Pediatric Chronic Specified Disease Medical Expense Subsidy

Pediatric Chronic Specified Disease Medical Expense Subsidy

This system subsidizes a portion of the medical expenses for children suffering from chronic illnesses specified by the Minister of Health, Labor and Welfare, using public funds, for guardians of children whose severity of illness exceeds a certain level. .

From July 1, 2020, along with the establishment of a Child Guidance Center in Itabashi Ward, Itabashi Ward will be responsible for medical expenses related to specific childhood chronic illnesses that were previously handled by the Tokyo Metropolitan Government.

To those who have a recipient certificate as of July 1, 2022

Once again, Itabashi Ward sent a new recipient certificate (asagi color) to your home. After July 1st, please use the new recipient certificate (Asagi color).

If you have applied for a change or renewal of your insurance by the end of June, and the Tokyo Metropolitan Government is still processing it, a new recipient certificate will be sent from Itabashi Ward after the procedure is completed.

Eligible people

Those who meet both the following conditions 1 and 2

  1. The applicant is a person under the age of 18 who lives in Itabashi City (has been registered as a resident or registered as an alien) (however, at the time of reaching the age of 18, the specific chronic childhood illness medical care beneficiary certificate ( (Hereinafter referred to as “recipient certificate”) and can be extended to under 20 years old only for those who have a valid medical care recipient certificate.) The applicant must be an insured person (a person supporting a patient (child) under medical insurance). Households enrolled in National Health Insurance must have a guardian who is the head of the household. If you are enrolled, you will be the patient (child) and the guardian of the same insurance).
  2. Those who have a disease covered by the specified chronic disease medical expenses subsidy system for children and who meet the certification criteria specified separately

Note 1) If the medical insurance is employee insurance and the patient (child) is an insured person (person) under the age of 18, the person who has the right of protection will be the applicant. Both parents can be applicants.

Note 2) If you are 18 years old or older and have moved from outside Itabashi City, you can apply only if you have a recipient certificate from another local government and are moving in within the valid period, so please apply promptly. In this case, the applicant must be an adult patient.

Note 3) If the insured person is away from home and does not live with the patient (child), the current guardian can apply.

Target diseases and certification criteria

The target diseases are 788 diseases (as of November 1, 2021). For a list of target diseases and their certification criteria (the degree of the disease state specified by the Ministry of Health, Labor and Welfare), please check the "Information Center for Specified Chronic Diseases in Pediatric Diseases" website.

About self-pay amount

The co-payment varies depending on the household situation and the condition of the child (if they meet the certification criteria for critically ill patients and those who wear respirators, etc.).

About critically ill patient certification

Among those who meet the certification criteria for the target disease, if it is recognized that they fall under the certification criteria for severely ill patients, the "severe" column of the "table of maximum co-payment amount" will be applied. (It is necessary to submit a declaration form for critically ill patients.)

About wearers such as respirators

Those who meet the certification criteria for the target disease and are always wearing a ventilator through a tracheostomy, a ventilator through a nasal mask or face mask, or an external or implanted artificial heart, as follows: If it is recognized that all the requirements are met, the column of "Respirator wearer" in the "Self-pay maximum amount table" will be applied (respiratory wearer's certificate must be submitted. ).

Expensive and long-term

If there are 6 or more months in which the total amount of medical expenses related to the payment authorization exceeds 50,000 yen within 12 months from the month in which the payment authorization for specified chronic disease medical expenses for children is received, the "Self-pay maximum amount table" The “Severe” column of (A copy and submission of the Severe Patient Certification Form and the Maximum Out-of-pocket Amount Control Table are required.)

However, medical expenses for the period when the medical expenses for specified chronic diseases of children are not approved, medical expenses for diseases not listed on the recipient certificate, medical institutions not listed on the recipient certificate (including pharmacies and home-visit nursing stations) ) does not include medical expenses.

Designated medical institution, designated doctor

Due to the introduction of the designated medical institution system, we have been designated in advance by the prefectural governor where the medical institution is located, the mayor of the designated city, the mayor of the core city, or the mayor of the city where the child guidance center is established (hereinafter referred to as the prefectural governor, etc.). Subsidies for medical expenses (including prescription medical expenses) are available only if you receive medical care at a medical institution (hospital, clinic, pharmacy, or home-visit nursing station).

In addition, the medical opinion (medical certificate) required for application for payment authorization for specified chronic disease medical expenses for children must be written by a doctor who has been designated as a "specified chronic disease doctor for children" by the prefectural governor.

The list of "Specified Chronic Disease Doctors for Pediatrics" and "Designated Chronic Specific Disease Medical Institutions for Pediatrics" designated by Itabashi Ward is as follows. For areas other than this ward, please check the website of each municipality.

About redemption payment

If you have paid medical care costs to a designated medical institution that exceed the maximum copayment amount shown on your beneficiary certificate, you can apply for reimbursement and have the medical care costs that exceed the maximum copayment amount refunded. increase.

About application

About new application (application documents are also available at the window)

About renewal application

If you continue to need the medical expense subsidy, you will need to apply for renewal before the expiration of the valid period described on the recipient certificate. When the renewal time approaches, we will send information on the renewal procedure to those who are eligible.

It takes 1-2 months from the time you apply until you receive your new recipient's certificate. (However, the above period may be exceeded if the documents are incomplete or if there are doubts about the content of the medical opinion.)

If the application is made after the validity period of the recipient's certificate has passed, the new validity period will start from the date of acceptance of the application. However, if you are 18 years of age or older, your application will not be accepted after the expiration date of your recipient's certificate. Please be sure to apply within the validity period of the recipient certificate.

About change application

In addition to submitting a notification of change, it is necessary to submit documents according to the details of the change. Please check the required documents before applying.

About reissuance application form

If you have lost, damaged or defaced your beneficiary card and need to reissue your beneficiary card, please submit an application for reissuance of your medical beneficiary card. If it is lost and found after being reissued, please return the old recipient certificate to Itabashi Ward.

If you move out of Itabashi Ward

If you move out of Itabashi Ward, the recipient certificate issued by Itabashi Ward will expire on the date you move out. Please return the recipient certificate issued by Itabashi Ward to Itabashi Ward after applying for the subsidy program for medical expenses for specified chronic diseases of children at the municipality where you are moving to.

Inquiries and submissions regarding applications

name telephone number Postal code address
Itabashi Health and Welfare Center 03-3579-2333 173-0014 32-15 Oyamahigashimachi, Itabashi-ku
Kamiitabashi Health and Welfare Center 03-3937-1041 174-0075 3-18-6 Sakuragawa, Itabashi-ku
Akatsuka Health and Welfare Center 03-3979-0511 175-0092 1-10-13 Akatsuka, Itabashi-ku
Shimura Health and Welfare Center 03-3969-3836 174-0046 2-5-5 Hasune, Itabashi-ku
Takashimadaira Health and Welfare Center 03-3938-8621 175-0082 3-13-28 Takashimadaira, Itabashi-ku

Inquiries about the system

Itabashi Ward Public Health Center Preventive Measures Division Management and Mental Intractable Disease Section


32-15 Oyamahigashimachi, Itabashi-ku

Telephone 03-3579-2329/Fax 03-3579-1337

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About this page inquiry

Healthy life department preventive measures section
32-15 Oyama Higashimachi, Itabashi-ku, Tokyo 173-0014
Phone: 03-3579-2329 Fax: 03-3579-1337
Please use the dedicated form for inquiries to the Preventive Measures Division, Department of Healthy Ikigai.

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