Sick or injured? What if you need medical care before insurance card arrives?

photo by pennythots

All registered residents residing in Japan are required to register for one of the public health insurance systems. Full-time employees are to be enrolled in Employee’s Health Insurance (EHI) while sole proprietors, unemployed and those who are not eligible to any other public health insurance enroll in National Health Insurance (NHI). In return for monthly insurance premium payments, members of public health insurance can take medical treatments by paying only a part of total medical costs when they get sick or injured. However, this is only if patients present their health insurance card at a hospital or clinic. So, what will happen if you cannot bring your insurance card with you for some reason, for example, if you haven’t received a health insurance card yet?

About health insurance card

Once you are enrolled in NHI or EHI, a health insurance card will be issued to you by the municipal office, Japan Health Insurance Association or other associations you enrolled with. A health insurance card is an important certificate which proves your right to receive medical benefits. You are required to present it at a medical institute so that you only have to pay a part of the costs when you take medical treatments. Also, a health insurance card need to be kept with care as it is often used as a personal ID in Japan.

Share of medical cost

Age group	Share of medical cost
Under school age	20%
School age to 69 years	30%
70 years and over (other than those with income comparable to current workforce)	20%
70 years and over (Those with income comparable to current workforce)	30%

Having medical care without health insurance card

If you cannot present your health insurance card at a hospital or clinic, you will have to pay the full amount of the medical expense for the treatments you received. If you are a member of public health insurance system, you can get a refund from the insurer later.

Getting refund at hospital or clinic

Depending on the hospital or clinic from which you get treatments, you may receive a refund at their counter if you return there later day to present your health insurance card. Just inquire your hospital or clinic if they would refund the insured part of your medical cost. Note that there is a due date to receive a refund at medical institutions. You need to visit the hospital or clinic with your insurance card before the deadline if you wish to get a refund from them.

If you cannot get a refund at hospital or clinic

You may get a refund at the insurer’s office such as municipal office or Japan Health Insurance Association office depending on the type of insurance system you enrolled in. The primary condition to get a refund from the insurer’s office is that you have inevitable reason that you couldn’t present your health insurance card. For example, your insurance card didn’t arrive by the time, or you accidentally got injured or sick while away from home. You may not pass an assessment to get a refund from the insurer if you just forgot to take your insurance card with you. Also, you must apply for a refund within 2 years from the date you paid the medical cost.

What to bring to get a refund

The following documents are required when you apply for a refund at the insurance provider’s office.

For National Health Insurance members

An application for a refund can be made at the NHI counter in the municipal office. required documents may vary by area, but generally you need to bring:

Filled application form
Your health insurance card
inkan
Valid bank book
Statement of medical expenses
Payment receipt

For members of other insurers

Members of insurance providers other than NHI can claim a refund at the counter of each organization. Required documents may vary by each organization, but generally you need to bring:

The application form
Statement of medical expenses
Payment receipt

Statement of medical expenses is required to examine whether medical expenses are properly calculated, or items are covered by the insurance. Make sure you get this certificate along with a payment receipt at the hospital or clinic.

If you claim a refund at the insurer’s office

Importantly, when you claim a refund of medical expenses at an insurer’s office, you should be aware that medical institutions in Japan adopt two different fee schedules, one is for the insured medical practices and the other for the free medical practices.

Insured medical practices: Medical treatments covered by public health insurance systems
Free medical practices: Medical treatments NOT covered by public health insurance systems

In Japan, medical expenses are calculated based on points given to each medical treatment.

Insured medical practices: Calculated by multiplying unit price JPY10 by the point of each treatment. Insured medical practices are exempt from the consumption tax.
Free medical practices: Unit price is discretionally determined by each hospital or clinic. That is, unit price can be JPY11, JPY20, JPY25 or more. Free medical practices are normally subject to the consumption tax.

Medical treatments covered by public health insurance are automatically calculated as the insured medical practices with flat rate of JPY10 if you present the health insurance card. On the other hand, if you don’t present the health insurance card, all the medical treatments you received are calculated as the free medical practices, even though you are a member of public health insurance system. Most of hospitals and clinics re-calculate your medical bill and refund the balance once you visit there with your health insurance card later day. However, if you get a refund from the insurer, the full amount of the medical cost is calculated by using unit price of the insured medical practices, no matter of the actual price you have paid. Therefore, if the hospital or clinic you visited has higher price settings for the free medical practices, the discrepancy caused by the difference in price setting will be on your cost. also, the consumption tax are non-refundable at the insurer’s office.

Get well, get well soon, we wish you to get well

Covering wide range of medical treatments, Japanese public insurance system is one of the top graded insurance system in the world. These systems cover almost all general medical practices so that members can get professional treatments with small amount of money. Sometimes, it takes rather long before you get your insurance card. If you get sick or injured and had medical care without your insurance card, you will need to pay the full amount of the cost first and get a refund for the balance later. Be aware that doctor’s bills for the insured medical practices and free medical practices are calculated differently. Considering the differences in fee settings between these two schedules, the best option to claim a refund would be visiting the hospital or clinic you had a treatment. Also, It is a good idea to keep your insurance card in your wallet all the time in case of emergency as a health insurance card is normally credit card size and handy to carry around.