Insurances Benefit/Claim Payments
Correct and Fair Insurance Payouts
We make various efforts to contact the policyholder during various phases of the insurance process, from claim receipt to payment assessment and post-payment, in order to inform customers if their situation fulfills the payment requirements for other insurance benefits. We will strive to continually improve our payment management system, based on feedback from customer surveys and the views of outside experts.
Providing Regular Information on Insurance Benefit Payouts
Every year we send a Total Life Plan Report to policyholders which provides a list of payment requirements for each customer, payout records for the previous 10-year period, and instances where special attention is required. Payment information is also provided to customers through brochures, our website, and various notifications that are sent out.
Proper Understanding of Claims and Correct Payment Procedures
We use our proprietary navigation system to inform policyholders about the claims documents required for the applicable payment requirements whenever they submit a claim for an insurance benefit. We have also established a dedicated inquiry desk at our head office for our Total Life Plan Designers who receive claims called the Insurance Proceeds Help Desk. Dedicated staff with expert knowledge of our insurance and claims processes also assist customers during the claims process.
During the payment process, all information on medical certificates submitted for a claim and the information necessary for a claim is automatically assigned a code. Information input into the system in each process is entered and verified within the system using reconciliation to further improve correctness.
Follow-up System for Customers after an Insurance Benefit is Paid
Using medical certificates in text data format, the possibility that a claim may meet other payment requirements is checked for, and customers are informed about the claim process (the Payment Information Integration System).
At the time of contract / During the contract period
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Sufficient notification of insurance contract and coverage
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- ● Customers are provided with insurance design documents (contract summary)
- ● An overview of contract terms and conditions is published on the Dai-ichi Life website
- ● The contract guide and brochure “Insurance Claim Procedures and Payment Examples” have been integrated together
- ● Customers are given a DVD-ROM with the terms and conditions of their policy and policy guide
- ● A copy of “Submitting Insurance Claims without Omission” is enclosed with the insurance policy
- ● Terms and conditions have been simplified
- ● The Policy Content Guidance System was established
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Regular information provisions and reminders to policyholders
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- ● Payment requirements for each of the policyholder's contracts are explained using the Total Life Plan Report
- ● Total Life Plan Reports are provided online using the Dai-ichi Life website
- ● A policyholder's claims and benefits history is included in their Total Life Plan Report
- ● Reminder messages are included with various notifications
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Making the claims process easier for policyholders
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- ● Dai-ichi Life covers the cost of medical certificates for which a claim or benefit was not eligible for payment (¥6,000)
- ● Our product lineup is continually revised and simplified
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Informing customers upon receipt of a claims application and of claims documents
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Correctly understanding details of claims
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- ● Upgraded the claims application receipt process
- ● Customers provided with a manual that contains easy-to-understand commentary on payment requirements for disability benefits
- ● Total Life Plan Designers' DL Pad mobile device comes equipped with a navigation system for insurance claims and benefits
- ● A dedicated contact center for the receipt of insurance claims and benefits applications has been set up
- ● The Insurance Proceeds Help Desk handles inquiries on claims from Total Life Plan Designers
- ● The medical treatment report contains a list of disease names that are eligible for payments in each policy
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Informing customers of claims procedures
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- ● Automatic name-based aggregation for policies when creating claims documents
- ● Requirements to confirm the disease name at the time claims documents are prepared
- ● The claims and benefits application confirmation sheet, which contains customer application information received by Dai-ichi Life at the start of a claim, is provided to customers
- ● The treatment report and supporting documents sheet, which contains clear explanations of the documents required to submit a claim, is provided to customers
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In-house training and guidance for ensuring reliable notifications
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- ● A dedicated group has been established for employee training and education within the Claims Department
- ● An administrative and underwriting academy has been established as a human resource development program for broadening expertise in payment operations and other work processes
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At the time of payment assessment and post-payment
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Correct payment assessments
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- ● Overhauled the payment assessment work flow system
- ● Conversion of all information about payments described on medical certificates to data
- ● Automatic conversion of medical information in data format to codes
- ● Introduced a systematic guiding function that supports payment assessment conducted by professional staff
- ● Reconciliation of several input results from medical certificate data conversion, medical information code conversion and payment assessment.
- ● Upgraded the payment system for group insurance
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Reconfirmation of payment details
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- ● Payment details are checked the next business day after procedures have been completed to prevent payment omissions
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Courtesy and reliable claims reminders
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- ● The Payment Information Integration System is used to inform customers who may be entitled to additional benefits
- ● The payment statement contains a reminder message to check for any insurance benefits or claims that have not been filed
- ● After the payment of hospitalization benefits, a policyholder is informed of making a claim for hospital visit benefits
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Improved explanations to customers regarding payment details
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- ● Payment statements contain more details and a dedicated contact center has been established for customer inquiries about payment details
- ● Insurance claim and benefit statements contain the date the claim was received
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