Sony Health Insurance Society

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When you incur high medical care costs

 

If the copayment you pay at a medical care institution per rezept*1 (calculated by patient, by month, by medical care institution, and by inpatient/outpatient/dental/pharmaceutical category) exceeds a certain maximum,*2 the amount beyond this figure will be paid by the Sony Health Insurance Society as “high-cost medical care benefits.” In addition, the Sony Health Insurance Society will pay amounts on copayments beyond 20,000 yen as additional benefits. (These benefits are paid automatically. In general, you do not need to apply for them.)

  • *1  A rezept is an invoice (medical cost details) issued by a medical care institution to the Health Insurance Society.
  • *2  See the table below.

Maximum copayment amount (per month) for a person younger than 70

Eligible person
Maximum copayment amount (per month) per household (inpatient/outpatient)
Frequent qualification of expenditures (fourth and subsequent times)
A. 830,000 yen or more 252,600 yen + (Total medical care costs - 842,000 yen) × 1% 140,100 yen
B. 530,000–790,000 yen 167,400 yen + (Total medical care costs - 558,000 yen) × 1% 93,000 yen
C. 280,000–500,000 yen 80,100 yen + (Total medical care costs - 267,000 yen) × 1% 44,400 yen
D. 260,000 yen or less 57,600 yen
E. Persons with low income
(exempted from municipal tax)
35,400 yen 24,600 yen
  • * High-cost medical care benefits are calculated based on the invoice for medical care costs issued by the medical care institution to the Health Insurance Society (rezept) calculated by patient, by month, by medical care institution, by inpatient/outpatient care category, and by medical/dental/pharmaceutical category. They do not include meal costs during inpatient care, premium bed costs, or care paid for at your own expense; these expenses are not covered by insurance.s
  • * If the same household received high-cost medical care benefits in three or more of the most recent 12 months, the copayment will be reduced in the fourth month and beyond.
  • * If members of the same household have made copayments exceeding 21,000 yen two or more times in the same month and the total of these two copayments exceeds the maximum copayment amount, the amount of such excess will be paid as total high-cost medical care benefits.
  • * See here concerning persons aged 70–74.
  • * See here concerning persons with low income.

If you want to reduce the amount you pay at the medical care institution

If a person less than 70 years of age expects to incur high medical care costs, it can be more convenient to obtain “a Certificate of Application of Maximum Copayment Amount” in advance. In principle, the Health Insurance Society will automatically pay benefits for medical care costs for which a copayment was paid. Even if you were unable to present a Health Insurance Maximum Copayment Amount Eligibility Certificate at the hospital, your final copayment amount will remain unchanged.

Prior application required

“The Certificate of Application of Maximum Copayment Amount” is used to confirm your income category. You must apply to the Health Insurance Society in advance for this Certificate.

If you receive medical care for specified diseases and disorders

Patients suffering from haemophilia, AIDS for which they are administered antiviral drugs, or chronic renal failure requiring artificial dialysis for an extended period may be eligible to pay just the following maximum copayment amount per month to the medical care institution if they obtain certification for specified diseases and disorders.
If you are eligible, apply for issue of Certificates Issued for Specific Disease Treatment.

Classification Copayment
Higher income earners
(530,000 or more)
Those less than 70 years of age and certified to have been diagnosed with chronic renal insufficiency 20,000 yen
Those other than the above 10,000 yen
Others 10,000 yen

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