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".
- 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
We recommend using a Myna health insurance card. By doing so, your cost-sharing maximum amount information will be provided with no need to give your consent and you will no longer need a Certificate of Application of Maximum Copayment Amount.
Required documents: |
Application Form for Issuance of Maximum Copayment for Health Insurance Sample |
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Deadline: | By the end of the month of hospitalization
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Applies to: | Insured persons or dependents whose copayment amounts for one month are expected to exceed their individual cost-sharing maximum amounts in the following cases:
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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.
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When you face high copayments for medical care or long-term care
Required documents: |
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[Documents to attach]
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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: |
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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
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Submit to: | Pfizer Health Insurance Society |
Notes: |
Apply to the health insurance society of which you are a member as of the basis date. |
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 |
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Deed of borrowing of High-Cost Medical Care Expense Sample |
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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 |
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Deadline: | As soon as possible |
Applies to: | Insured persons and dependents eligible for specified diseases and disorders |
Submit to: | Pfizer Health Insurance Society |