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When medical institution costs, it is reported application of payment, third party act

Last update date June 17, 2020

When medical institution costs

When you consult medical institution, please show identification of elderly aged 75 or over medical care person insured. At window, we bear 10% of medical expenses or 30%.
Self-pay ratio ("ratio listed in health insurance card of co-payment") when it hangs over medical institution varies according to income division. Income division is judged by taxable income (income after various subtraction) of municipal tax of our year (as for from April to July last year).

Income earner at the same level as active play

Person insured with 1.45 million yen or more taxable income of municipal tax and other people insured of same household.
Division is further divided into three phases by income.

  • Active play regular income earner 3: Taxable income of municipal tax 6.9 million yen or more
  • Active play regular income earner 2: Taxable income of municipal tax is less than 6.9 million yen 3.8 million yen or more
  • Active play regular income earner 1: Taxable income of municipal tax is less than 3.8 million yen 1.45 million yen or more

But it is sorted "the public" by application when total incomes such as people insured meet condition of lower [table].

Income criteria in the amount of standard income application application
The number of people insured Total income of the left person
One person insured Less than 3.83 million yen
Two people insured or more Less than 5.2 million yen
It is people from 70 years old to 74 years old in one person insured and same household Less than 5.2 million yen

The public

Person insured except income earner at the same level as active play, low-income person 2 and low-income person 1.

Low-income person 2

All the same household person insured (except low-income person 1) of municipal tax tax exemption.

Low-income person 1

Person insured that all the same household is municipal tax tax exemption, and each income of member of household is 0 yen (we calculate pension income for deduction 800,000 yen).

About "limit application, standard burden reduction certificate" (reduction certificate) and "limit application certificate"

When low-income person 1 or person corresponding to 2 shows "limit application, standard burden reduction certificate" (reduction certificate) to medical institution with health insurance card beforehand, it is when payment every window is to self-pay limit of income division of low-income person 1 or 2. Income division becomes the public when we do not show "limit application, standard burden reduction certificate" (reduction certificate) and is not reduced. In addition, in the case of hospitalization, meal medical expenses, life medical expenses are reduced.
When active play regular income earner 1 or person corresponding to 2 shows "limit application certificate" to medical institution depending on income division, payment every window becomes to limit of income division.
Please refer to ward office Insurance and Pension Division National Health Insurance Section for the details of procedure.

Application of payment

High medical costs

When self-pay of medical expenses of one month (the same during the month) became large, thing beyond self-pay limit returns as high medical costs (it applies to chisel for medical service under health insurance, and hospital room not covered by a health insurance plan charges or meal charges at admission do not come to apply). After applying personal unit, self-pay limit applies household unit. In addition, payment with medical institution is to self-pay limit for each window.
When we become a target of supply, we send application from interjurisdictional affiliation 3-4 months after medical treatment month. Please apply to ward office Insurance and Pension Division National Health Insurance Section of ward to live. It is transferred to designated account 2-3 months later after applying. In the case of transfer, we will tell by postcard.
It is transferred to designated account automatically once 3-4 months after the medical treatment moon which became targeted for supply from the next time when we apply. When we change transfer previous engagement seat (we will tell by postcard each transfer.), application is necessary for ward office Insurance and Pension Division National Health Insurance Section of ward to live again.
Please refer to ward office Insurance and Pension Division National Health Insurance Section for the details of procedure. Thing necessary for application is this.

Self-pay limit (monthly basis: in August, 2018 from medical treatment) of high medical costs
Income division Self-pay ratio Foreign limit (personal unit) Limit (household unit) that we matched outpatient department, hospitalization with
Active play regular income earner 3 30%

252,600 yen + (total medical expenses -842,000 yen) *1%
[140,100 yen] (note 1)

Active play regular income earner 2 30%

167,400 yen + (total medical expenses -558,000 yen) *1%
[93,000 yen] (note 1)

Active play regular income earner 1 30%

80,100 yen + (total medical expenses -267,000 yen) *1%
[44,400 yen] (note 1)

The public 10%

18,000 yen
<amount of annual upper limit 144,000 yen> (note 2)

57,600 yen
[44,400 yen] (note 1)

Low-income person 2 10% 8,000 yen 24,600 yen
Low-income person 1 10% 8,000 yen 15,000 yen

(note 1) It is from the fourth when we corresponded to high medical costs more than four times for the past 12 months to limit (multi-several times pertinence).
(note 2) We calculate in one year until July in the next year from August.

Hospitalization meal medical expenses, life medical expenses

When we were hospitalized, there are burdens such as meal charges (the food expenses bear one meal of unit, three times a day). Burden becomes expense of lower table for each type of hospital and bed. In addition, calculation of high medical costs does not contain meal medical treatment standard burden and life medical treatment standard burden.
When we paid expense of general income division in person corresponding to low-income person 1 or low-income person 2 without being able to show "limit application, standard burden reduction certificate" (reduction certificate) at the time of hospitalization, we can receive refund by applying.
Please refer to ward office Insurance and Pension Division National Health Insurance Section for the details of procedure. Thing necessary for application is this.

Meal medical treatment standard burden :Person insured bears the food expenses (meal medical treatment standard burden) when admitted to general hospital.
Income division The food expenses per one meal
Income earner 1-3 at the same level as active play and the public 460 yen
Designated incurable disease patient who does not correspond to low-income person 1.2 260 yen
Low-income person 2 (hospitalization until 90 days) 210 yen
Low-income person 2 (hospitalized more than 91 days during the past 12 months) 160 yen
Low-income person 1 100 yen

Life medical treatment standard burden :Person insured bears the food expenses and the residence costs (life medical treatment standard burden) when admitted to medical treatment bed. Please confirm to medical institution whether you correspond to medical treatment bed.
Income division The food expenses per one meal The residence costs per day
Income earner 1-3 at the same level as active play

460 yen

[420 yen (note 1)]

370 yen
The public

460 yen

[420 yen (note 1)]

370 yen
Low-income person 2 210 yen 370 yen
Low-income person 1 130 yen 370 yen
Old-age welfare pension recipient of low-income person 1 100 yen 0 yen

We bear the food expenses of sum same as general hospital about the need that high state continues and hospitalization medical care hospitalized in rehabilitation ward for convalescence. Designated incurable disease patient does not have burden of the residence costs.
(note 1) When we are admitted to hospital calculating life medical expenses (2) at hospitalization. (please confirm whether you are calculated to medical institution)

Large amount of care adding up medical expenses

When both burden and burden on The Long-term Care Insurance of medical insurance occur by household unit in medical insurance, and the one-year totals (as for the calculation period every year August 1 - next year end of July) exceed the amount of standard, we can receive refund of thing that exceeded.
As I send application to person whom I can keep under control if targeted for supply, please apply to ward office Insurance and Pension Division National Health Insurance Section of ward to live. We are going to send out sequentially from April through August about minute in 2018. Large amount of care adding up medical expenses need application every applicable year.
In addition, at first, please refer to medical insurance counter in charge of the municipalities before transference and The Long-term Care Insurance counter in charge for issuance of "self-pay certificate" when it is thought that self burdens exceeded the amount of standard as we moved into from outside the prefecture in the middle of calculation period and may not grasp if targeted for supply.
Please refer to ward office Insurance and Pension Division National Health Insurance Section for the details of procedure. Thing necessary for application is this.

Medical expenses

When you were treated for medical institution by sudden diseases abroad when you manufactured harness for treatment including corset, you pay, and please apply to insurance medical institutions for the total amount of medical expenses in ward office Insurance and Pension Division National Health Insurance Section of ward to live later once. When supply is accepted by interjurisdictional affiliation, sum except copayment is refunded. (it is at statute of limitations in progress for two years from the next day of day when we paid medical expenses and cannot provide.)
Please refer to ward office Insurance and Pension Division National Health Insurance Section for the details of procedure. Thing necessary for application is this.

Funeral costs

When person insured passed away, we pay 50,000 yen to person (the chief mourner) who performed the funeral as funeral costs by application. (it is statute of limitations in progress for two years from the next day of day when we performed funeral and cannot provide.)
Please refer to ward office Insurance and Pension Division National Health Insurance Section for the details of procedure. Thing necessary for application is this.

Other medical care benefits

As for the details about temporary nursing at home medical expenses, transportation costs, specific illness ("*tei*byo*yoju*sho" grant), please see homepage of Kanagawa elderly aged 75 or over medical care interjurisdictional affiliation.

List of main application about payment

When you perform application that lower table does not have, please refer to ward office Insurance and Pension Division National Health Insurance Section.

Thing which is necessary for application when we can apply
When we can apply Thing necessary for application
Supply application of high medical costs
  • Health insurance card (identification of elderly aged 75 or over medical care person insured)
  • We feel mark (thing to use vermilion for)
  • We can confirm transfer previous engagement seat (bankbooks)
  • When adult guardians are appointed, copy of entry certificates
Payment of balance application of meal medical treatment standard burden or life medical treatment burden
  • Health insurance card (identification of elderly aged 75 or over medical care person insured)
  • We feel mark (thing to use vermilion for)
  • We can confirm transfer previous engagement seat (bankbooks)
  • Receipt at admission
  • When adult guardians are appointed, copy of entry certificates
Payment of large amount of care adding up medical expenses application
  • Medical health insurance card (identification of elderly aged 75 or over medical care person insured)
  • Health insurance card of care
  • We feel mark (thing to use vermilion for)
  • We can confirm transfer previous engagement seat (bankbooks)
  • When there is change of insurance during calculation period, self-burden certificate
  • When adult guardians are appointed, copy of entry certificates
When we had a medical examination without having health insurance card by urgent other unavoidable circumstances including sudden illness
  • Health insurance card (identification of elderly aged 75 or over medical care person insured)
  • We feel mark (thing to use vermilion for)
  • We can confirm transfer previous engagement seat (bankbooks)
  • When adult guardians are appointed, copy of entry certificates
  • Receipt when we paid to medical institution
  • Receipt (receipt) ※It is usually different from medical expenses statement issued with receipt when we paid to medical institution.
When we made harness for treatment including corset
  • Health insurance card (identification of elderly aged 75 or over medical care person insured)
  • We feel mark (thing to use vermilion for)
  • We can confirm transfer previous engagement seat (bankbooks)
  • When adult guardians are appointed, copy of entry certificates
  • Statement of position of doctor
  • Documents which mention of wearing confirmation day by doctor is made
  • Receipt of the price and statement

When we were treated for medical institution by sudden diseases abroad
(insurance does not come to apply about treatment that is not applied in travel, Japan in treatment purpose)

  • Health insurance card (identification of elderly aged 75 or over medical care person insured)
  • We feel mark (thing to use vermilion for)
  • We can confirm transfer previous engagement seat (bankbooks)
  • When adult guardians are appointed, copy of entry certificates
  • Receipt of the price
  • Statement which medical treatment contents were listed in and Japanese translated sentence
  • Passport
  • Written consent

When we underwent surgical operation of bonesetter
(we finish if we show health insurance card just to pay copayment
Application procedure may be unnecessary.)

  • Health insurance card (identification of elderly aged 75 or over medical care person insured)
  • We feel mark (thing to use vermilion for)
  • We can confirm transfer previous engagement seat (bankbooks)
  • When adult guardians are appointed, copy of entry certificates
  • Receipt of the price
  • Surgical operation packing list
  • When undergo surgical operation by bone fracture, dislocation, written consent of doctor

Surgical operation of masseur rapid with the approval of doctor acupuncture
When we received
(we finish if we show health insurance card just to pay copayment
Application procedure may be unnecessary.)

  • Health insurance card (identification of elderly aged 75 or over medical care person insured)
  • We feel mark (thing to use vermilion for)
  • We can confirm transfer previous engagement seat (bankbooks)
  • When adult guardians are appointed, copy of entry certificates
  • Receipt of the price
  • Surgical operation packing list
  • Written consent of doctor
Payment of funeral costs application
  • Health insurance card (identification of elderly aged 75 or over medical care person insured) of person insured who passed away ※When it has been returned, it is unnecessary.
  • We feel mark of applicant (the chief mourner) (thing using vermilion)
  • We can confirm transfer previous engagement seat (bankbooks)
  • We can identify funeral day as the chief mourner (attendance at a funeral thank-you letter, funeral receipt)

Report of third party act

When we are damaged from the other party (third party) including traffic accident and case of bodily injury, we can be treated for insurance (medical system for elder senior citizens) by report. At first, please connect with ward office Insurance and Pension Division National Health Insurance Section of ward to live. Ward office Insurance and Pension Division National Health Insurance Section has "report of sickness and wound by act of third party". Traffic accident certificates of the police are necessary, too.
The other party who is assailant is thing which should bear expense that it cost for treatment, but we pay treatment costs by insurance (medical system for elder senior citizens) by report once, and interjurisdictional affiliation originally requests expense from the other party later. Please talk with ward office Insurance and Pension Division National Health Insurance Section of ward to live by all means before settlement out of court.

Inquiry to this page

Health and Social Welfare Bureau life Welfare Division medical assistance section

Telephone: 045-671-2409

Telephone: 045-671-2409

Fax: 045-664-0403

E-Mail address [email protected]

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