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 portion covered by health insurance. However, for children before compulsory education, it is 20%, and for those aged 70 and over, the burden ratio stated in the certificate of eligibility or the notice of qualification information applies.
In addition to the insurance-covered portion, there may be out-of-pocket expenses (such as document fees and extra bed charges). Out-of-pocket expenses are not eligible for 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.
In addition, we will send the Application Form for high-cost medical expenses 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 eligibility certificate for the maximum limit can be presented at the medical institution's reception, so 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.
Please note that if there are any unpaid health insurance taxes, the eligibility certificate for the maximum benefit may not be issued.

• Certificate of Eligibility for Maximum Amount Application

Hospitalization Meal Therapy Expenses

Regarding meals during hospitalization, the insured person is responsible for the standard burden amount. The standard burden amount is 510 yen per meal. For households exempt from resident tax, the standard burden amount can be reduced upon prior application.

• Meal costs during hospitalization