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When you incur high medical care costs

Your copayment for medical care costs is capped. If your copayment, as calculated based on certain standards, exceeds the maximum due to having received high-cost medical care, the excess amount will be paid (reimbursed) as High-Cost Medical Care Benefits. In addition, the Society will pay (reimburse) its own additional benefits to reduce your copayment to below the standard 30% (20% for family members under six years of age).

  • ①No action is required to apply for payment of the above benefits. High-Cost Medical Care Benefits are essentially paid based on application, but at the Takeda Health Insurance Society, for both High-Cost Medical Care Benefits and additional benefits, the amount calculated automatically by the computer system will be paid (reimbursed) about three months after the month in which the medical care is provided.
  • ②A sealed postcard will be sent by post to the insured person’s home address in the latter third of the month in which these benefits are paid, as both notice of payment details and proof of payment (notice of payment decision). The same information is also provided monthly in the medical care cost information (details of medical care costs and benefit payment details) on MY HEALTH WEB. Such information provision will entirely migrate to MY HEALTH WEB in the future, so if you have not yet completed the initial signup for MY HEALTH WEB, click here and complete the registration.
  • ③The amount you are required to pay at the medical care institution out of pocket (advance payment) may be significant in cases involving high medical care costs. You can reduce this amount to your individual cost-sharing maximum amount by presenting a Certificate of Application of Maximum Copayment Amount.
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When you want to reduce the amount of medical care costs you pay at the medical care institution

Required documents:
  • Request for Issuance of Certificate of Application of Maximum Copayment Amount
Applies to: Insured persons or dependents who expect to pay more than their Cost-Sharing Maximum Amounts for medical care costs incurred at the medical care institution over one month
Address inquiries to: Health Insurance Society
Period of validity Six months from effective date (first day of month of issue)
Using the certificate
  • One Maximum Co-payment Certificate for Health Insurance is required for each medical care institution.
  • Submit the certificate to the medical care institution when hospitalized. The institution will retain it and return it to you when you are discharged.
  • You can reuse the Maximum Co-payment Certificate for Health Insurance if you need to be readmitted to the hospital or to transfer to another hospital after discharge, as long as the period of validity has not expired. You will need to renew the certificate every time your income category changes.
Returning the certificate Please return the certificate to your employer or the Society if you lose your eligibility for insurance or its term of validity has expired.
Notes: You can use this system for both inpatient and outpatient costs.
Persons aged 70 or older can receive the same services by presenting their elderly benefits cards. However, those earning income at the same levels as active workers II or active workers I must submit a Maximum Copayment Certificate for Health Insurance.
To apply, provide the necessary information on the above document and submit to the Health Insurance Society if you are a Takeda Pharmaceutical Company Limited employee or a Voluntarily and Continuously Insured Person. If your employer is not Takeda Pharmaceutical Company Limited, submit via your employer.

When you use a Myna health insurance card, you will be exempt from payment in excess of the maximum copayment amount under the High-Cost Medical Care Benefits system without any prior procedures.
We recommend using a Myna health insurance card. Using this card will eliminate the need to apply in advance for a Certificate of Application of Maximum Copayment Amount.

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

Required documents:
  • Application for Payment of High-Cost Long-Term Care Combined Expenses

[Documents to attach]
Copayment certificate for long-term care insurance
Deadline: As soon as possible
Applies to: Insured persons whose total copayments for medical care and long-term care for persons within the same household during the one-year period exceeded the maximum amount
Address inquiries to: Health Insurance Society
Notes: For calculation purposes, the one-year period above refers to the period August 1 to July 31 the following year.

Annual High-Cost Medical Care Benefits for outpatient care (annual total of outpatient costs) for those aged 70 or older

Required documents:
  • Health Insurance Application for Payment of Benefits (Outpatient Annual Aggregate)/Issuance of Copayment Certificate for High-cost Medical Expenses
Deadline: As soon as possible
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 Society
Notes:

Apply to the health insurer that provides your coverage as of the base date.
If you were covered by another health insurer during the past year, obtain a copayment certificate from your previous insurer and attach to the application form.

Reference link
Measures for reducing cost burdens for persons aged 70-74: Cost-sharing maximum amounts for high-cost medical care

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