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Procedures

Receiving medical treatment
for non-insurance combination therapy

As for health insurance, as a general rule, all medical expenses, including medical treatment for health insurance, are to be borne by yourself when you receive medical treatment other than medical treatment.
However, even if you receive medical treatment other than insurance medical treatment, you can use the "evaluation medical treatment", "patient application medical treatment", and "selected medical treatment" specified by the Minister of Health, Labor and Welfare in combination with insurance medical treatment. In that case, all medical expenses other than insurance medical care will be borne by yourself, but for general insurance medical care, the portion other than part of the medical insurance will be covered by insurance benefits as "outside insurance medical treatment expenses".

Out-of-insurance combined medical expenses

There are the following three types of "out-of-insurance concomitant medical treatment expenses" approved by the Minister of Health, Labor and Welfare.

Evaluation medical treatment

Items that need to be evaluated from the perspective of efficiently providing appropriate medical care, items that aim for future insurance coverage

  • Advanced medicine
  • Pharmaceutical clinical trials
  • Medical device clinical trials
  • Administration of approved drugs before listing on the NHI price list
  • Use of approved medical devices before insurance coverage
  • Off-label use of drugs listed in the drug price standard

Patient application medical treatment

A mechanism for confirming the safety and effectiveness of advanced medical care desired by a patient, starting from the patient's request, so that the patient can receive it promptly at a nearby medical institution. It is a prerequisite that the medical treatment is aimed at insurance coverage in the future.
To make an application, please consult your medical institution such as your doctor first.

Medical treatment

Of medical treatments that are not covered by insurance, special medical treatments that patients wish to receive

  • Providing a special medical care environment
  • Reservation medical treatment
  • Overtime treatment
  • First visit to an unreferred patient in a hospital with more than 200 beds
  • Reexamination of a hospital with 200 beds or more
  • Medical activities that exceed the limit
  • Hospitalization for more than 180 days
  • Material difference for front teeth
  • Metal floor complete denture
  • Continuous management after treatment of pediatric caries

Specific example of non-insurance combined medical expenses

  • Part of dental care
    If you use materials or treatments that are not approved by health insurance, you will be treated as a free medical treatment, and you will have to pay all your own expenses. You only have to pay for the difference from the range allowed in.
  • Receiving advanced medical care
    If you receive advanced medical treatment that is not covered by insurance at university hospitals or special function hospitals, insurance will be applied to the basic parts other than the medical treatment (such as hospital charges and drug fees). The portion not covered by the insurance payment will be borne by the individual as the difference. Please note that some advanced medical treatments are not yet covered by this system.
  • Room charge for hospitalization
    Under health insurance, hospitalization is supposed to be in a general room, but if you wish, you can also enter a senior room such as a private room. In that case, you will have to pay for the difference from the hospitalization fee set by your health insurance.
    However, if you are admitted to an advanced room for the convenience of the hospital, or if you enter an intensive care unit due to therapeutic needs, you do not have to pay the difference.
  • When you first visit a large hospital without a letter of referral
    A special fee will be added to the initial consultation fee, and that portion will be borne by you.
    When a doctor visits a special function hospital or a hospital with more than 400 beds without a letter of referral, the patient will be required to pay a certain amount in principle due to the mandatory medical treatment.
  • 180 days hospitalization
    If you continue to be hospitalized due to the patient's circumstances despite the low need for hospitalization, only 85% of the basic hospitalization fee will be covered by insurance benefits, and you will be responsible for the difference.
  • Receiving medical treatment after hours
    If you receive overtime treatment, you will be charged the extra fee.
  • Receiving preventive medical care
    If you receive a medical appointment at a medical institution that has an approved medical appointment system, you will be responsible for the reservation fee.
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