If you paid the entire medical care cost up front
In some cases covered by health insurance, you will pay the full medical care costs to the medical care institution or other facility up front, after which you will be reimbursed by the Health Insurance Society later.
Please fill in the application form clearly and correctly. If it is not legible, we will return the application form.
|Reason for eligibility for payment of medical care expenses||Required documents|
|If you underwent treatment without your health insurance card due to sudden sickness||Application Form for Medical Care Expenses (advance payment) (A4)
Receipt, medical cost details (★1)
|If you received a live blood transfusion||Application Form for Medical Care Expenses (advance payment) (A4)
Receipt, blood transfusion certificate
|If you purchased and used prosthetic equipment such as an artificial arm or leg, an artificial eye, or a corset, as instructed by a physician:||please check here.|
|If you underwent acupuncture, moxibustion, massage, shiatsu, or similar treatment with an insurance doctor's approval:||Application Form for Medical Care Expenses (acupuncture) (A4)
Application Form for Medical Care Expenses (moxibustion/massage) (A4)
Receipt, written consent from an insurance doctor
|If you had eyeglasses or contact lenses prepared and purchased to treat juvenile amblyopia or other condition in a child of less than nine years of age:||please check here.|
|If you purchased a compression garment or similar item||please check here.|
|If you become sick or are injured overseas||please check here.|
|If you cannot walk to or between hospitals||please check here.|
★1 About medical cost details:
This document shows details of your medical care. The document differs from the medical care details provided together with your receipts. Ask your medical care institution to issue this document.
The document will be issued by the medical care institution in an envelope marked "Do not open.
You may be asked to submit a photograph of the prosthetic equipment.