Long-Term High-Cost Illnesses (Specified Diseases) Covered by Health Insurance

For diseases requiring prolonged treatment and incurring significantly high medical expenses, a special system exists to reduce the out-of-pocket maximum. This limit is set at ¥10,000 (¥20,000 for high-income individuals with chronic renal failure undergoing artificial kidney treatment), aiming to alleviate the financial burden of medical costs.

The specified diseases eligible for this long-term special provision are designated by law.

• ・Congenital hemophilia (factor VIII or factor IX deficiency) receiving plasma fractionation products.
• ・Chronic renal failure requiring artificial kidney treatment.
• ・Acquired immunodeficiency syndrome requiring administration of antiviral agents. (Including HIV infection, limited to persons specified by the Minister of Health, Labour and Welfare.)

Medical Support for Independence (Rehabilitation and Developmental Medical Care)

The Medical Support for Independence system is a publicly funded medical care program that reduces out-of-pocket expenses for medical care aimed at eliminating or alleviating physical and mental disabilities.

〈Eligible Individuals〉

Outpatient Psychiatric Care: Individuals with mental disorders such as schizophrenia as defined in Article 5 of the Mental Health and Welfare Act who require ongoing outpatient psychiatric treatment.

Rehabilitation Medical Care: Individuals aged 18 or older who have been issued a Physical Disability Certificate under the Welfare of Persons with Physical Disabilities Act and for whom treatment such as surgery to eliminate or reduce their disability is expected to yield definite results.

Developmental Medical Care: Children with physical disabilities for whom surgical treatment or other interventions to remove or reduce the disability are expected to yield definite results (under 18 years old)

Main Eligible Disabilities and Treatment Examples

• (1) Outpatient Psychiatric Care: Psychiatric disorders → Psychotropic medications, psychiatric day care, etc.
• (2) Rehabilitation Medical Care, Developmental Medical Care
  • a. Physical Disabilities... Joint contractures → Artificial joint replacement surgery
  • b. Visual Impairment... Cataracts → Lens extraction surgery
  • c. Internal Disabilities... Cardiac dysfunction → Valve replacement surgery, pacemaker implantation; Renal dysfunction → Kidney transplant, artificial dialysis

Osaka Prefecture Medical Expense Assistance Program for Persons with Severe Disabilities (Varies by municipality of residence)

The Medical Support for Independence system is a publicly funded medical care program that reduces out-of-pocket expenses for medical care aimed at eliminating or alleviating physical and mental disabilities.

〈Eligible Individuals〉

Individuals residing in municipalities within Osaka Prefecture who meet the following criteria

• (1) Holders of a Physical Disability Certificate with Grade 1 or 2 disability classification
• (2) Individuals with severe intellectual disabilities
• (3) Individuals with moderate intellectual disabilities who hold a Physical Disability Certificate
• (4) Individuals holding a Grade 1 Mental Disability Health and Welfare Certificate
• (5) Individuals holding either a Specific Medical Expense Recipient Certificate (for designated intractable diseases) or a Specific Disease Medical Recipient Certificate, and who are also eligible for Disability Pension Grade 1 or Special Child Rearing Allowance Grade 1

〈How to Receive Assistance〉

Apply at your local municipality to receive a ‘Severe Disability Medical Certificate’. At medical institutions within Osaka Prefecture, presenting the ‘Severe Disability Medical Certificate’ at the reception desk allows you to receive medical care by paying a portion of the out-of-pocket cost. However, in the following cases, you must first pay the medical expenses at the institution's reception desk. Later, submit an application at your municipal office with the receipt, etc., and the medical expenses minus the out-of-pocket portion will be reimbursed

• ・When you applied for the ‘Severe Disability Medical Certificate’ but its issuance is delayed
• ・When receiving medical care at a facility outside Osaka Prefecture
• ・When therapeutic devices are provided through medical expense payments, etc.
• ※The name of the medical certificate issued by municipalities (generally renewed annually in November) may vary by municipality.
• ※Expenses not covered by various medical insurance plans (e.g., medical certificate fees, medicine bottle fees, private room fees) are not eligible for medical expense subsidies.

Designated Intractable Diseases Medical Expense Assistance Program

On January 1, 2015, the “Act on Medical Care for Patients with Intractable Diseases” came into effect, establishing a medical expense assistance program based on this law. This program provides subsidies for a portion of the out-of-pocket medical expenses incurred by individuals suffering from diseases designated by the national government as Intractable Diseases (rare diseases with unclear mechanisms of onset and no established treatment methods, requiring long-term medical care).

〈Eligible Individuals〉

Individuals suffering from a Designated Intractable Disease (meeting the diagnostic criteria established by the Minister of Health, Labour and Welfare) who satisfy one of the following conditions

• (1) Individuals meeting the severity classification criteria established by the Minister of Health, Labour and Welfare.
• (2) Individuals for whom medical expenses (100% portion) exceeded ¥33,330 for at least 3 months within the 12 months preceding the month of application for treatment of the designated intractable disease (high-cost low-severity cases).
• ※Please consult your primary physician to determine eligibility.

〈Regarding Out-of-Pocket Expenses 〉

Under the medical expense subsidy based on the Intractable Diseases Act, a monthly out-of-pocket maximum is set based on income status (e.g., municipal resident tax assessment status). For medical expenses incurred within the same month (combined costs from multiple medical institutions, pharmacies, and visiting nursing stations), the portion exceeding this maximum is subsidized by public funds. If multiple patients within the same household receive medical expense subsidies for designated intractable diseases or pediatric chronic specified diseases, the out-of-pocket maximum is prorated.

Osaka Prefecture Welfare Medical Expense Subsidy Program

The Welfare Medical Expense Subsidy Program provides subsidies to municipalities that assist with a portion of the out-of-pocket medical expenses for severely disabled individuals, single-parent households, and infants/toddlers. This aims to reduce their financial burden, create an environment where they can more easily receive necessary medical care, and thereby promote health maintenance and welfare enhancement.

〈Eligible Individuals〉

• ・Individuals holding a Grade 1 or 2 Physical Disability Certificate
• ・Individuals with severe intellectual disabilities
• ・Individuals with moderate intellectual disabilities who also hold a Physical Disability Certificate
• ・Individuals holding a Grade 1 Mental Disability Health and Welfare Certificate
• Individuals holding a Specific Medical Expense Recipient Certificate (for designated intractable diseases) or a Specific Disease Medical Recipient Certificate, and who are equivalent to Grade 1 Disability Pension or Grade 1 Special Child Rearing Allowance recipients