IBM Japan Health Insurance Association

IBM Japan Health Insurance Association

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List of insurance benefits

Introduced below are the insurance benefits provided by the Society.

If you become sick or are injured

When benefits are paid Insurance benefits
** Benefits in parentheses are paid to dependents.
If you have received medical care for a nonoccupational sickness or injury using your health insurance card Medical Care Benefits (Dependents' Medical Care Expenses)
70-90% of medical care costs are provided as benefits-in-kind.
See here for details.
For meal and other expenses during hospitalization

Inpatient Meal Expenses, Impatient Living Expenses (Dependents' Medical Care Expenses)
Patient pays a copayment of 360 yen/meal, with the remainder provided as benefits-in-kind.

  • ** For patients with intractable diseases or specific chronic diseases of children, the patient cost-sharing amount is 260 yen/meal.
  • ** For patients aged 65 or older hospitalized in a convalescent facility, the patient pays copayments of 460 yen/meal and 320 yen/day in accommodation expenses. The rest is provided as benefits.

See here for details.

If you paid the entire medical care costs up front

Medical Care Expenses (Secondary Dependent Medical Costs)
Reimbursed based on requests if you receive medical care without a health insurance card due to unavoidable circumstances or purchase prosthetic equipment for treatment purposes

See here for details.

If you used medical transportation services

Transportation Expenses (Dependents' Transportation Expenses)
Amount calculated based on standards will be paid upon request when transported as instructed by a doctor

See here for details.

If you received nursing care on a visitation basis

Home-Visit Nursing Care Expenses (Dependents' Home-Visit Nursing Care Expenses)
70-90% of medical care costs are provided as benefits-in-kind.

See here for details.

If you incurred high medical care costs

High-Cost Medical Care Benefits (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).

See here for details.

additional benefits(The Health Insurance Association also provides its own independent benefits with Statutory Benefits)

See here for details.

If your combined copayments for health insurance and long-term care insurance are high

High Agregate Cost for Long-term Care Service (High Aggregate Cost for Long-term Care Service)
When the aggregate total of copayments paid on medical and long-term care over a single year exceeds the maximum, the amount in excess of the maximum, corresponding to the ratios of medical and long-term care costs.

See here for details.

If you received non-insured associated medical care

Non-insured Associated Medical Care Expenses (Dependents' Medical Care Expenses)
Benefits-in-kind for 70–90% of regular medical care costs

See here for details.

If you take time off from work due to sickness

When benefits are paid Insurance benefits
If you take at least four unpaid days off from work due to nonoccupational sickness or injury

Injury and Sickness Allowance
Amount equal to two-thirds of 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

See here for details.

Childbirth

When benefits are paid Insurance benefits
Childbirth after at least four months (85 days) of pregnancy

Childbirth and Childcare Lump-Sum Grant (Dependents' Childbirth and Childcare Lump-Sum Grant)
Pays 420,000 yen/child

See here for details.

If you take unpaid time off from work for 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

See here for details.

Death

When benefits are paid Insurance benefits
Death due to nonoccupational reasons

Funeral Expenses/Funeral Costs(Dependents' Funeral Expenses)
Pays 50,000 yen

See here for details.

After you leave your employer

When benefits are paid Insurance benefits
If you were receiving Injury and Sickness Allowance at the time you left your employer

Injury and Sickness Allowance

See here for details.

If you were receiving Maternity Allowance at the time you left your employer

Maternity Allowance

See here for details.

If childbirth occurred within six months after leaving the employer

Childbirth and Childcare Lump-Sum Grant

See here for details.

In the event of death within three months after leaving the employer

Funeral Expenses/Funeral Costs

See here for details.

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