Specific medical expenses (designated incurable disease) Subsidy Program (request for refund)

After applying for a specific medical expenses (designated incurable disease) grant program, until the recipient ID is received, treatment of the designated incurable disease indicated on the recipient ID.
You can refund a portion of your out-of-pocket expenses when you visit a designated medical institution under the incurable disease Act (including pharmacies and visiting nursing stations).
Please read this page carefully before applying.
　

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

①Please enter [Name, recipient number, date of birth, maximum monthly copayment, validity period of recipient ID] in the [Patient] column on the front in advance.
(At this stage, it is not necessary to fill in the [Requester] column and [Transfer destination] column. In addition, the back side is filled out by the medical institution. )
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②Submit one copy for each designated medical institution that took between the start date of the "valid period" and the "date on which the recipient ID arrived" and request creation.
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③When a specific medical expenses invoice is returned from the designated medical institution, fill in the [claimer] and [transfer destination] fields on the front.
If someone other than the patient is listed in the [claimer] column or [transfer destination] column, it is necessary to enter [Delegation column] at the bottom of the surface and seal in private seal that uses vermilion.
(If the patient, the claimant / transfer destination are all in the same name, it is not necessary to fill in the delegation column.)
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④[Requester] I'll stamp the seal in the column. You need seal in private seal, which uses vermilion.
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⑤If you have all the invoices you have requested from multiple medical institutions, fill in the date on the upper right of the surface with the date to be sent to the city hall, and mail them together in one envelope.
(You can also submit it to the ward office Elderly and Disabled Support Division window of your ward office. If there are any omissions or deficiencies in the submitted documents, please be aware that the incurable disease Countermeasure Section of the City Hall Health and Social Welfare Bureau Medical Aid Division will contact you. )
In addition, if another designated medical institution has already used the co-payment upper limit management slip within the medical treatment date of the specified medical expenses invoice, the Company will use the co-payment limit management slip.
Please also attach a copy of the co-payment limit management slip.
　

[If the specified medical expenses invoice cannot be accepted]
●[Requester] In the case of delegation, [Delegation column]) is marked with a stamp or thumbprint, signed instead of seal, or no seal.
●It is modified using correction fluid or correction tape. (If there is any correction, fill in the two lines and seal the correction mark.)
　
[In such a case, there is no refund for certain medical expenses]
●The out-of-pocket ratio of public medical insurance is 10% or 20%, and the total amount of out-of-pocket monthly out-of-pocket expenses does not exceed the monthly out-of-pocket limit on the recipient ID.
●Certificate issuance fee if there is no refund of medical expenses and certificate issuance fee exceeding 1,140 yen.
●(incurable disease) Specific medical expenses invoices created by non-designated medical institutions.
●medical expenses is before the validity period start date indicated on the recipient ID.
●medical expenses is suffering from treatment other than the designated incurable disease listed on the recipient ID.
●If you can 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 notice received after the transfer]
●[Specific medical expenses Payment Decision Notice] It is not a notification that claims the patient to pay.
It will be a notice of the amount paid, the name of the financial institution, the name of the branch, etc.
●The amount paid is calculated based on a specific medical expenses invoice and is paid from public health insurance and is paid by high medical costs.
Payment will be made after deducting the maximum monthly co-payment limit.

When requesting a refund of a specific medical expenses after the recipient of a specific medical expenses died;
It is necessary to attach the following petition and documents confirming that you are a legal heir (certificate of family register, resident certificate, etc.) to the specified medical expenses invoice:
Petition for application and receipt of specific medical expenses in Yokohama City (Excel: 19KB)
Petition about application and receipt of specific medical expenses of Yokohama-shi (PDF: 72KB)
　

〒231-0062
56 Minato Mirai 21 Clean Center at 1-1 Sakuragicho, Naka-ku, Yokohama City
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 specified medical expenses invoice, but the refund will be reviewed by the Health and Social Welfare Bureau Medical Aid Division incurable disease. Please note that the City Hall Health and Social Welfare Bureau Medical Aid Division, incurable disease Countermeasure Section will contact you regarding the specific medical expenses invoice you submitted. )