Understanding High-Cost Medical Expense Benefits for National Health Insurance in Sagamihara City
Sagamihara City’s National Health Insurance (Kokuho) program aims to support its residents by alleviating the financial burden of significant medical expenses. A key benefit provided is the high-cost medical expense benefit, which helps cover treatments that exceed a certain threshold within a given month. To ensure beneficiaries can fully utilize this system, it’s crucial to understand what types of medical expenses are eligible.
Recently, Sagamihara City published detailed information regarding the scope of medical expenses that qualify for the high-cost medical expense benefit. This informative update, posted on July 31, 2025, at 3:05 PM, serves as a valuable resource for all National Health Insurance members in the city.
What Constitutes Eligible Medical Expenses?
The high-cost medical expense benefit is designed to cover costs incurred from medical treatments and services that are generally recognized as necessary under the National Health Insurance system. This typically includes:
- Physician’s Fees: Costs associated with consultations, examinations, and diagnoses by doctors.
- Medication Costs: Expenses for prescription drugs prescribed by a physician.
- Medical Treatments and Procedures: Charges for various medical interventions, surgeries, and therapies.
- Hospitalization Fees: Costs related to inpatient care, including room charges, nursing care, and meals.
- Laboratory Tests and Imaging Services: Fees for diagnostic tests such as blood tests, X-rays, and MRIs.
- Rehabilitation Services: Expenses for physical therapy, occupational therapy, and speech therapy when deemed medically necessary.
- Dental Treatment: Costs for necessary dental procedures, excluding cosmetic treatments.
Important Exclusions to Note:
While the scope of eligible expenses is broad, it’s important to be aware of certain items that are typically not covered under the high-cost medical expense benefit:
- Non-covered services: Treatments or services that are not recognized as medically necessary or are considered elective.
- Private room charges: Expenses for private or semi-private hospital rooms beyond the standard coverage.
- Certain non-medical expenses: Items such as personal comfort items, telephone charges in hospitals, or optional services not directly related to medical treatment.
- Medical expenses incurred outside of Japan: Unless specific agreements are in place, treatments received overseas are generally not eligible.
- Expenses covered by other insurance or benefits: If medical costs are already fully covered by other public or private insurance schemes, they cannot be claimed again under the high-cost medical expense benefit.
Understanding the Benefit Threshold:
The high-cost medical expense benefit comes into play when an individual’s total out-of-pocket medical expenses within a single calendar month exceed a specific threshold. This threshold varies based on factors such as the individual’s age, income level, and the type of medical service received. Sagamihara City’s official website provides detailed tables and explanations of these thresholds, which are crucial for understanding when the benefit will be applied.
How to Access the Benefit:
Generally, there are two primary ways to access the high-cost medical expense benefit:
- Pre-approval (限度額適用認定証 – Gendogaku Tekiyou Ninteishou): By obtaining a “Certificate of Eligibility for High-Cost Medical Expenses” (限度額適用認定証) from Sagamihara City Hall before receiving treatment, individuals can often pay only up to their designated monthly limit at the time of service, simplifying the process.
- Post-treatment Reimbursement: If pre-approval was not obtained, individuals can submit an application for reimbursement after paying the full medical costs. The city will then review the application and reimburse the portion exceeding the established threshold.
Sagamihara City encourages all National Health Insurance members to familiarize themselves with the details of the high-cost medical expense benefit. By understanding what medical expenses are eligible and how to apply for the benefit, residents can ensure they are taking full advantage of the support available to manage their healthcare costs effectively. For the most current and specific information, please refer to the official Sagamihara City website or contact their National Health Insurance division directly.
【国保・給付】高額療養費の対象となる医療費とはどのようなものでしょうか。
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相模原市 published ‘【国保・給付】高額療養費の対象となる医療費とはどのようなものでしょうか。’ at 2025-07-31 15:05. Please write a detailed article about this news in a polite tone with relevant information. Please reply in English with the article only.