In the case of sickness or injury stemming from non-work related activities, under the health insurance system you must take your Individual Number Card or Eligibility Verification Certificate, etc. with you to a hospital to receive examinations or treatment.
Insured persons and dependents pay amounts equivalent to 30 percent of their medical care costs (20% for preschool children) (they also pay inpatient meal expenses and so on). Health Insurance Societies cover the remaining portion of these costs.
In other words, insured persons receive "medical treatment" as benefits in kind. Benefits in kind provided to persons presenting their health insurance cards are referred to as "Medical Care Benefits (Dpendent's Medical Care Expenses)."
See here concerning the personal cost burden for elderly persons 70-74 years covered by health insurance. >> "Elderly persons aged 70-74 pay 20% or 30% of medical costs, depending on their income"

At our Health Insurance Society, in cases where Medical Care Benefits (Dependents' Medical Care Expenses) are paid for treatment, we also provide a benefit of our own (additional benefit), and so the ultimate cost-sharing by an insured person or dependent is 20,000 yen (+fractions).

If applicable, the benefit of Medical Care Expenses (Dependents’ Medical Care Expenses) is provided at a later date, the amount of which is calculated by deducting 20,000 yen from monthly medical care costs (for a single case; excluding the portion covered by the benefit of High-Cost Medical Care Expenses, standard inpatient meal expenses, and standard inpatient living expenses) paid at the reception desk of the relevant hospital (any amount less than 100 yen is rounded down). This benefit will not be provided if the calculated amount is less than 500 yen. This is called a "Patient Cost-sharing Reimbursement (Dependents' Additional Total High-cost Medical Care Benefits)."
No application is necessary to receive this benefit. Reimbursements are automatically transferred to the insured person's bank account, along with his or her salary. Health Insurance Society uses the "detailed medical fee statement" it receives from hospitals as the basis for calculating reimbursement amounts. This practice results in a delay of about three months between medical treatment and reimbursement.

* However, if public medical assistance from national or local government is available for copayments, such assistance takes precedence. Additional benefits 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)

Scope of medical care

Medical Care Benefits cover all types of medical services required for treatment of sicknesses and injuries. Insured persons and their dependents are entitled to receive the treatment they require until they recover from sicknesses and injuries as long as they remain validly insured.

(1)

Medical examination

(2)

Provision of medicines or therapeutic materials

(3)

Treatment, operation, and other medical actions

(4)

Medical care and nursing care at home

(5)

Hospitalization (excluding meal, living and heating service) and nursing care at hospitals

Using the health insurance for treatment

You can receive insurance benefits when you fall sick or sustain an injury. However, not all hospitals and clinics offer insured treatment. You must present your My Number Card or Eligibility Verification Certificate, etc. at the reception desk of the relevant hospital or clinic.
Hospitals or clinics which treat health insurance are called "insurance medical care institution." You can receive insurance benefits for treatment at insurance medical care institutions all over the country.