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.


 
Description
FAQ

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

Amounts paid

Copyment:
30%
Medical Care Benefits:
70%

The copayment may be even lower, depending on age.

Preschool children (20% copayment)

20%
80%

Persons aged 70-74(20% copayment)

20%
80%

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 Society covers the remaining 70%.

The organization's additional benefits

(Paid per month, per person, per hospital)

Copayment
Copayment
Amounts calculated by deducting Table 1		 The organization's additional benefits
Patient Cost-sharing Reimbursement
(Dependents' Additional Total High-cost Medical Care Benefits
  • ** 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 benefit will not be paid if the calculated amount is less than 1,000 yen. The calculated amount will be rounded down to the nearest 1,000 yen.

Patient Cost-Sharing Reimbursements” (for dependents, “Dependents' Medical Care Additional Sum”)

The Health Insurance Organization later pays the amount of medical care costs paid at the hospital over one month minus amounts calculated by deducting Table 1, as “Patient Cost-Sharing Reimbursements” (for dependents, “Dependents' Medical Care Additional Sum”). This payment is calculated and made automatically based on “the Rezept (medical cost details)” sent by the hospital to the Health Insurance Organization. Payment will occur roughly three months after the month of the medical care.
See “When you incur high medical care costs: How High-Cost Medical Care Benefits are calculated” for a specific calculation example.

In addition, persons receiving medical expense subsidies as a result of public expenditure by local governments are not eligible for automatic payment.
For details, see "To those who receiving medical expense subsidies".

Table 1

Under 70 years

Standard monthly remuneration of the month
in which the medical care was provided		 Whole Household
(including elderly persons and the others)
830,000 yen or more 83,000 yen
530,000 yen - 790,000 yen
280,000 yen - 500,000 yen 45,000円
260,000 yen or less
Persons with low income * 30,000円
  • *Insured persons exempted from municipal tax

 

Elderly persons aged 70-74

Classification Single Individual
(outpatients only)		 Household Unit
(including inpatients)
Persons with high income *1 44,000 yen 45,000 yen
Persons with general income 20,000 yen 40,000 yen
Persons with low income Ⅰ　*2 10,000 yen 14,000 yen
Persons with low income Ⅱ　*3
  • * When the case is applicable to Total High-Cost Medical Care Additional Sum
    When the case is classified to general and cost-sharing amount for a rezept is less than 45,000 yen, or when the standard monthly remuneration is classified to 530,000 yen or more and cost-sharing amount is less than 83,000 yen, cost-sharing amount for each case is regarded as the cost-sharing maximum amount for each rezept.
    *1　When standard monthly remuneration of the month in which the medical care was provided is 280,000 yen or more (patient whose amount of patient cost-sharing is 30%)
    *2　In the case of that the income is 0 yen as a result of calculation
    *3　Insured persons exempted from municipal tax

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 Organization 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 Organization 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.