Guide to Living in Hiroshima Chapter 1 Health, Medical Care and Welfare

2Health Insurance
There are two major health insurance systems in Japan: Employees’ Health Insurance, which is aworkplace-based health insurance system for company employees and their dependents, andNational Health Insurance, which is operated by municipalities and is designed for people who do
not have Employees’ Health Insurance. Mid- to long-term foreign residents, special permanent
residents and those with a resident status specified by the Minister of Health, Labour and Welfare
who cannot enroll in the health insurance at their workplace due to their employment conditions
need to join the National Health Insurance.
For detailed information on health insurance systems, application procedures, benefits,insurance claims or payment, contact your municipal government office.
(1) Outline of Health Insurance Systems① National Health Insurance (NHI)A Enrollment
When a member in the household becomes eligible for NHI, theprocedures
head of the household should submit an application to the NHI
section of the municipal government office of their residence.
B Matters
Departure from Japan, moving-in/moving-out,
requiringenrollment/withdrawal from NHI, childbirth, death, change ofnotification
address/name/nationality/head of household, loss of NHI certificate,etc.
CHealthinsurance card

DInsurance
premium (tax)

A health insurance card will be issued to each individual in thehousehold (or a non-card type certificate for the entire household).
You must present your insurance card when receiving treatment at a
medical institution.
The head of the household is responsible for the payment ofpremiums. The amount of the premiums is determined by thenumber of NHI members in the household and the previous year’sfamily income. In the case that insurance premiums are not deductedfrom your pension, you can pay premiums at a financial institution
or your municipal government office using payment notices sent toyou, or through automatic debit through your bank account.

② Employees’ Health Insurance
A Enrollment
When employing a full-time employee—regardless of nationality,procedures
age or salary—the employer must submit an application to the Social
Insurance Office (or Health Insurance Association).
B Matters
The employer must notify the Social Insurance Office (or HealthrequiringInsurance Association) when an insured employee leaves thenotificationcompany, dies, changed his/her name, loses his/her health insurance
certificate, etc.
C Health
A health insurance card will be issued to the insured person andinsurance card
his/her dependents (some health insurance associations will issue
non-card type insurance certificates). You must present yourinsurance card when receiving treatment at a medical institution.
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暮らしの手引き広島 第１章 保健・医療・福祉DInsurance premiumE

Voluntary and continuous
insured person(voluntary enrollment
after retirement)

Premiums are determined in accordance with an insured person’ssalary and are shared equally between the employer and the insured
person. The employer pays the premiums (the amount paid by theinsured person plus the amount paid by the employer) to the insurer.
When an insured person who has been enrolled in the employees’
health insurance program continuously for more than two months
leaves the company, he/she is entitled to continue to be enrolled in
the insurance program for another two years. An application mustbe made to the Health Insurance Association within 20 days afterretirement.
Unlike while you were in the company, you must pay the entire
amount of the premiums.

③Latter-Stage Elderly Healthcare Insurance
AEligible persons

BMattersnotification

C

Healthcertificate

D

Persons aged 75 years and older (all persons aged 75 and older
enroll in the Latter-Stage Elderly Healthcare System on the day
when they reach 75 years of age; application not required)Those aged 65 to 74 are also eligible to be covered by the system if
approved as suffering specified disabilities by Hiroshima Prefecture
Wide-Area Association of Latter-Stage Healthcare (applicationrequired)requiring Departure from Japan, moving-in/moving-out, death, change ofaddress/name/nationality, loss of an insurance certificate, etc.

insurance A health insurance certificate will be issued for each person.
A health insurance certificate must be presented when receiving
medical services.
Insurance premium
The insurance premium is determined based on the insured person’sincome. In the case that insurance premiums are not deducted fromyour pension, you can pay the premiums at a financial institution or
your municipal government office using payment notices sent toyou, or through automatic debit through your bank account.

(2) Benefits of National Health Insurance (NHI), Employees’ Health Insurance, and Latter-Stage
Elderly Healthcare Insurance①

General Medical Benefits
Insured persons can receive medical treatment for their illnesses and injuries at the medicalinstitution of their choice by paying only a portion of the medical expense (work-related illnesses
and injuries are not covered by Employees’ Health Insurance).
The proportion of the cost to be borne by an insured person (copayment rate) is as follows:・ Those who enroll in Employees’ Health Insurance and their family members (dependents):
30%・ Those aged 70 or older: 20%*1 (30% for those who earn above a certain level of income)・ Children under six years of age*2: 20%
The same rate is applied to those enrolled in NHI.
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Guide to Living in Hiroshima Chapter 1 Health, Medical Care and Welfare

For those covered by the Latter-stage Elderly Healthcare Insurance Plan, the copayment rate is10% (30% for those who earn above a certain level of income).
Your health insurance plan—NHI, Employees’ Health Insurance or Latter-Stage Elderly
Healthcare Insurance—will pay the rest of the costs for the medical service.
*1 10% for those who were born before April 2, 1944 and whose income does not exceed a certain level*2 Until March 31 immediately following the day when they reach six years of age②

Refund on Medical Expenses
If you receive medical treatment without your health insurance card, you will be required
to pay the entire amount of the bill. However you can file for a refund pro rata (standardfees for the treatment received minus the copayment amount). (Corset, blood transfusion,treatment by a judo bonesetter or other oriental treatment, treatment by a doctor who does
not accept insurance, treatment without presenting your health insurance card, etc.)③

High-cost Medical Care Benefit
If the copayment amount for the medical care costs paid during the same month exceeds a
specified amount, the excess amount will be reimbursed upon application.

④

Childbirth and Childcare Lump-Sum Allowance (Dependent’s Childbirth and Childcare
Lump-Sum Allowance)
When an insured person or dependent gives birth to a baby after four months (85 days) ofpregnancy, 404,000 yen will be provided for each newborn baby (420,000 yen for aperson who gives birth at a childbirth facility that participates in the Japan ObstetricCompensation System for Cerebral Palsy*).
※The Japan Obstetric Compensation System for Cerebral Palsy is a system that provides compensation
payments promptly for children who suffer from severe cerebral palsy related to childbirth. Medical
institutions providing childbirth services can join the system.

⑤Funeral Allowance *except Employees’ Health Insurance
When an insured person dies, an allowance for funeral expenses will be given to theperson in charge of the funeral.

⑥⑦Funeral Expenses (Dependent’s Funeral Expenses) *Employees’ Health Insurance only
When an insured person dies, funeral expenses of 50,000 yen will be paid to the family
member who handles the burial. If the deceased person has no family members, the actual
cost of the burial will be paid to the person who handles the burial, up to the amount of
the funeral expenses benefit (50,000 yen). In the event of the death of a dependent family
member, 50,000 yen will be given to the insured person as the dependent’s funeral
expenses.
Childbirth Allowance * Employees’ Health Insurance only
When an insured woman takes time off from work for childbirth and is not paid a salaryby her employer, an amount equal to two-thirds of her standard daily wage will be paid
daily (for a maximum period from 42 days prior to the (expected) date of delivery [98days prior to the date of delivery in the case of multiple pregnancy] to 56 days after theday following the day of birth).

⑧Injury and Sickness Allowance *Employees’ Health Insurance only
When an insured person is absent from work due to illness or injury and is not paid salaryby the employer, an amount equal to two-thirds of his/her standard daily wage will bepaid for each absent day (for a maximum of 18 months reckoned from the fourth day ofthe absence from work).
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暮らしの手引き広島 第１章 保健・医療・福祉⑨Others
Meal expenses during hospitalization, special medical expenses, medical expenses forhome nursing, transportation expenses, etc.

Type of insurance

Contact

National Health Insurance

Municipal government office

Employees’ Health Insurance

・ Japan Health Insurance Association
・ Health Insurance Association

Latter-Stage Elderly Healthcare
Insurance

・ Municipal government office・ Wide-Area Association of Latter-Stage Elderly
Healthcare

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