Foreign travel now to be covered by NHI !! (Copied from the Nakano ward English newsletter 2001 Feb. edition):

Changes in the Medical Health Insurance System

As of January 1 of this year, a portion of the medical health insurance system was changed in terms of adjusting the personally-borne cost according to income. The main revisions are as follows:

National Health Insurance

1. Revision in the Personally-Borne Cost Ceiling for the High Medical Expense Subsidy
a. Ceilings were established for three categories -- "low income," "general" and "high income," respectively.
b. For those in the "general" and "high income" categories, if medical expenses exceed the designated ceiling, 1% of the difference is considered a personally-borne expense.

2. National Health Insurance can now be used for medical expenses incurred during overseas travel.

3. The cost of meals during hospitalization will be adjusted to -780 per day.

* There are restrictions, required documents and application forms in order to take advantage of Revisions 1 and 2. Please call for more information.

I got an answer to my question about getting the forms you need to bring with you when travelling so you can file claims with your Japanese National Health Insurance upon returning to Japan.

Depending on which country you were in you may be reimbursed almost in full, but the general feeling among us travelers is that visits to the Emergency Room in the USA will probably be compensated at a fairly low percentage. I have no actual proof or data on this though. I just know that one woman's endometriosis operation in the UK was paid for almost 100% by Japanese National Health Insurance.

There are three documents for downloading and printing on the following URL:

http://www.kokuho.or.jp/intra/html/kokuho/kaigai/honyaku.htm

You only need the 2nd and 3rd one.

Hope this helps someone!

I'd like to point out that Japanese health insurance is not that cheap. "Kokumin kenkoo hoken", though it covers 70% of the cost, the 30% co-payment still leaves about 10,000 yen per day for you to pay in the cheapest hospitals, never less. And a lot more in private hospitals. So a private insurance as a supplement to the Kokumin can really help.

Most of us don't figure this out until it is too late.

Tests can also be quite expensive even at only 30% of their total cost.

Hi,

Can therapy sessions with a clinical psychologist (whose referred to by the doctor)be covered by the Japanese Health insurance. What if the clinical psychologist is in private practice, how will the costs be reimbursed?

Any info appreciated

Rachel

Hi Rachel,

I think that it depends on the place that you visit, same as with doctor's offices here. Check it out with the office you plan to visit beforehand. According to the Japan Health Handbook:

"Japanese public insurance allows only for brief assessments of short-term outpatient pyschotherapy....If you need longer therapy, you'll usually be hospitalized or referred to a private counsellor.... Costs vary and not all services are covered by public or even private insurance."

The JHH also gives listings of quite a few English-speaking counsellors. It's a great resource book to have.

Hope this helps!

Karen

I just got a windfall payment for work completed in July last year, so thought I'd clear up some bills hanging over my head. I went to pay January, February and March of my NHI premiums and I had to fill out an extra form (apparently just a superficial formality) because I had missed the end of the fiscal year (31 March).

Having been here a long time I'm used to these small formalities. I want to mention that all things considered, the system is quite gentle. Since becoming a mother and for the first time in my life having to resort to financially irresponsible techniques, at least NHI doesn't cancel the policy when I miss the premium deadlines by several months! In fact, there aren't even any late fees. Of course my NHI is set up directly through me, not through my employer. If I had only one employer then the premiums would most likely be coming out of my pay envelope, and I couldn't use this gambit to make ends meet in the short term.

Dear Rach,
I only know one (Japanese) person who has sought counseling and medication (for depression), so I asked him how it was paid for. I'm afraid the answer was very non-specific (maybe there was an implication that the coverage is very limited?). I think it's a good question. It seems to me that particularly in the medical area of counseling, communication is essential, so most people will search out therapists, psychologists and psychiatrists who may be from the same cultural background and speak the same language. That might mean professionals who are not part of the NHI system. I would also really like more information on this subject.

Are there fluent English speaking professionals with cultural fluence as well, available under NHI auspices?

Hi,

My wife and I are three months pregnant and plan to move to Tokyo next month. We are considering applying for the NHI but want to make sure that we have the ability to utilize any hospital and the doctor of our choice. Are women who have NHI restricted in the prenatal services that they can receive?

Mark,
NHI does not "cover" pregnancy, which is considered a natural state for a woman as opposed to a state of "illness". HOWEVER, there is a present after a birth or miscarriage after (6?) months of about Y300,000 for those who are enrolled in NHI. So it is basically covered up to Y300,000. Also, NHI does not disallow "pre-existing" conditions. One or two pre-natal visits are covered with the coupons in the "boshi-techo" which you apply for after you have been confirmed pregnant, at your local city hall. See the related article on this subject at:

http://www.tokyowithkids.com/fyi/boshi_techo.html

I'm not sure precisely what this means. From what I've understood so far of the Japanese courts is that even when one decision is made in one court, other courts are not necessarily held to that decision since "each case is different". But for what it's worth, I'm copying it down here. Maybe this Supreme Court decision will result in policy changes on the administrative levels of many local governments.

The reason I've become interested in this topic is that I found out that embassy workers are often have trouble getting NHI because they are not on "normal" working visas but on special visas issued to diplomatic personnel.

Court: Overstaying foreigners can join national insurance

Thursday, January 15, 2004
TOKYO EThe Supreme Court ruled Thursday that it was illegal for the state and local authorities to bar all foreigners without valid residency status from the national health insurance program.

The court ruled it was illegal to deny Li Hsueh-shan, 51, who has lived in Japan since 1971, the right to join the insurance scheme. Li, a South Korean-born overseas Chinese, had appealed to the court after his compensation demand against the state and the Yokohama city government was rejected by lower courts. (Kyodo News)

Has any one successfully collected a reimbursement, even at a small percentage of the total, from NHI for health costs incurred overseas? I submitted the documents for some bills in the USA many months ago and have yet to hear back. Karen, didn't you also try this?

By the way, when I went to submit my claim at the ward office they also needed to see (and photocopy) my passport with the proof of dates of travel, and I had to provide my bank account information for the payment to be transferred to... eventually.

And of course I had to get all the significant info translated into Japanese. More trouble than it was worth I am suspecting.

Cornelia, this topic came up with a friend of mine today - foreigner (married to a Japanese doctor) who had some medical expenses back in Europe she wanted to claim, but she was told you can't claim anything back directly on overseas medical bills. What you can do, however, is offset the expenses against Japanese tax - when you're doing your annual tax return, there is a section somewhere for "uninsured medical expenses" and you can put both overseas and Japanese ones under this section. I'm not sure of the details, but I expect someone out there knows....

I have Japanese national health insurance and racked up a hefty medical bill (over $2000) while visiting Canada in October 2002. I applied for a reimbursement by having the Canadian doctor fill out these forms, which Cornelia so helpfully posted before:
http://www.kokuho.or.jp/intra/html/kokuho/kaigai/honyaku.htm
Everything then had to be translated.

There were several to and fros in communication. The tiniest of details put everything on hold. I persevered and kept on submitting the required information (although I didn't need to show my passport and didn't apply at the ward office; I did everything by telephone and mail). Months later I got my reimbursement: a whopping 12,000 yen!!! Hardly worth the time and energy I put into it, but oh well. It bought groceries for the week and that's worth something!

What I've learned from this experience is to always travel with a copy of those forms. Have the doctor fill it out immediately and in full. That will save a lot of hassle later on.

Good luck! I wish that I had a better outcome that I could report; I sure tried hard.

As Bethan mentioned, I also claimed the medical expenses in full on my tax. Any medical expense over 100,000 yen per family is deductible. I've mentioned this elsewhere, but I'll repeat that even transportation and supplies count towards this medical bill. Save your taxi receipts, your train fare totals, your receipts for bandaids and gauze, etc. It can all be counted. (Pregnant women can also count these expenses (train fare for every visit to the midwife or doctor) and exam and delivery fees.)

I'd be interested to hear about other people's experiences in claiming reimbursements on national health insurance for expenses incurred outside the country.

To basically echo Karen's experience, I finally got a reimbursement on my $1140 (USD) claim in December. They did not send me any sort of notice and the deposit straight into my bank account had a katakana explanation next to it which I could not decipher. So it took me a while to notice that they had processed my claim!
Anyway, the total reimbursement after all that trouble was Y11,550. Less than $100 USD at the prevailing exchange rate when the expenses were incurred (summer 2002).

So I think that it is practically a farce for the effort involved. But ofcourse a week's grocery money is something.

Does anyone know if a child can get NHI if the parents are not on it or does the whole family have to register?

"National Health Insurance coverage of children varies by Ward in Tokyo"
Above sentence is actually a bit inaccurate. What really happens is that some local governments provide health coverage in addition to the NHI coverage provided by the State.

For example, all of Tokyo's 23 wards cover children up to first grade (1 April following their 6th birthday) at a 100% (it used to be up to age 3). However, Kita-ku covers kids up to first grade 100% AND covers kids up to the end of Junior High School 100% in the case of hospital admissions (approximately age 15). And Minato-ku covers kids 100% for everything up to the end of Junior High School. And Taito-ku is planning on starting the same benefit starting 2005 April 1 as already in place in Minato-ku. The reasoning is apparently to attract families with children to move in or to encourage families to have more children.

So if you are participating in NHI, and trying to decide on where to live, you might choose a ward according to higher child health coverage benefits. It's very hard for me to track these developments since I am functionally illiterate in Japanese. I live in Bunkyo-ku which had considered a similar measure for this year but nixed it. They might be considering it again next year, but I'm not holding my breath because they have been working so consistently to reduce the public daycare facilities over the last 8 years, behavior which ultimately points to severe financial stress (or mis-management).

Setagaya-ku is popular with ex-pats (many of whom have private health insurance anyway) but they only cover kids 100% until the April following the 6th birthday like all 23 wards inside Tokyo. Outside the 23 wards (nijusan ku igai) there is a variety of supplemental benefit, generally low, for example, 100% for only the first 12 months, or just the usual co-payment and then you can reclaim it depending on income, etc. up to 100% to a higher age. There are some small villages in Japan that cover 100% up to age 18 (often where child population is very low and they want to keep families from moving out).

For those of you who don't know, NHI requires a co-payment due at every visit to a doctor of about 30%, and nation-wide 20% for kids under 3 years old. Unless the local government steps in and bolsters this. IF there are any inaccuracies in what I have written, please don't hesitate to add your knowledge to this thread. I don't claim that I can do 100% accurate research on this. The interesting thing here, is that lower governments are competing for a dwindling resource, PEOPLE, through their welfare policies.

There are two ways of getting NHI. One is through your employer (kenko hoken). The second way (for example "self-employed) is kokumin hoken. There are slightly different rules in co-payment percentages depending on which type of NHI participation the insurance holder has. (Actually there is a third way, as a government employee, called kyousai hoken, but with very rare exceptions, foreigners are not allowed to be employed by the government, so I don't even ask about this).

As for Sue Slater's question above, the notion of a child with parents needing coverage on it's own doesn't seem to make sense to anypone when I ask. If the child is an orphan or abandoned, then it would be covered under various welfare funds as a "survivor" and get full NHI coverage. I haven't been able to get anyone to even understand the question! I'd be very curious, Sue, if you found anything out from another quarter!

By Cornelia on Friday, January 28, 2005 - 11:16 am:
Regarding my post above, I got a friend to double check my info. And it seems that the new coverages going into effect 1 April 2005 in some wards are as follows below and Tito-ku is the leader of the pack!
Minato-ku to the end of elementary school - hospitalization only 100%
Kita-ku to the end of junior high school - hospitalization only 100%
Shinagawa-ku to the end of elementary school - outpatient and hospitalization 100%
Tito-ku to the end of junior high school - outpatient and hospitalization 100%

I need to run a couple of medical tests. Is there any resource to look up
which lists tests covered by insurance and how much they cost me. The trouble is each time I go to the doctor the receptionist is vague(gives a different answer each time) about the cost. Once she told me a test is not covered by insurance and I have to pay full, but then I told her that my friend had it done and she paid only copay then she agreed.
Next time I would like to be prepared before I go.
Thanks for any ideas.

Supplement to my post of January 13, 2005 above. As of 2006 April 1 (this year) I heard:

"Shibuya-ku started new help to the children from April. Medical bill is covered under 6 years children by the same way. And 6-15years children's bill is coverd after payed once."

Meaning that Shibuya-ku is now also supplementing NHI coverage for kids.

Hi All,

I have joined my husband few months back here in Japan on dependent Visa, my husband's organisation has covered us under global insurance however the reimbursement process is quite tedious. So we thought of opting for NHI, however were in for a suprise!!

We were told that since my husband has been staying here for almost 1.5 yrs he will have to pay the premium for that period as well and the amount sums up to quite a lot :-( we told then at the city ward office that since we already had a global insurance we would like to opt for NHI now but were told its not possible if we do not pay the premium for his stay here previously :-((

Can anyone give an insight on this please, if u enroll for NHI do u have to pay form the day u enter japan ( i.e considered the day u become eligible for it!!) or from the day u actually apply/enrol in NHI.

Your views would be appreciated
Thanks & Regards

I've been hearing this particular scenario recently from a couple of times. It did not used to be this way. I can't actually comment on this properly since I have been on NHI all along since I got my first working visa in Japan (a bit over 10 years ago). Back then people were always trying to figure out how to get out of NHI after they had already been in it for a while. The thing was, once you were in, it was very hard to get out. But you could always join. However, in the last couple of years, I've been hearing these stories about people being told that they will have to back-pay premiums.

I wonder if they are actively trying to discourage people from switching to NHI?

VB-
As with most pronouncements from government offices, you don't have a lot of options for challenging. Quoting someone else's experience has no meaning for them in your particular case. Their request has a sort of logic to it.

I'm wondering if you really compared the benefits provided by NHI vs your global carrier. I would think the latter covers more - even if the reimbursement is tedious. I would think the global carrier also gives you many more options for treatment. Most ex-pats feel that if something really serious comes up, they head back to home country. If you have that experience, NHI will not follow you out of Japan, but global one probably would.

Also, consider that if you'll be moving out of Japan in a few years, you'll have to go through the process of reestablishing with the global carrier.

Cornelia- I wouldn't be surprised if they are discouraging people. They are under a lot of funding pressure.

Thanks Cornelia & Scott...

Scott- I guess you are right, the benefits provided by the global insurance is definitely better hence makes sense to continue with it. Just need to figure out a way to make the reimbursement process more smoother which is no big hassle...

Just wanted to let u know that i have recently joined this forum and have found it very informative & helfpul as well. Gr8 site :-) thanks to all of U'll :-))

The English pages regarding Japanese NHI were updated September 2007 (still not very complete though):
http://www.sia.go.jp/e/
The Social Insurance Agency actually includes the pension system (as well as seafarer's system, etc.)