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Major medical care expenses supply system

Last update date January 22, 2019

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

In every calendar month, person younger than 70 years divides 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.

The self-pay ceiling of one younger than 70 years
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 ceiling 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 ceiling 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 ceiling 44,400 yen)
OhIncome amount of money
2.1 million yen or less
57,600 yen
(after the fourth ceiling 44,400 yen)
oFamily nurturer and National Health Insurance member
All the members are residence tax tax exemption
35,400 yen
(after the fourth ceiling 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 where there is person who cannot confirm income 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 one is alone with income (taxable income of residence tax 1.45 million yen or more) active for National Health Insurance person insured (as follows "elderly person") 70 years or older.44,400 yen80,100 yen + (medical expenses -267,000 yen) *1%
(after the fourth ceiling 44,400 yen)
The publicOne that 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 one is alone with income (taxable income of residence tax 1.45 million yen or more) active for National Health Insurance person insured (as follows "elderly person") 70 years or older.57,600 yen80,100 yen + (medical expenses -267,000 yen) *1%
(after the fourth ceiling 44,400 yen)
The publicOne that 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 ceiling 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 one is alone with income (taxable income of residence tax 6.9 million yen or more) active for National Health Insurance person insured (as follows "elderly person") 70 years or older.252,600 yen + (medical expenses -842,000 yen) *1%
(after the fourth ceiling 140,100 yen)
Income earner II at the same level as active playRegular which belongs to household where one is alone with income (taxable income of residence tax 3.8 million yen or more) active for National Health Insurance person insured (as follows "elderly person") 70 years or older.167,400 yen + (medical expenses -558,000 yen) *1%
(after the fourth ceiling 93,000 yen)
Income earner I at the same level as active playRegular which belongs to household where one is alone with income (taxable income of residence tax 1.45 million yen or more) active for National Health Insurance person insured (as follows "elderly person") 70 years or older.80,100 yen + (medical expenses -267,000 yen) *1%
(after the fourth ceiling 44,400 yen)
The publicOne that 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 ceiling 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 the self-pay ceiling is changed for medical treatment in August, 2018. About income earner at the same level as active play, the foreign ceiling is abolished, and the ceiling 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 the ceiling (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 "10% (person who reached 70-year-old birthday before April 1, 2014) or 20%" (person who reached 70-year-old birthday after April 2, 2014), too.

1.Income amount of money of person 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 2 households…Less than 5.2 million yen

2.When we correspond to condition of all next (1) - (3).
(1)Person taking out National Health Insurance 70 years or older is alone in household, and the is active play regular income earner.
(2)There is one (we limit to one 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)One and total amount of income of all the one targeted for (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 70 years old joining National Health Insurance in household where one is joining National Health Insurance that reached birthday 70 years or older are less than 2.1 million yen after January 2, 2015.

※Household where there is person who cannot confirm income does not become low income.

※One 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 ceiling 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 ceiling 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 one 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.
The self-pay ceiling is 10,000 yen (or 20,000 yen) from the moon applied for.

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

Exception of the self-pay ceiling
The ceiling which exception is applied toThe moon where exception of the ceiling is applied to
One (75-year-old birthday removes one-day case) that 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 joined 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 the self-pay ceiling
2 When we add up in the same household and exceed the self-pay ceiling
3 When we receive supply of high medical costs four times a year or more

  • 70 years or older and National Health Insurance calculation example younger than 70 years of high medical costs of household where member is
  1. About member 70 years or older…To page of member 70 years or older
  2. To 70 years or older and National Health Insurance calculation example younger than 70 years of high medical costs of household where member is
  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 dentistry: When one hospital, clinics has course and dentistry such as internal medicine, we treat dentistry as another 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 does not become a target of medical service under health insurance including hospital room not covered by a health insurance plan charges when we were hospitalized is excluded.
  7. Copayment of allowance for family medical expenses: We may become a target of high medical costs. ・To supply of ・ ・ allowance for family 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
  • 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.

When we were in trouble in payment (co-payment) at window of hospital

Incomes decrease by unemployment or disaster, and system of reduction, exemption of co-payment or the collection postponement may be available depending on the situation when we cannot pay co-payment at admission at window of hospital.
Please consult with ward office National Health Insurance Section of ward to live in detail.

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 kf-hokennenkin@city.yokohama.jp

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Page ID: 140-781-987

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