Subsidy for childbirth costs in Japan

It is common knowledge that families taking National Health Insurance (kokumin hoken) can apply for and receive a subsidy to partially offset the costs of childbirth. Since October 2006, the subsidy is 350,000 yen in Tokyo, but in trying to encourage higher birth rate, some cities like Osaka offers even higher subsidy for the third child onwards. Given that the costs of childbirth range from 380,000 to 550,000 at ‘normal’ hospitals, the subsidy of 350,000 is greatly appreciated by many.

Still, often Malaysian post-graduate students know little of the existence of another bigger subsidy for childbirth apart from the above-mentioned one. For JPA students who could get reimbursements from JPA for childbirth, it might mean little, but for Mambusho and other self-funded students, this other subsidy means a lot. We learned about the existence of this subsidy from undergraduate students – as well as tips on how to get reduction to pay kokumin hoken, etc.

So, let me share the procedure on how to get this particular subsidy. However, this subsidy is only applicable to full-time students/ wives of full-time students, whose head of household is here under College Student visa, and do not have a source of income here in Japan – scholarship is not considered as source of income for this purpose. Both husband/wife must be registered under kokumin hoken to be eligible for this subsidy.

First, the wife must get her boshi techo (mother and child healthbook). This can be done by getting a “ninshin shoumeisho” from the doctor who confirmed the pregnancy, and exchanged for a boshi techo at the city/ward health center. The boshi techo is usually given with various supplement pamphlets, including two tickets for “free” check-up; one to be used in the first half of pregnancy, the other in the second half. Women over 35 years will also receive a free ticket for scanning the baby once.

Once this is done, consult the Child Welfare (not the Health Insurance) desk on how to get a subsidy for childbirth by student/spouse of student. This varies from city to city, but in my particular ward, the real application could only be submitted after 35 weeks of pregnancy. What we did first however was to confirm if we were eligible for the scheme (we were), to get advice on which Hospital to go which will accept payment using this scheme, as well as advice on documents we need to submit for the real application.

Normally, people using this scheme will be advised to go to government-owned hospitals. However, in my case, since there is no government hospital in the vicinity (Taito-ku or Sumida-ku) which provides maternity services, I was advised to go to San Iku Kai Byoin, a private hospital which collaborates with my ward office regarding this scheme. It is advisable to go for check-ups at the designated hospital earlier on, because changing hospitals at the last minute could be quite a hassle.

On the 35^th week of pregnancy, go back to the Child Welfare desk for actual application of the scheme. Normally one would be asked to bring:

• Daigaku shomeisho (student certification from the university), huband/wife;
  
• Gaijin torokusho (Alien card), for both husband and wife;
• Boshi techo;
• Hokensho (medical insurance card), for both husband and wife;
• Hikazeisho (proof of no income. Could be obtained from the Tax section of city/ward office by showing proof that you are a student under scholarship), for both husband and wife, or in my case, just the head of household;
• Passport, for both husband and wife.

There will be a simple interview, and then you will be asked to wait for a certificate of some sort which will be sent by post. This certificate, stating that the childbirth costs would be paid by the ward office, must be submitted to the hospital when you go there for childbirth. Having this certificate means that you only have to pay very minimal charges at the hospital.

In my case, I was asked for a deposit of 35,000 yen, and then 20,000 yen was returned upon discharge from the hospital whereas the actual cost for childbirth at San Iku Kai was about 400,000 yen. I was later asked to pay 35,000 yen at the Child Welfare division at the ward office – meaning I only have to pay 50,000 yen instead of paying 400,000 yen

On top of that, I was still eligible to collect the 350,000 yen subsidy mentioned in the first paragraph. All the Health Insurance division wanted apart from my hokensho before giving me a fat "congratulatory" envelope, was proof that I had already given birth as documented in my boshi techo. (In fact, once a friend whose wife gave birth in Malaysia, was also eligible to collect this subsidy. But that happened in Gyotoku, where the officers in charge are often less kibishi than in other city/ward offices)

In short:

Without special subsidy:

• Hospital charges: 400,000 yen
• (offset by) Normal subsidy: 350,000 yen
• Total spending: 50,000 yen

With special subsidy (only applicable at appointed hospitals by respective ward/city office)

• Hospital charges + payment to ward office: 50,000 yen
  (the bulk of hospital charges was paid by ward/city office)
• (topped by) Normal subsidy: 350,000 yen
  
• Total earning: 300,000 yen