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When you incur high medical care costs

Your copayment for medical care costs is capped by the insured person’s income category. If your copayment (30% of medical care costs) exceeds the maximum, the excess amount will be calculated by the Society and 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

Required documents:
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:
  • When not using a Myna health insurance card
  • Examinations and treatment received at a medical care institution or other facility that has not adopted the online eligibility verification system
  • When not using a Myna health insurance card and you are 70 or older and in the same income category as active workers Ⅰ or Ⅱ
  • * Even when using a Myna health insurance card, 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.
Period of validity Within three months from the effective date (first date of month of issue)
Using the certificate
(Notes)		 ① Simply applying to the Health Insurance Association does not automatically reduce the amount you pay at the medical care institution. Be sure to show the certificate to the reception desk of the hospital no later than the time of payment.
② You must promptly return any expired or unused certificates to the Society. If you are unable to return a certificate, submit a Notice of Inability to Return Certificate.
③ If your income category (standard monthly remuneration) has changed, you must exchange certificates and make payment again at the hospital.
Returning the certificate Please return the certificate to the Society if you lose your eligibility or the certificate expires.
Notes: You can use this system for both inpatient and outpatient costs.
Persons aged 70 or older can receive the same services by presenting their elderly benefits cards.
To apply, provide the necessary information on the above documents and submit to the Health Insurance Association.

If a member aged 70 or older incurs high annual outpatient medical care costs (annual total of outpatient costs)

Applies to: Insured persons and dependents aged 70 or older whose total copayments for outpatient care within the past one year (last August 1 – July 31) exceeded 144,000 yen

* Applies only to those whose income category is “general” or “low-income” as of the basis date.
* Calculations exclude copayments made during a period in which the insured person or dependent earned income in the category “same income level as active workers.”
* The total copayment is the amount minus High-Cost Medical Care Benefits, additional benefits, public medical assistance, etc.
* This benefit applies to outpatient care received August 1, 2017 or later.
* Contact the Health Insurance Association if you believe you may be eligible.
Contact: Suntory Health Insurance Association
Notes: Apply to your health insurer as of the basis date.
If you were covered by other health insurance at any time during the past one year, you must obtain a copayment certificate from your previous health insurer.

Reference link
Measures for reducing cost burdens for persons aged 70-74: Cost-sharing maximum amounts for high-cost medical care

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