Claims for Overseas Medical Expenses for Those Enrolled in the Saitama City National Health Insurance (NHI) System

What documents do you need?

 1.    Application form for claim for payment of medical treatment expenses (available at the counters at ward offices and city hall).
 2.    Attending physician’s statement (to be completed and signed by doctor/practitioner).
 3.    Itemized receipt (to be obtained from the doctor/practitioner).
 4.    Receipt.
 5.    Any document (attending physician’s statement, itemized receipt, or receipt) that is in a language other than Japanese must be accompanied by Japanese translation (translator’s name and address must be attached).
 6.    Applicant’s passport (staff member will make a copy of the cover page, identification page, and arrival/departure page).
 7.    National Health Insurance card.
 8.    The head of the household’s seal (hanko) is required as he or she is responsible to fill out the application form and make the claim on behalf of the applicant (self-inking stamp seals are not accepted). For foreigners who do not have a seal, signature is also accepted.
 9.    A copy of the head of household’s bank account details including the name of the bank, branch, and account number.

Application Deadline

Applications to make a claim must be lodged within 2 years of the payment date of the medical expenses.

What Is Covered?

National Health Insurance benefits for medical treatments received overseas are the same of that covered inside Japan. However, there are exceptions such as the following:

 ·   Amenity beds that are not covered by the National Health Insurance policy.
 ·   Cosmetic surgery
 ·   Expensive dental materials and orthodontics.
 ·   When the applicant travels abroad for the purpose of receiving medical treatments.
 ·   Natural childbirth (*applicant may be eligible to apply for the one-time delivery and nursing allowance)
 ·   Illness or injuries from traffic accidents, fights, or such that involve illegal conduct, or that of third parties.

Important Points

 1.   In the case where the treatment spans over several months, a separate attending physician’s statement and itemized receipt are required for each month.
 2.   In the case where the applicant receives treatments as an inpatient and outpatient in the same month, a separate attending physician’s statement and itemized receipt are required for each occasion.
 3.   Applicants are responsible for covering all costs for the translation of documents.

Claim Outcome and Notification

 ·   The authorities will run a check on the documents submitted and decide whether a payment for the claim will be made out.
 ·   Payments for claims are generally made out at the end of the third month from the month you lodge the application.
 ·   In the case where the information on the documents are false or insufficient, payments for claims may be denied or delayed.
 ·   In the case where the information on the attending physician’s statement or the itemized receipt provided by the medical institute is missing or insufficient, your application will be regarded as document insufficiency.
 ·   In the case where your application for claim is denied, you may reorganize your documents and ensure that all the information provided is correct, and apply again.

How Much Is Covered?

The amount to be reimbursed for overseas medical expenses is calculated based on the standard fee (standard amount) for the same treatment set by medical institutions registered with the National Health Insurance system in Japan, minus the personally borne amount.

 ·   The amount of reimbursement to be paid will vary depending on the foreign currency exchange rate on the date of payment.

An example of coverage for overseas medical expenses: 

 ·   After reviewing the documents, a reimbursement of the medical expenses will be calculated based on the cost of medical expenses for the same treatment done in Japan.
 ·   This is an example for persons who are eligible for the NHI 30% personally borne percentage benefit program.
 ·   Specifically, if the amount of overseas medical expenses paid is more than the standard amount, the reimbursement amount will be the total of the standard amount less the personally borne amount. Or, if the amount of overseas medical expenses paid is less than the standard amount, the reimbursement amount will the total of the actual amount paid less than personally borne amount.