FAQ

According to the explanation on the website, high-cost medical expenses incurred upon hospitalization will ultimately be limited to a cost-sharing amount of 20,000 yen, but—even though I presented my Certificate of Application of Maximum Copayment Amount at the hospital reception desk, I had to pay 90,000 yen as the amount covered by health insurance. (This did not include the amount not covered by insurance, such as the difference in the bed fee.) Why?

The Certificate of Application of Maximum Copayment Amount is based on the national "High-Cost Medical Care Benefit system." Under this system, the amount you must pay at the reception desk is calculated based on your income (standard monthly remuneration) and coverage category A to E, which is indicated on the Certificate of Application of Maximum Copayment Amount.
This certificate does not show the additional amount system for original Health Insurance Society benefits (the amount in excess of 20,000 yen).
The amount of original Health Insurance Society Additional Benefits to be paid will be calculated based on the rezept submitted by the medical care institution via the payment fund. This amount will be paid three or more months after the medical treatment month through your company upon paying your salary. Voluntarily and continuously insured persons will be directly paid by the Health Insurance Society. Note that no application is necessary to benefit from the Additional Benefit system.