Documents related to medical expenses Grant Application (for 5th window in charge of National Health Insurance Section Benefit)

This is an application document for grants to children, single-parents, and severely disabled medical expenses. For details on the application, please see the link below. Please note that not all applications are posted.

Last Updated October 10, 2023

<If you wish to apply by mail, please contact the Asahi Ward Office Insurance and Pension Section Payment Section in advance>

1.Application Form for Subsidies for Medical Expenses for Pediatric Treatment

①Medical Certificate for infant Grant Application Form (and Consent Form) Transfer of Child Medical Subjects registration form (PDF: 179KB)

①Medical Certificate for infant Grant Application Form (and Consent Form) Transfer of Child Medical Subjects registration form (Excel: 26KB)

<Example> Medical Certificate for infant Grant Application Form (and Consent Form) Transfer of Child Medical Subjects registration form (PDF: 315KB)

②Child medical expenses supply application (PDF: 1,464KB)

②Child medical expenses Application Form (Excel: 372KB)

<Example> Child medical expenses supply application (PDF: 1,666KB)

Note) The child medical expenses application form and input form are set of two sheets. Please do not print on both sides.

Subsidies for Medical Expenses for Pediatric Treatment

２．medical expenses subsidy for severely disabled people, single-parent homes, etc. medical expenses subsidy application

①medical expenses supply application (severe disability, single-parent home, etc.) (PDF: 84KB)

<Example> medical expenses Payment Application Form (PDF: 870KB)

Grants for severely disabled people medical expenses

medical expenses subsidies for single-parent families

You may need a separate PDF reader to open a PDF file.
If you do not have it, you can download it free of charge from Adobe.
To download Adobe Acrobat Reader DC