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- Documents related to the National Health Insurance application (for 5th window in charge of National Health Insurance Section benefits)
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Documents related to the National Health Insurance application (for 5th window in charge of National Health Insurance Section benefits)
This is an application document for National Health Insurance. For details on the application, please see the link below. Please note that not all applications are posted.
Last Updated October 17, 2024
<If you wish to apply by mail, please contact the Asahi Ward Office Insurance and Pension Division Payment Section in advance.>
1.Application for Limit Application / Standard Burden Reduction Certification
[Note] For those 70 years or older, only those with the same level of active income (taxable income of less than 6.9 million yen) and households exempt from residence tax are required to apply the limit application certificate. For those 70 years or older, presenting your insurance card to a medical institution will result in a window burden up to the copayment limit according to the burden ratio, so you do not need a limit application certificate.
About application of limit application certificate
Please check here for details such as the burden category. Please note that only the person or the family of the same household can answer the burden category by telephone.
2.Application for medical expenses payment
①Medical expenses payment application form (PDF: 143KB)
Other forms such as statements that show the details of medical treatment are available at the link.
3.Documents related to high medical costs
This is a document related to the application of high medical costs. The application form for high medical costs is mailed to the relevant person.
①high medical costs Transfer Account Change Application Form (PDF: 53KB)
②high medical costs Application Method Change Application Form (PDF: 49KB)
③high medical costs Automatic Transfer Return Application Form (PDF: 50KB)
High medical expenses payment system
4.Large sum of nursing care expenses
5. Application for payment of standard burden difference
①Standard burden difference payment application (PDF: 126KB)
6. Funeral expenses payment application
①Funeral expenses payment application (PDF: 116KB)
②Application Form for Funeral Expenses Payment Application (PDF: 108KB)
7. Application for lump-sum payment for childbirth and childcare
①Application for lump-sum payment for childbirth and childcare (PDF: 114KB)
Payment of lump-sum payment for childbirth and childcare
8.Application for Certification of Specific Diseases
①Specific Disease Certification Application Form (PDF: 48KB)
9.Petition for Heir (common to benefit expenses)
①Petition for application and receipt of benefit expenses (PDF: 80KB)
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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: 551-033-542