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”.

Description

Procedures

FAQ

When you want to reduce the amount of medical care costs you pay at the medical care institution (when you want to have a Certificate of Application of Maximum Copayment Amount issued)
Those receiving treatment for specified diseases and disorders
When you face high copayments for medical care or long-term care
If you are aged 70 or older and incurred high annual costs for outpatient care (annual total of outpatient costs)

When you want to reduce the amount of medical care costs you pay at the medical care institution (when you want to have a Certificate of Application of Maximum Copayment Amount issued)

Required documents:	Application for Health Insurance Maximum Copayment/Standard Cost Reduction Example
Required documents:	[Documents to attach] If the insured person is exempt from municipal residence taxes, then append the insured person's most recent Tax Exemption Certificate (original copy). Please also submit a “Cause of Accident / Illness Inquiry”, if the cause of accident / illness is a traumatic injury(fractures, sprains, bruises,etc. ). Cause of Accident / Illness Inquiry (Reply)Form Example
Submit to:	FR Health Insurance Organization * Please check “Contact us, Access” at the bottom of the page for the address of the Organization.
Applies to:	Insured persons or dependents who expect to pay more than their Cost-Sharing Maximum Amounts for medical care costs incurred at the medical care institution over one month
Inquiries to:	FR Health Insurance Organization
Notes:	You can use this system for both inpatient and outpatient costs. We will only accept original application forms. (The submission of faxes, email attachments, etc. is not acceptable.) In general, the expiration date is one year after issuance. If the expiration date has passed or you have lost your eligibility, be sure to return the certificate to the Organization similarly to your insurance card. (If the certificate is lost, etc., it is necessary to submit a separate " Application Form for Reissue of Maximum Co-payment Eligibility Certificate".) To continue using the certificate after its expiration date has passed, please submit another "Application for Health Insurance Maximum Copayment/Standard Cost Reduction".

Those receiving treatment for specified diseases and disorders

Required documents:	Application for Certificate of Receipt of Medical Care for Specified Diseases Example
Submit to:	FR Health Insurance Organization * Please check “Contact us, Access” at the bottom of the page for the address of the Organization.
Deadline:	As soon as possible
Applies to:	Insured persons or dependents who receiving treatment for specified diseases and disorders
Inquiries to:	FR Health Insurance Organization

When you face high copayments for medical care or long-term care

Required documents:	If you require an Application for Payment of High Aggregate Cost for Long-Term Care Service/Application for Issue of a Copayment Certificate, please contact the Health Insurance Organization. (03-6865-0005: person in charge of benefits)
Required documents:	[Documents to attach] Copayment certificate for long-term care insurance
Deadline:	As soon as possible
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
Inquiries to:	FR Health Insurance Organization
Notes:	For calculation purposes, the one-year period above refers to the period August 1 to July 31 the following year.

If you are aged 70 or older and incurred high annual costs for outpatient care (annual total of outpatient costs)

If an insured person or dependent aged 70 or older receives medical care, the "annual total of outpatient costs" is calculated.

More specifically, under this system, if the annual total cost-sharing amount related to outpatient care for persons in the "general" category or "low income" category exceeds 144,000 yen as of the basis date (normally July 31 of every year (or the date of death in the event of death)), the excess amount is paid.

In addition to the usual payment application for High-cost Medical Care Benefits, please perform the procedure below with our health insurance organization.

In addition, if you require an Application for High-Cost Medical Care Benefits (Annual Total of Outpatient Costs)/Application for Issue of a Copayment Certificate, please contact the Health Insurance Organization. (03-6865-0005: person in charge of benefits)

Required documents:	1. If you are a member of the FR Health Insurance Organization as of the basis date (normally July 31 of every year (or the date of death in the event of death)) * If you were never covered by any other health insurance during the one-year period leading up to the basis date Application for High-Cost Medical Care Benefits (Annual Total of Outpatient Costs)/Application for Issue of a Copayment Certificate * If you were covered by any other health insurance during the one-year period leading up to the basis date Application for High-Cost Medical Care Benefits (Annual Total of Outpatient Costs)/Application for Issue of a Copayment Certificate High-Cost Medical Care Benefit Copayment (Annual Total) Certificates issued by other insurers
Required documents:	2. If you are not a member of the FR Health Insurance Organization as of the basis date (normally July 31 of every year (or the date of death in the event of death)) but you were a member of the FR Health Insurance Organization at any point during the one-year period leading up to the basis date Application for High-Cost Medical Care Benefits (Annual Total of Outpatient Costs)/Application for Issue of a Copayment Certificate
Deadline:	As soon as possible
Applies to:	Insured persons and dependents aged 70 or older whose total copayments for outpatient care during the one year period (from August 1 of the previous year to July 31) exceeded 144,000 yen * This benefit is available only to those whose income category is "general" or "low income" as of the basis date (July 31, or the day before the date of death in the event of the death of the insured person). * Calculations of High-Cost Medical Care Benefits exclude copayments paid during a period in which the insured person belonged to the "same income level as active workers" category.
Inquiries to:	FR Health Insurance Organization
Notes:	Apply to the Health Insurance Organization of which you are a member as of the basis date. Reference link Measures for reducing cost burdens for persons aged 70-74 “Cost-sharing maximum amounts for high-cost medical care”