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When sickness or injury keeps you from work
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 If an insured person takes time off work due to sickness or injury stemming from non-work related activities and is unable to earn salary or other income, 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 to maintain the livelihood of the insured person and his/her family. This is called an "Injury and Sickness Allowance."
Worker's accident compensation insurance covers sicknesses and injuries caused by accidents or disasters occurring on duty or during the commute to and from work.
However, when even illnesses and injuries on-the-job are not targeted for benefits of the Worker's Accident Compensation Insurance, benefits of the health insurance are provided except the duties as the officer of the corporation (except for a corporation less than five employees).
* For individuals who have been insured persons for less than 12 months, the lesser of i. or ii. below:
- Individual’s average standard monthly remuneration over the most recent continuous months prior to the month payment of the allowance begins
- Society’s average standard monthly remuneration for all insured persons as of September 30 of the fiscal year before the fiscal year including the date on which payment of the allowance begins
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On the following form, provide the necessary information under “To be completed by the insured person”; obtain certification from the employer of absence from work and salary payment status under “To be certified by the employer”; and obtain certification from a physician of inability to work during the period in question under “To be filled out by treating physician.” Submit the form to the Health Insurance Society.
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Procedural
Documents:
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1.
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"Claim for Injury and Sickness Allowance/ Additional Sum"
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 Conditions for provision of
benefits
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Insured persons can receive the Injury and Sickness Allowance
in the event all of the following four conditions apply.
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1. Treatment for sickness and
injury is in progress
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Insured persons can be regarded as being under treatment
even when they stay at home due to the sickness or injury
in question.
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2. Treatment prevents insured
persons from working
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In other words, insured persons cannot continue their
previous work due to sickness or injury.
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3. Sickness or injury causes
insured persons to miss work for three or more consecutive
days
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Insured persons begin receiving the Injury and Sickness
Allowance on the fourth day of consecutive absence. The
benefit is not provided during first three days (referred
to as the "waiting period").
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4. Sickness or injury results
in salary loss
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The insured person can also receive the balance in the
event his or her salary falls below the amount of the
Injury and Sickness Allowance.
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 Benefit provision
period
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The payment period for Injury and Sickness Allowance is 18 months in total from the date payment begins.
* Aggregating the days paid up to the total payment period of 18 months from the date on which payment begins will apply to the Injury and Sickness Allowance (payment of which begins on or after July 2, 2020) for which the payment period based on calendar days is less than 18 months as of December 31, 2021. The payment period will continue to be the period of 18 months from the date on which payment begins if 18 months from the date on which payment begins have passed as of that date.
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Cases in which you are eligible to receive the Maternity Allowance and Injury and Sickness Allowance concurrently |
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If you are eligible to receive Maternity Allowance and Injury and Sickness Allowance concurrently, payment of the Maternity Allowance will be granted priority. However, if the Maternity Allowance paid is less than the Injury and Sickness Allowance, the difference between the two amounts will be paid. |
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Cases in which you are eligible to receive Disability Employees' Pension
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Health Insurance Societies will stop providing insured persons
with the Injury and Sickness Allowance when these people become
entitled to the Disability Employees' Pension prescribed under
the Employees' Pension Insurance Law or to the Disability Basic
Pension prescribed under the National Pension Law. The provision
of benefits in these cases will cease even if the period for
provision has not ended.
The Injury and Sickness Allowance is not available to a benefit recipient
after disqualification receiving the Old Age Employees' Pension.
These rules do not apply when pension income totals less than the Injury
and Sickness Allowance. Health Insurance Societies will supply the balance
in such cases.
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Information for those receiving Injury and Sickness Allowance or undergoing treatment for illness or injury |
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If you have a disability pension grade, you are eligible to receive a disability pension after 18 months have passed since the date of the first examination. |
If you have a disability pension grade, you are eligible to claim a disability pension at any time until you reach the age of 65 years after 18 months have passed since the date of the first examination. |
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Many people receiving the Injury and Sickness Allowance or undergoing treatment for an illness or injury file claims for a disability pension late because they do not understand the structure of the disability pension system or how to file a claim for any subsequent exacerbation of a disability (claim filed by a person who did not have a disability pension grade at the date of certification of the disability but does qualify later due to worsening condition).
Be sure to file claims promptly. Filing late may reduce the total pension amount you are eligible to receive.
Information on disability pensions
Contact your local pension office or pension consultation center if you have any questions.
[Addresses of pension offices and pension consultation centers]
https://www.nenkin.go.jp/section/soudan/index.html
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Our Health Insurance Society provides a benefit of our own (additional benefit) on top of the Injury and Sickness Allowance. |
The Injury and Sickness Allowance Additional Sum is paid in addition to the Injury and Sickness Allowance.
■ Amount of Injury and Sickness Allowance Additional Sum ■
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 × 15% per day
* For individuals who have been insured persons for less than 12 months, the average standard monthly remuneration amount is determined in the same way as for Injury and Sickness Allowance.
* Even if salary etc. is paid by the employer during this period, if the amount of such remuneration is less than the sum of the Injury and Sickness Allowance and the Injury and Sickness Allowance Additional Sum, the difference will be paid to the individual in question.
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When sickness or injury keeps
you from work |
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