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 applying for High-Cost Medical Care Benefits
When you want to reduce the amount of medical care costs you pay at the medical care institution
When you face high copayments for medical care or long-term care

When applying for High-Cost Medical Care Benefits

If you did not apply for a Certificate of Application of Maximum Copayment Amount or failed to submit your Certificate at the hospital, the Health Insurance Society will reimburse you later in cash in the amount of the High-Cost Medical Care Benefits. The Society makes such payments automatically; you do not need to apply for benefits. Since these benefits are determined from medical cost details sent by the hospital to the Health Insurance Society, payments will occur roughly three months after the month of the medical care. Details of benefits paid will appear as part of your Web-based medical care cost details.

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:	Request for issuance of Maximum Co-payment Certificate for Health Insurance
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 * Even when using a Myna health insurance card, those in the low income category must apply in advance for a Maximum Copayment/Reduced Standard Copayment Certificate to be treated as falling in the low income category.
Submit to:	HR section of each corporation or Health Insurance Society
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:	Contact to the Soceity about this form.
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:	Health Insurance Society
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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