← 🏥 Health & Insurance ✨This page is an AI summary of official information. Please check the official page before proceeding.
🏥 Health & Insurance Open
High-Cost Medical Care Benefit / Maximum Copayment Certificate
💡 The Bottom Line
If medical expenses are high, apply for the 'High-Cost Medical Care Benefit' or get a 'Maximum Copayment Certificate' in advance to limit your out-of-pocket expenses to the maximum amount.
🗓 5W1H Overview
👤 Who
Ota citizens enrolled in National Health Insurance whose out-of-pocket medical expenses for one month have become high
📋 What
Refund of medical expenses exceeding the maximum out-of-pocket amount, or application of the maximum amount before hospitalization
⏰ When
From the month following the high medical expenses (application within 2 years) / Before hospitalization (in advance for Maximum Copayment Certificate)
📍 Where
Ota City Hall, National Health Insurance Division, or each health insurance association counter
❗ Why
To reduce the impact of high medical expenses on daily life
📝 How
[High-Cost Medical Care Benefit] Bring the application form and receipts after the month following the treatment month -> Review -> Refund. [Maximum Copayment Certificate] Apply before hospitalization -> Present the certificate at the hospital counter
⏱ Application for Maximum Copayment Certificate: About 15 minutes at the counter. Until refund of High-Cost Medical Care Benefit: About 3 months from application
📖 Easy Explanation
If your medical expenses at the hospital become too high, there is a 'High-Cost Medical Care Benefit' system where the amount exceeding a certain limit will be refunded later. Also, if you obtain a 'Maximum Copayment Certificate' before hospitalization, you can limit your payment at the counter to the maximum amount from the beginning.
Where to apply: Ota City Hall, National Health Insurance Division (0276-47-1111) or your health insurance counter.
For those under 70, the maximum monthly out-of-pocket amount is determined by income (ranging from a maximum of about ¥252,600 + α to a minimum of ¥35,400). You can also use 'Household Aggregation' to combine multiple medical expenses for those in the same household. Applications must be made within 2 years from the 1st of the month following the treatment month.
👥 Who Qualifies
- National Health Insurance enrollees
- Those whose out-of-pocket medical expenses for one month have become high
- Those scheduled for hospitalization
❓ FAQ
Can I consult even if I have no money?
Yes. Explanation and consultation of the system are free. Please contact the National Health Insurance Division (0276-47-1111).
Can I consult in a foreign language?
Interpreters may be available. Please call to consult first.
Can I use it with Social Insurance (company insurance)?
Yes. Social insurance also has a high-cost medical care benefit system. Please contact your employer's health insurance association or Kyokai Kenpo.
Will it be refunded automatically?
For National Health Insurance, an application is required. If you forget to apply, it will not be refunded.