IBM Japan Health Insurance Association

IBM Japan Health Insurance Association

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When you incur high medical care costs

Maximums are set for copayments for medical care costs. If your copayment calculated based on certain standards exceeds the maximum, the excess amount will be paid as High-Cost Medical Care Benefits.

If you want to reduce the amount of medical care costs you pay at the medical facility

Procedures

  1. STEP1Submit the Request for issuance of Maximum Co-payment Certificate for Health Insurance
  2. STEP2 After receiving your Certificate of Application of Maximum Copayment Amount, enter the address of the applicable person in the address space.

    Note: The Certificate will be sent by in-house mail (or mailed to your home).

  3. STEP3Show your Certificate of Application of Maximum Copayment Amount to the medical care institution.

    Note: Starting in April 2012, the Certificate will apply to both outpatient and inpatient care.

  4. STEP4Return your Certificate of Application of Maximum Copayment Amount.

    Note: Be sure to return the Certificate if any of the reasons for returns given below applies.
    The Certificate of Application of Maximum Copayment Amount must be returned at a later date when any of the following reasons apply. Safeguard your Certificate with care and be sure to have it to return, if necessary.

    Reasons for return:
    (Return your Certificate of Application of Maximum Copayment Amount to the Health Insurance Association at the earliest possible date.)
    - The Certificate expires.
    - The insured person is no longer eligible (this includes changes in the health insurance card symbol or number).
    - The person in question is no longer a dependent.
    - Changes in the standard monthly remuneration result in relevant changes in the applicable category (A or B).
    -The current month is the month subsequent to the month in which the 70th birthday of the person in question falls.
    -The person in question becomes an insured person under the Medical Care System for the Advanced Elderly before his/her 70th birthday.

Required documents
Applies to Insured persons or dependents of less than 70 years of age who expect to pay more than their Cost-sharing Maximum Amounts for medical care costs at the medical facility over a period of one month.
Send to
  • In-house mail: HZD-YY1, IBM Japan Health Insurance Association
    Or:
  • IBM Japan Health Insurance Association (HZD-YY1)
    19-21 Nihonbashi Hakozakicho, Chuo-ku, Tokyo 103-8510
Notes You can use this system for both inpatient and outpatient costs.
Persons aged 70 or older are eligible to receive the same services by presenting their Elderly Benefits Cards.

>> Click here if you have questions or inquiries.

If your copayments for medical care and long-term care are high

Required documents
  • Application for Payment of High Aggregate Cost for Long-Term Care Service

Documents to attach:
Copayment certificate for long-term care insurance

Deadline At the earliest possible date
Applies to Insured persons making copayments for both medical care and long-term care in the same household for whom the total copayment amount paid under both systems over a one-year period exceeds the maximum amount
Address any inquiries to Base amounts may differ with differences in the age distribution of household members and income categories.

For more information, contact your municipality’s long-term care insurance office.

Send to
  • In-house mail: HZD-YY1, IBM Japan Health Insurance Association
    Or:
  • IBM Japan Health Insurance Association (HZD-YY1)
    19-21 Nihonbashi Hakozakicho, Chuo-ku, Tokyo 103-8510
Notes For calculation purposes, the one-year period above refers to the period August 1 – July 31.

>> Click here if you have questions or inquiries.

Loans for high-cost medical expenses

Required documents
  • Contact the Health Insurance Association to request a loan application form.
Applies to

Insured persons expecting to receive High-cost Medical Care Benefits who have been billed by the medical care institution for medical care costs during a month subject to payment of High-cost Medical Care Benefits or who have already paid such costs

Loan amount 80% of expected amount of High-cost Medical Care Benefits to be paid (interest-free)
Period of loan Until the date of payment of the High-cost Medical Care Benefits corresponding to the loan
Deadline At the earliest possible date
Send to
  • In-house mail: HZD-YY1, IBM Japan Health Insurance Association
    Or:
  • IBM Japan Health Insurance Association (HZD-YY1)
    19-21 Nihonbashi Hakozakicho, Chuo-ku, Tokyo 103-8510

>> Click here if you have questions or inquiries.

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