Medical care for which health insurance can be used
Although health insurance can be applied to obtain most types of medical care, certain examinations and treatments are excluded. The treatment types for which "health insurance may be used" are called covered examinations and treatments. This section explains what types of medical care are covered and not covered by health insurance.

Health insurance can be applied to most kinds of medical care obtained.

[Medical care covered by insurance]
Types of medical care Details
1. Examinations Insurance can be used for examinations related to treatment of most non-workplace illnesses and injuries.
* For illnesses and injuries occurring in the workplace or while commuting, the first source of funding in most cases will be the Workers' Accident Compensation Insurance. Promptly submit notice of such illnesses or injuries to your employer (the company).
2. Pharmaceuticals or medical supplies Insurance covers pharmaceuticals (including oral medicines and shots) and medical supplies (such as bandages). In addition, if required for treatment, items such as crutches, hearing aids, and prosthetic arms and legs can be rented using health insurance.
Insurance applies only to pharmaceuticals covered by "the drug price standard" issued by the Ministry of Health, Labour and Welfare.
3. Treatment, surgery, etc. Insurance can be used for required medical treatments, surgery, etc.
However, insurance cannot be used for experimental treatments and special treatments not approved by the Japanese Association of Medical Sciences.
4. Hospitalization, healthcare Insurance can be used for hospitalization and related healthcare as deemed necessary by a physician. However, insurance can be used only to pay for general hospital rooms, not for special rooms (such as private rooms)(See below).
In addition,
the cost of meals while hospitalized must be borne by the insured at fixed standard prices.
5. Nursing for home healthcare Insurance can be used for the cost of nurses dispatched to a home from a "home-visit nursing station". However, insurance does not cover expenses such as transportation costs to the home.
* Individuals approved for long-term care insurance should generally seek coverage under long-term care insurance for such costs.

Note: To use special rooms (such as private rooms) during hospitalization, the individual hospitalized must himself or herself pay the difference between the cost of the special room and the cost of an ordinary room.

When undergoing medical care not covered by insurance (1 to 8 below), the patient must pay all related costs, including the amounts approved for insurance.

[Medical care not covered by insurance]
1. Examination or treatment related to conditions such as simple overwork or fatigue 2. Cosmetic surgery 3. Congenital disorders that do not obstruct bodily functions 4. Advanced experimental medical care
(see notes below)
Conditions such as simple overwork or fatigue Cosmetic surgery Congenital disorders that do not obstruct bodily functions Advanced experimental medical care
5. Vaccination 6. Normal delivery 7. Abortions 8. Physical checkups
Vaccination Normal delivery Abortions Physical checkups

Note: When receiving treatment as designated by the Minister of Health, Labour and Welfare at a medical institution approved by the governor (i.e., a specified and approved insurance medical care facility), surgery costs for advanced treatment only must be borne by the patient, with room charges and costs for ordinary treatment covered by health insurance (as specified medical care expenses). However, when receiving such treatment at an ordinary medical institution not designated as a specified and approved insurance medical care facility, the patient must pay the entire amount of related costs.

Questions & Answers
What types of dental examinations and treatment are not covered by insurance?

Dental care is divided into two categories: "covered examinations and treatment" and "non-covered (optional) examinations and treatment." The insured individual can select from one of the two treatment types "when selecting materials for filling a tooth or for replacing a pulled tooth."

However, insurance can be applied to treatment for front teeth involving cast crown restoration crafted using precious metals if the patient pays for differences in material costs. Although such coverage is generally authorized, be sure to consult with your dentist in advance.
* The difference in prices borne by the patient is the difference between "the cost of the precious metals purchased by the dentist" and "the cost of materials covered by health insurance."

Explanation of terminology

Cost of meals while hospitalized (standard amount)

Ordinary persons 780 yen*
Low-income individuals
(Households exempted from residence tax)
Hospitalization for 90 days or less 650 yen
Hospitalization for more than 90 days 500 yen
Members of households exempted from residence tax and eligible for old-age pension benefits 300 yen

* Any special meal or other services provided at the patient's request must be paid for by the individual himself or herself.
* Special cost-reduction measures may apply under extraordinary cases. Please contact Sony Health Insurance for detailed information, since "approval of a Health Insurance Authorization for Reductions in Standard Amounts form" is required for reduction of meal expenses.

Cost of meals while hospitalized

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