What to do if you don’t have enough money to cover your hospital bills

By on September 9, 2016


What’s great about the Japanese health care system is that when you are hospitalized, a big chunk of the medical bills you paid upfront  can be reimbursed to you within 3-4 months after making an insurance claim  under Japan’s “Kogakuryoyohi Seido” (High medical expenses coverage system).

The self-pay ceiling for those enrolled in Japan’s health insurance scheme is determined by their monthly income and is calculated as follows:


If the amount exceeds the self-pay ceiling, the insured has to pay the difference when he leaves the hospital.

What’s not great about the scheme is that not everyone has enough funds to cover his bills when he is discharged.  That brings us to this convenient way of paying less in case you find yourself in this situation.

In April 2007, a law came into effect allowing insured people to apply for ” Gendogaku Tekiyo Nintei” (Eligibility for Applicable Limits) designed to reduce payment when they leave the hospital. Here’s how the form looks like.


Gendogaku Tekiyo Nintei yoshi (Eligibility for Applicable Limits form)


Gendogaku Tekiyo Nintei sho (Certificate of Eligibility for Applicable Limits)

How does it work?

Let’s say your hospital bill for a month came to ¥1,000,000 of which the government pays 70% and you, 30%.

Under the ‘High Medical Expenses’ coverage, you pay ¥300,000 upfront of which ¥212,570 is reimbursed to you after 3-4 months. The actual hospitalization cost to you is ¥87,430.

Under the ‘Eligibility for Applicable Limits’ coverage, you pay only  ¥87,430 at the time of discharge. This, however, disqualifies you from applying for reimbursement.

Although the amount you pay remains the same,  the second scheme is less burdensome for some families.

How to apply

If your hospital bill is likely to exceed the self-pay ceiling, the administrative department of the hospital will give you the Eligibility for Applicable Limits form (Gendogaku Tekiyo Nintei yoshi ) or you can ask one from the hospital.  If the hospital runs out of forms, you can get one at the Ward office in charge of Health Insurance.  This may be filled up by the patient, direct relatives or authorized person.  The eligibility certificate will be mailed back to you.  Present this to the cashier along with the insurance card upon discharge.  (Note: Meal expense is not an allowed item in the insurance claim.)










About Ted Tanaka