If you become sick or are injured
If you become sick or are injured, present your health insurance card when undergoing examination or treatment to obtain the necessary medical care while paying just 30% of the applicable medical care costs. The amount paid at the hospital will be even lower for preschool children and elderly persons aged 70 or older.
Medical Care Benefits (for dependents, “Dependents' Medical Care Expenses”)
- ** Copayments for persons aged 70-74 (excluding persons earning income at the same levels as active workers) remained at 10% from April 2008 through March 2014. For persons turning 70 on or after April 1, 2014 (i.e., those born on or after April 2, 1944), the copayment will be 20%, starting with examinations or treatments in the month following the month in which they turn 70.
- ** Copayments will remain at 10% (20% for injury or illness caused by the actions of a third party) for persons turning 70 on or before March 31, 2014 (i.e., for those born April 2, 1939, through April 1, 1944).
- ** See here for information on measures for reducing cost burdens for persons aged 70–74.
- **Persons earning income at the same levels as active workers: This refers to elderly persons aged 70–74 whose standard monthly remuneration is 280,000 yen or more. See here for more information.
Under the health insurance system, the insurance benefits paid for nonoccupational sickness and injury are called “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 Association covers the remaining 70%.
The Health Insurance Association later pays the amount of medical care costs paid at the hospital over one month minus 25,000 yen (dependents:50,000 yen), as “Patient Cost-Sharing Reimbursements and Additional Benefits” (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 Association. 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.
Notify the Health Insurance Association if you were not charged a copayment because you presented a disability medical care card or a medical care identification card for infants at the medical care institution. The Association will take the steps necessary to ensure aid is not duplicated.
Even in the above cases, if you were unable to receive payment aid for some reason at the medical care institution and your copayment qualifies for High-Cost Medical Care Benefits or additional benefits, submit an application form for Patient Cost-sharing Reimbursements and Additional Benefits/Dependents’ Medical Care Additional Sum.
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”) 360 yen/meal for up to three meals/day (260 yen/meal for patients with intractable diseases or specific chronic diseases of children).
While the actual cost of meals during hospitalization is 640 yen/meal (for three meals/day) based on standard meal expenses, the Health Insurance Association 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 at a convalescent facility, he or she pays meal expenses of 460 yen/meal and accommodation expenses of 370 yen/day (**1) (called “the standard personal cost burden for living expenses”). The Health Insurance Association pays the amount of actual costs in excess of this standard personal cost burden for living expenses, as “Inpatient Living Expenses”.
- **1: For those with high degrees of medical necessity (Medical Care Categories II or III), the copayment for meal expenses is 360 yen, while the copayment for accommodation expenses is 200 yen. (For patients with designated intractable diseases, the copayment for meal expenses is 260 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.