When you incur high medical care costs
The copayment for medical care costs you can be required to pay is capped. If your copayment calculated based on a certain standards exceeds this maximum, the excess amount will be paid as “High-Cost Medical Care Benefits”.
- When you want to reduce the amount of medical care costs you pay at the medical care institution
- When you face high copayments for medical care or long-term care
When you want to reduce the amount of medical care costs you pay at the medical care institution
| Required documents: | *Japanese version only |
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| Applies to: | Insured persons or dependents who expect to pay more than their Cost-Sharing Maximum Amounts for medical care costs incurred at the medical care institution over one month |
| Address inquiries to: | Health Insurance Association |
| Notes: | You can use this system for both inpatient and outpatient costs. A Certificate of Application of Maximum Copayment Amount cannot be issued retroactive to any date before the first of the month in which the Health Insurance Association receives the application form (i.e., it cannot be issued for the previous month). A Certificate of Application of Maximum Copayment Amount is used to reduce the amount of medical care costs temporarily paid up front. Even if you do not have this certificate, you will be reimbursed for medical care costs together with your salary three months after the month of the examination or treatment. Therefore, the copayment remains the same whether or not you have this certificate. Apply for a Certificate of Application of Maximum Copayment Amount if you need one. In general, a Certificate of Application of Maximum Copayment Amount will be issued and sent on the day the Health Insurance Association receives the application or on the following business day. (If the month of the examination or treatment is two months or more into the future, the certificate will not be issued until one month before the examination or treatment.) If you apply using an Individual Number instead of a health insurance card code/number, you must submit other documents separately to confirm the Individual Number and your identity. |
When you face high copayments for medical care or long-term care
| Required documents: |
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[Documents to attach] |
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| Deadline: | As soon as possible |
| Applies to: | Insured persons paying copayments for both medical care and long-term care for all individuals in the same household, for whom the total copayment amount paid under both systems over a one-year period exceeds the maximum amount |
| Address inquiries to: | Health Insurance Association |
| Notes: | For calculation purposes, the one-year period above refers to the period August 1 to July 31 the following year. |