EY Japan
Health Insurance Society

1. The Health Insurance Society has configured a master database (hereinafter, “master data”) including an enrollee ledger and stores data on computers for operational processes to use throughout the entire health insurance society for input and processing of health insurance card numbers, names, dates of birth, genders, addresses, monthly remuneration and other items included in Notifications of Qualification as an Insured Person or Notifications of Change of Dependents when individuals enroll in the health insurance society.
2. The Health Insurance Society issues health insurance cards after verifying Notifications of Qualification as an Insured Person and Notifications of Change of Dependents.
3. When a Notification of Change of Dependents is submitted, certification is carried out based on income-certifying documents such as taxation/non-taxation certificates, copies of student ID cards, etc.
4. The Health Insurance Society requires insured persons to return health insurance cards when submitting a notification of forfeiture of eligibility, which are verified and stored for a fixed period of time before disposal.
5. The Health Insurance Society updates the data registered as master data according to applicable change (correction) notifications to update or add information to the master data.
6. The Health Insurance Society correlates data on benefits, insurance claim statements, health examination and other relevant data using the master data to verify benefit payments and other processes, to identify persons related to notifications on medical care costs and various other healthcare services, and to contact enrollees.
7. The Health Insurance Society may contact individuals using the address, name or any other contact information included on notifications or in the master data as necessary even after said individual loses eligibility as an insured person of the health insurance society.
8. The Health Insurance Society answers inquiries about qualification or forfeiture of eligibility and other such health insurance-related healthcare questions from healthcare providers, other insurers (including municipalities and pension offices), using personal information in the master data such as health insurance card numbers, names, dates of birth, genders, dates of qualification, or dates of forfeiture of qualification, after verifying the identity of the person making the inquiry.
9. The Health Insurance Society may ask other insured persons or third parties about health insurance card numbers, names, dates of birth, genders, dates of certification or loss of qualification or other information in the master data to make adjustments of duplicate benefits of other insured persons or healthcare providers if any discrepancies arise, such as examinations after an individual loses eligibility as an insured person.
10. The Health Insurance Society incorporates data from notifications on the calculation basis and monthly changes into the master data to charge insurance premiums, including adjusted insurance premiums and long-term care insurance premiums. In addition, the Health Insurance Society requests employers submit salary and bonus ledgers and other documentation for review when submitting a notification.
11. Some of the work of creating and inputting the master data, issuance of health insurance cards, and preparation of premium payment notices, etc., will be outsourced to a contractor.
12. The Health Insurance Society provides health insurance card numbers, names, dates of birth, genders, and addresses included in the master data about individuals applying for a physical examination to contract healthcare providers to use when sending results from the examination.

1. The Health Insurance Society enters data on computers for business processing and reviews application details to make proper payment decisions.
2. Payment records are saved as data entries and used for subsequent application checks.
3. The Health Insurance Society may ask a third-party insured person about health insurance card numbers, names, dates of birth and other information in the master data about individuals requesting childbirth and childcare lump-sum allowances or dependents’ childbirth and childcare lump-sum allowances when necessary for adjusting duplicate benefits of other insured person to make payment decisions.
4. The Health Insurance Society responds to inquiries about whether a request was made for childbirth and childcare lump-sum allowances or dependents’ childbirth and childcare lump-sum allowances from other insured persons by providing information about applications and benefits after verifying the identity of the person making the inquiry.
5. The Health Insurance Society reviews data on insurance claim statements of individuals requesting injury or illness allowance and asks the physician in charge for verification or evaluation, the status of medical treatments, and any other applicable information as necessary to make payment decisions.
6. We will outsource to outside vendors the processing for entry of benefit-related application documents in the Health Insurance Society’s computers for administrative processing, the checking of application contents, payment processing, etc.

1. The Health Insurance Society stores images and data of health insurance claim statements by the Health Insurance Claims Review & Reimbursement Services on its computers for business processing to use in healthcare businesses.
2. The Health Insurance Society reviews insurance claim statement data and requests a secondary evaluation by the Health Insurance Claims Review & Reimbursement Services for any questions arising about a claim.
3. As part of this request for a secondary evaluation, the Health Insurance Society shares the name of the health insurance society, the health insurance card number, name, date of birth, date of loss of qualification, the date on which medical care was provided and other relevant information with the healthcare provider for confirmation if a question arises about an exam after the individual loses their qualification as an insured person.
4. As part of a review of whether there are public expenditures of patients expected to pay high-cost medical expenses or medical cost subsidies from a municipality, the Health Insurance Society shares the name of the health insurance society, the health insurance card number, name, date of birth, and other relevant information with the healthcare provider for confirmation.
5. The Health Insurance Society uses insurance claim statement data to analyze medical costs and ensure no billing errors of the health insurance society as well as to provide post-health guidance after health checkups, and to identify candidates for education to prevent lifestyle-related diseases.
6. The Health Insurance Society uses insurance claim statement data to identify and provide guidance to enrollees who have undergone examinations at several healthcare providers in the same month.
7. The Health Insurance Society uses insurance claim statement data to make decisions on payments of high-cost medical expenses and benefits, such as co-payment reductions, additional aggregated high-cost medical expenses, and additional family medical expenses.
8. The Health Insurance Society refers to insurance claim statement data to make payment decisions about injury and illness allowances.
9. The Health Insurance Society refers to insurance claim statement data to make payment decisions about therapies and other medical treatments performed by judo therapists as well as medical costs for family dependents.
10. The Health Insurance Society refers to insurance claim statement data to make payment decisions about funeral expenses of an insured person or family.
11. The Health Insurance Society responds to requests for disclosure of insurance claim statements by providing relevant data for said insurance claim statements. Moreover, the Health Insurance Society only discloses information to approved parties in accordance with disclosure rules pertaining to disclosure requests.
12. The Health Insurance Society provides insurance claim statement data to contractors to notify enrollees of medical care costs.
13. The Health Insurance Society submits copies of insurance claim statements of relevant patients for any medical care provided due to traffic accidents or actions of a third party to non-life insurance companies and administrative contractors handling reimbursement of medical costs.
14. The Health Insurance Society outsources Japanese translations of statements of medical care costs and other documentation received from healthcare providers overseas to an external translation contractor.
15. The Health Insurance Society sends a copy of insurance claim statements and applications including some of the details in the course of applications to joint projects to pay high-cost medical expenses run by the National Federation of Health Insurance Societies (Kenporen) to receive subsidy grants.
16. Insurance claim statement data is stored in the Health Insurance Society computers, and the Health Insurance Society engages a contractor to check the details of the health insurance claims, perform re-examination procedures, and process payments for high-cost medical care and other expenses.

1. The Health Insurance Society outsources health checkups to medical contractors.
2. The Health Insurance Society receives the numerical result data from the medical contractor and notifies the patient of said results. The results data is also used to provide guidance after the checkup and identify candidates for education to prevent lifestyle-related diseases.
3. The Health Insurance Society provides health checkups in cooperation with employers. Accordingly, the Health Insurance Society contacts every employer about the numerical results of health checkups of insured persons (employees) as a general rule, and Health Insurance Society and the employer both store a copy to help in the health management of insured persons.
4. The Health Insurance Society saves result data from health checkups as master data to compare with future data for reference in the provision of health management services and health guidance.

1. The Health Insurance Society provides health insurance card numbers, names, genders, and addresses included in the master data about users of the Cafeteria Plan to contractors to use for various purchasing applications.
2. The Health Insurance Society uses health insurance card numbers, names and addresses in the master data when providing various healthcare services.
3. Payment of subsidies, etc. is outsourced to a vendor.

1. The Health Insurance Society carefully stores all materials about the appointment and hiring of EY Japan officers and employees after use.
2. The Health Insurance Society carefully stores all materials about the remuneration of EY Japan officers and employees to use for tax withholdings and other such processes.
3. The Health Insurance Society uses the List of Society Committee Members and List of Directors when contacting committee members and directors regarding the holding of Society Meetings, Board of Directors Meetings, etc.
4. The Health Insurance Society uses the List of Health Insurance Representatives at Workplaces at the Health Management Promotion Committee and in other business-related liaison work.

The Details of Medical Care Costs/Notice of Decision on Insurance Benefits established under “Purposes of Use of Personal Information” can be provided to third parties when “third parties” refers to dependents in the case of an insured person or to the insured person in the case of the insured person’s dependents.

1. Items of personal information provided to third parties
   name of person undergoing examination or treatment; year and month of examination; cost of examination or treatment; copayment; name of medical care institution providing examination or treatment; amount of cash benefits paid by the Health Insurance Society; amount of additional benefits
2. Means or method of provision:
   The Details of Medical Care Costs/Notice of Decision on Insurance Benefits, including the information under paragraph 1 above, will be posted to the insured person’s health insurance homepage each month. (Unchanged from existing method)