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I expect to incur high medical care costs. How can I apply for and use a Certificate of Application of Maximum Copayment Amount?
See below for information on how to apply for and use the Certificate.
1.Print and fill out the application form
- Download the form from the website, print the form, and complete. Refer to the example.
Request for issuance of Maximum Co-payment Certificate for Health Insurance
Example
2.Send the application form to Rakuten KENPO
*Note that the original (paper) application form will be accepted. Email attachments will not be accepted, whether in PDF or another format.
Send to:
Rakuten KENPO 3F, Rakuten Crimson House Annex 1-14-1 Tamagawa, Setagaya-ku, Tokyo 158-0094
By in-house mail:
Office: Annex; Department: Rakuten KENPO; Name: Staff in charge
3.The Certificate will be issued and sent after Rakuten KENPO has checked the document
- The Certificate will be issued on the same day if all entries in the document are complete.
- The Certificate of Application of Maximum Copayment Amount will be sent to the address indicated on the application form.
4.Present the Certificate of Application of Maximum Copayment Amount to the medical care institution
- When you show the Certificate of Application of Maximum Copayment Amount to the medical care institution, the amount you are required to pay at the medical care institution will be reduced to the legal Cost-Sharing Maximum Amount. (Amounts settled at actual cost, such as meal expenses and premium bed expenses, are not eligible for this reduction.)
5.Return the Certificate of Application of Maximum Copayment Amount to Rakuten KENPO
- Return the Certificate of Application of Maximum Copayment Amount to Rakuten KENPO after you are finished using it. (Send it to the same address to which you sent the application form above.)
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