If you become sick or are injured

If you become sick or are injured, you can use health insurance to get necessary medical treatment by making in principle a copayment of 30% of the medical care costs. The amount paid at the hospital counter is even lower for preschool children and elderly persons aged 70 or older.

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

Amounts paid

Copyment:
30%
Medical Care Benefits (Paid by the Health Insurance Society):
70%

The copayment may be even lower, depending on age.

Preschool children (20% copayment)

20%
80%

Persons aged 70-74(20% copayment) * Excluding those earning income equal to active workers

20%
80%

Persons aged 70-74 earning income at the same levels as active workers(30% copayment)

30%
70%

Using health insurance, you can get necessary medical care for treatment of nonoccupational sickness and injury by making a copayment of 30%. This is referred to as "Medical Care Benefits" (for dependents, "Dependents' Medical Care Expenses"). You pay only 30% of medical care costs at the medical care institution because the Health Insurance Association covers the remaining 70%.

The Health Insurance Society also provides its own independent benefits (additional benefits) to further reduce the patient's financial burden (Patient Cost-Sharing Reimbursements).

(Paid per month, per person, per hospital)

  • ** This benefit excludes amounts paid as High-cost Medical Care Benefits, as well as costs such as meal expenses, accommodation expenses, and premium bed expenses during hospitalization, from the copayment amount.
  • ** The calculated amount will be rounded down to the nearest 100 yen.

The Association provides its own benefits (additional benefits) in the amount of medical care costs* paid by the insured person and dependents at the medical care institution minus 25,000 yen.
These are called Patient Cost-Sharing Reimbursements (for dependents, Dependents’ Medical Care Additional Sum).
No application is required for these benefits, because the payment is automatically made after amounts are calculated based on rezepts (medical cost details) sent by hospitals to the Health Insurance Association.
The timing of payment is roughly three months after the month of examination or treatment. (Paid with the salary for current employees and paid separately for former employees)
See "When you incur high medical care costs: How High-Cost Medical Care Benefits are calculated" for a specific calculation example.

* Only medical care costs covered by health insurance are eligible. Calculated monthly, per individual, and per hospital (separately for categories such as outpatient/inpatient and medical/dental).
Costs eligible for additional benefits do not include the amount equivalent to High-Cost Medical Care Benefits, inpatient meal expenses, accommodation expenses, and costs for beds with extra charge, etc.
High-Cost Medical Care Benefits will be paid separately if you pay the portion eligible for High-Cost Medical Care Benefits yourself.

[Notes]

If you visit multiple medical care institutions (hospitals, pharmacies, dental clinics, etc.) for examination or treatment, you must pay a copayment of roughly 25,000 yen to each institution.
If you receive both inpatient and outpatient treatment at the same medical care institution, you must pay a copayment of roughly 25,000 yen for each.

Meals during hospitalization

If you are hospitalized, in addition to the 30% copayment on medical care costs, you must also pay yourself as meal expenses (referred to as "inpatient meal standard expenses") 510 yen/meal for up to three meals/day (300 yen/meal for patients with intractable diseases or specific chronic diseases of children).

While the actual cost of meals during hospitalization is 690 yen/meal (up to three meals/day) based on standard meal expenses, the Health Insurance Association pays the amount in excess of inpatient meal standard expenses, as "Inpatient Meal Expenses".

In addition, when an elderly person aged 65-74 is hospitalized in a long-term care bed, he or she pays meal expenses of 510 yen/meal (470 yen/meal at some medical care institutions) and accommodation expenses of 370 yen/day (**1) (called "the standard personal cost burden for living expenses"). The Health Insurance Association pays the amount of actual costs in excess of this standard personal cost burden for living expenses as "Inpatient Living Expenses."

  • **1: For patients with designated intractable diseases, the copayment for meal expenses is 300 yen, while the copayment for accommodation expenses is 0 yen.
  • **2: Costs are reduced still further for persons with low income. See here for more information.