Frequently Asked Questions (National Health Insurance)

QuestionPlease tell me about the cost burden when a National Health Insurance insured person is hospitalized.

Response

Regarding the cost burden for National Health Insurance subscribers in the event of hospitalization, it is as follows.
For more details, please see the related pages below.

Medical Expenses

It is 30% of the health insurance applicable portion. However, for children before compulsory education, it is 20%, and for those over 70 years old, it will be the burden ratio stated on the Older Adults Health Insurance Card.
Additionally, there may be out-of-pocket expenses (such as document fees, difference in bed charges, etc.) in addition to the insurance applicable portion. Out-of-pocket expenses are not subject to high-cost medical care benefits.

High-cost Medical Care Benefits

When the out-of-pocket Medical Expenses become high within the same month, if you apply and are approved, the amount exceeding the out-of-pocket cost (which varies by age and income) will be provided as high-cost medical care benefits.
Additionally, we will send the Application Form for high-cost medical care benefits to the head of the household approximately three months after the medical treatment.

• High-cost Medical Care Benefits

Certificate of Eligibility for Maximum Amount Application

The Certificate of Eligibility for Maximum Amount Application, when presented at the medical institution's reception, ensures that even if the monthly Medical Expenses become high, the amount paid to each medical institution will be limited to the household's self-burden limit.
Additionally, if there are any unpaid health insurance taxes, the Certificate of Eligibility for Maximum Amount Application may not be issued.

• Certificate of Eligibility for Maximum Amount Application

Hospitalization Meal Therapy Expenses

For meals during hospitalization, the standard burden amount is borne by the insured person. The standard burden amount is 460 yen per meal. For households exempt from resident tax, the standard burden amount will be reduced upon prior application.

• Meal costs during hospitalization