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- About application documents of medical system for elder senior citizens
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About application documents of medical system for elder senior citizens
For more information, please visit the link below. Please note that not all applications are posted.
Last Updated December 5, 2024
<If you are coming to the agency, please come to Insurance and Pension Division (5th window on the first floor).＞
１．Documents related to re-issuance
Issuance of Qualification Confirmation, etc.
※If you would like to add an application category such as the copayment limit to the qualification confirmation, please submit this application form.
２．Documents related to the certificate of specific illness
①Specific Disease Certification Application Form (PDF: 99KB)
②Certificate pertaining to the application for certification of specific diseases (PDF: 108KB)
About specific disease (outside site)
３．Application for medical expenses payment
４．Dietary and living expenses at the time of hospitalization
About meal medical expenses, living medical expenses at the time of hospitalization (outside site)
５．Funeral expenses
６．Common
①Petition for application and receipt of benefit expenses (PDF: 82KB)
②Transfer account change application form (PDF: 75KB)
※"1 Petition for application and receipt of benefit expenses" is a form required when the insured person dies.
If another household becomes the heir, certificate of family register etc. is required.
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
Inquiries to this page
Asahi Ward Insurance and Pension Division National Health Insurance Section Benefits
Telephone: 045-954-6138
Telephone: 045-954-6138
Fax: 045-954-5784
Page ID: 843-592-644
