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HOME > Introduction to Kenpo > List of insurance benefits
List of insurance benefits
 

>> List of insurance benefits available to insured persons
>> List of insurance benefits available to family members (dependents)


List of insurance benefits available to insured persons

Statutory Benefits
Benefits prescribed under the Health Insurance Act

When you become
sick or injured

Medical Care
Benefits

Equivalent to 70 percent (80 percent or 70 percent in the event the insured persons are 70-74 years of age) of the costs required for medical care

Additional Medical Costs not covered by insurance

Equivalent to 70 percent (90 percent or 70 percent in the event the insured persons are 70 years old or older) of the extra costs required for Additional Medical Costs not covered by insurance (limited to the basic part to which Medical Care Benefits is applicable)

Medical Care
Expenses

Standard amount of cash benefit as a refund upon insured person's request after paying advance money

High-cost
Medical Care
Benefits

Total High-cost
Medical Care
Benefits


*See here in the event the insured persons are 70-74 years of age.

When your copayment on medical care costs for a single case in one month exceeds the Cost-Sharing Maximum Amount for your income category, the excess amount is paid (Measures to reduce cost burden, for example, by calculating on the basis of total medical expenses paid by one household, are available).

High aggregate cost
for long-term care service

When the aggregate total of copayments paid on medical and long-term care over a single year exceeds the maximum, the amount in excess of the maximum, corresponding to the ratios of medical and long-term care costs

Home-visit
Nursing Care
Expenses

Equivalent to 70 percent of the overall prescribed costs required for home-visit nursing care

Inpatient Meal
Expenses

Amounts exceeding 360 yen/meal up to three meals/day *For patients with intractable diseases or specific chronic diseases of children, the patient cost-sharing amount is 260 yen/meal. For persons with low income, it is 100–210 yen.

Inpatient Living Expenses

Amounts exceeding standard copayment (460 yen/meal for meal expenses, 370 yen/day for accommodation expenses; subject to measures for reducing patients’ cost burdens) when insured persons aged 65-74 years are hospitalized for treatment

Transportation
Expenses

100 percent of the overall costs required for the transportation

When sickness or injury
keeps you from work

Injury and Sickness
Allowance

Equivalent to two-thirds of the average standard monthly remuneration over the most recent 12-month period ÷ 30 per day during unpaid period up to one year six months

When you have
given birth

Maternity
Allowance

Equivalent to two-thirds of the average standard monthly remuneration over the most recent 12-month period ÷ 30 per day for the unpaid period from 42 days (98 days for multiple pregnancy) before delivery date (delay period as well in the event the delivery date comes after the expected date) to 56 days after delivery date

Childbirth and
Childcare
Lump-sum Grant

420,000 yen for each delivery (for childbirth before 22 weeks gestation or for childbirth at medical institutions that have not joined the Japan Obstetric Compensation System for Cerebral Palsy, 404,000 yen for each delivery)

When you die

Funeral Expenses
(Costs)

50,000 yen

*

See here for benefits and individual cost-sharing for insured persons aged 70-74. >> "Elderly persons aged 70-74 pay 20% or 30% of medical costs, depending on their income."

Additional Benefits
Benefits on its own provided by Health Insurance Society in addition to statutory benefits

When you become
sick or injured

Patient
Cost-sharing
Reimbursements

The amount of patient cost-sharing per case in a month (those for High-cost Medical Care Benefits is excluded) minus 20,000 yen is provided (the amount less than 100 yen is rounded down). The amount less than 500 yen is not provided.

Additional
Total High-cost
Medical Care
Benefits

The total amount of individual cost-sharing minus 20,000 yen for each individual and family member is provided (the amount less than 100 yen is rounded down). The amount less than 500 yen is not provided.

Additional
Home-visit
Nursing Care
Expenses

The amount of patient's cost-sharing in a month (those for High-Cost Medical Care Benefit is excluded) minus 20,000 yen is provided (The amount less than 100 yen is rounded down). The amount less than 500 yen is not provided.

When sickness or injury
keeps you from work

Additional
Injury and Sickness
Allowance

Equivalent to 15 percent of the average standard monthly remuneration over the most recent 12-month period ÷ 30 per day during the unpaid period

When you have
given birth

Additional
Childbirth and
Childcare
Expenses

100,000 yen for each delivery

Additional
Maternity
Allowance

Equivalent to 20 percent of the average standard monthly remuneration over the most recent 12-month period ÷ 30 per day during the unpaid period

When you die

Additional
Funeral Expenses

Equivalent to standard monthly remuneration amount (100,000 yen minimum)



Top

List of insurance benefits available to family members (dependents)

Statutory Benefits
Benefits prescribed under the Health Insurance Act

When family members
become
sick or injured

Dependents'
Medical Care
Expenses

Equivalent to 70 percent (80 percent for infants through preschool age, and 80 percent or 70 percent in the event the dependents are 70-74 years of age) of the costs required for medical care

* Additional Medical Costs not covered by insurance

Equivalent to 70 percent (90 percent or 70 percent in the event the dependents are 70 years old or older) of the extra costs required for Additional Medical Costs not covered by insurance (limited to the basic part to which Medical Care Benefits is applicable)

Dependents'
Medical Care
Expenses

Standard amount of cash benefit as a refund upon insured person's request after paying advance money

Dependents'
High-cost
Medical Care
Benefits

Total High-cost
Medical Care
Beneits


*See here in the event the dependents are 70-74 years of age.

When your copayment on medical care costs for a single case in one month exceeds the Cost-Sharing Maximum Amount for your income category, the excess amount is paid (Measures to reduce cost burden, for example, by calculating on the basis of total medical expenses paid by one household, are available).

High aggregate cost
for long-term care service

When the aggregate total of copayments paid on medical and long-term care over a single year exceeds the maximum, the amount in excess of the maximum, corresponding to the ratios of medical and long-term care costs

Dependents'
Home-visit Nursing
Care Expenses

Equivalent to 70 percent of the overall prescribed costs required for home-visit nursing care

* Inpatient Meal
Expenses

Amounts exceeding 360 yen/meal up to three meals/day
*For patients with intractable diseases or specific chronic diseases of children, the patient cost-sharing amount is 260 yen/meal. For persons with low income, it is 100–210 yen.

* Inpatient Living Expenses

Amounts exceeding standard copayment (460 yen/meal for meal expenses, 370 yen/day for accommodation expenses; subject to measures for reducing patients' cost burdens) when insured persons aged 65-74 years are hospitalized for treatment

Dependents'
Transportation
Expenses

100 percent of the overall costs required for the transportation

When family members
have given birth

Dependents'
Childbirth and
Childcare
Lump-sum Grant

420,000 yen for dependents' each delivery (for childbirth before 22 weeks gestation or for childbirth at medical institutions that have not joined the Japan Obstetric Compensation System for Cerebral Palsy, 404,000 yen for each delivery)

When family members
die

Dependents'
Funeral Expenses

50,000 yen

*

All the "Additional Medical Costs not covered by insurance," "Inpatient Meal Expenses," and “Inpatient Living Expenses" are supplied in the form of "Dependents' Medical Care Benefits."

*

See here for benefits and individual cost-sharing for the dependents aged 70-74.
>> "Elderly persons aged 70-74 pay 20% or 30% of medical costs, depending on their income."

Additional Benefits
Benefits on its own provided by Health Insurance Society in addition to statutory benefits

When family members
become
sick or injured

Dependents'
Additional
Medical Care
Expenses

The amount of patient cost-sharing per case in a month (those for Dependents' High-Cost Medical Care is excluded) minus 20,000 yen is provided (the amount less than 100 yen is rounded down). The amount less than 500 yen is not provided.

Additional
Total High-cost
Medical Care
Benefits

The total amount of individual cost-sharing minus 20,000 yen for each individual and family member is provided (the amount less than 100 yen is rounded down). The amount less than 500 yen is not provided.

Dependents'
Additional
Home-visit
Nursing Care
Expenses

The amount of patient cost-sharing in a month (those for Dependents' High-cost Medical Care Benefits is excluded) minus 20,000 yen is provided (the amount less than 100 yen is rounded down). The amount less than 500 yen is not provided.

When family members
have given birth

Dependents'
Additional
Childbirth and
Childcare
Expenses

100,000 yen for dependents' each delivery

When family members
die

Dependents'
Additional
Funeral Expenses

100,000 yen (same amount for all family members)



Index Top
 
Introduction to Kenpo
  Health insurance outline
  What is health insurance?
  Tasks performed by Health Insurance Society
  Administration of Health Insurance Society
  What are insurance benefits?
  List of insurance benefits
  Table of monthly insurance premiums
  Medical care cost information
  Data Health Plans
  The Social Security and Tax Number System
Index



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