Certificate of Eligibility for Maximum Amount Application

"Certificate of Eligibility for Maximum Amount", or "Certificate of Eligibility for Maximum Amount and Reduction of Standard Burden Amount for Dietary Treatment" (hereinafter , "Certificate of Eligibility for Maximum Amount" etc.) when presented to a medical institution, the monthly co-payment made at the medical institution will be limited to the maximum out-of-pocket amount.

• Note: 1 Costs not covered by insurance (such as document fees, meal costs during hospitalization, and extra bed charges) are not included in the partial payment.
• Note: If you have received treatment at multiple medical institutions or if there is a difference payment applicable for multiple or household aggregation, a separate Application Form for High Medical Expenses will be sent.
• Note: 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 a "Certificate of Eligibility for Maximum Amount Application" or similar documents.

• Meal costs during hospitalization

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>

"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 instances in the past 12 months, including the month of treatment, where a single household exceeded the out-of-pocket limit.

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.

About the issuance of the "Limit Amount Application Certification" and others

For those aged 70 and over, individuals with a taxable income of 1.45 million yen or more but less than 6.9 million yen, as well as those from households exempt from resident tax, will need to apply for a Limit Amount Application Certificate.
For other individuals with a taxable income of 6.9 million yen or more and those aged 70 and over who fall under the general category, by presenting either a valid Older Adults Recipient Certificate, My Number Health Insurance Card, or Qualification Confirmation Document at medical institutions, the out-of-pocket expenses will be limited to the self-burden limit according to the burden ratio, so the Limit Amount Application Certificate is not required.

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

• 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: Those with unpaid National Health Insurance Tax will not be issued a "Certificate of Eligibility for Maximum Benefit" or similar documents.

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

Validity period of the "Limit Amount Application Certification" and others

It is from the first day of the month you applied until the end of July of the following year. If you still need it, please reapply after August 1st. If you are in a hurry, applications are accepted from one week prior.

Available Procedure Dates

City Hall is open from 8:30 AM to 5:00 PM on open days.
Notes: On holiday open days, hours are from 8:30 AM to noon and from 1:00 PM to 5:00 PM.
Attention: Holiday openings are only at City Hall.

If you use the My Health Insurance Card, no prior procedures are necessary.

If you use your My Number Card as a Health Insurance Card, the monthly co-payment you pay at medical institutions will be limited to the maximum out-of-pocket amount without any prior procedures. There is no need for prior applications such as the "Certificate of Eligibility for Maximum Amount of Co-payment," so please make sure to use your My Number Health Insurance Card.