Insurance application feature

What will change now with insurance application

Until now, all treatments were self-paid.

Before insurance coverage, each medical facility could set its own prices. This resulted in significant differences in cost between clinics, sometimes exceeding ¥200,000 for the same treatment.
→ Now that fertility treatments are covered by insurance, each procedure has a standardized fee under the national insurance system. This has eliminated price differences between clinics.

Although the timing of billing varied between medical facilities, patients were typically charged the full 100% of the treatment cost.
→With insurance coverage now in place, patients are generally responsible for only 30% of the total treatment cost.

There is less flexibility in choosing treatments

Fertility treatments have been rapidly evolving, with new specialized techniques and culture media continually emerging.
Until now, medical facilities would carefully evaluate and select which technologies and culture media to use, often incorporating specialized techniques as optional additions to existing treatments.
→With the introduction of insurance coverage, approved techniques can now be performed under insurance. However, techniques that have not yet been approved must still be offered as self-paid treatments.

という形で治療を行うことができます。 翻訳文章：However, mixed billing combining self-paid and insurance-covered treatments is not permitted. Therefore, if treatment includes any techniques not covered by insurance, the entire process must be conducted as self-paid treatment.
Some advanced medical technologies and tests, while not covered by insurance, are recognized as advanced medical care. In such cases, treatment can be provided as a combination of insurance-covered care and advanced medical care.

Abolition of subsidies

Until now, subsidies have been provided by the national government and local municipalities; however, following the introduction of insurance coverage for fertility treatments, these subsidies are scheduled to be phased out after a grace period.
→While the inclusion of artificial insemination—previously not covered by subsidies—under insurance coverage is a significant benefit, some patients will continue to undergo egg retrieval through self-paid treatment. Additionally, in certain cases, patients who had embryo transfers before insurance coverage began experienced lower out-of-pocket costs.

※Note: Based on initiatives for "medical expense subsidies" by local governments (Ministry of Health, Labour and Welfare)

(Figure 1) When Only National Subsidy Programs Are Used

(Figure 2) When Combined with Local Government Subsidy Programs

(Figure 3) Scope of Subsidy Coverage

Advantages and disadvantages

Advantages

• ●With insurance coverage, the perception that fertility treatments are expensive has changed, making it easier for patients to undergo treatment.
• ●Reduction of out-of-pocket costs
• ●Cost differences between medical institutions have been eliminated

Disadvantages

• ●Increased out-of-pocket costs for patients not covered by insurance
• ●The range of treatment options has narrowed
• ●The frequency and timing of clinic visits have changed (especially for men).

About Advanced Medical Care

Techniques not currently covered by insurance but expected to be included in the future can be performed as advanced medical care.
Each technique has specific indications, and if these criteria are met, advanced medical care can be provided alongside insurance-covered treatments.
If you have supplemental insurance with advanced medical care coverage, you may be reimbursed for these costs.

About the High-Cost Medical Expense Benefit System

Even though it became covered by insurance, the out-of-pocket amount still exceeds 100,000 yen and is not a small expense.
The High-Cost Medical Expense Benefit System can be used for treatment.
Please make your payment once at our hospital’s reception, then apply for a refund yourself, or before starting treatment, apply to your health insurance society or similar organization for the issuance of a “Certificate of Eligibility” (Certificate of Application for the Maximum Amount).
If you submit the Certificate of Eligibility at our hospital reception, your payment at the counter will be limited to a fixed amount.
However, claims must be made within the same month, and the maximum limit varies depending on factors such as annual income, so please contact your health insurance society or relevant organization for details.
※From “For Everyone Using the High-Cost Medical Expense Benefit System” (Ministry of Health, Labour and Welfare)

Mechanism of high-cost medical care expense system