New program aims to help DOD civilians in Japan get better health care 

Thousands of Defense Department civilians in Japan may get some help with access to local medical care under a new pilot program, but advocates are skeptical and point to continuing flaws in the system.

The nine-month pilot program for supplemental health support services begins Jan. 1 and runs through Sept. 29, according to the DOD announcement.

About 11,000 DOD civilians working in Japan will be eligible, ranging from commissary employees to DOD teachers and civilian health care providers, among others. Civilians will enroll during this year’s benefits open season from Nov. 11 to Dec. 9.

Defense Health Agency officials will announce more details about the program before the federal benefits open season begins. To be eligible, the employee must be enrolled in a participating health plan through the Federal Employees Health Benefits program.

DOD “recognizes the significant contributions of our DOD civilian workforce around the world….. we owe it to our civilians to facilitate access to health care no matter where they are,” Ashish Vazirani, acting under secretary of defense for personnel and readiness, said in DOD’s announcement.

The DOD established the pilot after a year-long effort to identify the concerns, according to the press release.

While DOD civilian access to health care in Japan has been a long-standing problem, critics say the situation worsened in 2022, when the Defense Health Agency restricted access to military treatment facilities in Japan, forcing many DOD civilians to depend on Japanese medical facilities. Medical billing has been one issue for these DOD civilians in Japan.

Japan Civilian Medical Advocacy, a grassroots advocacy program, says they welcome DOD’s steps to address the long-standing lack of medical access, but are concerned that the steps don’t go far enough, and should be addressed immediately.

The pilot program will include agreements with the insurance carriers who provide coverage under the Federal Employees Health Benefits Program in Japan, to establish direct billing. The non-appropriated fund employees in Japan are eligible for the program if they’re enrolled in an Aetna International plan.

Through a $4.2 million contract to International SOS Government Services Inc., the Defense Health Agency will provide a 24/7 call center, staffed with bilingual representatives to help identify needs, make appointments with health care providers and issue payment guarantees up front, according to the DOD announcement. International SOS is also the prime contractor for the Tricare Overseas Program.

But the proposed direct billing agreements are similar to existing International SOS supplemental services, “which have historically encountered substantial challenges,” the civilian advocacy group said in a statement.

“Japanese medical facilities retain the right to deny care at any time, even to active duty service members in life-threatening emergencies,” the group said. “Moreover, the availability of health care providers who meet U.S. standards remains insufficient.”

Dependents of these civilians aren’t eligible for these services during the pilot program, which is a “significant oversight,” the group said.

“Many of the most pressing health care challenges we encounter involve pregnancy, postpartum care, mental health, and pediatric cases – issues that impact entire families and ultimately affect mission readiness,” according to the advocacy group’s statement.

There’s also uncertainty about whether contractor employees and employees on temporary duty overseas are eligible for the pilot program.

Active-duty service members and Tricare Prime beneficiaries have priority in receiving health care in military hospitals and clinics, based on current federal law and DOD policy.

DOD civilians who aren’t Tricare beneficiaries are allowed to use military medical facilities on a space-available basis. Even DOD civilian medical providers can’t get care at the military hospitals in Japan where they are providing care, except on a space-available basis.