Types of health insurance benefits
Health insurance provides benefits for medical treatment (health insurance benefits hereinafter) as well as benefits for reducing the financial burden on the insured in the event of lengthy periods of time off for childbirth, illness, or injury, and for deaths.

Let's examine the major benefit categories.

The various types of benefits provided by a health insurance system (health insurance benefits) can be broken down into two major categories: "benefits in kind" and "cash benefits." These can be further subdivided into "statutory benefits" and "additional benefits." "Benefits in kind" refer to cases in which the insured or a dependent obtains medical examinations or treatment by presenting his or her health insurance card. In such cases, the payment in kind is made "in the form of medical care" provided to the patient.

  Benefits in kind Benefits in cash
Definition Receiving "payment in kind in the form of medical care" such as examination, treatment, medicine, or medical materials by or from a physician (or hospital). In other words, "receiving medical services." "Receiving cash assistance benefits" from Sony Health Insurance when payment of medical services in kind is inadequate.
Procedures for receiving benefits Not required
(In general, present just your health insurance card)
Required
(Benefits may not be provided unless you complete these procedures on your own)
  Statutory benefits Additional benefits
Definition This refers to benefits for which standard amounts paid, requirements, and other matters are stipulated in the Health Insurance Law. This refers to additional benefits provided by the Sony Health Insurance Society in addition to the statutory amounts.
Procedures for receiving benefits Certain procedures are required while others are elective
(Refer to the page covering each benefit for detailed information.)


Further categorization of all benefits

Content of benefits Statutory
benefits
Additional benefits
(Benefits in cash)
Procedures for receiving benefits
Benefits in kind Benefits available when undergoing examinations or treatment using your health insurance card Medical care benefits
Dependent medical expenses
Home-visit nursing care expenses
Dependent home-visit nursing care expenses
Copayment reimbursement
Dependent medical costs additional sum
Home-visit nursing care expenses additional sum
Dependent home-visit nursing care expenses additional sum
Not required
Benefits for reducing the amount of copayments High-cost medical care expenses (for the insured)
High-cost medical care expenses (for dependent)
Total high-cost medical care
Inpatient meal expenses
Copayment reimbursements
Dependent medical costs additional sum
Total high-cost medical care additional sum
---
Benefits in cash Benefits available after undergoing examinations or treatment without using health insurance card Medical costs
Secondary dependent medical costs
Copayment reimbursements
Dependent medical costs additional sum
Required
* These benefits are limited to cases approved by the Sony Health Insurance Society
Benefits for reducing the amount of copayments Transportation costs
Dependent transportation cost
Funeral expenses
Dependent funeral expenses
Childbirth and childcare lump-sum grant
Dependent childbirth and childcare lump-sum grant
Childbirth allowance
Injury and sickness allowance
---
---
---
Funeral expenses (costs) additional sum
Dependent funeral expenses additional sum
Childbirth and childcare additional sum
Dependent childbirth and childcare additional sum
Childbirth allowance additional sum
Injury and sickness allowance additional sum
/Extended injury and sickness allowance additional sum
Required

* The prescription period during which you can execute the right to demand benefits is two years. (The right to demand payment is lost thereafter)



Receiving benefits

When you use your health insurance card at a hospital, you will be directly charged for only part of the medical costs you incur (this portion of the total expense is called the copayment). This system can be used at all hospitals stipulated in the Health Insurance Law. In such cases, Sony Health Insurance pays the remaining costs to the hospital as insurance benefits. The source of these funds is the health insurance premiums paid by insured individuals and the employer.

Illustration Health insurance benefit system

Illustration: Health insurance benefit system


Copyright 2003 Sony Health Insurance Society All Rights Reserved.