YAZAKI Health Insurance Association

YAZAKI Health Insurance Association

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When you incur high medical care costs

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.

Required documents:
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.
Address inquiries to: The person in charge of social insurance at the establishment
Notes: You can use this system for both inpatient and outpatient costs.

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

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
Address inquiries to: The person in charge of social insurance at the establishment
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: There are no documents to submit.
In February of each year, any amount exceeding the maximum amount will be reimbursed.
Deadline: 　　　―
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.
Address inquiries to: Health Insurance Association
Notes:

Apply to the health insurance society of which you are a member as of the basis date.

Link

If receiving medical treatment for specified diseases and disorders

Required documents:
Deadline: As soon as possible
Applies to:

Illnesses covered

  • (1) Hemophilia
  • (2) Any chronic renal insufficiency for which dialysis is required
  • (3) AIDS cases for which antiviral drugs are administered
Address inquiries to: The person in charge of social insurance at the establishment
Notes:  

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