Salesforce
Health Association

Health Insurance System, Insurance Premiums, etc.

Do I have to enroll in health insurance?

Health insurance reduces your burden of medical expenses by asking you to pay insurance premiums according to your income in preparation for illness and injury. The health insurance then pays for a portion of the medical care you receive. In a universal health insurance system, all citizens enroll in a public medical insurance system. When a citizen has suffered an illness or injury, that citizen can receive treatment at any time and at any location, and only pays a portion of the medical care costs. Japan’s universal health insurance system was established in 1961. The public medical insurance system is roughly divided into “employee insurance (occupational field insurance)” and “National Health Insurance (regional insurance)” depending on the form of employment of each individual. Furthermore, in April 2008, the medical care system for elderly in the latter stage of life was added to insure people age 75 or older.
Both systems are operated using insurance premiums, and the law requires citizens to enroll in one of the medical insurance systems.
Employee insurance is divided into health insurance (union-managed health insurance and health insurance managed by the Japan Health Association [formerly government-managed health insurance]), seamen’s insurance, and mutual aid insurance associations. Furthermore, regional insurance is divided into municipal national health insurance and national health insurance societies. Health insurance is intended for workers working at private business establishments. Employers are responsible for conducting enrollment procedures, paying insurance premiums, and other insurance-related processes on a business unit basis.

What are the costs of operating a health association?

The main expenditures for operating a health association are health insurance benefits, contribution payments, healthcare service costs, and administrative expenses.
Each of these expenditures is described below.

• Health insurance benefits
  These benefits are payments of medical expenses to healthcare providers and partial refunds as well as additional benefits paid to insured persons as a system of a health association.
• Payments
  Costs to be borne in accordance with the “Latter-Stage Elderly Healthcare System” for mutual support from the working generation for medical care costs of older senior citizens aged 65 and over.
  Payments are broken down into “early-stage elderly payments,” “latter-stage elderly payments,” etc.
• Healthcare business expenses
  Health insurance societies are required to carry out health education, health counseling, health checkups, and other projects necessary to maintain and improve the health of insured persons and their dependents (family members). The healthcare business expenses are the expenses incurred for these projects.
• Administrative expenses
  These expenses are the costs incurred for the operation of health insurance societies. This includes personnel costs, costs for maintaining the core system for processing of health insurance paperwork, office rent, utilities and water supply costs, communication costs, equipment costs, and consumables costs.

In addition to general insurance premiums and nursing care insurance premiums, I have heard of something called adjusted premiums. What are adjusted premiums?

Nationwide health insurance societies cooperate to implement joint burden projects for high medical expenses and subsidy projects for financially distressed associations. In some cases, when high medical expenses are incurred, it is necessary to apply the insurance premiums of hundreds of enrollees to cover the expenses of a single enrollee. Therefore, all health insurance societies make contributions in advance and pay a portion of the high medical expenses above a certain amount as a subsidy. Additionally, subsidies from contributions are paid to health insurance societies whose financial situation has deteriorated due to issues such as an increase in medical expenses or changes in the industry structure.
Health insurance societies contribute adjusted insurance premiums to finance these subsidized projects (financial adjustments). This consortium is implemented by the National Federation of Health Insurance Societies.
The adjusted premium rate is determined by multiplying the basic adjusted premium rate by the correction rate. The basic adjusted premium rate is set by the Minister of Health, Labour and Welfare every year based on a Cabinet Order, and the correction rate (rate of increase/decrease) is set by the National Federation of Health Insurance Societies every year based on the financial situation of each association.

Are insurance premiums collected for family as well?

Unlike the National Health Insurance program, health insurance premiums are not collected for relatives who are dependents even though these dependents also receive health insurance benefits.
Because the insurance premiums for health insurance are charged for the insured person, the insurance premium does not change according to the number of dependents.
The insurance premium collected from a monthly salary is determined by the standard monthly salary of the insured person. The insurance premium collected from the bonus is determined based on the standard amount of the bonus. For both salaries and bonuses, health insurance premiums will be collected only from the insured person at the amount appropriate for each individual.
This also applies to long-term care insurance.

I will be transferred overseas. I’m 42 years old now, so I’m insured by long-term care insurance. Do I need to submit any documentation?

Enrollees between the ages of 40 and 65 who do not have an address in Japan cannot be classified as Category 2 insured persons covered by long-term care insurance. This case applies to individuals who are transferred overseas. Please submit a Notification of Exemption from Nursing Care Insurance (Applicable/Not Applicable) to the Salesforce Health Association through your employer. This applies to dependents as well as the insured person. Please fill in the following items on the Notification of Exemption from Nursing Care Insurance (Not Applicable):

1. Name and date of birth of the insured person/dependent
2. Health insurance code and number of insured person
3. Reasons for loss of eligibility as a Category 2 insured person, date, etc.

Furthermore, a Notice of Deleted Certificate of Residence, certificate of entry into exempt facilities, and other relevant documentation must be attached to the notification form as necessary. Long-term care insurance premiums are exempted by submitting the applicable exemption notification and other relevant forms. (Please be sure to submit the notification because insurance premiums will be collected if you fail to submit the necessary forms.) If the exempted individual becomes classified as a Category 2 insured person of long-term care insurance, please attach a Certificate of Residence (copy) (certificate showing the date of the move to a new address) to the Notification of Exemption from Nursing Care Insurance (Applicable/Not Applicable), and submit the materials to the Salesforce Health Association. Collection of long-term care insurance premiums starts from the month in which the move took place.

I am a foreign employee Are there any differences in the treatment of health insurance?

There is no difference in the sysyte of health insurance, and everyone can receive the same treatment.
However, in order for a family member to become a dependent, the family member must meet certain conditions set by law, such as “domestic residence.”
For details, please refer to “When I want to add / remove dependents.”

Health Insurance Cards, Eligibility Confirmation Documents

I lost my health insurance card. I’m worried that someone will do something bad with it. What should I do?

If your health insurance card has been stolen, please notify the police immediately in order to prevent fraudulent usage.
Please be sure to complete the procedures for the loss of a Health Insurance Card to the Health Insurance Society. Refer to the “Application Forms” page for information on where to submit application forms.
If you find your lost health insurance card after receiving a replacement, please return the health insurance card which was lost to the Salesforce Health Association.
After December 2, 2024, a health insurance card will no longer be issued, please register your Individual Number Card as a health insurance card or apply to issue an Eligibility Confirmation Document. Please refer to “How to Register your Individual Number Card as a health insurance card” under “Use of an Individual Number Card as a Health Insurance Card”.

I lost my Eligibility Confirmation Document (資格確認書). What should I do?

Please take one of the following:

①Registering your Individual Number Card as a health insurance card
Please refer to “How to Register your Individual Number Card as a health insurance card” under “Use of an Individual Number Card as a health insurance card”.

②If you do not have an Individual Number Insurance Card and would like to continue to use your Eligibility Confirmation Document to receive medical treatment, please apply for a reissuance of your Eligibility Confirmation Document.
Necessary documents:Application for Reissuance of health insurance card, Eligibility Confirmation Document or Elderly Beneficiary health insurance card Due to Loss/Damage

Do I have to show my health insurance card, Eligibility Confirmation Document, etc. every month when undergoing an examination at a healthcare provider?

When undergoing an examination at a healthcare provider, the patient pays his/her co-payment at the billing counter on the day of each examination, but the insurance claim from the healthcare provider is made on a monthly basis. Therefore, the healthcare provider needs to check the insurance in which the patient is enrolled every month.
When the company where you work changes, the health association where you are enrolled normally changes. Moreover, the national health insurance program in which you are enrolled also changes if the municipality where you live changes.
However, healthcare providers are not aware of the change to the insurance in which patients are enrolled. If the patient does not request a change, his or her medical expenses will be billed to the wrong health association. Therefore, many healthcare providers require patients to show their health insurance card, Eligibility Confirmation Document, etc. on the first visit of every month in order to verify which insurance a patient is enrolled.

When there is not a health insurance card, Eligibility Confirmation Document, etc. at hand, What should I do if I get sick?

Once you have paid the full amount of medical expenses incurred, please submit an “Application for Payment of Medical Care Costs (Advance Payment)” along with the original medical fee statement and receipts to the health insurance association.

Certification of Dependents

My wife retired because she will give birth to our child. How do I apply to certify her as a dependent?

The requirement for certification of dependents (annual income of 1.3 million yen or less) is reviewed based on the anticipated income for the period of one year starting on the application date. Therefore, your wife will be certified as a dependent after her retirement.
In the case of individuals who plan to receive unemployment benefits from employment insurance after giving birth, please complete the procedures to extend employment insurance benefits and obtain a Benefit Period Extension Notice, and then submit a copy of this notification to the Salesforce Health Association.
To apply, please submit the following documents promptly after retirement. (Refer to the “Application Forms” page for information on where to submit application forms.)

• Notification of Change of Dependents
• Dependent Record
• Separation Notice 1/2 (copy) or Certificate of Retirement

If employment insurance benefits began to be received after giving birth, complete procedures to temporarily remove your wife from your dependents, and then apply for her certification as a dependent again once the payment period has ended.

My wife plans to leave her company. She thinks she will start receiving unemployment benefits through employment insurance. Can I claim her as a dependent?

Certification as a dependent for health insurance coverage is based on whether the individual’s post-resignation income (including real estate income, etc.) exceeds the legally stipulated standard amount (under age 60: 1.3 million yen per year; disabled or age 60 or older: 1.8 million yen per year).
Therefore, your spouse would be recognized as a dependent from the time of resignation until she starts receiving payment of unemployment benefits from employment insurance. However, it will be necessary to complete (change) procedures to remove your spouse from your dependents when she starts receiving unemployment benefit payments.
When the payment period ends, your spouse will be recertified as a dependent. However, while she is receiving unemployment benefits, she must enroll in National Health Insurance. Please complete the enrollment procedures at your local National Health Insurance counter.

My wife is receiving unemployment benefits from employment insurance, but the payment period will end soon. What do I need to do to have her added as my dependent?

When the unemployment benefit payment period ends, the Public Employment Security Office stamps the Employment Insurance Benefit Eligibility Certificate for the individual to show that the payment period has ended. Please attach a stamped copy of both sides of the Employment Insurance Benefit Eligibility Certificate to the Notification of Change of Dependents, and then submit these forms to the Salesforce Health Association. (Refer to the “Application Forms” page for information on where to submit application forms.)

Are the unemployment benefits provided by employment insurance considered income?

Unemployment benefits are considered income because these benefits guarantee livelihood while job hunting for an individual who has been certified as unemployed and is unable to get a job despite having the will and ability to work.

My wife started working part time. Can I still claim her as my dependent?

Even if your wife is working part time, enrollment in her own health insurance is mandatory if she meets the requirements of an insured person.
The number of hours and days she works among other requirements determine whether your wife qualifies as an insured person at her place of employment.
If an Eligibility Notification, an Eligibility Confirmation Document, etc. has been issued by your wife’s employer or if she expects to earn an annual income of 1.3 million yen or more (more than 108,334 yen per month), you must remove her as your dependent. Please perform the necessary procedures.

Can I claim my parents as dependents even if I do not live with them?

Parents, grandparents, spouses, children, grandchildren, and siblings can be certified as dependents even if they do not live with you.
However, there must be no other person who can financially support them to qualify as a dependent.
In addition, the Salesforce Health Association certifies dependents based on the insured person’s track record of providing the individual with financial support. Therefore, it is necessary to show proof of the actual amount provided as assistance. Please consult the Salesforce Health Association.

*A track record of remittance that exceeds the salary of the applicable individual will be required. Money delivered by hand is not considered remittance. Remittance requires continued financial support (about once per month).

My mother lives near my home, and I would like to apply to claim her as a dependent. Since I visit her frequently, I hand her cash every month for her living expenses. Is giving her cash “by hand” approved as a method of sending living expenses?

It is necessary to objectively prove living expenses were sent; therefore, we do not recognize living expenses given “by hand” as approved evidence of remittance. To determine if an individual living separately from the insured person is a financial dependent, the Salesforce Health Association asks insured persons to submit actual records proving money was sent on a monthly basis though a financial institution.
Please note that money sent using registered mail for cash is also not recognized as proof of remittance.
We may ask you to submit proof of money sent in the past as well.

My dependent mother-in-law will be admitted to a special care facility for the elderly. I will also transfer her certificate of residence. Since living together is a legal requirement for dependents, do I have to remove my mother-in-law from my dependents?

The following facilities are considered an extension of living together: social welfare facilities for elderly care (special care homes for the elderly), geriatric health service facilities, long-term care medical facilities, and rehabilitation facilities for a person with physical (mental) disabilities. Therefore, if your mother-in-law qualifies as a dependent, you can continue to claim her as a dependent.

My child graduated from college, but hasn’t gotten a job. Can they continue to be enrolled in the Salesforce Health Association as my dependent?

The Salesforce Health Association certifies a person as a dependent if they have little to no income (annual income is less than 1.3 million yen).
A Certificate of Taxation/Exemption for Local Tax is required as a document to prove income. Please submit the certificate immediately if requested by the Salesforce Health Association.

My child got a job, so I would like to remove them from my dependents. What are the necessary procedures?

Please fill in the name of the dependent to remove and the date on which they ceased to be a dependent (date of employment) in the Notification of Change of Dependents, attach the documents below, and submit the notification to the Salesforce Health Association. (Refer to the “Application Forms” page for information on where to submit application forms.)

• Copy of the Eligibility Notification, the Eligibility Confirmation Document, etc. from their employer
• Health Insurance Card or Eligibility Confirmation Document of individual in question (issued by the Salesforce Health Association)

If you need a loss of qualification certificate, please contact the Salesforce Health Association in advance.

If a married couple are both working and each of them has their own health insurance, will a child be a dependent of the husband or wife?

As a general rule, the child shall be the dependent of the member of the couple whose estimated income for the next year is greater. If the difference in annual income between the husband and wife is 10% or less of the greater amount, the child shall be the dependent of the person supporting the household indicated in the notification.
If there are multiple children, it is generally not permitted to assign them separately as dependents; for example, making one child a dependent of the wife and one child a dependent of the husband.

Is there a difference between tax law dependents and health insurance dependents?

Dependents are certified under tax law based on the amount of income from January to December of the applicable year. On the other hand, a health association certifies dependents by considering the expected income amount during the year following the date of becoming a dependent. The standard amount of income for certification also differs between the tax law standard value and the health insurance standard value.

Medical Expense

What is the system for paying medical care costs?

Every patient pays a portion of their medical care costs at the billing counter of the healthcare provider. The healthcare provider submits a statement of medical expenses (insurance claim statement) to the health association for the remainder of the medical costs. The health association then pays the healthcare provider through a health insurance claims review and reimbursement service.
The health association and the health insurance claims review and reimbursement service both check the details of the medical care costs to ensure no billing errors or other mistakes in an effort to streamline medical care costs.

If I have to pay high medical costs for a long period of time, is the amount that I have to pay reduced?

If the same household has paid medical care costs that are classified as high-cost medical expenses for 3 months or more within the last 12 months, the limit for out-of-pocket payments will be reduced from the fourth month.
The amount differs according to your standard monthly remuneration. An amount exceeding the maximum out-of-pocket payments in the table below will be reimbursed.

[Limit for Out-of-Pocket Payments from the Fourth Month]

Standard monthly remuneration	Maximum Co-payment
830,000 yen or more	140,100 yen
530,000 yen – 790,000 yen	93,000 yen
280,000 yen – 500,000 yen	44,400 yen
260,000 yen or less	44,400 yen
Low-income earner	24,600 yen

In addition, if a person requires long-term, high-cost care due to a specified disease (hemophilia, acquired immunodeficiency syndrome for which antiviral drugs are administered, or chronic renal failure requiring dialysis), the maximum monthly out-of-pocket costs are 10,000 yen (the limit for monthly out-of-pocket costs is 20,000 yen for an upper income earner who undergoes dialysis). Please contact the Salesforce Health Association for details about the filing procedures.

Both partners in a married couple work, and both are insured by the Salesforce Health Association. If medical costs become high, can the married couple be treated as a joint household?

In a joint household, the insured person and dependents are treated as a single household, and out-of-pocket costs paid at the billing counter of 21,000 yen or more are subject to joint billing.
Unlike households in the Basic Resident Register, two people insured separately even if a married couple are not treated as a joint household because each insured person is considered a separate entity when determining whether or not to pay high-cost medical expenses.

I paid more than 270,000 yen in medical expenses at the billing counter when I was hospitalized recently. How do I file a claim for high-cost medical expenses?

Out-of-pocket medical expenses that exceed the maximum out-of-pocket payments for high-cost medical expenses are eligible for payment of health insurance benefits from the Salesforce Health Association.
(The limit for out-of-pocket payments for medical care costs varies by income. Please see “High-cost Medical Care Expenses.”)
The Salesforce Health Association will pay an amount calculated based on the statement of medical expenses from the healthcare provider, excluding meals and amenity bed costs while hospitalized. The payment will be made at the end of the month approximately three months after the month in which the insured person received medical care.* An application is not necessary.

What is an Eligibility Certificate for Ceiling-Amount Application? When do I use this certificate?

Under the High-Cost Medical Expense Benefit, a patient pays the full amount of the medical expenses charged at the billing counter. Afterwards, the Salesforce Health Association refunds the portion exceeding the out-of-pocket limit.
The Eligibility Certificate for Ceiling-Amount Application is used to reduce the amount of high-cost medical expenses from the amount paid at the billing counter of each healthcare provider. This certificate keeps the reduced amount within the out-of-pocket limit. Presenting this certificate at the billing counter is effective when the amount of payment is high because it limits the amount you pay to the maximum out-of-pocket payment. Previously, an application for this certificate was only available for hospitalizations. However, legal reforms have now made use of this certificate possible for outpatient care to support cancer treatments and other high-cost outpatient medical expenses.
Insured persons and dependents submit a “Application for Issuance of Eligibility Certificate for Ceiling-Amount Application” to the Salesforce Health Association in advance to receive issuance of this certificate. A patient submits the certificate issued by the Salesforce Health Association to the medical provider as an attachment to the health insurance card or the Eligibility Confirmation Document. By presenting an Eligibility Certificate for Ceiling-Amount Application, the amount paid at the billing counter will be limited to the legally-specified out-of-pocket maximum per month at each medical provider.
If you do not present an Eligibility Certificate for Ceiling-Amount Application, the high-cost medical expenses and additional costs will be refunded after the medical provider receives the insurance claim statement from the Salesforce Health Association about 3 months after care. Please check here for details on the procedures.
If you use your Individual Number Card as your health insurance card, you will be exempt from paying any out-of-pocket expenses that exceed the maximum amount under the High-Cost Medical Expenses System without undertaking any prior procedures.

What is a Certificate of Medical Treatment for Specified Diseases? When is this certificate used?

There is a system to reduce the out-of-pocket costs required for specified diseases that require high-cost medical expenses for a long period of time.
The Certificate of Medical Treatment for Specified Diseases is issued to patients with long-term high-cost diseases designated by the Minister of Health, Labour and Welfare. These patients can use the aforementioned system.
The diseases designated as specified diseases are as follows:

1. Chronic renal failure requiring dialysis
2. Congenital blood coagulation factor disorder (known as “hemophilia”)
3. Acquired immunodeficiency syndrome (HIV infection) caused by administration of blood coagulation factor preparations

In order to receive the special services stipulated by the system, the patient applies directly to the Salesforce Health Association, receives a Certificate of Medical Treatment for Specified Diseases, and then presents the certificate together with their health insurance card or Eligibility Confirmation Document at the billing counter of the healthcare provider. (A physician’s certificate is required.)
Please contact the Salesforce Health Association for details about the procedures.

My son got a job in April, but I forgot to remove him from my dependents. Will I be charged for medical care costs if he received medical care using Salesforce Health Association's insurance after April?

If your family member has found employment, please submit the Notification of Change of Dependents for removing a dependent immediately. In addition, if the dependent has a health insurance card or an Eligibility Confirmation Document, please attach it and submit it. (Refer to the “Application Forms” page for information on where to submit application forms.)
The Salesforce Health Association dependent status for the person who has obtained employment will be retroactively revoked from the date of employment.
The medical care costs for children billed to the Salesforce Health Association due to delayed notification of removal of dependents will be charged to the insured person at a later date. Therefore, the insured person will need to pay the full amount of these medical costs.
In addition, the statement of medical expenses (insurance claim statement) corresponding to the amount paid will be provided to the insured person by the Salesforce Health Association. If you notify the health association where your child is enrolled by their employer, you can be reimbursed for these medical care costs by the employer’s health association.

I would like to see a doctor at the clinic on my way home from work, but I didn’t bring my health insurance card, Eligibility Confirmation Document, etc. because I was in a hurry. In this case, can I use my health insurance to receive medical care?

Even if you do not have your health insurance card, Eligibility Confirmation Document, etc., you can receive medical care provided by health insurance. However, you will need to temporarily pay the full amount of medical care costs. Before receiving medical care, please consult with the billing staff at the clinic about how to handle your health insurance.
To have the medical care costs reimbursed, please attach the receipt (original) and the statement of medical expenses (original) to the Application for Payment of Medical Care Costs, and then submit the documents to the Salesforce Health Association.
The Salesforce Health Association will review and evaluate the documents in accordance with medical care standards, and issue payment to the applicant.

I was injured while traveling and didn’t have my health insurance card, Eligibility Confirmation Document, etc. with me, so I paid the entire amount myself. How do I file a claim for that amount?

Please fill in the required information on the Application for Payment of Medical Care Costs, attach the statement of medical expenses (original) and the receipt (original) issued by the healthcare provider, and then submit the request to the Salesforce Health Association. (Refer to the “Application Forms” page for information on where to submit application forms.)
The Salesforce Health Association will review the case and provide payment based on the established criteria.

I received medical treatment outside of Japan. Can I receive health insurance benefits?

If an insured person or dependent who is traveling, on a business trip, or is stationed overseas receives care at an overseas healthcare provider, that person can receive health insurance benefits under certain conditions. (*In some cases, overseas medical costs are not accepted as medical care costs.)
However, people from Japan cannot use their health insurance card, Eligibility Confirmation Document, etc. overseas. Therefore, if you receive medical care or medication at an overseas healthcare provider due to sudden illness or injury, you must temporarily pay the full amount of costs to the healthcare provider. After returning to Japan, you should then apply for reimbursement of the medical care costs from the Salesforce Health Association.

I lost my medical expense notice. Can I have the medical expense notice reissued?

We apologize, but we are unable to reissue medical expense notices.

Insurance Benefits

Do insurance premiums increase as the number of dependents increases?

The insurance premiums do not change even if the insured person has a family or a number of dependents.
Health insurance premiums are calculated for every insured person based on their salary and other remuneration.

I am currently hospitalized and I am not receiving a salary. How will my insurance premium change in this case?

As long as you are an insured person, you have to pay the premium even if you are not receiving a salary.
Generally, the employer pays the insurance premiums while an employee is not earning a salary. Then, at a later date, the employee will reimburse the employer for those premiums in accordance with an agreement reached through discussions with the employer. The insurance premium will be the same insurance premium before the absence. When an employee becomes unable to work due to medical care for illness or injury and therefore is not receiving wages, an injury and illness allowance is paid from the fourth day when three of the four days were consecutive. The daily amount paid is equivalent to two-thirds of the average monthly standard of remuneration for each of the 12 consecutive months prior to the start date for payment of the allowance divided by 30 (calculation standards differ depending on the insured period of the individual prior to the start date for payment of the allowance). This daily allowance will be paid for one year and six months counting from the payment start date.

What conditions must be satisfied to receive payment of medical transfer costs?

You must satisfy the three requirements below for approval of medical transfer costs:

• Medical transfer is necessary to receive appropriate medical care covered by insurance
• Mobility is significantly difficult
• Medical transfer is urgent or unavoidable

Please note that approval from the Salesforce Health Association is required to receive payment.

If I take a taxi to each doctor’s visit, will insurance cover these expenses as medical transfer costs?

Because these are normal outpatient fees incurred to receive medical care, they are not approved as medical transfer costs.
Insurance only covers medical transfer costs when an application has been submitted and the Salesforce Health Association has approved the costs in cases of hospitalization or medical transfer due to a serious illness or injury when it is difficult for a person to move by himself/herself and urgent medical transfer was performed at the discretion of a physician.

Both partners in a married couple work, and both were insured by the Salesforce Health Association. The wife left her job due to pregnancy and is now a dependent of her husband, but she gave birth within six months of her resignation (loss of qualification). In this case, will Salesforce Health Association pay both the Childbirth and Childcare Lump-sum Allowance for the wife and the Dependents’ Childbirth as well as the Childbirth and Childcare Lump-sum Allowance for the husband?

Childbirth is a single instance of medical care covered by health insurance. Therefore, Salesforce Health Association does not provide duplicate benefits.
The person making the claim can choose whether to receive the Childbirth and Childcare Lump-sum Allowance for the wife, or the Dependents’ Childbirth and Childcare Lump-sum Allowance for the husband.

I gave birth to twins. Is the Childbirth and Childcare Lump-sum Allowance (Dependents’ Childbirth and Childcare Lump-sum Allowance) paid for only one child?

In cases of multiple births, the insured person receives benefits for multiple children.
For twins, the insured person receives the childbirth lump-sum allowance or the dependents’ childbirth lump sum allowance and any additional allowance if applicable for two children.

I received a childbirth allowance for more than 42 days before giving birth because my childbirth was delayed beyond the due date. Can I still receive the allowance payment for 56 days after giving birth?

Yes, you can receive the allowance payment. If you give birth after your due date, the number of days from the due date to the date of birth will be extended and the allowance will be paid. Therefore, you will receive the childbirth allowance for “98 days + the number of days childbirth was delayed.”

I heard that there is a system to reduce the burden of payment at the billing counter of the healthcare provider when giving birth. Can you give me some information about this system?

The Salesforce Health Association provides a Childbirth and Childcare Lump-sum Allowance (Dependents’ Childbirth and Childcare Lump-sum Allowance) as a subsidy for childbirth costs when the insured person or a dependent has given birth. The Childbirth and Childcare Lump-sum Allowance Direct Payment System was established to mitigate the economic burden of the insured person paying the healthcare provider for childbirth costs by having the healthcare provider handle the application for payment and receipt of the Childbirth and Childcare Lump-sum Allowance instead of the insured person.
The healthcare provider will explain this system and ask the person who gave birth if she would like to take advantage of this system before releasing her from the hospital. If she would like to use this system, the individual pays only the amount exceeding the Childbirth and Childcare Lump-sum Allowance when discharged from the hospital. The Salesforce Health Association pays the healthcare provider an amount equivalent to the Childbirth and Childcare Lump-sum Allowance through its reimbursement service. If the cost of childbirth is less than the Childbirth and Childcare Lump-sum Allowance, the Salesforce Health Association pays the difference to the insured person.
A Substitute Payee System for the Childbirth and Childcare Lump-sum Allowance is also available. See more details here.

Can only dependents receive payments for funeral costs?

The person receiving payments for funeral costs does not necessarily need to be a health insurance dependent. Moreover, the person making the claim does not need to be living in the same household or a relative within certain proximity.
If the insured person has no family, the person holding the funeral can receive payment for funeral costs. The Salesforce Health Association recognizes the ceremony and hearse expenses, cremation, offerings to the spirit of the deceased, and payments of gratitude to monks and other such expenses required for the funeral.
Please fill in all of the required items on the Payment of Funeral Fees (Expenses) and Additional Benefits and submit it together with all of the attached documents necessary. (Refer to the “Application Forms” page for information on where to submit application forms.)

Can I receive payment for funeral expenses even in the case of suicide?

Funeral expenses are paid based on the occurrence of a death. Therefore, funeral expenses are paid even if the cause is suicide.
In the case of suicide (or attempted suicide), benefits for medical care costs leading up to death may be limited to insurance benefits for an intentional accident. However, the cause of death is unrelated the payment of insurance benefits for death, except for accidents during work and commuting. (If a person dies from an illness or injury due to a work-related cause or an accident when commuting to work, these benefits are based on the Labor Standards Act and the Industrial Accident Compensation Insurance Act.)
Please fill in all of the required items on the Payment of Funeral Fees (Expenses) and Additional Benefits and submit it together with all of the attached documents necessary. (Refer to the “Application Forms” page for information on where to submit application forms.)

The insured person died in an accident. The family member who is a dependent of the insured person who died is currently under a physician’s care. Will a surviving relative still be able to receive medical care through the existing health insurance?

Health insurance benefits, even benefits for medical care costs of dependent relatives, are paid to the insured person.
Therefore, if the insured person dies (withdraws from the health association), there is no one present to receive the insurance benefits. Consequently, benefits to dependent relatives will be discontinued at that point. (Family members are withdrawn from the Salesforce Health Association at the same time as the insured person and must enroll in new insurance.)

Can I use health insurance for medical care required due to a traffic accident?

Even if a traffic accident is caused by the action of a third party, you can receive medical care costs through the Salesforce Health Association, unless the accident occurred at or on the way to or from work.

Note: Please exercise caution regarding out-of-court settlements. The details of a settlement will determine the health insurance benefits that you will receive thereafter. Please consult with the Salesforce Health Association to make sure no unexpected issues arise at a later date.

Specific Examples Where Caution Is Required

Example 1: Settlements reached while undergoing medical care covered by your health insurance
If the victim (insured person or dependent) receives compensation of damages that includes medical care costs, health insurance will no longer cover medical care after the date of the settlement. The insured person or dependent will be required to pay all of the medical costs even if symptoms change and medical care is prolonged.

Example 2: Settlements reached by not including medical costs because health insurance is covering the medical care
The Salesforce Health Association cannot request damages for temporary medical costs from the party responsible if you forfeit your right to claim damages for medical expenses. Therefore, the victim (insured person) will be responsible for paying all medical costs.

Can I receive health insurance benefits if I am injured at or on my way to or from work?

No, you cannot receive health insurance benefits.
Workers’ compensation insurance covers injuries incurred at or commuting to or from work. Please make sure to apply for workers’ compensation because health insurance is not an option.

Can I attach a copy of the medical certificate for the Certification by Person in Charge of Medical Care (section completed by physician) section in the Application for Issuance of Injury and Illness Allowance?

The injury and illness allowance is a system aimed at ensuring livelihood while on leave from work. Incapacity to work is one requirement for issuance of this allowance. Therefore, a physician must certify your incapacity to work on the Application for Issuance of Injury and Illness Allowance.

Can I use health insurance for massages?

Health insurance covers medical massages treatments of insured persons with paralysis, joint contracture, and other ailments requiring massages as a treatment. However, in order to use health insurance, a physician must issue written consent or a medical certificate.
Please note that health insurance does not cover massages for day-to-day issues such as stiff shoulders or recovery from fatigue.

A sign at my chiropractic clinic says they accept various types of insurance. However, I heard health insurance cannot be used in some cases. When is it not possible to use insurance?

The following cases are examples of when health insurance does not cover chiropractic treatments:

1. Fatigue, stiff shoulders, or muscle soreness due to daily life
2. Muscle fatigue due to sports
3. A slipped disk which should be treated by a physician
4. Chronic diseases such as aftereffects of brain diseases
5. Vague long-term treatments that do not show signs the symptoms are improving
6. Natural pain in areas even if caused by a break, sprain or other injury treated several years prior
7. Neuralgic muscle pain (rheumatism and joint inflammation)
8. Medical care for fractures or dislocations done without the consent of a physician

Is there a deadline for applying for benefits?

The deadline for claiming health insurance benefits is two years.
For example, if you forget to claim the childbirth lump-sum allowance, funeral fees, or other such benefits and two years have passed, the statute of limitations will have expired and you will no longer be able to claim benefits.
If a beneficiary entitled to insurance benefits paid in cash (Childbirth and Childcare Lump-sum Allowance, medical care costs, injury and illness allowance, etc.) dies, the Civil Code states that the heir is able to claim and receive the benefits which have not yet been paid.

What are some examples of medical care that cannot be covered by health insurance?

Medical care that cannot be covered by health insurance can be classified into three main types.

1. Illnesses or injuries during work or commuting
   Illnesses and injuries caused by tasks at work are not covered by health insurance. A person is considered to be working during actual work, waiting at work, break times, and business trips. Commuting accidents are injuries or deaths caused by commuting.
2. Conditions not recognized as illness
   Health insurance is intended for medical care. Therefore, health insurance cannot be used for conditions that are not recognized as illness; for example, general fatigue or malaise, cosmetic surgery, surgery to correct near-sighted vision, and normal pregnancy and childbirth.
   In addition, health insurance does not cover health checkups, tests related to health checkups, and vaccinations.
3. Other restrictions
   One type of restriction applies to unlawful or wrongful acts. Specifically, fraudulent receipt of insurance benefits in relation to intentional criminal acts, intentional accidents such as suicide, accidents caused by fights or drunkenness, scams, and other fraudulent acts.
   Other types of restrictions apply to the use of special drugs and medical treatments. The use of drugs and medical care required to cure illnesses and injuries are limited to those approved by health insurance. Accordingly, other drugs or special medical treatment will not be covered by health insurance.

Health Checkups

I would like to undergo a comprehensive physical examination. What should I do?

For more information, please see “Scheduling Physical Examinations.”

The healthcare provider that I currently use offers a good-quality comprehensive physical examination. Therefore, I would like to have my healthcare provider added to the medical institutions contracted by the Salesforce Health Association. Is adding a healthcare provider difficult?

The Salesforce Health Association contracts healthcare providers by reviewing items such as the testing done for preventative medicine together with your employer. To become a medical institution contracted by the Salesforce Health Association, we examine the content and costs of health examinations, patient capacity, time required to process results data, clerical handling procedures and other factors. The Salesforce Health Association reviews healthcare providers with a small number of patients and other such medical institutions and dissolves contracts with any it judges unsuitable.
We continually strive to do our best in meeting the wishes of everyone. Please do not hesitate to contact the Salesforce Health Association with any proposals or feedback.

How will I be notified of the results of my comprehensive physical examination? Will my company also be notified?

The healthcare provider which conducted the comprehensive physical examination sends the results directly to the patient’s address.
In addition to notification from the healthcare provider which conducted the examination, insured persons (employees) can also confirm their results using the Physical Examination Results Management System on the Salesforce Health Association website. (The Salesforce Health Association enters and registers the physical examination results after the health examination results data arrives from the healthcare provider. Therefore, the results become available on the Physical Examination Results Management System for your review about two months after the month in which the medical examination was conducted at the earliest.)
In addition, these comprehensive physical examinations meet the statutory items defined by the Industrial Safety and Health Act. Employers are required to retain data related to these statutory items concerning employees. Accordingly, healthcare providers send data from the comprehensive physical examination results relevant to these statutory requirements to employers (companies).

I had an endoscopy during a physical examination which became a surgery to remove a polyp because a lesion was found. Is the cost of this surgery covered as part of the physical examination?

If an endoscopy finds a lesion and a surgical procedure begins using the endoscope, the procedure is treated as medical treatment to cover under the health insurance plan.
The insured person pays 30% of the medical costs if a patient under the age of 70, or 20% if a patient between the age of 70 and 74 (30% if a person earning the same level of income as those of working age) in the same way as if you had visited a medical institution.

What is metabolic syndrome?

Metabolic syndrome refers to a cluster of metabolic disorders in which an accumulation of visceral fat is thought to cause lifestyle diseases.
In addition to obesity with fat accumulated around the internal organs of the abdomen, metabolic syndrome also refers to a combination of hypertension, hyperglycemia, and hyperlipidemia. Research has shown leaving metabolic syndrome untreated increases the risk of diabetes and other lifestyle diseases as well as arteriosclerosis, which also heightens the potential of myocardial infarctions and strokes.

People over the age of 40 are required to have specific health examinations. How is this related to a comprehensive physical examination?

Comprehensive physical examinations provide all the legally mandated test items for compulsory health check-ups and specific health examinations. Therefore, if you have had a comprehensive physical examination, you have also undergone a specific health examination. Specific health guidance will be provided based on the results of the physical examination.

Health Insurance after Resignation

I was forced to leave my job at the company. What will happen to my health insurance while I am unemployed?

You may no longer use the health insurance in which you had been enrolled from the day after leaving the company.
You need to enroll in a new health insurance plan. The three enrollment options are as follows:

1. Enroll in National Health Insurance
   National Health Insurance calculates insurance premiums based on your income during the previous year. However, you need to check the price of these insurance premiums directly because the method for calculating the premiums varies by the municipality where you live.
2. Enroll with your company as an insured person with optional continued insurance after retirement
   You must enroll as an insured person with optional and continued insurance within 20 days after leaving your company. You will have to pay the full amount of insurance premiums. However, the benefit terms and conditions will remain the same as those of the Salesforce Health Association to which you were previously enrolled. Each health association also certifies dependents according to the same standards as before. The standard monthly remuneration used as the basis for calculating the insurance premiums compares the average standard monthly remuneration of the Salesforce Health Association and the standard monthly remuneration of the individual at the time they left the company and applies the lower standard monthly remuneration.
3. Enroll as a dependent on the health insurance policy of a relative
   This is an effective way to enroll in health insurance if you meet the criteria for certification to enroll as the dependent on the health insurance policy of a relative because it lowers the health insurance premiums paid by your family member. However, you cannot enroll as a dependent while receiving unemployment benefits from employment insurance.

I am currently receiving an injury and illness allowance. I am planning to retire soon. Will the injury and illness allowance be terminated when I retire?

The injury and illness allowance is a system established to ensure the livelihood of the insured person and family members during leave from work due to illness or injury. As a general rule, the injury and illness allowance is paid during the period of employment. However, if you have been insured for more than one year continuously before leaving your job, even after you leave your job and cease to be insured, you can continue to receive the injury and illness allowance for a total of one year and six months from the payment start date, provided that you are receiving the allowance at the time of leaving or meet the conditions for receiving the allowance. However, if you go to work on the day of leaving, you will not meet the conditions for receiving continued benefits, and therefore will not receive the illness and injury allowance after you lose eligibility (the day after the day of leaving).
In addition, if, having worked temporarily during the period of receipt of benefits after the date of leaving the company and becoming ineligible for the injury and illness allowance, payment of the injury and illness allowance will not be reinstated even if you become unable to work again in the future.
The amount of benefits and procedures for receiving benefits are the same for those who have resigned or retired as for those who are still employed, except you do not require a certificate from your employer.

Receiving an old-age pension after loss of eligibility
If a person who is continuing to receive the injury and illness allowance after loss of eligibility becomes a recipient of the old-age welfare annuity, etc., the injury and illness allowance will not be paid. However, if 1/360th of the pension amount is lower than the daily amount of the injury and illness allowance, the difference will be paid.

After I left my job, my family received medical treatment through the Salesforce Health Association's insurance mistakenly. Will I be charged for medical care costs in this case?

If you have your health insurance cards or Eligibility Confirmation Documents, you need to return all of them, including those for family, upon retirement. (Refer to the “Application Forms” page for information on where to submit application forms.)
If you received medical treatment using Salesforce Health Association's insurance, you will be required to pay the full amount of medical care costs paid by Salesforce Health Association at a later date.
However, you can file a claim for medical expenses with National Health Insurance or the new health association where you are enrolled for any medical care costs paid to the Salesforce Health Association.

I would like to enroll in the Salesforce Health Association as optional continued insurance after leaving my job. What kind of procedures are required?

You must satisfy the following two requirements to enroll as an insured person with optional continued insurance:

• You have lost your qualification as an insured person.
• You were an insured person for at least two months from the day before you lost your qualification.

Anyone who satisfies these requirements and wishes to enroll can apply to become an insured person with optional continued insurance.
Enter the required information on the “Notification of Qualification as a Person Covered by Optional Continued Insurance” and submit it directly to the health association “within 20 days” after losing qualification (starting on the day after your retirement date). The Salesforce Health Association will issue an Eligibility Notification, an Eligibility Confirmation Document, etc. once you are certified as an insured person with optional continued insurance.
Please note that you will be disqualified as an insured person if the insurance premiums are not paid by the payment deadline shown on the payment slip.
Moreover, your term of qualification as an insured person covered by optional continued insurance is two years.

How much will my premiums be once I have enrolled in optional continued insurance? Will this coverage or National Health Insurance coverage save me more money?

The premiums for optional continued insurance are not a fixed amount. In addition, you will be responsible for the entire amount because your employer will no longer pay part of the insurance premium. For information on actual premiums, please contact the Salesforce Health Association.
National Health Insurance premiums are calculated based on your income for the previous year, but the calculation method varies by municipality. Please contact your local National Health Insurance counter for specific details.
The Salesforce Health Association provides healthcare programs and additional benefit systems not available under National Health Insurance. We recommend you consider health insurance based not only on premiums, but on all aspects of coverage.

Will my insurance premiums remain the same for two years if I enroll in optional continued insurance?

The standard monthly remuneration used to calculate optional continued insurance premiums compares the average standard monthly remuneration of the Salesforce Health Association and the standard monthly remuneration of the individual at the time they left the company and applies the lower of standard monthly remuneration.
The average standard monthly remuneration of the Salesforce Health Association is calculated every year. The amount of the new average monthly remuneration starting from April 1st of the next year is determined by the average amount of monthly remuneration for all insured persons at the end of September every year.
Moreover, the insurance premium rate does not always stay the same. The Salesforce Health Association adjusts premiums according to its finalized budget. Some insured persons will see a change in their insurance premiums when the fiscal year changes.
Therefore, insurance premiums may stay the same, but this does not guarantee the insurance premiums will stay the same over the two-year period.

How do I pre-pay insurance premiums for optional continued insurance?

You can pre-pay the next period of optional continued insurance premiums as a payment unit.

1. Six months from April to September and October to March of the next year
2. Twelve months from April to March of the next year
3. The last day of the month in the payment unit from the month after you enroll as an insured person with optional continued insurance if enrolled in the middle of the fiscal year

The payment deadline for pre-paying insurance premiums is the last day of the month prior to the first month of the pre-payment period. The payment deadline is normally September 30th and March 31st.

e.g.: An insured person with optional continued insurance enrolled in May

Pay the insurance premiums before discounting the initial month of May (one-month of premiums)

Pre-pay the insurance premiums for four months from June to September or ten months from June to March of the next year (the payment deadline is the end of May)

*If an individual will lose their qualification because the period of enrollment in optional continued insurance will reach two years, the pre-payment period is handled the same way as the above.

After retirement, my husband enrolled in optional continued insurance with the Salesforce Health Association. After the two-year period passed, he withdrew from the insurance. However, he then passed away two months later. Can I still receive funeral benefits?

The Salesforce Health Association will pay funeral benefits if a formerly insured person who has lost their qualification within the last three months passes away.
These benefits are paid regardless of the cause of death.
Please attach the death certificate and other required documents to the Application for Payment of Funeral Fees, and then submit everything directly to the Salesforce Health Association.

Can I withdraw my enrollment in optional continued insurance early?

An insured person can withdraw from optional continued insurance on request.
Please submit an “Application for Forfeiture of Status as an Insured Person with Optional Continued Insurance.” Withdrawal will be effective on the first day of the month following the month that the Salesforce Health Association receives the request.

Privacy Policy

What kind of information is personal information?

Personal information refers to information about a living individual that can be used to identify a specific person by name, date of birth, and any other data that has the potential to identify a specific person contained within the information. Personal information also includes information which can be used to identify a specific person by easily collating it with other data.
The name, address, age, gender, telephone number, and email address of an individual are typical examples of personal information. However, attributes such as a person’s body, property, and social status as well as all other specific information such as income, work history, medical history, and educational background are protected as personal information.
Furthermore, any information about a deceased individual which is also information about a living individual, such as a surviving relative, is also protected as personal information about the living individual.
Even if information regarding a deceased individual is not subject to the Act on the Protection of Personal Information, data stored by the Salesforce Health Association is handled using the same safety management measures as personal information in order to prevent leakage, loss, or other security information incidents.

How does the Salesforce Health Association manage the results of my health checkups?

The Act on the Protection of Personal Information classifies the Salesforce Health Association as an entity handling personal information. The Salesforce Health Association handles a variety of personal information from data on medical care payments to remuneration and benefit records to data about dependents. Data on the results of physical examinations and health guidance are a type of personal information. We recognize that this data must be managed with the utmost care as personal information.
With the advancement of information processing technology and broader outsourcing, the Salesforce Health Association has become even more cautious in its management of personal information about insured persons and dependents. In order to ensure safe personal information management, we not only comply with the Personal Information Protection Regulations but also thoroughly educate our health insurance officers and staff, and constantly strive to thoroughly protect personal information.

Is personal information ever provided to third parties without the consent of the individual?

The Salesforce Health Association specifies the purposes of use for personal information in its Policy on the Protection of Personal Information. As a general rule, personal information is never provided to a third party or used for any other purposes than those listed in the Policy on the Protection of Personal Information without the consent of the individual.
However, personal information may be shared with a third party without the consent of an individual in the following cases:

1. When required by law
2. When related to the protection of human life or property, such as the provision of emergency relief or in times of disaster
3. When particularly necessary for the improvement of public health or the sound development of children
4. When necessary in the course of cooperation with a national agency, a local government, or an individual or entity delegated by such to execute an administrative process prescribed by law, and obtaining the consent of the individual may impede the execution of the process in question
5. When the business operator handling the personal information is an academic research institution, etc., and the provision of the personal data is essential for the publication of the results of the academic research or for teaching
6. When the business operator handling the personal information is an academic research institution, etc., and it is necessary to provide the personal data in question for the purpose of academic research
7. When the third party is an academic research institution, etc., and it is necessary for the third party to handle the personal data for the purpose of academic research

The Salesforce Health Association also shares personal information with Kenporen when involved in joint subsidy projects related to the payment of high medical expenses.
Personal information is also used for processes such as auditing of statements of medical expenses, internal business analyses of the Salesforce Health Association and staff training. These activities are not classified as provision to a third party, and therefore we do not obtain the consent of the individual.
Please note the insured person will be notified via medical expense notifications as well as notification of insurance benefit payment decisions.

I’m currently absent from work due to illness. If my workplace supervisor asks the Salesforce Health Association for the name of my illness or other information about my medical conditions, will you provide them with such information?

The Salesforce Health Association will never disclose the name of an illness or injury without the consent of the individual.

Using an Individual Number Cards as Health Insurance Card

Can I be seen at a hospital even if I don’t have an Individual Number Cards?

New health insurance cards will no longer be issued after December 2, 2024. Even after the discontinuation of Health Insurance Cards, transitional measures will be in place to allow Health Insurance Cards already issued to be used as usual for up to one year. Those who don't have an Individual Number Card or have not yet registered their Individual Number Card as a Health Insurance card can visit a medical institution with an “Eligibility Confirmation Document（資格確認書）” issued by Salesforce Health Association.

Can I use my Individual Number Card at all hospitals and pharmacies?

By registering your Individual Number Card as a health insurance card, you will be able to use your Individual Number Card to visit medical institutions. The Individual Number Card can only be used at medical institutions that have adopted the online eligibility confirmation system. Medical institutions and pharmacies where the Individual Number Card can be used are announced on the websites of the Ministry of Health, Labour and Welfare.

Do I need to worry about my Individual Number Cards being fraudulently used at hospitals?

Patients scan their card at the card readers of medical institutions and pharmacies themselves. The card is not given to staff at billing counters, etc., so employees will not handle your My Number. In addition, privacy-related information, such as medical visit history and drug information, is not registered in the card's IC chip.

What should I do if I lose my Individual Number Cards?

In case of loss or theft, you can temporarily suspend the use of your Individual Number Cards by calling a toll-free number 24 hours a day, 365 days a year.
Comprehensive Toll-Free Line for My Number 0120-0178-27