Western Digital Technologies Health Insurance Association

The Western Digital Technologies Health Insurance Association automatically calculates and pays the total amount of high-cost medical expenses and additional benefits for any out-of-pocket medical care costs exceeding the ceiling amount at a later date based on the medical cost statement (insurance claim) sent from the healthcare provider.
(This excludes amenity bed costs and other expenses not covered by insurance and the cost of inpatient meals.)

High-cost Medical Care Expenses

High-cost Medical Care Expenses and Co-payment Reductions (Additional Family Medical Expense Benefit)

The Western Digital Technologies Health Insurance Association reimburses insured persons and dependents for high-cost medical care expenses paid at the billing counter for inpatient or other medical care at a later date. A co-payment reduction (additional family medical expense benefit) is also offered as a unique benefit from the Western Digital Technologies Health Insurance Association.

Insured persons and dependents can limit payments at the billing counter of healthcare providers to the ceiling amount of out-of-pocket costs by applying for and presenting an Eligibility Certificate for Ceiling-Amount Application. See more details about the Eligibility Certificate for Ceiling-Amount Application here.

These benefits are calculated and automatically paid based on the certificate of medical remuneration sent by the healthcare provider to the Western Digital Technologies Health Insurance Association (insured persons and dependents do not need to submit an application), but the payment period is roughly three to four months after the month in which the insured person or dependent received medical care.

*Insured persons and dependents can reduce the burden of co-payments when the total amount of out-of-pocket payments for medical insurance or long-term care exceeds a certain amount through programs such as the high-cost medical care expense and high-cost long-term care cooperation system for reimbursements of excess medical care costs or certificates issued for specific disease treatments to reduce the ceiling amount for specific diseases incurring high-cost medical care expenses.

The Western Digital Technologies Health Insurance Association pays the amount exceeding the combined maximum total of 21,000 yen in out-of-pocket costs for two or more cases in the same household as aggregated high-cost medical care expenses.

Eligibility Certificate for Ceiling-Amount Application

Insured persons and dependents can apply to have a certificate issued by the Western Digital Technologies Health Insurance Association in advance for any out-of-pocket payments exceeding the ceiling amount to present at the billing counter of the healthcare provider in order to limit payment to only the medical costs up to the maximum amount.
If you use your Individual Number Card (My Number Card) as your health insurance card, you will be exempt from paying any out-of-pocket expenses that exceed the maximum amount under the High-Cost Medical Expenses System without undertaking any prior procedures.
There is no need to apply for an Eligibility Certificate for Ceiling-Amount Application in advance.

Calculation Method for High-Cost Medical Care Expenses

The Western Digital Technologies Health Insurance Association reimburses the amount of medical care expenses paid at the hospital billing counter less 25,000 yen (amounts less than 1,000 yen will not be paid; amounts less than 1,000 yen are rounded down) about three months after the insured person or dependent receives medical care regardless of whether a Certificate for Ceiling-Amount Application is presented.

*High-cost medical care expense benefits are calculated automatically and do not require an application.

In either case, the amount of final co-payment is the same.

Aggregated High-cost Medical Care Expenses for a Household

The Western Digital Technologies Health Insurance Association pays the amount exceeding the combined maximum total of 21,000 yen in out-of-pocket costs for two or more cases in the same month for the same household.

Four Months or More of High-cost Medical Care Expenses (Multiple Occurrences)

The co-payments from the fourth month in which high-cost medical care expenses exceed the ceiling amount vary as follows when insured persons and dependent have paid high-cost medical care expenses three or more times in one year (last 12 months) in the same household.

Regarding "the Annual Maximum"

Effective August 2026, an "Annual Maximum" has been established to help those requiring long-term medical treatment better plan for their "future medical expenses," which have been a source of anxiety.
When the total out-of-pocket expenses incurred over one fiscal year (August 1 of the previous year through July 31) exceed the "Annual Maximum" for the income bracket as of the standard date (July 31), in principle, the amount exceeding the ceiling will be paid as "High-Cost Medical Care Expenses."

Special Exception for Specific Diseases

Patients with hemophilia, acquired immune deficiency syndrome (AIDS) administered antiviral agents, and chronic renal failure requiring dialysis for an extended period only need to pay 10,000 yen per month to a healthcare provider once certified as a person with a specific disease. However, patients who require dialysis have a co-payment of 20,000 yen if their standard monthly remuneration is 530,000 yen or more. (This applies to both insured persons and dependents.)