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  3. High-Cost Medical Expense Benefit (Eligibility Certificate for Ceiling-Amount Application) or KOGAKU RYOYOHI SEIDO (GENDOGAKU TEKIYO NINTEISHO)

High-Cost Medical Expense Benefit (Eligibility Certificate for Ceiling-Amount Application) or KOGAKU RYOYOHI SEIDO (GENDOGAKU TEKIYO NINTEISHO)

高額療養費制度（限度額適用認定証）について

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If you have public health insurance coverage in Japan, you can apply for a “High-cost Medical Expense Benefit” in advance. You are only required to pay a pre-fixed ceiling amount at the cahiers desk. If you have paid the full amount already without showing an “Eligibility Certificate for Ceiling-Amount Application (GENDOGAKU TEKIYO NINTEISHO)” “Eligibility Certificate for Ceiling-Amount Application and Reduction of the Standard Amount of Patient Liability (GENDOGAKU TEKIYO ・HYOJUN FUTANGAKU GENGAKU NINTEISHO)”, you can claim a refund from your insurance provider.

日本の公的医療保険に加入している方は、事前の申請を行うことにより、窓口での支払い金額を月単位で一定の限度額まで抑えることができます。（「限度額適用認定証」または「限度額適用・標準負担額減額認定証」を使用せずに、支払いされた場合は、保険者に還付請求することができます。）

However, the following items will not be covered by the refund:
Private room charge, pajama rental fee, hospital food service fee and some medical expenses which are not covered by medical insurance (including advanced medical treatment not covered by medical insurance)
In addition, this system is not applicable if your medical expenses do not exceed the limit of your copayment amount.

ただし、個室代、病衣代、食事代や自費診療（保険診療の対象に至らない先進的医療を含む）などは含まれません。
また、医療費が自己負担額の限度を超えない場合も適用されません。

Procedures 手続き

Apply through your health insurance provider beforehand to get an “Eligibility Certificate for Ceiling-Amount Application” or an “Eligibility Certificate for Ceiling-Amount Application and Reduction of the Standard Amount of Patient Liability”. Please present this certificate at the reception desk. Your monthly payment will be no more than a specified amount.

加入されている医療保険の保険者に事前の申請を行い、保険者から発行される「限度額適用認定証」または「限度額適用・標準負担額減額認定証」を受付に提示してください。 支払い金額が月単位で一定の限度額までとなります。

However, if you delay in presenting the certificate, you may not able to benefit from this system.
If you have any questions or if there is something unclear about the necessary procedures for these applications, or about what happens if you transfer to another hospital, please ask your health insurance provider.

ただし、提示が遅れた場合は適用できない場合があります。
なお、事前の申請に必要な手続きや転院した時の取り扱いなど、ご不明な点がありましたら、加入されている医療保険の保険者までお問い合わせください。

This English translation has been prepared under the supervision of doctors, legal experts or others. When any difference in interpretation arises because of a nuanced difference in related languages or systems, the Japanese original shall be given priority.

本資料は、医師や法律の専門家等の監修をうけて作成されておりますが、日本と外国の言葉や制度等の違いにより解釈の違いが生じた際には、日本語を優先とします。

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