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Major medical care expenses supply system

Last update date August 21, 2020

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When we apply and are recognized when co-payment of medical expenses became expensive, we are provided with thing beyond self-pay limit as high medical costs later. In addition, amount of money to be expected to pay at the time of consultation becomes person receiving grant of "National Health Insurance limit application certificate" beforehand at ward office to self-pay limit per one month by showing the proof to medical institution (please confirm this about application of limit application certificate)
In addition, calculation method is different from self-pay limit in people 70 years or older and people under 70.
・・About ・ people 75 years or older to medical system for elder senior citizens

In every calendar month, people under 70 divide every hospitalization, outpatient into every medical institution for each medical department, Dentistry, and thing beyond 21,000 yen is targeted for calculation of high medical costs co-payment.
But we add up the co-payment with co-payment which it took with medical institution when prescription is issued by medical institution, and medicine is prescribed in dispensing pharmacy.

Self-pay limit of people under 70
DivisionIncome requirementsMonthly basis
AIncome amount of money
More than 9.01 million yen

252,600 yen + (medical expenses -842,000 yen) *1%
(after the fourth limit: 140,100 yen)

iIncome amount of money
9.01 million yen or less more than 6 million yen
167,400 yen + (medical expenses -558,000 yen) *1%
(after the fourth limit: 93,000 yen)
CormorantIncome amount of money
6 million yen or less more than 2.1 million yen
80,100 yen + (medical expenses -267,000 yen) *1%
(after the fourth limit: 44,400 yen)
OhIncome amount of money
2.1 million yen or less
57,600 yen
(after the fourth limit: 44,400 yen)
oFamily nurturer and National Health Insurance member
All the members are residence tax tax exemption
35,400 yen
(after the fourth limit: 24,600 yen)

※Income amount of money is amount of money that subtracted 330,000 yen and the amount of carrying forward of basic deduction of net loss from total income amount of money.
In addition, amount of money to use for division judgment becomes net total of income amount of money of all the National Health Insurance members in household.
※Household which we cannot confirm income, and there is becomes a for ward.
We lose our job by bankruptcy or discharge of company, and, as for the employment insurance which is "specific qualified recipient" or "identification reason retired employee", income division may be reduced in people who took out National Health Insurance. For more details, please consult with ward office Insurance and Pension Division National Health Insurance Section of ward to live.

[for July, 2017 medical treatment the past]
DivisionIncome requirementsOutpatient department
(personal unit)
Foreign + hospitalization
(household unit)
Income earner at the same level as active playRegular which belongs to household where person is alone with income (taxable income of residence tax 1.45 million yen or more) active for National Health Insurance people insured (as follows "elderly person") 70 years or older.44,400 yen80,100 yen + (medical expenses -267,000 yen) *1%
(after the fourth limit: 44,400 yen)
The publicPerson who comes under none of "low income 1" "low income 2" "income earner at the same level as active play"12,000 yen44,400 yen
Low income 2Residence tax tax exemption household8,000 yen24,600 yen
Low income 1Household (we calculate public pension deduction as 800,000 yen.) in residence tax tax exemption household for all the members of household without income8,000 yen15,000 yen
[for August, 2017 medical treatment after that for ... July, 2018 medical treatment]
DivisionIncome requirementsOutpatient department
(personal unit)
Foreign + hospitalization
(household unit)
Income earner at the same level as active playRegular which belongs to household where person is alone with income (taxable income of residence tax 1.45 million yen or more) active for National Health Insurance people insured (as follows "elderly person") 70 years or older.57,600 yen80,100 yen + (medical expenses -267,000 yen) *1%
(after the fourth limit: 44,400 yen)
The publicPerson who comes under none of "low income 1" "low income 2" "income earner at the same level as active play"14,000 yen57,600 yen
(after the fourth limit: 44,400 yen)
Low income 2Residence tax tax exemption household8,000 yen24,600 yen
Low income 1Household (we calculate public pension deduction as 800,000 yen.) in residence tax tax exemption household for all the members of household without income8,000 yen15,000 yen
[for August, 2018 medical treatment after that]
DivisionIncome requirementsOutpatient department
(personal unit)
Foreign + hospitalization
(household unit)
Income earner III at the same level as active playRegular which belongs to household where person is alone with income (taxable income of residence tax 6.9 million yen or more) active for National Health Insurance people insured (as follows "elderly person") 70 years or older.252,600 yen + (medical expenses -842,000 yen) *1%
(after the fourth limit: 140,100 yen)
Income earner II at the same level as active playRegular which belongs to household where person is alone with income (taxable income of residence tax 3.8 million yen or more) active for National Health Insurance people insured (as follows "elderly person") 70 years or older.167,400 yen + (medical expenses -558,000 yen) *1%
(after the fourth limit: 93,000 yen)
Income earner I at the same level as active playRegular which belongs to household where person is alone with income (taxable income of residence tax 1.45 million yen or more) active for National Health Insurance people insured (as follows "elderly person") 70 years or older.80,100 yen + (medical expenses -267,000 yen) *1%
(after the fourth limit: 44,400 yen)
The publicPerson who comes under none of "low income 1" "low income 2" "income earner at the same level as active play"18,000 yen57,600 yen
(after the fourth limit: 44,400 yen)
Low income 2Residence tax tax exemption household8,000 yen24,600 yen
Low income 1Household (we calculate public pension deduction as 800,000 yen.) in residence tax tax exemption household for all the members of household without income8,000 yen

15,000 yen


※After that self-pay limit is changed for medical treatment in August, 2018. About income earner at the same level as active play, foreign limit is abolished, and limit is subdivided by standard of assessment income of residence tax.

※After that we are provided with thing that exceeded from employee health insurance as "high medical costs" for August, 2017 medical treatment when the totals of foreign self-burden of one year (from August next year July) exceed limit (144,000 yen) a year newly about outpatient department of 70 years or older (general income earner and low-income person). We notify person who corresponded of application methods separately.

※When ... 3 corresponds to either condition of this, among income earners at the same level as active play, in the division, it is "the public" by application 1 of next, and self-pay ratio becomes "20%", too.

1.Income amount of money of people taking out National Health Insurance 70 years or older in the case of the following.

  • Household of one…Less than 3.83 million yen
  • More than two households…Less than 5.2 million yen

2.When we correspond to condition of all next (1) - (3).
(1)People taking out National Health Insurance 70 years or older are alone in household, and the person is active regular income earner.
(2)There is person (we limit to that continues from day when it shifted to medical system for elder senior citizens, and belongs to same household.) transferred to medical system for elder senior citizens in same household by National Health Insurance.
(3)(1)And total amount of income of all the target (2) are within 5.2 million yen of this.

3.When the totals of income amount of money (carrying forward deduction - basics of total income amount of money - net loss deduction) of people joining National Health Insurance in household which we take out National Health Insurance that reached 70-year-old birthday after January 2, 2015, and there is 70 years or older are 2.1 million yen or less.

※Household which we cannot confirm income, and there is does not become low income.

※Person corresponding to income earner II at the same level as active play, income earner I at the same level as active play, low income II, low income I, please receive grant of "National Health Insurance limit application certificate" before hospitalization beforehand at ward office.

As for the one-month self-pay at one hospital, it is to 10,000 yen if we show cases such as hemophilia and chronic kidney failure receiving artificial dialysis, "*tei*byo*yoju*sho".
But, among people insured receiving artificial dialysis with under 70 years old, as for the one-month self-pay limit to modify artificial dialysis about belonging to a and division i for ward, it is to 20,000 yen.

Grant of *tei*byo*yoju*sho

Applicable person has documents (statements of position of doctor), health insurance card, private seal (thing to use vermilion for) proving the fact, and please report to ward office National Health Insurance Section of ward to live.
Self-pay limit is 10,000 yen (or 20,000 yen) from the moon applied for.

Exception that self-pay limit becomes at half price is applied to person corresponded to in the next condition only for said this month. This exception is applied about medical expenses after January, 2009.

Exception of self-pay limit
Limit which exception is applied toThe moon where exception of limit is applied to
Person (75-year-old birthday removes one-day case) who was transferred to medical system for elder senior citizens on 75-year-old birthday by National Health InsuranceThe 75-year-old birth moon
Dependent of social insurance that took out National Health Insurance by the social insurance person having shifted to medical system for elder senior citizens on 75-year-old birthday (National Health Insurance that participation day is 1st is excluded)Participation month of National Health Insurance
Family of union member of National Health Insurance Association which took out National Health Insurance by union member of National Health Insurance Association having shifted to medical system for elder senior citizens on 75-year-old birthday (National Health Insurance that participation day is 1st is excluded.)Participation month of National Health Insurance
  • Calculation example of high medical costs in case of household only for under 70 years old

1.When sums of co-payment for a month exceed self-pay limit
2. When we add up in the same household and exceed self-pay limit
3. When we receive supply of high medical costs four times a year or more

  • Calculation example of high medical costs of household where there are 70 years or older and National Health Insurance members under 70
  1. About members 70 years or older…To page of members 70 years or older
  2. To calculation example of high medical costs of household where there are 70 years or older and National Health Insurance members under 70
  1. We calculate every calendar month: About consultation from the first day of month to the end of the month, we calculate as one month.
  2. Together with hospital, clinics : We calculate for each hospital, clinics .
  3. Hospitalization and going to hospital: Even as for one hospital, clinics hospitalization and going to hospital other; calculate.
  4. Calculation another as for the Dentistry: When one hospital, clinics has course and Dentistry such as Internal medicine, we treat Dentistry as different hospital or clinics .
  5. Standard burden to affect the food expenses and residence costs at admission: We do not enter co-payment calculating high medical costs.
  6. Including hospital room not covered by a health insurance plan: Thing which medical service under health insurance including hospital room not covered by a health insurance plan charges when we were hospitalized does not come to apply to is excluded.
  7. Copayment of medical expenses: We may become a target of high medical costs. ・To payment of ・ ・ medical expenses (co-payment)
  8. When we paid drug costs in outside Parliament prescription: We may become a target of high medical costs.

In the usual case, for the end of yoku々tsuki (if, e.g., target month is April June) of the moon which became a target of high medical costs supply, I send supply application and petition. You have the following, and please apply to ward office Insurance and Pension Division of ward to live.

  • Supply application which I sent and petition (you put together, and, if there are any supply applications of non-application, take.)
  • Identity verification documents of person grinding the next agency
  • (certificates with driver's license, passport, other photographs of the face)
  • Health insurance card and private seal (thing using vermilion)
  • Bank book of bank or reserves such as account numbers

※When supply application and petition does not reach even if we leave the target moon more than three months, please refer to ward office National Health Insurance Section. When submission of "statement" is late to provide based on submitted "statement" from medical institution, high medical costs, please note that it becomes late that supply application and petition reaches.
※It is statute of limitations in two years from 1st in the next month of medical treatment month, and please be careful as you cannot apply.
※If supply application and petition arrives, please confirm whether contents match receipt of person who received medical treatment.
Case such as not knowing that mention contents of supply application and petition do not fit receipt bring receipt to window.
※Because fraction that co-payment to pay is less than 10 yen is actually rounded off to medical institution, amount of money listed in supply application and petition may be different from receipt at hand.
※When you perform final income tax return (medical expenses subtraction) of tax, please perform supply application of high medical costs earlier.
For more details, please ask tax office (the outside site) of jurisdiction.

About application of people 70 years or older

Supply method of high medical costs is changed for congestion reducing of burden reduction of people insured 70 years or older and window about households with all the joining family nurturer and National Health Insurance 70 years or over from June, 2019.
Application was necessary, but will do automatic transfer about subsequent high medical costs so far whenever we correspond to high medical costs by being accompanied toward the household targeted for automatic transfer, and having you apply to Insurance and Pension Division of ward to live for high medical costs once in future.

[household targeted for automatic transfer]
Household targeted for automatic transfer becomes household which met all the following requirements.

・Households (it may vary according to medical treatment (composition) reward statement (following, submission time of "receipt") from medical institution.) as of 1st of the moon which received medical treatment with all family nurturer (we include imitation family nurturer) and the National Health Insurance members 70 years or over
・Receipt about third party act is not included in calculation object of high medical costs
・Family nurturer does not die in the calculation month (two months later of the moon which usually received medical treatment) of high medical costs

[method of application]
In the usual case, for the end of yoku々tsuki (if, e.g., target month is April June) of the moon which became a target of high medical costs supply, I send supply application and petition. You have the following, and please apply to ward office Insurance and Pension Division of ward to live.

  • Supply application which I sent after June, 2019 and petition
  • Identity verification documents of person grinding the next agency
  • (certificates with driver's license, passport, other photographs of the face)
  • Health insurance card and private seal (thing using vermilion)
  • Bank book of bank or reserves such as account numbers

[flow until payment]
When all family nurturer and the people taking out National Health Insurance correspond to high medical costs after application about households 70 years or older in the first time, we transfer to account which had you appoint automatically. (it usually becomes transfer of the end of the month three months after medical treatment month.)
In the case of automatic transfer, I send supply decision notification as before.

※When you change account of transfer or when you do not hope for automatic transfer, please inform living ward office Insurance and Pension Division National Health Insurance Section of so.
※When we do not meet requirements of automatic transfer by changes of the household situation, submission of application is necessary whenever we correspond to high medical costs without becoming automatic transfer.
※On the reception desk date of application, submission of application may be necessary depending on the postal arrival situation without becoming automatic transfer at the time of high medical costs pertinence on the next time.

Inquiry about procedure

Please refer to ward office Insurance and Pension Division National Health Insurance Section of ward to live.

List of references of each ward office Insurance and Pension Division National Health Insurance Section
Inquiry by emailPhone number
Tsurumi Ward Insurance and Pension Division National Health Insurance Section045-510-1810
Kanagawa Ward Insurance and Pension Division National Health Insurance Section045-411-7126
Nishi Ward Insurance and Pension Division National Health Insurance Section045-320-8427, 045-320-8428
Naka Ward Insurance and Pension Division National Health Insurance Section045-224-8317, 045-224-8318
Minami Ward Insurance and Pension Division National Health Insurance Section045-341-1128
Konan Ward Insurance and Pension Division National Health Insurance Section045-847-8423
Hodogaya Ward Insurance and Pension Division National Health Insurance Section045-334-6338
Asahi Ward Insurance and Pension Division National Health Insurance Section045-954-6138
Isogo Ward Insurance and Pension Division National Health Insurance Section045-750-2428
Kanazawa Ward Insurance and Pension Division National Health Insurance Section045-788-7838, 045-788-7839
Kohoku Ward Insurance and Pension Division National Health Insurance Section045-540-2351
Midori Ward Insurance and Pension Division National Health Insurance Section045-930-2344
Aoba Ward Insurance and Pension Division National Health Insurance Section045-978-2337
Tsuzuki Ward   Insurance and Pension Division National Health Insurance Section045-948-2336, 045-948-2337
Totsuka Ward Insurance and Pension Division National Health Insurance Section045-866-8450
Sakae Ward Insurance and Pension Division National Health Insurance Section045-894-8426
Izumi Ward Insurance and Pension Division National Health Insurance Section045-800-2425, 045-800-2426, 045-800-2427
Seya Ward Insurance and Pension Division National Health Insurance Section045-367-5727, 045-367-5728

Inquiry to this page

Health and Social Welfare Bureau life Welfare Division Insurance and Pension Division

Telephone: 045-671-2424

Telephone: 045-671-2424

Fax: 045-664-0403 (to ward office as for the inquiry about procedure mentioned above please contact)

E-Mail address [email protected]

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