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When a family member is added

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  3. When a family member is added

Family members depending upon an insured person will be paid insurance benefits by the health insurance. These family members are called “dependents.” In order to be certified as a dependent, relevant family members need to meet certain conditions on “scope of family members” and “income.”

  • In order to be certified as a dependent, the relevant family member needs to acquire certification from the Health Insurance Society.
  • If there is a change relating to a dependent, please report this within 30 days.

Scope of family members

The extent of family members eligible to become dependents is relatives within three degrees. Additionally, living together with or separately from the relevant family member has an effect on the conditions.

家族の範囲

Standard of income

In order to become a dependent, the relevant family member needs to “mainly depend on the insured person’s income for a living.”

In case of living together In case of living separately
Annual income of a person eligible to be classified as a dependent shall be less than 1.3 million yen (1.8 million yen for those aged over 60 or disabled) or his/her monthly income shall be less than 108,334 yen (150,000 yen for those aged over 60 or disabled), and shall be less than half of the insured person. Annual income of a person eligible to be classified as a dependent shall be less than 1.3 million yen (1.8 million yen for those aged over 60 or disabled) or his/her monthly income shall be less than 108,334 yen (150,000 yen for those aged over 60 or disabled), and the income shall be less than the remittance sent by the insured person.

収入の基準

Note 1:
For the condition “mainly depend on the insured person’s income for a living” in the “standards for becoming a dependent,” it will be decided by comprehensively taking into account matters such as the validity of the cost-of-living and burden status, and number of family members the insured person is able to support considering his/her income.
Note 2:
The scope of income, annual income and monthly income will be work income including part-time job, second job, work done at home, pension income, interest and dividend, income from real estate, employment insurance unemployment benefits, as well as sickness allowance and maternity allowance of health insurance.
Please note that these amounts are the total benefit payment amount and not the take-home amount.
Note 3:
Even if a family member has been a dependent, in a case where he/she no longer meets the “standards for becoming a dependent” through circumstances such as an increase in income due to an extension of part-time job hours, he/she needs to be removed as a dependent. Please take action promptly in such a case.
Note 4:
It is specified in law that a “Dependent (change) notification” must be submitted within five days of a change of dependent (in Article 38 of the Ordinance for Enforcement of the Health Insurance Act). However, there may be cases where the necessary notification attachments cannot be obtained and sent before the submission limit. Therefore the Health Insurance Society sets a general rule as below. However, we may take exceptional measures in individual situations, for example delay in notification due to being affected by a disaster.

●For certification of qualification of the dependent, the certification date will be the same as the date of the change, as long as the notification is received within 30 days of the change (including the date of the change).
When notification arrives or is received 31 days or more after the date of the change, certification date will be the day the notification is received. However, in case of notification concerning birth, the certification date will be the birth date even if it is received 31 days or more after the date of the change.

Example 1:
Marriage on May 1. Notification arrives or is received on May 30. Certification Date: May 1.
Example 2:
Marriage on May 1. Notification arrives or is received on June 15. Certification Date: June 15.
Example 3:
Birth on May 1. Notification arrives or is received on June 15. Certification Date: May 1.

●For termination of dependent qualification, the termination date will be the same as the date of the change regardless of the receip t date of the notification.
If a dependent uses his/her health insurance card at a hospital or complete medical checkup assistance after the date of the change, please make sure that all the benefits provided are returned.

Example 4:
Become ineligible through starting employment on April 1. Notification is received on April 30. Termination Date: April 1.
Example 5:
Become ineligible through divorce on April 1. Notification is received on May 10. Termination Date: April 1.

Please refer here for details on certification criteria to become a dependent.

When changes occur for a dependent

When the number of dependents increases through marriage or childbirth, and also when a family member that has been certified as a dependent ceases to meet the dependent certification standard by becoming employed, beginning to live separately, or dying, you must take action. Coca-Cola Bottlers Japan Health Insurance Society confirms qualification of dependents annually.

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