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HOME > When you become sick or injured?> When your medical costs grow large > In cases in which personal payments for medical and long-term care are remarkably high
In cases in which personal payments for medical and long-term care are remarkably high
 

When an insured person or dependent in the same household pays copayments for both medical and long-term care, if the total amount of copayments under health insurance and long-term care insurance over a period of one year (August 1 through July 31, referred to as the "calculation period") exceeds the maximum copayment amount, the amount in excess of that maximum will be reimbursed in cash at a later date by the health insurance provider as high aggregate cost for long-term care service, and by the long-term care insurance provider as high aggregate cost for long-term care service, with the amount paid by each corresponding to the percentage of the excess amount accounted for by each type of insurance. This is not paid when the amount in excess of the maximum is 500 yen or less.

Note: This is not paid when no copayment has been paid for either health insurance or long-term care insurance.


Maximum co-payments by income and age category


Category Under 70 years 70-74 years
830,000 yen or more
of standard monthly remuneration		 2,120,000 yen
530,000 yen - 790,000 yen
of standard monthly remuneration		 1,410,000 yen
280,000 yen - 500,000 yen
of standard monthly remuneration		 670,000 yen
260,000 yen or less
of standard monthly remuneration		 600,000 yen 560,000 yen
Persons with low income Persons with low income (II) *1 340,000 yen 310,000 yen
Persons with low income (I) *2 190,000 yen

Note:

The annual amount is calculated for the 12-month period from August 1 through July 31.

*1

Persons aged 70-74 who are insured persons and dependents, and exempt from paying municipal tax.

*2

Persons aged 70 or above in households whose insured persons and dependents are all exempt from paying municipal tax and whose incomes meet certain standards (e.g., annual income of 800,000 yen or less).


Procedure

On or after the day after (August 1) the ending date of the calculation period (July 31), fill out the required information on the following documents, attach a document certifying the amount of your copayment under long-term care insurance, and submit these to the Health Insurance Society.

Procedural
Documents:

1.

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

2.

Copayment Certificate

*Applying for a copayment certificate

Submit the Application for Benefits/Application for Issue of a Copayment Certificate to your municipality (municipality in which the insured person under long-term care insurance resides) to have a copayment certificate issued for a long-term care insurance copayment. If you were covered under another health insurance plan such as another health insurance society or National Health Insurance during the calculation period and you paid a copayment under such insurance, you will need to submit a similar application to that insurer.


For which household can aggregate copayments be totaled ?

The household for which aggregate copayments can be totaled is the household as defined for medical insurance purposes, consisting of the insured person and his or her dependents under health insurance.


Calculating the amount of high aggregate cost for long-term care service

Copayments eligible for this system are health insurance copayments (not including those for high-cost medical care benefits or additional benefits) and long-term care insurance copayments (not including those for high long-term care service costs) paid during the calculation period by the insurance person or dependent as of the ending date of the calculation period (July 31).

Copayments paid during the calculation period under another health insurance plan such as another health insurance society or National Health Insurance may be included in the aggregate total as well.As with high-cost medical care benefits, assistance for high aggregate cost for long-term care service excludes the cost of meals and accommodations and premium beds.

For persons less than 70 years of age, copayments of less than 21,000 yen/month are not eligible.


I was covered under another health insurance society through March. Can I include the copayments I paid over that period in the aggregate total as well?

Yes, you can. In this case, you will need to apply to your previous health insurance society for issuance of a copayment certificate. When reimbursement is made for high aggregate cost for long-term care service, your previous health insurance society will reimburse the amount corresponding to the percentage of eligible copayments made under its coverage.

My father, who lives with me, is covered under the long life medical care system. Can his copayment be included in the aggregate total too?

Since under the medical insurance system insured persons covered under the long life medical care system are not considered to be part of the same household as insured persons under other plans, in this case your father's copayment cannot be included in the aggregate total.
Howeber, if your father was your dependent for any period during the calculation period, his copayment for that period can be included in the aggregate total.

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