If you paid the entire medical care cost up front
In certain cases, if you paid the entire medical care cost up front for unavoidable reasons, you can later apply to the Health Insurance Society to be reimbursed for the amount covered by the corresponding benefits.
If you paid the entire medical care cost up front
Of the amount you paid up front, you will be reimbursed for the amount from which the benefit ratio reflecting your age and income has been subtracted. Benefits will not necessarily cover all of the costs you paid.
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If you received treatment at a medical care institution without presenting your health insurance card due to sudden illness while traveling or other such cases, you must pay the entire amount of medical care costs yourself. However, you can apply to the Health Insurance Society to be reimbursed for the amount you paid up front corresponding to the cost of insured medical consultation and treatment.
If the procedures to issue your health insurance card were not yet complete
If you paid the full amount of the medical care costs up front because you were unable to present your health insurance card since its issuance procedures were not yet complete
If you were unable to present your health insurance card due to sudden illness
If you paid the full amount of the medical care costs up front because you were unable to present your health insurance card due to sudden sickness while traveling or similar compelling reasons
If you accidentally used your previous insurer’ s health insurance card
If you paid the share of medical care costs covered by health insurance (70% or 80%) to your previous health insurance society because you accidentally used your previous insurer’s health insurance card after loss of eligibility under your previous insurer
If you purchased prosthetic or other equipment (including prosthetic equipment, eyeglasses for correcting juvenile amblyopia or other such conditions, or compression garments [e.g., compression stockings])
Prosthetic or other equipment eligible for payment includes prosthetic equipment, eyeglasses for correcting juvenile amblyopia or other such conditions, or compression garments (e.g., compression stockings) prepared based on a doctor’s instructions and deemed necessary by a doctor for treatment.
Prosthetic or other equipment intended for convenience in everyday living, prosthetic or other equipment intended for cosmetic purposes, or prosthetic or other equipment prepared after the patient’s condition has stabilized are not covered for benefits.
|Eligible eyeglasses||Eyeglasses prepared under a doctor’s instructions for therapeutic use in correcting amblyopia or strabismus or for refractive correction following surgery for congenital cataracts in a child younger than nine|
|Maximum cost of purchase||Eyeglasses are subject to a maximum amount (38,461 yen) under the Health Insurance Act.
You must pay any amount beyond this yourself.
|Replacing eyeglasses||Less than five years old: Eyeglasses may be replaced with new eyeglasses no sooner than one year after the child begins wearing them.
Five years and older: Eyeglasses may be replaced with new eyeglasses no sooner than two years after the child begins wearing them.
|Eligible for compression garments||To treat postoperative lymphedema of the arms or legs following surgery for a malignant tumor involving a lymphadenectomy|
|Maximum cost of purchase||Compression stockings: 28,000 yen (25,000 yen for one foot); compression sleeves: 16,000 yen; compression gloves: 15,000 yen|
|Maximum quantity purchased||Based on laundering needs, up to two compression garments may be purchased at one time for each region of the body to which they will be fitted.|
|Repurchase of compression garments||Compression garments may be repurchased no earlier than six months after the previous purchase.|
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:
①Medical care not authorized as insured medical care in Japan is not covered for benefits.
- ②Treatment received while traveling overseas expressly for the purpose of medical care is not covered for benefits.
- ③Benefits are paid based on amounts calculated by subtracting the patient’s copayment amount from what the usual medical care costs in Japan for the same injury or illness (or the actual amount paid overseas, whichever is lower).
①If overseas medical care is eligible for health insurance coverage, since details such as medical systems and treatment methods differ between Japan and overseas and because the treatment received overseas is converted under Japanese rules, insurance benefits may cover as little as one-tenth of the actual costs incurred.
- * Be sure to contact the Sony Health Insurance Society before incurring overseas medical care costs.
Acupuncture and moxa cautery
- Only conditions involving primarily chronic pain such as neuralgia, rheumatism, cervicobrachial syndrome, stiff and painful shoulders, lower back pain, and aftereffects of cervical sprain are covered by health insurance.
- A physician’s consent is required before receiving acupuncture or moxa cautery treatment under health insurance coverage.
- Acupuncture or moxa cautery treatment administered at the same time as treatment at an insurance medical care institution for the same injury or illness (for example, a chronic condition for which a physician considers there are no appropriate means of treatment available) is not covered by health insurance.
- Only cases requiring massage treatment for medical reasons, such as muscular paralysis and articular contracture, are covered by health insurance.
- A physician’s consent is required before receiving massage treatment under health insurance coverage.
- Health insurance does not cover massage for fatigue recovery or relaxation purposes, or massage to prevent disease.
Transportation expenses may be paid if necessary on a temporary and urgent basis, as indicated by a physician, due to patient difficulty in moving due to illness or injury and the current medical care institution lacks the facilities or other resources required for adequate care.
- Emergency transportation of a patient injured at an accident site
- Transportation following severe illness or injury on a remote island or similar location at which nearby hospitals are unable to provide adequate care
- 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.
Expiration of health insurance benefits
The right to claim health insurance benefits expires after two years.
The two-year period after which the right to claim health insurance benefits for medical care costs expires begins on the day after the date of the receipt. (Article 193 of the Health Insurance Act)