Settling high medical expenses at the medical institution window

When you want to settle a large amount of medical expenses at a medical institution window

Health insurance limit application certification application

  ・ For tax-exempt households, please see here.

・Please refer to here for the maximum amount of self-pay for high-cost medical treatment.

When submitting

● If an insured person or dependent under the age of 70 receives insurance medical treatment and the out-of-pocket medical expenses are high,
  the medical institution will pay the high medical expenses that normally take about 3 months from the medical treatment month. When receiving a certificate that can be settled in advance at the counter.

● The certificate is valid until August 31st, so you
  will need to renew it if you want to use it after September.
  For renewal, please send the application form and your certificate to us by the end of September .
  If the previous year was taxable income and the current year is tax exempt , please send the tax exemption application, the   current year ‘s tax exemption certificate, and your certificate to our association by the end of July .

Submission Deadline

Promptly (Applicable from the 1st of the application month)

Submission destination

4-1-1 Toranomon, Minato-ku, Tokyo 105-6906
Bell System 24, 6th floor, Kamiyacho Trust Tower Health Insurance Association

* Certificates will be sent by registered mail the next business day after the application is received.


If you lose your qualification or the expiration date has passed , please be sure to return the issued [Health Insurance Limit Application Certificate] to our health insurance as soon as possible.

If you lose it and cannot return it, please fill in and seal the [Health Insurance Limit Application Certificate Loss Report] and
send it to our association.

Entry example