The copayment for medical care costs you can be required to pay is capped. If your copayment calculated based on a certain standards exceeds this 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
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.
* You cannot apply after being discharged from the hospital. Please apply in advance. If you receive medical care using your My Number insurance card, this application is not necessary, as the process can be handled through online verification.
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:
Examinations and treatment received at a medical care institution or other facility that has not adopted the online eligibility verification system
When not using a Myna health insurance card
When not using a Myna health insurance card and you are 70 or older and in the same income category as active workers Ⅰ or Ⅱ
* Even when using a Myna health insurance card, those in the low income category must apply in advance for a Maximum Copayment/Reduced Standard Copayment Certificate to be treated as falling in the low income category.
Submit to:
For Astellas G members (those with insurance card codes 101, 120, or 121)
…Astellas Pharma Inc. Human Resource Operations
By post:
2-5-1 Nihonbashi-Honcho, Chuo-ku, Tokyo 103-8411
Astellas Pharma Inc. Human Resource Operations
For Amgen Inc. members (those with insurance card code 125)
…Amgen Inc. Payroll and Social Insurance Outsourcing Partner (please check the company intranet)
For Eurofins Analytical Science Laboratories, Inc. members (those with insurance card code 201)
…Eurofins Human Resources
For voluntarily and continuously insured members (insurance card code 180)
…Astellas Health Insurance Society
Notes:
* You can use this system for both inpatient and outpatient costs.
* If applying for a certificate, please fill out the necessary information in the above documents before hospitalization and submit them to the submission address for the various notifications listed above.
* If you do not apply for a certificate or do not present the certificate at the reception desk, high-cost medical expense payments will be made at a later date by the Health Insurance Society. Calculations are performed automatically by the Health Insurance Society, so no application is necessary. The timing of the payment will be approximately three months after the month of treatment, as calculations are based on the medical fee statements sent from the hospital to the Health Insurance Society.
When you face high copayments for medical care or long-term care
Required documents:
Certificate of Out-of-Pocket Expenses for Long-Term Care Insurance
* Please submit a Payment Application Form/Out-of-pocket Expense Certificate Application Form to your local municipal office to receive the certificate.
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:
For Astellas G members (those with insurance card codes 101, 120, or 121)
…Astellas Pharma Inc. Human Resource Operations
By post:
2-5-1 Nihonbashi-Honcho, Chuo-ku, Tokyo 103-8411
Astellas Pharma Inc. Human Resource Operations
For Amgen Inc. members (those with insurance card code 125)
…Amgen Inc. Payroll and Social Insurance Outsourcing Partner (please check the company intranet)
For Eurofins Analytical Science Laboratories, Inc. members (those with insurance card code 201)
…Eurofins Human Resources
For voluntarily and continuously insured members (insurance card code 180)
…Astellas Health Insurance Society
Notes:
For calculation purposes, the one-year period above refers to the period August 1 to July 31 the following year.
