Presentation on theme: "Summarized below is essential health insurance information for members of the FR Health Insurance Organization. See the FR Health Insurance Organization’s."— Presentation transcript:
Summarized below is essential health insurance information for members of the FR Health Insurance Organization. See the FR Health Insurance Organization’s website for more information. Overview of the Health Insurance Organization ●What is health insurance? Sickness, injury, childbirth, and death can impose significant economic burdens on our lives. To help individuals prepare for and cope with such events, health insurance systems allow the employer and individual employees to share the cost of insurance premiums so that employees can receive benefits when they need them. ＊ The FR Health Insurance Organization … The FR Health Insurance Organization manages health insurance for individuals working in the Fast Retailing Group. In general, it provides insurance benefits to reduce the burden of medical costs; temporary disability benefits when a member takes time off from work due to sickness or injury; and healthcare activities to help promote and maintain good health. ●The FR Health Insurance funding and costs ●Eligibility at the FR Health Insurance Organization. ～ Insured persons ～ Employees of the Fast Retailing Group who meet certain conditions can become insured persons under the FR Health Insurance Organization, with the right to receive insurance benefits and the obligation to pay insurance premiums. Insured persons covered by National Health Insurance, dependents covered under the health insurance system to which a family member belongs, and voluntary continuous insured persons enrolled in other health insurance programs before joining the FR Health Insurance Organization must complete procedures to withdraw from such insurance programs. ＊ Funding ＊ Costs of activity management Premiums paid by the employer and insured persons (84 yen per 1000 yen of salary and bonuses) Insurance benefits (benefits for medical costs, childbirth, death, etc.) Health activities expenses (e.g., subsidies for health checkups, health consultation, WELBOX, etc.) Payments to the national government (e.g., support payments to the medical care system for the advanced elderly, aged 75 or older) http://http://www.fr-kenpo.or.jp/eng/member/01_info/107.html HOME ＞ Introduction ＞ Table of Monthly insurance premiums Guide to health insurance http://http://www.fr-kenpo.or.jp/eng/index.html Updated on March 1st., 2013
Eligibility at the FR Health Insurance Organization 〜 Dependent persons 〜 ● Eligibility at the FR Health Insurance Organization as dependent persons Your family members can also enroll under FR insurance as dependents (dependent family members) if they meet certain conditions and have been authorized as dependents: ※ Since all persons aged 75 or older are covered under the medical care system for the advanced elderly, they are not eligible to be dependent family members. http://www.fr-kenpo.or.jp/eng/member/02_life/202/20202.html HOME ＞ Subject search by life situation ＞ When you get married ＞ How to register a family member as a dependent (dependent certification) (i)They must depend on the income of the insured person for their livelihood. (ii)Their annual income must be less than 1.3 million yen (or less than 1.8 million yen if aged 60 or older or a person with a disability) and less than one-half the income of the insured person (if living apart from the insured person, the insured person must remit an amount on which the dependent family member can live). (iii)They must be within the third degree of consanguinity (see chart below). Great-grand parents Grand parents Parents Uncles and aunts Parents Spouse Elder brothers and sisters Younger brothers and sisters Insured person Spouse Children Nephews and nieces SpouseChildrenSpouse Nephews and nieces Grand children Spouse Great-grand children Spouse Younger brothers and sisters Elder brothers and sisters The number is degree of relationship Those in must live together ③ ② ①① ② ③ ① ② ② ③ ① ② ③ ③ ③ ※ Be sure to check the FR Health Insurance Organization’s website for details of authorization criteria, conditions, and applications. You can also check on procedures and other topics.
Insurance benefits and procedures for filing claims ●Medical care benefits Received when you present your health insurance card 【 Copayment rate 】 Preschool ─────────────── 20% From elementary school to 69 years of age － 30% 70-74 years of age ─────── 10%-30% ●List of insurance benefits Injury and Sickness Allowance If you are on leave from work due to sickness or injury and meet certain conditions Two-thirds of your standard daily remuneration per day (for up to 18 months from the fourth day of leave) Employer (salary/social insurance) High-cost medical care benefits If your medical-cost copayment exceeds a certain amount (Funds are automatically remitted three months later from seeing a doctor to the bank account into which your salary is paid) Payment of amounts beyond the maximum 【 Maximum copayment amount (specified by law) 】 〈 High-income earners 〉 Monthly remuneration 530,000 yen or above …150,000yen+ （ Full medical costs−500,000yen ） ×1 ％ 〈 Standard income earners 〉 Monthly remuneration less than 530,000yen …80,100yen+ （ Full medical costs−267,000yen ） ×1 ％ 〈 Persons exempt from municipal taxes 〉 …35,400yen Not necessary ☆ Independent benefits of the FR Health Insurance Organization At the FR Health Insurance Organization, your final copayment amount will not exceed the amount shown at right (Funds are automatically remitted three months later from seeing a doctor to the bank account into which your salary is paid) 【 Final copayment amount 】 〈 High-income earners 〉 Monthly remuneration 530,000 yen or above …83,000yen+ （ Full medical costs−500,000yen ） ×1 ％ 〈 Standard income earners 〉 Monthly remuneration less than 530,000 yen …45,000yen+ （ Full medical costs−267,000yen ） ×1 ％ Elderly 〈 Income at or above a certain level 〉 …45,000yen+ （ Full medical costs−267,000yen ） ×1 ％ 〈 Standard 〉 …45,000yen Insurance benefits Description of system Nature of benefits Eligible persons Where to file claims I D If you are unable to work due to sickness or injury I If you are sick or injured ※ Health insurance card for the elderly issued …Insured persons …Dependent persons D I Employer(salary/social insurance) … Salary and social insurance team at the head office
Insurance benefits Description of system Nature of benefits Eligible persons Where to file claims Maximum Co-payment Authorization If you present a Maximum Co-payment Authorization, the amount you pay at the medical institution will not exceed the maximum specified by law. If you received the Authorization in advance, the amount you pay at the medical institution (to a single institution per month) will not exceed the maximum copayment amount (specified by law). The FR Health Insurance Organization Home-visit nursing care expenses When a person requiring continual medical care at home receives home-visit nursing care 70% of costs incurred Inpatient meal expenses While hospitalized, you must pay 260 yen per meal (up to three meals per day). The balance remaining after subtracting the figure at left from the inpatient meal expenses Transportation expenses When transportation is required for treatment but sickness or injury makes movement difficult Full amount of costs incurred ※ Only if authorized by a doctor due to difficulty in walking. Overseas medical expenses Costs incurred due to sickness or injury overseas Pay the entire amount yourself and apply for reimbursement at a later date. If you received medical care overseas, the health insurance system will pay benefits for care that would have been covered in Japan. Rather than the full amount paid, the amount of the reimbursement is calculated based on medical costs specified under Japan’s insurance system, based on the specifics of medical treatments and detailed receipts issued by the overseas hospital. Note that you will not necessarily be reimbursed 70% (or 80%) of the cost, as you would in Japan. 【 Applications required for reimbursement 】 ( ⅰ )Application Form for Overseas Medical care Expenses ( ⅱ )Specifics of medical treatments ( ⅲ )Detailed receipts ※ You are required to attach Japanese translations to document Nos. ii and iii. I D If you are sick or injured If you are sick or injured overseas
Insurance benefits Description of system Nature of benefits Eligible persons Where to file claims Maternity Allowance If you are on leave from work due to childbirth Two-thirds of your standard daily remuneration per day (For 42 days before the date of birth [98 days for a multiple birth] and 56 days after the date of birth) Employer (salary/social insurance) Childbirth and Childcare Lump-sum Grant You are eligible to use the following systems after delivering: Direct payment system The facility where the birth will take place applies to the Health Insurance organization for payment of the lump-sum grant on behalf of the insured person. Proxy receipt system (in place at smaller facilities, including medical clinics and maternity clinics) The insured person applies to the Health Insurance organization in advance; the facility where the birth will take place is named as the proxy recipient. Neither system Pay the full amount of childbirth costs at the medical facility and receive the lump- sum grant at a later date. 420,000 yen per child ※ 390,000 yen in the following cases: childbirth at a facility that is not a member of the Japan Obstetric Compensation System for Cerebral Palsy; childbirth after less than 22 weeks of pregnancy; childbirth overseas ※ In cases in which the childbirth cost is less than 420,000 yen, you are required to apply for reimbursement. The FR Health Insurance Organization Funeral expenses ※ The amount of benefits to which are added the benefits provided by FR Health Insurance independently (additional benefits) If Insured persons die50,000yen - 100,000yen Employer (salary/social insurance) If dependent persons die50,000yen - 60,000yen I D I D I ※ Insurance benefits expire after two years. Your right to receive health insurance benefits for a specific event expires after two years. Keep this in mind if you must claim the benefits yourself. ★ See the FR Health Insurance Organization’s website for more information. http://www.fr-kenpo.or.jp/eng/member/01_info/106.html HOME ＞ Introduction ＞ List of insurance benefits Death If you have given birth
Notification of Health Insurance card loss Submit these forms by the set. Employer (salary/social insurance) Application Form for Reissue of Health Insurance Card (Card loss/ Damage) Notification of Health Insurance Dependent (Change) See the FR Health Insurance Organization’s website. （ http://www.fr-kenpo.or.jp/eng/member/ 02_life/202/pdf/20202_b.pdf ） Notification of name change(correction) of insured person Submit this notice with the health insurance card issued under your previous name. ※ The same procedure applies, if the name of the dependent person changes. ※ Insured persons must also notify the company of any change in their name. Notification of change of address Submit an address change notice to FR Health Insurance if the address of a dependent persons has changed. ※ Submit the notice to the employer if the address of the insured person has changed. The FR Health insurance Organization Notification of applicability (non-applicability) for long-term care insurance exemption See the FR Health Insurance Organization’s website. （ http://www.fr-kenpo.or.jp/eng/ member/02_life/207/20701.html ） Employer (salary/social insurance) Topics covered by application forms Key points of application D I D I D D I ●List of procedures related to health insurance cards and applicability ★ You can download application forms below. http://www.fr-kenpo.or.jp/eng/member/05_sinsei/index.html HOME ＞ Application forms Eligible persons Where to file claims If you lose your health insurance card If you want to name a family member as a dependent If your name has changed If your address has changed If your address changes to an overseas address …Insured persons…Dependent persons D I D Employer(salary/social insurance) …Salary and social insurance team at the head office
Cases not covered by health insurance ●Health insurance does not cover certain types of medical care. You cannot use health insurance in the following cases: ・ Any treatment or therapy elected to treat simple overwork or fatigue ・ Plastic surgery for cosmetic reasons ・ Blemishes, birthmarks, or other cosmetic factors that do not impede work or everyday life ・ Nearsightedness, farsightedness, astigmatism, squinting, or similar conditions with no prospect of recovery ・ Vaccination shots or oral medicine ・ Abortions performed for economic reasons ・ Experimental treatments not covered by insurance ※ In certain cases, health insurance may be available for use on an exceptional basis. ●Health insurance does not cover treatment for injuries sustained during work or while commuting to or from work. You may not use health insurance for injuries sustained during work or while commuting to or from work. In certain cases, such incidents may be covered by workers’ accident compensation insurance. Be sure to inform Salary and social insurance team at the head office. ＊ Proceed carefully with out-of-court settlements Choosing to settle out of court too quickly may lead to unexpected problems, including restrictions on the amount of costs you can claim. If you have been involved in a traffic accident (due to the actions of a third party) ●Be sure to submit a notice to the FR Health Insurance Organization Traditionally, the party responsible pays the medical costs of sickness or injury due to the actions of a third party. When the party responsible cannot be identified or in other such cases, the Health Insurance Organization may loan the funds required for medical costs on a temporary basis. In such cases, be sure to notify the Health Insurance Organization. ※ Actions of a third party …Injuries stemming from traffic accidents, altercations, bites from other people’s dogs, food poisoning from food eaten at a restaurant or purchased, collisions or accidents incurred while skiing, snowboarding, or other such activities, falling objects at construction sites, and so forth.
Treatment by a judo therapist (osteopath, bonesetter) ●You can use health insurance for a specific range of treatments. ●Take care regarding the following matters: (i) Carefully check the contents of the Application for Reimbursement of Medical Expenses before signing. (ii) Obtain and retain receipts. (Treatment is eligible for medical expenses deductions on your income tax.) (iii) Get an examination from a doctor if you do not recover after visiting for extended periods. (You may have another condition.) (iv) Extended examinations, including those for other body parts or family members, are not covered. Acupuncture or moxibustion (i) Requires doctor’s consent. (ii) Costs must be paid in full and in advance. (iii) Attach your receipt and doctor’s letter of consent to the Application for Reimbursement of Medical Expenses and submit to the FR Health Insurance Organization. (iv) Get an examination from a doctor if you do not recover after visiting for extended periods. Cases in which you can use health insurance: Cases not covered by health insurance: ・ Acute sprains, bruises, fractures, torn muscles ・ Broken bones, cracked bones, dislocations (all treatment other than first aid requires doctor’s consent) ・ Injury while you are at work or while you are traveling to work ・ Overwork, stiff shoulders, lower-back pain, or poor health attributable to everyday life ・ Muscular fatigue, muscle pain, etc. due to sports activities ・ Pain due to disease (such as rheumatism, age-related stiff and painful shoulders, or arthritis) ・ Treatment in surgery or plastic surgery departments when treatment for the same region of the body is already scheduled for that date ・ Treatment for extended periods with no prospect of recovery ●You may be asked for more information about your conditions and use of insurance.
Don’t forget to get your annual health checkups Persons eligible for checkups Insured Dependent （ dependent spouse ・ 40 years of age and older ） Guide Whether you work in Japan or overseas, don’t forget to get the annual health checkup provided by your employer. Whether you live in Japan or overseas, don’t forget to get the annual health checkup provided by the FR Health Insurance Organization. How to apply Persons working in Japan Persons working overseas Persons living in Japan Persons living overseas To schedule your checkup, contact directly the hospital contracted to provide the checkups. Thereafter, apply to EWEL, Inc. for a checkup. To schedule your checkup via the web, go to the health checkup site accessible via the FR Health Insurance Organization‘s website. To schedule your checkup, contact directly the hospital contracted to provide the checkups, as described in the checkup reminder sent from the FR Health Insurance Organization. To schedule your checkup via the web, go to the health checkup site accessible via the FR Health Insurance Organization’s website. Examinations The focus of the checkups will differ depending on your age and gender. Complete check-ups will be added for persons of age 35 and for those 40 years and older. Tests for Helicobacter pylori and pepsinogen (stomach cancer) and tests for cervical and breast cancer for women will be added for those at certain key ages. For certain optional exams, you may be responsible for paying the exam fee yourself. Checkup results The medical facility that provides the health checkup will send the examination results directly to you (to the patient). The results of these checkups are stored in the FR Health Insurance Organization’s database “KENKO BOX” to make it possible to assess your changing health over the years. After your checkup Health maintenance guidance based on checkup data is provided to maintain and promote health. Industrial physicians play central roles in these services. Annual health checkups are the first step in health management. We recommend that you schedule a checkup immediately after receiving the checkup reminder from your employer or the FR Health Insurance Organization. ※ You must be covered by FR Health Insurance as of the date of the checkup. ※ Health checkups are provided once annually. ※ Health checkups are subcontracted to EWEL, Inc. ※ Go to the FR Health Insurance website for more information on what aspects of your health checkups examine and information on the handling of personal information.
Members are eligible for consultations on topics ranging from childcare to mental health. All content is in Japanese. ●Mental and physical health consultation ※ You can also call from your mobile phone. ※ In-person consultations are also available. ●Consultation website 「 Online service for mental and physical health 」 https://www.healthy-hotline.com ●Childcare consultation mobile site 「 My Baby Club 」 ●Consultation from overseas (available by calling collect) http://www.fr-kenpo.or.jp/hoken/list.pdf ※ Use these services with confidence; all personal information will be held in the strictest confidence. 0120-832-238 Open throughout the year ID ： 06139596 ID ・ PASSWORD ： 06139596 Information about the household medicine purchasing service Click on this banner from the FR Health Insurance Organization website! （ http://www.fr-kenpo.or.jp/member/07_hoken/704.html ） HOME ＞ Information about the household medicine purchasing service As part of efforts to help protect member health, we will make home medical supplies and other materials available at special prices. We encourage you to use these to keep your home prepared for various medical needs.
If you want to take a break A range of welfare programs are available at a discount from a menu of services targeting specific life stages. These include members-only sports clubs, childcare support, and tickets for various recreational events. The service also gives members access to a range of attractive information. Start by accessing “WELBOX” on the FR Health Insurance Organization website. 《 This is a welfare program provided by EWEL, Inc. in partnership with the FR Health Insurance Organization. 》 You can access WELBOX starting around one month after your health insurance card arrives. ● How to apply from your mobile phone https://mwb.jp 8051 Staff number （４ figures ） The date of your birth ( 8 figures ) OR ●How to apply from your smartphone www.smart- welbox.com Access the log in page of website(welbox.com) from your smartphone to display the website for smartphone. Access the mobile site (mwb.jp) from your smartphone to display the website for smartphones. Two kinds of way to log in ➊ Log in using your membership number ➋ Log in using your email address To use these services, go to the following URL or QR code to log in from your mobile phone. From you computer, access the services from the website. All content in the linked pages in Japanese.
Fitness Special admission to fitness clubs LIFE SUPPORT Many services are available! Example of services You can choose from more than 4,000 options, according to your own specific stage in life. Entertainment Special admission to movie tickets 109 CINEMAS ＆ TOKYU CINEMAS The basic ticket charge1,800yen ⇒ 1,200yen TOHO CINEMAS The basic ticket charge1,800yen ⇒ 1,300yen KONAMI SPORTS-CLUB The usage charge （ once/fiscal year ） 840yen - 2,730yen CENTRAL SPORTS The usage charge (once/fiscal year ） 500yen - 2,000yen Example of services
Relaxation ・ Beauty care Other Skill up Book ・ CD ・ DVD Healthcare Nursing careHousing Disney Resort and USJ Special admission to recreation Special admission to massage services 【 Limited time offer 】 ・ Tokyo Disney Resort ・ Universal Studio JAPAN Information on special (subsidized) admission tickets!! Example of services てもみん (TEMOMIN) The basic tickets charge 1,050yen ⇒ Membership price 840yen リフレッシュしたいとき（日本旅行） Show your FR Health Insurance Organization health insurance card at any Nippon Travel Agency branch (excluding OMC, independent agents, or special agents) to get discounts of 3–5% on travel costs. Go to the Nippon Travel Agency website (http://www.nta.co.jp/shop/) or contact NTA below to locate the nearest branch. 日本旅行 (NIPPON TRAVEL AGENCY) YAMAGUCHI branch TEL ： 083-972-2211 10 ： 00 ～ 18 ： 00 (Except for Saturday, Sunday and A public holiday) NIPPON TRAVEL AGENCY Example of services
If you leave the company or lose eligibility for the FR Health Insurance Organization (loss of eligibility) You can no longer use your FR Health Insurance Organization health insurance card once you have lost your coverage under the health insurance system because you left the company or because your contracted hours changed !! 【 How to return 】 If you leave the company Withdrawal from health insurance due to changes in contracted hours Return your card by post Return your card via regular in-house mail (or by post). Addressed to Salary and social insurance team at the head office ●If you are no longer eligible Return your health insurance card promptly on the day at the time of your departure from the company or at the time of your contract change. ※ If you have dependent family members, you must return their health insurance cards as well. After your retirement If you begin new employment immediately. If you do not begin new employment immediately. You will become an insured person under the health insurance provided by your new employer. You will become a voluntarily continuously insured person. You will become a member of the National Health Insurance Organization. You will become a dependent of your spouse or child. ※ You must meet certain conditions to be named a dependent. ※ Those issued elderly benefits cards or a Certificate of Application of Maximum Copayment Amount must return these together with their health insurance cards. ※ If you use your health insurance card after the date you left the company or the date on which your contract changed, you will be required to repay any medical costs incurred.
＊ Voluntarily continuously insured persons Those who have been insured for at least two months before loss of eligibility may continue to receive insurance benefits as voluntarily continuously insured persons for a period of two years following loss of eligibility for FR Health Insurance. (Note that you will not be eligible for Maternity Allowance or Injury and Sickness Allowance.) If you wish to become a voluntarily continuously insured person, submit the Application for Voluntarily and Continuously Insured Person Status to the FR Health Insurance Organization no later than 20 days after you lose your eligibility. If you have any dependent persons, submit the Notification of Health Insurance Dependent (Change) for Voluntarily and Continuously Insured Persons. You can check on procedures at the FR Health Insurance Organization’s website. http://www.fr-kenpo.or.jp/eng/member/02_life/208/20803.html HOME ＞ Subject search by life situation ＞ When you retire ＞ When you wish to remain a member of our Health Insurance Organization ＊ Benefits after loss of eligibility In certain cases, those who have been insured for at least one year continuously before loss of eligibility may be eligible to receive Injury and Sickness Allowances ※, the Childbirth and Childcare Lump-sum Grant, Maternity Allowances ※, and Funeral fees even after losing their eligibility. However, even those eligible to receive the preceding benefits will not receive any additional benefits. http://www.fr-kenpo.or.jp/eng/member/02_life/208/208.html HOME ＞ Subject search by life situation ＞ When you retire ＞ ※ This applies only to cases in which the individuals continue to receive benefits that they were already receiving while still employed by the company.
FR Health Insurance Organization TEL ： 03-6865-0005 ／ FAX ： 03-6865-0006 8 ： 00 〜 17 ： 00 （ Except for Saturdays and Sundays ） The information provided includes detailed information on insurance benefits and healthcare activities, how to perform various procedures, and the latest news from the Health Insurance Organization. Use this service alongside this guide for a wealth of information useful for healthy living. http://www.fr-kenpo.or.jp/eng/index.html Reference Information about the FR Health Insurance Organization’s website Downloads Application forms You can download various notification and application forms related to health insurance and healthcare activities. Introduction Provides a profile of FR Health Insurance and introduces the health insurance system. Subject search by life situation Explains the benefits available and necessary procedures for individual life situations. Languages Click here to select the languages. (Japanese or English) News &Topics Regularly features important announcements and the latest information from the FR Health Insurance Organization.