High-Cost Medical Expense Reimbursement Application (Kyokai Kenpo)

Who it is for

Insured persons covered by the Japan Health Insurance Association (Kyokai Kenpo), or their heirs if the insured person has passed away.

When it applies

Payment of medical expenses at a healthcare provider's counter that exceeds the monthly self-payment limit for the insured person's household (insured person and dependents).

Eligibility

• The applicant is an insured person (or their heir, if deceased) under the Japan Health Insurance Association (Kyokai Kenpo).
• Medical expenses were paid at the medical institution's counter during a single calendar month.
• The total out-of-pocket amount paid by the household (the insured person and their dependents) for that month exceeded the applicable monthly self-payment limit (based on age and income classification).

Required documents

• Health Insurance High-Cost Medical Expense Payment Application Form
  健康保険高額療養費支給申請書
• Tax certificate (tax-exempt certificate) for the insured person (only required if opting out of My Number information verification)
  被保険者の（非）課税証明書（マイナンバーを利用した情報照会を希望しない場合のみ提出が必要です）
• Tax certificates (tax-exempt certificates) for the insured person and all dependents (only required if opting out of My Number information verification)
  被保険者および被扶養者全員の（非）課税証明書（マイナンバーを利用した情報照会を希望しない場合のみ提出が必要です）
• Notice of rejection or termination of public assistance (for those whose need for public assistance was eliminated due to application of the 'limitation on payment' or 'standard burden reduction' certification)
  「限度額適用・標準負担額減額認定」の適用を受けることにより生活保護を必要としなくなる方 〇「限度額適用・標準負担額認定該当」と記載された「保護却下通知書」もしくは「保護廃止決定通知書」
• Copy of receipt from the medical institution (for cases where medical expenses were subsidized by another public program, reducing the patient's out-of-pocket cost)
  公的制度から医療費の助成を受け、窓口負担が減額されている方 〇助成を受けた診療についての、医療機関からの領収書のコピー
• Family register transcript (koseki tohon) or other document proving relationship to the deceased insured person (if applied for by an heir)
  被保険者が亡くなられ、相続人が請求する場合 〇被保険者との続柄がわかる「戸籍謄本」等
• Personal identification documents (e.g., My Number Card copy, residence certificate with My Number, driver's license, or passport)
  本人確認書類

Deadline

2 years after the first day of the month following the month of medical treatment

Official wording: 診療月の翌月1日

How to submit

• Electronic application (recommended)
• Mail (postal submission) to the local Kyokai Kenpo branch

Where to submit

Japan Health Insurance Association (Kyokai Kenpo) prefectural branch office