National Health Insurance member? Your medical cost in overseas may be covered

photo by lee

Getting travel insurance is quite common practice before people go abroad and you probably got one before you came to Japan. Primary function of travel insurance is to cover unexpected medical treatment costs due to injury or illness while traveling, other than covering loss, damage or theft of your properties. But if you are covered by National Health Insurance of Japan, it is important to remember that your overseas medical expense may be covered. This system is called Overseas Medical Treatment Benefit Claim.

About Overseas Medical Treatment Benefit Claim

Overseas Medical Treatment Benefit is paid to cover medical treatments you received in overseas which are equivalent to medial cares in Japan covered by National Health Insurance. Benefit amount is calculated based on standard medical cost of equivalent treatment provided in Japanese medical institutes. If overseas medical costs is lower than Japanese standard costs, the amount if benefit will be 70% of actual medical cost paid in overseas. To receive Overseas Medical Treatment Benefit, you must pay full amount of overseas medical costs first, then make a claim after you return to Japan. Once your claim accepted, you will receive an equivalent amount of 70-90% of Japanese standard medical costs.

Claiming Overseas Medical Treatment Benefit

Required documents

To claim Overseas Medical Treatment Benefit, you are required to submit the following documents.

Attending physician/dentist’s statement
Itemized receipt
Agreement of authorization
Japanese translation of attending physician/dentist’s statement
Japanese translation of Itemized receipt
Original copy of medical expense receipt
Passport of a patient which proves the period of stay in overseas while receiving medical treatment
National Health Insurance card
Inkan (personal seal)
Bank detail of head of household

Document 1～3 can be downloaded from website of each city. Print a few copies of each document before traveling to overseas. Formats may differ by cities, and you need to print correct ones. Inquire your local municipal office in case you are not able to download these forms.

How to claim

Print “attending physician/dentist’s statement”, “itemized receipt”, and “table of international classification of diseases” and bring them with you to overseas.
Give your doctor “table of international classification of diseases” and ask him/her to fill in “physician/dentist’s statement”, “itemized receipt”.
Receive a medical expense receipt from the medical care provider
Have Japanese translation of “attending physician/dentist’s statement” and “itemized receipt” and bring all the documents to your local municipal office to make a claim.
Overseas Medical Treatment Benefit will be transferred to a bank account of head of your household.

Reminders

Medical services not covered by National Health Insurance

Overseas Medical Treatment Benefit is claimable only if treatments you received in overseas fall within medical services covered by National Health Insurance in Japan. The followings are examples of medical services which are not eligible for National Health Insurance.

Cosmetic surgery
Health checks
Normal birth
Job-related injury or illness
Injury due to bad behavior such as fighting and drunkenness

Other than the above, your overseas medical expenses will NOT be covered if travel abroad for the purpose of receiving medical treatment.

Claim period

Overseas Medical Treatment Benefit Claim must be made within 2years from the day a patient paid medical expense to an overseas medical institute.

Preparation is crucial

To claim Overseas Medical Treatment Benefit, you must submit documents written by an attending surgeon or dentist. Also, these documents are required for every single treatment. It is recommended to print adequate number of forms in advance.

Consider travel insurance in comparison

Fees for medical treatments are determined according to laws of each country. While Overseas Medical Treatment Benefit is paid only in the extent of the amount covered by National Health Insurance, overseas medical fees can be far higher than those in Japan. In such a case, general travel insurance may offer better coverage. It is important to compare travel insurance with National Health Insurance before traveling abroad.

Prevention is better than cure

Overseas Medical Treatment Benefit system allows those who travel abroad to have an equivalent coverage to National Health Insurance in Japan. This is a great advantage for National Health Insurance member as premium of travel insurance increases according to the length of covered period. However, note that Overseas Medical Treatment Benefit system only covers medical cares that are covered by National Health Insurance system in Japan. That means, medical services not covered by Japanese National Health Insurance are not eligible for this benefit even though such treatments are covered by insurance in the country you received the treatment. Considering these points, it is important to include travel insurance in the options as sometimes travel insurance offers better coverage.