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


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.


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.


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.


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.