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 Association will reimburse you later.

Description
Procedures
FAQ

If you paid the entire medical care cost up front

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

Of the amount you paid up front,
70% of the amount calculated based on insured medical consultation and treatment**
  • ** Benefit ratios vary by age and income
  • ** Benefits will not necessarily cover all the costs you paid. The amount paid is calculated based on treatment methods and charges authorized under the Health Insurance Act.

If you undergo treatment at a medical care institution without using your Myna health insurance card etc. in cases such as sudden sickness while traveling, you must pay the entire amount of medical care costs yourself. However, you can apply to the Health Insurance Association for reimbursement of the amount you paid up front corresponding to the cost of medical care covered by health insurance.
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

Medical Care Expenses will also be paid in the following cases:

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
  • Lymphedema of the arms or legs occurring after surgery for malignant tumor involving lymph node dissection (extensive resection) in the groin, pelvic region, or axillary region; primary lymphedema of the arms or legs
  • Intractable ulcer due to chronic venous insufficiency
 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

Caution

  • The right to claim health insurance benefits expires in two years.
  • Even if a doctor instructs you to make a brace, or if a medical institution or a brace supplier tells you that 70% of the cost of the brace will be returned by the health insurance society at a later date,it is up to the health insurance society to decide whether to pay it as medical expenses. Even if a doctor instructs you to do so, you may not be eligible for payment as a result of the examination by the health insurance society.
  • Please submit the original receipts and other attached documents. (The original documents are kept by the health insurance society).When you apply to the local government for out-of-pocket expenses for medical expenses for children, etc., you need to make a copy of the receipts and other documents.Please keep a copy and submit it to the local government office together with the payment decision notification that will be sent to you from the health insurance society after payment.

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 association 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.

Caution

  • This applies only to cases in which a doctor recognizes the need for temporary or emergency transportation.
  • The advance approval of the Health Insurance Association 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 Association 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
    • * Urgency (Urgency to save lives unless transferred to a well-equipped medical facility as soon as possible.) is required.
      [Examples]
      ・If the patient is injured at a disaster site, etc. and is transferred in an emergency
      ・If the person gets sick or injured on a remote island, etc., and they are transferred for a reason such as the following: their symptoms are serious and suitable medical treatment is not available at a nearby hospital.
    • *Transfers in cases where there is no urgency, such as temporary transfers when going to a hospital, etc., are not covered.

Cases that cannot be approved as transportation expenses

  • Cases where the person transfers to a distant hospital even though sufficient treatment can be obtained at a nearby hospital
  • Cases where the person is hospitalized at a travel or business-trip destination due to an emergency, but then transfers in order to be at a hospital close to home
  • Cases where the person is hospitalized due to an emergency and then transfers to a different hospital after their symptoms stabilize for the purpose of rehabilitation, etc.
  • Cases where the person cannot walk to the hospital and is therefore transferred
  • Transportation expenses incurred as a result of walking from the person’s home to the hospital

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.