If you become sick or are injured

Medical Care Benefits (for dependents, “Dependents' Medical Care Expenses”)

• ** See here for information on measures for reducing cost burdens for persons aged 70–74.

• ** Persons earning income at the same levels as active workers: This refers to elderly persons aged 70–74 whose standard monthly remuneration is 280,000 yen or more. See here for more information.

Under the health insurance system, the insurance benefits paid for nonoccupational sickness and injury are called “Medical Care Benefits” (for dependents, “Dependents' Medical Care Expenses”). You pay only 30% of medical care costs at medical care institutions because the Health Insurance Society covers the remaining 70%, based on insurance premiums paid by members.

The Health Insurance Society will pay the amount of medical care costs you paid at the reception desk of the hospital over one month minus 20,000 yen (varies with income) at a later date, as “Patient Cost-Sharing Reimbursements and Additional Benefits” (for dependents, “Dependents’ Medical Care Additional Sum”). The amount is calculated and paid automatically based on the Rezept (medical cost details) sent by the hospital to the Health Insurance Society. Payment will occur three or more months after the month in which the medical care is provided.
See “When you incur high medical care costs: Example of calculating High-Cost Medical Care Benefits” for an example of these calculations.

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”) 490 yen/meal for up to three meals/day (280 yen/meal for patients with intractable diseases or specific chronic diseases of children).

While the actual cost of meals during hospitalization is 670 yen/meal (up to three meals/day) based on standard meal expenses, the Health Insurance Society 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 at a convalescent facility, he or she pays meal expenses of 490 yen/meal and accommodation expenses of 370 yen/day (**1) (called “the standard personal cost burden for living expenses”). The Health Insurance Society 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 280 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.