About ceiling application certificate, etc.
Update date: February 21, 2024
If you present your “Certificate of Maximum Amount Application” or “Certificate of Maximum Application/Dietary Treatment Standard Copayment Reduction” (hereinafter referred to as “Certificate of Ceiling Amount Application”, etc. ) to a medical institution, you will receive a monthly payment at the medical institution. The co-payments will be limited to the maximum co-payment amount.
Notes: 1 Expenses not covered by insurance (documentation fees, meal costs during hospitalization , extra bed charges, etc.) are not included in the co-payment.
Notes: 2 If you receive treatment at multiple medical institutions or if you are eligible for multiple/household combinations and there is a difference in payment, we will send you a separate application form for high-cost medical care expenses.
Notes: 3 If you have registered your health insurance card on your My Number Card and use a medical institution where you can check your medical insurance eligibility online, you do not need to present a ``Certificate of Limit Application'' etc.
About the copayment limit
Self-pay limit for those under 70 years old
| Division | Income requirements (total income amount, etc. - 430,000 yen) | Monthly copayment limit |
|---|---|---|
| ah | Households exceeding 9,010,000 yen or households with undeclared income | 252,600 yen + (total medical expenses - 842,000 yen) x 1% <Multiple times applicable: 140,100 yen> |
| stomach | Households with income over 6 million yen and below 9.01 million yen | 167,400 yen + (total medical expenses - 558,000 yen) x 1% <Applicable multiple times: 93,000 yen> |
| hare | Households with income over 2.1 million yen and below 6 million yen | 80,100 yen + (total medical expenses - 267,000 yen) x 1% <Multiple times applicable: 44,400 yen> |
| workman | Households under 2.1 million yen | 57,600 yen <Multiple times applicable: 44,400 yen> |
| o | Resident tax exempt household | 35,400 yen <Multiple times applicable: 24,600 yen> |
“Multiple occurrences” means that if one household has exceeded the co-payment limit four times or more in the past 12 months, including the month of medical treatment, the co-payment limit will be applied from the fourth time onwards. is.
Maximum co-payment for those aged 70 or over and under 75
| income category | Monthly copayment limit Outpatient (per individual) | 1 month copayment limit Outpatient + Hospitalization (per household) | |
|---|---|---|---|
| active duty 3 | taxable income 6.9 million yen or more |
252,600 yen + (medical expenses - 842,000 yen) x 1% <4th and subsequent times: 140,100 yen (note 4)> |
|
| active duty 2 | taxable income 3.8 million yen or more |
167,400 yen + (medical expenses - 558,000 yen) x 1% <4th and subsequent times: 93,000 yen (note 4)> |
|
| active duty 1 | taxable income 1,450,000 yen or more |
80,100 yen + (medical expenses - 267,000 yen) x 1% <4th and subsequent times: 44,400 yen (note 4)> |
|
| General (Note 1) | taxable income Less than 1.45 million yen |
18,000 yen <Annual limit (August to July of the following year): 144,000 yen> |
57,600 yen <4th and subsequent times: 44,400 yen (note 4)> |
| Low income person 2 (note 2) | (Note 3) | 8,000 yen | 24,600 yen |
| Low income person 1 (note 2) | (Note 3) and income is below a certain standard | 8,000 yen | 15,000 yen |
Note 1: Including cases where the total household income is less than 5.2 million yen (less than 3.83 million yen for single-person households) and where the total "old proviso income" is 2.1 million yen or less.
Note 2: Households exempted from resident tax are the same as before. We will issue a Certificate of Maximum Amount Application/Standard Contribution Reduction.
Note 3: Households where the head of the household and all insured persons of the National Health Insurance are exempt from residence tax.
Note 4: If the limit is reached three times or more within the past 12 months, the limit will be reduced from the 4th time onwards.
Issuance of "Ceiling Certificate" etc.
For those aged 70 and over, those with a taxable income of 1.45 million yen or more but less than 6.9 million yen, and those in households exempt from residence tax, please apply for a certificate of ceiling application.
For other active income earners (taxable income of 6.9 million yen or more) and those 70 years of age or older who fall under the general category, by presenting an elderly recipient ID card to a medical institution, the co-payment limit will be reduced according to the burden ratio. You will not be required to obtain a certificate of application of the maximum amount as you will be required to pay up to the amount at the counter.
Items required for issuance procedures such as "Certificate of Limit Application" etc.
- insurance card
- signature stamp
- Identity verification documents
- Individual Number (My Number) Confirmation Documents
Notes: 1 If you complete the procedure at the Hirao/Wakabadai branch office, it will be sent by mail.
Notes: 2. A “Certificate of Limit Application” etc. cannot be issued to those who have not paid their National Health Insurance tax.
Validity period of “Certificate of Application of Ceiling Amount”, etc.
From the first day of the month in which you apply until the last day of July. If you still need it, please apply again after August 1st. If you are in a hurry, we accept orders from one week in advance.
Available date and time
From 8:30 a.m. to 5:00 p.m. of open agency day Remarks: From 8:30 a.m. to noon, 1:00 p.m. to 5:00 p.m. on holiday open agency day Note: Only city hall is open agency on holiday.
If you use Myna Insurance Card, no advance procedures are required.
If you use your My Number Card as your insurance card, your monthly co-payments at medical institutions can be kept up to the co-payment limit without any prior procedures. You do not need to apply for a "Certificate of Limit Application" in advance, so please use the Myna Insurance Card.
Inquiries about this page
Inagi City Citizens Department Insurance and Pension Division
2111 Higashi Naganuma, Inagi City, Tokyo
Phone: 042-378-2111 Fax: 042-377-4781
