Procedures

Family Dependents

Health insurance not only provides benefits to insured persons but also their family dependents. These family members are referred to only as dependents, and their scope is defined by law.
The HGST Health Insurance Association needs to certify family members as dependents.

Adding a Family Dependent

Family members whose livelihood is supported by the income of the insured person 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 and other requirements that must be fulfilled.
Dependents for health insurance purposes adhere to completely different criteria from dependents under tax law or in relation to corporate allowances for dependents.

Scope of Individuals Qualifying as Dependents

Individuals qualifying as dependents
regardless of whether living with the insured person
  • Spouse (common-law marriages)
  • Children and grandchildren
  • Siblings
  • Parents, grandparents and other relatives who have a relationship of lineal ascendant with the insured person
Individuals who must live with
the insured person
  • Family other than the above within three degrees of kinship
  • Parents-in-law or step children (even in common-law marriages) of insured person
  • Parents-in-law or step children of a deceased spouse (even in common-law marriages)
Scope of dependents

Standards for Certification of Dependents

Each of the following requirements must be met for a person to be certified as the dependent of an insured person. The HGST Health Insurance Association fully reviews the following items to carefully decide whether the person qualifies as a dependent.

Individuals must live in Japan*New requirement added as of April 1, 2020

Partial revisions to the Health Insurance Act and other laws added a provision that a dependent shall, in principle, live in Japan for certification as a dependent on April 1, 2020.
As an exception to this requirement, individuals such as foreign exchange students or family accompanying an insured person overseas who have been living in Japan before departure and who have a high likelihood of returning to live in Japan in the future due to the purpose for stay overseas satisfy the requirement for a dependent to live in Japan even without an address in Japan (certificate of residence).

  • A dependent shall, in principle, live in Japan (certificate of residence)
    *However, foreign nationals residing in Japan for a long stay (up to one year) on a medical-stay visa or for the purpose of tourism or recreation do not qualify as a dependent even if living in Japan (certificate of residence) according to an exemption in the Health Insurance Act.
  • An individual who does not have an address in Japan (certificate of residence) but whose basis of livelihood is in Japan
    *Individuals are approved as an exception to the requirement for a dependent to live in Japan by confirming their visa status and other circumstances.
[Reasons for Exceptions to the Requirement for a Dependent to Live in Japan and Examples of the Supporting Documentation]
Reason Supporting Document
1. Students studying overseas
Copy of the visa and student ID as well as enrollment and admission certificates
2. Person accompanying an insured person stationed overseas
Copy of the visa and letter of appointment for overseas assignment as well as a copy of a residence certificate issued by an overseas public institution
3. Person temporarily traveling overseas for any purpose other than employment
(tourism, recreation, volunteer activities, etc.)
Copy of the visa, proof of the volunteer dispatching agency, and the volunteer participation agreement
4. Person who has a personal relationship, such as birth or marriage, with the insured person while assigned overseas
Copy of documents certifying birth, marriage, etc.
*Please include a Japanese translation signed by the translator for any supporting documents written in a different language with the rest of the materials.

Income Requirements

  • The annual income of the individual must be less than 1.3 million yen (1.8 million yen for individuals aged 60 or older or persons with disabilities)
  • The annual income of the individual must be less than half that of the insured person
[Dependents Living Separately from the Insured Person]
  • The annual income of the individual is less than the financial support of the insured person
  • The total income and financial support of the dependent is above the amount needed to maintain a standard quality of life
- Remittance
A track record of remittance that exceeds the individual's annual income is required. Money delivered by hand is not considered remittance. Remittance requires continuity (about once per month), and a remittance certificate (indicating the sender and the recipient) which is able to prove the wire transfer request from a financial institution or other such documents must be submitted.

Other

  • The insured person provides the individual financial support
    The insured persons must be providing the majority of living expenses to the individual. Even if the income criteria are met, the individual will not qualify as a dependent if economically independent.
  • The insured person must have the ability to financially support the individual
    The insured person must have the ability to provide consistent economic support to the family member. Even if all of the other requirements are met, the individual will not qualify as a dependent if the HGST Health Insurance Association determines the insured person does not have the means to provide financial support.
[Another Person is Obligated to Support the Individual]
  • A person with a higher priority obligation to support the individual, such as the mother or father in the case of siblings and grandparents, does not have the ability to do so.
  • There are unavoidable reasons that the insured person must support the family member.
[Dependent Children When Husband and Wife Are Both Employed]
  • Compare the couple's incomes and make the one with the greater amount of expected income for the next year the dependent.
  • If the incomes are at the same level, the child becomes the dependent of the parent who is the main person supporting the household indicated in the notification.
*If there are multiple children, it is not permitted in principle to support them separately by their parents. Therefore, all of the children will become dependents of the parent with the higher income.
[Family Members Age 16 or Older but Under Age 60 (Excluding Students)]
Individuals who are age 16 or older but under age 60 are at an age that allows them to work. In many cases, these individuals can live independently without the economic support of the insured person. 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 person is providing a majority of the living expenses to the individual.
[Unemployment and Other Benefits]
As a general rule, an individual who is receiving unemployment benefits is unlikely to be able to live mainly on the income of the insured person. Therefore, these individuals usually do not qualify as dependents. However, these individuals may qualify as a dependent if the amount of unemployment benefits is small*. In addition, individuals who are waiting for benefits or who are in a benefit restriction period can qualify as dependents because they have no income.
*Individuals under the age of 60 with a basic daily allowance of less than 3,612 yen, or individuals age 60 or older and persons with disabilities who have a basic daily allowance less than 5,000 yen
Procedures
To add a family member as a dependent, please fill in the necessary information in the documents below, attach the necessary attachments, and submit the materials within five days. (Refer to the “Application Forms” page for information on where to submit application forms.)
Required
documents

Confirmation of Dependent Qualifications (Verification)

The HGST Health Insurance Association conducts confirmation of dependent qualifications with a set deadline and reviews continued certification as a dependent. Individuals who are unable to submit the required documentation at the time of this review may lose their eligibility as a dependent. Therefore, insured persons need to prepare and be ready to submit proof of remittance and other documents at any time.

Punitive Measures for Fraudulent Applications

If the HGST Health Insurance Association discovers an insured person has obtained certification of a family member who is not actually receiving financial support through a fraudulent application, the family member will not only lose eligibility as a dependent but also be required to reimburse the HGST Health Insurance Association for any and all medical expenses and other payments made during the relevant period.

Removing a Family Member as a Dependent

Procedures to take a family member off the dependents list must be taken if the family member who was certified as a dependent no longer fulfills the requirements for certification as a dependent due to employment, living separately from the insured person, death or other such reasons.

  1. The annual income of a dependent continuously reaches 1.3 million yen or more (or 1.8 million yen or more for individuals age 60 or older)
    • The income from non-regular or part-time work increased for a wife or child who is a dependent
    • The annual pension increased for a parent who is a dependent, etc.
    *Please note that individuals lose qualification as a dependent as of the time they begin working (earning an income), not when their earnings exceed the maximum annual income. This policy also applies if the individual has started working but is unable to enroll in a health insurance plan at the new employer. Please make sure to complete the procedures to remove the individual as a dependent.
  2. A dependent begins receiving employment insurance (unemployment or other benefits)
    (Individuals who have extended the payment period, etc.) Please make sure to complete the procedures to remove the individual as a dependent if benefit payments will be made at a later date.
  3. A dependent no longer has a relationship with the insured person
    • A child who was a dependent has enrolled in another health insurance plan as an insured person
    • A daughter who was a dependent marries and becomes a dependent of her husband
    • A spouse who was a dependent is no longer supported by the insured person due to divorce
    • A family member who was a dependent has passed away, etc.
    *An individual who has been removed as a dependent needs to either enroll in National Health Insurance or another health insurance program as an insured person or complete procedures to become a new dependent of the family member who is providing financial support.
Procedures
Fill in the necessary information in the document below, attach the health insurance card for the relevant dependent, and submit all of the materials. (Please submit the materials within five days after the change. Refer to the “Application Forms” page for information on where to submit application forms.)
Required
documents
  • Dependent Change Notification (Removal)
    PDF Entry Sample
  • Health insurance card (relevant dependent)

Date of Dependent Removal

The date for removing a dependent is the day on which the reason for submitting the Dependent Change Notification arose.
However, in the case of death, the day after the individual passed away is the day on which the dependent is removed. The day on which an individual who has begun working and has been issued a health insurance card becomes eligible for health insurance through an employer is the day on which the dependent is removed as a dependent.

Ramifications of Forgetting to Remove a Dependent

If an insured person fails to complete the procedures to remove a dependent despite the fact that a dependent has already lost eligibility as a dependent, the HGST Health Insurance Association retroactively revokes their certification as a dependent and requests the insured person reimburse any and all medical costs or other benefits the person received as a dependent if the individual accidentally used his or her health insurance card during that time.

*Please notify the healthcare provider on your next visit if an individual has been formally removed as a dependent and enrolled in a different health insurance plan.

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