When a Member or a Dependent Becomes ill or is Injured
A1:If you are under age 70 , or age over 70 and holding an “Elderly Recipient Certificate” with a copayment rate of 30% (restricted to individuals with a monthly standard salary between 280,000 and 790,000 yen), you can reduce the burden by showing your “Maximum Amount Application Certificate” at the hospital, and will only have to pay up to the amount specified by the Benefit for High-cost Medical Care.
For those age 70 and above and having a Monthly Standard Salary of 830,000 yen or more, or holding an “Elderly Recipient Certificate” with a copayment rate of 20%, show your “Elderly Recipient Certificate” at the hospital.
A2:Membership card can be used for Judo therapy only for the following cases; traumatic bone fracture, dislocation, bruise or sprain, muscle or tendon rupture from indirect force (also called muscle strain, it may come with crush injury). 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.
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