NOVARTIS HEALTH INSURANCE ASSOCIATION Wahaha Web

NOVARTIS HEALTH INSURANCE ASSOCIATION Wahaha Web

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When you incur high medical care costs

The copayment for medical care costs you can be required to pay is capped. If your copayment calculated based on a certain standards exceeds this maximum, the excess amount will be paid as “High-Cost Medical Care Benefits”.

When you want to reduce the amount of medical care costs you pay at the medical care institution

We recommend using a Myna health insurance card. Doing so will allow the provision of your cost-sharing maximum amount information via online eligibility verification, eliminating the need for a Certificate of Application of Maximum Copayment Amount.

Required documents:
Applies to: Insured persons or dependents whose copayment amounts for one month are expected to exceed their individual cost-sharing maximum amounts in the following cases:
  • If you are eligible to be issued a Health Insurance Eligibility Certificate that does not include information equivalent to the Certificate of Application of Maximum Copayment Amount (and if you are 70 or older, in the same income category as active workers Ⅰ or Ⅱ)
  • * Even when using a Myna health insurance card, those in the low income category must apply in advance for a Maximum Copayment/Reduced Standard Copayment Certificate to be treated as falling in the low income category.
Notes: You can use this system for both inpatient and outpatient costs.
* Information of how to submit. > Click/Tap Here
Issuance and return "Certificate of Application of Maximum Copayment Amount" is sent by registered mail in two or three days after receipt.
  • Return the certificate to Health Insurance Societies after finishing inpatient or outpatient treatment, or when it expires.

When you face high copayments for medical care or long-term care

Required documents: Application for Payment of High Aggregate Cost for Long-Term Care Service
  • *Contact Health Insurance Societies.

[Documents to attach]
Copayment certificate for long-term care insurance

  • Apply for issuance at the reception desk for Long-term Care Insurance in the municipal office.
Applies to: Insured persons paying copayments for both medical care and long-term care for all individuals in the same household, for whom the total copayment amount paid under both systems over a one-year period exceeds the maximum amount
Notes: For calculation purposes, the one-year period above refers to the period August 1 to July 31 the following year.

Loans for high-cost medical expenses

When High-cost Medical Care Benefits is applied, after the claim, the provision needs for approximately 3 month through the insurer checks. To assist the medical cost for the meantime, 80% of the estimated amount of High-cost Medical Care Benefits is loaned without interest. This is "financing system of large medical cost on health insurance".
Required documents:
  • Application Form for a loan of high-cost medical care expenses
  • *Contact Health Insurance Societies.

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