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| List of insurance benefits |
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|  List of insurance benefits
available to insured persons
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Statutory Benefits
 Benefits prescribed under the Health Insurance Act
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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 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 also 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 510 yen/meal up to three meals/day *For patients with intractable diseases or specific chronic diseases of children, the patient cost-sharing amount is 300 yen/meal. For persons with low income, it is 110–240 yen. |
Inpatient Living Expenses |
Amounts exceeding standard copayment (510 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 |
An amount equivalent to two-thirds of the average standard monthly remuneration over the continuous 12-month period immediately preceding the month including the date on which payment of the Injury and Sickness Allowance begins ÷ 30 per day is paid for a total of one year and six months. |
When you have
given birth |
Maternity
Allowance |
An amount equivalent to two-thirds of the average standard monthly remuneration over the continuous 12-month period immediately preceding the month including the date on which payment of the Maternity Allowance begins ÷ 30 per day is paid for the period from 42 days (98 days for multiple pregnancy) before the delivery date (payable for the delay period as well in the event the delivery date comes after the expected date) to 56 days after the delivery date. |
Childbirth
and
Childcare
Lump-sum Grant |
500,000 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, 488,000 yen for each delivery) |
When you die |
Funeral
Expenses
(Costs) |
50,000 yen |
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| Additional
Benefits
Benefits on its own provided by Health Insurance Society in addition to statutory
benefits |
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When you become
sick or injured
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Patient
Cost-sharing
Reimbursements
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The amount of patient cost-sharing for a single case (excluding the portion covered by the benefit of Dependents’ High-Cost Medical Care Expenses) minus 20,000 yen is provided (any amount less than 100 yen is rounded down).
The amount less than 500 yen
is not
provided.
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Additional
Total High-cost
Medical Care
Benefits
|
The total amount of individual cost-sharing for a single case minus 20,000 yen is provided (any amount less than 100 yen is rounded down).
The amount
less than 500 yen is not provided. |
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Additional
Home-visit
Nursing Care
Expenses
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The amount of patient cost-sharing for a single case (excluding the portion covered by the benefit of Dependents’ High-cost Medical Care Expenses) minus 20,000 yen is provided (any amount less than 100 yen is rounded down).
The amount less than 500 yen is not provided.
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| 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
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When you have
given birth
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Additional
Childbirth and
Childcare
Expenses
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100,000 yen for each delivery
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Additional
Maternity
Allowance
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Equivalent to 20 percent of the average standard monthly remuneration over the most recent 12-month period ÷ 30 per day during the unpaid period
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When you die
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Additional
Funeral Expenses
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Equivalent to standard monthly remuneration amount
(100,000 yen minimum)
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* A single case is defined as one set of medical cost details. Medical cost details are prepared by each medical care institution per patient per month (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). Out-of-hospital prescriptions for which the date of visiting the pharmacy and the date of visiting the medical care institution issuing the prescription fall in the same month are regarded to belong to the same single case.
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List of insurance benefits available
to family members (dependents)
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|
Statutory Benefits
Benefits prescribed under the Health Insurance Act
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|
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 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 also 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 510 yen/meal up to three meals/day
*For patients with intractable diseases or specific chronic diseases of children, the patient cost-sharing amount is 300 yen/meal. For persons with low income, it is 110–240 yen. |
* Inpatient Living
Expenses |
Amounts exceeding standard copayment (510 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 |
500,000 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, 488,000 yen for each delivery) |
When family
members
die |
Dependents'
Funeral Expenses |
50,000 yen |
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| Additional
Benefits
Benefits on its own provided by Health Insurance Society in addition to statutory
benefits |
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* A single case is defined as one set of medical cost details. Medical cost details are prepared by each medical care institution per patient per month (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). Out-of-hospital prescriptions for which the date of visiting the pharmacy and the date of visiting the medical care institution issuing the prescription fall in the same month are regarded to belong to the same single case.
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