When you get sick or injured in Japan and go to hospitals, the medical care costs you should pay are only 30% of all the costs, thanks to Japan's health insurance system. However, what if your injury or sickness is massive and it costs you a million yen? High-Cost Medical Expense Benefit is a system that helps you in that case.
Upon the High-Cost Medical Expense Benefit, if your medical expenses become high due to surgery, hospitalization, or other reasons, and if the amount exceeds the upper limit set according to the person's age or annual income, the excess amount will be paid by health insurance. See the table below showing the maximum amount of your payment according to the standard yearly remuneration.
| Category (Standard yearly remuneration) | Maximum amount |
| JPY11,600,000 or more | JPY252,600 + (Medical care cost - JPY842,000)*1% |
| JPY7,700,000-JPY11,600,000 | JPY167,400 + (Medical care cost - JPY558,000)*1% |
| JPY3,300,000-JPY7,700,000 | JPY80,100 + (Medical care cost - JPY267,000)*1% |
| JPY3,700,000 or less | JPY57,600 |
| People with resident tax exemption | JPY35,400 |
(1)The specific amount depends on health insurance
(2)This table is for people whose age is less than 69.
If you get injured in a traffic accident in Japan, and the medical care cost is expected to be high, use High-Cost Medical Expense Benefit. According to the above table, if your yearly remuneration is JPY3,400,000, the medical care costs you should pay won't become higher than the amount of JPY80,100 + (Medical care cost - JPY267,000)*1%. Accurately, the excess amount will be paid back to you by health insurance.
How to apply for High-Cost Medical Expense Benefit
Send an application for High-Cost Medical Expense Benefit to your public health insurance, and they will pay the excess amount of medical cost to your bank account.
If you are not sure what health insurance you have, check your health insurance card having their association name. For example, health insurance is supposed to be Health insurance associations, prefectural branches of the association Kenpo, municipal national health insurance, medical care system for the elderly, mutual aid associations, etc..
What kind of medical costs are covered by High-Cost Medical Expense Benefit?
Medical costs which a patient paid are subject for High-Cost Medical Expense Benefit. Food expenses, living cost, and extra bed charge and cost of advanced medical care are not subject for High-Cost Medical Expense Benefit.
When can I get paid back?
It usually takes at least three months to get paid back by High-Cost Medical Expense Benefit. After a patient submits an application for High-Cost Medical Expense Benefit and a hospital submit his/her subscription to health insurance, the health insurance will examine the application.
If waiting for three months is inconvenient for you, Get Eligibility Certificate for Ceiling-Amount Application from your health insurance. With the certificate, you only have to pay the maximum amount at the hospital, and the rest of the costs are covered by the health insurance later on. In more detail, contact your health insurance.
Caution
High-Cost Medical Expense Benefit is calculated for each Rezept (Medical Fee details) That means you cannot add up the medical expenses if you receive treatment over a month.