By presenting the “Ceiling Amount Application/Standard Contribution Reduction Certificate (reduction certificate)” or “Ceiling Amount Application Certificate” at a medical institution, etc., you can pay medical expenses up to the maximum amount. am.
This is intended to reduce the amount of payment you have to make at the counter to avoid having to temporarily pay for medical expenses and later receive a refund. In addition, meal charges (covered by insurance) during hospitalization will be reduced.
About new coronavirus infectious disease measures
In order to prevent the spread of the new coronavirus infection, we recommend that you apply by mail.
Please mail the application form to the Latter-stage Senior Citizen Qualification Section.
Postal address: Postal code 176-8501 6-12-1 Toyotama Kita, Nerima-ku Nerima Ward Office Latter-stage Elderly Qualification Section
As a general rule, the counter only accepts applications and omits detailed explanations.
If you have no choice but to come to the counter, please check the congestion status of the counter from the following website and visit the office during an open time. You can check the reception status of the window in real time on the Internet or smartphone.
Nerima-ku real-time window congestion information (external site) 
Out-of-pocket limit
| income category | Outpatient + Hospitalization (per household) |
|---|---|
|
Income equivalent to that of active workers3 |
252,600 yen + (100% medical expenses - 842,000 yen) x 1% (Multiple times 140,100 yen * Note 1) |
|
Income equivalent to working age 2 |
167,400 yen + (100% medical expenses - 558,000 yen) x 1% (Multiple times 93,000 yen * Note 1) |
|
Income equivalent to active duty 1 |
80,100 yen + (100% medical expenses - 267,000 yen) x 1% (Multiple times 44,400 yen * Note 1) |
| income category | Outpatient (per individual) | Outpatient + Hospitalization (per household) |
|---|---|---|
| General 2 |
6,000 yen + (100% medical expenses - 30,000 yen) x 10% |
57,600 yen (multiple times 44,400 yen * Note 1) |
| income category | Outpatient (per individual) | Outpatient + Hospitalization (per household) |
|---|---|---|
| General ("General 1" after October 1, 2022) |
18,000 yen (Upper annual limit of 144,000 yen * Note 2) |
57,600 yen (Multiple times 44,400 yen * Note 1) |
| Division 2 ・Inhabitant tax exempt households who do not fall under Category 1 |
8,000 yen | 24,600 yen |
| Division 1 ・Inhabitant tax-exempt households with income of 0 yen for all members of the household (the deduction for public pension income is 800,000 yen, and salary income is calculated by deducting an additional 100,000 yen after deducting salary income). ・Those who are exempt from residence tax and are receiving old-age welfare pensions. |
8,000 yen | 15,000 yen |
Note 1: In the last 12 months, including the month of medical treatment, if high-cost medical expenses were paid three times, the maximum amount that will be applied from the fourth time onwards (multiple times applicable). However, payment by "outpatient (per individual) maximum amount" is not included in the number of times applicable to multiple times. In addition, members of medical care for the elderly who have an income equivalent to that of active workers are included in the number of times of multiple cases even if they fall under the limit of "outpatient + hospitalization (per household)" only for individual outpatients.
The number of times covered by this multiple times does not include the number of times covered by medical insurance (medical insurance for the elderly aged 75 or over in other prefectures, national health insurance, health insurance, mutual aid).
Note 2: “[Medical care for the elderly] When medical expenses become high (high-cost medical expenses)”, “When annual outpatient medical expenses become high [high-cost medical expenses (outpatient annual total)]” Please refer to.
Limit Application/Standard Contribution Reduction Certificate (Reduction Certificate) and Limit Application Certificate
| Certificate type | Target audience | Explanation |
|---|---|---|
|
Maximum amount application / Standard burden amount reduction certificate (reduction certificate) |
If the self-pay rate is 10% and you fall under Category 1 or 2, you can apply for a grant. |
By presenting your certificate at the reception desk of a medical institution, the burden of medical expenses covered by insurance and meal costs during hospitalization will be reduced. |
|
Limit application certificate |
If the self-pay rate is 30% and you fall under income 1 or 2 above, you can apply for a grant. |
If you show it at the counter of a medical institution, etc., the maximum copayment amount for medical expenses covered by insurance will be applied. |
Applicable to long-term hospitalization
Those who fall under "Category 2" in the table above and have been hospitalized for 90 days in the past 12 months (If the period covered by other health insurance is also certified as Category 2, it will be counted as the number of hospitalized days. can be applied), the food expenses during hospitalization will be reduced from 210 yen per meal to 160 yen per meal.
In addition, even if the reduction certificate is not issued, the number of days of hospitalization during the reduction certification period of Category 2 can be included in the determination of long-term hospitalization.
For more information, please contact the National Health Insurance and Pension Division Latter-stage Senior Citizen Qualification Section Telephone: 03-5984-4587 (direct)
About application and procedures
It will be applied from the 1st of the month in which you applied (or the date of qualification for those who obtained the qualification after that). The expiration date is July 31st every year.
Once you apply, it will be automatically renewed, so there is no need for any subsequent procedures. In mid-July every year, we will send a certificate with a new expiration date to those who are still eligible.
Reduction certificate
1. We are sending you an application form.
2. Please submit the application form to the Nerima Ward National Health Insurance and Pension Division Latter-stage Elderly Qualification Section (by mail or at the counter).
If you apply for long-term hospitalization, you will need a receipt from a medical institution that shows that you have been hospitalized for more than 90 days in the past 12 months.
For more information, please contact the National Health Insurance and Pension Division Latter-stage Elderly Qualification Section Telephone: 03-5984-4587 (direct) .
Limit application certificate
1. For confirmation of eligibility, please contact the National Health Insurance and Pension Section Latter-stage Senior Citizen Qualification Section Phone: 03-5984-4587 (direct line) . We will check in advance if you are eligible.
2. Once we have confirmed your eligibility, we will send you an application form. You can also download the application form.
3. Please submit the application form to the Nerima Ward National Health Insurance and Pension Division Latter-stage Elderly Qualification Section (by mail or at the counter).
Download the application form for the reduction certificate/maximum application certificate
Reissuance of Certificate of Reduction/Certificate of Application of Maximum Amount
If you have lost, defaced, or damaged your Certificate of Reduction or Maximum Amount Application, please apply for reissuance.
In principle, the certificate will be delivered by mail (ordinary mail). If you wish to receive same-day issuance, please contact the National Health Insurance and Pension Division Latter-stage Elderly Qualification Section in advance. Telephone: 03-5984-4587 (direct)
For details, refer to " [Medical care for the elderly] Issuance of health insurance card (reissuance) page.
Food expenses during hospitalization
| income category | food cost per meal |
|---|---|
|
Those who pay 30% or those who pay 20% (after October 1, 2022) |
460 yen *Note |
|
Those with 10% copayment and who are in “Category 2” in the table above (within 90 days of hospitalization in the past 12 months) |
210 yen |
|
Those who are 10% of the cost and are in "Category 2" in the above table (the number of days of hospitalization in the past 12 months is 90 days or more, long-term hospitalization applies) |
160 yen |
|
Those who pay 10% and fall under "Category 1" in the table above |
100 yen |
Annotation
- Patients with designated intractable diseases will be charged 260 yen per meal.
- For those who have been continuously hospitalized in a psychiatric bed from before April 1, 2015 to April 1, 2016, the fee will remain unchanged at 260 yen per meal for the time being.
| income category | Food cost per meal for those who do not require hospitalization | Meal costs per meal for those who require hospital care (respirators, those requiring parenteral nutrition, those with intractable diseases, etc.) | Living expenses per day |
|---|---|---|---|
|
30% burden |
460 yen Note: In some cases, the fee is 420 yen depending on the facility standards of insurance medical institutions. |
370 yen | |
|
Those who pay 10% and fall under "Category 2" in the table above |
210 yen |
210 yen (160 yen for long-term hospitalization) |
|
|
Those who pay 10% and fall under "Category 1" in the table above |
130 yen | 100 yen | |
|
Old-age welfare pension recipients who are in "Category 1" in the above table and who pay 10% |
100 yen | 0 Yen | |
If you are hospitalized in a bed mainly for those who need long-term medical treatment, food and housing expenses will be charged.
However, for those with designated intractable diseases, the criteria for "hospitalization other than nursing beds" in the table above will apply.
About the application for payment of the difference for dietary treatment
If you do not receive a reduction in the meal cost at the time of hospitalization and have paid more, you can later apply for a refund of the difference.
In addition, if you apply for long-term hospitalization, you may be eligible for the difference payment.
For more information, please contact the National Health Insurance and Pension Division Latter-stage Senior Citizen Qualification Section Telephone: 03-5984-4587 (direct)
Application form download
[Medical care for the latter-stage elderly] Application for meal price difference
inquiry
Citizens Department, National Health Insurance and Pension Section, Senior Citizen Qualification Section Telephone: 03-5984-4587 Fax: 03-5984-1212