IBM Japan Health Insurance Association

IBM Japan Health Insurance Association

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Childbirth

“The Childbirth and Childcare Lump-Sum Grant” is paid when an insured person gives birth and “the Dependents' Childbirth and Childcare Lump-Sum Grant” is paid when a dependent family member gives birth. Don't forget to add the newborn as a dependent in these cases.

Childbirth and Childcare Lump-Sum Grant (for dependents, “the Dependents' Childbirth and Childcare Lump-Sum Grant”)

In cases of childbirth, 420,000 yen/child is paid to help with the costs of birth. This benefit is called “the Childbirth and Childcare Lump-Sum Grant”.

We encourage you to take advantage of systems available to reduce the amount paid at the hospital

Since you must apply for payment of the Childbirth and Childcare Lump-sum Grant after childbirth, ordinarily you would have to pay a large amount of expenses at the hospital. However, you can use “the system of direct payment of Childbirth and Childcare Lump-sum Grant to medical institutions” or “the system of receipt of the Childbirth and Childcare Lump-sum Grant directly by the medical institutions on your behalf” to reduce this financial burden. When using these systems, the amount you pay at the hospital is only the amount of childbirth expenses minus the amount of the Childbirth and Childcare Lump-sum Grant.
If the amount of childbirth costs is less than the amount of the Childbirth and Childcare Lump-Sum Grant to be paid, the Health Insurance Association will pay the difference.

System of direct payment of Childbirth and Childcare Lump-sum Grant to medical institutions

Under this system, the institution where you plan to give birth applies for and receives payment of the Childbirth and Childcare Lump-sum Grant on the insured person's behalf.
Use of this system requires only the exchange of agreement documents with the institution where you plan to give birth. No application to the Health Insurance Association is required.

  • ** If childbirth costs exceed 420,000 yen, pay the excess amount to the hospital or other institution when you check out.
  • ** If childbirth costs are less than 420,000 yen, the difference will be automatically paid when the hospital or other institution requests payment from the Health Insurance Association directly. No application is required.
  • ** You must sign the proper consent documents indicating you do not wish to use the system of direct payment of Childbirth and Childcare Lump-sum Grant to medical institutions if you choose instead to apply to the Health Insurance Association for the Childbirth and Childcare Lump-sum Grant at a later date.

System of receipt of the Childbirth and Childcare Lump-sum Grant directly by the medical institutions on your behalf

Apply to the Health Insurance Association in advance to designate the institution where you plan to give birth as the direct recipient of the Childbirth and Childcare Lump-sum Grant on your behalf.
You can use this system at certain small institutions that have submitted notices to the Ministry of Health, Labour and Welfare.

Childbirth

Under health insurance system, “childbirth” refers to live birth, stillbirth, or abortion after at least four months (85 days) of pregnancy. Since normal childbirths do not qualify as insurance medical care (benefits-in-kind), the Childbirth and Childcare Lump-Sum Grant is paid in cash to assist with the costs of childbirth.

Health insurance covers abnormal childbirth and other cases treated as sickness, as well as cases such as those involving complications of other sicknesses.
In cases involving high medical care costs such as those for hospitalization or surgery, you can use “a Certificate of Application of Maximum Copayment Amount” to reduce the amount you pay at the hospital. See here for the application procedures for the Certificate of Application of Maximum Copayment Amount. “Procedures for Certificate of Application of Maximum Copayment Amount

The maternity medical care compensation scheme

This system pays compensation when a newborn child develops cerebral palsy despite being born through normal pregnancy and birth. The Japan Council for Quality Health Care manages the system, and most medical institutions providing childbirth services are members.
In principle, childbirths eligible for compensation involve birth weights of 1,400 g or more following at least 32 weeks of pregnancy in which the newborn has a serious case of cerebral palsy equivalent to a grade 1 or grade 2 physical disability (Evaluation criteria for compensation differ depending on the date of birth. See this reference link below).

Reference link

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