A Guide to Living in Saitama. Chapter 4: Health Insurance and Medical. Treatment
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1 A Guide to Living in Saitama Chapter 4: Health Insurance and Medical Treatment 医療 社会保険 ( 医療保険 社会保険社会保険 病院病院 医療機関案内 ) 1. Japanese Health Insurance System The Japanese Health Insurance System is set up to help alleviate people's medical expenses in the case of illness, disease or injury. In principal all residents of Japan, regardless of their nationality, are required to subscribe to a public health insurance program. There are 2 systems: the National Health Insurance System for company employees and their families and an Employee s Health Insurance System for the self employed. 2. National Health Insurance Foreign nationals who have a valid alien registration card as well as an appropriate status of residence and period of stay that permits them to stay in Japan for 1 year or longer or they can prove they have already been in Japan for over 1 year are able subscribe to the National Health Insurance. (Please note that those who are already subscribers to an Employee s Health Insurance are not eligible.) There are 2 types of National Health Insurance. One is administered by local governments and the other, for certain occupations, by National Health Insurance Unions. (1) Subscription To join the National Health Insurance, apply at your local municipal or ward office s National Health Insurance Department, or at your local union if a National Health Insurance Union administers your insurance. You are required 1
2 to bring your Alien Registration Card and name seal. Please note that if the period of stay printed on your Alien Registration Card is less than 1 year, you must show proof that you will be living in Japan for over a year. (2) Insurance Premium The premium is calculated according to the number of people in your family, and the income you earned the previous year. Consequently, this fee may change every year. For households with individuals between the ages of 40 and 64, a nursing care tax will also be included. Each municipality and National Health Insurance Union sets its own premiums (and tax rates). You pay your annual premium (and tax) in equal installments. Payment is accepted at local municipal or ward offices, banks or post offices. (3) Insurance Certificate Each household covered by National Health Insurance is issued one Health Insurance Certificate. This proves that you and your dependents are insured. Be sure to take it with you when you go to a hospital or clinic. You must notify the National Health Insurance Department of your local municipal or ward office in the following cases: a) When you subscribe to or withdraw from another public health insurance system; b) When you move; c) When a child is born; d) When the subscriber dies; e) When your name or address changes, or the head of the household changes; f) When turning 75 years old; or g) When you lose your Health Insurance Certificate. (4) Benefits a) Medical & Dental: When you receive medical or dental treatment at a hospital or clinic and show your Health Insurance Certificate, 70% of the expense is covered by insurance. You are responsible the remaining 30%. Please note that in the case of children under 3 years old, 80% is covered 2
3 by insurance, and for people over 70 years of age, 70% or 90% is covered. b) Childbirth and child rearing: When you have a baby, a designated amount is provided to assist with the costs of childbirth. c) Funeral: When the subscriber dies, a designated amount is provided to assist with the costs of the funeral. d) Medical Treatment Assistance: When your medical expenses for 1 month exceed the designated level, the excess amount is covered by insurance. (5) Cases Not Covered by Insurance Ordinary health checks, inoculations, cosmetic surgery, orthodontics, ordinary childbirth and work-related illness and injuries are not covered by National Health Insurance. For further information, contact the National Health Insurance Department of your local municipal or ward office or the National Health Insurance Union you belong to. 3. Employees' Health Insurance Subscription to Employee s Health Insurance is mandatory for people who work for companies or organizations where it is offered. (1) Insurance Premium The monthly premium is calculated by multiplying your standard monthly salary by the premium rate. Your employer bears half of the monthly premium while the remaining half is born by the individual and it is usually deducted from the monthly salary. Also, for people between the ages 45 to 60, the additional nursing care payments. (2) Benefits a) Medical & Dental: When you receive medical or dental treatment at a hospital or clinic and you show your Health Insurance Certificate, 70% of 3
4 the expense is covered by insurance. The remaining 30% is the patients responsibility. If the fee is very high, a high-cost medical care benefit is provided. b) Childcare: When you have a baby, a designated amount is provided to assist with the costs of childbirth. c) Funeral: When the subscriber dies, a designated amount is provided to assist with the costs of the funeral. d) Medical Treatment Assistance: When your medical expenses for 1 month exceed the designated level, the excess amount is covered by insurance. (3) Cases Not Covered by Insurance Ordinary health checks, inoculations, cosmetic surgery, orthodontics, ordinary childbirth and work-related illness and injuries are not covered by Employee s Health Insurance. If you receive medical treatment as a result of a traffic accident, report the accident to your Insurer (The Social Insurance Office or National Health Insurance Union). For further information, contact your Insurer. 4. Nursing Care Insurance Nursing Care Insurance was established as part of the Social Health Insurance System in April It was designed to assist elderly persons, who have come to require nursing care, to remain as self-sufficient as possible. The insurance and its benefits are administered by local municipalities. Benefits are available to all individuals aged 65 and over as well as those aged from 40 to 64 who are enrolled in medical insurance programs. People who do no have Japanese citizenship are able to receive benefits if they meet the following 2 requirements: a) You have completed your alien registration; b) You have been granted a period of stay in Japan of 1 year or longer or you can prove that you have already resided in Japan for at least 1 year. For details, please visit the Nursing Care Insurance Counter at your local municipal office. 4
5 (1) Insurance Premium a) For persons aged 65 and over, your premium is determined by the municipality you live in as well as your level of income. b) For persons between the ages 40 and 64 who subscribe to medical insurance, your premium is calculated according to the terms of your medical insurance policy. (2) Benefits There are services for people certified as requiring assistance or nursing care depending on their condition. a) Home Services: 12 different services including visits from home-helpers, day care services provided at institutions and short term stays at institutions as well as subsidies for the purchase of welfare equipment and house remodeling (i.e. installation of barrier-free fixtures). b) Facility Services: services provided when admitted to one of the following: geriatric welfare and nursing care facilities, nursing homes for the elderly, hospitals with long-term geriatric medical treatment facilities. c) Regional community based services (Focusing on day care, 5 types of services are provided such as the small scale nursing apartments which is a multifunctional service combined with an overnight stay service according to the needs of the patients) (3) Application for the Recognition of the Need for Care In order to receive services from the Nursing Care Insurance System, you have to obtain Recognition of the Need for Care Certificate (yōkaigo nintei). To obtain an application for this certificate, please consult the Nursing Care Insurance Counter at your local municipal or ward office. (4) Cost for the Beneficiary Persons receiving benefits from nursing care insurance are, as a general rule, responsible for 10% of the cost of the services received. 5. Doctor Consultations When you need to see a doctor, simply go to a clinic or hospital near you. Should you 5
6 require specific treatment from a specialist, the physician examining you will give you a letter of reference (shōkai jō) which will enable you to go to a hospital with the necessary facilities. You cannot receive an examination at prefectural hospitals or ones affiliated with universities offering specialized services without a letter of reference. (1) Consultation Procedures at a Hospital a) Submit your insurance card to the reception desk if you are a new patient and tell them which unit you would to go to for treatment. b) Take the patient s chart and consultation ticket and go to you to the appropriate unit. c) At the unit's reception desk you are required to submit a form before seeing the doctor. d) After your consultation with the doctor, you are required to pay at the cashier. e) If you require medication, go to the pharmacy within the hospital, or to a designated pharmacy outside of the hospital, and present your prescription written by your doctor. They will then prepare the appropriate medication for you. 6. Hospitalization There are 3 kinds of hospital rooms: private rooms, two-bed rooms and common rooms. All types of health insurance cover the cost of staying in a common room. However, if you wish to stay in private or two-bed room, you will be responsible for paying additional charges. 7. Medical Information Services (1) Saitama Emergency Medical Information Center The Saitama Emergency Medical Information Center provides free 24-hour information, 365 days a year in Japanese, on where to go in the case of a medical emergency (Except in the case of dentistry or psychiatry) (2) AMDA International Medical Information Center AMDA offers free information about Japanese medical, welfare, insurance systems and 6
7 information regarding medical institutions that offer treatment in languages other than Japanese. TEL: URL: Language(s) Days Available Hours Available English, Chinese, Spanish, Thai, Mon ~ Fri 9:00am ~ 5:00pm Korean Portuguese Mon, Wed, Fri 9:00am ~ 5:00pm Tagalog Wed 1:00pm ~ 5:00pm (3) Medical Institutions with Languages other than Japanese A list of medical institutions that offer services in languages other than Japanese can be found on the Saitama International Association website. URL: 7
Birth Age
Social security system supporting people throughout their lifetime Birth Age 6 12 15 18 20 40 50 60 70 75 Before school School period Child-raising/working period After retirement [Health/medical care]
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This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.avmed.org/go/state or by calling 1-888-762-8633 Important
VERIZON COMMUNICATIONS: MID-ATLANTIC
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.kp.org or by calling 1-855-249-5018. Important Questions
Western Health Advantage: WHA Platinum 90 HMO 0/20 w/child Dental. Coverage Period: 1/1/ /31/2016
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.westernhealth.com or by calling 1-888-563-2250. Important
Your Cost If You Use a Non- Plan Provider Primary care visit to treat an injury or illness. Your Cost If You Use a Plan Provider
: TriNet Group, Inc. CO HMO 20 Coverage Period: 10/01/2016-09/30/2017 Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage for: Individual / Family Plan Type: HMO This is only
Deductible plus $50 Deductible plus $50 40% after Deductible 1, 6. Deductible plus $50
204 Benefits Summary - RETIREMENT VISION PAID TIME OFF MEDICAL DENTAL LIFE DISABILITY RETIREMENT VISION PAID TIME OFF MEDICAL DENTAL LIFE DISABILITY RETIREMENT VISION PAID TIME OFF MEDICAL DENTAL LIFE
to pay for covered services you use. Check your policy or plan document to see What is the overall deductible?
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.aetna.com or by calling 1-800-560-3724. Important Questions
$300 Individual; $ 800 Family. Applies to out-of-network services only. What is the overall deductible?
What is the overall deductible? This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.indecscorp.com or by
BlueOptions What is the overall deductible?
BlueOptions 03769 Coverage Period: 04/01/2016-03/31/2017 with Rx $20/$40/$70 Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage for: Individual and/or Family Plan Type: PPO
The HPHC Insurance Company PPO Summary of Benefits and Coverage: WhatthisPlanCovers&WhatitCosts
Massachusetts The HPHC Insurance Company PPO Summary of Benefits and Coverage: WhatthisPlanCovers&WhatitCosts Coverage Period: 07/01/2016 06/30/2017 Coverage for: Individual + Family Plan Type: PPO This
There is no deductible on this plan.
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.anthem.com/ca or by calling 1-800-888-8288 Important
CA UHC Bronze Plus EVN/3J8 Summary of Benefits and Coverage: What This Plan Covers & What it Costs
CA UHC Bronze Plus EVN/3J8 Summary of Benefits and Coverage: What This Plan Covers & What it Costs Coverage Period: 12/01/2016 11/30/2017 Coverage for: All Coverage Tiers Plan Type: HMO Important Questions
Choice Plus Plan 14K / 0QG Coverage Period: 07/01/ /30/2015
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at welcometouhc.com or by calling 1-866-633-2446. Important
Community Core PPO Coverage Period: 01/01/ /31/2017
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.mycmc.com to log onto the Community Medical Centers Forum
UHC CarePlus Plan 246 Coverage Period: 01/01/ /31/2015
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.myuhc.com or by calling 1-888-JDEERE1. Important Questions
Western Health Advantage: WHA Bronze 60 HMO 6000/70 w/child Dental. Coverage Period: 1/1/ /31/2016
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.westernhealth.com or by calling 1-888-563-2250. Important
Health Plan: Citrus Valley Health Partners Coverage Period: Beginning on or after 1/1/2016 Summary of Benefits and Coverage:
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.myhnas.com or by calling 1-855-323-1132. Important Questions
Important Questions Answers Why this Matters:
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at https://eoc.anthem.com/eocdps/fi or by calling 1-800-542-9402.
BlueCare 55. No. No. Yes. For a list of participating providers, see or call
BlueCare 55 Coverage Period: 04/01/2016-03/31/2017 with Rx $15/$35/$60 Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage for: Individual and/or Family Plan Type: HMO This
: Silver S13S, Network S Coverage Period: 01/01/ /31/2016
: Silver S13S, Network S Coverage Period: 01/01/2016-12/31/2016 Summary of Benefits & Coverage: What this Plan Covers & What it Costs Coverage for: Individual or Family Plan Type: PPO This is only a summary.
Highmark Blue Shield: PPO Coverage Period: 07/01/ /30/2016
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.highmarkblueshield.com or by calling 1-888-745-3212.
This health plan meets Minimum Creditable Coverage standards and will satisfy the individual mandate that you have health insurance.
This is a Massachusetts Large Group Plan This health plan meets Minimum Creditable Coverage standards and will satisfy the individual mandate that you have health insurance. Massachusetts Requirement to
Important Questions Answers Why this Matters: What is the overall deductible?
: Recreational Equipment Inc HMO 215 Coverage Period: 01/01/2015-12/31/2015 Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage for: Individual / Family Plan Type: HMO This