If you become sick or are injured

If you become sick or are injured, you can use health insurance to get necessary medical treatment by making in principle a copayment of 30% of the medical care costs. The amount paid at the hospital counter is even lower for preschool children and elderly persons aged 70 or older.

Description
FAQ

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

Amounts paid

Copyment:
30%
Medical Care Benefits (Paid by the Health Insurance Society):
70%

The copayment may be even lower, depending on age.

Preschool children (20% copayment)

20%
80%

Persons aged 70-74(20% copayment) * Excluding those earning income equal to active workers

20%
80%

Using health insurance, you can get necessary medical care for treatment of nonoccupational sickness and injury by making a copayment of 30%. This is referred to as "Medical Care Benefits" (for dependents, "Dependents' Medical Care Expenses"). You pay only 30% of medical care costs at the medical care institution because the Health Insurance Society covers the remaining 70%.

The society's additional benefits

(Paid per month, per person, per hospital)

Copayment
Copayment
20,000 yen		 The society's additional benefits
Patient Cost-Sharing Reimbursements
(Dependents' Medical Care Additional Sum)
  • ** This benefit excludes amounts paid as High-cost Medical Care Benefits, as well as costs such as meal expenses, accommodation expenses, and premium bed expenses during hospitalization, from the copayment amount.
  • ** The benefit will not be paid if the calculated amount is less than 1,000 yen. The calculated amount will be rounded down to the nearest 100 yen.

Partient Cost-Sharing Reimbursements(For dependents : Dependents'Medical Care Addiitional Sum)

Total eligible copayment amount (excluding total high-cost medical care benefits and standard expenses for inpatient meal and living expenses) minus 20,000 yen per case, as "Patient Cost-Sharing Reimbursements" (for dependents, "Dependents' Medical Care Additional Sum"). This payment is calculated and made automatically based on "the Rezept (medical cost details)" sent by the hospital to the Health Insurance Society. Payment will occur roughly three months after the month of the medical care.
See "When you incur high medical care costs: How High-Cost Medical Care Benefits are calculated" for a specific calculation example.

Meals during hospitalization

If you are hospitalized, in addition to the 30% copayment on medical care costs, you must also pay yourself as meal expenses (referred to as "inpatient meal standard expenses") 490 yen/meal for up to three meals/day (280 yen/meal for patients with intractable diseases or specific chronic diseases of children).

While the actual cost of meals during hospitalization is 670 yen/meal (up to three meals/day) based on standard meal expenses, the Health Insurance Society pays the amount in excess of inpatient meal standard expenses, as "Inpatient Meal Expenses".

In addition, when an elderly person aged 65-74 is hospitalized in a long-term care bed, he or she pays meal expenses of 490 yen/meal (450 yen/meal at some medical care institutions) and accommodation expenses of 370 yen/day (**1) (called "the standard personal cost burden for living expenses"). The Health Insurance Society pays the amount of actual costs in excess of this standard personal cost burden for living expenses as "Inpatient Living Expenses."

  • **1: For patients with designated intractable diseases, the copayment for meal expenses is 280 yen, while the copayment for accommodation expenses is 0 yen.
  • **2: Costs are reduced still further for persons with low income. See here for more information.