Friday, October 07, 2011

Health Insurance Guide #4: Optional Insurance

Today's topic is optional health insurance, which covers hospital fees and doctor fees that are not covered by your regular insurance.

The Basics
Supplemental insurance is usually known as "medical treatment insurance" (医療保険 iryo hoken) and is sold by numerous different agencies including Japan Post, Aflac, Metlife, and so on.

Unlike the one-size-fits-all insurance schemes, supplemental insurance comes in a variety of flavors. Since most doctors visits will only drain you of a bit of pocket money, optional insurance is usually aimed at prolonged hospitalization (入院 nyuin), cancer treatments (がん gan), surgery (手術 shujutsu), or "advanced medical treatment" (先進医療 senshin iryo)--which is usually defined as cutting edge recently approved treatment methods that might not be fully covered by the public insurance system.

Most companies divide their insurance products into two main categories which include the aforementioned treatment insurance, and cancer insurance (がん保険 gan hoken). Many companies offer a comprehensive package that covers both cancer and medical treatment with various yearly and monthly payout limits.

When shopping for cancer insurance, make sure you look at the fine print. Many companies have multi-tiered plans and lower cost options often do not include treatments for certain types of common and/or invasive cancers. One of the big restrictions is for cancers of the digestional tract (消化器がん shoka-ki gan) due to the fact that there is significantly high occurrence of this form of cancer in the Japanese population. If you want "full coverage" you will have to pay a higher monthly rate.

Furthermore, there are two basic types of coverage: fixed term (定期 teiki) and life-time (終身 shushin). Fixed term is set for a given time (usually measured in years) and life-time, as the name implies, is good until you kick the bucket. Many life-time plans include survivor benefits in the result that you die of medical complications or non-natural factors over the course of treatment

Eligibility and Shopping Around
Since medical treatment insurance is a private concern, companies reserve the right to turn down your application based on factors such as health problems and having an overly hazardous line of work. Many companies do not require a doctors exam before signing up, although this can vary based on age and other factors. In addition, insurers reserve the right to request a check-up and any necessary information from your doctor if they have any doubts about your insurability. Pre-existing conditions generally are not covered by optional insurance.

Luckily, due to Japan's bountiful supply of medical insurance providers, you can shop around for plans of all shapes and sizes. Many insurers have monthly premium calculators on their website and major shopping sites like Kakaku and Yahoo Japan have insurance comparison websites where you can look at a variety of quotes all at once.

Cost and Reimbursement
Cost for optional insurance is almost entirely based on age. Therefore, a healthy 20 or 30 year old can get insurance for as little as 1000-something yen a month while an individual in their 50s or 60s can expect to pay double or triple the price depending on the benefits offered.

Once you start paying for your plan (usually in monthly or yearly installments), your insurance company will send you an insurance certificate (保険証券 hoken shoken).

Your insurance will not kick in until after your first payment. Payouts are generally made in the form of reimbursements where in you send the insurance company your receipts and paperwork and, after an employee reviews your eligibility, the company will transfer you the money to either your bank account or the account of your medical provider. Make sure to check with your provider about what sort of forms are required before you submit a claim.

Some hospitals may allow you to defer out of pocket payments for treatment so long as you designate the hospital as the recipient of the insurance money. However, this is by no means universal so make sure you check with your medical provider. The hospital or doctor may require proof that you are current on your insurance payments and that your plan covers your treatment.

If you plan on getting your own plan and you don't know much Japanese, it is advisable to bring along someone who does, as most forms are not available in English.

Pop by again next Friday for our feature on the moral and monetary quandary of enrolling in Japanese Health Insurance.

Other posts in this series

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