Specified medical expenses (designated incurable disease) subsidy program (request for refund)

After applying for a specific medical expenses (designated incurable disease) subsidy program and until the recipient's identification card arrives, such as after applying for the specified incurable disease subsidy program and until the recipient ID is delivered.
You can refund a part of your co-payment when you visit a designated medical institution (including pharmacies and home-visit nursing stations) based on the incurable disease Law.
Please read this page carefully and apply for it.
　

Specific medical expenses Invoice (Excel: 31KB)
Specific medical expenses Invoice (PDF: 282KB)
Please use the above form when requesting a refund if you are using [Medical Insurance].
　
Specific medical expenses (care benefits, etc.) Invoice (Excel: 27KB)
Specific medical expenses (care benefits, etc.) Invoice (PDF: 270KB)
Please use the above form when requesting a refund if you are using [The Long-term Care Insurance].
　

①In the [Patient] column on the front, please enter [Name, recipient number, date of birth, maximum monthly co-payment, validity period of recipient ID] in advance.
(At this stage, it is not necessary to fill in the [claimer] column and [Transfer destination] fields. Also, please fill in the back side by the medical institution.)
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②Submit one copy for each designated medical institution from the start date of the "valid period" and the "date on which the recipient ID arrived" and request the creation.
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③When you receive a specific medical expenses invoice from the designated medical institution, fill in the [claimer] and [transfer destination] fields on the front.
If a person other than the patient is listed in the [Request] or [Transferee] columns, the [Delegation column] at the bottom of the surface and seal in private seal using vermilion are required.
(If the patient and the claimant / transfer destination are all of the same name, it is not necessary to fill in the delegation column.)
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④[Claimer] Seal the mark in the column. In addition, seal in private seal, which uses vermilion is required.
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⑤If you have all the invoices requested to multiple medical institutions, please fill in the date at the top right of the front and post it in one envelope.
(You can also submit it to the ward office Elderly and Disabled Support Division window in your ward. In addition, please be aware that the submitted documents are missing or incomplete, as the City Hall Health and Social Welfare Bureau Medical Aid Division incurable disease Countermeasures Section will contact you. )
Also, if another designated medical institution has already used the self-pay upper limit management slip within the medical treatment date of the specific medical expenses invoice.
Please also attach a copy of the self-pay upper limit management slip.
　

[If you cannot accept a specific medical expenses invoice]
●[Claimer] "Stamps and thumbprints are stamped", "signs are signed instead of seal" or "No seal".
●It is modified using a correction fluid or a correction tape. (If there is a correction, fill in the two lines and seal the correction mark.)
　
[In this case, there is no refund for specific medical expenses]
●The out-of-pocket ratio of public medical insurance is 10% or 20%, and the total amount of self-pay per month does not exceed the maximum monthly co-payment listed on the beneficiary certificate.
●Certificate issuance fee without medical expenses refund and certificate issuance fee exceeding 1,140 yen.
●(of incurable disease) Specific medical expenses invoice prepared by an unspecified medical institution.
●medical expenses is prior to the start date indicated on the recipient's card.
●medical expenses receiving treatment other than the designated incurable disease listed on the recipient's ID.
●If you can get a refund at the designated medical institution window within this month.
(Please contact the medical institution to see if you can refund the current month at the window of the medical institution.)
　
[About the amount transferred to your account and the specific medical expenses payment decision letter received after the transfer]
●[Specific medical expenses Payment Decision Notice] It is not a notice that charges the patient to pay.
It will be a notice of the payment amount, financial institution name, branch name, etc.
●The amount paid is calculated based on the specific medical expenses bill and high medical costs and paid by public health insurance.
Payment will be made after deducting the maximum monthly co-payment.

In the case of requesting a refund for a specific medical expenses after the death of a recipient of a specified medical expenses
The following petition and documents confirming the identity of the legal heir (certificate of family register, resident certificate, etc.) must be attached to the Specified medical expenses Invoice.
Request for Application and Receipt of Yokohama City Specific medical expenses (Excel: 19KB)
Petition for Application and Receipt of Yokohama City Specific medical expenses (PDF: 72KB)
　

〒231-0062
56 Minatomirai 21 Clean Center, 1-1, Sakuragicho, Naka-ku, Yokohama
City of Yokohama, Health and Social Welfare Bureau Medical Aid Division, incurable disease
　

Health and Welfare Center Elderly and Disabled Support Division
(The ward office can also accept the specific medical expenses invoice, but the refund will be reviewed by the incurable disease Countermeasure Section, Health and Social Welfare Bureau Medical Aid Division. Please note that the City Hall Health and Social Welfare Bureau Medical Aid Division incurable disease Countermeasures Section will contact you regarding the specific medical expenses bill submitted. )