About application by mail (subsidized by medical expenses such as children, severely disabled people, single-parent homes)

Please send the following to Totsuka Ward Office Insurance and Pension Division. Medical Certificate will be delivered by mail.

• Medical Certificate for infant grant application form (PDF: 378KB) <Entry example (PDF: 438KB)>
• A copy of your child's health insurance card
• A copy of your parent's 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 to Totsuka Ward Office Insurance and Pension Division.

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

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

• Child medical expenses supply application, supply application input vote (PDF: 308KB) <Entry example (PDF: 435KB)>
• Receipt of medical institutions, etc. (original)
• Notice of payment decision of employee health insurance (copiable) ※This is necessary when employee health insurance provides insurance benefits such as high medical costs and additional benefits.

• Payment application form and input form are 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. First, fill out one sheet and copy the necessary number of sheets by referring to the “Approach to Number of Application Forms” below. If you wish to transfer money to an account other than the applicant, fill out and seal all applications in the power of attorney column (using vermilion). No stamp is required.

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

• A: 3 copies of the application form necessary number of sheets
  • ○○Clinic (for medical treatment in January 2019: 2 receipts)
  • ○○Clinic (for medical treatment in February 2019: 1 receipt)
  • △△Pharmacy (for dispensing in January 2019: 2 receipts)
• B-chan (hospitalized from January to February 2019, outpatient consultation after discharge): Four copies of the application form necessary number of sheets
  • ○× University Hospital Pediatrics (for hospitalization in January 2019: 2 receipts)
  • ○× University Hospital Pediatrics (for hospitalization in February 2019: 1 receipt)
  • ○× University Hospital Pediatrics (for outpatients in February 2019: 1 receipt)
  • ○× University Hospital Ophthalmology (for outpatients in February 2019: 2 receipts)

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

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

• medical expenses supply application form (PDF: 91KB) <Entry example (PDF: 138KB)>
• Receipt of medical institutions, etc. (original)
• Notice of payment decision of employee health insurance (copiable) ※This is necessary when employee health insurance provides 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 first and copy necessary number of sheets by referring to the “Approach to Number of Application Forms” below. If you wish to transfer money to an account other than the applicant, fill out and seal all applications in the power of attorney column (using vermilion). No stamp is required.

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

[Example of necessary number of sheets]

• If there is a receipt from an outpatient and dispensing pharmacy for two months
  • ○○Clinic (for medical treatment in January 2019: 2 receipts)
  • ○○Clinic (for medical treatment in February 2019: 1 receipt)
  • △△Pharmacy (for dispensing in January 2019: 2 receipts)
  • In this case, there are three necessary number of sheets copies of the application form.
• When hospitalized and consulted an outpatient after discharge
  • ○× University Hospital Pediatrics (for hospitalization in January 2019: 2 receipts)
  • ○× University Hospital Pediatrics (for hospitalization in February 2019: 1 receipt)
  • ○× University Hospital Pediatrics (for outpatients in February 2019: 1 receipt)
  • ○× University Hospital Ophthalmology (for outpatients in February 2019: 2 receipts)
  • In this case, there are four necessary number of sheets copies of the application form.

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