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.

  • * You can use your Individual Number Card as a health insurance card at medical care institutions or other facilities adopting the online eligibility verification system. (Requires advance registration on Mynaportal etc.)

Medical Care Benefits (for dependents, “Dependents' Medical Care Expenses”)

Amounts paid

Copyment:
30%
Medical Care Benefits (Paid by the Health Insurance Association):
70%

The copayment may be even lower, depending on age.

Preschool children (20% copayment)

20%
80%

Persons aged 70-74 (20% copayment)

20%
80%

Persons aged 70-74 earning income at the same levels as active workers(30% copayment)

30%
70%

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 Association's additional benefits

(Paid per month, per person, per hospital, per Rezept (medical cost details))

Copayment
Copayment
Insured persons
-25,000 yen
Dependents-
50,000 yen
The Association's additional benefits Patient Cost-Sharing Reimbursements
(Dependents' Medical Care Additional Sum)
  • * This benefit excludes amounts paid as High-cost Medical Care Benefits, as well as costs such as meal expenses, accommodation expenses, and premium bed expenses during hospitalization, from the copayment amount.
  • * The calculated amount will be rounded down to the nearest 100 yen.

Patient Cost-Sharing Reimbursements (For dependents: Dependents' Medical Care Additional Sum)

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” (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.

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”) 490 yen/meal for up to three meals/day (280 yen/meal for patients with intractable diseases or specific chronic diseases of children).

While the actual cost of meals during hospitalization is 670 yen/meal (up to 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 490 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 patients with designated intractable diseases, the copayment for meal expenses is 280 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.