Alyssa Lane
Accenture offers medical insurance benefits to its employees, which can be claimed in two ways: through the provision of medical care to treat sickness or injury, or by reimbursing the cost of medical care. In Japan, billing and payment are conducted through healthcare bill check and payment organizations such as the Health Insurance Claims Review & Reimbursement Services (HICRRS). The Health Insurance Society is billed for medical care costs about two months later, and other payments are made at least three months after the month of medical care. It is important to note that insurance benefits are only available for treatments authorized in advance by the national government as eligible for insurance coverage.
| Characteristics | Values |
|---|---|
| Type of insurance benefits | Provision of medical care, provision of money to cover the cost of medical care |
| What is covered | Nonoccupational sickness or injury, childbirth, death |
| What is not covered | Vaccinations, injuries sustained in juvenile training schools, penal institutions, detention facilities |
| Billing and payment | Conducted through healthcare bill check and payment organizations such as the Health Insurance Claims Review & Reimbursement Services |
| Cost structure | 20% co-pay applicable |
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What You'll Learn
Billing and payment for medical insurance
Billing Process
After you receive medical services, your doctor's office will typically submit a bill, also known as a claim, to your insurance company. This claim outlines the services provided to you during your visit. The insurance company will then review the claim and determine the amount they will cover. It's important to note that not all services may be covered, and you may be responsible for paying certain charges not included in your insurance plan.
Payment Process
Once the insurance company has processed the claim, they will send a payment to your doctor's office for the covered services. You may receive an Explanation of Benefits (EOB) from your insurance company, which details the services provided, the amount billed, the allowed amount, any co-payments or deductibles, and the amount paid to the provider. It's important to review the EOB carefully to understand what your insurance company is paying for and what you may be responsible for paying.
Your Responsibilities
As the patient, you may be required to make certain payments, such as co-payments (a fixed fee for each service) or deductibles (an annual amount you pay before your insurance plan covers the rest). These payments are typically made directly to the healthcare provider or doctor's office. Additionally, if you have any balances remaining after insurance payment, such as for non-covered services or amounts not paid by insurance, you will be responsible for settling those charges.
Understanding the Billing Statement
When reviewing billing statements, pay attention to the dates of service, descriptions of services, and corresponding charges. If there are any discrepancies or unclear items, don't hesitate to contact your doctor's office or insurance company for clarification. Keeping your EOBs and statements organized can make it easier to track and understand your medical expenses.
Insurance Coverage
It's important to understand what services are covered by your insurance plan. Some plans may have specific exclusions, such as immunizations or experimental treatments. Review your insurance policy or contact your insurance provider to clarify any coverage-related questions. Additionally, if you have multiple insurance plans, coordinate your benefits to determine the primary and secondary carriers.
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Medical care services provided
Benefits-in-kind are available for the treatment of non-occupational sickness or injury. This includes treatment at a hospital or clinic providing medical care covered by health insurance. However, it is important to note that benefits are only provided for treatments authorized in advance by the national government as eligible for insurance coverage. Worker's Accident Compensation Insurance is also available for injuries sustained at work or during your commute.
Cash benefits are provided to cover the cost of medical care. This includes the cost of treatment for sickness or injury. Medical care institutions bill the Health Insurance Society for its share of the costs of sickness and injury treatment received by members on a monthly basis. Billing and payment are conducted through healthcare bill check and payment organizations, such as the Health Insurance Claims Review & Reimbursement Services (HICRRS).
In addition to benefits-in-kind and cash benefits, the Accenture Health Insurance Society also provides coverage for childbirth and death. This includes payment for authorized treatments and services related to these events. It is important to note that vaccinations are not covered by health insurance, but health service points can be used for them in certain cases.
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Cash benefits
For childbirth, the Childbirth and Childcare Lump-Sum Grant is provided to assist with costs. This grant can be used in two ways: through direct payment to medical institutions or by having the medical institution receive the grant on the insured person's behalf. In the latter case, the insured person only pays the amount of childbirth expenses minus the grant. Additionally, the Health Insurance Society provides its own independent benefits beyond the Childbirth and Childcare Lump-Sum Grant, offering an additional 50,000 yen for an insured person and 30,000 yen for a dependent family.
In the event of an employee's death, their nominee would be entitled to a lump sum payout covered under the Future Service Liability (FSL) insurance. Furthermore, if an employee becomes disabled and unable to work, Accenture will continue to pay a portion of their salary for up to 180 days.
It's important to note that billing and payment for medical care costs are typically handled by organizations such as the Health Insurance Claims Review & Reimbursement Services (HICRRS). The Health Insurance Society is billed for these costs about two months after the initial claim. Other payments, such as the distribution of benefits to individual members, usually take place at least three months after the month of medical care.
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Nonoccupational sickness or injury
If you are an Accenture employee and are suffering from a nonoccupational sickness or injury, you can avail of treatment at a hospital or clinic providing medical care covered by your health insurance. This includes instances where you have paid the entire medical care cost upfront or taken time off from work due to sickness.
In the case of nonoccupational sickness or injury, insurance benefits are restricted for individuals in Juvenile Training Schools, penal institutions, detention facilities, or similar facilities. This is due to the availability of alternate medical care benefits at public expenditure.
If you are hospitalized for a nonoccupational sickness or injury, measures are in place to reduce the burden of medical care costs. You may also be eligible to receive the Injury and Sickness Allowance concurrently with other benefits, such as the Maternity Allowance or the Childbirth and Childcare Lump-Sum Grant.
To claim medical insurance for a nonoccupational sickness or injury, you will need to notify the Health Insurance Society and submit relevant documentation. This may include a medical certificate, a copy of your health insurance card, and proof of employment or loss of employment. If you have recently left your employer, you will need to return your health insurance card and join an appropriate medical care insurance program based on your individual circumstances.
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$25.99
Worker's Accident Compensation Insurance
If you are an Accenture employee, you can benefit from the Worker's Accident Compensation Insurance in case of injuries sustained at work or while commuting. This insurance covers medical expenses for workplace injuries and death benefits. It also covers certain lost wages on a temporary and permanent basis.
It is important to note that you cannot receive benefits from both Worker's Accident Compensation Insurance and regular Health Insurance for the same injury. Health insurance is meant for non-occupational sickness or injury and provides benefits in two ways: by providing the medical care itself to treat a sickness or injury, and by providing money to cover the cost of medical care. "Benefits-in-kind" refer to the provision of medical care, while "cash benefits" refer to the provision of cash to cover medical care costs.
Billing and payment of medical care costs for Accenture employees in Japan are carried out through healthcare bill check and payment organizations such as the Health Insurance Claims Review & Reimbursement Services (HICRRS).
Occupational Accident Insurance is another option for independent contractors and business owners who are not covered under a Workers' Compensation policy. Occupational Accident Insurance can be a cost-effective solution, providing similar coverage for work-related injuries at a lower premium than Workers' Compensation. It is widely accepted, especially in trucking and other industries.
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Frequently asked questions
The Accenture Health Insurance Society is the name of the insurance benefits system at Accenture. It provides medical care services and covers the payment for these services in the event of non-occupational sickness, injury, childbirth, and death.
The benefits of the system are provided in two ways: the provision of the medical care itself to treat a sickness or injury, and the provision of money to cover the cost of medical care.
Billing and payment are conducted through healthcare bill check and payment organizations, such as the Health Insurance Claims Review & Reimbursement Services (HICRRS). The Health Insurance Society is billed for medical care costs about two months later.
Insurance benefits are only available for treatment authorized in advance by the national government as eligible for insurance coverage. They are also restricted for individuals in Juvenile Training Schools, penal institutions, detention facilities, or similar facilities.
