[High-cost medical expenses system] Do you know that there is a profitable system for returning medical expenses?

I've heard of the "high-cost medical care system," but I think many people don't know the details.

So what is the high-cost medical treatment system?

Here, let's introduce the high-cost medical treatment system.

What is the high-cost medical treatment system?

The high-cost medical care system is a profitable system in which if the medical expenses paid by yourself from the beginning of the month to the end of the month are high, the portion exceeding a certain amount will be returned.

Presenting your health insurance card at a medical institution generally costs 30%, but medical expenses can still be high, so the high-cost medical care system sets an upper limit on monthly medical expenses. Will be.

Depending on your income, the self-pay limit differs in the case of the high-cost medical treatment system.

The high-cost medical care system used to be divided into three categories, but the health insurance system was revised in January 2015 and changed to five categories.

In particular, the burden has increased for standard monthly salaries of 830,000 yen or more.

Things to be aware of in the high-cost medical treatment system

The high-cost medical treatment system does not cover meals, extra beds, or insurance.

In addition, due to the revision of the high-cost medical treatment system, the classification notation of the limit application certificate has changed from January 2015.

Here, let's introduce a specific case when actually using the high-cost medical treatment system.

For example, let's assume that the standard monthly salary of 320,000 yen, the window burden ratio of 30%, and the total medical expenses for one month are 1 million yen.

In this case, 70% of 700,000 yen does not have to be borne by the medical insurance system such as public health insurance, and 30% of 300,000 yen will be borne by the counter, and the high-cost medical treatment system will be applied. After that, the maximum amount of self-pay will be 87430 yen.

In addition, please check the detailed calculation contents as they are also introduced on the net.

If you issue a certificate of application of the limit amount, you will be refunded 212570 yen by paying 30% of 300,000 yen at the counter and applying for a large amount of medical expenses at a later date.

On the other hand, if you issue a certificate of application of the limit amount, you will pay the self-pay amount of 87430 yen at the counter.

Basically, it is not necessary to apply for a refund of high-cost medical expenses, but it may be necessary to add up households as an application.

How to apply for a high-cost medical treatment system

There are two ways to apply for the high-cost medical care system: one is to apply for the high-cost medical care after the fact, and the other is to apply before using the limit application certificate.

The payment amount is the same for both, but let me introduce the difference between the two application methods.

For example, let's assume that the total medical expenses are 1 million yen with a 30% window burden.

In addition, it is considered as a "general" income category for those under 70 years old.

When applying for payment of high-cost medical expenses after the fact

If you pay 30% of 300,000 yen at the counter and apply for a large amount of medical expenses at a later date, 212570 yen will be refunded.

As a flow, pay medical expenses of 30% of the burden at the counter once, apply for high medical expenses if the limit is exceeded for one month, and exceed the limit of medical expenses Will be refunded, and so on.

If you are applying for a large amount of medical expenses, you will need a receipt from a medical institution.

Therefore, keep it in a safe place so that you do not lose it.

For more information, please contact the insurance company you are in.

The application window differs depending on the insurance company you have, so please contact the insurance company listed on your insurance card.

The case of National Health Insurance differs depending on the municipality, so check with the person in charge of National Health Insurance where you live.

To apply, you will need your insurance card, receipt, transfer account, and seal.

When proceeding before using the limit application certificate

The limit application certificate is issued when you apply to the insurance company you are in.

Regardless of outpatient or hospitalization, if you apply for the limit application certificate in advance, you will be able to pay at the counter at your own expense limit.

If you are under the age of 70 and you think that medical expenses will be high due to surgery or hospitalization, get a certificate of limit application in advance.

Even if you are not sure whether you will exceed the self-pay limit, be prepared in advance so that you can apply.

As a flow,

Apply for a limit application certificate to the insurer you are in
Insurer issues a certificate of limit application
Present the limit application certificate to the counter
Pay up to the self-pay limit for medical expenses

It will be like that.

Even if you do not apply for the limit application certificate, if you are over 70 years old, the payment at the counter will automatically be up to the self-pay limit.

However, please note that the "Certificate of Applicable Limit / Standard Burden" is required for low-income earners.

The application window differs depending on the insurance company you have, so contact the insurance company listed on your insurance card.

The case of National Health Insurance differs depending on the municipality, so check with the person in charge of National Health Insurance where you live.

To apply, you will need your insurance card, receipt, transfer account, and seal.