Microsoft Health Insurance Association

Microsoft Health Insurance Association

  • Japanese
  • English
Text Size
  • Small
  • Medium
  • Large

The List of Documents to Submit for Certification of Dependents

Please fill in the application form clearly and correctly. If it is not legible, we will return the application form.

Family members who may either live with or live apart from the insured person

Additional documents may be requested in addition to those listed below. Check with the Health Insurance Society if you have any questions.

** Submit the documents together with the Notification of Health Insurance Dependent (Change).
Documents to attach
◯: Documents that must be submitted
△: Documents required in certain situations
Original document is required unless otherwise noted.
Family member to be certified
Spouse Child under the age of 18 Child age 18 or older Parent Brothers and sisters, grandchildren
Student Non-student Age 18 or older Under the age of 18
Regardless of reason for application Residence certificate(for all household menbers)
Dependent Survey Form    

You must attach the following documents when applying for the reasons indicated below:

Reason for application Documents to attach  
Childbirth Documents accepted for verification of spouse’s income *1            
Upon its reception Documents accepted for verification of spouse’s income *1        
Income verification documents *2  
Certificate of school attendance *3        
Marriage Income verification documents *2            
Certificate of Family Register
or Certificate of Acceptance of Marriage Report (copy)
           
Loss of employment (◎1) Retirement certificate (copy)
or Separation slip (copy)
or Certificate of Loss of Eligibility for Health Insurance (Employees’ Pension)
   
Dependent Certification Pledge      
End of receipt of employment insurance benefits Certificate of eligibility for employment insurance benefits (copy)    
Decreased income Income verification documents *2    

In addition to the above documents, persons in the following cases must attach additional documents:

Situation Documents to attach  
Pension recipients Notice of pension payment (copy of most recent notice) (Note)      
When living apart from the insured person (◎2) Proof of remittance (for three most recent months)        
Certificate of Family Register
Self-employed Final income tax return (copy)
Financial statement for blue return (copy)
Statement of earnings and expenses (copy)
   
Discontinuation of business Notice of discontinuation of business (copy)    
Was a member of another health insurance association Certification of loss of eligibility
  • Note: Certificates of income and withholding tax for pension payments are invalid.

Family members who must live with the insured person

Separate documents may also be required in cases other than those listed below. Check with the Health Insurance Society if you have any questions.

** Submit the documents together with the Notification of Health Insurance Dependent (Change).
Documents to attach
◯: Required documents
△: Any of the following required
Original document is required unless otherwise noted.
Family member to be certified
Father-in-law or mother-in-law Nephews and nieces Uncles and aunts
Age 18 or older Under the age of 18
Regardless of reason for application Residence certificate (for all household menbers)
Dependent Survey Form

You must attach the following documents when applying for the reasons indicated below:

Reason for application Documents to attach        
Upon its reception Income verification documents *2  
Certificate of school attendance *3


Loss of employment (◎1) Retirement certificate (copy)
or Separation slip (copy)
or Certificate of Loss of Eligibility for Health Insurance (Employees' Pension)
 
Dependent Certification Pledge  
End of receipt of employment insurance benefits Certificate of eligibility for employment insurance benefits (copy)  
Decreased income Income verification documents *2  

In addition to the above documents, persons in the following cases must attach additional documents:

Reason for application Documents to attach  
Pension recipients Notice of pension payment (copy of most recent notice) (Note)  
Self-employed Final income tax return (copy)
Financial statement for blue return (copy)
Statement of earnings and expenses (copy)
 
Discontinuation of business Notice of discontinuation of business (copy)  
Was a member of another health insurance association Certification of loss of eligibility
  • Note: Certificates of income and withholding tax for pension payments are invalid.

Institutions from which to obtain documents to attach

Proof of remittance (2) For proof of remittance, submit a remittance receipt from the financial institution showing the recipient of the remittance, a copy of your passbook, a cash registered mail receipt, etc.
Employment insurance separation slip Previous employer
Certificate of Loss of Eligibility for Health Insurance (Employees’ Pension) Your previous employer or your previous health insurer or pension provider
Certificate of eligibility for employment insurance benefits (1) Public Employment Security Office
Certificate of school attendance *3 School
Dependent Survey Form You can download here
Tax-exemption certificate Municipal government
Payment notice for pension, etc. Pension provider
Certificate of residence Municipal government

In some cases, you may be asked to submit additional documents.

*1 Documents accepted for verification of spouse’s income

If the insured person’s spouse is not already a dependent, you must submit documents that can be used to verify his or her income for the previous year.

  • Certificate of income and withholding tax (copy) for non-dependent spouse
  • Tax exemption certificate (issued within the past three months) or final income tax return (copy) for non-dependent spouse
  • * If both spouses are employed
    Cases in which children are dependents of both spouses are handled as described below.
  • In principle, no matter how many dependents the family has, all will be regarded as dependents of the parent with the higher annual income. For this reason, you may be asked to submit certification of income for family members other than Microsoft Health Insurance Association insured persons and dependents.
  • If both spouses earn roughly the same annual income, the children will be dependents of the parent providing the primary support for their livelihood.
  • * Case by no spouse
    If your household is a single-parent household, indicate this on the notice of change and please attach a certificate of residence that can be used to verify relationship and name.

*2 Documents accepted for income verification

  • Tax exemption certificate (issued within the past three months) Note: Since this document indicates income from the previous year, you must submit additional documentation if your income changed between the previous year and the time you are applying. (For example, if your tax exemption certificate indicates a salary but you left your employer and no longer earn any income, submit a certificate of retirement [copy] or separation slip [copy], etc.)
  • Salary details for the most recent three months, etc.
  • Employment contracts or other documents that can be used to confirm that the dependent’s income does not exceed the monthly figure of 108,333 yen specified in the dependent certification criteria (i.e., documents indicating hourly wages, working hours, days worked, overtime hours, amounts paid for transportation expenses, employment tenure, etc., that clearly indicate or can be used to calculate the amounts paid) and salary details for one month.

*3 Certificate of school attendance

  • You do not need to attach a certificate of school attendance for high-school students. Please note the year in school (e.g., second year of high school) on the "occupation or year in school" field of the Notification of Health Insurance Dependent (Change). 
    If dependents are a student over 18 years of age, please attach Certificate of school attendance. The copies of the student identification card will not be accepted.
  • If dependents are not a student, or if dependents are a student but have income, please attach Income verification documents.

◎1 Applying to be certified as a dependent due to retirement

A family member seeking to become a dependent due to loss of employment cannot be named a dependent while receiving employment insurance benefits. (The family member may be named a dependent if his or her base allowance daily amount is less than 3,612 yen if under 60 years of age or less than 5,000 yen if aged 60 or older.)

◎2 Applying to have a family member living separately certified as a dependent

  • Simply stating that the funds were given to the family member in person does not constitute proof of allowance. It must be possible to document that an allowance is granted to the family member.
  • In principle, the allowance must be provided monthly. This is necessary to allow objective documentation that the dependent lives primarily off the income (allowance) of the insured person and because the purpose of this allowance is to pay for the dependent's living expenses.
  • The allowance cannot be granted for several months at a time in one lump sum.

PAGE TOP