The health insurance dependents system

Family members within three degrees of consanguinity from the insured person who depend on the insured for their livelihood may use the insured’s health insurance system. Insurance premiums do not change with the number of dependents (although long-term care insurance premiums may be collected for family members aged 40-65). In addition, each dependent family member will be issued an individual health insurance card.

• * Since the definition of health insurance dependents differs from that under income tax and resident tax laws, it is not necessarily the case that you can apply for an income tax dependent to be named a health insurance dependent as well. Check with your employer’s HR section about income tax and resident tax dependents.

Review

The Society implements a review process to determine dependent eligibility and to ensure appropriate use of insurance premiums paid by its members. To ensure the fairness and equity of the review process, members will be asked to submit documentation issued by public agencies, employers, or other parties, instead of verbal confirmation.

Notification

Submit a notification in the following cases for family members who meet the conditions for dependency:

• You have dependent family members when you take employment and join the Health Insurance Society.
• The status of family has changed due to marriage, childbirth, a family member leaving his or her job, or other reasons.
  

Conditions

Dependent flowchart: Use the following chart to determine whether the family member qualifies as a dependent.

Condition 1. The person to be named a dependent must not be an insured person under another health insurance plan.

• ⇒ You cannot apply to name as a dependent a family member who has become an insured person of another health insurance plan, due to new employment or for other reasons.
  In addition, you must undertake dependent removal procedures if a family member certified as a dependent joins another health insurance plan due to new employment or for other reasons.
  

Condition 2. The family member must be within three degrees of consanguinity from the insured. (See Fig 1 below.)

Family members other than lineal ascendants (e.g., parents and grandparents), spouse, children, grandchildren, and siblings must live with the insured.

* Illustration: Concept of three degrees of consanguinity for dependent certification

Condition 3. The income of the family member to be named a dependent must satisfy the conditions in the table below.

• * The individual in question must meet all income conditions A, B, and C. (Even if annual income is less than amount A, if the average income over three months exceeds amount B, the income requirement is not satisfied.)
• * As used here, income refers to permanent income (continuing from the present into the future) used to cover living expenses, whether taxable or not taxable under the Income Tax Act or other laws. It does not include temporary income.
  

• ★ For health insurance purposes, self-employment income is defined as gross receipts minus directly necessary expenses. Directly necessary expenses refer to the cost of raw materials and other costs needed for production activities?for example, in the case of a pastry shop, flour and eggs. For more information, refer to the List of Directly Necessary Expenses indicating what the Recruit Health Insurance Society regards as directly necessary expenses.
  (Since the special deduction for blue tax return filers is a special benefit of filing a blue tax return, not an actual expense, it is not considered a directly necessary expense.)
  

Condition 4. In case of living together ：Must satisfy Condition 3 and earn less than the insured.
In case of living separately ：To be named a dependent, the insured must remit a monthly allowance that exceeds the income of the family member. (This allowance must not be handed to the family member in person.)

• ★ Allowance: This refers to a fixed amount sent monthly by funds transfer from a financial institution or by registered mail to help with the living expenses of a family member living separately. Assistance with the cost of living by directly handing cash or shared use of a credit card in the name of the insured is not admitted by the Recruit Health Insurance Society because there is no way to verify the fact of the allowance.

Condition 5. Must depend primarily on the income of the insured. (This condition is not satisfied by partial monetary assistance.)

• ⇒ You (the insured) cannot apply to name a family member as a dependent if he or she receives assistance with living costs from another family member and the insured is not his or her primary provider.

• ★ The condition above assumes that the insured person supports one family member. A family member may not be certified as a dependent even if the above condition is met?for example, if the insured person supports multiple family members or if the family member has a spouse (e.g., your father or mother).

Date of certification

The dependent notification must be submitted within five days after the family member becomes a dependent.
If the notification is delayed by two months or longer, submit a written explanation for the delay.

• * Benefits will be provided by the Recruit Health Insurance Society starting with examinations and treatment at medical care institutions on or after the date of certification.

If a family member no longer qualifies as a dependent

If a family member no longer meets the conditions for being a dependent due to new employment, increased income, or other reasons, submit the following documents within five days to your employer’s section in charge of social insurance operations.

• The health insurance card of the relevant dependent
• Notification of Health Insurance Dependent (Change)

• * You will be billed for all incurred costs if a person who no longer meets the conditions of a dependent uses a Recruit Health Insurance Society health insurance card (including use for examinations and treatment at medical care institutions and other health insurance services).