If you paid the entire medical care cost up front
In some cases under the health insurance system, if you paid the entire medical care cost to the medical care institution or other facility up front, the Health Insurance Society will reimburse you later.
If you paid the entire medical care cost up front
If you have undergone treatment at a medical care institution without showing your health insurance card in cases such as sudden sickness while traveling, you will have to pay the entire amount of medical care costs yourself. However, you can apply to the Health Insurance Society for reimbursement of the amount you paid up front corresponding to the cost of insured medical consultation and treatment.
The benefits paid for such medical care costs paid up front are referred to as “Medical Care Expenses.”
- Reference link
Medical Care Expenses will be paid in cases such as these
Even if you did not show your health insurance card, health insurance will pay “Medical Care Expenses” in cases such as the following:
|Reason for payment of Medical Care Expenses||Benefit details|
|If you received a live blood transfusion||70% of the basic charges|
|If you purchased and used prosthetic equipment such as an artificial arm or leg, an artificial eye, or a corset, as instructed by a physician||70% of the basic charges|
|If you underwent acupuncture, moxibustion, massage, shiatsu, or similar treatment with an insurance doctor's approval||70% of the basic charges|
|If you had eyeglasses or contact lenses prepared and purchased to treat juvenile amblyopia or other condition in a child of less than nine years of age||70% of the basic charges or the maximum amount, whichever is the smaller (80% for a preschool child)|
|When purchasing a compression garment to treat the following diseases
||70% of the basic charges or the maximum amount, whichever is the smaller|
|If you purchased limbal-supported rigid contact lenses for disfigured corneas due to ocular sequelae after experiencing Stevens-Johnson syndrome or toxic epidermal necrolysis:||70% of the basic charges or the maximum amount, whichever is the smaller|
If you become sick or are injured overseas
Caution: You can also be reimbursed for medical care costs paid for examination and treatment at medical care institutions overseas as “Medical Care Expenses”. However, note the following:
Benefits will not necessarily cover all the costs you paid.
- ** Since the level and cost of medical care vary by country, the amount eligible for coverage through benefits is calculated based on medical care costs established under the health insurance system in Japan, using as reference “an attending physician's statement” and “itemized receipts” issued by the overseas hospital.
- You must submit all of the following to claim benefits: attending physician's statement; itemized receipts; copy of document verifying your overseas travel (such as a passport); and letter stating that you agree to the health insurance society making detailed inquiries to the overseas medical care institution or other organization about your treatment.
- Any documents attached in a foreign language must be translated into Japanese.
- Treatment not covered by insurance in Japan will not be eligible for benefits.
- Benefits will not be paid if you went overseas specifically to undergo treatment.
When you cannot walk to or between hospitals
Transportation Expenses (for dependents, “Dependents' Transportation Expenses”)
If a patient finds it very difficult to walk due to sickness or injury and he or she must visit the hospital or transfer between hospitals for treatment purposes, the cost of transportation will be paid as “Transportation Expenses” as deemed necessary by a doctor.
- This applies only to cases in which a doctor recognizes the need for temporary or emergency transportation.
- The advance approval of the Health Insurance Society is required (or after the fact in unavoidable situations).
- Non-emergency transportation costs, such as the cost of ordinary visits to the hospital, are not eligible for these benefits.
Standards under which you can receive Transportation Expenses
Transportation Expenses will be paid when a doctor recognizes the need for temporary or emergency transportation and the Health Insurance Society has determined that all of the following conditions apply:
- The medical care for which the transportation is required is appropriate as insured medical consultation and treatment.
- The sickness or injury for which the treatment is required makes it difficult for the patient to move.
- In an emergency or other unavoidable case
Details of benefits
The amount paid as “Transportation Expenses” is the cost of transportation calculated based on the standard amount, assuming use of the most economic and ordinary routes. In the case the actually incurred expenses were less than the standard amount, only the actual expenses will be paid.
Costs eligible for payment of Transportation Expenses
Costs eligible for payment are:
- Fares when using automobile, train, or other means;
- In principle, transportation and associated costs for up to one person if an accompanying doctor or nurse is required.
If the patient has paid the costs for medical administration of the accompanying doctor or nurse, that amount will be paid as Medical Care Expenses. Transportation Expenses will be paid for the transportation of patients who find it impossible or difficult to walk; it will not be approved for the cost of transportation used for ordinary visits to the hospital or the cost of transporting bedding or other personal belongings needed for hospitalization.