About application by mail (medical expenses subsidy such as child, severely disabled, single-parent home)

Please send the following items to Insurance and Pension Division, Totsuka Ward Office. We will deliver the Medical Certificate by mail.

• Medical Certificate for infant Grant Application Form (PDF: 378KB)＜Example of entry (PDF: 438KB)＞
• A copy of your child's health insurance card
• A copy of your parents' income certificate (only for children moving in from outside the city. The required year varies depending on the age and transfer time. )

Please send the following items to Insurance and Pension Division, Totsuka Ward Office.

• registration form (PDF: 378KB)＜Example of entry (PDF: 507KB)＞
• A copy of your child's health insurance card

Please send the following items to Insurance and Pension Division, Totsuka Ward Office.

• Child medical expenses Payment Application Form / Payment Application Input Form (PDF: 308KB)＜Example of entry (PDF: 435KB)＞
• Receipt of medical institutions (original)
• employee health insurance's payment decision letter (copy permitted) ※Required if employee health insurance receives insurance benefits such as high medical costs and additional benefits.

• The payment application form and the input form are a set of two sheets. Please do not print on both sides.
• If you have more than one receipt, you will need more than one application form. Please fill out one sheet and copy necessary number of sheets by referring to the "Thinking About Number of Application Forms" below. If you wish to transfer to an account other than the applicant, fill out and seal all the applications in the power of attorney column on all applications (using vermilion). No stamping is required) is required.

One application form is required for each patient, medical institution (Medical consultation fee), every month of medical treatment (dispensing), and for each hospitalization / outpatient.
[Example of necessary number of sheets]

• Mr. A: Three copies of the application form in necessary number of sheets
  • ○○Clinic (January 19, 2007: 2 receipts)
  • ○○Clinic (February 2007: 1 receipt)
  • △△Pharmacy (dispensed in January 2007: 2 receipts)
• B-chan (hospitalized from January to February 19, and outpatient consultation after discharge): Four necessary number of sheets forms.
  • ○× University Hospital Pediatrics (inpatient in January 2007: 2 receipts)
  • ○× University Hospital Pediatrics (inpatient in February 2007: 1 receipt)
  • ○X University Hospital Pediatrics (February 2007: 1 receipt)
  • ○× University Hospital Ophthalmology (for outpatients in February 2007: 2 receipts)

〒244-0003
16-17, Totsukacho, Totsuka-ku
Medical Certificate for infant Insurance and Pension Division, Totsuka Ward Office

Please send the following items to Insurance and Pension Division, Totsuka Ward Office.

• medical expenses Application Form (PDF: 91KB)＜Example of entry (PDF: 138KB)＞
• Receipt of medical institutions (original)
• employee health insurance's payment decision letter (copy permitted) ※Required if employee health insurance receives insurance benefits such as high medical costs and additional benefits.

• If you have more than one receipt, you will need more than one application form. Please fill in one sheet and copy necessary number of sheets by referring to "How to Applicant Number of Applications" below. If you wish to transfer to an account other than the applicant, fill out and seal all the applications in the power of attorney column on all applications (using vermilion). No stamping is required) is required.

One application form is required for each patient, medical institution (Medical consultation fee), every month of medical treatment (dispensing), and for each hospitalization / outpatient.

[Example of necessary number of sheets]

• 2 months of outpatient and dispensing pharmacy receipt
  • ○○Clinic (January 19, 2007: 2 receipts)
  • ○○Clinic (February 2007: 1 receipt)
  • △△Pharmacy (dispensed in January 2007: 2 receipts)
  • In this case, there are three necessary number of sheets applications in this case.
• If you are hospitalized and go to an outpatient clinic after discharge
  • ○× University Hospital Pediatrics (inpatient in January 2007: 2 receipts)
  • ○× University Hospital Pediatrics (inpatient in February 2007: 1 receipt)
  • ○X University Hospital Pediatrics (February 2007: 1 receipt)
  • ○× University Hospital Ophthalmology (for outpatients in February 2007: 2 receipts)
  • In this case, there are four necessary number of sheets applications.

〒244-0003
16-17, Totsukacho, Totsuka-ku
National Health Insurance Section Insurance and Pension Division, Totsuka Ward Office