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Short-Term Benefits

When a Member or a Dependent Becomes ill or is Injured

Q1: How can I reduce the burden of copayment? I have long been hospitalized and anticipate high medical bills.

A1: If you are aged less than 70 years, present your “Maximum Amount Application Certificate” at the hospital. PMAC pays the amount equivalent to high-cost medical care expenses to the medical institution, which is normally paid as a benefit payment, thus you need not cover the cost of the care at the hospital. If you are 70 years or older, present your “Elderly Recipient Certificate” at the medical institution.

Q2: Can I use my membership card when I go see a osteopathic physician or Judo therapist as with other medical services?

A2: The only cases where you can use your membership card for Judo therapy is for sprains, bruises, contusions (muscle strain) caused by acute or subacute trauma. For bone fractures and dislocations excepting emergency treatment, physician consent is required. Medical care costs for the following injuries that are not diagnosed as traumatic injuries are paid in full by the patient since the membership card cannot be used.

  • Non-injury conditions such as stiff shoulders and muscle fatigue.
  • massage therapy.
  • long term discursive treatments where symptomatic improvement cannot be expected.
  • treatments that should be conducted by a physician.

Q3: Should I submit any form or document when I file a claim for Benefit for High-cost Medical Care, Copayment refund, Copayment refund for dependent inpatient care benefit, Dependent inpatient care benefit ?

A3: When you have used the Membership Card for an insurance-covered treatment, you do not have to submit any documents as procedures are processed on our side.
However, when you have to fully pay the medical expenses due to an unavoidable circumstance, you will be claiming for copayment refund later. In this case, we shall regard that you have filed a claim for others as well, there is no need to submit any document for them.

Q4: I use a taxi to go to hospital. Can I apply for the transportation expense benefit?

A4: PMAC will reimburse for the cost of transportation only when a patient cannot or can hardly walk and needs transportation to get hospitalized for medical treatment. So the answer is “no” in your case.

Q5: I am planning to travel abroad. If I get sick and receive medical care at my travel destination, is the medical care cost covered as a medical expense benefit or medical expense benefit for dependents?

A5: Medical expense benefit/medical expense benefit for dependents within the range converted based on Japanese insured medical treatment standards is provided. When requesting payment, proof of detailed medical treatment provided by the local doctor at the travel destination is required. Therefore, it is recommended that you take a copy of the " Attending Physicians’ statement" with you while traveling. As a result of converting the treatment received to Japanese insured medical care standards, the payment may be significantly smaller than the amount paid at the travel destination. Please note that this payment does not apply to traveling abroad for the purpose of receiving medical care.

Q6: If I become sick while employed, can I receive insured medical treatment for the illness using my membership after I retire from the job?

A6: After your retirement, you cannot receive insured medical treatment using your "Membership card." Please return your "Membership card," "Elderly Recipient Certificate," "Maximum Amount Application Certificate." After your retirement, you need to follow the procedures to join National Health Insurance, etc. Persons whose membership period before retirement continues for more than 1 year and 1 day can receive Short-term benefits as Voluntarily Continued Insurance Member.

When a Child is Born

Q7: We both are members. When my wife gives birth, she will be paid the Maternity Benefit. Will I be paid the Dependent Maternity Benefit then?

A7: The Dependent Maternity Benefit is payable when a family member certified as a member’s dependent. Your wife is one of your family but not a dependent in our definition. Therefore you are neither paid the Dependent Maternity Benefit nor Supplementary Benefit.

Q8: In case of twins, I understand that I will be paid the Maternity Benefit for each. Will the Maternity Allowance be paid in the same way?

A8: The payment of the Maternity Allowance is intended to support your living during absence from work. Therefore the Maternity Allowance will not be doubly paid. However, payment starts from 98 days before the date of childbirth instead of 42 days.

In Case of Death

Q9: Will any benefit be paid for the burial of a stillborn child?

A9: The Dependent’s Burial Benefit and Supplementary Burial Benefit are paid when a family member certified as a member’s dependent passed away. Since a stillborn child is not a dependent in our definition, there is no benefit to be paid.

In Case of Harm from Floods, Earthquake, and Other Disasters

Q10: My wife and I are both members. Will each of us be paid the Disaster Relief Benefit when our house has been burned down?

A10: Yes, the Disaster Relief Benefit is paid to both of you.