Medical billing
Japan — the national fee schedule and the high-cost medical expense benefit
NationalJPUnverified — check before relying on it
Japan
- Rule id
- medical.jp
- Version
- 1.0.0
- In force from
- December 27, 1958
- Last read against its sources
- August 5, 2026
- Countries bound
- Japan
In plain language
What this regime says.
Japan bills insured treatment against a single national fee schedule, and caps household out-of-pocket spending each month through the high-cost medical expense benefit — which is claimed far less often than it applies.
Who is covered
People insured under Japanese health insurance and treated in Japan.
What you get
An itemised statement, and a refund of monthly out-of-pocket costs above the applicable cap.
Where claims go wrong
- Paying at the counter and never applying for the high-cost benefit.
- Not asking for the limit-amount certificate before a planned admission, which applies the cap up front.
Authority
Every citation,
with its pinpoint.
A claim that cites “EU law” gets filed. A claim that cites Article 7(1)(c) gets answered. These are the exact coordinates this entry rests on.
- Health Insurance Act (健康保険法) and the National Health Insurance Act (国民健康保険法)Japanese health insurance legislationThe statutory basis of universal insurance, the national fee schedule against which insured treatment is billed, and the high-cost medical expense benefit (高額療養費)
Sources
Where a figure is indexed, converted or published by a regulator rather than fixed in the instrument, the provenance is recorded separately. Anything marked as a modelled estimate is exactly that — a model, not a statutory number.
- Health insurance, the fee schedule and the high-cost medical expense benefitMinistry of Health, Labour and Welfareretrieved 2026-08-05
What it imposes
Clocks, defences and the ladder.
A rule module builds these while it evaluates, because a limitation period depends on which forum is open to you. What follows is the structure this regime produces — deliberately with no dates and no figures, because those belong to your facts rather than to the law.
What it entitles you to, beyond money
- The high-cost medical expense benefitA monthly out-of-pocket cap by income band, refunded on application to your insurer.
- Review of the itemised receipt against the fee scheduleInsured treatment is billed in schedule points. Ask for the itemised receipt (領収書 and 明細書) and check the points against the schedule.
Where to take it next
- Ask the institution for the itemised statementInstitutions are generally required to issue an itemised statement on request.Claim directtypically 21 days
- Apply to your insurer for the high-cost benefit and the limit-amount certificateThe insurer administers the cap and the refund.Internal appealtypically 90 days
- Prefectural social insurance examination committeeReviews insurer decisions on benefits.Regulatortypically 120 days
Documents
What this regime can produce.
Every one of these is a document you send yourself, in your own name. Duesday never writes to anybody on your behalf and is never anyone’s agent.
The same claim type elsewhere
EU cross-border healthcare — Directive 2011/24/EU reimbursement, the EHIC and the S2EUSupranational — 27 countriesDirective 2011/24/EU, Arts. 6, 7 and 8Confidence: highFrance — dépassements d'honoraires, secteur 1 and 2, and the OPTAMFRNational — FranceCode de la santé publique, art. R. 4127-53Confidence: mediumGermany — the GOÄ and GOZ private billing schedules and their multiplier limitsDENational — GermanyGebührenordnung für Ärzte (GOÄ), §§ 2, 5 and 12Confidence: mediumIreland — public hospital charges, medical cards and the HSE complaints routeIENational — IrelandHealth Act 1970 (as amended)Confidence: lowItaly — Servizio Sanitario Nazionale, the ticket and the URP routeITNational — ItalyLegge 23 dicembre 1978, n. 833Confidence: lowNetherlands — NZa tariffs, the eigen risico and the SKGZ dispute routeNLNational — NetherlandsWet marktordening gezondheidszorg (Wmg), art. 35Confidence: mediumSpain — Sistema Nacional de Salud coverage and the right to economic informationESNational — SpainLey 41/2002, de autonomía del pacienteConfidence: lowUnited Kingdom — NHS charging, overseas visitor invoices and private healthcareGBNational — United KingdomNational Health Service Act 2006, s. 1(4)Confidence: medium
Other rights in the same countries
Japan — Act on Specified Commercial Transactions and the final-confirmation-screen rulesJPNational — Japan特定商取引に関する法律 (Act on Specified Commercial Transactions), Act No. 57 of 1976Confidence: mediumJapan — dormant deposits (Act No. 101 of 2016, in force 1 January 2018)JPNational — JapanAct on Utilization of Funds Related to Dormant Deposits to Promote Public Interest Activities by the Private Sector (Act No. 101 of 2016)Confidence: mediumJapan — filed conditions of carriage, the Consumer Contract Act and the Montreal ConventionJPNational — Japan航空法 第106条 (Civil Aeronautics Act, Art. 106 — filed conditions of carriage)Confidence: mediumJapan — Installment Sales Act connection of defences and Specified Commercial Transactions ActJPNational — Japan割賦販売法 第30条の4 (Installment Sales Act, art. 30-4)Confidence: mediumJapan — Japan PostJPNational — JapanPostal Act (Act No. 165 of 1947) and Japan Post's service termsConfidence: lowJapan — JR delay certificates (遅延証明書) and limited express-charge refundsJPNational — JapanCarriers’ published conditions of carriage (運送約款)Confidence: lowJapan — tax-inclusive price display and misleading representationsJPNational — JapanAct against Unjustifiable Premiums and Misleading Representations (Act No. 134 of 1962), art. 5Confidence: mediumJapan — two-stage collective consumer redressJPNational — JapanAct on Special Provisions of Civil Procedure for Collective Recovery of Property Damage Incurred by Consumers (Act No. 96 of 2013)Confidence: low
Does this one reach your facts?
The engine runs every regime that could apply at once and reconciles them, rather than making you guess which page to read.
Not a law firm. Not legal advice. You send it yourself. This page describes a law; it is not advice about your situation and no outcome is promised.