If the medical expenses paid (out-of-pocket amount) exceed a certain amount (out-of-pocket maximum amount), it will be paid as high-cost medical expenses.

Applicable households will receive a "Notification of High-Cost Medical Care Benefits" three to four months after the month of medical treatment. The “Application for Payment” is enclosed, so please apply by mail.
The limit and calculation method are as follows.
Please note that if two years have passed since the 1st of the month following the month of medical treatment, it will expire and will not be paid.

From November 2022, the simplification of the application procedure for high-cost medical care expenses began. Click here for details.

Simplification of high-cost medical expenses payment application procedures has begun

Method of calculation

Meal expenses during hospitalization, bed charges not covered by health insurance, etc. are not covered.
The calculation method is different for those under 70 and those over 70.

Click here for high-cost medical expenses for those aged 70 to 74.

Under 70 years old

If there are multiple people in the same household who paid 21,000 yen or more in the co-payment at the same hospital, etc. within the same month, and the combined amount exceeds the maximum amount shown in the table below, the excess amount is paid.
For each hospital, even in the same hospital, inpatient, outpatient, and dental expenses are calculated separately, and if there are two or more that are 21,000 yen or more, they are calculated together.

・The former proviso income refers to the amount obtained by subtracting the basic exemption amount of 430,000 yen*1 for resident tax from the total income amount (excluding retirement income amount). (The basic deduction amount before 2020 was 330,000 yen, but it will be changed from 2021 due to the tax system revision.)
・If there is a person in the household who has not declared their income, or whose income is unknown due to moving, etc., the household is considered to have a total income of over 9,010,000 yen.
・Since the above income determination is performed every year, the income classification may change if the income changes. Also, the fiscal year for judging will switch to August.
・For those who are receiving reduction measures for insurance premiums for involuntary unemployed people, the application category will be determined based on income that is 70% less than employment income.

*1 If the total income amount exceeds 24 million yen, it will be reduced in stages.

About ceiling application certificate

By presenting a Certificate of Application of Maximum Amount Application, etc., the maximum amount you can pay at the counter of a hospital, etc., will be the maximum amount.
In addition, households exempt from resident tax can receive a Certificate of Maximum Amount Application/Standard Contribution Reduction Certificate, which reduces the cost of meals as well.
A prior application is required for the issuance of a Certificate of Eligibility for Maximum Amount Application. Please bring your insurance card, etc., and apply for the issuance of a certificate. A valid certificate will be issued from the first day of the month to which the application date belongs.
In addition, if you pay the co-payment without presenting your certificate and fall under high-cost medical care, we will send you a "notice of payment of high-cost medical care" and a "payment application" 3 to 4 months after the month of medical treatment. To do.

Details of National Health Insurance Benefits

About specific illness medical treatment certificate

For diseases that require high medical costs over the long term and are designated by the Minister of Health, Labor and Welfare (hemophilia, chronic renal failure requiring dialysis, HIV infection caused by administration of blood coagulation factor preparations), monthly You will be issued a certificate of medical treatment for a specific disease, with a copayment limit of up to 10,000 yen.
For high-income households under the age of 70 who require dialysis due to chronic renal failure, the maximum co-payment is 20,000 yen. When applying, you will need your health insurance card and a doctor's opinion or a document proving that you are suffering from the disease.
Please apply at Ward Office 2F No. 1 (National Health Insurance Payment Section).

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