With Japan’s insurance system, when you are taking Social Insurance (社会保険) or National Insurance (国民保険), if you fall ill and are hospitalized, you have to pay 30% of the total fee. In case of serious illness, long hospital stay or expensive surgery, this 30% will be very huge, sometimes unable to pay! Read the article below, we will show you how to reduce this remaining medical fee.

1. Medical expense limit system:

To receive the benefit that is written above, you need to register with the insurance company (if you take out social insurance – 社会保険, please open the insurance card and call the insurance company written in the 保険者名称 section) or go to the Ward Office (if you take out the national health insurance – 国民保険). After applying, they will give you an Eligibility Certificate for Ceiling-Amount Application – 限度額適用認定証 (げんどがくてきようにんていしょ). Thereafter, present this certificate along with your insurance card at the Hospital Reception Counter. If you do not present the paper in advance, you will have to pay the full amount of out-of-pocket expense (30% of total). Finally, don’t forget to keep all invoices and follow the process to get the excess amount back, which usually takes about 3 months or more. Therefore, if you decide to stay in the hospital for a long time, it is better to do the procedure before paying the hospital fee.

    2. Medical expense limits (based on household income):

For example:

In case you belong to the group of patients who are eligible to receive hospital fee exemption or reduction (monthly income is in the range of 28-50 man) as shown above, the total hospital fee for the month is 100 man, the out-of-pocket medical expense is 30%, then how much do you have to pay at the counter?

Case 1: Not presenting the Eligibility Certificate for Ceiling-Amount Application when paying at the counter.
At that time, you have to pay the full 30% of the 100 man is 30 man, after going through the medical expense limit procedure with the insurance company, you will be refunded 212,570 yen after about 3 months.

Case 2: Presenting the Eligibility Certificate for Ceiling-Amount Application when paying at the counter.
You will only have to pay the amount equal to the medical expense limit amount according to the formula in table 1:
80,100 yen + (1,000,000 yen – 267,000 yen) × 1% = 87,430 yen

Attention:

1)  The medical expense limit system is calculated according to medical expenses incurred in 1 month, from the 1st to the end of the month. In the case of long-term hospitalization, admission should be done at the beginning of the month.

2)  When admitted to the hospital, you should prepare an Eligibility Certificate for Ceiling-Amount Application.

3)  Medical expenses of more than one family member can be combined to calculate the medical expense limit.

4)  In case you do not present the Eligibility Certificate for Ceiling-Amount Application at the time of payment, you can apply for a refund within 2 years from the date of payment.

5)  Room, meal, and facility fees are not covered by insurance, so you must ask in advance to avoid high fees at the time of payment.