Documents to attach for dependent certification
- This is information on documents to attach to the application form T-011: Notification of Health Insurance Dependent Change (Increase).
Note that the application cannot be accepted if you submit only the documents to attach.
You can find the application form T-011: Notification of Health Insurance Dependent Change (Increase) by accessing “Application forms” at the top of the homepage. - No documents need to be attached if the reason for application is a change in the insured person’s place of employment (company) or re-employment.
- In principle, note that the necessary documents will not be returned after they are submitted.
- You may be asked to submit other documents in addition to those described below during the certification review process.
Your cooperation is appreciated in such cases.
Submit the applicable documents under [B] together with those under [A].
If [C] applies, submit the relevant documents together with those under [A] and [B].
[A] Documents required regardless of the subject person’s relationship to the insured, reason for applying, etc.
| Reason for application | Documents to attach |
|---|---|
| All reasons | Certificate of residence or request for certificate of items stated in resident register
|
Report on Circumstances of Dependent
|
[B] Documents required depending on the reason for applying ◎ Attach these together with the documents under [A].
| Reason for application | Documents to attach |
|---|---|
| Concurrent with acquisition of eligibility as insured person | ★Documents for confirmation of income |
| Marriage | ★Documents for confirmation of income Certificate of receipt of marriage registration (copy acceptable) or certified copy of family register (copy acceptable) |
| Childbirth | Certificates of income and withholding tax of both spouses for the previous year (copies) * You may be asked to submit additional documents in the event of differences in income amounts between the previous year and the time of application and anticipated future amounts. |
| Loss of employment (* Note 1) |
Separation slips 1 and 2 (copies) or retirement certificate Request for Dependent Certification Due to Receipt/Non-Receipt of Unemployment or Other Benefits |
| Termination of receipt of unemployment benefits (* Note 1) |
Certificate of eligibility for employment insurance benefits (copies of all pages) * “Payment terminated” must be printed on the last page. |
| Live with the insured person | ★Documents for confirmation of income |
| Within income standards | ★Documents for confirmation of income |
- (* Note 1) If the dependent has other income after separation from employment or termination of receipt of unemployment benefits, attach the applicable documents under “★ Documents for confirmation of income” in addition to the above documents.
[C] Documents required depending on the circumstances ◎ Attach all applicable documents depending on the circumstances together with the documents under [A] and [B].
| Applicable circumstances | Documents to attach |
|---|---|
| When applying for a child for whom both the insured person and his or her spouse provide | Certificates of income and withholding tax of both spouses for the previous year (copies)
|
| When applying for the spouse’s family member for whom both the insured person and his or her spouse provide | Certificates of income and withholding tax of both spouses for the previous year (copies)
|
| If the relationship between the insured person and the person subject to the application cannot be confirmed from the certificate of residence | Certified copy of family register (copy acceptable) |
| If the person subject to the application was a Voluntarily and Continuously Insured Person during the period until dependency began | Certificate of Loss of Eligibility As a Voluntarily and Continuously Insured Person (copy acceptable) |
|
If the person subject to the application has a parent, spouse, etc. (* Note 2) |
★Documentation of the income of the parent, spouse, etc.
|
| Applying for a child who lives separately in order to attend school (daytime classes) | Certificate of school attendance (copy acceptable)
|
| Live apart from the insured person | Documentation of allowance amounts for the most recent three months (* Note 3)
|
- (* Note 2) The case will be reviewed if another relative would normally be considered responsible for providing for the person subject to the application.
- (* Note 3) These will be checked for a period of three months. If the allowance has just begun, we will review first for the months for which documentation can be attached. You will be required to submit documentation for the remaining months at a later date.
Beginning on April 1, 2020, when applying to name as a dependent a person who qualifies for the exceptions to the domestic residency requirement, submit the documentation specified in the table below in place of a certificate of residence, in addition to the documentation conventionally required when applying to name a family member as a dependent. (Determine which documents need to be attached based on the date dependency began.)
| Reasons for exception | Certifying documentation | |
|---|---|---|
| (1) | Student studying abroad | Copy of visa |
| (2) | Family member accompanying an insured person posted abroad | A copy of any of the following: visa, written appointment overseas, certificate of residence issued by a foreign public agency. |
| (3) | Person traveling abroad temporarily for sightseeing, recreation, volunteer activities, or other reasons unrelated to employment | Copy of visa (For volunteer activities, in addition to the copy of visa, a copy of any of the following: certificate of agency dispatched for volunteer activities, certificate of consent to participate in volunteer activities) |
| (4) | Person recognized as equivalent to (2) above due to family relationship to an insured person arising while the insured person is posted abroad | Copy of documentation certifying birth, marriage. |
| (5) | In addition to (1)-(4) above, person recognized to have a livelihood based in Japan in consideration of purposes of traveling abroad and other circumstances | Subject to determination on a case-by-case basis. Please contact Hitachi Health Insurance Society. |
- Note: If documents were prepared in a foreign language, please attach a Japanese translation signed by the translator.
◎In principle, only documents obtained within three months of application are valid.
| Documents | Notes concerning | Where to get it |
|---|---|---|
| Certificate of residence | Omit permanent domicile and Individual Number (My Number). Obtain a certificate showing all members of the household subject to the application. Must show all items of information (not omissible) other than Individual Number and permanent domicile. |
Municipal office |
| Request for certificate of items stated in resident register | Have the municipal government certify the Hitachi Health Insurance Society’s designated form. In principle, a certificate of items entered in the certificate of residence issued by the municipal government will not be accepted. Foreign residents must obtain certificates of residence. |
Hitachi health insurance society homepage |
| Request for certificate of employment | Have the employer of the family member subject to the application certify the Hitachi Health Insurance Society’s designated form. Use this document if pay statements for the most recent three months are unavailable because employment began recently or for other reasons. In principle, a certificate of employment issued by the employer of the family member subject to the application will not be accepted. |
Hitachi health insurance society homepage |
| Retirement certificate | Obtain a certificate issued on a date on or after the date of separation, rather than a certificate of planned separation. | Place of employment before separation |
| Separation slip (1) and (2) |
If the separation slip shows your Individual Number (My Number), be sure to black out the number so that it cannot be read after making the copy. | Place of employment before separation |
| Tax-exemption certificate | Must show amounts of “0 yen” for all income. | Municipal office |
| Notice of pension remittance | This notice is sent periodically by postcard or other form. | Japan Pension Service, corporate pension funds, etc. |
| Estimated pension amount calculation results | Inquire with the parties shown at right for an estimate of your anticipated pension amount. | Pension office The Japan Pension Service’s Nenkin Net, etc. |
| Income tax return | Prepare a copy of your final income tax return filed and received. A payment record will not be accepted. If the final income tax return shows your Individual Number (My Number), be sure to black out the number so that it cannot be read after making the copy. |
Tax office |
Documentation of allowance amounts
|
Must clearly indicate the remittance date, the remittance amount, the remitting party (insured person), and the beneficiary (person subject to the application). | Financial institutions, etc. |
- ◆In principle, note that the necessary documents will not be returned after they are submitted.
- ◆You may be asked to submit other documents in addition to those described during the certification review process. We ask for your cooperation in these cases.