Adding a family member

Procedures

Family members whose lives are supported by the insured individual's income can receive health insurance benefits as "dependents." The mere fact of being a family member does not qualify someone to be a dependent for health insurance purposes. There are certain legal, etc., requirements that must be fulfilled.
Dependents for health insurance purposes are under criteria that are completely different from dependents in relation to the company's dependent allowance or under tax law.

Range of people who can become dependents

A person who may live with or separately from the insured person	Spouse (possibly close relationship) Children Grand children Siblings Direct family members of insured persons such as parents and grandparents
A person whose condition is to live with the insured person	Relatives within third degree other than above Parents and sons of the insured’s spouse(or relatives) Parents and mothers after death of their spouse

Standards for Certification of Dependents

Each of the following conditions must be met for a person to be certified as the insured individual's dependent. The Health Insurance Society reviews the following items comprehensively and carefully then decides whether the person qualifies as a dependent.

Condition of income

The person’s annual must be less than 1.3million yen(1.8million yen in the case of those aged 60 or older or a disabled person)
Less than half the income of the insured person

[ When living in a different home ]

The person’s income must be less than 1.3million yen (1.8million yen in the case of those aged 60 or older or a disabled person)and less than half the income of the insured person

・Remittances

A track record of remittance that exceeds the individual's annual salary is required. Money delivered by hand is not considered to be remittance. Remittance requires continuity (about once per month), and a remittance certificate (indicating the sender and the recipient) must be submitted.

Other

The insured individual is providing that person with support.
The insured individual must be providing most of the person's living expenses. Even if the income criteria are met, the person will not be considered to be a dependent if he or she is economically independent.
The insured individual must have the ability to support the person.
The insured individual must have the ability to provide economic support to provide continuously for the family. Even if other requirements are met, the person will not be added as a dependent if it is judged that the insured individual does not have the ability to provide support.

[ If there is another person with the obligation to support the individual ]

The people with a higher priority obligation to support the person ("parents," etc., in the case of siblings and grandparents) do not have the ability to do so.
There are unavoidable reasons that the insured individual must support the family member.

[ Dependent children when husband and wife are both employed ]

As a rule, children become dependents of the parent with the higher income.
If the incomes are at the same level, the child will become the dependent of the parent who is the main person supporting the household, as they have notified.

* If there are multiple children, the Health Insurance Act does not allow them to be divided between the parents as dependents, so all of the children will become dependents of the parent with the higher income.

[ Family members age 16 or over, under age 60 (excluding students) ]

Individuals who are age 16 or older and under age 60 are at an age that allows them to work, and in many cases they can live independently without the economic support of the insured individual. Accordingly, to become a dependent, documents must be submitted certifying that the person is unable to work, and notification must be submitted indicating that the insured individual must provide most of the person's living expenses.

[ If unemployment, etc., benefits are received ]

As a rule, while the person is receiving unemployment benefits, it is unlikely that he or she "is living mainly on the income of the insured individual," so he or she will not be recognized as a dependent.

Procedures

If you want to add a family member as a dependent, enter the required information in the following documents, attach the required documents, and submit the application to the Health Insurance Society within five days, via the human resources department of your company.

Required documents

Health Insurance Dependent Notice(Change)
EXCEL
Required documents listed in "List of attachment documents necessary for making an application for dependents"
PDF
Current Circumstances of Dependent to Be Covered
EXCEL

* Please submit it within five days after the change.

The day of dependent certification

Even after the Dependent Change Notification has been submitted, the person does not qualify as a dependent until the Health Insurance Society certifies him or her as a dependent. Once the person has been certified as a dependent, he or she can receive the same insurance benefits as the insured individual for treatment of injuries and illness, beginning on the day of certification.

The day of dependent certification

If a child has been born	Birthdate
If the individual has dependents at the time of hiring	The day on which the insured individual acquired eligibility
When there is a new dependent	The day on which the reason arose

Confirmation of dependent qualifications (verification)

Confirmation of dependent qualifications is conducted with a set deadline, and recertification will be conducted. If you are unable to submit the required documents at the time of the investigation, the eligibility may be revoked, so it is necessary to prepare proof of remittances and other documents so that they can be submitted at any time.

Punitive Measures for Fraudulent Applications

If it is discovered that the insured individual has obtained certification under false pretenses of a family member who is not actually being supported, the dependent's eligibility will be retroactively revoked and all medical expenses and other payments made during the relevant period must be returned.

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