Works Human Intelligence Health Insurance Society

Health Insurance Cards

I lost my health insurance card. I'm worried that someone will do something bad with it. What should I do?

If it has been stolen, etc., please notify the police immediately.
To have another card issued to you, submit a "Lost Health Insurance Card Replacement Application" form to the human resources department of your company.
If you are enrolled in optional continued insurance coverage, please mail the form and a copy of your personal identification (driver's license, passport, or other photo ID issued by a governmental agency) directly to the Health Insurance Society.

I'm worried about not having my insurance card with me during the processing of a "Notification of Dependents for Health Insurance (Changes)." What should I do if I get sick?

Please pay the relevant costs yourself at that time. When your insurance card has been issued, please take it to that healthcare provider and ask them if the refund can be done there first. If the healthcare provider cannot do it, please attach the statement of medical expenses (health insurance claim) and the receipt (original) to the "Medical Expense Benefit Payment Request" and submit them to the Health Insurance Society via the human resources department of your company.

Certification of Dependents

My wife retired because she will give birth. How do I apply for certification of dependents?

The requirement for certification of dependents (annual income of ¥1.3 million or less) is reviewed based on the anticipated income for the period of one year starting on the application date, so your wife will be certified as a dependent as of the date on which she retired.
In the case of individuals who plan to receive payment of employment insurance unemployment benefits after giving birth, please complete the procedures to extend employment insurance benefits and obtain a "Benefit Period Extension Notice" and submit a copy to the human resources department of your company.

To apply, please submit the following documents promptly after retirement.

• Dependent Change Notification
• Separation Notice (copy) or Certificate of Retirement
• Maternal and child health handbook (copy)

If employment insurance benefits began to be received after giving birth, complete procedures to temporarily remove your wife from your dependents, then apply for her certification as a dependent again once the payment period has ended.

My wife has been receiving employment insurance unemployment benefits, but the payment period will end soon. What do I need to do to have her added as my dependent?

When the unemployment benefit payment period ends, the Public Employment Security Office stamps the individual's "Employment Insurance Benefit Eligibility Certificate" indicating that the payment period has ended. Please make a copy of both sides of the Certificate and submit it with a "Dependent Change Notification" to the human resources department of your company.

My wife's annual income from part-time employment exceeds ¥1.3 million. At what point should I have her removed from my dependents?

Please submit a Dependent Change Notification and the health insurance card and complete the procedures to remove your wife from your dependents promptly when her income has exceeded the limit. After the procedures have been completed, she will be enrolled in National Health Insurance, so please complete the enrollment procedures at your local National Health Insurance counter.

My child graduated from college, but hasn't gotten a job. Can she continue to be enrolled in the Health Insurance Society as my dependent?

The Works Human Intelligence Health Insurance Society certifies individuals as dependents when they do not have a certain level of income (less than ¥1.3 million per year), so a local taxation certificate/tax exemption certificate will be required to verify the income.
If the Health Insurance Society requests submittal of the certificate, please submit the documentation promptly.

My spouse retired from the company. His income for this year was ¥1.3 million or more. He plans to begin receiving employment insurance unemployment benefits in a few months. At what point would he be considered to be a dependent?

Certification as a dependent for health insurance coverage is based on whether the individual's post-retirement income (including real estate income, etc.) exceeds the legally stipulated standard amount (under age 60: ¥1.3 million per year; disabled or age 60 or older: ¥1.8 million per year).
So, your spouse would be recognized as a dependent from the time of retirement until reception of employment insurance unemployment benefit payments begin. However, it will be necessary to complete (change) procedures to remove your spouse from your dependents when reception of unemployment benefit payments begin.
When the payment period ends, your spouse will be recertified as a dependent, but during the payment period he will be enrolled in National Health Insurance, so please complete the enrollment procedures at your local National Health Insurance counter.

I'm the eldest son. I would like to support my parents who live out in a rural area.

Parents, grandparents, spouses, children, grandchildren, and younger siblings can be certified as dependents even if they do not live with you.
However, this is conditioned upon there being no other person to support them. For example, if your parents lived with your younger brother, your younger brother would be responsible for supporting them, and they would not be certified as your dependents unless there were a considerable reason that your brother could not support them.
In addition, the Health Insurance Society certifies dependents based on your track record of providing them with economic support, so it would be necessary to show proof of the actual amount provided as assistance. Please consult with the human resources department of your company, which is the contact for such matters.

Insurance Premiums/
Insurance Benefits

The medical expenses I paid at the hospital when I was hospitalized were over ¥270,000. I heard that I could file a claim for high medical expenses. How do I do that?

Beginning with examination and treatment received in January 2015, out-of-pocket medical expenses that exceed the maximum for high medical expenses (Category A: ¥252,600 + (Medical expenses - ¥842,000) x 1%; Category B: ¥167,400 + (Medical expenses - ¥558,000) x 1%; Category C: ¥80,100 + (Medical expenses - ¥267,000) x 1%) are eligible for payment of health insurance benefits from the Health Insurance Society.

There are no procedures to be completed. Amounts are calculated automatically based on the statement of medical expenses the Health Insurance Society receives from the healthcare provider, and out-of-pocket amounts over ¥20,000 (combined total of additional benefits and high medical cost benefits), excluding meals and amenity bed costs while hospitalized, will be paid. The payment will be made at the end of the month approximately three months after the month in which the exaination/treatment was received.

[High medical expenses and additional benefit amounts for individuals between the ages of 0 and 15 (third year of junior high school)]

Assistance with medical expenses is provided by the local municipality (the contents of the assistance differ by municipality), so automatic payment is not provided. If you incur high medical expenses, please contact the Health Insurance Society.

In some cases, the destination for payment of benefits is unclear, so please be sure to indicate the account to deposit payments in the personal information section of the health insurance website.

I was injured while traveling, and didn't have my health insurance card with me, so I paid the entire amount myself. How do I file a claim for that amount?

Enter the required information on a "Medical Expense Benefit Payment Request" form, attach the statement of medical expenses (health insurance claim) and the receipt (original) issued by the healthcare provider, and submit them to the Health Insurance Society via the human resources department of your company. The case will be reviewed and the payment will be made by the Health Insurance Society based on the established criteria.

Physical Examinations

How to receive the Works Human Intelligence Health Insurance Society Health Insurance physical examination and comprehensive medical examination

1. As a rule, there are two types of physical examination: Adult physical examination (lifestyle disease examination) for people under age 35 and a comprehensive medical examination for people age 35 or older. Appointments for comprehensive medical examinations, etc., must be made online or by phone.
2. When you make an appointment, the Health Insurance Society will send you a "Physical Examination Approval Form" by e-mail, postal mail, or fax. (Choose your desired method.)
3. On the day of your appointment, please take your health insurance card for identification and the "Physical Examination Approval Form."

In the adult physical examination (lifestyle disease examination), stomach x-rays and gynecological examinations are optional.

Due to the risk of radioactive contamination of young people from being x-rayed every year, it is left up to the individual to decide whether to do so.
Individuals who are concerned about their gastrointestinal health and individuals who have not been x-rayed for a number of years should have x-rays taken. You will not incur additional out-of-pocket expenses for this.
Gynecological examinations are also at the request of the individual.

Are the results of my examination secure?

Both the healthcare providers and the Health Insurance Society have an obligation to observe confidentiality.
The Industrial Safety and Health Act requires business operators to provide employees with a legally stipulated physical examination once each year.
However, in this case as well, only comprehensive reports are submitted to officials, such as the number of individuals who received physical examinations and the results. Personal information is not included. The Society compiles the examination results to gain an understanding of the health of people covered by Works Human Intelligence Health Insurance Society Health Insurance. In consultation with industrial physicians, we strive to provide everyone with programs that will be helpful in managing their health.

I would like to add optional tests to a physical examination or comprehensive medical examination. Can I use points for that?

Points can be used for any of the options registered on the Health Insurance website.
Although we coordinate with healthcare providers prior to listing options on the website, if the option that you plan to receive is not listed, please contact the Health Insurance Society.
Because points can only be used for appointments made in advance, options added on the day of your examination must be paid for in cash. Please make an appointment with the healthcare provider or on the Health Insurance website in advance.

I would like to receive a gastroendoscopy instead of stomach x-rays as part of the comprehensive medical examination.

From the perspective of health insurance, there is not a significant difference in cost, and many people undergo a gastroendoscopy as a second examination as a result of stomach x-rays, so it will be allowed instead of stomach x-rays as part of the first examination if the healthcare provider is able to accommodate.
However, it will not be allowed if the healthcare provider requires fees for both x-rays and the gastroendoscopy in such cases. Please keep this in mind.

I would like to be examined at a non-contracted healthcare provider.

Please be examined at a contracted healthcare provider. The Health Insurance Society's contract fees are much lower than normal fees.
If there is a specific healthcare provider that you would like to use, please contact the Health Insurance Society through the assigned person at your workplace, at the discretion of your workplace. Additional contracts will be considered.
Healthcare providers, etc., with a low rate of examinations are reviewed each year, and contracts may be canceled in some cases if it is judged that the provider is not suitable.

I'm over 35 years old, but I only want to receive the adult physical examination (lifestyle disease examination).

The examination is conducted at the request of the individual, so it is up to you.
We recommend that individuals in the specified age group receive the comprehensive medical examination as much as possible.

I would like to receive a comprehensive medical examination twice each year.

Although there may be a need for two examinations per year with advanced age, the Health Insurance Society's subsidy is limited to once each fiscal year (from April to March of the following year).
However, Cafeteria Points can be used for the second examination, so please consult with the Health Insurance Society.

I'm under age 35. Can I receive a comprehensive medical examination?

The Health Insurance Society does not cover the cost of outpatient comprehensive medical checkups for insured individuals and their dependents who are under age 35. You will be responsible for the entire cost in such cases. (In addition, the difference in cost will not be paid, and points cannot be used.)

Are second examinations covered by health insurance?

The handling of costs for second examinations is as follows. (Please be sure to receive the second examination no later than three months after the initial examination.)

• When the reexamination is conducted by the same healthcare provider as the initial physical examination
  No payment is required at the time of the examination. The healthcare provider will bill the Health Insurance Society for the entire amount.
  * However, some healthcare providers handle second examinations and in-depth examinations as "health insurance examination/treatment" and require payment of 30% of the cost at the time of the examination. Please be aware that you will be responsible for payment in such cases.
• When the reexamination is conducted by a non-contract healthcare provider (No health insurance subsidy)
  • You will be responsible for payment of 30% of the cost charged at the time of the examination.
  • Subsidies for costs at some contract healthcare providers where payment of 30% is required at the time of the examination have been discontinued.

[How to receive the examination]

It is not necessary to apply online. Please contact the healthcare provider that conducted the initial examination directly.

Post-retirement Health Insurance

I would like to continue optional enrollment after retirement. How much will my premium be? Also, which saves me more money, this coverage or National Health Insurance coverage?

The premium for the Voluntarily and Continuously Insured Persons System is calculated by multiplying your standard monthly compensation at the time of your retirement, or the average standard monthly compensation of all individuals insured by the Society (see the notice from the Health Insurance Society), whichever is lower, by the insurance premium rate.
National Health Insurance premiums are calculated based on your income for the previous year. However, the calculation method is different for each municipality, so please contact your local National Health Insurance counter for specific details.

The Health Insurance Society's health insurance has healthcare programs and added benefits systems not available from National Health Insurance, so be sure to make your decision based not only on premiums, but on all aspects.

How do I pay premiums for the Voluntarily and Continuously Insured Persons System?

After the application for eligibility for voluntary continuous insured has been received, the Health Insurance Society will send you an insurance premium payment slip. Please transfer payment to the Health Insurance Society's account from the teller's counter of your financial institution, or from an ATM, etc., by the payment deadline. When the payment has been confirmed, you will be sent your new insurance card.
Please note that you will be responsible for any fees required for the transfer.

I'm retiring at the end of March. How do I pay insurance premiums?

Premiums can be paid monthly, or prepaid for six months at a time (from April through September and from October through March of the following year) or for the entire year (from April through March of the following year). If you select prepayment, you will receive a discount on your premium. Please contact the Health Insurance Society for the amount and other details.
The amount for the first month is not applicable, but the prepayment will be the amount for the next month through March of the following year.

Can I withdraw from enrollment in optional continued coverage early?

Please be aware that once you have enrolled, you cannot withdraw (forfeit eligibility) except in the following cases. Individuals who would like to prepay should pay particular attention.

1. The enrollment period has reached two years.
2. The individual has enrolled in other health insurance due to new employment. (National Health Insurance is not included.)
3. The premium has not been paid by the payment deadline.
4. The individual has died.
5. The individual is now covered under latter-stage elderly healthcare insurance.

The individual has been employed again. I would like to withdraw from enrollment.

Please fill out the necessary sections of the Notice of Loss of Eligibility as a Voluntarily and Continuously Insured Person form and submit it to the Health Insurance Society along with your optional continued insurance card and a copy of your insurance card from your new company.
If any part of your premiums is to be refunded due to prepayment, etc., you will be sent a refund statement once the procedures for forfeiture of eligibility have been completed.
The refund will be transferred to the designated account by the end of the month in which it is processed.

I plan on withdrawing by not paying the premium. Is there any procedure I need to complete for that?

Please promptly return the insurance cards of all family members to the Society once the payment deadline has passed.
When forfeiture procedures have been completed, you will be sent an Eligibility Forfeiture Notice.

Personal Information Protection

Is personal information ever provided to third parties without the consent of the individual?

Personal information is not provided to third parties without the consent of the individual except in the following cases.

• Matters that legally do not require consent and matters that do not apply to third parties
  1. When sending health insurance claims to examining organizations and other cases based on laws and regulations
  2. Cases of emergencies, disasters, etc., in which it is required to protect human life, physical health, or property, and in which it is difficult to obtain the consent of the individual
  3. Cases in which it is necessary for public health or the wholesome development of children, and in which it is difficult to obtain the consent of the individual
  4. Cases in which it is necessary to provide cooperation to national governmental bodies or local public entities, to perform work stipulated by laws and regulations, and in which obtaining the consent of the individual may hinder the performance of the applicable work
  5. Subsidy projects related to payment of high medical expenses conducted jointly with Kenporen
• Comprehensive consent items
  Notification to an entire household in the case of medical expense statements and notification of insurance benefit payment decisions

The Act on the Protection of Personal Information stipulates that the right to disclose, correct, add, delete, terminate use of, or eliminate personal data belongs to the individual enrollee.

The majority of personal data on enrollees held by the Health Insurance Society is held due to notification, etc., based on the Health Insurance Act. The Health Insurance Act stipulates mandatory enrollment at each business site, excluding people covered by optional continued insurance. As a rule, the data cannot be deleted or eliminated at the request of the enrollee. The remaining right is to terminate use of the personal data, but even if termination of use of personal information is requested, in many cases, the individual will no longer be able to receive benefits or undergo physical examinations. In addition, it is also possible that benefits to the enrollee will be lost in other healthcare business as well. This means that, practically speaking, the rights related to the work of the Health Insurance Society that enrollees can exercise are limited to disclosure, correction, and termination of use of part of the data.

I'm absent from work due to illness. If my supervisor asks the Health Insurance Society for the name of my illness, etc., will it be provided?

As a rule, personal information will not be provided to third parties without the consent of the individual. In such cases as well, the name of the illness or injury will not be disclosed without the consent of the individual.

Can I make inquiries about my ID and password over the phone, etc.?

When inquiries are made, it is necessary for the Health Insurance Society to verify the identity of the individual. Please be aware that it could take some time to go through the process of identification. Be sure to manage your ID and password, etc., responsibly.

How can I let you know when I have questions or requests about the handling of personal information?

The Health Insurance Society has a "Privacy Officer," so please communicate with your contact with the Health Insurance Society. We will do our best to respond quickly and appropriately.

Cafeteria Points

I was just hired. I would like to use the Health Insurance Society's Cafeteria Points.

To access the Works Human Intelligence Health Insurance Society website, you will need to acquire an ID and password.
Preparation for initial registration is generally completed in about one week after notification of eligibility is received from the human resources department of the individual company. Please access "Initial Registration" on the Home page of the website and complete the procedures for acquiring your ID and password.

I was hired in October. What will happen with the points I'm given?

Points are given in fiscal year (April through March of the following year) units based on the health insurance budget. New employees are given points for the months remaining (6 months) in that fiscal year from October.

I plan to retire from the company at the end of this month. How long can I use my Cafeteria Points?

You can use your points until the day of your retirement.
Please note that if you use points after your day of retirement, you will be billed at a later date for corresponding amount.

The use of points is limited to the menu used while employed.
In the case of travel and physical examinations, assessment is based on the date of use, so even if you make an appointment prior to retirement, points cannot be used if the date of the appointment is after the retirement date.
In the case of purchases of pharmaceuticals, the date of application is considered to be the date of use, so points can be used even if the application was made prior to retirement but the items were received after retirement.

I would like to continue optional enrollment after retirement. Will I be able to use Cafeteria Points?

When you enroll in optional continued coverage, you can continue using the remaining balance of points from when you were still employed. Your ID and password will also remain the same.
You can use Cafeteria Points until the day before you lose optional continued coverage.

I retired from the company, then the next day I was hired by a different company that is a member of the same Works Human Intelligence Health Insurance Society. What will happen to my Cafeteria Points in this case?

If you take employment with a different company on your own volition, the Cafeteria Points you had while with the previous company will no longer be valid as of the day after your retirement date. At the new company, you will be handled as a mid-year hire. You will be given points for the months remaining in that fiscal year. We apologize for the inconvenience, but you will need to complete the initial procedures again on the Health Insurance Cafeteria website. Preparation for initial registration is generally completed in about one week after notification of eligibility is received from the human resources department of the individual company. Please access the Home page of the website and complete the procedures for acquiring your ID and password.
If your transfer to a different company was for reasons attributable to the previous company, the balance of points you had at the time you left the previous company can be used at the new company as well. Your ID and password will also remain the same.

I have multiple types of Cafeteria Point. In what order are they used?

The order in which Cafeteria Points are used is as follows, regardless of their expiration date.

* However, if there are points of the same type that have differing expiration dates, they will be used in order of soonest expiration date.

1. Bonus points (Points granted during various campaigns)
2. Purchased points (Points purchased on or after Wednesday, October 10, 2018)
3. Granted points (Points granted by the Health Insurance Society)
4. Purchased points (Points purchased on or before Tuesday, October 9, 2018)