Health insurance provides insurance benefits not just to insured persons but also to their dependent family members. These family members are referred to as “dependents”. Family members must meet certain conditions related to “residency in Japan,” “the extent of the family relationship,” and “income” before they are authorized as dependents.
- Dependents must be certified by the Health Insurance Society.
- If there is any change in your dependents, submit notification of the change within five days.
Extent of family relationship
Only family members within the third degree of consanguinity may be certified as dependents. Conditions for dependent eligibility also vary depending on whether or not the family member lives with the insured person.
To be certified as a dependent, a family member must live primarily off the income of the insured person.
|If the family member lives with the insured person||If the family member lives apart from the insured person||The family member's annual income must be less than 1.3 million yen (1.8 million yen if aged 60 or above, or disabled) and it must be less than one-half the income of the insured person.||The family member's annual income must be less than 1.3 million yen (1.8 million yen if aged 60 or above, or disabled) and must be less than the amount of the allowance sent to the family member from the insured person.|
Income for self-employed persons
Income for salary earners is based on gross income. For the self-employed, the portion qualifying as income can vary at the various stages of revenue accounting. Thus, the Microsoft Health Insurance Association applies the following standards for self-employed persons:
- Income is defined as revenue before deductions for necessary expenses, not final taxable income amount. (The rationale behind this approach is that the income of salary earners is also regarded as the amount before deductions for necessary expenses?in their case, salary deductions.)
- However, purchasing costs are deducted for self-employed persons involved in businesses involving merchandise sales or food service, since the direct cost of purchasing stock cannot be considered revenue. Income in this case is defined as net sales minus purchasing costs?or what is generally referred to as gross profit on sales.
Requirements when applying to have a parent, mother-in-law, father-in-law, or grandparent recognized as a dependent
As a matter of course, married couples are assumed to live together and to have primary responsibility for mutual aid and support, so they strongly rely on the income of each other for their livelihood.
For this reason, if a parent or grandparent for whom you are applying for dependent certification has a spouse, the actual conditions of the couple’s household and livelihood will be assessed to determine whether or not the subject of the application depends mainly on the income of the insured person for his or her livelihood on a continual basis.
Specifically, even if one of the spouse’s incomes is below the standard amount, if the other spouse earns enough for both spouses to live on, that spouse is regarded as the person with primary responsibility for the couple’s livelihood, and the parent or grandparent may not be named a dependent of the insured person.
New requirement concerning residency in Japan for dependent certification
From April 2020, a requirement related to residency in Japan is added to the requirements for certification of health insurance dependents. In principle, from April 1, 2020, those who do not have addresses in Japan cannot be certified as dependents (with certain exceptions—for example, students studying abroad).
Rationale underlying the domestic residency requirement
Determinations of residency are based on whether a person is registered to the basic resident register (i.e., whether or not the person has a certificate of residence). In principle, those who have certificates of residence in Japan meet the domestic residency requirement.
- Note: Even those who have certificates of residence in Japan will not satisfy the domestic residency requirement if they clearly do not reside in Japan—for example, those employed overseas.
Exceptions to the domestic residency requirement
Those whose livelihoods are recognized to be based in Japan, such as students studying abroad temporarily, are considered to meet the domestic residency requirement on an exceptional basis, even if they actually reside overseas.
[Cases qualifying as exceptions to the domestic residency requirement]
- (1) Students studying abroad
- (2) Family members accompanying an insured person posted abroad
- (3) Those traveling abroad temporarily for sightseeing, recreation, volunteer activities, or other reasons unrelated to employment
- (4) Those who enter into a family relationship to an insured person while the insured person is posted abroad
- (5) In addition to those described under (1)-(4) above, others whose livelihoods are recognized to be based in Japan in consideration of purposes of traveling abroad and other circumstances
Cases in which a person cannot be certified as a dependent even if he or she resides in Japan
Those who come to Japan on medical visas or on long-stay visas for sightseeing or recreational purposes cannot be certified as dependents, even if they reside in Japan.
As an interim measure, if a person who would lose his or her eligibility as a dependent due to the addition of the domestic residency requirement is hospitalized in a medical care institution in Japan as of the date of enactment of the requirement (April 1, 2020), his or her eligibility will continue during the period of hospitalization.
If there has been a change in dependents
You must take specific steps if the number of dependents increases due to marriage or childbirth or a family member is no longer eligible as a dependent for reasons such as employment, living apart from the insured person, or death. The Health Insurance Society checks the eligibility status of dependents annually.