Microsoft Health Insurance Association

Microsoft Health Insurance Association

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

Dependent
Dependent Survey Form

Notification of Health Insurance Dependent (Change)

electronic_form

Dependent Certification Pledge

electronic_form

Insurance card
Application Form for Reissue of Health Insurance Card (Card loss/Damage)

electronic_form

Notification of Name Change (Correction)

electronic_form

Application Form relating to Sex Notation of Health Insurance Card

electronic_form

My number (Social Security and Tax Number System)
My Number (Social Security / Tax Number System) Application form to the Health Insurance Association

electronic_form

Benefit
Application Form for Issuance of Maximum Copayment for Health Insurance

electronic_form


Application Form for loss of Maximum Copayment Certificate for Health Insurance

electronic_form

Application Form for issue of Certificates Issued for Specific Disease Treatment

electronic_form

Application Form for Medical Care Expenses (advance payment)

electronic_form

Application Form for Medical Care Expenses (orthotics for treatment/pediatric medical glasses)

electronic_form

Photos of the made orthosis

electronic_form

Confirmation documents for making orthotics

electronic_form

Application Form for Medical Care Expenses (acupuncture)

electronic_form

Application Form for Medical Care Expenses (moxibustion/massage)

electronic_form

Application for Payment of Childbirth and Childcare Lump-sum Grant (for Receipt on Your Behalf)

electronic_form

Claim for Childbirth and Childcare Lump-sum Grant/ Additional Sum (not using system of direct payment)

electronic_form

Letter of Consent

electronic_form

Claim for Maternity Allowance

electronic_form

Claim for Injury and Sickness Allowance

electronic_form

Claim for Funeral Expenses

electronic_form

Application Form for Transportation Expenses

electronic_form

Application Form for Overseas Medical Care Expenses

electronic_form

Attending Physician's Statement(Form A) , Japanese translation (Form A-2)

electronic_form

Attending Physician's Statement(Form B) , Japanese translation (Form B-2)

electronic_form

Agreement of Authorization for Overseas Medical Care Expenses

electronic_form

Insured person (dependent person) qualification
Request for Health Insurance Certificate (Certificate of loss of qualification etc)

electronic_form

Notification of Applicability for Long-term Care Insurance Exemption

electronic_form

Notification of Non-applicability for Long-term Care Insurance Exemption

electronic_form

Voluntarily and continuously insurance
Application Form for Certification as Voluntarily and Continuously Insured Person

electronic_form

Notification of Change of Registration Matters for a Voluntarily and Continuously Insured Person

electronic_form

Application Form for Disqualification as Health Insurance Voluntarily and Continuously Insured Person

electronic_form

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