{
  "verdict": "cap_applies",
  "summary": "You pay at most ¥92,940 for 2026-11; about ¥207,060 of your ¥300,000 copay comes back.",
  "ageGroup": "under70",
  "band": {
    "id": "y370",
    "label": "Income about ¥3.7M–5.1M",
    "labelJa": "年収約370〜510万円",
    "annualIncome": "about ¥3.7M–5.1M",
    "smr": "¥280k–340k",
    "nhiIncome": "¥2.1M–3.13M",
    "taxable70": "¥1.45M–2.03M",
    "legacy": "ウ",
    "source": "standardMonthlyRemuneration"
  },
  "burdenRate": 0.3,
  "schedule": {
    "id": "r8",
    "label": "Stage 1 (treatment Aug 2026 – Jul 2027): higher caps, new annual cap",
    "from": "2026-08",
    "to": "2027-07"
  },
  "month": {
    "month": "2026-11",
    "schedule": "r8",
    "setting": "inpatient",
    "totalCost": 1000000,
    "copay": 300000,
    "manyTimes": false,
    "monthlyCap": 92940,
    "formula": "¥85,800 + (¥1,000,000 − ¥286,000) × 1%",
    "outpatientCap": null,
    "outpatientOnlyCap": false,
    "youPay": 92940,
    "monthlyRefund": 207060
  },
  "caps": {
    "monthlyBase": 85800,
    "threshold": 286000,
    "manyTimes": 44400,
    "annual": 530000,
    "outpatient70": null,
    "outpatientAnnual70": null
  },
  "annualCap": {
    "period": {
      "from": "2026-08",
      "to": "2027-07"
    },
    "amount": 530000,
    "note": "Counts what you paid after monthly refunds, for the Aug–Jul year. It started for treatment from Aug 2026."
  },
  "from2027": {
    "schedule": "r9",
    "monthlyCap": 92940,
    "youPay": 92940,
    "formula": "¥85,800 + (¥1,000,000 − ¥286,000) × 1%",
    "annualCap": 530000,
    "changeJPY": 0
  },
  "beforeAug2026": {
    "schedule": "pre",
    "monthlyCap": 87430,
    "youPay": 87430,
    "formula": "¥80,100 + (¥1,000,000 − ¥267,000) × 1%",
    "annualCap": null,
    "changeJPY": 5510
  },
  "claim": {
    "deadline": "2028-11-30",
    "rule": "2 years from the 1st of the month after treatment (消滅時効 2年)"
  },
  "tracker": null,
  "steps": [
    "Show your My Number insurance card (マイナ保険証) or a 限度額適用認定証 at the hospital, and the counter charges only up to the cap, so you don't have to pay first and wait.",
    "If you already paid more, claim the refund from your insurer: 協会けんぽ or your company's health insurance society (健康保険組合), or the city office for National Health Insurance (国民健康保険) or late-stage elderly insurance (後期高齢者医療). Many send you the form automatically about 3–4 months later.",
    "Claim deadline for 2026-11: 2028-11-30 (2 years from the 1st of the following month).",
    "Under 70: add bills of ¥21,000 or more per hospital per month (inpatient, outpatient and dental counted separately; pharmacy bills join the prescribing clinic) for you and family on the same insurance, then the cap applies to the total.",
    "Hospital meals, private-room fees (差額ベッド), advanced medical care (先進医療) and uninsured treatment don't count.",
    "Ask your insurer about extra benefits (付加給付): many company health insurance societies cap costs lower, often around ¥20,000–25,000 a month.",
    "From Aug 2026 there is also a yearly cap (Aug–Jul): ¥530,000 for your band. Keep your receipts."
  ],
  "notCounted": [
    "Hospital meal charges (入院時食事療養費)",
    "Private / semi-private room fees (差額ベッド代)",
    "Advanced medical care (先進医療) technical fees",
    "Uninsured treatment, cosmetics, certificates"
  ],
  "callCenter": "MHLW high-cost medical expense call center 0120-617-111 (Japanese)",
  "rulesAsOf": "2026-11-04",
  "sources": [
    "https://www.mhlw.go.jp/stf/seisakunitsuite/bunya/kenkou_iryou/iryouhoken/juuyou/kougakuiryou/index.html",
    "https://www.mhlw.go.jp/content/001726232.pdf",
    "https://www.mhlw.go.jp/content/001729632.pdf",
    "https://www.kyoukaikenpo.or.jp/g3/sb3030/r150/",
    "https://www.city.setagaya.lg.jp/02060/33049.html",
    "https://www.city.machida.tokyo.jp/kurashi/hoken/kokuho/ironnakyuufu/kougaku.html",
    "https://www.city.fukuoka.lg.jp/hofuku/hokennenkin/hp/kokuminkenkouhoken/09-00.html",
    "https://laws.e-gov.go.jp/law/215IO0000000243"
  ],
  "disclaimer": "Educational estimate, not medical, financial or legal advice. Not affiliated with the Ministry of Health, Labour and Welfare (MHLW), Japan Health Insurance Association (協会けんぽ), any health insurance society, city NHI office or hospital. Your insurer decides the actual benefit; extra benefits (付加給付) and local subsidies can lower your cost further. Rules as of 2026-11-04.",
  "docs": "https://japan-medical-cost-cap.vercel.app/openapi.json"
}