High-Cost Medical Expense Benefit
- Japanese
- 高額療養費
This is a system in which if the out-of-pocket amount of medical expenses incurred in the same month (from the first day of the month to the last day of the month) becomes expensive, the amount exceeding a certain amount (out-of-pocket amount) will be refunded.
If you show an Eligibility Certificate for Ceiling-Amount Application(Company Health Insurance/National Health Insurance), the payment will be settled.
Benefits, Systems
Co-payment
| Health Insurance: Standard monthly salary | National Health Insurance: Charged standard amount * 2 | Co-payment | Multiple times applicable |
| 830,000 yen or more | 9.01 million yen | 252,600 yen + (total medical expenses * 3-842,000 yen) x 1% | 140,100 yen |
| 530,000 to 790,000 yen | 6 million yen to over 9.01 million yen | 167,400 yen + (total medical expenses-558,000 yen) x 1% | 93,000 yen |
| 280,000 to 500,000 yen | 2.1 million yen to 6 million yen | 80,100 yen + (total medical expenses-267,000 yen) x 1% | 44,400 yen |
| 260,000 yen or less | 2.1 million yen or less | 57,600 yen | 44,400 yen |
| - | Resident tax exemption | 35,400 yen | 24,600 yen |
* 1 The standard amount of levy is the amount obtained by subtracting 430,000 yen from income.
* 2 Multiple times is a mechanism in which the self-pay limit is reduced from the 4th time when the self-pay limit is reached 3 times or more within the past 12 months. If you move from health insurance to National Health Insurance, it will not be counted.
* 3 Total medical expenses are the total amount of expenses covered by public insurance. "
Others
Even in the same medical institution, it is calculated separately for medical inpatient, medical outpatient, dental inpatient, and dental outpatient. Dispensing is calculated together with outpatient clinics. If there is a high-priced medical treatment in the same month in the household, it will be added up. If you are under 70 years old, you can add up the amount of self-pay (1 month) calculated for each examinee of 21,000 yen or more.
Links of Keywords
Application
Application for postpay
For health insurance, apply to the health insurance association or union that you have joined. For National health insurance, apply to your municipal office.
- Application Form(Company Health Insurance)
- Tax Exemption Certificate (if you have joined health insurance and are classed as a residence tax exempted household)
Links of Keywords
Others (Note,important Points, Points)
Refunds will take more than 3 months from the month you received the medical treatment, so you should apply to get an Eligibility Certificate for Ceiling-Amount Application(Company health Insurance)/Ceiling-Amount Application(National health Insurance) in advance, in order to reduce the financial burden that this time frame could incur.