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Elderly aged 75 or over medical care application dossier (for Insurance and Pension Division National Health Insurance Section fifth window)

It is application documents about medical system for elder senior citizens. For more information about application, please see linked page. In addition, we do not publish all applications.

Last update date June 26, 2020

<when you want mail application, please contact Asahi Ward government office Insurance and Pension Division payment responsible beforehand>

1.Re-grant dossier

2.Limit application, standard burden reduction authorization application

※Application varies according to division.
[note 1] Limit application certificate becomes necessary only for income earner (less than taxable income 6.9 million yen) at the same level as active play and residence tax tax exemption household. As by showing health insurance card to medical institution, it is window burden to self-pay limit depending on burden ratio about other person, limit application certificate is unnecessary.
[note 2] Please confirm link about the details such as burden division. In addition, please note that it limits to the person or family of the household to be able to answer on the telephone about burden division.

3.Specific illness certificate dossier

4.Medical expenses supply application

5.Standard burden balance supply application

6.Funeral costs

7.Premium dossier


Adobe Acrobat Reader DC (old Adobe Reader) is necessary to open file of Portable Document Format.
Person who does not have can download free of charge from Adobe company.
Get Adobe Acrobat Reader DCTo downloading of Adobe Acrobat Reader DC

Inquiry to this page

Asahi Ward Insurance and Pension Division National Health Insurance Section payment responsible

Telephone: 045-954-6138

Telephone: 045-954-6138

Fax: 045-954-5784

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Page ID: 843-592-644

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