I.   The primary function of the Association is to provide reimbursement of medical expenses and life insurance benefits for non-Japanese visiting or residing in Japan.

II.  Benefits & Indemnification

1.    Medical benefits

2.    Disability benefits

3.    Life insurance benefits

4.    Personal liability indemnity

III.  Membership Fees

Individual Plan	Annual Plan	Semiannual Plan	Senior Citizen Plan	Annual Plan	Semiannual Plan
18 – 60 years old	¥49,800	¥30,000	61- 65 years old	¥49,800	¥30,000

Child Plan	Annual Plan	Semiannual Plan
1 – 17 years old	¥43,800	¥28,000

IV.  Joining the Association, membership requirements

1. The Association was established to provide reimbursement of medical expenses and life insurance benefits for non-Japanese citizens visiting or residing in Japan. Membership is restricted to non-Japanese citizens. Individual, family, and group plans (e.g. for company employees) are available.
2. Please apply to become a member. Applicants will be eligible for membership after paying the membership fees and receiving approval from the Association.
3. Please fill out the Application Form and Statement of Health Condition Form and pay the membership fees.
4. Individual plans are available for applicants 18 to 60 years of age, and child plans are available for applicants 1 to 17 years of age. Individual members may also apply for membership for family members up to the third degree of kinship living at the same address. Members that have been enrolled for at least a year and members that are enrolled as part of a group plan are eligible for the senior citizen plan from age 61-65. However, those in specified occupations (Appendix 2) will not be eligible to apply.
5. Applicants residing in a country other than Japan are eligible to join the Association provided they can show proof of temporary residence in Japan.
6. All applicants are required to submit the Statement of Health Condition Form. Neither benefits nor indemnification will be payable if this statement is not submitted. Life insurance benefits will not be payable if a beneficiary has not been designated on the Application Form.
7. Please note that membership of the Association will be denied if the Application Form or Statement of Health Condition Form contain false statements, misrepresentations, or if information has been omitted or concealed. If membership has already been obtained, membership fees paid will be forfeit without refund. Applicants are also required to notify the Association in the event of changes to personal details such as change of occupation or address.
8. Applicants are not required to show either a passport or visa. However, we may ask for proof of non-Japanese nationality as circumstances demand. Applicants will be denied membership if they are unable to show proof of non-Japanese nationality, or if the Association is unable to verify such proof. Membership will be void without any refund of fees should applicants acquire membership despite not fulfilling the membership conditions.
9. Applicants may not join the Association or renew membership without the consent of the Association. Reasons for denial will not be disclosed.
10. The Association has been created exclusively for non-Japanese citizens visiting or residing in Japan and shall carry out its mission abiding by the laws of Japan and the Terms and Conditions of the Association.
11. No benefits, indemnification or other benefits or services will be provided by the Association outside Japan.
12. Payment for claims will be made directly into the bank account designated by the member. All bank accounts must be within Japan and belong to a financial organization operating in Japan.
13. Those employed in occupations specified by the Association (Appendix 2) are required to list the details of such on the Statement of Health Condition Form. Applicants that have changed jobs and are now employed in specified occupations are required to notify the Association immediately. Failure to do so may result in a reduction in insurance benefits or total forfeit of indemnification. Applicants involved in the follow occupations are not allowed to join the Association: Forestry, Mining, Lognshoreman.

V.  Details of Benefits and Indemnification

The Association will pay all benefits and indemnification as long as the member resides in Japan and pays membership fees.

1.    Medical benefits

a)    Medical coverage
The Association will reimburse 100% of the cost of medical expenses incurred including diagnosis and treatment at medical facilities (hospitals and clinics etc.) in Japan.

Coverage for individual and child plans for a particular illness or injury will be limited to one payment up to a maximum of ¥2,000,000 and will not exceed 180 days from the time of the first medical consultation. Coverage for senior citizen members for a particular illness or injury will be limited to one payment up to a maximum of ¥1,000,000 and will not exceed 180 days from the time of the first medical consultation.

In the event of a recurrence of an illness after treatment or a period in excess of 3 weeks between treatments, the Association shall determine whether such illness shall be covered and the extent of coverage based on the continuity of the illness. (Indemnification may not be provided in some instances.)

Medical expenses include charges for the first and subsequent consultations and related charges for tests, treatment, prescriptions, and hospitalization. (Price differences in bed rental expenses, meal expenses, and miscellaneous personal expenses are excluded).

In addition to the above conditions, 50% of rehabilitation expenses are covered by the plan.

Treatment at chiropractors and bone-setting clinics, alternative medical treatments, and overseas treatment are not covered by the plan.

A payment of 50% of the specified medical benefits shall apply to Inguinal Hernia diagnosed 6 months after joining. Benefits will not be provided for preexisting conditions or diagnosis within 6 months of joining.

In the event the member is required to enter hospital, the member is required to contact the Association before being admitted. In the event of an emergency or whereby the member is admitted in a state of unconsciousness, we request that representative of the member contact the Association within 48 hours of admittance. Whereby the Association is not contacted within 48 hours, payment of benefits shall be limited to 50% of the specified medical benefits.

b)    Exclusion
The Association will cover all fees of ¥10,000 and over for a particular injury or illness up to the maximum amounts stipulated above. For example, if a member receives hospital treatment for a cold and fees total ¥20,000, the ¥20,000 will be reimbursed in full. However, in accordance with a) above, reimbursement may not be provided for certain conditions..

c)    A medical diagnosis report must be submitted with claims. Other documents such as letters of referral will not be accepted in place of a medical diagnosis report. The Association will cover the cost of the diagnosis report provided that: it is for an injury or illness covered by this plan; and the cost of the medical treatment is equal to or exceeds ¥10,000. For clarity, please consider the following:

Example A: ¥10,000 medical treatment costs + ¥3,000 diagnosis report fee = ¥13,000
Example B: ¥7,000 medical treatment costs + ¥3,000 diagnosis report fee = ¥10,000

In the case of Example A of this section, the cost of both the medical expense and the diagnosis fee will be paid. However, in the case of Example B of this section, neither the medical expense nor the diagnosis fee will be paid.

d)    Coverage will not be provided for extraordinary medical expenses or treatment that is beyond the scope stipulated in a).

2.    Life insurance benefits
For death within Japan from disease or its symptoms, accidents or prolonged symptoms, benefits will be paid according to the chart below. No benefits will be paid for death overseas.

 

Cause of death	Adult	Child, Senior citizen plan
Accident	¥7,000000	¥5,000,000
Illness, natural cause, etc.	¥3,000,000	¥3,000,000

 

3.    Disability benefits
Members will receive up to ¥5,000,000 in the event of an injury occurring in Japan that leads to permanent disability. The amount will be calculated in accordance with a separate set of regulations (based on the Injury Insurance Regulations).

4.    Personal liability indemnity (Only applicable to the Adult Plans - Children's Plans are excluded from coverage)
The association will pay indemnities for personal liability up to a maximum of ¥10,000,000 in the event that members inflict damage upon a third party in Japan within the scope of daily life in accordance with a separate set of regulations (based on Personal Liability Indemnity Regulations).

5.    Collecting necessary documents and other materials for 2. life insurance benefits, 3. disability benefits, and 4. personal liability indemnity claims and related expenses incurred is the responsibility of the member and/or beneficiary. Verificationfrom a third party such as the police is necessary for 4. personal liability indemnity claims. Please be sure to file a report within one week of the incident.The Association may not cover full indemnity in the case that the report is not filed within this period.

VI.  Exclusions
Benefits will not be paid for hospital or treatment fees or the death of a member or third party through illness or accident in the following cases. Disability benefits and personal liability indemnities are also excluded in these circumstances.

1. In the event that the disease, accident, or death occurs before membership was acquired.
2. Benefits will not be paid for 1. regardless of whether the member was aware of the condition before acquiring membership.
3. In the event that the disease, accident, or death occurs after membership has expired, become invalid, or has been cancelled.
4. Congenital and hereditary diseases, symptoms, or any related conditions.
5. Medical care administered by a person who is not a licensed medical doctor or in a facility that is not officially registered as a hospital or clinic in Japan.
6. Alternative medicine and treatment such as chiropractics, bone-setting, acupuncture, and herbal medicine.
7. Pregnancy, childbirth, and/or complications relating thereof.(Sterilization operations, miscarriage, abortion, etc.)
8. Medical check-ups.
9. Suicide, intentional injury, fighting, other dangerous activities, etc.
10. High-risk sports (diving, bungee jumping, martial arts including boxing, judo, karate, American football, mountain climbing, snowboarding, car racing, professional sports, etc.) and sports played with a sporting association.
11. Illness or accident resulting from illegal behavior, illegal medical treatment, or medicine.
12. Driving a motor vehicle without insurance or a license (Jibaiseki and ninnihoken). All passengers�f injuries are also exempt in the case of a traffic accident.
13. Illness or accident arising from alcohol, medicine, or drugs.
14. Diseases, injuries, or accidents due to acts of war, terrorism, revolution, or riots, etc.
15. Dental care or treatment.
16. Cosmetic or plastic surgery.
17. When no actual illness, accident, or objective symptoms are found.
18. In cases where the Association does not recognize an illness or injury, or when the Association reaches such a conclusion following an investigation. Also, in cases where the Association deems that the member is receiving excessive medical treatment, such as remaining in hospital for longer than necessary or an excessive number of consultations.
19. In cases of epidemic, contagious diseases, or group toxicosis.
20. HIV, SARS, or any other new epidemics.
21. Organ transplant, sterility treatments, hair treatments (all body hair treatments), dialysis, cirrhosis of the liver, hepatitis, varicocele surgery.
22. Sex change operations, weight control operations, etc.
23. Emotional disorders and any related brain disorders or therapy, etc.
24. Conditions caused by radioactivity or radiation.
25. The onset of disease, disease symptoms, illness, accident, or death overseas.
26. Traffic accidents, industrial accidents, natural disasters, etc. Illness or accident claims covered by other insurance plans. (Under certain circumstances, disability benefits and life insurance benefits may be paid.) For claims covered by other insurance plans, those other insurance plans shall take precedence. The Association will pay up to costs not covered by Japanese Health Insurance or Social Insurance Schemes up to a maximum of 30%, provided such illnesses or injuries are covered by this plan.
27. Typhoons, rainstorms, earthquakes, tsunamis, volcanic eruptions, and other natural disasters.
28. Astigmatism, nearsightedness, farsightedness, vision correction, glasses, contact lenses, prosthetic limbs, crutches, etc.
29. Cancer, diabetes, kidney or gallstones, hyperlipidemia, high blood pressure, athlete's foot, ingrown toenails, any type of chronic illness, etc. In cases where it is difficult to establish the onset of illness, benefits will not be paid for the first six months after joining the Association. Neither will benefits be paid for such conditions contracted during this period.
30. Poor circulation, menstrual pains, irregular menstruation, constipation, anemia, and other constitution-related ailments.
31. Menopausal disorders, presbyopia, cataracts, glaucoma, and any other ailments related to advanced age.
32. Price difference in bed rental, meals, and private or semi-private room costs are excluded from hospitalization fees.
33. Please note that neither benefits nor indemnities will be paid if the member fails to cooperate with the Association�fs medical investigation.
34. Benefits and indemnities will not be paid if the Statement of Health Form is not submitted.
35. Neither benefits nor indemnities will be paid if there are any false statements or misrepresentations in the Application Form or Statement of Health Condition Form.
36. All life insurance benefits are void if a beneficiary has not been designated on the Application Form.
37. Any claims made 60 days or more after the completion of medical treatment, death, or accident or claims made after 210 days after the first consultation for treatment that has taken 150 days or longer since the first consultation.
38. Inguinal Hernia diagnosed before or within 6 months of joining.
39. Any claim made over 180 days from the date of diagnosis.
40. Any continual treatment for an injury or illness for which the member has already been compensated.
41. Intractable diseases.

 

VII.  Coverage Period (Membership period)

1. Under normal circumstances, if the membership application and fees are received by 3:00 p.m. and no Effective Date is specified, coverage will be activated from 4:00 pm on the same day that both items have been processed. In the case that membership fees are paid at a convenience store or through cash on delivery, membership will be activated at 8:00 a.m. the following day.
2. For new members, coverage for death from illness and medical coverage will commence from 12:00 a.m. 7 days after membership has been acquired.
3. All benefits and indemnities will only be paid as long as membership is valid.
4. Membership will expire at 4:00 pm on the date specified at the time of application.

Membership and renewal fees

1. The validity period is in principle 1 year or 6 months. Membership fees can be paid via bank transfer or at convenience stores following application. The Association will mail out a special fund transfer form for customers wishing to pay at a convenience store. Please pay membership fees promptly. The procedure for membership renewal is the same.
2. Plans cannot be cancelled after memberships or renewals have been processed. Membership fees will not be refunded. A request in writing for cancellation from the member within 8 days of completion of processing of a membership application or renewal will be accepted and membership fees refunded.

Claiming Benefits

1. All membership fees must be paid in full. If membership fees are not fully paid, benefit claims will be deducted accordingly.
2. Members must submit the benefit claim form, doctor�fs medical certificate, and receipts (copies not acceptable) within 60 days of completion of treatment. Additional documentation will be required in the case of claims for death, disability or personal liability. Claims must be submitted within 60 days of death, accident or completion of medical treatment.
3. If medical treatment exceeds 150 days, please follow the procedure outlined above within 210 days of your first medical consultation.
4. Benefit claims will be void if not made within the period specified in 2. and 3.
5. The Association will conduct an investigation and/or medical investigation following the submission of a claim in the correct manner. Funds will be transferred within 30-60 days to the bank account or postal account designated by the member if the required conditions are fulfilled. Investigations may take longer than this time in some cases.
6. Reimbursements for medical treatment fees of ¥10,000 or more will be made in full in accordance with the regulations.
7. Please ensure that medical diagnosis reports have all necessary information entered and are signed by a doctor. Submit one medical diagnosis report for each injury or illness benefit claim. Associated costs will be borne by the Association. Please note that the Association will not pay for more than one medical diagnosis report.
8. The designated beneficiary should file life insurance benefit claims. Please submit all further necessary paperwork requested by the Association. Investigations into the claim may take some time.
9. Up to two people may be designated as life insurance beneficiaries. However, only family members residing in Japan, or family members up to two degrees of kinship living in the member�fs home country are eligible. Life insurance benefits are void in cases where there is no beneficiary designated. In the case where Person A, the person who is given priority as noted on the Application cannot be identified or reached within 1 year of death, Person B will receive life insurance benefits. Life insurance benefits shall not be paid whereby Person B cannot be identified or reached within 6 months.
10. Please submit claims within 30 days of termination of membership following 2. and 3. above if you do not intend to renew membership. No claims will be processed after this period if you are no longer a member.
11. Claims will not be processed if membership has become invalid or has been terminated.
12. Please be sure to sign the consent form for investigations to the medical institution about necessary particulars when submitting claims. We may not be able to process claims without your consent.
13. Benefits and indemnities will only be paid during the validity of their plan.
14. If you have any objections regarding benefits or indemnities awarded by the Association, please send us documentary evidence by mail. Claims will be reinvestigated upon verification of the contents. Due to the possibility of misunderstandings, telephone, oral and e-mail enquiries will not be accepted.
15. When you get the medical diagnosis report filled, please show your identification (passport, alien registration, driving license, etc) if this section of the application is not signed by the doctor we will not reimburse the claim.
16. Benefits provided by the Association will cover 100% of charges for medical treatment. Depending on the hospital, you may be charged in excess of 100%. Please note that in the event of such you may incur out of pocket expenses. Please confirm with the hospital before your consultation.

Cancellation and termination

1. Membership will be cancelled immediately and all privileges terminated if at any point a member violates the Association�fs Terms and Conditions.
2. When renewing, it is necessary to pay all fees in full by the time membership expires. Failure to do so will result in termination of membership.
3. A new plan must be established if fees are not paid within one week of membership expiration.
4. Condition 3. also applies to group plans. A new plan must be established if renewal fees are not paid by the date specified in the special contract.
5. Membership will become invalid when leaving the country (or Japanese territory or waters or when filling out paperwork to leave the country at an airport in Japan) until return to Japan. Benefit and indemnity claims for any illness, accident, death, disability, or personal liability occurring during that time are invalid. The same terms apply for the time members return to their home country.
6. Membership will be cancelled and all privileges terminated if a member acts against the interests of the Association such as submitting fraudulent claims or lending a membership card to another person. Damages may be sought on certain occasions.
7. Membership will be cancelled at the discretion of the Association if the said member cannot comprehend the system and regulations of the Association.
8. In the case of invalidation or cancellation, membership fees paid will not be refunded.
9. Please file all claims within 60 days of the completion of medical treatment, death or accident, or within 210 days of the first medical consultation in the event the duration of treatment exceeds 150 days. Claims submitted after this period are invalid and will not be processed. Please send all documents as quickly as possible.
10. Further to the conditions stipulated in 9. claims submitted after 30 days from membership expiration will not be processed.

Other

1. The Association was established specifically for non-Japanese residents visiting or residing in Japan. The Association conducts operations in accordance with all Japanese laws and Association Terms and Conditions.
2. The Association has special reinsurance agreements with other Japanese insurance companies to ensure that members can participate in the plan free from concern.
3. The operating regulations for all benefits and indemnities are handled in accordance with the Injury Insurance Regulations of Japanese casualty insurance companies. The Association strives to provide a reasonable and fair benefit and indemnity system.
4. These Terms and Conditions will be constantly reviewed and are subject to change. All changes are applicable upon renewal of membership. Please check the Terms and Conditions at that time. When claims are processed it will be based on the Japanese version of the contract.