Application form (For general insured person)
- Application form (For general insured person)
- Application form (For Voluntarily and Continuously Insured Person, Special-Case Retired Insured Person)
- Forms related to health insurance cards and eligibility coverage
- Forms related to insurance benefits and claims
- Forms related to subsidies for health checkups, etc.
Forms related to health insurance cards and eligibility coverage (For general insured person)
Name of Application form | Application support system | Application Form | Example |
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T-002 Notification of Change (Correction) of Name, Date of Birth, etc. T-011 Notification of Health Insurance Dependent Change (Increase) T-012 Notification of Health Insurance Dependent Change (Removal) T-022 Notification of Change (decrease) of Dependents and Address (For those applicable to the Medical Care System for the Advanced Elderly) T-101 Application Form for Reissue of Health Insurance Card T-501 Notification of Overseas Posting Exempt from Long-term Care Insurance/Return to Japan (for Overseas Residents, etc.) |
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T-020 Report on Unemployment/Lack of Income | ー | ||
T-102 Notification of non-return of insured person's card for those who lost their eligibility | ー | ||
T-103 Notification of Inability to Return Health Insurance Card for bulk updating | ー | ||
T-202 Application form for issuance of Certificate of Eligibility | ー | ||
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T-401 Request for Certificate of Eligibility/Loss of Eligibility | Log in |
Consult with the Operations Dept. (Application) of the Health Insurance Society if you have gender identity disorder and would prefer not to have the name or gender from your family register indicated on your health insurance card.
Forms related to insurance benefits and claims (For general insured person)
Name of Application form | Application support system | Application Form | Example |
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K-601 Request for issuance of Maximum Co-payment Certificate for Health Insurance | Log in | ||
K-501 Application for Certification of Benefits | ー | ||
K-001 Claim for Medical Care Expenses (Advance Payment, Prosthetic Equipment, etc.)
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K-002 Detailed receipt (examination and treatment) | ー | ー | |
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Consult with the Operations Dept. (Benefits) of the Health Insurance Society if you have gender identity disorder and have changed the gender or name indicated on your health insurance card and would also prefer to change the corresponding description on the Certificate of Application of Maximum Copayment Amount or other documents.
Procedures related to subsidies for health checkups, etc. (For general insured person)
Contents | Name of Application form |
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When you have paid the entire cost of the health checkup in advance. | |
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Application support system Request for subsidy for health checkups
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If you are unable to use the application support system | |
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