About application by mail (subsidized by medical expenses such as children, severely disabled people, single-parent homes)

〒230-0051
3-20-1, Tsurumichuo, Tsurumi-ku, Yokohama-shi
Tsurumi Ward Office, Insurance and Pension Division Pediatric Medicine

Please send the following to Tsurumi Ward Office Insurance and Pension Division.

• medical expenses Payment Application Form (PDF: 53KB)＜Example of entry (PDF: 211KB)＞
• Receipt of medical institutions, etc. (original)
• Notice of payment decision of employee health insurance (copiable) ※This is necessary when employee health insurance provides insurance benefits such as high medical costs and additional benefits.

• If you have more than one receipt, you will need more than one application form. First, fill in one sheet, refer to the following “Approach to Number of Application Forms”, copy necessary number of sheets, and seal all applications (private seal, which uses vermilion). No stamp is allowed.
• Since the received receipt cannot be returned, please make a copy if necessary.
• Compensation cannot be provided if the mail does not reach the ward office due to a postal accident. When applying, please make a copy of the documents to be mailed at your own risk, and use postal tracking services such as specified record mail or registered mail.

One application form is required for each patient, for each medical institution (Medical consultation fee), for each medical treatment (dispensing) month, and for each hospitalization and outpatient department.

[Example of necessary number of sheets]

• If there is a receipt from an outpatient and dispensing pharmacy for two months
  • ○○Clinic (for outpatients in January 2019: 2 receipts)
  • ○○Clinic (February 2019 Outpatient: 1 receipt)
  • △△Pharmacy (for dispensing in January 2019: 2 receipts)
  • In this case, there are three necessary number of sheets copies of the application form.
• When hospitalized and consulted an outpatient after discharge
  • ○× University Hospital Pediatrics (for hospitalization in January 2019: 2 receipts)
  • ○× University Hospital Pediatrics (for hospitalization in February 2019: 1 receipt)
  • ○× University Hospital Pediatrics (for outpatients in February 2019: 1 receipt)
  • ○× University Hospital Ophthalmology (for outpatients in February 2019: 2 receipts)
  • In this case, there are four necessary number of sheets copies of the application form.

〒230-0051
3-20-1, Tsurumichuo, Tsurumi-ku, Yokohama-shi
Tsurumi Ward Office Insurance and Pension Division, medical expenses, Severely Disabled Persons / Single-parent Homes, etc. medical expenses