Friday, September 16, 2011

Health Insurance Guide #1: The Fundamentals 2/2

Welcome back to part 2 of AccessJ's Japanese health insurance super guide. In this section, we will continue discussing the fundamentals of the insurance system including how to pay, co-payments, and third party damages. 

Read on...

Premium/Tax Payment
There are several options available for paying your health insurance premiums (in the case of EHI) or tax (in the case of NHI). The options are as follows:
  • Deducted directly from your monthly salary (EHI only)
  • Pay at an institution (convenience store, post office, etc) in a series of 6-10 installments (NHI only)
  • Pay via automatic bank transfer (NHI only)
EHI premiums are split between you and your employer wherein you pay in the form of a monthly fixed premium deducted from your paycheck before taxes. However, if you are on the NHI program, your payments are classified as a taxThis is an important distinction because you are obligated to pay the tax on your own without your employer to deduct it from your pre-tax earnings. If you opt to skip out the tax for whatever reason city/prefectural government you can go to court and ask for a draft or lien on your bank account.  

In the coming installments we will discuss the details of how premiums are calculated.

Although you pay regularly for your insurance, you are in most cases required to bare some additional costs when visiting the doctor. The magic number to remember for most people is 30%, since that represents the portion of the costs you must shoulder yourself for NHI and EHI. There are deductions and discounts available to the elderly, disabled, and for infants which we will cover later. 

While 30% may seem like a lot, medical treatment prices in Japan are heavily cost controlled and even at full price, most procedures are only a fraction of the price found in the USA. Amounts are subject to change annually as the doctors union haggles with the government over proper pricing. Doctors and hospitals in Japan charge based on a point system (保険点数 hoken tensu) assigned to each treatment, medication, and procedure. Clinics also add extra points for things like a first time visiting fee (which gets reduced if you continue to see the same doctor) and points for writing prescriptions. 

Third Party Damages and Coverage

There are limits to "third party damages" (i.e. stuff caused by the actions of others or circumstances out of your control) when applied to public and private health insurance. For instance, if you are in a traffic accident accident and need medical attention afterwards then you must submit a proof of accident form and/or any settlement papers regarding said accident to your insurance institution. Failure to do so will result in non-payment of your doctor's bill.

The All-Japan Health Insurance Association (全国健康保険協会 zenkoku kenko hoken kyokai) lists the following as grounds for "adjustments" to your benefits:
  • Malicious criminal acts and incidents
  • Injury resulting from fights, intoxication, and/or "significant misconduct"
  • Conditions resulting from failure to follow your doctor's instructions or follow the diagnosis of your health care provider without proper cause
  • Receiving or attempting to receive insurance payments via fraud or other improper means (i.e. "borrowing" a friends insurance card for a visit to the clinic)
  • Failure to comply with document submission requests and/or inquiries made by the insurer
  • When receiving benefits from local or national institutions as prescribed by the Infectious Disease Prevention Act and other related laws.
So, long story short, if alcochol tends to give you a bad case of angry fists or you don't take those pills your doctor gave you then be prepared to pay out of your own wallet for treatment. 

Well, that about covers the basics of health insurance in Japan. Tune in to our next installment where we'll cover the system in more detail.

Other posts in this series

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