Procedures

Reimbursements for Medical Care Costs Paid Up Front

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 HGST Health Insurance 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 HGST Health Insurance Association reimburses insured persons or dependents 70% 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% of the actual costs is not always covered by health insurance.
Please always take a receipt because the receipt is required when making a claim for medical care costs.

Required
documents
  • Application for Payment of Medical Care Costs
    PDF Entry Sample
  • Receipt (original)
  • Certificate of medical remuneration (original)
    *The certificate of medical remuneration is not the examination statement issued with the receipt.
*Individuals eligible for medical care subsidies for infants or children should make and store a copy of any original materials that are submitted.

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.
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 HGST Health Insurance Association may not approve re-fabrication of a therapeutic device if the lifespan determined for each device has not passed.

Required
documents
  • Application for Payment of Medical Care Costs
    PDF Entry Sample
    *Please apply for each healthcare provider every month.
    *When submitting an application for orthopedic shoes, please attach a picture of the orthopedic shoes (one able to verify the real orthopedic shoes actually worn by the patient) to the second page of this application.
  • Receipt (itemized receipt including therapeutic devices; original)
  • Physician's certificate of consent (original)
*Individuals eligible for medical care subsidies for infants or children should make and store a copy of any original materials that are submitted.

Acupuncture, Moxibustion or Massage Payments

The HGST Health Insurance Association only reimburses the basic charges for treatments provided by acupuncturists, moxibustionists, or massage professionals approved by a physician.

Please take note!

  • 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).
  • 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.
Required
documents
  • Application for Payment of Medical Care Costs
    (Acupuncture/Moxibustion)
    PDF Entry Sample
  • Application for Payment of Medical Care Costs
    (Massages)
    PDF Entry Sample
  • Physician's certificate of treatment consent (every six months; original)
  • Receipt including the details of medical care (original)

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 Candidates and Amount of Benefits

Eligible candidates Dependents under age 9
Amount of benefits Types of supportive devices in accordance with the Child Welfare Act
Insurance covers 70% (80% for preschool children) of the amount actually paid up to the maximum for eye glasses (36,700 yen)/contact lenses (15,400 yen/contact) × 1.06 (1.048 for purchases on or before September 30, 2019) to treat amblyopia.
Example:
Eye glasses purchased for 30,000 yen 30,000 yen x 0.7 = 21,000 yen
Eye glasses purchased for 50,000 yen 38,902 yen (maximum coverage 36,700 yen × 1.06) × 0.7 = 27,231 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
Required
documents
  • Application for Payment of Medical Care Costs
    PDF Entry 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 attending insurance 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 HGST Health Insurance Association calculates such expenses based on the medical care costs stipulated by health insurance in Japan.
The benefits may at times be smaller than the actual amount paid because medical care costs differ by country.
Please note insured persons and dependents are not eligible for benefits if traveling overseas to receive medical care.

Procedures
Required
documents
  1. Application for Payment of Medical Care Costs
    PDF Entry Sample
  2. Attending Physician’s Statement or Attending Dentist's Statement
  3. Itemized receipt (original)
  4. Investigation Authorization Agreement for Overseas Medical Care Costs
    PDF
  5. Copy of passport (page for verification of patient name and travel history)
  6. Translations of both 2 and 3 if written in a foreign language
    (including the translator’s name, address, and contact information; there is no designated format)
*Please file the Application for Payment of Medical Care Costs, Attending Physician’s Statement, and receipts in monthly increments by patient, healthcare provider, inpatient and outpatient treatment.

About Limbal-supported Contact Lenses for Abnormal Corneal Shape

The purchase of contact lenses for Stevens-Johnson Syndrome and ocular sequelae of toxic epidermal necrosis became eligible for insurance benefits in April 2018.

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 HGST Health Insurance Association if a second purchase is necessary due to loss or damage caused by disasters or other unavoidable circumstances.
Required
documents
  • Application for Payment of Medical Care Costs
    PDF Entry Sample
  • A copy of the instructions from the physician (HGST-network 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 HGST Health Insurance Association reimburses insured persons and dependents for the cost of blood as well when undergoing blood transfusions.

Required
documents
  • Application for Payment of Medical Care Costs
    *Please contact the HGST Health Insurance Association.
  • Itemized (medical) receipt (original)
  • Certificate of the attending physician who recognized a need for the transfusion (original)
  • Receipt for blood costs (original)
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