Jun 03, 2023 06:00:00

Acquisition & application method of ``limit application certificate'' that allows you to set the window payment of medical expenses to zero yen over a certain amount, and the burden is saved because the limit is set for monthly payment

If you have paid high medical expenses for surgery, hospitalization, etc., you can receive payment for the amount you paid in excess of the limit by using

the high-cost medical care benefit system . In this high-cost medical care benefit system, in addition to the system in which the payment is made after the medical expenses are paid, there is also a system in which a `` certificate of application of the maximum amount' ' is issued, which eliminates the need for payments exceeding the monthly limit. . As long as you have a ceiling amount application certificate, even if the surgery costs several hundred thousand yen, you can reduce the burden by keeping the payment amount under the ceiling amount. When I was in need of surgery and hospitalization due to a traffic accident, I actually applied for the issuance of a limit application certificate and it was accepted, so I tried to summarize the application procedure in an easy-to-understand manner.

For those who receive expensive outpatient medical care | Ministry of Health, Labor and Welfare
https://www.mhlw.go.jp/stf/seisakunitsuite/bunya/kenkou_iryou/iryouhoken/kougaku_gairai/index.html

When medical costs are likely to become high | Health insurance in times like these | Japan Health Insurance Association
https://www.kyoukaikenpo.or.jp/g3/sb3020/r151/

A certificate of eligibility for maximum copayment is a certificate issued by the insurer of the health insurance that you are enrolled in. By presenting the eligibility certificate for eligibility for maximum copayment at the counter of a medical institution, you will be able to pay medical expenses that exceed your copayment limit. No longer required. The monthly co-payment limit varies depending on the age and income of the insured person. For example, in my case, I am under 70 years old and have a standard monthly remuneration of 260,000 yen or less, so my copayment limit is 57,600 yen.

Even if a Certificate of Eligibility for Ceiling Amount is issued, the money already paid will not be refunded immediately. must be obtained before paying medical expenses.

You can apply for a Certificate of Eligibility for Ceiling Amount Application by mailing the application form to your health insurance insurer. The procedure below shows the procedure for applying at the Japan Health Insurance Association (Kyokai Kenpo), which I am a member of, but even if you are enrolled in insurance such as a health insurance association or municipality, please contact the insurer in advance. Apply, have a ceiling application certificate issued, and show the ceiling application certificate at a medical institution.” The flow is the same.

When applying to the Japan Health Insurance Association for issuance of a Certificate of Maximum Amount Application, if the previous fiscal year's resident tax was levied, the ' Health Insurance Maximum Amount Application Certification Application Form ' should be submitted.・Submission of standard burden amount reduction certification application form is required. Since the author was subject to resident tax, I decided to submit an application for health insurance limit application certification.

An application form for health insurance limit coverage is available in PDF format at the link below.

Health Insurance Limit Application Application Form | Application Form | Japan Health Insurance Association
https://www.kyoukaikenpo.or.jp/g2/cat230/r121/

On the application form distribution page, two types of PDF files, 'for handwriting' and 'for input', are distributed. If you have installed ' Adobe Acrobat Reader ' on your PC, you can easily enter the necessary information from your PC by downloading the 'input' PDF file.

When you click 'For input', the PDF file will open in the browser, but the browser may not be able to enter the necessary information correctly, so click the save button to download it.

Next, open the downloaded PDF file with Adobe Acrobat Reader, and fill in the necessary items referring to the (PDF file) entry example .

Please note that it is necessary to enter the furigana of the name in half-width katakana among the necessary items. Half-width katakana can be entered by pressing the 'F8 key' after entering hiragana.

If you have an insured person's card at hand and the mailing address of the limit application certificate is the same as the address of the insured person, it is OK just to fill in the 'insured person information' and 'certified person column'.

After completing the input, print it on the printer.

After completing the application form, send it to the prefectural branch of the Japan Health Insurance Association to which you are a member. You can check the address of the prefectural branch at the following link.

Prefectural Branch | About Japan Health Insurance Association | Japan Health Insurance Association

https://www.kyoukaikenpo.or.jp/about/sb7130/sbb7131/1762-620/

As a result of putting the application form in the nearest post on April 11, 2023, an envelope containing a ceiling application certificate arrived in the afternoon of April 24, 2023.

The actual limit application certificate is below. If you submit this certificate to the window of the medical institution, you can keep your monthly medical expenses within the maximum out-of-pocket amount.

In addition, this time, I received a request for exceeding the copayment limit on the morning of April 24, 2023 (before receiving the ceiling application certificate), and the next medical examination was in May 2023, so I received the ceiling application certificate. was not able to demonstrate the effect of Since it takes several weeks from application to issuance of a Certificate of Eligibility for Ceiling Amount Application, we recommend that you apply as soon as possible if you find that you will need to pay high medical expenses for surgery or hospitalization.