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Time/National Health Insurance that medical expenses become large

The last update date:

 Medical expenses become large for diseases, and therefore self-burden of the person may become large, too.

The person burden of medical service under health insurance costs with insurance medical institutions such as hospitals has the upper limit (please refer to (3) large amount medical expenses self-pay limit.) of one month.

Thing more than limits is returned as large amount medical treatment by application, but this has two ways of methods.

(1) Payment (window burden) with medical institution is (to limit) cheaply.

(2) We do supply application of thing beyond limit in city hall. (as receipt from medical institution arrives, and supply empties, it takes time. Indication is three months later of medical treatment month.)

 

(1) Burden at medical institution window becomes cheaper.

 

[limit application certificate]  

 By showing to window of medical institutions such as hospitals, payment becomes from beginning to limit because we prove the amount of upper limit of large amount medical expenses self-pay of one month.  

 Under 70 years old were applications only for hospitalization, but were increased to outpatients from medical treatment minute in April, 2012.

(person you have, please already confirm expiration date. When time limit expires, please apply.)

  In the case of tax exemption household, "limit application, standard burden certificate" is issued.

 "Standard burden certificate" reduces meal charges at admission.

In addition, we are further reduced when the hospitalization days are over 90 days. In the case of application, bring thing to understand of the hospitalization days to receipts. (person of 70 years or older division (1) is unnecessary.)

 It is until 12 months ago and performs calculation more than 90 days including application month.

 Please refer to this for the details. Hospitalization meal medical expenses

 In addition, refund in city hall may be necessary. (2)Please refer to case to receive refund in city hall.

● Target person

  Target person of "limit application certificate" is people under 70.

  People 70 years or older judge limit from burden ratio and "standard burden reduction certificate" of identification of old recipient.

  In the case of tax exemption household, please do grant application of standard burden reduction certificate.

Under 70 years old

Limit division

 Necessary certificate

 A - e

 Limit application certificate

 o

 Limit application, standard burden reduction certificate

 

70 years or older

 Limit division

 Necessary certificate

 Income earner taxable income 6.9 million yen at the same level as active play or more

 None

 Income earner taxable income 3.8 million yen at the same level as active play or more

 Limit application certificate

 Income earner taxable income 1.45 million yen at the same level as active play or more

 Limit application certificate

 The public (less than taxable income 1.45 million yen)

 None

 Low-income person (2)

 Standard burden reduction certificate

 Low-income person (1)

 Standard burden reduction certificate

 

● Thing necessary for application

Health insurance card, old identification of recipient (only as for the applicable person), seal (as for the killer whale grouper, impossible)

* When people of transference do not know income, the taxation situation of National Health Insurance member in Tagawa-shi, certificate about income of address place is necessary in past.

● Place to apply for

 Person in charge of the first floor of the city hall citizen's section insurance (11) - (12) turn window

 

    • ※ There is payment of large amount of medical expenses application in the lower berth.

(2) When we receive refund in city hall 

 

[payment of large amount of medical expenses]

 If application is accepted when self-burden of medical expenses became large, thing beyond limit is paid as large amount of medical expenses later.

Calculation calculates large amount of medical expenses of person of old recipients under 75 70 years old in household or older and calculates the amount of object of people under 70 in total next.

(3) Thing more than large amount of medical expenses self-pay limits becomes a target of supply.

 ● Case that supply is thought about

Oh, it is mint condition of limit application certificate

Self-burdens exceeded limit because we did not show "limit application certificate" to hospitals.

A lot of i pertinence is applied

When we got refund for the past 12 months more than three times, burden after the fourth became cheaper, but paid to self-pay limit of high as it was not revealed by medical institution.

There is cormorant patient's payment of medical expenses to become a target to add up

Medical expenses (21,000 yen or more, 70 years or older pays) from 1 yen than two places, and under (70 years old exceed limit when they add up.to be targeted for adding up

・We add up two or more medical institutions

・Even the same medical institution adds up hospitalization, outpatient department, dentistry

・We add up two people or more in the same household

 ● Thing necessary for application

     ・Bank book in the name of health insurance card, old identification of recipient (only as for the applicable person), seal (killer whale grouper impossibility), receipt (as for the thing of receipt type, impossible), family nurturer

  

Attachment Expensive medical expenses application With new window(PDF: 102.4 kilobytes)

● Place to apply for

   Person in charge of the first floor of the city hall citizen's section insurance (11) - (12) turn window

 

 

(3) Expensive medical expenses self scot

 

Under 70 years old

Income requirements

 Division

 Limit

 Majority pertinence

 Adding up standard

 Income exceeds 9.01 million yen

 A

 252,600 yen + (medical expenses -842,000 yen) *1%

 140,100 yen

 21,000 yen

 Income exceeds 6 million yen

 i

 167,400 yen + (medical expenses -167,400 yen) *1%

93,000 yen

21,000 yen 

 Income exceeds 2.1 million yen

 Cormorant

 80,100 yen + (medical expenses -267,000 yen) *1%

44,400 yen

21,000 yen

 Income is 2.1 million yen or less

 Oh

 57,600 yen

44,400 yen

21,000 yen 

 Residence tax tax exemption

o

 35,400 yen

24,600 yen

21,000 yen 

 

 ※ Pertinence is burden after the fourth a lot when we receive refund more than three times in the past 12 months.

 ※ When we pay self-burdens 21,000 yen or more more than twice in one household the same during the month, we add them up and are provided with share beyond limit.

※ As for part of the congenital blood clotting factor disorder and people in chronic kidney failure that artificial dialysis needs and HIV infection to be caused by the dosage of blood clotting factor preparation, as for the self-pay limit about the medical expenses, it is to 10,000 yen (in people who but need artificial dialysis under 70 in any of a i 20,000 yen) for one month if we submit "*tei*byo*yoju*sho" to window of hospital.

 ● The way of calculation

・ We calculate about consultation every calendar months from 1st of month to the end of the month.

・ We calculate for each medical institution

・ Hospitalization and outpatient department and dentistry are separate calculations with one medical institution

・ We calculate for each National Health Insurance member of the same household individually

・ The outside where meal charges or extra charge for the special room in hospital not to become a target of medical service under health insurance are targeted for supply


Income earner 70 years old or older at the same level as active play

Income division

Outpatient department and hospitalization (household unit)

 Majority pertinence

Taxable income 6.9 million yen or more

 252,600 yen + (medical expenses -842,000 yen) *1%

 140,100 yen

Taxable income 3.8 million yen or more

 167,400 yen + (medical expenses -558,000 yen) *1%

 93,000 yen

Taxable income 1.45 million yen or more

 80,100 yen + (medical expenses -267,000 yen) *1%

 44,400 yen

 

Other than income earner 70 years old or older at the same level as active play

 Income division

 Outpatient department (personal unit)

 Outpatient department and hospitalization (household unit)

 The public (less than taxable income 1.45 million yen)

 18,000 yen

57,600 yen 

 Low-income person (2)

 8,000 yen

24,600 yen 

 Low-income person (1)

 8,000 yen

15,000 yen 

 

※ Pertinence is burden after the fourth when we received refund more than three times in the past 12 months a lot.

※ Low-income person (2): Person who all family nurturer and the National Health Insurance people insured of the same household are people of residence tax tax exemption, and does not correspond to low-income person (1).

※ Low-income person (1): People that National Health Insurance person insured is residence tax tax exemption, and each income is 0 yen and pension incomes are 800,000 yen or less in family nurturer and same household all the members

※ In 75 years old arrival month, limit of National Health Insurance and medical system for elder senior citizens becomes by a half each.

※ As for part of the congenital blood clotting factor disorder and people in chronic kidney failure that artificial dialysis needs and HIV infection to be caused by the dosage of blood clotting factor preparation, as for the self-pay limit about the medical expenses, it is to 10,000 yen for one month if we submit "*tei*byo*yoju*sho" to window of hospital.

 ● The way of calculation

・We calculate about self-burden of people (person having identification of old recipient) under 75 70 years old in household or older.

・After having applied limit to medical expenses (including share of dispensing pharmacy) for outpatient by personal unit, calculation method applies limit of household unit to medical expenses including hospitalization.

・The outside where meal charges (standard burden) at admission or extra charge for the special room in hospital not to become a target of medical service under health insurance are targeted for supply

 

(4) When the total of self-pay of medical care and care becomes large

 

 When the totals of one year (from August to next year July) of self-burden of medical insurance and care insurance exceed certain limit, we are provided with sum that we exceeded by application. We calculate sum that we exceeded in the use ratio of medical insurance and care insurance and are paid for medical insurance as "large amount of care adding up medical expenses".

 

Cases 70 years old or older under 75

Income division

 Annual limit

 Income earner taxable income 6.9 million yen at the same level as active play or more

2.12 million yen

 Income earner taxable income 3.8 million yen at the same level as active play or more

1.41 million yen

 Income earner taxable income 1.45 million yen at the same level as active play or more

670,000 yen

 The public (less than taxable income 1.45 million yen)

560,000 yen

 Low-income person (2)

310,000 yen

 Low-income person (1)

190,000 yen

 

Cases under 70

Income requirements

 Division

 Annual limit

We exceed 9.01 million yen

 A

 2.12 million yen

We exceed 6 million yen

 i

 1.41 million yen

We exceed 2.1 million yen

 Cormorant

 670,000 yen

2.1 million yen or less

 Oh

 600,000 yen

 Residence tax tax exemption

 o

 340,000 yen

 

●   Application is window of medical insurance

We perform application at window of medical insurance taking out at at July 31.

We send notice of application to applicable person in people taking out Tagawa-shi National Health Insurance through the year.
 Person taking out social insurance, please ask association kempoya health insurance union joining.

※  Self burden certificate which insurer where moved person joined National Health Insurance of Tagawa-shi from other medical insurance including case and social insurance that we moved from other municipalities to before issues may be necessary.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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Inquiry
(ID: 1730)
Tagawa-shi government office
〒825-8501  1-1, Chuomachi, Tagawa-shi, Fukuoka   Tel: 0947-44-2000 (main)   Fax: 0947-46-0124  
[open agency time] From 8:30 a.m. to 5:00 p.m. (except Saturdays, Sundays and holidays, New Year holidays)
※Only citizen's section window (various certificate issuance) extends every Thursday at time until 7:00 p.m.
Copyright (C) City of Tagawa

Tagawa-shi government office

〒825-8501
1-1, Chuomachi, Tagawa-shi, Fukuoka
Tel: 0947-44-2000 (main)
Copyright (C) City of Tagawa