Health Insurance System

List of Insurance Benefits

List of Insurance Benefits for Individuals (Insured Persons)

Illness and Injuries

Treatment benefit 70% of the medical expenses for both out-patient and in-patient care
Treatment benefit
(Individuals age 70 to 74)
80% of the medical expenses for both out-patient and in-patient care
*However, this is 70% for individuals age 70 to 74 who are income earners comparable to active service.
Expenses for combined covered/non-covered medical care 70% of the medical expenses for treatment within the scope of health insurance if combined with non-covered treatment
Medical Care Costs Standard amount of reimbursement for claims to the HGST Health Insurance Association after paying expenses out of pocket
High-cost medical expenses Amount exceeding out-of-pocket medical costs for one treatment per month when above the maximum amount (the maximum amount differs for low-income earners and individuals age 70 to 74)
Aggregated high-cost medical expenses Amount exceeding the combined maximum total of 21,000 yen in out-of-pocket costs for two or more cases in the same household for the same month
Amount of co-payment reductions
and additional aggregated high-cost medical expenses
(additional benefit)
Payment of an amount calculated by deducting 25,000 yen from the out-of-pocket amount (rounded down to the nearest 1,000 yen)
Combined total of high-cost long-term care expenses Excess amount proportionally divided according to the ratio of medical and long-term care expenses if the combined total of out-of-pocket payments of medical and long-term care expenses for one year exceeds the maximum limit
In-patient dietary treatment expenses
and in-patient daily living treatment expenses
Meal expenses exceeding 460 yen for each meal for up to three meals per day;
the amount of housing expenses exceeding 370 yen per day in cases of in-patient daily living treatment expenses
*There are measures available to mitigate the burden on low income earners and other insured persons.
Home-visit nursing care expenses 70% of the stipulated expenses
Additional home-visit
nursing care expenses (additional benefit)
Payment of an amount calculated by deducting 25,000 yen from the out-of-pocket amount (rounded down to the nearest 1,000 yen)
Transfer costs The actual expenses within the range of the standard amount calculated by the HGST Health Insurance Association

Incapacity to Work Due to Illness or Injury

Injury and illness allowance Amount equivalent to two-thirds per day of leave [average standard monthly remuneration for the last 12 months divided by 30] for 18 months

Maternity

Maternity allowance An amount equivalent to two-thirds per day of leave [average standard monthly remuneration for the last 12 months divided by 30] for 42 days before childbirth (98 days for twins or other multiple births; payment also provided for any period childbirth is delayed from the due date), and 56 days after childbirth
Lump-sum birth/childcare benefit 420,000 yen per child (408,000 yen if birth took place before 22 weeks or the individual gave birth at a hospital or other medical institution that is not a member of the Japan Obstetric Compensation System for Cerebral Palsy)

Death of an individual

Funeral expenses (fees) Uniform 50,000 yen

List of Family (Dependent) Benefits

Illness or Injury

Family medical treatment expenses 70% of the medical expenses for both out-patient and in-patient care
Family medical treatment expenses
(pre-school child
and individuals age 70 to 74)
80% of the medical expenses for both out-patient and in-patient care
*However, this is 70% for individuals age 70 to 74 who are income earners comparable to active service.
Expenses for combined covered/non-covered medical care* 70% of the medical expenses for treatment within the scope of health insurance if combined with non-covered treatment
Medical treatment expenses* Standard amount of reimbursement for claims to the HGST Health Insurance Association after paying expenses out of pocket
High-cost medical expenses Amount exceeding out-of-pocket payments of medical expenses in a single month exceeding the stipulated amount (there are also measures to mitigate the burden, such as totaling amounts for the entire household)
Aggregated high-cost medical expenses Amount exceeding the combined maximum total of 21,000 yen in out-of-pocket costs for two or more cases in the same household for the same month
Additional family medical expenses
and Additional aggregated high-cost medical expenses
(additional benefits)
Payment of an amount calculated by deducting 25,000 yen from the out-of-pocket amount (rounded down to the nearest 1,000 yen)
Combined total of high-cost nursing care expenses Excess amount proportionally divided according to the ratio of medical and long-term care expenses if the combined total of out-of-pocket payments of medical and long-term care expenses for one year exceeds the maximum limit
In-patient dietary treatment expenses
and in-patient daily living treatment expenses*
Meal expenses exceeding 460 yen for each meal for up to three meals per day;
the amount of housing expenses exceeding 370 yen per day in cases of in-patient daily living treatment expenses
*There are measures available to mitigate the burden on low income earners and other insured persons.
Family home-visit nursing care expenses 70% of all stipulated expenses
Additional home-visit
nursing care expenses (additional benefit)
Payment of an amount calculated by deducting 25,000 yen from the out-of-pocket amount (rounded down to the nearest 1,000 yen)
Family transfer costs The actual expenses within the range of the standard amount calculated by the HGST Health Insurance Association

*When expenses for combined covered/non-covered medical care, treatment expenses, in-patient dietary treatment expenses, or in-patient daily living treatment expenses are paid to a dependent, these benefits are paid as family medical treatment expenses.

Childbirth

Dependent’s childbirth/childcare lump-sum allowance 420,000 yen per child (408,000 yen if birth took place before 22 weeks or the individual gave birth at a hospital or other medical institution that is not a member of the Japan Obstetric Compensation System for Cerebral Palsy)

Death of an individual

Funeral expenses for a family member Uniform 50,000 yen
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