Medical care cost information

To date, the Society has used postal mail to send medical care cost information on the medical care costs you paid and the actual costs of medical care. Starting in January 2025, medical care cost information has been digitized and posted to the Kenpo MyPortal.

Tips

Check the actual medical care costs using your “medical care cost information” and receipts or detailed statements.

Medical care costs for sickness and injury treatment are uniformly determined at all hospitals in Japan, based on the standards established by the Japanese government as Medical Fees. However, using health insurance, the only amount you pay at a hospital is the copayment. This can make it hard to grasp the actual medical care costs incurred.

For this reason, the Health Insurance Society prepares and distributes to insured persons “medical care cost information” showing details such as the amount of medical care costs you paid in one year and the benefits paid by the Society.

The “medical care cost information” is prepared based on medical care cost data from medical care institutions.
Medical care cost data is sent from medical care institutions to the Health Insurance Society via the healthcare bill check and payment organization two months after the month of the examination or treatment and is posted as “medical care cost information” on Kenpo MyPortal three months after the month of the examination or treatment.

Posting schedule

Your latest “medical care cost information” will be updated after 3 months you have received your treatment. This update will happen around the 10th of each month.
The medical care cost information for examinations and treatment received in December of the previous year, which is required for medical expenses deductions, will be in principle posted around late February each year.
These costs may be eligible for medical expenses deductions when filing your final tax return.

Reference link

Medical expenses deductions

In addition, medical care institutions will issue receipts showing medical care costs per item, including charges for the first consultation, checkup charges and treatment charges, as well as detailed statements showing more detailed “medical care information”. Try to check these against the medical care cost information you receive from the Health Insurance Society later.

こんなことにご注意ください

Since medical care cost data may arrive late due to circumstances at medical care institutions or the healthcare bill check and payment organization, the medical care cost information may not be displayed according to the posting schedule (three months after the month of the examination or treatment). In such cases, the information will be posted as soon as the data arrives at the Health Insurance Society.
The amount you paid at the counter / “あなたが窓口で支払った額” shown in the medical care cost information may differ from the actual amount you paid in cases of medical care received at public expense or medical assistance provided by municipal governments.
If you have received medical care covered by health insurance, the costs for subsequent treatment not covered by health insurance but eligible for medical care benefits may also be indicated in the medical care cost information.
Since cost data for judotherapist treatment (at a bonesetter’s clinic or osteopathic clinic) takes more than three months to arrive at the Health Insurance Society, the medical care cost information will be delayed from the usual posting schedule. The name of the treatment clinic will be left blank.

Assessment of reduced payment

What is assessment of reduced payment?

Information on medical care costs for examinations and treatment received by presenting an Individual Number Card or health insurance card will be submitted for billing by the medical care institution to the healthcare bill check and payment organization and reviewed to confirm that the items of examination or treatment for the diagnosed illness or injury conform to the rules on medical care covered by health insurance.
If, upon review, it is determined that the items of examination or treatment are not appropriate, the medical care costs billed by the medical care institution will be reduced. The Health Insurance Society will be billed for the reduced amount. This is called an assessment of reduced payment. Your copayment is calculated based on total medical care costs before an assessment of reduced payment. So, the amount of copayment you already paid at the counter will be higher than the amount of copayment revised after an assessment of reduced payment.

Notice of assessment of reduced payment

From January 2025, the Health Insurance Society has notified members of medical care costs subject to assessment of reduced payment in the medical care cost information on Kenpo MyPortal. Corresponding medical care costs are indicated by an asterisk (※) under “Examination/treatment category: By benefit type.”
Check the difference in amounts by comparing the “Amount you paid at the counter” (excluding amounts of statutory benefits and additional benefits, if any) in the medical care cost information with the receipt issued by the medical care institution.
Under a guidance from the Ministry of Health, Labour and Welfare, you will be notified of any identified reductions in amounts of 10,000 yen or more from the copayment you paid at the medical care institution.

If your medical care cost information indicates an assessment of reduced payment

The insured person or dependent family member seeking a refund may request one directly from the medical care institution.
However, the overpayment will not be refunded immediately if the medical care institution has requested a secondary review or similar procedures from the healthcare bill check and payment organization.
No refund will be provided if results of the secondary review determine the medical care was appropriate.
Consult first with the medical care institution in question.

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