Health Insurance System
List of insurance benefits
An Insured Individual Benefits List
If you become sick or are injured
| edical Care Benefits | 70% of the medical expenses for both out-patient and in-patient care |
|---|---|
| High Agregate Cost for Long-term Care Service |
80% of the medical expenses for both out-patient and in-patient care * However, 70% for individuals age 70 to age 74 who are earners of income comparable to active service.
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| High Agregate Cost for Long-term Care Service | 70% of the medical expenses for treatment within the scope of health insurance if combined with non-covered treatment |
| Medical Care Expenses | A standard amount will be paid if you submit a claim to the Health Insurance Society after paying expenses yourself. |
| High-Cost Medical Care Benefits | When your copayment on medical care costs for a single case in one month exceeds the Cost-Sharing Maximum Amount for your income category, the excess amount is paid (Measures to reduce cost burden,for example,by calculating on the basis of total medical expenses paid by one household, are available). |
| Non-insured Associated Medical Care Expenses | If there are two or more cases of out-of-pocket payments of ¥21,000 or more during the same month and in the same household, and the combined total exceeds the maximum amount, the excess amount |
|
Copayment refund/ Aggregated high medical expenses additional amount (additional benefit) |
The amount resulting from deducting ¥20,000 from the out-of-pocket amount is paid. |
| Combined total of high-cost nursing care expenses | If the combined total of out-of-pocket payments of medical and nursing care expenses for one year exceeds the maximum limit, the excess amount proportionally divided according to the ratio of medical and nursing care |
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In-patient dietary treatment expenses/ In-patient daily living treatment expenses |
The amount of meal expenses exceeding ¥460 for each meal, for up to three meals per day. (In the case of in-patient daily living treatment expenses) The amount of housing expenses exceeding ¥370 per day * There are measures available to mitigate the burden on low income earners, etc.
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| Home-visit Nursing Expenses | 70% of the stipulated expenses |
|
ome-visit Nursing Expenses Additional amount (additional benefit) |
The amount resulting from deducting ¥20,000 from the out-of-pocket amount is paid. |
| Transportation Expenses | The actual expenses within the range of the standard amount calculated by the Health Insurance Society |
If you take time off from work due to sickness
| Injury and Sickness Allowance | Amount equal to two-thirds of the average standard monthly remuneration over the most recent 12-month period÷30 paid per day off over 18 months,starting from the fourth day off |
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Childbirth
| Maternity Allowance | Amount equal to two-thirds of the average standard monthly remuneration over the most recent 12-month period÷30 paid per day off over the period starting from the 42nd day prior to the anticipated due date (98th day prior to anticipated due date for multiple births;also paid for days after anticipated due date if the birth is late) through the 56th day after delivery |
|---|---|
| Lump-sum birth/childcare benefit |
Pays ¥500,000/child When deliver it at hospitals of a case of the delivery within number 22 weeks and the obstetrics medical care compensation system non-participation in a week for gestational ages;¥488,000) |
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Lump-sum birth/childcare benefit Additional amount (additional benefit) |
Pays ¥120,000 per child |
Death
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Funeral Expenses/ Funeral Costs |
Pays ¥50,000 |
|---|---|
|
Burial fees additional amount (Additional benefit) |
One month of the standard monthly compensation (¥360,000 max.) |
Family (Dependent) Benefits List
When an individual has suffered an illness or injury
| Family medical treatment expenses | 70% of the medical expenses for both out-patient and in-patient care |
|---|---|
|
Family medical treatment expenses (Children before entry to elementary school/Individuals age 70 to age 74) |
80% of the medical expenses for both out-patient and in-patient care * However, 70% for individuals age 70 to age 74 who are earners of income comparable to active service.
|
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Expenses for combined covered/ non-covered medical care* |
70% of the medical expenses for treatment within the scope of health insurance if combined with non-covered treatment |
| Medical treatment expenses* | A standard amount will be paid if you submit a claim to the Health Insurance Society after paying expenses yourself. |
| High-Cost Medical Care Benefits | If the amount of out-of-pocket payments of medical expenses in a single month exceeds the stipulated amount, the excess amount (There are also measures to mitigate the burden, such as totaling amounts for the entire household.) |
| Aggregated high medical expenses | If there are two or more cases of out-of-pocket payments of ¥21,000 or more during the same month and in the same household, and the combined total exceeds the maximum amount, the excess amount |
|
Additional amount for family medical treatment expenses/ Additional amount for aggregated high medical expenses(additional benefit) |
The amount resulting from deducting ¥20,000 from the out-of-pocket amount is paid. |
| Combined total of high-cost nursing care expenses | If the combined total of out-of-pocket payments of medical and nursing care expenses for one year exceeds the maximum limit, the excess amount proportionally divided according to the ratio of medical and nursing care |
| In-patient daily living treatment expenses |
The amount of meal expenses exceeding ¥460 for each meal, for up to three meals per day. (In the case of in-patient daily living treatment expenses) The amount of housing expenses exceeding ¥370 per day * There are measures available to mitigate the burden on low income earners, etc.
|
| Family home-visit nursing expenses | 70% of all stipulated expenses |
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Family home-visit nursing care expenses Additional amount (additional benefit) |
The amount resulting from deducting ¥20,000 from the out-of-pocket amount is paid. |
| Family transportation costs | The actual expenses within the range of the standard amount calculated by the Health Insurance Society |
* When "expenses for combined covered/non-covered medical care," "treatment expenses," "in-patient dietary treatment expenses," or "in-patient daily living treatment expenses" are paid to a dependent, they are paid as "family medical treatment expenses."
When an individual has given birth
|
Family lump-sum birth/ childcare benefit |
¥500,000 per child (¥488,000 if birth took place before 22 weeks or the individual gave birth at a hospital, etc., that is not a member of the Japan Obstetric Compensation System for Cerebral Palsy) |
|---|---|
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Family lump-sum birth/childcare benefit Additional amount (additional benefit) |
¥120,000 per child |
When an individual has died
| Family member burial fees | Uniform ¥50,000 |
|---|---|
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Family member burial fees additional amount (Additional benefit) |
Uniform ¥50,000 |