Chugoku-Shikoku Regional AIDS Center

3.Other medical payment services

Specified chronic childhood disease medical expense assistance program

What is a specified chronic childhood disease medical expense assistance program?

Specified chronic childhood disease medical expense assistance program is the program in which the national government studies the treatment of children 20 years old and under, who need treatment for specified long-term diseases, to lessen the burden of medical costs. Effective April 1, 2005, the program was moved under the Child Welfare Act and amendments made to the contents.

1. Target diseases

There are 756 target diseases in 16 groups. HIV-positive children who are under the treatment of the listed disease can apply for the program.

2. Qualifying age

For all diseases, new registrants under 18 can now continued to be studied until they turn 20. For continuance, application must be made while the patient is 18 years of age (from the 18th birthday to the day before the 19th birthday). Only those whose continued treatment is deemed necessary will be eligible.

3. Scope of medical care

Previously, benefits were not necessarily granted to all outpatients, depending on their disease. Effective April 1, 2005, outpatients and inpatients of all diseases are now eligible for benefits. Medical care benefits are granted to eligible patients, on medical fees for treatment, cost of special diet during hospitalization, insured prescription drugs and visiting nurses. Benefits do not cover assistive devices.

4. Copayment

The amount of individual copayment will be determined from the amount of municipal and income taxes paid the previous year by the primary income earner of the household (see the table below).
*However, persons who apply to the following are exempt from paying medical costs.
a) Persons with hemophilia (including patients eligible for the congenital blood coagulation factor deficiency disease medical treatment research project)
b) Persons eligible for severe disease compensation

[Table] Maximum copayment for specified chronic childhood disease medical expense assistance program (Japanese Yen)

Division Guideline for annual income
(a household consisting of a married couple and one child)
Maximum limit
(Patient’s copayment ratio: 20%, outpatient and inpatient)
General Severe* Those who require support such as mechanical ventilator
Household on welfare 0
Municipal inhabitant’s tax-exempt Low income I (less than about 800,000 yen) 1,250 500
Low income lI (less than about 2,000,000 yen) 2,500
General income I
(Municipal inhabitant’s tax is under 71,000 yen, or annual income is about 4,300,000 yen)
5,000 2,500
General income Ⅱ
(Municipal inhabitant’s tax is under 251,000 yen, or annual income is less than about 8,500,000 yen)
10,000 5,000
High income
(Municipal inhabitant’s tax is over 251,000 yen, or annual income is more than about 8,500,000 yen)
15,000 10,000
Meals during hospitalization 50% of expense

*Severe: If one of the followings applies, it is regarded “severe.” (1)Persons who pay high medical cost over a long period of time. More specifically, a total medical expense per month exceeds 50,000 yen (if a patient bears 20% of medical costs, it would be 10,000 yen/month) more than six times a year. (2)Persons who fall under the criteria of a patient with severe disease.

5. Recommendation to obtain a Physical Disability Certificate

Persons who are past the age subject to the specified chronic childhood disease medical expense assistance program can no longer use the program and many of them apply to the “medical payment for services and supports for persons with disabilities,” for which a physical disability certificate is required. However, those who started taking anti-HIV drugs from childhood are sometimes unable to obtain the certificate as they do not meet the standard of certification. Therefore, we advise patients to get the physical disability certificate before they start to take anti-HIV drugs.

How do I apply for a specified chronic childhood disease medical care certificate?

Submit the necessary documents to the government office (e.g. welfare section) or health office in your jurisdiction (in person or by mail).

What you need

  • Application form
  • Personal seal
  • Health insurance card
  • Letter of consent to make a reference to the insurer
  • Medical assessment (to be filled in by physician)
  • Proof regarding primary income earner's income taxes of the primary income earner (copy of tax deduction certificate or income tax return) <see note 1>
  • Application for critically ill patient certification <see note 2>
  • Documentation to prove extent of disability (e.g. copy of physical disability certificate or disability pension certificate) <see note 3>

<note 1> Not necessary for persons with hemophilia or those applying for critically ill patient certification.
<note 2> Only necessary for those applying for critically ill patient certification.
<note 3> Only necessary for those applying for critically ill patient certification.

As a rule, guardians are now responsible for application procedures, but this may be done in lieu of the patient or guardian. New registration for continuance must be made each year. Necessary documents are available at government offices and medical institutions. Some organizations will download applications from municipal websites.

When can I start using the specified chronic childhood disease medical care certificate?

The certificate is good from the date of application, unless otherwise specified. If medical expenses were incurred between the date of application and the date of receipt from the issuing authority, remuneration will be made for the amount exceeding the limit of copayment. In the case of the City of Hiroshima, if application had been made within one month of medical expenditure, the date of issuance may be set back to the date of diagnosis on the doctor's report or the day that treatment commenced. However, commencement will not be set back beyond the date that diagnosis was confirmed, thus will not cover tests and other procedures made prior to final diagnosis.

Where can I use the specified chronic childhood disease medical care certificate?

As the specified disease and name of institution at the time of diagnosis is specified on the medical care certificate, this system can only be effective at the institution mentioned on the certificate, for the particular disease. For treatment of said disease at a separate institution, additional registration for that institution can be made.

What do I need to do, when visiting a medical institution?

Submit the certificate with your insurance card to the medical institution when you arrive. If you simultaneously have any other coverage (e.g. infant medication or critical illness benefits), submit documents for those as well.

What will my copayment be like?

Your payment will not exceed the monthly cost-bearing limit stated on your medical care certificate. If the invoice does not exceed that amount, you will need to pay that amount. You will need to pay the amount up to your monthly limit for each medical institution. If the total amount paid to all institutions exceeds your monthly cost-bearing limit, you will receive remuneration by applying to the health center within the government of your local jurisdiction.

What happens when emergency consultation at another hospital becomes necessary?

If the consultation is for treatment of an eligible disease, application can be made for coverage from the day that treatment commenced. When adding a medical institution visited for an emergency, indicate the emergency in the space provided for reason of addition.