When you incur high medical care costs

Your copayment for medical care costs is capped. If your copayment calculated based on certain standards exceeds the maximum, the excess amount will be paid as “High-Cost Medical Care Benefits”.

If you want to reduce the amount of medical care costs you pay at the counter of medical care institutions
When you face high copayments for medical care or long-term care (High Aggregate Cost for Long-Term Care Service)
Receiving treatment for specified diseases

If you want to reduce the amount of medical care costs you pay at the counter of medical care institutions

The Certificate of Application of Maximum Copayment Amount takes effect when presented to the medical care institution in advance together with your health insurance card in cases in which medical care costs are expected to be high.
You do not need to apply if you already have paid the medical care costs.

Required documents:	Request for Issuance of Maximum Copayment Certificate for Health Insurance(A4) Example
Required documents:	When the insured person is exempt from resident tax Request for Issuance of Maximum Copayment/Reduced Standard Copayment Certificate(A4) Example [Documents to attach] Tax exempt certificate (original) * A tax exempt certificate for the previous fiscal year is required for examinations and treatment in April-July. A tax exempt certificate for the current fiscal year is required for examinations and treatment in August-March. (Example) Examinations and treatment in August 2020 – July 2021: Tax exempt certificate for FY2020 Examinations and treatment in August 2021 – July 2022: Tax exempt certificate for FY2021 * In cases that qualify as long-term hospitalization (hospitalization for longer than 90 days during the one-year period before the month of application, limited to hospitalization during a period not subject to resident tax), attach documentation of the hospitalization period (e.g., a receipt showing the period of hospitalization).
Applies to:	Insured persons and dependents who expect copayments for one month’s medical care costs to exceed the maximum copayment for High-Cost Medical Care Benefits 1 Members of households exempt from resident tax (i.e., when the insured person him or herself is exempt from resident tax) aged 70 and older must request Maximum Copayment/Reduced Standard Copayment Certificates. 2 Since August 2018, insured persons and dependents aged 70 and older earning income comparable to that of active workers in income categories I and II must apply using the Request for Issuance of Maximum Copayment Certificate for Health Insurance. Present the Certificate of Application of Maximum Copayment Amount together with elderly benefits cards to limit copayments paid at the medical care institution to the maximum copayment amount for the applicable category. ・Income comparable to that of active workers in income category I: standard monthly remuneration of 280,000 – 500,000 yen ・Income comparable to that of active workers in income category II: standard monthly remuneration of 530,000 – 790,000 yen
Submit to:	Staff in charge of Maximum Copayment, Operations Group, Recruit Health Insurance Society Gran Tokyo South Tower, 1-9-2 Marunouchi, Chiyoda-ku, Tokyo 100-6640
Address inquiries to:	Operations Group, Health Insurance Society 0120-501-042 (Choose voice guidance option 1.)
Notes:	May be used for both inpatient and outpatient care. For those under 70 years of age whose standard monthly remuneration is 530,000 yen or more (category ア or イ), the applicable category is ア or イ according to standard monthly remuneration, even if not subject to resident tax. For those 70-74 years of age earning income comparable to that of active workers (i.e., whose standard monthly remuneration is 280,000 yen or more, the applicable category is income comparable to that of active workers, even if not subject to resident tax. The Certificate of Application of Maximum Copayment Amount is valid for up to one year or through August 31, whichever comes first. Submit the Request for Issuance of Maximum Copayment Certificate for Health Insurance again if you desire continued issue of a Certificate of Application of Maximum Copayment Amount after the expiration date. In principle, the Certificate of Application of Maximum Copayment Amount will be issued and mailed about three working days from the day the request form is received by the Health Insurance Society. If the application period begins in the following month or later, it will be issued and mailed on the first of the following month or later. It will not be issued on a weekend or holiday, or during the New Year’s holidays. If you apply by notifying your Individual Number instead of your health insurance card code/number, you must submit separate documents to verify your Individual Number and your identification. See here for more information on the documents that need to be submitted for Individual Numbers.

When you face high copayments for medical care or long-term care (High Aggregate Cost for Long-Term Care Service)

Flow of applying for High Aggregate Cost for Long-Term Care Service

STEP1The long-term care insurance insured person applies to the long-term care insurer (municipality) for a Copayment Certificate.
STEP2The long-term care insurer (municipality) receiving the application in Step 1 issues the Copayment Certificate.
* If a Recruit Health Insurance Society member was a member of another medical insurance plan during the period in question, submission of a Copayment Certificate from the other medical insurer may be required.
STEP3The recipient of the certificate in Step 2 submits to the medical (health) insurer as of the basis date (July 31) the Application for Payment of High Aggregate Cost for Long-Term Care Service with the Copayment Certificate attached.
STEP4After the payment amount is determined by the medical insurer (e.g., health insurance society), it notifies the long-term care insurer (municipality) of the calculation results (the amount payable).
* High Aggregate Cost for Long-term Care Service is paid after determining the amounts proportional to the copayment amount for each insurer (long-term care insurance and medical insurance).
STEP5Benefits are shouldered proportionally between the medical insurer (e.g., health insurance society) and the long-term care insurer (municipality). The medical insurer (e.g., health insurance society) pays the High Aggregate Cost for Long-Term Care Service, while the long-term care insurer pays the high aggregate cost for long-term care services.
* Notice of payment will be sent from each insurer upon payment.
* Since medical care costs for examinations and treatment in July will be checked in October or later, their payments will be made in November or later.

Required documents:	Application for Payment of High Aggregate Cost for Long-Term Care Service(A4) Example
Required documents:	[Documents to attach] Copayment Certificate for long-term insurance * If a Recruit Health Insurance Society member was a member of another medical insurance plan during the period in question, attachment of a Copayment Certificate from the other medical insurer may be required.
Deadline:	Within two years from the day after the basis date Basis date: The end date of the calculation period (July 31). However, in the event that the member of health or long-term care insurance (person subject to settlement) no longer is a member due to having died during the calculation period (August 1 of the previous year – July 31), the basis date will be the day before loss of eligibility.
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
Submit to:	See here for where to submit.
Address inquiries to:	Operations Group, Health Insurance Society 0120-501-042 (Choose voice guidance option 1.)
Notes:	For calculation purposes, the one-year period above refers to the period August 1 to July 31 the following year. If you apply by notifying your Individual Number instead of your health insurance card code/number, you must submit separate documents to verify your Individual Number and your identification. See here for more information on the documents that need to be submitted for Individual Numbers.

Receiving treatment for specified diseases

Required documents:	Application Form for Certificate Issued for Specified Disease Treatment(A4) Example
Applies to:	Persons diagnosed with the following diseases specified by the Minister of Health, Labour and Welfare of Japan as to require costly continued treatment for lengthy periods: Chronic renal failure requiring artificial kidney (artificial dialysis) Congenital blood coagulation factor disorder Acquired immune deficiency syndrome (AIDS)
Details of benefits	Copayments for diseases 1-3 above 1. Copayment amount reduced to 10,000 yen (20,000 yen for high income earners younger than 70 years of age and their dependents) For cases 2 and 3, the 10,000 yen copayment need not be paid at the medical care institution because it is paid from public funds.
Submit to:	See here for where to submit.
Address inquiries to:	Operations Group, Health Insurance Society 0120-501-042 (Choose voice guidance option 1.)
Notes:	If you apply by notifying your Individual Number instead of your health insurance card code/number, you must submit separate documents to verify your Individual Number and your identification. See here for more information on the documents that need to be submitted for Individual Numbers.

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