High-cost Medical Care Benefits

If the monthly co-payment (note) paid at a medical institution exceeds the self-burden limit due to illness or injury, the city will provide the difference as high-cost medical expenses.
If you are eligible, we will send the Application Form to the head of the household three months after the month of treatment, so please apply by mail or at the City Hall or Branch Office when you receive the Application Form.

Note: Costs not covered by insurance (such as document fees, meal costs during hospitalization, and extra bed charges) are not eligible for high-cost medical expense reimbursement.

• Meal costs during hospitalization

Required items for applying for high-cost medical care benefits

• Application Form sent from the city
• Seal
• Documents that indicate the transfer account, such as a bankbook
• Identity Verification Documents
• Personal Number (My Number) Confirmation Document

When providing high-cost medical expense benefits, there may be cases where it is applied to unpaid National Health Insurance Tax.

In the case of mail application, please fill out the necessary information and return the stamped Application Form.

• Identity verification documents / Individual number (My Number) verification documents

Automatic transfer for high-cost medical expenses has become available

Until now, to receive high-cost medical expense benefits, it was necessary to apply for each applicable month, but it will now be possible to set up automatic transfers upon request.

How to Apply for Automatic Bank Transfer

Please check the "Automatic Transfer Request" section of the High Medical Expense Payment Application Form when applying.
Once you register your account, you will not need to go through the application process again, and payments will be automatically transferred to the designated account from the city. A notification of the High Medical Expense Payment Decision will be sent at the time of transfer.

Cases Not Subject to Automatic Transfer

Automatic transfers will be canceled in the following cases. Please submit the Application Form again.

• In the case of changes in household composition due to moving out, household separation, etc.
• If the transfer to the specified account could not be made due to account cancellation, etc.
• In case of insurance tax arrears
• If payment at the hospital has not been completed

Notes

• For the applications that were submitted in the past, it is still necessary to submit the Application Form as before.
• After applying for automatic transfer, the Application Form for High-Cost Medical Expense Benefits will not be sent.
• Please check the payment amount and transfer date on the payment decision notification.
• Even if you apply for automatic transfer, it may take time for the automatic transfer to begin. In that case, we will send you the Application Form, so please make your application.

When it is known in advance that high Medical Expenses will be incurred

When you incur high Medical Expenses due to hospitalization or outpatient care, presenting the "Eligibility Certificate for Maximum Amount" at the medical institution will limit your out-of-pocket payment at the counter to the maximum amount for one month (from the 1st to the end of the month).
Since the calculation is done separately for each medical institution (hospitalization and outpatient) and pharmacy, if you visit multiple medical institutions in the same month, you may need to apply for high-cost medical care benefits.

• Certificate of Eligibility for Maximum Amount Application

Procedures for the "Limit Amount Application Certification" and others

For those aged 70 and over, individuals with taxable income between 1.45 million yen and less than 6.9 million yen who are considered active income earners, as well as those from households exempt from resident tax, will need to apply for a limit application certification.
For other active income earners (taxable income of 6.9 million yen or more) and those aged 70 and over who fall under the general category, by presenting the Older Adults Benefit Certificate at medical institutions, the out-of-pocket expenses will be limited to the maximum burden amount according to the burden ratio, so the limit application certification is not required.

Items required for the procedure for the "Eligibility Certificate for Maximum Amount" and others

• Health Insurance Card
• Seal
• Identity Verification Documents
• Personal Number (My Number) Confirmation Document

• Note: 1 If you complete the procedure at the Hirao or Wakabadai Branch Office, it will be sent by mail.
• Note: 2 Those who have unpaid National Health Insurance Tax cannot receive this.

• Identity verification documents / Individual number (My Number) verification documents

Using the My Number Card as a Health Insurance Card

If you have registered to use your Health Insurance Card with your My Number Card and are using a medical institution that allows online verification of health insurance eligibility, there is no need to present documents such as the "Certificate of Eligibility for Maximum Amounts".

About the Limit of Self-Burden Amount

Self-Payment Limit for Those Under 70 Years Old

Category	Income Requirements (Total Income Amount - 430,000 yen)	Monthly Self-Expense Limit
A	Households with income exceeding 9.01 million yen or households with unreported income	252,600 yen + (Total Medical Expenses - 842,000 yen) × 1% <Multiple occurrences applicable: 140,100 yen>
I	Households with income over 6 million yen and up to 9.01 million yen	167,400 yen + (Total Medical Expenses - 558,000 yen) × 1% <Applicable multiple times: 93,000 yen>
U	Households with income over 2.1 million yen and below 6 million yen	80,100 yen + (Total Medical Expenses - 267,000 yen) × 1% <Applicable multiple times: 44,400 yen>
E	Households with income below 2.1 million yen	57,600 yen <Applicable multiple times: 44,400 yen>
O	Households Exempt from Resident Tax	35,400 yen <Multiple occurrences applicable: 24,600 yen>

• If the total amount of co-payments for each medical institution exceeds the above-mentioned self-burden limit of 21,000 yen per month, the difference will be paid.
• Inpatient and outpatient, medical and dental are calculated separately.
• The pharmacy portion, when combined with the amount from the prescribing medical institution, will be subject to aggregation if it exceeds 21,000 yen per month.
• "Multiple occurrences" refers to the limit on out-of-pocket expenses that applies from the fourth occurrence onward when there have been four or more payments of high-cost medical care benefits within the past 12 months, including the month in which the treatment occurred, for a single household.

Limit on Self-Payment for Individuals Aged 70 to Under 75

Income Category	Monthly Self-Payment Limit Outpatient (per individual)	Monthly Self-Payment Limit Outpatient + Inpatient (per household)
Active Level 3: Taxable Income of 6.9 million yen or more	252,600 yen + (Medical Expenses - 842,000 yen) × 1% <After the 4th time: 140,100 yen (Note 4)>	252,600 yen + (Medical Expenses - 842,000 yen) × 1% <After the 4th time: 140,100 yen (Note 4)>
Active Level 2: Taxable Income of 3.8 million yen or more	167,400 yen + (Medical Expenses - 558,000 yen) × 1% <After the 4th time: 93,000 yen (Note 4)>	167,400 yen + (Medical Expenses - 558,000 yen) × 1% <After the 4th time: 93,000 yen (Note 4)>
Active Level 1: Taxable Income of 1.45 million yen or more	80,100 yen + (Medical Expenses - 267,000 yen) × 1% <After the 4th time: 44,400 yen (Note 4)>	80,100 yen + (Medical Expenses - 267,000 yen) × 1% <After the 4th time: 44,400 yen (Note 4)>
General (Note 1): Taxable income less than 1.45 million yen	18,000 yen Annual limit (from August to the following July) 144,000 yen	57,600 yen <From the 4th time onwards: 44,400 yen (Note 4)>
Low-income individuals 2 (Note 2): (Note 3)	8,000 yen	24,600 yen
Low-income individuals 1 (Note 2): (Note 3) and income below a certain standard	8,000 yen	15,000 yen

• Note 1: This includes cases where the total household income is less than 5.2 million yen (less than 3.83 million yen for single-person households) or where the total amount of "old exception income" is 2.1 million yen or less.
• Note 2: For households exempt from resident tax, it will remain as before. A certificate for the application of the limit amount and reduction of the standard burden will be issued.
• Note 3: A household where the head of the household and all insured persons under the National Health Insurance are exempt from resident tax.
• Note 4: If you reach the limit three or more times within the past 12 months, from the fourth time it will be classified as 'multiple occurrences', and the limit will be lowered.

When combining those under 70 years old and those between 70 and 75 years old

1. Apply the limit for outpatient services (individual basis) for those aged 70 to under 75 first.
2. In addition, the limit amount for households of individuals aged 70 to under 75, including hospitalization, will be applied.
3. Add the combined amount for those under 70 years old (self-burden limit amount of 21,000 yen or more) to apply the limit for those under 70 years old

Available Procedure Dates

Open hours are from 8:30 AM to 5:00 PM
Note: On holidays, open hours are from 8:30 AM to noon and from 1:00 PM to 5:00 PM
Caution: Holiday openings are only at City Hall.

Annual Total for Outpatient Services

If the total amount of out-of-pocket expenses for outpatient treatment exceeds 144,400 yen for the annual period (from August to the following July), the difference will be paid.
Households that may be eligible will receive a notification and Application Form around January to February.

Eligibility

Those who meet all of the following criteria

• As of July 31, those who are enrolled in the National Health Insurance and are 70 years old or older
• As of July 31, those with income classifications of "General", "Low Income 2", and "Low Income 1"

Note: Those who joined the National Health Insurance of Inagi City from another health insurance during the eligible period may not receive an Application Form.