* Only Japanese version available
- Insurance card and application-related forms
- Benefit and claims-related forms
- Health activities-related forms
Insurance card and application-related forms
Adding a family member, or removing a family member
| form | example |
|---|---|
| Notification of Health Insurance Dependent Change | Example |
| Dependent Report | Example |
| List of Documents to Submit for Dependent Certification |
If you lose or damage your health insurance card
If the name has changed
If you wish to remain a member of the Health Insurance Society after you leave your employer
| form | example |
|---|---|
| Application Form for Certification as Voluntarily and Continuously Insured Person | Example |
If you lose eligibility as a Voluntarily and Continuously Insured Person
| form | example |
|---|---|
| Notification of Loss of Eligibility as Voluntarily and Continuously Insured Person | Example |
When you are exempt from the long-term care insurance program
Benefit and claims-related forms
If you take time off from work due to sickness or injury
If you paid the entire medical care cost up front
| form | example |
|---|---|
| Application Form for Medical Care Expenses | Example |
| Application Form for Medical Care Expenses (Acupuncture, Moxibustion) | |
| Application Form for Medical Care Expenses (Massage, Shiatsu) | |
Attending physician's statement (Overseas)
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|
| Attending physician's statement (Dental) |
If there is an unavoidable emergency transfer due to difficulty moving as a result of an sickness or injury
| form | example |
|---|---|
| Application Form for Transportation Expenses | Example |
Childbirth
| form | example |
|---|---|
| Application for Payment of Childbirth and Childcare Lump-sum Grant | Example |
| Application for Payment of Childbirth and Childcare Lump-sum Grant (for Receipt on Your Behalf) | Example |
If you take time off from work for childbirth
| form | example |
|---|---|
| Application for Payment of Maternity Allowance | Example |
Death
| form | example |
|---|---|
| Application for Payment of Funeral Expenses | Example |
When you incur high medical care costs
| form | example |
|---|---|
| Request for issuance of Maximum Co-payment Certificate for Health Insurance | Example |
| Application for Payment of In-home Care Support | Example |
If you receive treatment for chronic nephritis that require artificial dialysis or haemophilia
Health activities-related forms
If the full amount of the health examination costs was paid upfront
| form | example |
|---|---|
| Application Form for a Health Examination (Enrollee/Family Member) Subsidy | Example |
| Application Form for a Re-Examination Advance Payment Amount | Example |
When receiving flu vaccination cost subsidy
| form | example |
|---|---|
| Claim for a Flu Vaccination Cost Subsidy | Example |