For individuals receiving medical care at public expense
For certain medical conditions and for individuals meeting certain conditions (infants, single parents, etc.), the national or local government may assist in patient cost-sharing (copayments). This is referred to as "public expenditure." Individuals receiving such assistance must apply to Sony Health Insurance.


Making a declaration to Sony Health Insurance if you do not pay at the hospital

Healthcare provided through public expenditure generally includes the following care categories. Individuals who do not need to pay at the hospital due to such assistance must declare such to Sony Health Insurance. If no declaration is submitted, Sony Health Insurance will be unaware that public expenditures were used and will automatically send benefit payments, resulting in receipt of duplicate benefits, from "the government" and from "Sony Health Insurance."

If they occur, by law such duplicate payments must be returned. To avoid this inconvenience, be sure to request cancellation of insurance benefits in such cases.

PDF: Illustration: Primary cases of public expenditure health care assistance



If you become ineligible for receipt of public assistance

Individuals who become ineligible for receipt of public assistance are advised to submit an "Application [for Resumption] of Insurance Benefits Payments" to Sony Health Insurance to have benefit payments restored.
Even if you pay at the hospital, you will not receive insurance benefits if you fail to submit this application.

When you must pay medical costs in the following situations, you can receive benefits by taking the required procedures at the appropriate office of your local government and "requesting reimbursement" or by submitting a "Request for Payment of Benefits to Sony Health Insurance."

Cases in which you can request payment of health insurance benefits via a Request for Payment of Benefits
The care received was provided outside your prefecture and therefore ineligible for public assistance.
  When you forgot to bring the certification necessary for public assistance (medical certificate, etc.) to the medical institution and therefore were not eligible for public assistance.
  Public assistance was no longer available because you moved.
  You made payments yourself because you had not yet submitted a request to have benefits restored.

List of forms related to public assistance
What to do in certain cases Documents to be submitted Remarks
If you receive (or become eligible to receive) public assistance for medical costs

"Application for Suspension of Insurance Benefits Payments"

Submit this promptly to avoid duplicate payments.
If you change the status of a family member formerly receiving public assistance to a dependent

"Application for Suspension of Insurance Benefits Payments"

When submitting a "Dependent (Change) Notice," submit this as well.
If the public assistance system or details have changed due to a move

"Application for Suspension of Insurance Benefits Payments"

Be sure to submit notice, since the contents of the application will likely change as well.
When you become ineligible for receipt of public assistance due to a move or age restrictions

"Application for Resumption of Insurance Benefits Payments"

Sony Health Insurance benefits previously suspended will be restored.

* Submit notices promptly via the individual in charge of health insurance matters at your workplace.


Copyright 2003 Sony Health Insurance Society All Rights Reserved.