If you become sick or are injured
If you become sick or are injured, present your health insurance card when undergoing an examination or treatment to obtain the necessary medical care while paying just a portion of the applicable medical care costs.
Medical Care Benefits (for dependents, “Dependents' Medical Care Expenses”)
- * Those aged 70 or younger
When an insured person becomes sick or is injured, he or she can obtain medical care while paying just 30% of the applicable medical care costs simply by presenting his or her health insurance card at a medical care institution. The Health Insurance Society pays the remaining 70%. Similarly, dependents can present their health insurance card at medical care institutions to obtain medical care while paying just 30% of applicable medical care costs (for those from elementary school age through the age of 69) or 20% (if a preschool child). The Health Insurance Society will pay the remaining 70% or 80% as dependent medical expenses.
- * Those aged 70–74
Those aged 70–74 years are referred to as Elderly Recipients. The copayment they pay at the medical care institution is 20% (10% if born April 1, 1944, or earlier), or 30% for persons earning income at levels equivalent to active workers.
(* “Persons earning income at levels equivalent to active workers” refers to persons of ages 70–74 whose standard monthly remuneration is 280,000 yen or more. See here for more information.)
When seeking examination or treatment, show your elderly benefits card in addition to your health insurance card at the medical care institution. The Medical Care System for the Advanced Elderly covers all persons aged 75 and older (65 and older with a qualifying disability).
The Sony Health Insurance Society' s additional benefits
If the copayment you pay at the medical care institution*1 exceeds a certain amount,*2 the amount beyond this ceiling*3 will be refunded by the Sony Health Insurance Society as copayment reimbursement in the case of an insured person or the dependent medical care additional sum in the case of a dependent. (This refund is processed automatically. You do not need to apply for it.) This is a benefit independently provided by the Sony Health Insurance Society.
- *1 Calculated in units of invoices (rezepts)sent from medical care institutions to the Society (by patient, by month, by medical care institution, by inpatient/outpatient care category, and by medical/dental/pharmaceutical category). However, the invoices (rezepts) for medical care costs paid for outpatient care and for pharmaceutical costs paid at a dispensing pharmacy outside the hospital for a prescription from the same hospital will be totaled and regarded as a single invoice (rezept).
- *2 Max. 20,000 yen
- *3 Figures are rounded down to the nearest 100 yen.
- * Excludes inpatient meal expenses, premium bed costs, or costs paid on your own for care not covered by insurance.
- * Refunds will typically be remitted about three months after the examination or treatment.
- * Payment may be delayed if receipt (rezept) of the invoice for medical care costs from the medical care institution for costs to be borne by the Health Insurance Society is delayed.
- * Those eligible to receive publicly funded medical assistance from their municipal governments are not eligible for automatic payment. See “Those eligible for medical assistance from their municipal governments” for more information.
The Health Insurance Society will reimburse you at a later date for medical care costs paid at the hospital in one month minus 20,000 yen as copayment reimbursement (for dependents, dependent medical care additional sum).Reimbursements are calculated and processed automatically based on the rezept (medical cost details) sent from the hospital to the Health Insurance Society. You will receive the reimbursement about three months after the month of examination or treatment.
For specific examples of calculations, refer to “High-Cost Medical Care Benefits and the Sony Health Insurance Society’s Additional Benefits”.
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”) 360 yen/meal for up to three meals/day (260 yen/meal for patients with intractable diseases or specific chronic diseases of children).
While the actual cost of meals during hospitalization is 640 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 460 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 those with high degrees of medical necessity (Medical Care Categories II or III), the copayment for meal expenses is 370 yen, while the copayment for accommodation expenses is 200 yen. (For patients with designated intractable diseases, the copayment for meal expenses is 260 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.