When you incur high medical care costs

Your copayment for medical care costs is capped. If your copayment calculated based on certain standards exceeds the maximum, the excess amount will be paid as "High-Cost Medical Care Benefits".

Description
Procedures

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. Doing so will allow the provision of your cost-sharing maximum amount information via online eligibility verification, eliminating the need for a Certificate of Application of Maximum Copayment Amount.

Required documents:
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:
  • If you are eligible to be issued a Health Insurance Eligibility Certificate that does not include information equivalent to the Certificate of Application of Maximum Copayment Amount (and if you are 70 or older, in the same income category as active workers Ⅰ or Ⅱ)
  • * 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: First Operation Section, Second Operation Section
Staff in charge of benefits
Notes: You can use this system for both inpatient and outpatient costs.

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

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: First Operation Section, Second Operation Section
Staff in charge of benefits
Notes: For calculation purposes, the one-year period above refers to the period August 1 to July 31 the following year.

If you are aged 70 or older and incurred high annual costs for outpatient care (annual total of outpatient costs)

Applies to:

Insured persons and dependents aged 70 or older whose total copayments for outpatient care during the one year period (from August 1 of the previous year to July 31) exceeded 144,000 yen

  • * This benefit is available only to those whose income category is "general" or "low income" as of the basis date (July 31, or the day before the date of death in the event of the death of the insured person).
  • * Calculations of High-Cost Medical Care Benefits exclude copayments paid during a period in which the insured person belonged to the "same income level as active workers" category.
Address inquiries to: First Operation Section, Second Operation Section
Staff in charge of benefits
Notes:

* The Health Insurance Society calculates the benefit amount based on medical cost details and pays it automatically in January of the following year.
Apply to the health insurance society of which you are a member as of the basis date.
If you were covered by another health insurance plan for any time during the past year, obtain a copayment certificate from the previous health insurer.

Reference link