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

Required documents:
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
Submission destination Send the application form
Notes: You can use this system for both inpatient and outpatient costs.
Without no application for issue of a co-payment maximum certificate or no presentation of your certificate at the reception desk of the hospital,the Health Insurance Society provides a cash payment as High-cost Medical Care Benefits at a later date.At the Health Insurance Society, this is carried out automatically, so there is no need to make an application. Note that because the calculation is made on the basis of the "detailed medical fee statement" sent to the Health Insurance Society by the hospital, the payment will be made around three months end of the month after the 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
Submission destination Send the application form
Notes: For calculation purposes, the one-year period above refers to the period August 1 to July 31 the following year.

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