When you make an advance payment
Insured persons or dependents who undergo an examination at a healthcare provider or other medical institution without a health insurance card due to sudden illness or who purchase support corsets or pediatric eye glasses need to pay the entire amount of general medical care costs up front. The Salesforce Health Association reimburses the medical care costs as medical care expenses if the insured person or dependent gather and submit the necessary materials for the medical services covered by insurance.
Patients Receiving Medical Care for a Sudden Illness Without a Health Insurance Card
The Salesforce Health Association reimburses insured persons or dependents 70% (80%) of the amount assessed based on the treatment methods and fees approved by health insurance for medical care received without a health insurance card or from an out-of-network healthcare provider due to a sudden illness or other unavoidable circumstances while traveling. In such cases, 70% (80%) of the actual costs is not always covered by health insurance.
Please be sure to receive the receipt and statement of medical expenses when requesting payment of medical treatment expenses.
- Application for Payment of Medical Care Costs
PDF EXCEL Completed Sample - Receipt (original copy)
- Statement of medical expenses (original copy)
*The statement of medical expenses is not the examination statement issued with the receipt.
Support Corsets, Casts, Compression Garments and Other Therapeutic Devices
The therapeutic devices eligible for benefits are only those deemed as necessary for medical care by a physician or those fabricated under their guidance, and 70% (80%) of the standard amount for therapeutic devices will be paid.
Any therapeutic device used for convenience in daily life, beautification, or fabricated after a medical condition stops progressing is not covered by insurance.
In addition, the Salesforce Health Association may not approve re-fabrication of a therapeutic device if the lifespan determined for each device has not passed.
- Application for Payment of Medical Care Costs
PDF EXCEL Completed Sample*Please apply for each healthcare provider every month. - Receipt (itemized receipt including therapeutic devices; original copy)
- Physician’s certificate of consent (original copy)
Acupuncture, Moxibustion or Massage Payments
The Salesforce Health Association reimburses 70% (80%) of the standard amount for treatments provided by acupuncturists, moxibustionists, or massage professionals, provided that that said treatment providers are approved by an insurance society physician
Please take note!
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Acupuncture and moxibustion: Only major symptoms of chronic pain, such as neuralgic muscle pain, lower back pain, shoulder periarthritis, rheumatism, cervicobrachial syndrome, and cervical sprain (whiplash)
*Health insurance does not cover these treatments if an individual is treated for the same illness or injury at a healthcare provider (combined treatments).
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Massage: Only necessary medical massage treatments for paralysis or joint contracture
*Massage treatments for comfort or to recover from fatigue are not covered by insurance.
Pediatric Amblyopia and Other Therapeutic Eye Glasses
Therapeutic eye glasses and contact lenses for pediatric amblyopia, strabismus, or refraction after congenital cataract surgery are eligible for benefits.
Eye glasses used for near sightedness, astigmatism or other simple vision correction are not covered by insurance.
In addition, eye patches and fresnel membrane prisms used for strabismus correction or other such care are also not covered by insurance.
Please check whether the eyewear is covered by insurance if recommended by a physician and have the healthcare provider create the necessary materials.
Eligible Persons and Amount of Benefits
| Eligible Persons | <Dependents under age 9> |
|---|---|
| Amount of benefits |
Items of prosthetic devices based on the provisions of the Child Welfare Act The upper limit is 1.06 × “eyeglasses for amblyopia (38,200 yen)” “contact lenses (13,000 yen per lens).” 70% of the actual amount paid will be covered by health insurance (80% benefit for children who have not yet entered elementary school). |
| Eye glasses purchased for 30,000 yen | 30,000 yen x 0.7 = 21,000 yen |
|---|---|
| Eye glasses purchased for 50,000 yen | 40,492 yen (maximum coverage 38,200 yen × 1.06) × 0.7 = 28,344 yen |
About Renewals
- Children under age 5: Therapeutic eyewear worn for at least 1 year before renewal
- Children over age 5: Therapeutic eyewear worn for at least 2 years before renewal
- Application for Payment of Medical Care Costs
PDF EXCEL Completed Sample - Receipts or other materials to certify the amount of costs when fabricating or purchasing therapeutic eye glasses
Include the information below on the receipt (original)- The name of the individual (child) as the addressee- Cost of the therapeutic eye glasses for treatment of amblyopia (XX yen for frame and XX yen for lenses) and other specific details- The amount to include is the actual purchase price including tax - A copy of the instructions from the insurance society physician to fabricate the therapeutic eye glasses, etc. (physician’s written opinion)
- Patient examination/test results (prescription for the eye glasses; original)
Illnesses or Injuries Occurring Overseas
If you see a physician at a healthcare provider due to illness or injury while traveling or staying abroad, the Salesforce Health Association calculates such expenses based on the medical care costs stipulated by health insurance in Japan.
The benefiJapanese translation of attached documentsts may at times be smaller than the actual amount paid because medical care costs differ by country.
Note that you will not be eligible for benefits if you travel overseas for the purpose of receiving medical treatment.
- 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
About Limbal-supported Contact Lenses for Abnormal Corneal Shape
From April 2018, benefits will be paid for contact lenses purchased due to Stevens-Johnson syndrome and the ocular after-effects of toxic epidermal necrolysis.
| Maximum Amount of Payment | Up to 158,000 yen per contact lens |
|---|---|
| Percentage of payment |
Preschool children: 80% Elementary school children to individuals age 69: 70% Individuals age 70 and older: 70% to 80% according to income |
|
Second purchase (subsequent application) |
5 years after initial purchase
*Please consult with the Salesforce Health Association if a second purchase is necessary due to loss or damage caused by disasters or other unavoidable circumstances.
|
- Application for Payment of Medical Care Costs
PDF EXCEL Completed Sample - A copy of the instructions from the physician (insurance society physician) to fabricate the therapeutic eye glasses or contact lenses
*The document needs to include the name of the illness or injury
- Copy of the test results
*Not required if included on the instructions from the physician
- Receipt
*The document needs to be itemized and include the name of the patient
Blood Transfusion (Fresh Blood) Costs
The Salesforce Health Association reimburses also insured persons and dependents 70% (80%) of the standard amount for the cost of blood when undergoing blood transfusions.
- Application for Payment of Medical Care Costs
*Please contact the health association. - Itemized (medical) receipt (original copy)
- Certificate of the attending physician who recognized a need for the transfusion (original)
- Receipt for blood costs (original)