PAYOUTS AVAILABLE UNDER THE NATIONALHEALTH INSURANCE SCHEME IN KOBE CITY
1.

REDUCTION OF MEDICAL FEES PAID DIRECTLY AT THE MEDICAL FACILITY
If you present your health insurance card at the hospital service desk, your out-of-pocket

expenses will be limited to either 20% or 30% of the actual medical fees incurred, as follows:Preschool children: 20%

Start of school through age 69: 30%

People aged 70 through 74: 20% or 30% (if your income is comparable to that of an ordinaryworking person). Please present your senior recipient certificate along with your regular
health insurance card.

People aged 70 through 74, who are enrolled in the national health insurance scheme, aredeemed to have an income comparable to that of an ordinary working person, if the taxable
portion of their net income for the purposes of resident tax is 1,450,000 yen or higher, or if thecombined net income for all applicable members of their household exceeds 2,100,000 yen after
basic deductions are applied. The amount of basic deduction depends on the combined incomeof your household. If the combined income of your household is under 24,000,000 yen, thisdeduction is set at 430,000 yen. Please also note that carryover deductions for casualty losses are
not considered when calculating your total net income.
You will be able to use the senior recipient certificate starting with the first day of the monthfollowing your 70th birthday.
People born on the first day of the month will be able to use it from their 70th birthday.

The certificate will be mailed to your address at the end of the month of your 70th birthday,
or at the end of the previous month if you were born on the first day of the month.

Medical services covered by this health insurance include: medical examinations, treatment,
administration of medicine, injections and other similar procedures, hospitalization and nursing(excl. meals), home care (home visits by the family doctor), as well as home-visit nursing care (ifdeemed necessary by the attending physician).

2.

YOUR HEALTH INSURANCE CARD CANNOT BE USED IN FOLLOWING SITUATIONS:A) For procedures deemed to be unrelated to illness, such as routine and full physicalexaminations, vaccinations, plastic surgery, dental materials (e.g. gold alloys), normalchildbirth and extra bed charges.
B) For procedures covered by workers’ compensation insurance (i.e. injuries and illnesses
that happened at work or during commute).

[Important]
Benefits under the national health insurance scheme may be limited in following situations:A) Accidents related to criminal activity or caused intentionallyB) Injuries and illnesses caused by fights or inebriationC) When the patient disregards the directions of their physician or insurer
If you are injured in a traffic accident, you can seek medical treatment under the national healthinsurance scheme. In this case, however, we ask that you visit the national health insurance desk
at your local ward or branch office and submit a “notice of injury or illness sustained due to actionsof a third party” and other related documents, regardless of whether negligence occurred. Basedon these documents, the responsible party will be billed for the 70% (or 80%) of your medical fees,
which are covered by the national health insurance.

3.

MEDICAL TREATMENT FEES
In the following cases, you will be asked to pay your medical bill in full first, and then you will

be able to apply for a partial refund at the national health insurance service desk of your local
ward or branch office (or Seishin Chuo Community Service Center for those who live within its
jurisdiction, except for cases ④ ⑤ and ⑥).
As long as your premium payments are up to date, in cases ① and ③, you may also apply for apartial refund at a government administrative center. Your application will be reviewed and in thecase of a positive decision, you will receive a refund (excl. the co-pay amount). Please note,however, that if you are behind on your premium payments, such refunds may be used to cover
them.

①

If you receive medical treatment without producing your health insurance card, forinstance because of a sudden illness②

If you receive medical treatment using a different health insurance, for which you wereno longer eligible③

If you need to purchase a prosthetic or supportive device, such as a medical corset, thatyour attending physician deemed necessary for your treatment④

If you receive bone fracture or sprain treatment from a bonesetter, providing the service
is covered by the health insurance⑤

If you receive massage, acupuncture or moxibustion procedures as part of your medicaltreatment and with consent from your attending physician⑥

If you receive medical treatment using an insurance eligibility certificate instead of ahealth insurance card⑦

If you receive treatment abroad

4. LUMP-SUM ALLOWANCE FOR CHILDBIRTH AND NURSING
After childbirth, persons insured under the national health insurance scheme will receive alump-sum allowance for childbirth and nursing in the amount of 420,000 yen (404,000 yen fordeliveries carried out at institutions that are not registered with the obstetric compensationsystem). If you choose to make use of the direct payment system for this allowance, it will be paid
directly to your hospital and you will not have to pay as much at the hospital service desk.
*Starting with the 12th week (85th day) of pregnancy, this allowance will
be provided even in the case of miscarriage or stillbirth.

(1) IF YOU CHOOSE TO USE THE DIRECT PAYMENT SYSTEM
Prior to the delivery of the child, bring your health insurance card to the medical institution
where you plan to have the baby and tell them that you would like to make use of the direct
payment system. Should your medical bill exceed the amount of this allowance, you will have topay the difference at the hospital service desk. If it is lower, however, you will be able to file anapplication to receive the difference at your local ward or branch office (or Seishin Chuo
Community Service Center for those who live within its jurisdiction).
(2) IF YOU CHOOSE NOT TO USE THE DIRECT PAYMENT SYSTEM
You may also choose to not use this system and receive this allowance yourself. In this case,
you will need to pay your medical bill in full at the hospital, and then file an application at thegovernment administrative center or the national health insurance service desk of your local wardor branch office (or Seishin Chuo Community Service Center for those who live within its
jurisdiction). Please note, however, that you will not be able to file this application at thegovernment administrative center if your premium payments are overdue.
*If you receive the same lump-sum allowance under a different insurance,
you will not receive it through the national health insurance scheme.

5.

FUNERAL SERVICE FEES
When a person insured under the national health insurance scheme passes away, the person

in charge of making funeral arrangements (in principle, the chief mourner) will receive funeralservice fees in the amount of 50,000 yen if they file an application at the government
administrative center or the national health insurance service desk of their local ward or branch
office (or Seishin Chuo Community Service Center for those who live within its jurisdiction). Please
note, however, that you will not be able to file this application at the government administrative
center if your premium payments are overdue.

6. SPECIFIED DISEASE TREATMENT CERTIFICATE(The Seishin Chuo Community Service Center only accepts and processes applications.
Certificates are mailed out by the Nishi Ward Office at a later date.)
If you present a Specified Disease Treatment Certificate at the hospital service desk, your outof-pocket expenses will be limited to 10,000 yen (or 20,000 yen) per month. Please file anapplication at the national health insurance service desk of your local ward or branch office (orSeishin Chuo Community Service Center for those who live within its jurisdiction). Applications
must include supporting documentation, such as a doctor’s report.
ELIGIBLE HEALTH CONDITIONS (designated by the Minister of Health, Labor and Welfare)Chronic renal failure requiring dialysis

Certain congenital blood coagulation factor disorders (hemophilia)

HIV infections caused by transfusion of infected blood products*The out-of-pocket medical expenses for dialysis patients age 69 or under,
who are part of upper-class households (income category A or B) will belimited to 20,000 yen per month.

7-1. HIGH-COST MEDICAL CARE BENEFIT SYSTEM
If your out-of-pocket medical expenses are extremely high, you can apply to receive a refundfor the portion that exceeds a certain limit.
(1) IF THE MEDICAL FEES ARE ONLY FOR HOUSEHOLD MEMBERS AGED 69 OR UNDER
Whenever a single member of your household incurs out-of-pocket medical expenses in excess of21,000 yen at a single medical institution during the same month, your household becomes eligible
to apply for a partial refund. In order to receive this partial refund, however, the total of qualifying
out-of-pocket expenses (at least 21,000 yen for one person in one month at a single hospital) for
your household needs to exceed the threshold amount for your income bracket.
TABLE 1: OUT-OF-POCKET MEDICAL EXPENSE LIMIT (MONTHLY)
Income Bracket
Income exceeds
9,010,000 yen

CategoryA

Income between
6,000,001 –B

9,010,000 yen
Income between
2,100,001 –C

6,000,000 yen
Income at or below
2,100,000 yen

Resident taxexempt householdDE

252,600 yen + [(Total medical fees - 842,000 yen) × 1%]
From 4th instance: 140,100 yen

167,400 yen + [(Total medical fees - 558,000 yen) × 1%]
From 4th instance: 93,000 yen

80,100 yen + [(Total medical fees - 267,000 yen) × 1%]
From 4th instance: 44,400 yen

57,600 yen
From 4th instance: 44,400 yen

35,400 yen
From 4th instance: 24,600 yen“Income” is the combined net income for all members of your household who areenrolled in the national health insurance scheme, after basic deductions are applied.

(2) IF THE MEDICAL FEES ARE ONLY FOR HOUSEHOLD MEMBERS AGED 70 THROUGH 74
For out-of-pocket medical expenses paid during the same month, you can apply to receive arefund for the portion that exceeds a certain limit. This portion is calculated as shown in the tablebelow, in the following order.
1: The Outpatient Limit (Per Individual) (see table below) is applied to the total out-of-pocket
expenses for each individual’s outpatient medical care, and the portion that exceeds this limit
is calculated.
2: The outpatient out-of-pocket expenses that remain from 1 are combined with the inpatient
out-of-pocket expenses for household members aged 70-74. The Maximum Limit (PerHousehold) (see table below) is applied to this total, and the portion that exceeds this limit
is calculated.
TABLE 2: OUT-OF-POCKET MEDICAL EXPENSE LIMIT (MONTHLY)
Income Bracketfor Households

Outpatient Limit

Maximum Limit

with Seniors(Per Individual)(Per Household)Comparable

252,600 yen + [(Total medical fees - 842,000 yen) × 1%]

Income III*

From 4th instance: 140,100 yen

Comparable

167,400 yen + [(Total medical fees - 558,000 yen) × 1%]

Income II*

From 4th instance: 93,000 yen

Comparable

80,100 yen + [(Total medical fees - 267,000 yen) × 1%]

Income I*

From 4th instance: 44,400 yen
18,000 yen

General IncomeYearly maximum

57,600 yen(August through July):

From 4th instance: 44,400 yen

144,000 yen
Low Income II
Low Income I

8,000 yen

See next page for an explanation of the income brackets.

24,600 yen
15,000 yen

INCOME BRACKETS
 Comparable Income III
Households with a national health insurance recipient aged 70-74, whose taxable
portion of their total net income for the purposes of resident tax is at least 6,900,000yen Comparable Income IIHouseholds with a national health insurance recipient aged 70-74, whose taxable
portion of their total net income for the purposes of resident tax is at least 3,800,000yen Comparable Income I
Households with a national health insurance recipient aged 70-74, whose taxable
portion of their total net income for the purposes of resident tax is at least 1,450,000
yen General IncomeHouseholds that do not fall under any of the other categories in this table Low Income IIHouseholds in which both the head of household and all national health insurance
recipients are exempt from paying resident taxes
 Low Income I
In addition to meeting the conditions for the Low Income II bracket, the household’s
income* is 0 yen (after necessary expenses are subtracted from each income source(800,000 yen is subtracted in the case of public pension)) *If the incomes include
employment income, 100,000 yen is deducted from the employment income before
determining whether the household falls under this income bracket (effective fromAugust 2021)

(3) IF THE MEDICAL FEES ARE FOR BOTH HOUSEHOLDMEMBERS AGED 69 OR UNDER, AND MEMBERS AGED 70-74
The high-cost medical care benefit amount is disbursed for the entire household as follows:(1) Individual out-of-pocket outpatient expenses are calculated for members aged 70-74 todetermine if they are over the individual limit. Expenses in excess of this limit will berefunded.
(2) Next, all out-of-pocket expenses incurred by household members aged 70-74 arecalculated to determine if they are over the household limit for people in this age group.
Expenses in excess of this limit will be refunded.
(3) All out-of-pocket expenses incurred by household members aged 70-74 within thehousehold limit for people in this age group are added to applicable out-of-pocket
expenses (at least 21,000 yen for one person in one month at a single hospital) incurredby household members aged 69 and under, and compared against the threshold amountfor your income bracket. Expenses in excess of this threshold will be refunded along withthe refunds in (1) and (2).

(4) IF YOU HAVE RECEIVED THIS BENEFIT AT LEAST 4 TIMES
If a single household has received the high-cost medical care benefit at least 3 times in the past 12months, the out-of-pocket medical expense limit will decrease from the 4th benefit onwards(shown in italics in Tables 1 and 2), and the portion that exceeds this limit will be refunded.
*If you change addresses within Hyogo Prefecture and the structure of yourhousehold is determined to be the same, the refund count will carry over.

7-2. APPLYING FOR HIGH-COST MEDICAL CARE BENEFITSAt the end of the month two months after your visit to the hospital, if your estimated high-cost
medical care benefit amount is at least 1,000 yen, and you have no overdue premium payments,
you will be mailed a notification packet. Once you have received this notification, please fill out
the application and submit it in the enclosed return envelope.
While it is also possible to file your application at the national health insurance service desk ofyour local ward or branch office before receiving the notification packet, you will not receive yourrefund any sooner than if you had filed your application by mail.
Except for persons with estimated benefit amounts under 1,000 yen, please wait to receive thenotification packet before filing your application.

8. ELIGIBILITY CERTIFICATE FOR OUT-OF-POCKET MEDICAL EXPENSE LIMIT(The Seishin Chuo Community Service Center only accepts and processes applications.
Certificates are mailed out by the Nishi Ward Office at a later date.)
If you have an Eligibility Certificate for Out-of-Pocket Medical Expense Limit (or Eligibility
Certificate for Out-of-Pocket Medical Expense Limit / Eligibility Certificate for Standard Amount ofPatient Liability, if you are in a resident tax-exempt household), the out-of-pocket medical
expense limit can be applied to 1 month’s medical fees at a single hospital.
If you are 70-74 years old and fall under either the General Income or the Low Income IIbrackets, you can simply present your senior recipient certificate. Your out-of-pocket expenses
will be reduced to the limit amount, and no additional procedures at the hospital are necessary.
Applications for the Eligibility Certificate can be filed at the government administrative center or
the national health insurance service desk of your local ward or branch office.
[Important]Your certificate will be valid from the 1st day of the month in which you filed your application. Inprinciple, this certificate cannot be issued retroactively, so please carry out all necessary
procedures as soon as possible if you are to be hospitalized. Please note, however, that if you are
aged 69 or under and have overdue premium payments, you cannot receive this certificate.

9. HOSPITAL MEAL FEES
Hospital meal fees are treated separately from treatment and medicine fees. You will bear partof the fee for each meal up to the basic limit, and the remainder will be covered by the national
health insurance.
BASIC HOSPITAL MEAL EXPENSE LIMIT (PER MEAL)
Households subject to resident tax:

Resident tax-exempt households (90 or fewerdays of hospitalization in the past 12 months):

460 yen
210 yen*

Persons aged 70-74 in the Low Income I bracket, who
are also members of a resident tax-exempt household:

100 yenIf you are in a resident tax-exempt household and present either an Eligibility Certificate for
Out-of-Pocket Medical Expense Limit / Eligibility Certificate for Standard Amount of Patient
Liability or a standalone Eligibility Certificate for Standard Amount of Patient Liability), yourhospital meal fees will be reduced as shown above.
*If you have been hospitalized for more than 90 days within the last 12 months, you can fileanother application to be issued a certificate that will lower each hospital meal’s fee to 160 yen,effective from the 1st of the next month after you apply (excluding periods during which yourhousehold was exempt from resident tax and it fell under the Low Income I bracket). Please filean application at the government administrative center or the national health insurance service
desk of your local ward or branch office.