If the total monthly copayment amount exceeds a certain amount, the excess amount will be refunded as high-cost medical care expenses.
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) 
Application method
- We will send an application form to the target person at least four months after the month of medical treatment ( no prior application required ).
- Please submit the application form to the Latter-stage Senior Citizens Qualification Section, National Health Insurance and Pension Section, Nerima Ward.
Once you apply, your bank account information will be registered, so from the next time onwards, even if you do not apply, we will automatically transfer the high-cost medical care benefit to you within four months from the month of your medical treatment.
Application period
2 years after receipt of application
Method of calculation
- For outpatients within the same month, the amount exceeding the maximum amount will be paid for each individual.
- If you receive both outpatient and inpatient services in the same month, or if there are multiple insured persons in the same household, the co-payments for outpatient services remaining after 1 above will be added together, and the limits for each household will be calculated. The excess amount will be paid.
Note: Households whose income category is equivalent to working income 1, 2, 3 (30% copayment) will be paid an amount exceeding the maximum amount by adding up all outpatient and hospital co-payments.
|
In the case of a single-person household with a general classification [Self-pay limit: 18,000 yen] |
|
|---|---|
|
△ Monthly copayment at hospitals, etc. |
|
Hospital A: 16,000 yen + Pharmacy B: 5,000 yen = 21,000 yen
Total copayment amount: 21,000 yen - Copayment maximum amount: 18,000 yen = 3,000 yen |
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 |
| Category 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, for insured persons with an income equivalent to that of active workers, even if only individual outpatients fall under the limit of "outpatient + hospitalization (per household)", it is included in the number of times applicable.
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: Please refer to " When the annual medical expenses related to outpatient are high [high-cost medical expenses (outpatient annual total)] ".
Reduction of the burden for those whose self-pay ratio is "20%" (consideration measure)
For the three years from October 1, 2020 to September 30, 2025, the burden of outpatient medical care will increase in order to prevent a sudden increase in the co-payment amount for those whose co-payment ratio is "20%". The upper limit of the amount will be 3,000 yen per month, and the amount paid in excess of the upper limit will be refunded as high-cost medical expenses. .
Please note the following
- Calculate by month (calendar month), person, and medical institution. (Even if medical expenses for multiple months are paid together, the calculation will be made for each medical treatment month.)
- Even in the same medical institution, inpatient and outpatient, medical and dental are calculated separately.
- Only the portion covered by insurance is included in the calculation, and meals at the time of hospitalization and extra bed charges that are not covered by insurance are not included.
- The co-payment limit for the month in which you turn 75 in the middle of the month (excluding those born on the 1st) applies to both the medical insurance you were enrolled in up to that point and the medical system for the elderly aged 75 or over. will be halved (the limit applies to each individual).
If the medical expenses are reduced due to the examination by the examination payment organization, it may not be included in the calculation.
When the annual outpatient medical expenses become high [high-cost medical expenses (outpatient annual total)]
During the calculation period (August 1st to July 31st of the following year), outpatients (per individual) with a copayment rate of 10% or 20% as of the reference date (see "Notes" below) If the total amount of the burden exceeds 144,000 yen, the excess amount will be paid as high-cost medical expenses (annual total for outpatients).
- If you have applied for high-cost medical care benefits (monthly) or outpatient annual total (every year) in the past, you do not need to apply in principle.
- For those who need to apply newly, an application form will be sent from the inter-regional union around February every year.Once you receive it, please submit it to Nerima Ward (Late-stage Elderly Qualification Section).
Please be careful
- The base date for the calculation period is, in principle, July 31st. However, if the eligibility is lost in the middle of the calculation period, it is the day before the date of loss.
- For those who received high-cost medical care benefits (per month) during the calculation period, the amount will be deducted from the calculation of the copayment amount.
- The self-pay amount for the month in which the co-payment ratio was "30%" during the calculation period is not included in the calculation.
inquiry
Citizens Department, National Health Insurance and Pension Division, Senior Citizen Qualification Section
Phone: 03-5984-4587 (direct) Fax: 03-5984-1212
Send an email to this department