IBM Japan Health Insurance Association

IBM Japan Health Insurance Association

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If you take time off from work due to sickness

“Injury and Sickness Allowance” is paid when an insured person unable to earn a salary or other income while unable to work due to a nonoccupational sickness or injury.

Injury and Sickness Allowance

When an insured person is unable to earn a salary or other income while taking time off work due to a nonoccupational sickness or injury, insurance will pay him or her an amount equal to two-thirds of his or her average standard monthly remuneration over the most recent 12-month period ÷ 30 per day off work, to help protect the livelihood of the insured person and his or her family. This is called “the Injury and Sickness Allowance”. Even if the insured person receives a salary or other income from his or her place of work, if the amount of such income is less than the Injury and Sickness Allowance then the difference in amounts is paid as Injury and Sickness Allowance.

The Association's additional benefits

Injury and Sickness Allowance Additional Sum
The Health Insurance Association also provides its own independent benefits (additional benefits) in addition to the Injury and Sickness Allowance.
The amount of the Injury and Sickness Allowance Additional Sum is the amount equal to 9% of your average standard monthly remuneration over the most recent 12-month period ÷ 30 minus the amount of the Injury and Sickness Allowance, per day off work.

Additional Extended Injury and Sickness Allowance
If you still need time off from work after the end of the statutory benefit period (up to 18 months from the time benefit payments begin, you will be paid 75/100 (75%) of the previous amount per day off until the total length of the payment period reaches 540 days as Additional Extended Injury and Sickness Allowance (for up to three years after the start of payment of the Injury and Sickness Allowance).

Example of payment of Injury and Sickness Allowance and Additional Extended Injury and Sickness Allowance

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Conditions for payment

This benefit is paid when all four of the following conditions are met.

  • You are recuperating under treatment for sickness or injury (recuperation at home is acceptable).
  • You are unable to perform your previous job because you are recuperating from sickness or injury.
  • You have taken at least three consecutive days off.

    • ** Payment of this benefit begins on the fourth consecutive day off.
    • ** The first three days are referred to as the waiting period, and no benefits are paid for those days.
  • You are unable to receive salary or other income

    • ** Even if you are receiving a salary or other income, if the amount of such income is less than the Injury and Sickness Allowance then the Society will pay the difference.

Cases in which you are eligible to receive the Injury and Sickness Allowance and Maternity Allowance concurrently

If you become eligible to receive the Injury and Sickness Allowance and Maternity Allowance concurrently, payment of the Maternity Allowance will be granted priority.  However, if the Maternity Allowance paid is less than the Injury and Sickness Allowance, the difference between the two amounts will be paid.

If you become eligible for Disability Employees’ Pension

If you become eligible to receive Disability Employees’ Pension under Employees’ Pension Insurance (including the Disability Basic Pension under the National Pension program), payment of the Injury and Sickness Allowance will end.

Injury and Sickness Allowance benefits will not be paid after retirement if you receive Old-Age Employees’ Pension or similar benefits.

Reference link

However, the Society will pay the difference if the amount paid by the pension or other program in any of the above cases is less than the amount of the Injury and Sickness Allowance.

If the cause is a workplace accident

If the cause is an accident at the workplace or while commuting, Worker's Accident Compensation Insurance applies instead of health insurance. Check with the person responsible at your establishment for more information.

When a person receiving injury and sickness allowance leaves the company

If a person who has been an insured person for a period of at least one year is receiving injury and sickness allowance when he or she leaves the company and remains unable to work due to that illness or injury, he or she will continue to receive payment for injury and sickness allowance for a period of up to 18 months from the first payment.
However, payment of the allowance will stop if the individual becomes able to work during this period.

  • Note: Special-Case Retired Insured Persons will not be supplied.

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