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 |
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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.
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| 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 Western Digital Technologies 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 |
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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 |
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In-patient dietary treatment expenses and in-patient daily living treatment expenses |
Meal expenses exceeding 490 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.
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| Home-visit nursing care expenses | 70% of the stipulated expenses |
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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 Western Digital Technologies 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 |
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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 |
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| Lump-sum birth/childcare benefit | 500,000 yen per child (488,000 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 |
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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 |
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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.
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| 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 Western Digital Technologies 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 |
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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 |
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In-patient dietary treatment expenses and in-patient daily living treatment expenses* |
Meal expenses exceeding 490 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.
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| Family home-visit nursing care expenses | 70% of all stipulated expenses |
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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 Western Digital Technologies 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 | 500,000 yen per child (488,000 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) |
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Death of an individual
| Funeral expenses for a family member | Uniform 50,000 yen |
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