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 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 receive the Loan of High-Cost Medical Care Expense
When you are eligible for specified diseases and disorders

When you want to reduce the amount of medical care costs you pay at the medical care institution

Required documents:	Application Form for Issuance of Maximum Copayment for Health Insurance Sample
Deadline:	By the end of the month of hospitalization * If the “Certificate of Application of Maximum Copayment Amount” is issued at the time of hospitalization, the effective date is the first day of the month in which the application is accepted.
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
Submit to:	Pfizer Health Insurance Society
Notes:	You can use this system for both inpatient and outpatient costs. Please return the certificate to the Health Insurance Society as soon as possible in the following cases. When it has reached the expiration date When you no longer need the certificate because you are no longer hospitalized or going to the hospital When you are no longer a member of the Pfizer Health Insurance Society When it becomes the month after the month you turned 70 years old

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

Required documents:	Application for Payment of High Aggregate Cost for Long-Term Care Service
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
Submit to:	Pfizer Health Insurance Society
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)

Required documents:	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.
Submit to:	Pfizer Health Insurance Society
Notes:	Apply to the health insurance society 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"

When you receive the Loan of High-Cost Medical Care Expense

If medical care costs are likely to be high due to hospitalization, etc., you can receive a loan from the Health Insurance Society equivalent to 80% of the amount you paid for the two-month period until you receive the High-Cost Medical Care Benefits.

Required documents:	Application Form for Loan of High-Cost Medical Care Expense Sample
Required documents:	Deed of borrowing of High-Cost Medical Care Expense Sample
Deadline:	As soon as possible
Applies to:	Insured persons or dependents who are expected to receive the High-Cost Medical Care Expense
Submit to:	Pfizer Health Insurance Society

When you are eligible for specified diseases and disorders

Required documents:	Application Form for issue of Certificates Issued for Specific Disease Treatment Sample
Deadline:	As soon as possible
Applies to:	Insured persons and dependents eligible for specified diseases and disorders
Submit to:	Pfizer Health Insurance Society