> Q&A > Short-Term Benefits
When a Member or a Dependent Becomes ill or is Injured
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.
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.
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.
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.
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
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.
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
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
A10: Yes, the Disaster Relief Benefit is paid to both of you.