Procedures

Medical Care for Illness or Injury

Insured persons and dependents present a health insurance card to hospitals or healthcare clinics to receive examinations, first aid, medication, and other healthcare services for a portion of the medical care costs for any non-occupational illness or injury. The Western Digital Technologies Health Insurance Association covers the remainder of those medical care costs.

Out-of-pocket Costs for Inpatient and Outpatient Services

Percentage of Out-of-pocket Costs

Age 70 to 74 20% 
*30% for income earners comparable to individuals in active service
Elementary school children to individuals age 69 30%
Preschool children 20%
*Income earners at the same level as active employees age 70 to 74 are insured persons or dependents who have a standard monthly remuneration of 280,000 yen or more. However, these insured persons and dependents may pay the standard 20% out-of-pocket costs by filing an application with the Western Digital Technologies Health Insurance Association if:
  • The individual is age 70 or older and earns less than 3.83 million yen annually without any dependents
  • The individual has a dependent or former dependent age 70 or older and has a total combined annual income of less than 5.20 million yen

Costs of Inpatient Meals

The Western Digital Technologies Health Insurance Association has also determined the amount patients pay out-of-pocket (standard out-of-pocket payments) even for meals during hospitalizations, and health insurance covers any costs exceeding the maximum amount of out-of-pocket costs as inpatient daily dietary treatment expenses.
However, any special menu options or special requests are treated as special surcharges paid by the insured person or dependent in the same way as amenity bed costs or other extraneous surcharges are when hospitalized in a deluxe hospital room.
Moreover, standard out-of-pocket costs for meals are not treated as high-cost medical care expenses.

Standard Out-of-pocket Costs for Each Inpatient Meal

General 490 yen
*280 yen for patients with incurable diseases or specific pediatric chronic diseases
Low-income earners
(exempt from municipal residence tax, etc.)
First 90-days of hospitalization: 230 yen
91 days or more after hospitalization: 180 yen
Elderly beneficiaries of low-income earner households 110 yen
*Patients age 65 or older hospitalized in a long-term care facility pay 490 yen per meal and 370 yen per day in resident fees (referred to as the standard out-of-pocket payment for inpatient daily living treatment expenses). The Western Digital Technologies Health Insurance Association further reduces the out-of-pocket costs for low-income earners.
*Revised on June 1, 2024

Medical Care Received Outside of Japan

Insured persons and dependents who have received medical care from a healthcare provider outside of Japan can apply for reimbursement of some of the medical care costs paid out in full out of pocket.
However, insured persons and dependents from Japan cannot use their health insurance cards overseas. Therefore, if an insured person or dependent receives medical care or medication at a healthcare provider overseas due to sudden illness or injury, they must temporarily pay the full medical care costs to the healthcare provider. After returning to Japan, the insured person or dependent may then apply for reimbursement of the medical care costs from the Western Digital Technologies Health Insurance Association. The insured person will receive payment from the Western Digital Technologies Health Insurance Association for the medical care costs (overseas medical treatment expenses) calculated according to the standard costs of medical care for the same treatment if received in Japan based on that application. The Western Digital Technologies Health Insurance Association determines whether or not the medical care costs are covered by insurance using the same criteria as that in Japan. Therefore, any medical care not approved by health insurance is not covered.

Medical care covered by health insurance Non-occupational illnesses or injuries
*The Western Digital Technologies Health Insurance Association does not cover illness or injury occurring at or on the way to and from work.
Scope of medical coverage Treatments, medications, medical supply payments, procedures, surgeries or other medical care necessary to treat an illness or injury

However, insured persons will not receive benefits for medical care such as the types listed below.

  • Treatments or procedures not covered by health insurance
  • Normal birth, physical examinations, and vaccinations
  • Medical care or treatments provided for travel overseas
  • General over-the-counter medications
  • Corrective dental treatments or the use of materials not covered by health insurance

Calculation and Payment of Overseas Medical Care Costs

The Western Digital Technologies Health Insurance Association calculates the overseas medical care expenses by estimating the medical care costs when receiving treatment through health insurance in Japan while referring to the details of medical care statements and converting the actual medical care costs incurred at a local healthcare provider into Japanese yen to apply the out-of-pocket amount to whichever is lower.
Furthermore, the Japanese currency conversion rate used to calculate the payment of overseas medical care costs uses the foreign exchange conversion rate (selling rate for individuals exchanging Japanese yen to a foreign currency) on the date of the payment decision.

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 for each month by patient, by healthcare provider, and by inpatient and outpatient treatments.
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