To Life Insurance Policyholders

Preparing Family Members
for Dementia

The Life Insurance Association of Japan

Introduction
In a super-ageing society where people live for 100 years, we recognise thatenhancing services provided to the elderly and preparing an environment in which
policyholders can renew their policies with peace of mind is a very importantundertaking for the life insurance industry, which provides long-term coverage andother services for various life stages. The number of dementia patients is growing
rapidly, and the entire life insurance industry is coming together to provide support.
This booklet goes over the challenges faced not only by the individual but also
their family members, including the inconveniences, when the policyholder/family
members develop dementia and summarises the preparations that family members
should make. We hope you will take advantage of the information it contains.

Contents

１ Why is it necessary to prepare for dementia?
１‑ １ Preparation in life and life insurance procedures

３

１‑

2

Average life and healthy life expectancy

４

１‑

3

Ageing of the population and increasing numbers of dementia patients

５
６

Reference: What is dementia?

2 How can people prepare for dementia?
2‑

１ Diﬃculties experienced by family members when policyholder develops dementia

7

2‑

2

Preparations to make with family members before developing dementia

8

Reference: Designated proxy claim scheme/Designated proxy claim riders

11

3 What kinds of systems and mechanisms are in place?
3‑

１ Adult guardianship system

13

3‑

2

Family trusts

14

From the editor-in-chief

15
16

Reference: Customer support
Contact information for life insurance consultations and complaints

18

Checklist

19

2

１

Why is it necessary to prepare
for dementia?

１‑ １ Preparation in life and life insurance procedures
During our lives, it is necessary to review our insurance policies and complete various
procedures on various occasions, such as when children are born, when children leave thehome, when we are hospitalised, and when family members pass away.

(Example)

SingleChildren born andmoving out

MarriedPreparation for
hospitalisation,
death, etc.

Preparations(example)

Retirement

Preparation for inheritance,
dementia, etc.

Beneﬁt claims (such as for hospitalisation) andinsurance claims (such as for death)
Procedures(example)●Addresschanges●Beneﬁciary●Review of coverage●Beneﬁciary changes(in the event of spouse s death)changesFigure 1: Illustration of necessary preparations and life insurance procedures3

2 Average life and healthy life expectancy

１‑

In a super-ageing society where people live for 100 years, average life expectancy continues
to increase. On the other hand, there is about a 10-year diﬀerence between life and healthy
life expectancy. (Healthy life expectancy is how long an individual is expected to live ingood health and independently.) Since average life expectancy is expected to continue
increasing, it is important to work on increasing healthy life expectancy.

Average Life Expectancy and Future Projections
Past record

(Age)

95

Male

Projections

Female

90
84.60

85

87.26

87.64

81.90
78.76

80
74.66

75

77.72

75.92

70.19

70
65

86.30

88.72

79.55

81.09

81.34

83.27 84.02

91.35

84.66 84.95

Projections for 45 years in the futureture

73.35

Average life expectancy
for men

69.31
61.5

82.39

91.06
89.63 90.40

Average life expectancy
for women

65.32

85 yearsaround 91years
around

60
55

58.0
1950

1960

1970

19８0

19９0

２００0

２０１0

２０１７

２０２０

２０３０

２０４０

２０５０

２０６０

２０６５ (Year)

Figure 2: Prepared based on 2018 Annual Report on the Ageing Society (Cabinet Oﬃce)

Diﬀerence Between Average Life Expectancy and Healthy Life Expectancy (2016)
60

Men

70

80

Average life expectancy: 80.98 years
Healthy life expectancy:
72.14 years

Women

90 years of age

Diﬀerence of approx.
9 years

Average life expectancy: 87.14 years
Healthy life expectancy:
74.49 years

Diﬀerence of approx.
13 years

Figure 3: Prepared based on 2018 Annual Report on the Ageing Society (Cabinet Oﬃce)

4

Ageing of the population and increasing
numbers of dementia patients

１‑
‑ 33
１

The number of people with dementia is increasing as society ages, and the prevalence
spikes with age, particularly at 75 years of age and older. Since the prevalence of dementia is
expected to continue increasing and anyone can develop it, it is not somebody else s problem.
When a life insurance policyholder develops dementia, diﬃculties arise with respect to insurance
procedures and other matters (see page 7).

Spike in Prevalence (Particularly at 75 Years of Age and Older)
（％）

90

Male

83.7

Female

80
70

65.1

Prevalence of dementia
rises rapidly at the ageof 75 and older

60
50

43.9

40
30

10
0

50.6

90-94

95- （Age）

35.0

24.2

20

49.0

14.4
3.8
2.8

65-69

16.8

4.9
3.9
70-74

11.7
75-79

80-84

85-89

Figure 4: Prepared based on the FY2011 summary/shared research report Incidence Rate of Dementia in the Urban Area, and Response
to Living Functional Disability Caused by Dementia of the Comprehensive Research Project on Measures against Dementia for the
MHLW Health and Labour Sciences Research Grants (Takashi Asada et al.)Signiﬁcant Percentages of People Develop Dementia

Number of dementia
patients (estimate)
Percentage of people
65 years of age andolder with dementia

2012

2040

2060

4.62 million

9.53 million

11.54 million

15.0％

25.4％

One in sevendevelop dementia

One in fourdevelop dementia

34.3％

One in threedevelop dementia

Figure 5: Prepared based on the preliminary results from Research on the Future Estimation of the Elderly Population with Dementia in Japan(Special Research Project for the MHLW Health and Labour Sciences Research Grants of FY2014 by Professor Ninomiya of Kyushu University)and projected number of people/(rate) with dementia on the assumption that the prevalence of dementia for each age group increases

5What is dementia?
Dementia refers to a group of symptoms associated with diﬃculties indaily life (lasting six months or longer) arising from various disorders

Referencethat result from damage to or deterioration of brain cells due todiﬀerent factors.

Symptoms of dementia include core, behavioral, and psychologicalsymptoms.

Core symptoms

Memory disorders

Being unable to remember or recall things

Impaired comprehension
or judgment

Slowed thinking
Loss of ability to use appliances and ATMs

Functional disorders

Loss of ability to plan and act
Forgetting time and place and eventually

Disorientation

relationships with other people<Getting lost> Walking around and forgetting how to get back<Delusions> Becoming convinced of things that are not true, such as theft of belongings<Hallucinations> Seeing or hearing things that are not there

Main behavioral
and psychologicalsymptoms<Violent behavior> Becoming violent because of the inability to express feelings orcontrol emotions<Delirium> Becoming nervous and confused, walking around the house and talking to self, etc.
<Depression> Feeling down and becoming lethargic<Personality changes> Changes in personality, such as a mild person becoming
short-tempered<Uncleanliness> Refusal to bathe, playing with excrement, etc.

Mild Cognitive Impairment (MCI)
This is in between normal function and cognitive impairment. The individual is forgetful but
is not impaired in terms of daily life.
As of 2012, the estimate was that 4 million individuals were aﬀected. It is said that around10-30% of those with mild cognitive impairment (MCI) develop dementia every year.

1〜2%
Healthysubjects
16〜41%

Mild cognitive
impairment(MCI)

10〜30%

Mild dementia

Moderatedementia

Severedementia

Figure 6: Prepared based on material from the Social Security Council Long-Term Care Insurance
Subcommittee (June 20, 2019)（Ministry of Health, Labour and Welfare）

6

2

How can people prepare
for dementia?

2 ‑‑ １
１
2

Diﬃculties experienced by family members
when policyholder develops dementia

When a policyholder develops dementia, their judgment becomes impaired not only causing
problems in their daily life but also preventing them from managing their own assets. This
makes it diﬃcult for them to manage and perform procedures related to various contracts,
including life insurance. In such cases, the diﬃculties tend to be handled with help fromfamily members and others, but there are times when even family members have diﬃculty
handling procedures related to life insurance. It is important to make preparations together
with family while the policyholder is healthy.

Diﬃculties faced by family members

Do not know whether
family member
is insured(Even if insured...)Do not know the detailsof the policy◯◯会社

See page 8(Even if the policy is in hand...)Do not know whether
beneﬁts can be claimed
on behalf of the insured◯◯会社

See page 9

7

See pages 10 -12

22 ‑‑ 22
Example1

Preparations to make with family members
before developing dementia

Do not know whether

family member is insured
The policyholder (individual) is enrolled in health insurance.
His judgment has been impaired for several years.
Recently, he was hospitalised for pneumonia.

Policyholder

Beneﬁciary

Insured: Individual

Insured: IndividualDiﬃculties faced by family members

Wife

If he is enrolled in life insurance, I would liketo claim beneﬁts, but I don t even know if
he s enrolled.

There are cases where family members have heard that the individual isenrolled in life insurance but they do not know which life insurance company.

Preparations to make beforehand
Make sure that family members know which insurance company and the details of thepolicy before developing dementia. (See page 9)8

Example2

Do not know

the details of the policy

The policyholder (individual) is enrolled in insurance payable at death.
Recently, his judgment has become impaired.
His wife came across an insurance certiﬁcate that she did not know about.

Policyholder

Beneﬁciary

Wife

Insured: IndividualDiﬃculties faced by family members

Wife

I called the life insurance company to check thedetails of the policy, but I was told that I would
need the consent of my husband, the policyholder.
However, he has dementia, so I cannot ask him.

In principle, consent of the policyholder is required to respond to insurance
policy inquiries by family members and others.

Preparations to make beforehandTell family members about life insurance while healthy and let them know the detailsof the policy. (It is also important to come up with ideas, such as checking on an
ongoing basis on special occasions or at other times.)
Decide on a place to store insurance certiﬁcates and other documents related to thepolicy and let family members know.
* In principle, inquiries about insurance policies from persons other than the policyholder cannot be answered.
* Check the details on the policy notices sent out regularly by your life insurance company.
* In addition to the individual s contact information, some companies also oﬀer services that include registering family
member contact information and providing policy details to family members who are registered in advance. If your life
insurance company provides information on such a service, consider registering for it.
* Handling of cases such as that in the example varies depending on the life insurance company. Reach out to your life
insurance company for details.

9

Example3

Do not know whether beneﬁts can
be claimed on behalf of the insured
The policyholder (and insured) let his family members know that he wasenrolled in health insurance.
His judgment has been impaired for several years. Recently, he washospitalised for pneumonia.

Policyholder

Beneﬁciary

Insured: Individual

Insured: IndividualDiﬃculties faced by family members

Wife

My husband has dementia, so he can t ﬁle a claim.
I m concerned that I may just not be able to get
the beneﬁts.

Preparations to make beforehand

Check to see if a proxy claim scheme (designated proxy claim scheme/designatedproxy claim riders) is used. (See page 11)

If used, check to see who the designated proxy claimant is and let that person
know they have been designated.

* Normally, beneﬁts for hospitalisation are claimed by the insured, but life insurance companies have designatedproxy claim schemes/designated proxy claim riders for cases in which the insured is unable to ﬁle the claim
themselves.
* In addition to proxy claim schemes, some companies have schemes in place for family members who are registeredin advance at the insured s request to be able to perform procedures such as beneﬁt claims.
* Handling of cases such as that in the example varies depending on the life insurance company. Reach out to yourlife insurance company for details.

10Designated proxy claim scheme/
Designated proxy claim riders

Reference

What are designated proxy claim schemes/
designated proxy claim riders?
This is a scheme established by life
insurance companies for designated proxy
to claim beneﬁts on behalf of the insured.
The policyholder designates the proxywhen the contract is signed or thereafter.

Designated

Policyholder

Proxy* Normally, if the policyholder and the insured are diﬀerent
people, consent of the insured is required.
* The applicable scope varies depending on the life
insurance company. Some life insurance companies may
not oﬀer such a scheme.
* Some companies also have schemes (riders) allowing
procedures to be completed by someone other than thepolicyholder on their behalf. Reach out to your life
insurance company for details.

Who can be a designated proxy?

Although it varies depending on the life
insurance company, generally, the insured s
Wife

spouse, direct blood relatives, familyChildmembers living in the same household(relatives within the third degree), andother such individuals can be designated.

Grandchild

Nephew

Niece* The names of the schemes and riders vary depending on the life insurance company. Reach out to your life insurance company for details.

11

Example

4 Beneﬁciary passes away
The policyholder (individual) is enrolled in insurance payable at death. Recently,
his judgment has become impaired.
His wife, the beneﬁciary, passed away. As such, the beneﬁciary needs to be changed.
Needs to bechanged
Policyholder

Beneﬁciary

Insured: Individual

Wife

Child

Diﬃculties faced by family members

Child

I would like to make myself the beneﬁciary,
but I was told that my father has dementia,
so the change cannot be made. What do I do?

There are also cases in which the beneﬁciary develops dementia or another illness,making it diﬃcult to ﬁle an insurance claim when the policyholder passes away.

Preparations to make beforehand
When an individual develops dementia, it is no longer possible to conﬁrm their intentions.
Thus, this prevents legal procedures, contract signing, etc. In such cases, normally the only
proxy that can perform procedures on behalf of the insured are those who are adultguardians or voluntarily appointed guardians under the adult guardianship system.
Consider deciding on a voluntarily appointed guardian beforehand and having a trusted family
member who can perform the procedures on your behalf as one option ((Another method of property management is the family trust scheme (See page 13).
See page 14).)

If you have wishes for how your property will be managed when you develop dementia,
discuss them with your family and loved ones.
Consider deciding on a voluntarily appointed guardian or a family trust as ways todetermine how your property will be managed before you develop dementia.
* Handling of cases such as that in the example varies depending on the life insurance company. Reach out to yourlife insurance company for details.

12

3
3‑

What kinds of systems
and mechanisms
are in place?

１ Adult guardianship system

If your judgment becomes impaired due to dementia or other illness, it can be diﬃcult tomanage property such as real estate and deposit accounts, sign contracts for nursing careservices or entering facilities, discuss partitioning of your estate, etc. The adult guardianshipsystem is a national system for protecting and supporting those without suﬃcient power of
judgment. There are two categories under the adult guardianship system.

① Legal guardianship system
Living expenses,
personal custody,
etc.
Ward (individual)

Professional guardian(such as a lawyer)
Selectguardian

ReportingAfter a family member ﬁles a petition for a person whose
judgment is already impaired due to dementia or otherillness, a family court will select an adult guardian who will
provide care and support the individual in daily life,
medical care, nursing care, welfare, and other such
everyday matters. They are classiﬁed as guardians,

Petitioncurators, and assistants, which can be used depending on

Family court

the individual s circumstances, such as the degree towhich their judgment is impaired.

Family member② Voluntarily appointed guardianship system
Designate via
notarised document

Ward (individual)This system allows the individual to decide what kind of
support they will receive in the future if their judgment
becomes impaired from a guardian they appoint

Living expenses, etc.

Voluntarily appointed guardian(such as a family member)Supervision
Selection
Family court

Reporting

Voluntary guardian
supervisor

themselves while they still have suﬃcient power of
judgment by means of a contract. When the individual s
judgment becomes impaired, the voluntarily appointed
guardian ﬁles a petition with the family court for selectionof a voluntary guardian supervisor and provides theindividual with care and support under the supervision of
the voluntary guardian supervisor.

Reference: Legal-Support Adult Guardian Center (https://www.legal-support.or.jp/english)

13

3‑

2

Family trusts

Family trusts are a method of property management. This is a scheme provided by a private
business operator in which assets such as real estate and deposit accounts held by theindividual are entrusted to a family member, who manages and disposes of them on theirbehalf, after deciding the purpose (e.g. dementia countermeasures, retirement living
expenses, and nursing care expenses). These trusts consist of three parties: the trustor, thetrustee, and the beneﬁciary.

The person entrusting their own assets

Trustor

The person entrusted with assets, managing andTrusteedisposing of them according to the purpose of the trust

The person receiving the beneﬁts, such as the income

Beneﬁciary

generated from the entrusted assets

TrustorTrustee

Trust agreement
Asset managementand disposal
ParentChild

Beneﬁciaryrights
Beneﬁciary

Guidance
Livingexpenses, etc.

ReportingTrustsupervisor
ParentCheck

For details on and how to use family trusts, consult with a lawyer orjudicial scrivener.

14

From the editor-in-chief
We all share the desire not to develop dementia. Unfortunately,
no matter how many preventive steps we take, a certain
percentage of us will develop some type of dementia. Since a lotof people feel that thinking about developing dementia isdepressing, they try not to think about it. However, developing
dementia does not mean you cannot do anything anymore.
As long as you have the proper support, you can still enjoy life
even after developing symptoms.
It is important to make preparations now to ensure that the
beneﬁts make it into the hands of the family member(s) who will
support you so that you can live a fulﬁlling life even if you develop
dementia. This is also a diﬃcult subject for family members tobroach. Thus, we suggest that you share information with yourfamily members during a holiday season, such as year-end/New
Year s and Obon (Lantern Festival). Sharing your thoughts withyour family members is sure to strengthen those bonds as well.

Jin Narumoto
Professor, Graduate School of Medical Science, Kyoto Prefectural University of Medicine
Completed doctoral program at Graduate School of Medical Science, Kyoto Prefectural University of
Medicine. His main ﬁelds of research include clinical research on the cognitive functions andpsychiatric symptoms of dementia patients and study of mental illness using brain scans. He serves
as representative director of Decision-Making Support Organisation Japan and has authored several
books, including Practical Guide for Dementia Friendly Financial Services (CREATES KAMOGAWA)
and Ninchisho no hito no iryou sentaku to ishi-kettei shien 認知症の人の医療選択と意思決定支援[Supporting the Medical Choice and Decision-making of Dementia Patients] (CREATES KAMOGAWA).

15

Reference

Customer support(As of February 2021)

Contact a representative at your life insurance company or
use the contact information below for life insurance
consultations.
* Check The Life Insurance Association of Japan website for the latest
contact information.
https://www.seiho.or.jp/english/(In alphabetical order)

A

AEON Allianz Life Insurance Co., Ltd.

0120-953-863

Aﬂac Life Insurance Japan Ltd.

0120-5555-95

Asahi Mutual Life Insurance Co.

0120-714-532

AXA Life Insurance Co., Ltd.

0120-030-775

AXA Direct Life Insurance Company Limited

0120-953-831

CARDIF Assurance Vie

0120-820-275

Crédit Agricole Life Insurance Company Japan Ltd.

0120-60-1221

D

Daido Life Insurance Co.

0120-789-501

F

Fukoku Mutual Life Insurance Co.

0120-259-817

Fukokushinrai Life Insurance Co., Ltd.

0120-700-651

FWD Fuji Life Insurance Company, Limited

0120-211-901

H

Hanasaku Life Insurance Co., Ltd.

0120-8739-17

J

JAPAN POST INSURANCE Co., Ltd.

0120-552-950

L

LIFENET INSURANCE COMPANY

0120-205-566

M

Manulife Life Insurance Company

0120-063-730

Medicare Life Insurance Co., Ltd.

0120-315-056

Meiji Yasuda Life Insurance Company

0120-662-332

C

16

MetLife Insurance K.K.

0120-880-533

Midori Life Insurance Company

0120-566-322

Mitsui Sumitomo Aioi Life Insurance Co., Limited 0120-324-386
Mitsui Sumitomo Primary Life Insurance Co., Ltd. 0120-125-104

N

NIPPON LIFE INSURANCE COMPANY

0120-201-021

Nippon Wealth Life Insurance Company Limited

0120-817-024

NN Life Insurance Company, Ltd.

0120-521-513

O

ORIX Life Insurance Corporation

0120-227-780

R

Rakuten Life Insurance Co., Ltd.

0120-977-010

S

SBI Life Insurance Co., Ltd.

0120-272-811

Sompo Himawari Life Insurance, Inc.

0120-273-211

Sony Life Insurance Co., Ltd.

0120-158-821

Sony Life With Insurance Co., Ltd.

0120-966-066

SUMITOMO LIFE INSURANCE COMPANY

0120-307-506

The Dai-ichi Life Insurance Company, Limited

0120-157-157

The Dai-ichi Frontier Life Insurance Co., Ltd.

0120-876-126

The Gibraltar Life Insurance Co., Ltd.

0120-37-2269

The Neo First Life Insurance Company, Limited

0120-312-201

The Prudential Life Insurance Co., Ltd.

0120-810-740

The Prudential Gibraltar Financial
Life Insurance Co., Ltd.

0120-56-2269
0120-28-2269

T(If you enrolled through a ﬁnancial
institution, etc.)(If you enrolled through the former
Yamato Life Insurance Company)

TAIJU LIFE INSURANCE COMPANY LIMITED(Formerly Mitsui Life Insurance Co., Ltd.)

0120-318-766

Taiyo Life Insurance Company

0120-97-2111

Tokio Marine & Nichido Life Insurance Co., Ltd.

0120-016-234

you enrolled through the former
0120-301-396
T&D FINANCIAL LIFE INSURANCE (Ifsales
branch)(If you enrolled through a ﬁnancial
COMPANY
institution, etc.)
0120-302-572

Z

Zurich Life Insurance Company Ltd.

170120-860-129

Reference

Contact information for life insurance
consultations and complaints

Consultants with extensive specialised knowledge are available to speak withyou regarding consultations, inquiries, and complaints concerning life insurance.

Reference
Life Insurance Consultation Center

9:00 a.m. - 5:00 p.m.(closed on Saturdays, Sundays, holidays, and year-end/New Yearʼs)*At year-end, the center is open until December 28 and opens again on January 4 of the following year.

By telephone

Tel: +81-3-3286-2648* Calls to the Life Insurance Consultation Oﬃce are recorded to improve the quality of theservice. Thank you for your understanding.

In person(*Please arrive by 4:00 p.m.)

3rd ﬂoor, Shin-Kokusai Building, 4-1 Marunouchi 3-Chome, Chiyoda-ku,
Tokyo 100-0005, Japan (inside LIAJ)
Liaison oﬃces have been opened in 50 locations nationwide.
Check the Life Insurance Association of Japan website for the location nearest to you.

https://www.seiho.or.jp/english/
Information on Arbitration Council
If the Life Insurance Consultation Center receives a complaint that cannot be
resolved via thorough discussion between the life insurance company and thepolicyholder, etc., you can use an Arbitration Council in place to provide a decisionfrom a fair and neutral position (to support dispute resolution).
In principle, if the complaint received by the Life Insurance Consultation Center is
not resolved within one month after the life insurance company is notiﬁed andasked to respond, the complaint can be ﬁled with the Arbitration Council.

18

Reference

Checklist

Check what preparations can be made together with family members while
the policyholder is healthy.

１Tell family members about life insurance and let themknow the details of the policy.
Decide on a place to store insurance certiﬁcates and２other documents related to the policy and let family
members know.

３

Check to see if a proxy claim scheme is used.

If a proxy claim scheme is used, check to see who the４designated proxy claimant is and let that person
know they have been designated.

５

Talk with your family members and loved ones
about how your property will be managed if you
develop dementia.
Consider deciding on a voluntarily appointed

６

guardian or a family trust as ways to determine
how your property will be managed.

19

See pages

8-9

See pages

8-9

See pages

10-11

See pages

10-11

See pages

12-14

See pages

12-14

To Life Insurance Policyholders: Preparing Family Members for Dementia
Editor-in-chief: Jin Narumoto (Professor, Graduate School of Medical Science,
Kyoto Prefectural University of Medicine)
Published: February 2021
Publisher: The Life Insurance Association of Japan
3rd ﬂoor, Shin-Kokusai Building, 4-1 Marunouchi 3-Chome, Chiyoda-ku,
Tokyo 100-0005, Japan
Tel: +81-3-3286-2652
Website: https://www.seiho.or.jp/english/