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Tuesday, Nov. 16, 2004

THE ZEIT GIST

Health care puzzles

In the second of a two-part series Tomoko Furukawa deals with more Japanese health insurance issues


Broad coverage?

The Japanese health insurance system is designed to cover you anywhere in Japan, though prices vary from region to region.

If you are on a business trip, your health insurance will also cover you overseas. If you are on holiday, it is advisable to take out travel insurance before you go. Some local authorities have been known to reimburse policyholders for medical expenses incurred overseas while traveling, though this is an entirely case-by-case system and should not be counted on.

Rejoining the system?

If you leave and then attempt to rejoin the the Japanese insurance system, you are obliged to pay up to two years worth of back premiums.

However, if you rejoin the system by paying two years of premiums, you can then claim compensation for medical expenses incurred up to 5 years previously.

Specialist treatment

If you receive permission from your NHI or EHI office, you can sometimes receive reimbursement for plaster casts, corsets, artificial eyes, acupuncture, massage and other specialist treatments.

Tax Deductions

If your medical bills for the year are over 100,000 yen, policyholders in the NHI and EHI schemes can claim a tax deduction on the amount of costs over this figure.

Workmen's Insurance

Injuries or illness suffered in or on the way to work are not covered under Japanese health insurance, but rather fall under the terms of Workmen's Accident Compensation Insurance.

Under Japanese law, all workers, regardless of status (full-time/part-time) and visa legitimacy are eligible for benefits should they be injured while working or commuting to work, or if they develop a work-related illness or injury.

However, foreign trainees on trainee visas are excepted. In their case, employers or organizations which brought the trainees over are obliged to have adequate support systems in place should a trainee suffer injury or illness.

Under Workmen's Insurance, compensation or treatment benefits will be paid if a worker undergoes treatment for an injury or disease.

If you must be absent from work for four or more days due to illness or injury, you are entitled to an allowance equivalent to 60 percent of your daily pay -- if you have dependents. If you have no dependents and need to be hospitalized, the subsidy is only 40 percent.

It is not your company, but the Labor Standards Inspection Office that decides if you are eligible for compensation.

However, the Labor Standards Law does not provide for compensation for injuries suffered while commuting to and from work.

If you are receiving a reduced income during your recuperation period which is less than the subsidy, you can apply at your local health insurance office for a subsidy to make up the difference.

In the case that a worker is disabled as a result of a work-related injury, a disability allowance will be paid, the amount of which depends on the degree of disability.

If you are injured or become sick in work, but your visa is due to expire before the period of treatment is up, you can continue to receive benefits even though you have left the country. For details on conditions and amounts, you should pay a visit to your local Labor Standard Supervision Office.

A company cannot fire a formerly ill or injured employee within 30 days of his or her returning to work.

Sick Leave

There is no set system of sick leave in Japan. Rather, individual work contracts and work regulations operated by companies may or not allow for sick leave, paid or otherwise.

It is possible that if you are sick for an extended period, usually stipulated in a contract or in work regulations, you will receive an allowance. It is also possible that you will lose your job if absent from work for a certain period.

Overseas students

Overseas students who join the National Health Insurance System are eligible for an 80 percent rebate on medical treatment covered under NHI. This is paid for by the Association for International Education, Japan.

Eye tests

Eye tests are covered under the EHI/NHI and are carried out in most hospitals. Glasses and contact lenses are not covered. National and Employee Health Insurance will cover the cost of artificial eyes upon consultation with a local health office.

Childbirth

In Japan, pregnancy is viewed as a voluntary condition. For this reason, childbirth is not covered under National or Employee Health Insurance.

However, this refers to only "normal," or essentially trouble-free deliveries. Caesarean sections and other "abnormal" procedures and complications in pregnancy or childbirth are covered.

While "normal childbirth is not covered, there is a lump sum of 300,000 yen paid after births, stillbirths and miscarriages of 85 days gestation to help with childbirth-related costs, such as midwifery or clinic expenses.

If the mother is the policy-holder, she can apply for the 300,000 yen or one-half her standard monthly income (whichever is more).

If the mother is taking a leave of absence from work and does not enjoy the benefits of paid maternity leave, she can apply for an EHI subsidy amounting to 60 percent of her standard daily pay for the period of absence. This subsidy covers a period from 42 days before the birth (98 days for multiple births) to 56 days after the birth.

Abortion for economic reasons is not covered under NHI and EHI.

Dental care

While there are several dental clinics catering for the foreign community in Japan, many are private and do not accept Employee or National Health Insurance.

Those facilities that do accept EHI or NHI offer a number of services under the scheme. Preventive check-ups are available, which include checks and treatment for cavities and decay. Since check-ups are free, those with insurance can visit their dentists to determine their needs before deciding whether they're willing or not to pay more for treatment.

Teeth cleaning is available, though it may be necessary to pay a small additional fee.

Some treatments are not covered by health insurance, though some types of cheaper fillings and treatments, such as bridging and rinsing are. Ceramic caps and gold fillings are usually not covered.

Orthodontic and cosmetic dentistry work (straightening of teeth etc.) are not covered under Japanese health insurance, though some reimbursement may be available for damage suffered in an accident -- though coverage for damage incurred while drunk or fighting may prove a tough sell.

In the case of accidents caused by a third-party, that person must pay, though there are exceptions if the third party is unable to pay.

Mental health

There are a number of valuable resources available in languages other than Japanese for those seeking counseling or support.

As well as the below, you should check your local city or town hall for information on support groups.

TOKYO ENGLISH LIFELINE Tel.: (03) 5774-0992 Web: www.telljp.com

JAPAN HELPLINE Tel.: (0570) 000-911 Web: www.jhelp.com

ALCOHOLICS ANONYMOUS (03)3971-1471 Web: www.aatokyo.org/

OVEREATERS ANONYMOUS Tel.: (03) 5605-9425 Web: www.oatokyo.org

Clarification

In last week's column, due to a technical error, we incorrectly stated the amount of costs that an EHI policyholder must pay.

The insurance payment system has recently been changed so that all policyholders and their dependents (excluding those under 3 and over 70) under both the National and Employee health Insurance Systems must pay 30 percent of medical costs.

Send your questions and views, good and bad, on the Japanese health system to community@japantimes.co.jp


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