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
FAQ

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.

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:
  • 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 Ⅰ or Ⅱ
  • If you are in the low income category (certificate of application of maximum copayment/reduced standard copayment)
Address inquiries and Submit to: The person in charge of social insurance administration at your company (If you are voluntarily and continuously insured, please inquire with the Health Insurance Society instead.)
Notes: You can use this system for both inpatient and outpatient costs.

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

Required documents:

[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: The person in charge of social insurance administration at your company (If you are voluntarily and continuously insured, please inquire with the Health Insurance Society instead.)
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)

Required documents:
Deadline: As soon as possible
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: The person in charge of social insurance administration at your company (If you are voluntarily and continuously insured, please inquire with the Health Insurance Society instead.)
Notes:

Apply to the health insurance society of which you are a member as of the basis date.

Reference link