High-Cost Medical Expense Benefit
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.
|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. "
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.
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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)
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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.