverage of brain damage aftereffects as provided by life insurance policies
lags behind coverage as provided by non-life insurance policies)
7.
Intellectual disabilities and life insurance (Journal of the Association of Life Insurance Medicine of Japan;
was conferred the Life Insurance Association of Japan’s Chairman’s Award for this paper)
8.
Life insurance and ethical issues (Journal of the Association of Life Insurance Medicine of Japan; wasconferred the Life Insurance Association of Japan’s Chairman’s Award for this paper)
9.
A study of genetic information in the post-sequencing era (Hoken Kenkyu; editorial on insurance theory
based on recent genetic knowledge at the Insurance Institute of Keio University)
10. Launching anticancer drug treatment coverage (Journal of the Institute of Life Insurance Management;
explaining the challenges that arise when developing products based on the provision of anticancer drug
coverage)
11. Underwritten palliative medical insurance and the substandard market (Journal of the Institute of Life
Insurance Management; explaining the challenges that arise when making products available to thesubstandard market)
12. Medical progress and insurance policy conditions (Insurance Science Magazine; editorial on the issues
surrounding the long-term nature of insurance products and the variability of medicine)
13. Genetic screening and insurance issues: What does Angie’s statement imply? (Institute of Life InsuranceManagement; editorial on the challenges attributed to the infiltration of genetic screening)

209

210

All rights reserved. No part of this publication may be
reproduced without the prior permission of the publisher.
Public Interest Incorporated Foundation
Oriental Life Insurance Cultural Development Center
The Prudential Tower 20F, 2-13-10 Nagata-cho
Chiyoda-ku, Tokyo 100-0014, Japan
Telephone: 81-3-5501-6570 Fax: 81-3-5501-6448
E-mail: info@olis.or.jp
Website: www.olis.or.jp

This book was originally published by the Hoken Mainichi Shimbun Co., Ltd., in August 2016. With
the consent of the author and the publisher, OLICD Center translated the book into English in March
2021.
211