A

Health insurance term Contents
Acquisition of a qualification As soon as you join the company, you will join our health insurance association. This is called health insurance qualification acquisition, and the date of joining the company is the qualification acquisition date.
Additional Benefits In addition to the statutory benefits, which are the insurance benefits stipulated by the Health Insurance Act, the benefits stipulated by the Health Insurance Association are called additional pay. Each health insurance association can decide an amount of additional pay.

B

Health insurance term Contents
Burial charges (burial costs) The burial fee is a fixed amount of 50,000 yen provided by the health insurance association when the insured or dependents die. On the other hand, the burial fee is paid up to 50,000 yen by the health insurance association as the actual cost when a person has no relatives.

C

Health insurance term Contents
Childbirth and childcare lump sum Since normal pregnancy and childbirth are not illnesses, you cannot use health insurance and pay the entire amount, but the "lump-sum childbirth and childbirth allowance" covers part of the childbirth costs. If the insured or dependents become pregnant for more than 4 months (12 weeks), they will be eligible for a lump-sum birth allowance of 404,000 yen per child. Furthermore, if you become pregnant for more than 22 weeks and give birth at a medical institution that is a member of the obstetrics medical compensation system, an additional 16,000 yen will be added to 420,000 yen. It is also paid for stillbirth and miscarriage.

D

Health insurance term Contents
Direct payment system The direct payment system is a system in which the health insurance association pays childbirth costs directly to the delivery institution through the payment institution, up to the amount of the lump-sum childbirth and childcare allowance. By using this system, you will only be able to pay at the counter in excess of the lump-sum birth allowance.
Dependents Family members who maintain their livelihood from the income of the insured person.

E

Health insurance term Contents
Elderly beneficiary certificate At the age of 70, you will become an elderly beneficiary until you are 75 years old (shift to the medical system for the elderly), and you will be issued a "health insurance elderly beneficiary certificate". It is necessary to show the "elderly beneficiary card" together with the "health insurance card" when receiving medical treatment.
Enterprise Companies that are members of the health insurance association

F

Health insurance term Contents
Free Continuous Insurance System If you lose your insured status due to retirement, you can continue to be insured for two years if you apply.

G

Health insurance term Contents
Generic drug hope seal This is a sticker that you can put on your health insurance card and medication notebook to convey your intention to use generic drugs to medical institutions.
When issuing a new health insurance card, a sticker will be distributed, but if you wish, please contact the Health Insurance Association.

H

Health insurance term Contents
High-Cost Medical Care Benefits After receiving medical treatment under health insurance, the amount of out-of-pocket expenses per medical institution per month (excluding the out-of-pocket expenses for meals at admission, living expenses at admission, and the difference between non-insurance combined medical expenses) When you exceed it, the excess amount will be paid by your health insurance.
In addition, our health insurance association provides its own additional benefits, and refunds the amount exceeding 25,000 yen. Refunds are calculated automatically, so no application or other procedures are required.

I

Health insurance term Contents
Injury and illness allowance This is a benefit to stabilize the life of the insured person during the leave of absence when the insured person cannot work due to illness or injury. If you have to take a leave of absence for more than 3 consecutive days, the amount equivalent to 2/3 of the standard amount on the day you start paying from the 4th day does not exceed 1 year and 6 months at the maximum It will be provided. If the employer pays the remuneration during the leave, the payment of the injury and illness allowance will be stopped, but if the amount of the remuneration is lower than the injury and illness allowance, the difference will be paid.
Insured person The person who is entering health insurance
Insurance benefits Various benefits provided when the insured person and dependents get sick or injured for something other than work, provide medical services such as medical treatment and medication, and give birth or die. Benefits will payment will by cash.
Providing these medical services and providing benefits
Insurance fee The insurance fee rate of the health insurance association is determined within the range of 30/1000 to 130/1000 of the standard monthly salary depending on the financial situation, and the amount obtained by multiplying this fee rate by the standard monthly salary is the monthly fee. In addition, insurence fee will be collected from bonuses the same fee rate. As a general rule, people between the ages of 40 and 65, the standard monthly salary multiplied by the long-term care insurance fee rate will be collected as the long-term care insurance fee.

L

Health insurance term Contents
Legal benefits This is the insurance benefit stipulated by the Health Insurance Law, and is the same for all health insurance associations.

M

Health insurance term Contents
Maximum Co-payment Certificate When medical expenses are high, by presenting this certificate at the medical institution window, the monthly payment amount per medical institution is the maximum amount to be paid by yourself at the Insurance medical institution.
(additional bed not covered by a health insurance plan charges and meal burden at admission are excluded for medical expenses not covered by insurance)
Maternity allowance It is paid to support the life of the insured when the salary is reduced or unpaid during the leave period due to childbirth. Basically, between 42 days before the date of childbirth and 56 days after the date of childbirth, an amount equivalent to two-thirds of the standard amount on the day when payment is started is paid for one day of the leave period. If the compensation is paid during the period when you cannot work, the payment of the maternity allowance will be stopped, but if the amount of the compensation is lower than the maternity allowance, the difference will be paid.
Medical fee statement (receipt) A statement describing the treatments taken by the medical institution and the drugs used to charge the health insurance association for medical expenses.
Medical expenses In the case of health insurance, it is a general rule to present your health insurance card to the counter of the insurance medical institution to receive medical services, but due to a sudden illness, you have no choice but to have your health insurance card at hand. If so, in principle, 30% of the burden will be paid in advance), and the money that will be refunded from the health insurance later is called medical expenses. Also, if you receive medical treatment overseas, you will be paid medical expenses according to domestic standards.

N

Health insurance term Contents
Notice of medical expenses It is a statement of medical expenses when an insured person or a dependent receives medical treatment with a health insurance card.
As a general rule, you can check it on the portal site "PepUp" from 3 months after receiving medical treatment.

P

Health insurance term Contents
Prescription The right to health insurance benefits has no statute of limitations for in-kind benefits, but has a two-year statute of limitations for cash benefits.
If you forget to claim and two years have passed, you will not be able to receive the benefits. The starting date of the two-year statute of limitations is that the injury and illness allowance and the maternity allowance will be applied to each day when the employee becomes incapacitated and from the following day. The lump-sum childbirth and childcare allowance starts the day after the day of childbirth, the burial fee starts the day after the day of death, and the medical treatment fee starts the day after the patient pays in advance.
PepUp A portal site that allows individual notifications such as medical expense notifications, health examination results, generic difference notifications, and health insurance notifications.

R

Health insurance term Contents
Receipt of medical treatment for specific illness from health insurance It is monthly basis 10,000 yen because of a medical institution of the specific illness having one self-pay ceiling by showing it in the window of the medical institution. (However, if the standard monthly salary is 530,000 yen or more, you should pay your own expense 20,000 yen a month.)
The eligible diseases are designated by the Minister of Health, Labor and Welfare because they require high medical expenses for a long time, and are as follows.
  • Chronic kidney disease requiring dialysis
  • hemophilia
  • Acquired immunodeficiency syndrome receiving antiviral drugs

S

Health insurance term Contents
Social Insurance Medical Fee Payment Fund After examining whether the medical expenses related to medical treatment from the insurance medical institution (pharmacy) are correct, make a claim to the health insurance association (insurer) and pay the medical expenses paid by the health insurance association to the insurance medical institution. Institution to do
Severe illness prevention This is a health business carried out by our health insurance association for the purpose of preventing the aggravation of lifestyle-related diseases. Based on the results of the medical examination, it is judged that treatment is required, and a notification is sent to those who do not have a medical institution's medical examination history to recommend medical examination.
Specific disease It is a disease designated by the Ministry of Health, Labor and Welfare as a specific disease in the clinical research field of the intractable disease overcoming research project.
standard monthly salary The monthly salary and other remuneration that the insured person receives from the company is divided into grades 1 ～ 50.
It is also used as a basis for calculating insurance premiums, injury and sickness allowances, and maternity allowances.

W

Health insurance term Contents
Workers' accident compensation insurance Social insurance will provide benefits in case of sickness or injury due to work or commuting. About health insurance will provide benefits such as medical expenses for sickness and injuries outside of work, and lump-sum payments in case of childbirth or death.