Procedures

Work Leave Due to Illness or Injury
(Application for Illness or Injury Allowance)

Insured persons who do not receive compensation for a period of time due to work leave caused by a non-occupational illness or injury may receive benefits calculated through the calculation method below for each day of leave. However, workers’ compensation insurance applies to any illness or injury caused by an accident or incident which happened at or on the way to or from work.

Requirements for Receiving Payment

Necessary for recuperation The individual may recuperate even at home if healing from a non-work-related illness or injury.
Incapacity to work The individual has been deemed to have an incapacity to work when unable to do the work in their previous capacity even if able to take on a job with a lighter load. However, a physician’s certificate is required throughout the extent of leave.
Three or more continuous days
of leave from work
Health insurance does not cover the first three days of leave as a waiting period. Benefits start from the fourth day an insured person is unable to work.
No work compensation Work leave benefits for illness and injury are not paid if the amount of compensation provided by the employer is higher than the illness and injury allowance. If the amount of compensation is less, the HGST Health Insurance Association pays the difference.

Payment Period

It is 18 months from the day when the injury and illness allowance was first paid, including the total number of days paid. The illness and injury allowance also ends if an insured person receives a disability pension or allowance for the same illness or injury from employees’ pension insurance or an old-age welfare annuity. However, the HGST Health Insurance Association pays any difference for 18 months including the number of payment days if that amount is less than the illness and injury allowance.

Image of payment period
*Please apply by including the waiting period when filing an application

Daily benefit = Standard daily remuneration x 2/3

Calculation Method for Standard Daily Remuneration

Individual enrolled at least
one year as an insured person
since the start of premium payments
Average remuneration in the last 12 months
Individual enrolled less than
one year as an insured person
since the start of premium payments
  1. The average standard daily remuneration during the period as an insured person;
  2. or the average standard daily remuneration for all insured persons if less
*The amount of remuneration is adjusted according to any amount of compensation paid by the employer.
Procedures
Fill in the required information in the documents below, obtain a certificate from your physician, and submit these materials to the HGST Health Insurance Association.
(Refer to the “Application Forms” page for information on where to submit application forms.)
Required
documents
  • Application for Injury and Illness Allowance
    PDF Entry Sample
  • Consent form (only required for the first claim)
    PDF
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