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 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 you want to reduce the amount of medical care costs you pay at the medical care institution

We recommend using your My Number Card as your Health Insurance Certificate. Doing so will allow the provision of your cost-sharing maximum amount information via online eligibility verification, eliminating the need for a Certificate of Application of Maximum Copayment Amount.

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: If you are eligible to be issued a Health Insurance Eligibility Certificate that does not include information equivalent to the Certificate of Application of Maximum Copayment Amount (and if you are 70 or older, in the same income category as active workers Ⅰ or Ⅱ) * Even when using a My Number Card as their Health Insurance Certificate, 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.
Notes:	You can use this system for both inpatient and outpatient costs.

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:

If you are eligible to be issued a Health Insurance Eligibility Certificate that does not include information equivalent to the Certificate of Application of Maximum Copayment Amount (and if you are 70 or older, in the same income category as active workers Ⅰ or Ⅱ)

* Even when using a My Number Card as their Health Insurance Certificate, 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.

Notes:

You can use this system for both inpatient and outpatient costs.

Persons with an Individual Number Card

Required documents:	By submitting your Individual Number Card as your health insurance card at the reception of a medical care institution or other institution1, you can limit the amount you will pay at the reception to the Cost-Sharing Maximum Amount2. 1 It must be a medical care institution or other institution that has adopted the online eligibility verification system. 2 You must consent to the “Indication of Maximum Amount Information” at the reception.

Required documents:

By submitting your Individual Number Card as your health insurance card at the reception of a medical care institution or other institution*1, you can limit the amount you will pay at the reception to the Cost-Sharing Maximum Amount*2.

*1 It must be a medical care institution or other institution that has adopted the online eligibility verification system.
*2 You must consent to the “Indication of Maximum Amount Information” at the reception.

Persons without an Individual Number Card

Required documents:	We’re sorry, but the electronic application service is only available in Japanese. To apply in English, please mail a paper application form to Accenture Health Insurance Society. Request for Issue of Health Insurance Eligibility Certificate for Ceiling-Amount Application Form Example
Required documents:	(Those with low income, such as those who are exempt from municipal inhabitant tax) Health Insurance Application for Eligibility Certificate for Ceiling-Amount/Reduction of the Standard Amount of Patient Liability Example
Address inquiries to:	See here for more information on where to obtain and submit the documents.

When you face high copayments for medical care or long-term care

Required documents:	Application for Payment of High Aggregate Cost for Long-Term Care Service
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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