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- National Health Insurance Application Documents (for National Health Insurance Section Payment Section 5)
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National Health Insurance Application Documents (for National Health Insurance Section Payment Section 5)
This is an application document for National Health Insurance. For more information about the application, please refer to the following link. In addition, not all applications are posted.
Last Updated July 8, 2021
<If you wish to apply by mail, please contact Insurance and Pension Division Benefits Section, Asahi Ward Office in advance>
１．Application for limit application and standard burden reduction
[Note] For those 70 years or older, only those who earn the same level as active duty (taxable income of less than 6.9 million yen) and households exempt from residence tax will need a limit application certificate. For those 70 years or older, presenting your health insurance card to a medical institution, you will be charged 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 burden classification. Please note that you or your family of the same household can answer the burden category by phone.
２．Medical expenses payment application form
①Medical expenses payment application form (PDF: 143KB)
Other forms such as statements that show the contents of medical treatment are available at the link.
３．Documents related to high medical costs
Documents related to high medical costs's application. high medical costs's application form 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．High-cost nursing care combined medical expenses
5． Application form for payment of standard burden difference
①Standard Burden Difference Payment Application Form (PDF: 126KB)
6． Application form for payment of funeral expenses
①Funeral Expenses Payment Application Form (PDF: 116KB)
②Application for Payment of Funeral Expenses (PDF: 108KB)
7． Application form for lump-sum payment for childbirth
①Application form for lump-sum childcare lump sum payment (PDF: 114KB)
Payment of lump-sum payment for childbirth
８．Application for Specific Disease Certification
①Specific Disease Certification Application Form (PDF: 48KB)
９．Letter of Heir (common benefit expenses)
①Petition for Application and Receipt of Benefit Expenses (PDF: 80KB)
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For inquiries to this page
Asahi Ward, Insurance and Pension Division National Health Insurance Section
Phone: 045-954-6138
Phone: 045-954-6138
Fax: 045-954-5784
Page ID: 551-033-542
