If you paid the entire medical care cost up front

In some cases under the health insurance system, if you paid the entire medical care cost to the medical care institution or other facility up front, the Health Insurance Society will reimburse you later.

* See the next page for the application form to be used when you have paid the entire health checkup (examination) cost yourself up front.

Click here for the application form for general insured persons.
Click here for the application form for Voluntarily and Continuously Insured Persons and Special-Case Retired Insured Persons.

If you paid the entire medical care cost up front
If you reimbursed medical care costs billed to you by another health insurance society
If you were fitted with a corset or other equipment
If you underwent acupuncture/moxibustion with a physician’s consent
Massage treatment with physician’s consent
If you had eyeglasses prepared to treat juvenile amblyopia
Examination or treatment at a medical care institution overseas

If you paid the entire medical care cost up front

Eligibility to join	Insured person (employee) If the symbol starts with "1".	Voluntarily and Continuously Insured Person If the symbol starts with "2".	Special-Case Retired Insured Person If the symbol starts with "3".
Application Form	Application support system Claim for Medical Care Expenses (Advance Payment, Prosthetic Equipment, etc.) （Connect to Hitachi Group Intranet.）	Claim for Medical Care Expenses (Advance Payment, Prosthetic Equipment, etc.) Example
Application Form	If you are unable to use the application support system Claim for Medical Care Expenses (Advance Payment, Prosthetic Equipment, etc.) Example
Documents to attach	Receipt (original) Medical cost details issued by medical care institution Or Details of examination and treatment issued by medical care institution (original) Or Detailed receipt (examination and treatment) Medical　Dental　Pharmaceutical	Receipt (original) Medical cost details issued by medical care institution Or Details of examination and treatment issued by medical care institution (original) Or Detailed receipt (examination and treatment) Medical　Dental　Pharmaceutical
Deadline	Within two years from the date on which expenses were paid	Within two years from the date on which expenses were paid
Submit documents to	Your employer’s health insurance contact (e.g., General Affairs, Labor Management)	Operations (Benefits) Hitachi Health Insurance Society Higashi-Ochanomizu Building, 2-29, Kanda Awaji-cho, Chiyoda-ku, Tokyo, 101-0063
Others	The amount paid will be calculated based on costs qualifying as insured examination and treatment. See the Notice of Medical Costs/Notice of Cash Benefit Decision to check the amount paid. A separate notification is required for injury or sickness attributable to third-party actions. Contact the contact point indicated below.	The amount paid will be calculated based on costs qualifying as insured examination and treatment. See the Notice of Medical Costs/Notice of Cash Benefit Decision to check the amount paid. A separate notification is required for injury or sickness attributable to third-party actions. Contact the contact point indicated below.
Address inquiries to	Operations (Benefits) Hitachi health insurance society　 TEL 03-4554-3030	Operations (Benefits) Hitachi health insurance society　 TEL 03-4554-3030

If you reimbursed medical care costs billed to you by another health insurance society

Eligibility to join	Insured person (employee) If the symbol starts with "1".	Voluntarily and Continuously Insured Person If the symbol starts with "2".	Special-Case Retired Insured Person If the symbol starts with "3".
Application Form	Application support system Claim for Medical Care Expenses (Advance Payment, Prosthetic Equipment, etc.) （Connect to Hitachi Group Intranet.）	Claim for Medical Care Expenses (Advance Payment, Prosthetic Equipment, etc.) Example
Application Form	If you are unable to use the application support system Claim for Medical Care Expenses (Advance Payment, Prosthetic Equipment, etc.) Example
Documents to attach	Receipt (original) received from National Health Insurance, another health insurance society, etc. Or payment slip stamped “Received” (original) Medical cost details (issued by the insurer refunding medical expenses) Submit the unopened envelope containing medical cost details.	Receipt (original) received from National Health Insurance, another health insurance society, etc. Or payment slip stamped “Received” (original) Medical cost details (issued by the insurer refunding medical expenses) Submit the unopened envelope containing medical cost details.
Deadline	Within two years from the date on which expenses were paid	Within two years from the date on which expenses were paid
Submit documents to	Your employer’s health insurance contact (e.g., General Affairs, Labor Management)	Operations (Benefits) Hitachi Health Insurance Society Higashi-Ochanomizu Building, 2-29, Kanda Awaji-cho, Chiyoda-ku, Tokyo, 101-0063
Others	A maximum limit applies to the amount paid. See the Notice of Medical Costs/Notice of Cash Benefit Decision to check the amount paid. A separate notification is required for injury or sickness attributable to third-party actions. Contact the contact point indicated below.	A maximum limit applies to the amount paid. See the Notice of Medical Costs/Notice of Cash Benefit Decision to check the amount paid. A separate notification is required for injury or sickness attributable to third-party actions. Contact the contact point indicated below.
Address inquiries to	Operations (Benefits) Hitachi health insurance society　 TEL 03-4554-3030	Operations (Benefits) Hitachi health insurance society　 TEL 03-4554-3030

If you were fitted with a corset or other equipment

Eligibility to join	Insured person (employee) If the symbol starts with "1".	Voluntarily and Continuously Insured Person If the symbol starts with "2".	Special-Case Retired Insured Person If the symbol starts with "3".
Application Form	Application support system Claim for Medical Care Expenses (Advance Payment, Prosthetic Equipment, etc.) （Connect to Hitachi Group Intranet.）	Claim for Medical Care Expenses (Advance Payment, Prosthetic Equipment, etc.) Example
Application Form	If you are unable to use the application support system Claim for Medical Care Expenses (Advance Payment, Prosthetic Equipment, etc.) Example
Documents to attach	Receipt indicating equipment details (original) Certificate from a doctor issued by a medical care institution clearly indicating the need for the equipment for medical reasons (original) Or Certificate of instruction to fabricate prosthetic equipment and fitting thereof For prosthetic footwear, a photograph of the equipment (actual equipment worn by the patient)	Receipt indicating equipment details (original) Certificate from a doctor issued by a medical care institution clearly indicating the need for the equipment for medical reasons (original) Or Certificate of instruction to fabricate prosthetic equipment and fitting thereof For prosthetic footwear, a photograph of the equipment (actual equipment worn by the patient)
Deadline	Within two years from the date on which expenses were paid	Within two years from the date on which expenses were paid
Submit documents to	Your employer’s health insurance contact (e.g., General Affairs, Labor Management)	Operations (Benefits) Hitachi Health Insurance Society Higashi-Ochanomizu Building, 2-29, Kanda Awaji-cho, Chiyoda-ku, Tokyo, 101-0063
Others	A maximum limit applies to the amount paid. See the Notice of Medical Costs/Notice of Cash Benefit Decision to check the amount paid. A separate notification is required for injury or sickness attributable to third-party actions. Contact the contact point indicated below.	A maximum limit applies to the amount paid. See the Notice of Medical Costs/Notice of Cash Benefit Decision to check the amount paid. A separate notification is required for injury or sickness attributable to third-party actions. Contact the contact point indicated below.
Address inquiries to	Operations (Benefits) Hitachi health insurance society　 TEL 03-4554-3030	Operations (Benefits) Hitachi health insurance society　 TEL 03-4554-3030

If you underwent acupuncture/moxibustion with a physician’s consent

Eligibility to join	Insured person (employee) If the symbol starts with "1".	Voluntarily and Continuously Insured Person If the symbol starts with "2".	Special-Case Retired Insured Person If the symbol starts with "3".
Application Form	Claim for Medical Care Expenses (for Acupuncture/Moxibustion) Example	Claim for Medical Care Expenses (for Acupuncture/Moxibustion) Example
Documents to attach	Application Form for Medical Care Expenses (for Acupuncture/Moxibustion) Obtain an Application Form for Medical Care Expenses from the acupuncture clinic where you received treatment. Receipt (original) Clearly indicating the name of the person treated Receipt Submittal Sheet (Physician’s) Letter of Consent (for Acupuncture/Moxibustion)	Application Form for Medical Care Expenses (for Acupuncture/Moxibustion) Obtain an Application Form for Medical Care Expenses from the acupuncture clinic where you received treatment. Receipt (original) Clearly indicating the name of the person treated Receipt Submittal Sheet (Physician’s) Letter of Consent (for Acupuncture/Moxibustion)
Deadline	Within two years from the date on which expenses were paid	Within two years from the date on which expenses were paid
Submit documents to	Your employer’s health insurance contact (e.g., General Affairs, Labor Management)	Operations (Benefits) Hitachi Health Insurance Society Higashi-Ochanomizu Building, 2-29, Kanda Awaji-cho, Chiyoda-ku, Tokyo, 101-0063
Others	The amount paid will be calculated based on standards for calculating acupuncture/moxibustion costs. See the Notice of Medical Costs/Notice of Cash Benefit Decision to check the amount paid. Health insurance does not cover acupuncture/moxibustion if you received treatment such as medication (including patches) or injection at a hospital or clinic for the same illness or injury. A separate notification is required for injury or sickness attributable to third-party actions. Contact the contact point indicated below.	The amount paid will be calculated based on standards for calculating acupuncture/moxibustion costs. See the Notice of Medical Costs/Notice of Cash Benefit Decision to check the amount paid. Health insurance does not cover acupuncture/moxibustion if you received treatment such as medication (including patches) or injection at a hospital or clinic for the same illness or injury. A separate notification is required for injury or sickness attributable to third-party actions. Contact the contact point indicated below.
Address inquiries to	Operations (Benefits) Hitachi health insurance society　 TEL 03-4554-3030	Operations (Benefits) Hitachi health insurance society　 TEL 03-4554-3030

Massage treatment with physician’s consent

Eligibility to join	Insured person (employee) If the symbol starts with "1".	Voluntarily and Continuously Insured Person If the symbol starts with "2".	Special-Case Retired Insured Person If the symbol starts with "3".
Application Form	Claim for Medical Care Expenses (for Massage) Example	Claim for Medical Care Expenses (for Massage) Example
Documents to attach	Application Form for Medical Care Expenses (for Massage) Obtain an Application Form for Medical Care Expenses from the massage clinic where you received treatment. Receipt (original) Clearly indicating the name of the person treated Receipt Submittal Sheet (Physician’s) Letter of Consent (for Massage)	Application Form for Medical Care Expenses (for Massage) Obtain an Application Form for Medical Care Expenses from the massage clinic where you received treatment. Receipt (original) Clearly indicating the name of the person treated Receipt Submittal Sheet (Physician’s) Letter of Consent (for Massage)
Deadline	Within two years from the date on which expenses were paid	Within two years from the date on which expenses were paid
Submit documents to	Your employer’s health insurance contact (e.g., General Affairs, Labor Management)	Operations (Benefits) Hitachi Health Insurance Society Higashi-Ochanomizu Building, 2-29, Kanda Awaji-cho, Chiyoda-ku, Tokyo, 101-0063
Others	The amount paid will be calculated based on standards for calculating massage costs. See the Notice of Medical Costs/Notice of Cash Benefit Decision to check the amount paid. A separate notification is required for injury or sickness attributable to third-party actions. Contact the contact point indicated below.	The amount paid will be calculated based on standards for calculating massage costs. See the Notice of Medical Costs/Notice of Cash Benefit Decision to check the amount paid. A separate notification is required for injury or sickness attributable to third-party actions. Contact the contact point indicated below.
Address inquiries to	Operations (Benefits) Hitachi health insurance society　 TEL 03-4554-3030	Operations (Benefits) Hitachi health insurance society　 TEL 03-4554-3030

If you had eyeglasses prepared to treat juvenile amblyopia

Eligibility to join	Insured person (employee) If the symbol starts with "1".	Voluntarily and Continuously Insured Person If the symbol starts with "2".	Special-Case Retired Insured Person If the symbol starts with "3".
Application Form	Application support system Claim for Medical Care Expenses (Advance Payment, Prosthetic Equipment, etc.) （Connect to Hitachi Group Intranet.）	Claim for Medical Care Expenses (Advance Payment, Prosthetic Equipment, etc.) Example
Application Form	If you are unable to use the application support system Claim for Medical Care Expenses (Advance Payment, Prosthetic Equipment, etc.) Example
Documents to attach	Receipt (original) In the name of the patient Or With notes clearly identifying the patient Prescription for eyeglasses prepared for therapeutic use from the physician in charge of treatment Prescription for eyeglasses prepared to treat juvenile amblyopia or similar conditions Or Certificate from a doctor clearly indicating the need for eyeglasses, etc. for medical reasons Results of patient examination This need not be attached if Document 2 above indicates results of vision examination, etc.	Receipt (original) In the name of the patient Or With notes clearly identifying the patient Prescription for eyeglasses prepared for therapeutic use from the physician in charge of treatment Prescription for eyeglasses prepared to treat juvenile amblyopia or similar conditions Or Certificate from a doctor clearly indicating the need for eyeglasses, etc. for medical reasons Results of patient examination This need not be attached if Document 2 above indicates results of vision examination, etc.
Deadline	Within two years from the date on which expenses were paid	Within two years from the date on which expenses were paid
Submit documents to	Your employer’s health insurance contact (e.g., General Affairs, Labor Management)	Operations (Benefits) Hitachi Health Insurance Society Higashi-Ochanomizu Building, 2-29, Kanda Awaji-cho, Chiyoda-ku, Tokyo, 101-0063
Others	A maximum limit applies to the amount paid. See the Notice of Medical Costs/Notice of Cash Benefit Decision to check the amount paid.	A maximum limit applies to the amount paid. See the Notice of Medical Costs/Notice of Cash Benefit Decision to check the amount paid.
Address inquiries to	Operations (Benefits) Hitachi health insurance society　 TEL 03-4554-3030	Operations (Benefits) Hitachi health insurance society　 TEL 03-4554-3030

Examination or treatment at a medical care institution overseas

Eligibility to join	Insured person (employee) If the symbol starts with "1".	Voluntarily and Continuously Insured Person If the symbol starts with "2".	Special-Case Retired Insured Person If the symbol starts with "3".
Application Form	Application support system Claim for Overseas Medical Care Expenses （Connect to Hitachi Group Intranet.）	Claim for Overseas Medical Care Expenses Example
Application Form	If you are unable to use the application support system Claim for Overseas Medical Care Expenses Example	Claim for Overseas Medical Care Expenses Example
Documents to attach	Receipt (original) Medical Consultation Details (statement) For medical or pharmaceutical For dental Overseas Medical Care Expenses (Japanese translation) Passport indicating the period of travel (copy) Pages indicating the name and stamp upon entry to or exit from the country visited Or Boarding passes or other documentation of overseas travel (copies) * Document 4 is not required for travel overseas for business reasons (i.e., accompanying family members of employees posted overseas, employees traveling overseas on business).	Receipt (original) Medical Consultation Details (statement) For medical or pharmaceutical For dental Overseas Medical Care Expenses (Japanese translation) Passport indicating the period of travel (copy) Pages indicating the name and stamp upon entry to or exit from the country visited Or Boarding passes or other documentation of overseas travel (copies)
Deadline	Within two years from the date on which expenses were paid	Within two years from the date on which expenses were paid
Submit documents to	Your employer’s health insurance contact (e.g., General Affairs, Labor Management)	Operations (Benefits) Hitachi Health Insurance Society Higashi-Ochanomizu Building, 2-29, Kanda Awaji-cho, Chiyoda-ku, Tokyo, 101-0063
Others	The amount paid will be calculated based on costs qualifying as insured examination and treatment in Japan. The amount paid will be calculated based on costs qualifying as insured examination and treatment. A separate notification is required for injury or sickness attributable to third-party actions. Contact the contact point indicated below.	The amount paid will be calculated based on costs qualifying as insured examination and treatment in Japan. The amount paid will be calculated based on costs qualifying as insured examination and treatment. A separate notification is required for injury or sickness attributable to third-party actions. Contact the contact point indicated below.
Address inquiries to	Operations (Benefits) Hitachi health insurance society　 TEL 03-4554-3030	Operations (Benefits) Hitachi health insurance society　 TEL 03-4554-3030

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