Dependent certification criteria and list of documents to attach
Dependent certification criteria
All conditions for certification must be met for a family member to be certified as a dependent.
The Health Insurance Society determines whether or not a family member qualifies as a dependent based on a strict and comprehensive review of application documents, grounds for certification, attached documents, and other information.
Conditions for certification
- The family member is within the scope of dependents authorized by the Health Insurance Act.
- The family member has no other priority support obligor.
(Priority support obligor refers to the family member’s spouse, the father of the insured if the family member is his or her mother, the family member’s parents if the family member is the insured’s sibling or grandparent, and so on.) - The priority support obligor is unable to provide for the family member and the insured person is obliged to provide for the family member due to an unavoidable reason.
- The insured person is actually the main economic provider for the family member. (* The insured person is the main source of income on which the family member depends for his or her living.)
(The insured person bears most of the family member’s living costs.) - The insured person has financial capabilities to provide continuously for the family member as his or her dependent.
- If the family member lives together with the insured in the same household (*1), the dependent’s annual income must be less than 1.3 million yen (*2) and less than one-half of the insured’s annual income.
- If the family member lives apart from the insured person, in addition to satisfying the conditions under 6 above, the dependent’s annual income must be less than the allowance remitted to him or her by the insured person.
(*1)
Living together does not necessarily mean the two will be considered as members of the same household. The dependent must live in the same house with and subsist on the same household budget as the insured. Even if the two live on the same household budget, they will be regarded to live in separate households if their family residential areas are clearly demarcated: for example, in the case of two-household residences.
(*2)
For those aged 60 or older and those receiving disability pension, annual income must be less than 1.8 million yen. Annual income includes income from employees’ pensions, public employees’ pensions, and similar sources.
Dependent’s income
Maximum amount of dependent’s income
Dependent’s age | Maximum income amounts |
---|---|
Under 60 | Annual income less than 1.3 million yen (less than 108,334 yen/month) |
60 or older | Annual income less than 1.8 million yen (less than 150,000 yen/month) |
Under 60 and satisfies requirements for disability pension |
Scope of income
- Salary income (including nontaxable commuting expenses and bonuses)
- Various types of pension income (Employees’ Pension, National Pension, nontaxable survivor’s pension, disability pension, mutual aid association pension for public officials, corporate pension, private pension, etc.)
- Business income (income from self-employed business in agriculture, fisheries, commerce, industry, etc.; income from insurance sales or other freelance work)
- Real estate income (rent income on land, buildings, parking lots, etc.)
- Interest income (interest on deposits, securities, etc.)
- Investment income (stock dividends, etc.)
- Miscellaneous income (manuscript fees, royalties, performance fees, etc.)
- Illness and injury allowance or maternity allowance from health insurance
- Employment insurance benefits
- Allowances from persons other than the insured person (for living expenses, child support, etc.)
- Other continuing/recurring income (transfer income, etc.)
Income calculation methods and related notes
- A dependent’s income is determined based on the amount of gross income before tax deductions (including bonuses, commuting expenses, and so forth), not the amount of net income.
- Except for the following, all earnings are defined as income:
Temporary income: for example, retirement benefits and revenues from the sale of real estate - For self-employed persons (including those self-employed in agriculture or fisheries), income is determined based on business income.
Determination of income is based on income remaining after deducting direct business expenses (see Tables 1 and 2) from gross income on the final income tax return (with “Received” Tax Office stamp and documents showing individual revenues and expenditures attached).
<Table 1: List of valid expenses for calculating business income and real estate income>
Type | Accept-able? (Y/N) | Type | Accept-able? (Y/N) | Type | Accept-able? (Y/N) | Type | Accept-able? (Y/N) |
---|---|---|---|---|---|---|---|
Cost of sales |
○ | Interest discounts | × | Travel and transportation expenses | × | Welfare expenses | × |
Salaries and wages | ○ | Taxes and other public charges | × | Telecommuni-cations expenses | × | Advertising and promotion expenses | × |
Depreciation expenses | × | Non-life insurance premiums | × | Entertainment expenses | × | Supplies costs | ○ |
Allowance for doubtful accounts | × | Utilities costs | ○ | Repair costs | ○ | Packing and shipping costs | × |
<Table 2: List of valid expenses for calculating agricultural income>
Seed and sapling costs | Repair costs | Agricultural equipment (supplies) costs | Land rent |
Stock costs | Rice center usage charges | Agricultural chemical and sanitation costs | Land improvement costs |
Fertilizer costs | Water charges | Materials costs | |
Feed costs | Tenancy costs | Utilities costs |
Concept of annual income
When working (or receiving pension payments) all year | Confirming with income from January 1 through December 31 |
---|---|
When starting a new job or changing one’s employment contract (or the pension amount is changed) during the year | Converted to projected income for one year from the date of starting a new job or changing one’s employment contract (or the date on which the pension amount is changed) |
When leaving a job during the year | Considered to be zero yen if no income is earned after leaving a job |
<< Family members aged 16 – 59 >>
Those typically eligible to be dependents under health insurance are (1) your spouse; (2) children under 16 years of age; and (3) family members aged 60 or older.
Family members aged 16 – 59 are considered to be of working age. In many cases, these individuals are able to live on their own without economic support from the insured person. For this reason, to have such a family member certified as a dependent, you must submit documentation showing that he or she is unable to work and must rely on support from the insured person for most of the cost of living.
Documents to attach when applying for dependent certification
①List of documents to attach for dependent certification (basic documents)
See below for a list of basic documents that must be submitted in addition to the Notification of Health Insurance Dependent (Change).
(※Copy is also acceptable)
Relationship to the insured person | Documents certifying income amount, relationship, cohabitation with the insured, and the dependence of the family member on the income of the insured | ||||||||
---|---|---|---|---|---|---|---|---|---|
Certification of annual income (income certificate) or taxation (tax exemption) certificate※ | Certificate of school attendance or student ID※ | Certificate of residence※ | Official copy of family register※ | Dependent Status Notice | Remarks | ||||
Must depend on the insured’s income |
May live apart from the insured | Spouse | ○ | ○ | ○ | ○ | ○ | See documents that must be attached for dependent certification (supplemental) | |
Child | Preschool child | ○ | Single-parent household ○ |
||||||
Child attending compulsory education | ○ | ○ | |||||||
Child who has completed compulsory education | ○ | ○ | ○ | ○ | |||||
Parent | ○ | ○ | ○ | ○ | |||||
Grandchild, sibling | ○ | ○ | ○ | ○ | ○ | ||||
Must live with the insured | Parent-in-law |
○ | ○ | ○ | ○ | ||||
Aunt, uncle, niece, or nephew | ○ | ○ | ○ | ○ | ○ |
[Note] Depending on circumstances, you may also be asked to submit other certifying documents.
◎Submit the most recent version of each certifying document.
For purposes of dependent certification, the Society asks its members to submit a certificate of residence for the entire household. Please note that this requirement will continue to apply. The information provided in this attached document cannot be confirmed through the Social Security and Tax Number System.
Must have been issued within one month. | Official copy of family register (showing relationship between the insured person and dependent) |
---|---|
Certificate of residence (showing all members of the household; must not omit each member’s relationship to the insured) | |
Certificate of school attendance |
②Documents that must be attached for dependent certification (supplemental)
- [Individuals receiving public pension benefits (National Pension, Employees’ Pension, survivor’s pension, public employees’ pension, etc.)]
Most recent copy of pension amendment notice or copy of notice of pension remittance (showing the name and amount) - [Individuals earning non-salary income (including income from self-employed business)]
Copy of final income tax return for previous tax year (with “Received” Tax Office stamp) - [Individuals who have left their job (eligible to receive unemployment insurance benefits)]
* Individuals planning to receive unemployment insurance (employment insurance) benefits:
Copy of certificate of eligibility for employment insurance benefits; Written Pledge (A): Unemployment Benefits after completing procedures at the Public Employment Security Office
* Individuals planning to defer unemployment insurance (employment insurance) benefits:
Copies of employment insurance separation slips 1 and 2; Written Pledge (A): Unemployment Benefits after completing procedures at the Public Employment Security Office
Individuals for whom unemployment insurance (employment insurance) benefits have ended:
Copies of both sides of certificates of eligibility for employment insurance benefits through the end of payment of benefits - [Individuals not eligible to receive unemployment insurance (employment insurance) benefits]
Retirement certificate and certificate of nonparticipation in employment insurance (unemployment insurance) - [Individuals who have started a job (including part-time work)]
Copies of salary details for most recent three months
* If salary details for three months are unavailable
Most recent salary details available for submittal, together with copy of employment contract, employment certificate, or certificate of planned salary payment - [Individuals whose income has declined (continuing employment)]
Copies of salary details starting with the month in which income declined; certificate from employer stating the family member is employed at an annual salary of less than 1.3 million yen - [Individuals whose businesses have ceased operating]
Copy of notice of cessation of business (with “Received” Tax Office stamp) - [When applying for a child and your spouse is not a dependent (i.e., both spouses work)]
Certification of the income amounts of the insured person and the spouse (e.g., income certificate or taxation [tax exemption] certificate, certificate of income and withholding tax);
(Copy is also acceptable)Dependent Status Notice - [When applying for a child in a single-parent household]
Official copy of family register;(Copy is also acceptable)Dependent Status Notice - [If the family member is a person with a disability]
Copy of physically disabled persons’ certificate and copy of medical certificate if receiving municipal subsidies for medical care costs If receiving a disability pension, also the most recent copy of pension amendment notice or copy of disability pension notice - [If the family member lost his or her eligibility after becoming a Voluntarily and Continuously Insured Person after leaving a job]
Certificate of Loss of Eligibility As a Voluntarily and Continuously Insured Person - [If living separately (the allowance remitted by the insured person must exceed the dependent’s annual income)]
Proof of remittance (most recent three months’ bank or postal remittance receipts certifying remittance, copies of remittance slips from ATMs, etc.)
* Family members living apart from the insured person but seeking dependent status must depend primarily on a continuing allowance from the insured person to cover his or her costs of living. The allowance must be remitted regularly (each month) from a financial institution to the family member’s account in an amount at least equal to the family member’s income.
Certificate of residence for entire household in which the family member lives - [Certificate of Loss of Health Insurance Eligibility]
Depending on the circumstances of the person subject to certification, a Certificate of Loss of Eligibility from his or her previous health insurance society may be required.
(This is not required if the family member was previously covered by National Health Insurance.)
[Important]
①You may be asked to submit additional documents.
②Decisions concerning dependent certification are based on a comprehensive review of all these documents submitted. Submitting the documents does not automatically lead to dependent certification.
<< Confirmation of dependent eligibility (inspection/confirmation) >>
The Society will periodically review dependents for recertification purposes.
Documents such as proof of remittance must be retained. In certain cases, a dependent’s eligibility may be cancelled if the necessary documents cannot be submitted during the recertification process.
The Health Insurance Society strives to undertake fair and rigorous certification pursuant to the Health Insurance Act and other laws and regulations governing social insurance. Certification of an ineligible family member as a dependent and payments to him or her of insurance benefits from the Health Insurance Society diverts invaluable insurance premiums to ineligible parties and harms both the Company and insured persons. We ask that members make accurate reports to help prevent misuse of health insurance premiums.
<< Penalties for fraudulent applications >>
If an insured person is determined to have fraudulently applied for and received certification of an ineligible family member as a dependent, the dependent’s eligibility will be cancelled retroactively. In such cases, all medical care costs and other benefits paid over the period must be refunded.