‘Certificate of Eligibility for
Ceiling-Amount Application’For people who are 69 years old or underThis is targeted forthe age group of…

69 years oldor under

For insured patients who are 69 years old or under, your monthly payment at the cashier will be no
more than a specified amount shown in the table below by presenting the “Certificate of Eligibility for
Ceiling-Amount Application” to the medical institution with your health insurance card especially if you
will be admitted for a long period of time or if your medical expenses are expected to be high. (Pleasenote that meals, extra charges for rooms, private practices etc. are not covered.)Monthly copayment with ceiling-amountMonthly payment with ceiling-amount (within 12 months including your 1st month)Type

Each meal fee
in the hospital

Until 3rd time

After 4tha

252,600 + (total medical fees – 842,000 yen) x 1%

140,100 yen

460 yeni

167,400 + (total medical fees – 558,000 yen) x 1%

93,000 yen

460 yenu

80,100 + (total medical fees – 267,000 yen) x 1%

44,400 yen

460 yene

57,600 yen

44,400 yen

460 yeno35,400 yen24,600 yen

If over 90 days,decreased to 160 yen
by applying

210 yen※Total medical fees indicate 100% medical fee payment.

※Meal fees are left unchanged for patients with tax-exempt households, intractable disease, and specified chronic childhood disease.

※Above is the amount for one month from the 1st to the last day of each month. Please be careful that calculations are conducted
separately for inpatient care and outpatient care.
※Meals and extra charges for hospital rooms are not included in self-pay with ceiling-amount.
※You cannot apply for the past months payment.

Things to be careful when calculating your copayment with ceiling-amount1

Calculate by calendar month(from the 1st to the last day of each month)

2 Calculate different clinical departments together
if they belong to the same medical institution

34
Calculate Medical and Dental department
Calculate inpatient and outpatient care separately
separately even if they belong to the same medical institution

5Meals, extra charges for hospital rooms, private practice in dentistry, etc. duringhospitalization that are not covered by insurance are not included※Household including a person over 70 years old will get reimbursement from the National Health Insurer if total medical fees within the same
household get over the ceiling-amount payment.

Forconsultation

National health insurance holders:

Person in charge at Municipal OfficeSocial insurance holders:

The Japan Health Insurance Association

Mutual or cooperative insurance holders:

Person in charge※Please present your ‘Certificate of Eligibility of Ceiling-Amount’ together with healthinsurance card on the day of admission and on the first day of every month.

‘Certificate of Eligibility for Ceiling-Amount Application’‘Eligibility for Ceiling-Amount Application andReduction of the Standard Amount of Patient Liability’This is targeted
for the age group of…

70 years oldand above※Include some of those who are
65 yrs. old or above

For those who are between 70 and 74 yrs. old / with Medical Care System for Older Senior Citizens

For some of those with income comparable to current workforce (copayment of 30%), they can apply for the ‘Certificateof Eligibility for Ceiling-Amount Application’ to the insurer and present it to the medical institution so that yourmonthly payment at the cashier will be no more than a specified amount shown in the table below (green frame).
Additionally, if all members of the household are exempted from tax, they can apply for the ‘Eligibilit y for
Ceiling-Amount Application and Reduction of the Standard Amount of Patient Liability’ to the insurer and present it to
the medical institution so that your monthly payment at the cashier will be no more than a specified amount shown in
the table below (red frame). Please refer to monthly payment with ceiling amount. (Please note that meals, extra
charges for rooms, private practices etc. are not covered.)Monthly copayment with ceiling-amountMonthly payment with ceiling-amount (within 12 months including your 1st month)
Copayment
Typecategorythrd

Until 3 time

★ Peoplewith income
comparable tocurrent
workforce

After 4Each meal fee
in the hospitalⅢ

252,600 + (total medical fees – 842,000 yen) x 1% 140,100 yen

460 yenⅡ

167,400 + (total medical fees – 558,000 yen) x 1% 93,000 yen

460 yenⅠ

80,100 + (total medical fees – 267,000 yen) x 1% 44,400 yen

460 yenGeneral57,600 yen

44,400 yen

460 yen

Low-income TypeⅡ
groupⅡ

24,600 yen

24,600 yen

If over 90 days,decreased to 160
yen by applying

Low-income TypeⅠ
groupⅠ

15,000 yen

15,000 yen

100 yen

210 yen★If not applied for ceiling amount certificate, medical cost will be calculated by using Ⅲ. If patient falls into Ⅱ orⅠ,
they can get refunded by the insurer after payment.
※Total medical fees indicate 100% medical fee payment.
※Meal fees are left unchanged for patients with tax-exempt households, intractable disease, and specified chronic childhood disease.
※Above is the amount for one month from the 1st to the last day of each month. Please be careful that calculations are conducted
separately for inpatient care and outpatient care.
※Meals and extra charges for hospital rooms are not included in self-pay with ceiling-amount. ※You cannot apply for the past months payment.

1
3

Things to be careful when calculating your copayment with ceiling-amountCalculate by calendar month(from the 1st to the last day of each month)

2 Calculate different clinical departments together
if they belong to the same medical institution

4
Calculate Medical and Dental department
Calculate inpatient and outpatient care separately
separately even if they belong to the same medical institution

5Meals, extra charges for hospital rooms, private practice in dentistry, etc. during hospitalization that are not covered by insurance are not included

Forconsultation

Please inquire of the health insurance division ateach Municipal Office or of the insurer.

※Please present your ‘Certificate of Eligibility of Ceiling-Amount’ together with healthinsurance card on the day of admission and on the first day of every month.