Reimbursement for a full payment of medical expenses

When you use the “Membership Card” for an insurance-covered treatment, you only have to pay 30% of the total medical cost (see Copayment for using Medical Institutions for details). However, there may be cases where you will have to pay the full amount because you are unable to use it. In such cases, you may be reimbursed by 70 percent later upon our approval of your claim for reimbursement.

Unavoidable circumstances where you cannot use your Membership Card

You must present your “Membership Card” when you undergo medical treatment for illness or injury. But there may be cases where you have to pay the medical expenses in full due to unavoidable circumstances. They may be reimbursed later as medical expenses upon our approval.

“Unavoidable circumstances” means a situation where:

1. You became ill or injured and needed urgent medical treatment at a medical institution where health insurance is not acceptable (e.g. a seasonally operated medical office or medical institution overseas), or
2. Your “Membership Card” was not available for use due to factors other than your negligence. An example is that you had an acute disease overseas or that your “Membership Card” was still in the process of preparation.

Note:

1. Since the amount of reimbursement is determined based on the National Health Insurance (NHI) point system, it may be less than the amount you actually paid for medical treatment.
2. Since medical expenses you paid during your study or trip abroad are recalculated based on the NHI point system, the amount of reimbursement will mostly be much less than the actual amount you paid.

Expenses for medical apparatuses

• The expenses for medical apparatuses approved as necessary by a doctor such as corsets, medical support hose and child’s glasses for Amblyopia treatment may be reimbursed as medical expenses upon claim.
• Convenience tools and equipment such as glasses, hearing aids, wheelchairs, gastroptosis healing bands, and hernia belts are not regarded as medical items; therefore they are not within the scope of reimbursement.

Acupuncture, moxibustion, and massages

When you get acupuncture, or moxa cautery to heal chronic pains of the following six disorders (e.g. neuralgia, rheumatism, cervicobrachial syndrome, frozen shoulder (Adhesive capsulitis), lower back pain (lumbago), sequela after cervical sprain), or receive massage for muscular paralysis, arthrogryposis, and other symptoms that are medically incurable, such treatment fees may be regarded as medical expenses if you claim this to PMAC with a doctor’s written consent.

Note:
Fees for treatment without a doctor’s written consent are not regarded as medical expenses; therefore they are not covered by insurance.

Note:Submit appropriate forms and documents as follows.

1. When you have used other person’s health insurance by mistake, submit Original receipt and the envelope with a note "Do not open without owner’s approval" containing a copy of “Statement of Medical Service Fees issued by the National Health Insurance or other health insurance society”, which was given to you when you paid back.
   Note:
   Return the envelope unopened.
2. When you have paid in full for dental treatment, submit the “Certificate for Receipt of Dental Service Fees” or a copy of ”Statement of Medical Service Fees” with the bill of receipt.
3. When you have paid in full for medicine provided by a pharmacist, submit the “Certificate for Receipt of Pharmaceutical Service Fees” or a copy of ”Statement of Medical Service Fees” with Original receipt.
4. When you have paid in full for bone-setting treatment, submit the “Certificate for Receipt of Bone-setting Service Fees” or a copy of “Statement of Medical Expenses” and the original receipt.
5. When you have undergone medical treatment overseas, refer to here.
   Note:
   Japanese translation is required when the documents are written in a foreign language.
6. When you have purchased medical apparatus such as corsets, submit a “Doctor’s Written Opinion” and the original receipt detailing the purchase of such apparatus. Submitting a photograph of the apparatus is required only for a shoe-shaped apparatus.
7. When you have got massages, acupuncture or moxibustion, submit a “doctor’s written consent” and Original receipt detailing treatment.
8. When you have undergone blood transfusion, submit a “doctor’s statement” of necessity on blood transfusion and Original receipt for the blood transfusion.
9. Transportation costs of bone marrow transplantation and organ transplantation may require the written opinion of the doctor (approving the necessity of the transport), receipts (original), and certificates showing the route and method of transportation to be submitted.
10. Other cases: Evidence papers shall be submitted upon request.