If the out-of-pocket amount for both the insured and dependents who have received insurance medical treatment exceeds a certain amount ( out-of-pocket amount) per receipt , the excess amount will be paid as “high medical expenses” .
This system is designed to reduce the burden on patients.
Originally, high-cost medical expenses are cash benefits provided by application, but at our health insurance, high-cost medical expenses for medical treatment received by presenting your health insurance card will be automatically paid based on the invoice (receipt) from the medical institution. ..
In addition, when the association automatically pays high-cost medical expenses, it will be calculated according to income categories a to d.
If you are an insured person who falls under the income category E, please mail the tax exemption certificate to our association.
Please note that the year of the tax exemption certificate sent will differ depending on the year and month of the consultation.
From August of the previous year to July of the current year ⇒ Tax exemption certificate of the previous year
From August of the current year to July of the following year ⇒Certificate of tax exemption for the current year
If you would like to settle high medical expenses at the medical institution window, please refer to here .
Medical expenses that are subject to high-cost medical expenses are
calculated for each medical fee statement (receipt) that arrives from the medical institution to the health insurance association in the same month (one month). In addition, self-payment of meals at the time of admission is not covered.
Even if the above-mentioned high-cost medical expenses do not reach the self-pay limit, if
two or more people in the same household exceed 21,000 yen each in the same month, the total will be added when the self-
pay limit is exceeded. A large amount of medical expenses will be paid.
The same applies when the same person goes to two or more medical institutions in the same month and each costs 21,000 yen
or more.
If the same household receives 4 or more high-cost medical expenses in one year (last 12 months), the self-pay limit will change as follows from the 4th time .
Out-of-pocket limit for renal dialysis patients and hemophilia patients (in the case of specific illness)
The maximum amount of self-pay for renal dialysis patients who require kidney dialysis is 10,000 yen [general income earners]
or 20,000 yen [high-income earners (standard monthly salary of 530,000 yen or more)]. In addition, the maximum amount of self-pay for hemophilia patients
with factor IX and factor IX disorders is 10,000 yen per receipt.
However, there is a public expense burden including other factor disabilities, and there is
virtually .*The maximum amount of self-pay for HIV-infected persons due to blood products is 10,000 yen per receipt, but there is a public expense
and there is virtually no self-pay.*For the procedure, please apply to our health insurance for the issuance of the health insurance specific illness medical treatment certificate issuance application.
*The maximum amount of self-pay for HIV-infected persons due to blood products is 10,000 yen per receipt, but there is a public expense
and there is virtually no self-pay.*For the procedure, please apply to our health insurance for the issuance of the health insurance specific illness medical treatment certificate issuance application.
There is a high-cost medical treatment system under the Health Insurance Act so that insured persons and dependents can receive medical treatment under insurance and
do not have to worry even if the out-of-pocket amount of medical expenses
is .
However, high-cost medical expenses will
be so if high medical expenses continue to occur during that period, the burden will increase.
Therefore, there is a system to receive medical expenses until the high medical expenses are paid
.
Insured or dependents who have been billed or paid by a medical institution for medical expenses that are expected to be paid a large amount of medical expenses by the Japan Health Insurance Association*Except when there is a public expense for the medical expenses
Expected amount of high-cost medical treatment x 80%*Calculated amount is rounded down to the nearest 1,000 yen
- High-cost medical expenses fund loan application form: Fill in the person
- power of attorney
- Certificate of points covered by insurance (or a copy of a bill or receipt
issued by a medical institution that shows the total points covered by insurance )
→ After examining the contents, we will decide whether or not to lend.
No procedure is required.
It will be offset when the high-cost medical expenses are paid, and the amount exceeding the loan amount will be paid.
High-cost medical expenses fund loan application
<Caution> Do not use a friction ballpoint pen when filling out the documents.
