IBM Japan Health Insurance Association

IBM Japan Health Insurance Association

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If you paid the entire medical care cost up front

In some cases under the health insurance system, if you paid the entire medical care cost to the medical care institution or other facility up front, the Health Insurance Association will reimburse you later.

If you paid the entire medical care cost up front

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 Association 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

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 basic charges (80% for preschool child) as the cost of blood for a live blood transfusion
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 basic charges (80% for preschool child) for insured persons and dependents
If you underwent acupuncture, moxibustion, massage, or similar treatment with a physician's consent 70% of basic charges (80% for preschool child) for insured persons and dependents
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 cost of preparation or purchase (up to the maximum amount) for children of less than nine years of age (80% for preschool child)
  • Note: The maximum amount is the cost of glasses for amblyopia (36,700 yen) or contact lenses (15,400 yen/lens) x 1.048
If you purchased a compression garment or similar item to treat lymphedema of the arms or legs

70% of basic charges (80% for preschool child) for insured persons and dependents

Maximum amounts:

  • Compression stockings: 28,000 yen (25,000 yen for single foot)
  • Compression arm sleeves: 16,000 yen
  • Compression gloves: 15,000 yen

If you become sick or are injured overseas

Caution: You can also be reimbursed for medical care costs paid for examination and treatment at medical care institutions overseas as “Medical Care Expenses”. However, note the following:

  • Benefits will not necessarily cover all the costs you paid.

    • ** Since the level and cost of medical care vary by country, the amount eligible for coverage through benefits is calculated based on medical care costs established under the health insurance system in Japan, using as reference “an attending physician's statement” and “itemized receipts” issued by the overseas hospital.
  • You must submit all of the following to claim benefits: attending physician's statement; itemized receipts; copy of docment verifying your overseas travel (such as a passport); and letter stating that you aggree to the health insurance society making detailed inquiries to the overseas medical care institution or other organization about your treatment.
  • Any documents attached in a foreign language must be translated into Japanese.
  • Treatment not covered by insurance in Japan will not be eligible for benefits.
  • Benefits will not be paid if you went overseas specifically to undergo treatment.

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.

Caution

  • This applies only to cases in which a doctor recognizes the need for temporary or emergency transportation.
  • The advance approval of the Health Insurance Association is required (or after the fact in unavoidable situations).
  • Non-emergency transportation costs, such as the cost of ordinary visits to the hospital, are not eligible for these benefits.

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 Association 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

Examples of cases in which transportation expenses will be paid

Administrative notice based on Article 80 of the enforcement regulations to the Health Insurance Act: Specific examples in which payment of transportation expenses is authorized

  • An injured patient is transported by emergency transportation from the site of an accident, etc. to a medical care institution.
  • A patient is hospitalized with a grave condition or seriously injured on a remote island or similar location, then subsequently transported to the nearest medical care institution capable of providing required treatment not available or extremely difficult to provide at medical care institutions near where the illness or injury occurred.
  • A patient unable to move on his or her own is transferred between hospitals on doctor’s orders due to an emergency condition not adequately treatable at the original medical care institution.]

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.

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