High medical expenses

If you go to the hospital due to illness or injury and the monthly co-payment (note) you pay at the medical institution exceeds the copayment limit, the city will pay the difference as high-cost medical expenses.
If you are eligible, as a general rule, an application will be sent to the head of the household three months after the month of medical treatment. Once you receive the application, please apply by mail or at the counter at City Hall or a branch office.

Note: Expenses not covered by insurance (documentation fees, meal costs during hospitalization , extra bed charges, etc.) are not eligible for high-cost medical treatment.

• Application form sent from the city
• signature stamp
• Something that shows the transfer account, such as a passbook
• Identity verification documents
• Individual number (My Number) confirmation documents

When we pay high-cost medical expenses, we may appropriate for unpaid part of National Health Insurance tax.

If applying by mail, please fill in the required information and return the application form with your seal affixed.

Until now, in order to receive high-cost medical expenses, you had to apply for them each month, but now you can have the money transferred automatically if you wish.

How to apply for automatic transfer

Please check the "Automatic transfer request" box on the High-Cost Medical Care Expenses Payment Application Form.
Once you have registered your account, you will not need to go through the application process again, and the city will automatically transfer the money to your designated account. When the money is transferred, you will be sent a Notice of Payment of High-Cost Medical Expenses.

If you are not eligible for automatic transfer

Automatic transfer will be canceled in the following cases: Please submit the payment application form again.

• If there is a change in household composition due to moving out, household separation, etc.
• If the transfer to the specified account cannot be made due to account cancellation, etc.　
• If there is arrears in insurance tax payments
• If you have not yet paid at the hospital

Notes

• If you have submitted an application in the past, you will need to continue submitting the application as usual.
• After applying for automatic transfer, the application form for high-cost medical care expenses will not be sent.
• Please check the payment decision letter for the payment amount, transfer date, etc.
• Even if you apply for automatic transfer, it may take some time before the automatic transfer starts. In that case, we will send you an application form, so please apply.

　If you incur high medical expenses for hospitalization or outpatient care, you can pay the maximum amount of your out-of-pocket expenses for one month (from the 1st to the end of the month) by presenting your “Certificate of Application of Ceiling Amount Application” to the medical institution. Up to
Since the calculation is made for each medical institution (inpatient/outpatient) and pharmacy separately, you may need to apply for high-cost medical care benefits if you have consultations at multiple medical institutions, etc. in the same month.

　If you are 70 years old or older and have a taxable income of 1,450,000 yen or more and less than 6,900,000 yen, and if you are in a household exempt from residential tax, you will need a ceiling amount application certificate, so please apply.
Other income earners (taxable income of 6,900,000 yen or more) and people aged 70 and over who fall into the general category can present their elderly recipient certificate to the medical institution, and the self-pay limit according to the burden ratio will be covered. You do not need a Certificate of Application of Ceiling Amount as the amount will be borne by the counter up to the amount.

Documents required for procedures such as "Certificate of Application of Ceiling Amount Application"

• insurance card
• signature stamp
• Identity verification documents
• Individual number (My Number) confirmation documents

Remarks: 1 If you complete the procedures at the Hirao/Wakabadai branch office, we will mail it to you.
Note: 2 The certificate cannot be issued to those who have not paid the National Health Insurance tax.

If you are registered to use 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'' or other documents.

• If the sum of co-payments of 21,000 yen or more per month for each medical institution exceeds the above co-payment limit, the difference will be paid.
• Inpatient and outpatient, medical and dental are calculated separately.
• The pharmacy portion, together with the prescription medical institution portion, will be added up if the monthly amount is 21,000 yen or more.
• “Multiple times applicable” is the self-pay maximum amount that will be applied from the 4th time onwards when one household has received high-cost medical care benefits 4 times or more in the past 12 months, including the month of medical treatment.

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 residence tax remain the same. 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.

1. The maximum amount for outpatient services (individual) for those aged 70 and over and under 75 will be applied first.
2. In addition, the maximum amount per household for those aged 70 or older and younger than 75 applies, including hospitalization.
3. Add to this the total eligible amount for those under 70 years of age (co-payment limit of 21,000 yen or more), and apply the maximum amount for those under 70 years of age.

Possible date and time for procedures

8:30 a.m. to 5 p.m. on public holidays Note: On public holidays, 8:30 a.m. to noon and 1 p.m. to 5 p.m. Note: Only City Hall is open on public holidays.

If the total annual self-pay amount for outpatient treatment (for one year from August to the following July) exceeds 144,400 yen, the difference will be paid. Notifications and application forms will be sent to households that may be eligible from January to February.

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Those who meet all of the following criteria

• Those who are enrolled in National Health Insurance as of July 31st and are 70 years of age or older
• Those whose income classification as of July 31st is "general", "low income 2", or "low income 1"

Note: We may not be able to send application forms to those who joined Inagi City's National Health Insurance from another health insurance company during the applicable period.