If you become sick or are injured

If you become sick or are injured, you can use health insurance to get necessary medical treatment by making in principle a copayment of 30% of the medical care costs. The amount paid at the hospital counter is even lower for preschool children and elderly persons aged 70 or older.

Description

Medical Care Benefits (for dependents, "Dependents' Medical Care Expenses")

Amounts paid

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

The copayment may be even lower, depending on age.

Preschool children (20% copayment)

20%
80%

Persons aged 70-74(20% copayment) * Excluding those earning income equal to active workers

20%
80%

Using health insurance, you can get necessary medical care for treatment of nonoccupational sickness and injury by making a copayment of 30%. This is referred to as "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 Society covers the remaining 70%.

The society's additional benefits

(Paid per month, per person, per hospital)

Copayment
Copayment
20,000 yen		 The society'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 benefit will not be paid if the calculated amount is less than 500 yen. The calculated amount will be rounded down to the nearest 100 yen.
  • * A single case refers to one set of medical cost details. Medical cost details are prepared monthly for each patient by each medical care institution. (Note that inpatient medical care, outpatient medical care, inpatient dental care, and outpatient dental care are handled separately, even if provided by the same medical care institution.) External prescriptions for which the dates of visiting the pharmacy and the dates of visiting the medical care institution issuing the prescriptions fall in the same month are considered to belong to the same single case.
  • * When publicly funded medical assistance is available, regardless of the method of assistance, Society statutes call for giving priority to publicly funded medical assistance and adjusting the additional sum accordingly.

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

The Health Insurance Society later pays the amount of medical care costs paid at the hospital over one month minus 20,000 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 Society. 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.

  • * However, when publicly funded medical assistance is available from the national or local government for the copayment amount, the publicly funded medical assistance will be given priority and the additional benefit will be adjusted accordingly.
    (Examples: medical assistance for young children, medical assistance for people with severe physical and mental disabilities, medical assistance for expectant and nursing mothers)

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") 510 yen/meal for up to three meals/day (300 yen/meal for patients with intractable diseases or specific chronic diseases of children).

While the actual cost of meals during hospitalization is 690 yen/meal (up to three meals/day) based on standard meal expenses, the Health Insurance Society 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 in a long-term care bed, he or she pays meal expenses of 510 yen/meal (470 yen/meal at some medical care institutions) and accommodation expenses of 370 yen/day (**1) (called "the standard personal cost burden for living expenses"). The Health Insurance Society 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 300 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.