Transportation expenses are reimbursed when a seriously ill or injured person uses a vehicle, etc., to go to the hospital or is transferred between hospitals on a physician’s orders in an emergency and for unavoidable reasons. However, expenses to and from the hospital are not considered “transfer expenses.”
3. Reimbursement of Transfer Expense
(1) How to apply for high-cost medical care reimbursement
You will be sent an application form three months after the month in which the medical care was received. After you receive this form, please have the head of the household complete and submit it to the city.
If you foresee exceedingly high medical care costs prior to receiving treatment at a medical institution, please obtain the Eligibility Certificate for Ceiling-Amount Application from the National Health Insurance Benefits Subsection in advance. Present the Eligibility Certificate for Ceiling-Amount Application along with your National Health Insurance card and you will be required to pay only the maximum ceiling of personally-borne expenses. Please refer to page 43 for how to apply for the Eligibility Certificate for Ceiling-Amount Application.
(2) How high-cost medical care coverage is calculated
Medical care expenses eligible for high-cost medical care coverage are calculated as follows.
(a) Eligible medical care expenses are calculated on a monthly basis
(b) Applicable co-payments for medical care are included in the calculation. (However, amounts of less than 21,000 yen for each medical institution (hospital or dental office and hospitalization or outpatient) for those under the age of 70 are excluded from the calculation.)
①How high-cost medical care coverage is calculated for individuals
If one person in the household has paid medical expenses eligible for high-cost medical care coverage, the amount calculated from (a) and (b) above that exceeds the maximum ceiling of personally-borne expenses from the chart below is eligible for coverage.
Persons who are eligible for the Elderly Member’s Certificate will first be reimbursed for the portion of outpatient care only. If hospitalization expenses were incurred, the self-pay amount remaining from the calculation of the outpatient care only will be added to the cost of the hospitalization, and coverage will be provided for any amount that exceeds the maximum ceiling for personally-borne expenses for both outpatient care and hospitalization. This combined amount of the eligible outpatient care and hospitalization expense is the extent of coverage provided by high-cost medical care reimbursement.
When eligible expenses paid for medical care received at a medical institution for illness or injury exceed the maximum ceiling of personally-borne expenses, the National Health Insurance reimburses the amount that exceeded this limit at a later date with high-cost medical care coverage.
4. Reimbursement of High-Cost Medical Care
National Health Insurance Card, a doctor’s written diagnosis (in a special format), receipts, personal seal of the head of household (vermillion ink pad) (signature acceptable if you do not have a seal) and bank account number of the head of household.
＜ Required Items ＞
A doctor’s certificate, written consents and/or any other submitted documentation is subject to evaluation, and may not necessarily be subject to a refund of medical expenses.
重病や重傷などにより緊急に、かつやむを得ない理由で、医師の指示により、入院、転院 するため、自動車などを使用したときの移送費用。ただし、通院、退院の費用は移送と認め られません。
（１）高額療養費の申請方法
診療月の約 3 か月後に申請書を送付します。届いてから、世帯主が申請をしてください。
また、医療機関にかかる前に医療費が高額にかかることが予定される場合には、あらか じめ国保給付係で限度額適用認定証の交付を受けてください。限度額適用認定証を保険証 と一緒に医療機関の窓口に提示することで、医療機関の窓口での支払いが、自己負担限度 額までとなります。限度額適用認定証の申請については、43 ページをご覧ください。
（2）高額療養費の計算方法
高額療養費の計算対象となる医療費は、次により算出されます。
ア．カレンダーのひとつきごとに計算します。
イ．保険適用となる医療費の一部負担金を計算対象とします（ただし70歳未満の場合には、
医療機関（医科・歯科、入院・外来別）ごとに金額が 21,000 円未満のものは計算対象 外）。
①計算対象が 1 名の場合の計算方法
世帯に高額療養費の対象となる医療費がかかった方が1名であれば、上記の「ア」及び
「イ」で計算した額が次の表に示す自己負担限度額を超えた場合に、超えた分が高額療養 費になります。
高齢受給者証対象者については、まず外来分のみで高額療養費を算出します（外来分）。
次に、入院分があれば、外来分のみの計算で残っている自己負担額（＝外来分の自己負担 限度額）と入院分の医療費を合計して、外来＋入院の自己負担限度額を超えた額を算出し ます（入院分）。これら（外来分）と（入院分）の額を合計した金額が高額療養費になります。
3. 移送費の支給
医師の証明書や同意書があっても、審査により支給対象にならない場合があります。
保険証、医師の意見書（所定の様式）、領収書、世帯主の印かん（朱肉を使うもの）（なけ ればサインでもよい）、世帯主名義の口座番号
＜手続きに必要なもの＞
病気やけがで医療機関にかかり、高額療養費の計算対象となる医療費が自己負担限度 額を超えると、超えた分は高額療養費として支給されます。
4. 高額療養費の支給
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重病或重伤者等遇紧急情况并且根据医生的指示不得不住院、转院时需要使用汽车护送 的费用。但是，就诊或出院的费用不能作为移送费。
3. 移送费的支付
（1）高额疗养费的申请方法
在诊疗月后的大约 3 个月之后发送申请单。请户主在收到后进行申请。
此外，在前往医疗机构就医前预计会花费高额医疗费时，请预先从国保给付系领取限额 适用认定证。将限额适用认定证与保险证一起提交给医疗机构的窗口，在医疗机构窗口最 多只需支付自我负担限额的金额。关于限额适用认定证的申请，请参阅第 44 页。
（2）高额疗养费的计算方法
成为高额疗养费计算对象的医疗费按照如下所述进行计算。
(a) 按日历各月进行计算。
(b) 以适用保险医疗的医疗费的一部分负担金额为计算对象。（但是，当未满 70 岁时，向 不同医疗机构（住院、门诊、医科、牙科）分别支付的金额不到 21,000日元的，不属 于计算对象）
①计算对象者为1人时的计算方法
如果家庭中有 1人花费属于高额疗养费对象的医疗费，则根据上述 (a) 及 (b) 计算出 的金额超过下表所示的自我负担限额时，超过的部分将作为高额疗养费。
关于高龄领取者证对象者，首先仅对门诊部分计算高额疗养费（门诊部分）。其次，如果 有住院部分，将在仅针对门诊部分的计算中剩余的自我负担额（＝门诊部分的自我负担限 额）与住院部分的医疗费进行合计，计算超出门诊＋住院的自我负担限额的金额（住院部 分）。将这些（门诊部分）与（住院部分）进行合计的金额就是高额疗养费。
因生病及受伤到医疗机构接受治疗，当作为高额疗养费计算对象的医疗费超过自我负担 限额时，超过部分可作为高额疗养费获得支付。
4. 高额疗养费的支付
即使有医生的证明书或同意书，但也有经过审查不予支付的情况。
＜申请时所需要的材料＞
保险证、医生的意见书（规定格式）、发票、户主的印章（限使用印泥的印章，没有印 章时签字亦可）、户主名义的银行账号
(1) 고액 요양비 신청 방법
진료받은 달로부터 3 개월후에 청구서를 발송 합니다 . 그 청구서를 받으시면 세대주가 신청을 해 주세요 .
또 의료기관에서 진료를 받기 전에 고액진료비가 예상되면 미리 국보 급부계에서 한도액 적용 인정증을 교부 받아 주십시오 . 한도액 적용 인정증을 보험증과 함께 의료기관 창구에 제출하면 의료기관 창구에서 납부하는 진료비는 자기부담 한도액 범위 이내로 지불할수 있습니다. 한도액 적용 인정증의 신청은 44 페이지를 참조해 주십시오 .
(2) 고약 요양비의 계산 방법
고액 요양비의 계산 대상이 되는 의료비는 아래의 방법으로 산출 합니다 가 . 달력 대로 한달씩 끊어서 계산 합니다
나 . 보험 적용이 되는 의료비의 일부 부담금을 계산 대상으로 합니다 . （단, 70 세 미만인 경우는 의료기관（의과-치과, 입원-외래별）별로 금액이 21,000엔 미만인 것은 계산 대상에서 제외）
①계산 대상자가 한 분일 경우의 계산 방법
세대에 고액 요양비의 대상이 되는 의료비를 내야 하는 분이 한분일 경우는 위에서 열거한 [가]및 [ 나]에서 계산한 액수가 다음의 표에 있는 자기부담 한도액을 초과했을 경우, 그 초과분이 고액 요양비가 됩니다 .
고령 수급자증 대상자에 대해서는 우선 외래 분에 한하여 고액 요양비를 산출 합니다（외래분）. 그 다음으로 입원 분에 대해서는 외래분을 계산하고 남은 자기 부담액（외래분의 자기부담 한도액）과 입원분의 의료비를 합산하여 외래 + 입원의 자기부담액을 초과한 금액을 산출 합니다 （입원분） 이렇게 （외래분）과 （입원분）의 금액을 중환자 또는 심한 부상자 등을 긴급히 , 또한 피치 못할 사정으로 의사의 지시에 따라 입원 , 전원 시키기 위해 자동차 등을 이용한 경우의 이송비용 . 단 , 통원 , 퇴원의 비용은 이송으로 인정하지 않습니다.
3. 이송비 지급
의사의 증명서나 동의서가 있어도 심사에 의해 지급대상이 되지 않는 경우도 있습 니다.
보험증, 의사의 의견서（소정의 양식）, 영수증, 세대주의 인감（인주를 사용하는 것） （인감이 없을 경우 사인으로 대체 가능）, 세대주 명의의 계좌번호
＜수속에 필요한 지참물＞
질병이나 부상으로 의료기관에서 치료를 받고 고액 요양비의 계산 대상이 되는 의료비가 자기 부담 한도액을 초과했으면 그 초과분은 고액 요양비로써 지급 됩니다.
4. 고액요양비 지급
*1 Old proviso income… Old proviso income is equal to total net income minus ¥ 330,000, the basic deduction for the residents’ tax. Households that have not filed the residents’ tax will be classified in the “Old proviso income over ¥ 9,010,000” bracket.
*2 Earners with Income Comparable to Working Persons… Households where taxable income is ¥1.45 million or more and the individual is eligible for the Elderly Members Certificate.
However, households with a total old proviso income of ¥ 2.10 million or less are classified in the “General” bracket.
*3 Low Income Level II… Head of household and all the members of National Health Insurance who belong to a household that is exempt from Residential Tax.
*4 Low Income Level I… Among Low Income Level II, those who belong to a household where the income of each member is below a certain standard.
The above table contains maximum ceilings for personally-borne expenses beginning with the billing for January 2015. For such expenses regarding periods from December 2014 and earlier, consult the National Health Insurance Benefits Subsection.
Those under 70 years of ageThose eligible for an Elderly Members Certificate
Old proviso income * 1 over ¥ 9,010,000 旧ただし書所得 ※ 1
901 万円超 70歳未満の方
高齢受給者証対象者
Old proviso income over ¥ 6,000,000～¥ 9,010,000 旧ただし書所得
600 万円超～ 901 万円以下
Old proviso income over ¥ 2,100,000～¥ 6,000,000 旧ただし書所得
210 万円超～ 600 万円以下
Old proviso income less than ¥ 2,100,000 旧ただし書所得 210 万円以下
Household Exempt from Resident’s Tax 住民税非課税世帯
Low Income Level II * 3 低所得Ⅱ※ 3
Low Income Level I * 4 低所得Ⅰ※ 4
Outpatient (per individual)
（個人単位）外来 Outpatient and Hospitalization
(per household) 外来＋入院
（世帯単位）
Category
区分 自己負担限度額 Maximum Ceiling of Personally-borne Expenses
Maximum Ceiling of Personally-borne Expenses