Notice of benefit amounts
The Recruit Health Insurance Society provides High-Cost Medical Care Benefits and other benefits if copayments for medical care costs received at a medical care institution are high. The Recruit Health Insurance Society sends out a notice of medical care costs and benefit amounts when providing high-cost medical care or other benefits.
- * Keep the notice of medical care costs and benefit amounts in a safe place. This important medical record cannot be reissued.
Benefits shown on the notice of medical care costs and benefit amounts
High-Cost Medical Care Benefits (statutory benefits)
When the copayment (separate for inpatient care and outpatient care with prescription) for examinations and treatment at a single medical care institution for a single patient in a single month (from the first to the last day of the calendar month) is high, the amount beyond the maximum of the maximum copayment amount (see Table 1 below) is paid as High-Cost Medical Care Benefits.
| Normal | Multiple cases | |
|---|---|---|
| Not subject to resident tax | 35,400 yen | 24,600 yen |
| Standard monthly remuneration: up to 260,000 yen |
57,600 yen | 44,400 yen |
| Standard monthly remuneration: 280,000 − 500,000 yen |
80,100 yen + (medical care costs − 267,000 yen) × 1% | 44,400 yen |
| Standard monthly remuneration: 530,000 - 790,000 yen |
167,400 yen + (medical care costs − 558,000 yen) × 1% | 93,000 yen |
| Standard monthly remuneration: 830,000 yen or more |
252,600 yen + (medical care costs − 842,000 yen) × 1% | 140,100 yen |
If you receive High-Cost Medical Care Benefits four or more times in one fiscal year, the Cost-Sharing Maximum Amount will change to the amount for multiple cases, starting with the fourth time.
- * Costs not covered by insurance such as premium bed costs and meal costs for inpatient care are not eligible for benefits.
- * You cannot combine the costs of inpatient and outpatient care nor the costs of medical and dental care, even if all care is received at the same institution (excluding cases eligible for aggregate single household costs).
-
* For multiple hospitalizations, the amounts will be calculated separately for each month.
For more information on calculating amounts of High-Cost Medical Care Benefits and other benefits, please refer to “When you incur high medical care costs” (“Description” sheet) under “Health insurance benefits.”
You do not need to apply for benefits even if you incur high medical care costs.
The Recruit Health Insurance Society determines high-cost medical care benefits automatically based on medical cost details sent from medical care institutions. No separate application is needed.
When a notice of medical care costs and benefit amounts is sent
A notice of medical care costs and benefit amounts is typically sent to those for whom a decision has been made concerning benefits three months after the month of the examination or treatment. (However, the time at which benefits are actually paid may vary for various reasons, including delays in receiving medical cost details from the medical care institution.)