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”.

Procedures

Description

When you want to reduce the amount of medical care costs you pay at the medical care institution

We recommend using a Myna health insurance card.
By doing so, your cost-sharing maximum amount information will be provided with no need to give your consent and you will no longer need a Certificate of Application of Maximum Copayment Amount.
However, if you fall under [Applies to:] below, we will issue a conventional Certificate of Application of Maximum Copayment Amount.
Contact the AIG Health Insurance Association (aigkenpo@aig.co.jp) so that we can send you an application form.

Required documents:

*Japanese version only

Applies to:

Insured persons or dependents whose copayment amounts for one month are expected to exceed their individual cost-sharing maximum amounts in the following cases:

Examinations and treatment received at a medical care institution or other facility that has not adopted the online eligibility verification system
When not using a Myna health insurance card
When not using a Myna health insurance card and you are 70 or older and in the same income category as active workers Ⅱ (standard monthly remuneration: 530,000 - 790,000 yen) or Ⅰ (standard monthly remuneration: 280,000 - 500,000 yen

* Even when using a Myna health insurance card, those in the low income category must apply in advance for a Maximum Copayment/Reduced Standard Copayment Certificate to be treated as falling in the low income category.

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.)

When you face high copayments for medical care or long-term care

Required documents:

“Application for Payment of High Aggregate Cost for Long-Term Care Service”

[Documents to attach]
Copayment certificate for long-term care insurance

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.