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
| Required documents: | |
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| Applies to: | Insured persons or dependents who expect to pay more than their Cost-Sharing Maximum Amounts for medical care costs incurred at the medical care institution over one month |
| 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. |
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[Documents to attach] |
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| 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. |