Certificate of Eligibility for Maximum Amount Application

"Certificate of Eligibility for Maximum Amount Application", or "Certificate of Eligibility for Maximum Amount Application and Reduction of Standard Meal Therapy Co-payment" (hereinafter referred to as "Certificate of Eligibility for Maximum Amount Application" etc.), when presented at medical institutions, limits the monthly partial payment you pay at the medical institution to the self-payment limit amount. If you have registered your My Number Card for use as a Health Insurance Card and use a medical institution that can verify your medical insurance eligibility online, you do not need to present the "Certificate of Eligibility for Maximum Amount Application" etc. However, if you fall under Category O or Low-Income Category 2 and your hospitalization exceeds 90 days, an application is required.

• Note: 1 Costs not covered by insurance (such as document fees, meal costs during hospitalization, and extra bed charges) are not included in the partial payment.
• Note: If you have received treatment at multiple medical institutions or if there is a difference payment applicable for multiple or household aggregation, a separate Application Form for High Medical Expenses will be sent.

• Meal Costs During Hospitalization

About the Limit of Self-Burden Amount

Self-Payment Limit for Those Under 70 Years Old

Category	Income Requirements (Total income amount etc. - 430,000 yen)	Monthly Self-Expense Limit
A	Households with income exceeding 9.01 million yen Or, households with unreported income	270,300 yen + (Total Medical Expenses - 901,000 yen) × 1% <Multiple occurrences applicable: 140,100 yen> <Annual Limit (Yearly Amount) 1,680,000 yen>
I	Households with income over 6 million yen and up to 9.01 million yen	179,100 yen + (Total Medical Expenses - 597,000 yen) × 1% <Multiple applicable: 93,000 yen> <Annual Limit (Yearly Amount) 1,110,000 yen>
U	Households with income over 2.1 million yen and below 6 million yen	85,800 yen + (Total Medical Expenses - 286,000 yen) × 1% <Multiple occurrences applicable: 44,400 yen> <Annual Limit (Yearly) 530,000 yen>
E	Households with income below 2.1 million yen	61,500 yen <Multiple occurrences applicable: 44,400 yen> <Annual Limit (Yearly) 530,000 yen Note 1>
O	Households Exempt from Resident Tax	36,900 yen <Multiple occurrences applicable: 24,600 yen> <Annual Limit (Yearly) 290,000 yen>

Note 1: For category E, if it is confirmed that the income requirement is up to approximately 2 million yen, an annual limit of 410,000 yen will be applied, and reimbursement payments will be made from October 2027 onward.

・"Multiple occurrences applicable" refers to the self-payment limit applied from the 4th time onward when a single household has received high-cost medical expense benefits 4 times or more within the past 12 months, including the month when treatment occurred.

・The annual limit is calculated over a one-year period from August to July of the following year.

Limit on Self-Payment for Individuals Aged 70 to Under 75

Income Category	Monthly Self-Expense Limit Outpatient (per individual)	Monthly Self-Expense Limit Outpatient + Inpatient (per household)
Active Level 3: Taxable income of 6.9 million yen or more	270,300 yen + (Medical Expenses – 901,000 yen) × 1% <Multiple occurrences applicable: 140,100 yen> <Annual Limit (Yearly) 1,680,000 yen>	270,300 yen + (Medical Expenses – 901,000 yen) × 1% <Multiple occurrences applicable: 140,100 yen> <Annual Limit (Yearly) 1,680,000 yen>
Equivalent to Active Duty 2: Taxable Income of 3.8 million yen or more	179,100 yen + (Medical Expenses – 597,000 yen) × 1% <Multiple applicable: 93,000 yen> <Annual Limit (Yearly Amount) 1,110,000 yen>	179,100 yen + (Medical Expenses – 597,000 yen) × 1% <Multiple applicable: 93,000 yen> <Annual Limit (Yearly Amount) 1,110,000 yen>
Active Level 1: Taxable Income of 1.45 million yen or more	85,800 yen + (Medical Expenses – 286,000 yen) × 1% <Multiple occurrences applicable: 44,400 yen> <Annual Limit (Yearly) 530,000 yen>	85,800 yen + (Medical Expenses – 286,000 yen) × 1% <Multiple Times: 44,400 yen> <Annual Limit (Yearly) 530,000 yen>
General (Note 1): Taxable income under 1.45 million yen	¥22,000 <Annual limit (annual amount) ¥216,000>	61,500 yen <Multiple occurrences applicable: 44,400 yen> <Annual limit (annual amount) ¥530,000 (Note 4) >
Low-Income Individuals 2 (Note 2): (Note 3)	¥11,000 <Annual limit (annual amount) ¥96,000>	¥25,700 <Multiple occurrences applicable: 24,600 yen> <Annual limit (annual amount) ¥290,000>
Low-Income Person 1 (Note 2): (Note 3) and income below a certain standard	8,000 yen	15,700 yen <Annual limit (annual amount) 180,000 yen>

• Note 1: This includes cases where the total household income is less than 5.2 million yen (less than 3.83 million yen for single-person households) or where the total amount of "old exception income" is 2.1 million yen or less.
• Note 2: For households exempt from resident tax, it will remain as before. A certificate for the application of the limit amount and reduction of the standard burden will be issued.
• Note 3: A household where the head of the household and all insured persons under the National Health Insurance are exempt from resident tax.
• Note 4: Among the general income categories, if it is confirmed that the taxable income is up to 2 million yen, an annual limit of 410,000 yen will be applied for hospitalization, and reimbursement payment will be made from October 2027 onward.
• "Multiple occurrences" refers to the limit on out-of-pocket expenses that applies from the fourth occurrence onward when there have been four or more payments of high-cost medical care benefits within the past 12 months, including the month in which the treatment occurred, for a single household.
• The annual limit is calculated over a one-year period from August to July of the following year.

About the issuance of the "Limit Amount Application Certification" and others

For those aged 70 and over, individuals with taxable income between 1.45 million yen and less than 6.9 million yen, as well as those from households exempt from resident tax, will need to apply for a certificate of eligibility for the limit amount.
For other individuals with income comparable to working-age persons (taxable income of 6.9 million yen or more) and those aged 70 and over who fall under the general category, by presenting a My Number Health Insurance Card or Qualification Confirmation Document at medical institutions, the out-of-pocket payment at the counter will be up to the self-pay limit according to the burden ratio, so a Certificate of Eligibility for Maximum Amount is not required.

Items required for the issuance procedure of the "Eligibility Certificate for Maximum Amount" and others

• Identity Verification Documents
• Personal Number (My Number) Confirmation Document

• Note: 1. If you complete the procedure at the Hirao or Wakabadai Branch Office, it will be sent by mail.
• Note: Those with unpaid National Health Insurance Tax will not be issued a "Certificate of Eligibility for Maximum Benefit" or similar documents.

• Identity verification documents / Individual number (My Number) verification documents

Validity period of the "Limit Amount Application Certification" and others

It is from the first day of the month you applied until the end of July of the following year. If you still need it, please reapply after August 1st. If you are in a hurry, applications are accepted from one week prior.

Available Procedure Dates

Open on weekdays from 8:30 AM to 5:00 PM
Note: On holidays when the office is open, hours are from 8:30 AM to 12:00 PM and from 1:00 PM to 5:00 PM
Note: Holiday opening hours apply only to City Hall.