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Documents Necessary for Each Specific Circumstance

Some forms can be downloaded from this website.


Statutory benefits
Type of benefit Documents required Note
Health care benefits Medical Treatment Benefit, Meal costs during hospitalization, Living costs during hospitalization,
Parallel Uninsured Medical Coverage, Home-visit nursing care benefit, Dependent’s home-visit nursing care benefit
Present the Membership Card or Membership Card for a Dependent at the medical institution. < No procedures are required >
Copayment refund, Copayment refund for dependent
Note:

·When you had medical treatment without showing insurance card

·When you had medical treatment overseas

★Claim form for ”Copayment refund, Copayment refund for dependent”

< Visits using other insurances >
◇Receipts used to clear up another insurance
◇Statement of medical expenses issued by another insurance (copy)

< Visits paid by yourself >
★Certificate for Receipt of Medical Treatment Fees or
◇Statement of medical expenses
◇Receipt

< Visits outside of Japan >
★ Attending Physicians’ statement
★ Record of medical care overseas
★ Agreement of Authorization
◇Receipts
◇ Documents to certify your passage
Documents in foreign language requires a Japanese translation

< Creating Orthotics >
◇Written opinion of the doctor
◇Receipt (full statement)
For other causes of claim refer to ”Submit appropriate forms and documents as follows”.
< Need to apply >
Benefit for High-cost Medical Care When the Membership Card is presented at the hospital, no other procedures are required. You must apply in advance when you wish to reduce the copayment of High-cost Medical Care for hospitalization.
★Submit the “Claim form for Maximum Amount Application Certificate“.

★Submit the ”Claim form for medical treatment expenses” when a member or dependent paid in full.
< Need to apply >
Benefit for Combined High-cost Medical Care ◇“Claim form for Benefit for Combined High-cost Medical Care and Issuance of Copayment Certificate”
◇Copayment Certificate
< Need to apply >
Transportation expense benefit for member or dependent ★ “Claim form for Transportation expense benefit for member or dependent”
◇Transportation receipts
< Need to apply >
Maternity Benefit, Dependent Maternity Benefit “Claim form for Maternity Benefit” When the Direct Payment System after childbirth is used, no procedures are required.
< Need to apply >
Burial Benefit, Dependent Burial Benefit ★“Claim form for Burial Benefit”
◇Original copy of “Family Register” from which the name of the deceased has been removed, original copy of Death Certificate, or copy of Cremation Permit
  1. If a member without any dependents dies, attach the original receipt and full statement for the burial expense which is addressed to the claimant.
  2. The cause of death must be specified in detail

< Need to apply >

Leave benefits Sickness and Injury Allowance ★”Claim form for Sickness and Injury Allowance” Claim shall be filed on a monthly basis. Each claim of the month is accepted from the following month onwards.
< Need to apply >
Maternity Allowance ★”Claim form for Maternity Allowance” The Maternity Allowance is payable as one off payment (by claiming after 56 days of childbirth) or in two installments (one installment before birth and the other after childbirth)
< Need to apply >
Leave Allowance ★”Claim form for Leave Allowance” Written evidence of leave of absence from work is also required.
< Need to apply >
Disaster relief benefits Condolence Benefit, Dependent Condolence Benefit ★ ”Claim form for Member’s/Dependent’s Condolence Benefit”
◇Situation Report
Original copy of “Family Register” is required to prove that the claimer is a bereaved family.
< Need to apply >
Disaster Relief Benefit ◇“Claim form for Disaster Relief Benefit”
◇”Disaster Situation Report”
The disaster situation and damage must be described in detail in the “Disaster Situation Report”.
< Need to apply >

Supplementary benefits (in cash)
Type of benefit Documents required Note
Supplementary benefits Copayment refund for dependent No procedures are required when the benefit is to be paid together with dependent’s
Copayment refund or dependent’s home-visit nursing care benefit.
For health insurance covered medical treatment
By submitting the ”Claim form for medical treatment expenses”, you will be paid the supplementary benefit as well. For self-pay medical treatment
Dependent’s home-visit nursing care benefit No procedures are required.  
Inpatient care benefit No procedures are required.  
Dependent Inpatient care benefit  
Maternity Benefit By claiming statutory benefits, you will be paid this benefit as well.
No procedures are required in case of the Direct Payment System.
 
Dependent Maternity Benefit  
Sickness and Injury Benefit ★“Claim for Sickness and Injury Benefit” Available after the completion of statutory benefits payment.
Burial Benefit By claiming statutory benefits, you will be paid supplementary benefit as well.  
Dependent Burial Benefit
Condolence Benefit
Dependent Condolence Benefit
Disaster Relief Benefit When the damage is deemed small, the Supplementary Relief Money may only be paid.
Marriage Allowance “Claim form for Marriage Allowance”
◇Original copy of "Marriage Registration Acceptance Certificate", original copy of “Family Register” or original copy of “Extract of Family Register”
In case of absence of marriage registration in the registry office, these documents are required: original copy of a member’s “Family Register” and that of a spouse’s “Family Register”, or original copy of a member’s “Extract of Family Register” and that of a spouse’s “Extract of Family Register”,
and a member’s written pledge of marriage certified by the school authorities and document certify their marriage
< Need to apply >

Copayment refund (in cash)
Type of benefit Documents required Note
Copayment refund No procedures are required when the refund is paid together with Medical Treatment Benefit, Parallel Unisured Medical Coverage, or home-visit nursing care benefit. For health insurance covered medical treatment
By submitting the ”Claim form for medical treatment expenses”, you will be paid the refund as well. For self-pay medical treatment

Note: Forms and documents for submission may change. Contact the school office or PMAC for confirmation.