FAQ

Below are answers to some of the questions frequently asked by enrollees. Please check for your question here first.

Insurance Systems, 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 Insurance 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 insurance association?
The main expenditures for operating a health insurance association are health insurance benefits, contribution payments, healthcare business 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 insurance association.
  • Contribution payments
    These contributions are for medical expenses borne by the current working population for older senior citizens and people who have left the workforce at retirement age. This includes latter-stage elderly support, younger senior citizen contribution payments, retirement benefit contributions, ward transfer aid, and elderly health contributions.
  • Healthcare business expenses
    Health insurance societies are required to carry out health education, health counseling, health examinations, 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 HGST Health Insurance 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. Insured person's insurance card code and number
  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 HGST Health Insurance Association. Collection of long-term care insurance premiums starts from the month in which the move took place.

Health Insurance Cards

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.
To request the issuance of another health insurance card, please fill in the required information in the Health Insurance Card Replacement Application and submit the application form. (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 HGST Health Insurance Association.
Do I have to show my health insurance card 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 insurance 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 insurance association. Therefore, many healthcare providers require patients to show their health insurance card on the first visit of every month in order to verify which insurance a patient is enrolled.
I'm worried about not having my health insurance card while my Notification of Dependents for Health Insurance (Changes) is under review. What should I do if I get sick?
Please initially pay the entire bill incurred for any medical expenses, and then attach the statement of medical expenses (receipt) and the receipt (original) to a Medical Expense Benefit Payment Request after your dependent is certified in order to request reimbursement of medical expenses from the HGST 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 HGST Health Insurance 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.)
  • Dependent Change Notification
  • 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 retire from 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-retirement 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 retirement 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 Dependent Change Notification, and then submit these forms to the HGST Health Insurance 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 a health insurance card 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 HGST Health Insurance 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 HGST Health Insurance 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 HGST Health Insurance 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 she continue to be enrolled in the HGST Health Insurance Association as my dependent?
The HGST Health Insurance 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 HGST Health Insurance Association.
My child got a job, so I would like to remove her from my dependents. What are the necessary procedures?
Please fill in the name of the dependent to remove and the date on which she no longer qualified as a your dependent (data of employment) in the Dependent Change Notification, attach the documents below, and submit the notification to the HGST Health Insurance Association. (Refer to the “Application Forms” page for information on where to submit application forms.)
  • Copy of the health insurance card from their employer
  • Health insurance card of the dependent (issued by the HGST Health Insurance Association)
If you need a loss of qualification certificate, please contact the HGST Health Insurance 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 becomes the dependent of the person who has the highest income expected for the next year by comparing the earnings of the husband and wife. If the annual income of the couple is approximately the same, the child will become the dependent of the person who spends the most money on the child’s living expenses. However, the actual situation of the household budget, social conventions, and other such factors are also taken fully into account.
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 insurance 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 Care Costs

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 costs (insurance claim) to the health insurance association for the remainder of the medical costs. The health insurance association then pays the healthcare provider through a health insurance claims review and reimbursement service.
The health insurance 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 Cost-Sharing Maximum Amount
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 such as that for hemophilia, which is designated as a specified disease, or chronic renal failure that requires 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 HGST Health Insurance Association for details about the filing procedures.
Both partners in a married couple work and are insured by the HGST Health Insurance Association. If medical costs become high, can the married couple be treated as a joint household?
In a joint household, the insured persons 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 HGST Health Insurance Association.
(The limit for out-of-pocket payments for medical care costs varies by income. Please see “High-cost Medical Care Expenses.”)
HGST Health Insurance 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 HGST Health Insurance 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 Request for Issue of Health Insurance Eligibility Certificate for Ceiling-Amount Application Form to the HGST Health Insurance Association in advance to receive issuance of this certificate. A patient submits the certificate issued by the HGST Health Insurance Association to the medical provider as an attachment to the health insurance card. By presenting a ceiling-amount eligibility certificate, 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 a ceiling-amount eligibility certificate, the high-cost medical expenses and additional costs will be refunded after the medical provider receives the receipt from the HGST Health Insurance Association about 3 months after care. Please contact the HGST Health Insurance Association for details about the filing procedures.
What is a Certificate of Care 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 Care 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: (As of October 1, 2010)
  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 HGST Health Insurance Association, receives a Certificate of Care for Specified Diseases, and then presents the certificate together with their health insurance card at the billing counter of the healthcare provider. (A physician’s certificate is required.)
Please contact the HGST Health Insurance 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 used the health insurance card to receive medical care after April?
If your family member has gotten a job, attach the health insurance card from the HGST Health Insurance Association for the person who has been employed to the Dependent Transfer Notification, and then immediately perform the filing procedures for removing a dependent. (Refer to the “Application Forms” page for information on where to submit application forms.)
The HGST Health Insurance Association dependent qualifications 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 HGST Health Insurance Association due to delayed notification for removal of dependents will be charged to the insured person at a later date. Therefore, you will need to pay the full amount of these medical costs.
In addition, the statement of medical costs (receipt) corresponding to the amount paid will be provided to the insured person by the HGST Health Insurance Association. If you notify the health insurance association where your child is enrolled by his employer, you can be reimbursed for these medical care costs by his employer’s health insurance 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 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, 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 costs (original) to the Application for Payment of Medical Care Costs, and then submit the documents to the HGST Health Insurance Association.
The HGST Health Insurance 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 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 Medical Expense Benefit Payment Request, attach the statement of medical expenses (original) and the receipt (original) issued by the healthcare provider, and then submit the request to the HGST Health Insurance Association. (Refer to the “Application Forms” page for information on where to submit application forms.)
HGST Health Insurance 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 cards 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 HGST Health Insurance 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 Premiums/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. Healthcare premiums only change with fluctuations in standard monthly remuneration (wages). The insurance premiums deducted from your salary are calculated based on the average amount paid in April, May, and June every year. (Insurance premiums may be adjusted if your salary changes significantly at other times of the year.)
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 the insured period of the individual prior to the start date for payment of the allowance). This daily allowance will be paid for 1 year and 6 months in total 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:
  • The medical transfer is necessary to receive appropriate insured medical care
  • It is remarkably difficult for you to move by yourself
  • The need for medical transfer is urgent or unavoidable
Please note that approval from the HGST Health Insurance 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 HGST Health Insurance 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 are insured by the HGST Health Insurance Association. The wife retired 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 HGST Health Insurance 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 actually a single instance of medical care covered by health insurance. Therefore, HGST Health Insurance 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 maternity 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 maternity 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 HGST Health Insurance 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 HGST Health Insurance 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 HGST Health Insurance 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 HGST Health Insurance 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 then submit application 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 a suicide (or attempted suicide), medical care costs leading up to death are limited to the insurance benefits for an intentional accident. However, except in the event of accidents at or commuting to or from work, the cause of death is unrelated to the insurance benefits for death. (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 insurance 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 HGST Health Insurance 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 HGST Health Insurance Association, unless the accident occurred at or on the way to or from work.
Note: Please be cautious during out-of-court settlements. The details of a settlement will determine the health insurance benefits that you will receive thereafter. Please consult with the HGST Health Insurance 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 damages that include medical care costs, health insurance will no longer cover medical care after the date of the settlement. The insured person or their 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 HGST Health Insurance 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 physical examinations, tests related to physical examinations, 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.

Physical Examinations

I would like to undergo a physical examination. What should I do?
For more information, please see “Scheduling Physical Examinations.”
I would like to have a gastroendoscopy instead of stomach x-rays. Will medical insurance cover this?
Physical examinations have both stomach x-ray and gastroendoscopy options.
Some healthcare providers may only offer one type of test or charge different fees for each type of test.
When choosing the healthcare provider which will perform your physical examination, please check which test is offered and make a reservation with a healthcare provider who provides the type of test you would like.
The healthcare provider where I currently go offers a good-quality comprehensive medical checkup. Therefore, I would like to have my healthcare provider added to the medical institutions contracted by the HGST Health Insurance Association. Is adding a healthcare provider difficult?
The HGST Health Insurance 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 HGST Health Insurance 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 HGST Health Insurance 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 HGST Health Insurance Association with any proposals or feedback.
How will I be notified of the results of my physical examination? Will my company also be notified?
The healthcare provider which conducted the 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 HGST Health Insurance Association website. (The HGST Health Insurance 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 presents a health insurance card and 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), at the billing counter of the healthcare provider.
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 physical examination, you have also undergone a specific health examination. Specific health guidance will be provided based on the results of the physical examination.

Post-retirement Health Insurance

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 and 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 pay the full insurance premium, but the terms and benefits remain the same as the health insurance in which you were previously enrolled. Each health insurance 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 HGST Health Insurance 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 guarantee the livelihood of the individual (insured person) and his/her family during the period he/she is absent from work due to illness or injury. In principle, the benefits are paid while the employee is employed, but if the employee has been insured for at least one year continuously before resigning, even after resigning and ceasing to be insured, if the employee is receiving sickness benefits at the time of resignation or meets the conditions for receiving such benefits, he/she can continue to receive them for a total of one year and six months from the starting date of the benefits, even if he/she is not insured at the time of resignation. If you are not insured, you can continue to receive the benefit for a total of one year and six months from the date of commencement of the payment. However, if the employee goes to work on the day of retirement, he/she does not meet the conditions for receiving the continued benefits and will not receive the injury and sickness benefits after the loss of eligibility (the day after the retirement date).In addition, even if you become incapacitated for work again after having worked once during the period of entitlement after the date of retirement, the payment of the injury and illness allowance will not be reinstated.The amount of benefits and procedures for receiving benefits after retirement are the same as those during the period of employment, but "certification by the employer" is not required.

*When you are entitled to receive an old-age pension after disqualificationIf a person who is receiving the continuation of the injury and illness allowance after disqualification becomes a recipient of the old-age pension, etc., the injury and illness allowance will not be paid. However, if 1/360 of the pension amount is lower than the daily amount of the injury and sickness allowance, the difference will be paid.

After I left my job, my family accidentally used the health insurance card. Will I be charged for medical care costs in this case?
You must return all of your insurance cards, including those for family, upon retirement. (Refer to the “Application Forms” page for information on where to submit application forms.)
If you use your health insurance card after you have been disqualified as a member of the HGST Health Insurance Association, you will be required to pay the full amount of medical care costs paid by the HGST Health Insurance Association at a later date.
However, you can file a claim for medical expenses with National Health Insurance or the new health insurance association where you are enrolled for any medical care costs paid to the HGST Health Insurance Association.
What procedures are necessary to enroll as an insured person with optional and continued insurance with the HGST Health Insurance Association after leaving my job?
You must satisfy the following two requirements to enroll as an insured person with optional and 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 individual covered as an insured person with optional and continued insurance.
Fill in the required information and submit the Application for Eligibility for Optional and Continued Insurance directly to the HGST Health Insurance Association within 20 days after losing certification as an insured person (starting on the day after your retirement date). The HGST Health Insurance Association will issue a health insurance card once you are certified as an insured person with optional and 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 with optional and continued insurance is two years.
How much will my premiums be once I have enrolled in optional and continued insurance? Will this coverage or National Health Insurance coverage save me more money?
The premiums for optional and 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 HGST Health Insurance 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 HGST Health Insurance Association provides healthcare programs and additional benefit systems not available from 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 and continued insurance?
The standard monthly remuneration used to calculate the optional and continued insurance premiums compares the average standard monthly remuneration of the HGST Health Insurance 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 compensation of the HGST Health Insurance 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 HGST Health Insurance 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 and continued insurance?
You can pre-pay the next period of optional and 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 and 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 and 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 and continued insurance will reach two years, the pre-payment period is handled the same way as the above.
My husband enrolled in optional and continued insurance with the HGST Health Insurance Association after he retired. He withdrew because two years had passed. However, he then passed away two months later. Can I still receive funeral benefits?
The HGST Health Insurance 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 HGST Health Insurance Association.
Can I withdraw my enrollment in optional and continued insurance early?
You can withdraw at your request.
Please submit ”Notification for Loss of Qualification as an Insured Person with Optional and Continued Insurance” to the HGST health insurance association.You will be withdrawn on the 1st of the month following the acceptance by HGST health insurance association.

Using the Health Insurance Service Options and Points

Health Insurance Service Options
The Health Insurance Act requires health insurance societies to hold health education, health consulting, health checkups as well as other events and workshops to promote and better the health of insured persons and dependents. However, because these types of events and workshops tend to be used by only certain individuals, the HGST Health Insurance Association has adopted health insurance service options for all of our insured persons to use broadly.
The Health Insurance Service Options is a system subsidized by the HGST Health Insurance Association for all insured persons and dependents to select services from a menu of options set according to the health insurance business. Please use this system to prevent illness and better your health.
What are health points?
Health points (one yen per point) are assigned to each insured person at the start of the fiscal year (April 1st every year). These points expire two fiscal years after they are assigned to insured persons.
You can view details about the points assigned to you as an insured person on the Status of Point Usage section of the HGST Health Insurance Association website. (Points are assigned proportionately by month if you joined the company during the fiscal year.)
Please note that these points can only be used while an individual is certified as an insured person or dependent. The date of physical examinations, use of lodging facilities, and other services is the date of use. A reservation is not the date of use. However, the application date for purchase of over-the-counter medications for family, health products and other such items is considered the usage date. Please take note of the deadlines for using these points.
Notes on using points
The Health Insurance Service Options is a system only for insured persons and dependents to use for selecting necessities under his/her own discretion. This system can be used easily twenty-four hours a day, but please take care in your selection of service options and handling of products.
Please also note the HGST Health Insurance Association does not accept responsibility for any accidents or damage incurred while using these service plans.
--> Health Insurance Service Options

Personal Information Protection

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 HGST Health Insurance 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 HGST Health Insurance Association manage the results of my physical examinations?
The Act on the Protection of Personal Information classifies the HGST Health Insurance Association as an entity handling personal information. The HGST Health Insurance 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 HGST Health Insurance 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 HGST Health Insurance 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 it is especially necessary for the improvement of public health or the sound growth of children
  4. When it is necessary to cooperate with a national agency, a local government, or an individual or entity entrusted by either a national agency or local government to execute affairs prescribed by law, and obtaining the consent of the individual may impede the execution of such affairs.
  5. When the business operator handling the personal information is an academic research institution, etc., and the provision of the personal data is unavoidable 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 relevant personal data for academic research purposes
  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 academic research purposes
The HGST Health Insurance 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 on medical costs, internal business analyses of the HGST Health Insurance 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 HGST Health Insurance Association for the name of my illness or other information about my medical conditions, will you provide them with such information?
The HGST Health Insurance Association will never disclose the name of an illness or injury without the consent of the individual.
PAGE TOP