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[patient, product for designated medical institutions] The amount of specific medical expenses (designated incurable disease ) self-pay upper limit management vote

Last update date July 30, 2020

[product for people who already have identification of recipient] When mention column of the amount of self-pay upper limit management vote is not enough

Please stick the following PDF files on the amount of self-pay upper limit management vote of identification of recipient after print.
After having stuck, have border which we stuck on medical institution having you list first push tally seal of medical institution.

[we ask patient]
・Medical institution lists the amount of self-pay upper limit management vote. (patient, please do not list.)
・You see the amount of self-pay upper limit management vote each check at window,
Please confirm whether "(including amount of accumulation] of [monthly basis) which hospital lists" [self-burden] accords with "amount of money to pay at window" ※.
※There may not be self-pay, but has you list in the amount of self-pay upper limit management vote as usual when we use other Medical Certificate together.
In addition, have me list about column even if it is social security [for date, designated medical institution name, medical expenses total sum (100%)].
When identification of recipient is used with medical institution mistaking mention (e.g., omission of mention or calculation error),
Calculation error may occur with medical institution and self-burdens increase or to list in the lower step.
 

[product for medical institutions] About mention of the amount of self-pay upper limit management vote

About all designated medical institutions common attention

[Ministry of Health, Labour and Welfare material] About mention method of the amount of self-pay upper limit management vote (for designated medical institution)

About mention methods such as the amount of self-pay upper limit management votes to affect specific medical expenses (for designated medical institution) (PDF: 1,173KB) (June, 2019 version)
[we ask medical institution]
Because, in the case of request for specific medical expenses refund, is necessary, in Yokohama-shi of month follow after column was beyond 50,000 yen [for medical expenses total sum (100%)], and ask for mention.

About way of thinking of mention of the amount of, self-pay upper limit management vote of that there is not self-pay such as, social security which used other Medical Certificate together that reached self-pay upper limit monthly basis

・Please list medical expenses (including The Long-term Care Insurance) about designated incurable disease which you suffered from the during the month concerned in column [for date, designated medical institution name, medical expenses total sum (100%)] after it reached ... self-pay upper limit monthly basis that reached self-pay upper limit monthly basis. [the amount of accumulation of self-burden, monthly basis] Please draw slanted line about column.
・Please list even patient without ... copayment which used other Medical Certificate together in the same way as patient with self-pay as usual. If it reaches self-pay upper limit monthly basis, please draw slanted line about [the amount of accumulation of self-burden, monthly basis] column of afterward.
・Please list about social security ... [for date, designated medical institution name, medical expenses total sum (100%)] column. [the amount of accumulation of self-burden, monthly basis] Please draw slanted line about column.
 

[product for hospital, clinics , drugstores] About mention method of the amount of self-pay upper limit management vote

Each consultation, please list the amount of self-pay upper limit management vote. (but you may list in 1 step in the each month concerned in a mass when you collect the use of plural days in hospitalization in a mass.)
In addition, please list while being careful to write parenthesis.
[date] ・・ ・ patient lists day using medical institution. (not day when we collected copayment. In addition, in the case of hospitalization, please list monthly.)
[designated medical institution name] ・We seal or list ・ ・ medical institution name. (please list not to be applied to amount of money of)] column for [medical expenses total sum (100%.)
[for medical expenses total sum (100%)] ・* * List the total sum of day that took advantage of. (not score. In addition, in the case of specific medical expenses refund, it may be necessary. After having exceeded 50,000 yen, please continue listing.)
[self-burden] ・We list to the sum if we reach sum that patient bore at ・ ・ window or self-pay upper limit monthly basis. (the bill of patient of 30% burden becomes 20%. In addition, please draw slanted line like entry example of identification of recipient after it reached self-pay upper limit monthly basis.)
Particularly, [self-burden] please confirm that there are not medical expenses of designated incurable disease to request on column and the day being the same amount, mention leak. (when omission of mention and mention error occur at the upper section, error occurs when it reached self-pay upper limit monthly basis in the lower berth.)
[the amount of accumulation of monthly basis] ・We list amount of money that ・ ・ patient bore at window of each designated medical institution until we reach self-pay upper limit monthly basis for total. (please draw slanted line after it reached self-pay upper limit monthly basis.)
 

[be suitable for office (at-home medical treatment, temporary nursing at home station visiting patient's house)] About mention method of the amount of self-pay upper limit management vote

Each visit, please list the amount of self-pay upper limit management vote. (but you may list in a mass on the last day of the month concerned when you will collect multiple visit in a mass later.)
In addition, please list while being careful to write parenthesis when we list.
[date] ・・ ・ patient lists day using medical institution. (not day when we collected copayment. In addition, multiple house call when we visit concerned please list monthly on the last day of the end of the month.)
[designated medical institution name] ・We seal or list ・ ・ medical institution name. (please list not to be applied to amount of money of)] column for [medical expenses total sum (100%.)
[for medical expenses total sum (100%)] ・* * List the total sum of day that took advantage of. (not score. In addition, it may be necessary to confirm specific medical expenses . After having exceeded 50,000 yen, please continue listing.)
[self-burden] ・If it reaches sum that ・ ・ patient bore or self-pay upper limit monthly basis, we list to the sum. (the bill of patient of 30% burden becomes 20%. In addition, please draw slanted line like entry example of identification of recipient after it reached self-pay upper limit monthly basis.)
Particularly, [self-burden] please confirm that there are not medical expenses of designated incurable disease which is about to resemble column on that day being the same amount and mention leak. (when omission of mention and mention error occur at the upper section, error occurs when it reached self-pay upper limit monthly basis in the lower berth.)
[the amount of accumulation of monthly basis] ・We list amount of money that ・ ・ patient bore at window of each designated medical institution until we reach self-pay upper limit monthly basis for total. (please draw slanted line after it reached self-pay upper limit monthly basis.)
 

FAQs

As you publish inquiry to receive a lot from all of the medical institutions in Yokohama-shi, please read in total.
For more information, look here. ➡ FAQs
 

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Inquiry to this page

Health and Social Welfare Bureau health business section incurable disease measures charge

Telephone: 045-671-4040 (weekdays 8:45-17:00)

Telephone: 045-671-4040 (weekdays 8:45-17:00)

Fax: 045-664-5788

E-Mail address [email protected]

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