Frequently Asked Questions (National Health Insurance)

QuestionWhat benefits can be received under the National Health Insurance?

Response

Benefits available under the National Health Insurance include those for health incidents such as illness, injury, childbirth, and death. The main benefits are as follows. All claims are subject to review, and only those that are approved will be eligible for insurance benefits.

1. Medical services such as examinations, medication, and hospitalization provided at medical institutions due to illness or injury are considered benefits for medical care, and the payment will be partially borne by the patient.
2. Regarding meal costs during hospitalization, the National Health Insurance provides hospitalization meal therapy expenses, and the payment by the insured is a partial burden.
3. If the medical expenses for one month become high, the amount exceeding the household limit will be reimbursed as high-cost medical expenses. (About three months after the treatment, an Application Form will be sent from City Hall.)
4. In cases like the following, if you have initially paid the full amount, the portion excluding your out-of-pocket expenses will be refunded later.
   • When you are unable to present your Health Insurance Card at a medical institution due to an emergency and have to bear the full cost
   • When the cost of orthopedic devices such as corsets deemed necessary by a physician for treatment is incurred
   • When receiving treatment from a judo therapist who does not handle national health insurance for fractures or sprains.
   • When receiving treatments such as acupuncture, moxibustion, or massage recognized as necessary by a physician
   • When receiving medical services at a medical institution while traveling abroad (excluding cases where the travel was for treatment purposes)
   • Costs for blood transfusions of live blood during surgeries recognized as necessary by a physician (limited to third parties)
5. When you give birth, a childbirth and childcare lump-sum payment will be provided. If you are beyond 12 weeks of pregnancy (85 days), it will be provided even in the case of stillbirth or miscarriage. (In principle, the childbirth and childcare lump-sum payment is paid directly from the National Health Insurance to medical institutions, which reduces the out-of-pocket expenses accordingly.)
6. When someone passes away, funeral services expenses will be provided to those who conducted the funeral.
7. In cases where the use of home nursing stations is recognized as necessary by a physician, home nursing care fees will be paid to the home nursing station by the National Health Insurance, so the payment will be partially borne by the patient.
8. Transportation costs will be covered only when, due to a doctor's instructions, it is unavoidable to urgently transport a seriously ill patient for hospitalization or transfer, and an application is made and deemed necessary.