10 Mar High-Cost Medical Expense Benefit (Eligibility Certificate for Ceiling-Amount Application)
“Kogaku-ryoyo-hi Gendogaku-tekiyo Nintei-sho” for those under 70 years of age
If you/your dependents apply for the issue of the certificate，or Kogaku-ryoyo-hi Gendogaku-tekiyo Nintei-sho which certifies your limit of monthly medical care cost，your payment for the hospital will be flat sum．
Further information，Please ask at the insurance organization－which you are insured．
The certificate can be applied subject to presentation when you are hospitalized．(After you leave hospital，The hospital can not refund．It will be refunded from the insurance organization，if you apply.)
The coverage of the certificate is only the treatment fee．(Your own expenses such as meals，pajamas，documents are not covered.)
Limits of treatment fee
1. If you/your dependents total co-payments to an insurance hospital/clinic in a same month exceeds over the payment limit as shown in “Case(1)” on the table below, the excess over the limit will be reimbursed (co-payments for outpatient service, inpatient service, medical service or dental service are calculated individually).
2. If you/your dependents have received the reimbursement for 3 months in a year, the total excess over the payment limit shown in “Case(2)” on the table below will be reimbursed for and after the forth month.
3. If two or more members of your household have paid more than ¥21,000 of co-payments each, the total medical care expenses that exceeds the sum of individual payments limit shown in both “Case(1)” and “Case(2)” below will be reimbursed．
|Limit on monthly basis：
|Limit on monthly basis：
|Low income persons *1||¥35,400||¥24,600|
|General *3||¥80100+(Medical care expense－¥267,000)x l%||¥44,400|
|Higher income persons *4||¥167,400+(Medical care expense－¥558,000)x l%||¥93,000|
|Higher income persons *5||¥252,600+(Medical care expense－¥842,000)x l%||¥140,100|
*1 The Public Assistance beneficiaries and persons of municipal tax exempted households.
*2 Households with a total income of less than￥2,100,000 after ￥330,000 has been deducted for each insurance subscriber.
*3 Households with a total income of more than￥2,100,000 and under ￥6,000,000 after￥330,000 has been deducted for each insurance subscriber.
*4 Households with a total income of more than ¥6,000,000 and under ￥9,010,000 after￥330,000 has been deducted for each subscriber.
*5 Households with a total income of more than ￥9.000,000 after ￥330,000 has been deducted for each insurance subscriber.
Please also refer to the “For those mothers scheduled to have a C-Section” page.