When you incur high medical care costs

High-Cost Medical Care Benefits (for dependents, "Dependents' High-Cost Medical Care Benefits")

Amount paid

If the copayment amount for medical care costs paid at the reception desk of the hospital becomes high, the Health Insurance Society will pay the amount beyond a certain figure later (the Cost-Sharing Maximum Amount) to help ease the burden of medical care costs. This is referred to as "High-Cost Medical Care Benefits" (for dependents, "Dependents' High-Cost Medical Care Benefits").

High-Cost Medical Care Benefits are calculated for medical care costs incurred over a one-month period, from the first through the last day of the month. High-Cost Medical Care Benefits are also calculated on a per-person, per-hospital (outpatient/inpatient, medical/dental, etc.) basis.

If you want to make sure the amount you pay at the reception desk of the hospital will not exceed the Cost-Sharing Maximum Amounts

By using a Myna health insurance card, you can ensure that the amount of medical care costs the hospital bills you (per month) will not exceed the individual cost-sharing maximum amount and thus reduce the amount you must pay at the reception desk of the hospital, because your cost-sharing maximum amount information will be provided with no need to give your consent.
(Available for both inpatient and outpatient care)

See here for more information.

Reference link

• Using Individual Number Cards as health insurance cards

Note that you will need a Certificate of Application of Maximum Copayment Amount in the following cases. If you need this certificate, apply in advance.

• Examinations and treatment received at a medical care institution or other facility that has not adopted the online eligibility verification system
• If you are in the low income category (certificate of application of maximum copayment/reduced standard copayment)

Reference link

• When you incur high medical care costs「When you want to reduce the amount of medical care costs you pay at the medical care institution」

How High-Cost Medical Care Benefits are calculated

Calculation example: If the copayment for one months' medical care costs is 300,000 yen (for an insured person with 280,000 yen - 500,000 yen of standard monthly remuneration)

If your copayment is reduced still further

You can combine copayments for an entire household (Total High-cost Medical Care Benefits)

Even when the copayment for one case for one month is less than the maximum, if members of the same household have made copayments of 21,000 yen or more multiple times in the same month, they can combine those amounts for the purposes of the Cost-Sharing Maximum Amount.
If the total amount exceeds the Cost-Sharing Maximum Amount, then the excess amount is paid by the Health Insurance Society as "Total High-cost Medical Care Benefits".

The Cost-Sharing Maximum Amount will be reduced for frequent qualification of expenditures.

If a single household qualifies for High-Cost Medical Care Benefits three or more months in a single year (the most recent 12 months), the Cost-Sharing Maximum Amount will be reduced to the amount of the table below starting with the fourth month.

• **See here for persons aged 70-74.
• **See here concerning persons with low income.

Those receiving treatment for specified diseases and disorders

The amount paid to the medical care institution will not exceed 10,000 yen per month for patients with haemophilia, patients with AIDS receiving antiviral drugs, and patients with chronic nephritis who require artificial dialysis for an extended period, if they have been certified as having specified diseases and disorders. However, if a patient requiring artificial dialysis and under 70 years of age qualifies as a person with 530,000 yen or more of standard monthly remuneration, his or her copayment will be 20,000 yen/month.
If you are eligible, apply to the Health Insurance Society as a recipient of specific disease treatment.

If copayments for medical care and long-term care are high

When people in the same household pay copayments for both medical care and long-term care and the total copayment amount paid by the household over a one-year period (August 1 of the previous year to July 31) exceeds the maximum amount below, the excess amount is paid by health insurance and by long-term care insurance as "High Aggregate Cost for Long-term Care Services".

• ** The benefit will not be paid when the amount in excess of the maximum is 500 yen or less.
• ** For persons less than 70 years of age, this applies if each copayment for medical care costs is 21,000 yen or more.
• ** This is not paid when no copayment has been paid for either health insurance or long-term care insurance.

Cost-Sharing Maximum Amount