IBM Japan Health Insurance Association

IBM Japan Health Insurance Association

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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”)

  • ** While the copayment for a person aged 70-74 (excluding persons earning income at the same levels as active workers) would ordinarily be 20%, it currently remains at 10%, due to a freeze on implementing the increase in copayments.
  • ** In addition to health insurance cards, the Association issues Elderly Benefits Cards to members aged 70–74. The Elderly Benefits Card will indicate your copayment rate.

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 320 yen/day (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”.

** Costs are reduced still further for persons with low income. See here for more information.

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