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).

For specific examples of calculations, refer to “High-Cost Medical Care Benefits and the Sony Health Insurance Society’s Additional Benefits”.

• If you want to reduce the amount you pay at the medical care institution
• If you incur high medical care costs two or more times in the same month
• If copayments for medical care and long-term care are high