When you incur high medical care costs
Your copayment for medical care costs is capped. If your copayment calculated based on certain standards exceeds the maximum, the excess amount will be paid as “High-Cost Medical Care Benefits”.
If you incur high medical care costs, statutory and non-statutory programs (e.g., High-Cost Medical Care Benefits, Patient Cost-Sharing Reimbursements) are available to reduce your copayment below the standard 30% (20% for family members under six years of age).
- i. No action is needed to use the above programs. The amount calculated automatically by the computer system will be refunded about three months after the month of examination or treatment.
A 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.
- ii. The amount you are required to pay at the medical care institution out of pocket (advance payment) may be significant for cases involving high medical care costs. You can reduce this amount in line with certain rules by submitting a Certificate of Application of Maximum Copayment Amount.
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