If you paid the entire medical care cost up front

If you paid the entire medical care cost up front

Medical Care Expenses (for dependents, Dependents' Medical Care Expenses)

• ** Benefit ratios vary by age and income
• ** Benefits will not necessarily cover all the costs you paid.
  The amount paid is calculated based on treatment methods and charges authorized under the Health Insurance Act.

If you have undergone treatment at a medical care institution without showing your health insurance card in cases such as sudden sickness while traveling, you will have to pay the entire amount of medical care costs yourself. However, you can apply to the Health Insurance Society for reimbursement of the amount you paid up front corresponding to the cost of insured medical consultation and treatment.
The benefits paid for such medical care costs paid up front are referred to as "Medical Care Expenses."

Reference link

• If you become sick or are injured

Medical Care Expenses will be paid in cases such as these

Even if you did not show your health insurance card, health insurance will pay "Medical Care Expenses" in cases such as the following:

Reason for payment of Medical Care Expenses	Benefit details
If you received a live blood transfusion	70% of the basic charges
If you purchased and used prosthetic equipment such as an artificial arm or leg, an artificial eye, or a corset, as instructed by a physician	70% of the basic charges
If you underwent acupuncture, moxibustion, massage, shiatsu, or similar treatment with an insurance doctor's approval Reference link If you underwent acupuncture, moxibustion, massage, or shiatsu with an insurance doctor's approval	70% of the basic charges
If you had eyeglasses or contact lenses prepared and purchased to treat juvenile amblyopia or other condition in a child of less than nine years of age	70% of the basic charges or the maximum amount, whichever is the smaller (80% for a preschool child)
When purchasing a compression garment to treat the following diseases Lymphedema of the arms or legs occurring after surgery for malignant tumor involving lymph node dissection (extensive resection) in the groin, pelvic region, or axillary region; primary lymphedema of the arms or legs Intractable ulcer due to chronic venous insufficiency	70% of the basic charges or the maximum amount, whichever is the smaller
If you purchased limbal-supported rigid contact lenses for disfigured corneas due to ocular sequelae after experiencing Stevens-Johnson syndrome or toxic epidermal necrolysis:	70% of the basic charges or the maximum amount, whichever is the smaller

If you become sick or are injured overseas

If you suffer from a sudden illness or injury while posted abroad or on an overseas business trip and have no choice other than to have a medical consultation at a local medical care institution, the medical care costs you paid can be refunded as "medical care expenses." However, these benefits do not cover cases of travel overseas to receive medical treatment that is also available in Japan, medical acts that are not covered by insurance in Japan, etc.
Because overseas medical care expenses are generally calculated by converting them to the equivalent treatment costs of medical care received in Japan, the amount that is refunded may differ greatly from the amount that was actually paid, depending on the country or medical care institution.
Caution:

• Treatment that is not covered by insurance in Japan is not eligible for benefits.
  • Cosmetic surgery
  • Implants, orthodontics, expensive dental materials, etc.
  • Childbirth costs (natural delivery)
  • Medical care costs that are not part of medical consultation and treatment in Japan, premium bed costs, meal costs, etc.
• No benefits are paid if treatment is received after going overseas for the purpose of treatment.
• Injuries due to the acts of third parties, including traffic accidents and fights, injuries while on the job, etc.

Even in the case of medical expenses that are covered by benefits, please note the points below.

• Not all paid costs are eligible for benefits.
  • * As the level of treatment and treatment costs differ depending on the country, benefits will cover an amount calculated based on the treatment costs stipulated for Japanese health insurance based on the details of medical treatment and itemized receipts issued by overseas hospitals.
• For each claim, it is necessary to attach the details of medical treatment, itemized receipts, a copy of documents (passport, etc.) that can be used to confirm the fact that you traveled, and a letter of consent to inquire with the overseas medical care institution, etc.
• In the case of documents created in a language other than Japanese, a Japanese translation will be necessary.

When you cannot walk to or between hospitals

Transportation Expenses (for dependents, "Dependents' Transportation Expenses")

If a patient finds it very difficult to walk due to sickness or injury and he or she must visit the hospital or transfer between hospitals for treatment purposes, the cost of transportation will be paid as "Transportation Expenses" as deemed necessary by a doctor.

Standards under which you can receive Transportation Expenses

Transportation Expenses will be paid when a doctor recognizes the need for temporary or emergency transportation and the Health Insurance Society has determined that all of the following conditions apply:

• The medical care for which the transportation is required is appropriate as insured medical consultation and treatment.
• The sickness or injury for which the treatment is required makes it difficult for the patient to move.
• In an emergency or other unavoidable case

Details of benefits

The amount paid as "Transportation Expenses" is the cost of transportation calculated based on the standard amount, assuming use of the most economic and ordinary routes. In the case the actually incurred expenses were less than the standard amount, only the actual expenses will be paid.

Costs eligible for payment of Transportation Expenses

Costs eligible for payment are:

• Fares when using automobile, train, or other means;
• In principle, transportation and associated costs for up to one person if an accompanying doctor or nurse is required.

If the patient has paid the costs for medical administration of the accompanying doctor or nurse, that amount will be paid as Medical Care Expenses. Transportation Expenses will be paid for the transportation of patients who find it impossible or difficult to walk; it will not be approved for the cost of transportation used for ordinary visits to the hospital or the cost of transporting bedding or other personal belongings needed for hospitalization.