* Only Japanese version available
- Health insurance eligibility and application-related forms
- Benefit and claims-related forms
- Health activities-related forms
Health insurance eligibility and application-related forms
Adding a family member, or removing a family member
If you lose or damage your health insurance card
| No. | form | example |
|---|---|---|
| 5 | Application Form for Reissue of Health Insurance Card (Card loss/Damage) | Example |
| 6 | Application Form for Issue/Reissue of Health Insurance Eligibility Certificate | Example |
If the name has changed
| No. | form | example |
|---|---|---|
| 7 | Notification of Name Change of Insured Person (Family) | Example |
If you wish to remain a member of the Health Insurance Society after you leave your employer
| No. | form | example |
|---|---|---|
| 8 | Application Form for Certification as Voluntarily and Continuously Insured Person | Example |
If you lose eligibility as a Voluntarily and Continuously Insured Person
| No. | form | example |
|---|---|---|
| 9 | Notification of Loss of Eligibility as Voluntarily and Continuously Insured Person | Example |
When you are exempt from the long-term care insurance program
| No. | form | example |
|---|---|---|
| 10 | Notification of Long-term Care Insurance (Qualification/ Disqualification) | Example |
Benefit and claims-related forms
If you take time off from work due to sickness or injury
| No. | form | example |
|---|---|---|
| 12 | Application for Payment of Injury and Illness Allowance | Example |
If you paid the entire medical care cost up front
If there is an unavoidable emergency transfer due to difficulty moving as a result of an sickness or injury
| No. | form | example |
|---|---|---|
| 22 | Application Form for Transportation Expenses | Example |
Childbirth
If you take time off from work for childbirth
| No. | form | example |
|---|---|---|
| 25 | Application for Payment of Maternity Allowance | Example |
Death
| No. | form | example |
|---|---|---|
| 26 | Application for Payment of Funeral Expenses | Example |
| 27 | Notification of Succession of Rights |
When you incur high medical care costs
| No. | form | example |
|---|---|---|
| 28 | Request for issuance of Maximum Co-payment Certificate for Health Insurance | Example |
If you receive treatment for chronic nephritis that require artificial dialysis or haemophilia
| No. | form | example |
|---|---|---|
| 29 | Application for Certificate of Treatment for Specified Diseases and Disorders | Example |