Medical Care for Illness or Injury
Insured persons and dependents present a health insurance card to hospitals or healthcare clinics to receive examinations, first aid, medication, and other healthcare services for a portion of the medical care costs for any non-occupational illness or injury. The Salesforce Health Association covers the remainder of those medical care costs.
Out-of-pocket Costs for Inpatient and Outpatient Services
Percentage of Out-of-pocket Costs
| Age 70 to 74 |
20% *30% for income earners comparable to individuals in active service
|
|---|---|
| Elementary school children to individuals age 69 | 30% |
| Preschool children | 20% |
- The individual is age 70 or older and earns less than 3.83 million yen annually without any dependents
- The individual has a dependent or former dependent age 70 or older and has a total combined annual income of less than 5.20 million yen
Costs of Inpatient Meals
The Salesforce Health Association has also determined the amount patients pay out-of-pocket (standard out-of-pocket payments) even for meals during hospitalizations, and health insurance covers any costs exceeding the maximum amount of out-of-pocket costs as inpatient daily dietary treatment expenses.
However, any special menu options or special requests are treated as special surcharges paid by the insured person or dependent in the same way as amenity bed costs or other extraneous surcharges are when hospitalized in a deluxe hospital room.
Moreover, standard out-of-pocket costs for meals are not treated as high-cost medical care expenses.
Standard Out-of-pocket Costs for Each Inpatient Meal
| General |
510 yen *280 yen for patients with incurable diseases or specified pediatric chronic diseases
|
|---|---|
|
Low-income earners (exempt from municipal residence tax, etc.) |
First 90-days of hospitalization: 240 yen 91 days or more after hospitalization: 190 yen |
| Elderly beneficiaries of low-income earner households | 110 yen |
Medical Care Received Outside of Japan
Insured persons and dependents who have received medical care from a healthcare provider outside of Japan can apply for reimbursement of some of the medical care costs paid out in full out of pocket.
However, insured persons and dependents from Japan cannot use their health insurance cards overseas. Therefore, if an insured person or dependent receives medical care or medication at a healthcare provider overseas due to sudden illness or injury, they must temporarily pay the full medical care costs to the healthcare provider. After returning to Japan, the insured person or dependent may then apply for reimbursement of the medical care costs from the Salesforce Health Association. The insured person will receive payment from the Salesforce Health Association for the medical care costs (overseas medical treatment expenses) calculated according to the standard costs of medical care for the same treatment if received in Japan based on that application. The Salesforce Health Association determines whether or not the medical care costs are covered by insurance using the same criteria as that in Japan. Therefore, any medical care not approved by health insurance is not covered.
| Medical care covered by health insurance |
Non-occupational illnesses or injuries
*The Salesforce Health Association does not cover illness or injury occurring at or on the way to and from work.
|
|---|---|
| Scope of medical coverage | Treatments, medications, medical supply payments, procedures, surgeries or other medical care necessary to treat an illness or injury |
However, insured persons will not receive benefits for medical care such as the types listed below.
- Treatments or procedures not covered by health insurance
- Normal birth, health checkups, and vaccinations
- Medical care or treatments provided for travel overseas
- General over-the-counter medications
- Corrective dental treatments or the use of materials not covered by health insurance
Calculation and Payment of Overseas Medical Care Costs
The Salesforce Health Association calculates the overseas medical care expenses by estimating the medical care costs when receiving treatment through health insurance in Japan while referring to the details of medical care statements and converting the actual medical care costs incurred at a local healthcare provider into Japanese yen to apply the out-of-pocket amount to whichever is lower.
Furthermore, the Japanese currency conversion rate used to calculate the payment of overseas medical care costs uses the foreign exchange conversion rate (selling rate for individuals exchanging Japanese yen to a foreign currency) on the date of the payment decision.
- Application for Payment of Medical Care Costs (Overseas Medical Expenses)
PDF EXCEL Completed Sample - Attending Physician's Statement (Form A) (Overseas)
PDF EXCEL - Itemized Receipt (Form B) (Overseas)
PDF EXCEL - Attending Physician's Statement (Dental) (Overseas)
PDF EXCEL - Investigation Authorization Agreement for Overseas Medical Care Costs (Overseas)
PDF EXCEL - Receipt of payment made overseas (original)
- Document showing the period of overseas stay (copies from passport, etc.)
- Japanese translation of attached documents