Family membership
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.
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- Dependents must be certified by the Health Insurance Society.
- If there is any change in your dependents, in principle, submit notification of the change within five days.
Extent of family relationship
The scope of family members eligible to be certified as dependents is legally defined. To be certified as dependent, the family member must meet certain conditions as provided for in the Health Insurance Act or the notification of the Ministry of Health, Labour and Welfare, etc. Conditions for dependent eligibility also vary depending on whether or not the family member lives with the insured person. “The same household” referred to in the Health Insurance means “A group of persons who live together and share the same household budget,” and basically differs from “Simple living together” or “Two households at the same address which does not share household budget.”
Elderly person aged 75 or older cannot become a dependent of the health insurance, being an insured person of Late-stage Medical Care System for the elderly.
Family members who may live with or apart from the insured person:
- Spouse (including common law spouse)
- Children, grandchildren
- Siblings
- Parents and other lineal ascendants
Family members who must live with the insured person:
- Family members within the third degree of consanguinity other than those above
- Parents and children of the insured person's common law spouse
- Parents and children of deceased common law spouse
Eliminated the provision that requires elder brothers and sisters to live with the insured person to be eligible as dependents, starting October 1, 2016.
Requirements
To be certified as dependent, the family member must meet all of the conditions. The Health Insurance Society requires the applicant to submit documents which enable it to objectively confirm the facts on the following items, reviews the submitted documents comprehensively, and judges whether or not the applicant falls under a dependent:
- that he/she is in the extent of family relationship as provided for the Health Insurance Act;
- that he/she does not falls under the Late-stage Medical Care System for the elderly;
- that he/she mainly lives on insured person's income;
- that the fact that his/her living expenses are “mainly” borne by the insured person can be confirmed;
- that the insured person has economic capacity to continuously support him/her;
- that if he/she has any income, it meets the prescribed income requirement;
- that necessary documents required by the Health Insurance Society at the time of the review for certification or the implementation of annual validation (examination of eligibility for dependent) are submitted by due date;
- that if there is any other support obligor (*1) than the insured person, the contribution rate of the insured person in the dependent's livelihood is continuously higher than that of said support obligor (*2).
- *1 Other support obligor mean, for example, a “spouse” of the insured person in the case of a child, a “father” of the insured person in the case of a mother, and a “father, mother, or elder brother or sister” of the insured person in the case of a younger brother or sister.
- *2 In the case of husband and wife working together and supporting children, the children shall be dependents of either of which with the persistent larger annual income, regardless of the number of the children. In cases where respective annual incomes of husband and wife are nearly equal or where there is any temporary decrease or increase in annual income, income forecast, etc. in the past or future shall also be taken into account. [Handling of a supporting dependents jointly made by husband and wife]
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 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.
Income standards
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 a person with a disability that is eligible for receipt of Disability Employees’ Pension benefits) and 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 a person with a disability that is eligible for receipt of Disability Employees’ Pension benefits) and must be less than the amount of the allowance sent to the family member from the insured person, and furthermore, the amount of the monthly allowance sent to the family member must exceed one-half of the amount of his/her monthly living expenses. |
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Government measures to address annual income barriers (starting in October 2023)
What are annual income barriers?
Annual income barriers refer to threshold income amounts that determine whether or not taxes and social insurance premiums are incurred.
Individuals who have dependent status and work part-time or other non-regular jobs will lose their dependent status if their annual income exceeds a certain figure, and become an insured person under a company health insurance plan, National Health Insurance, or other insurance system. They will then be required to pay social insurance premiums, which may result in lower take-home pay.
One of two different annual income barriers applies for social insurance premiums, depending on company size and other factors: 1.06 million yen or 1.3 million yen.
(Source: Provisional measures to address annual income barriers (Ministry of Health, Labour and Welfare))
| 1.06 million yen annual income barrier | At companies with 51 or more employees, an employee will incur social insurance premiums if certain conditions, such as when monthly wages are 88,000 yen or more (i.e., annual income is approximately 1.06 million yen or more), are satisfied. |
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| 1.3 million yen* annual income barrier | Social insurance premiums are incurred automatically without exception, since the worker no longer meets the dependent eligibility criteria. |
- * 1.8 million yen if aged 60 or above or with a disability eligible for receipt of Disability Employees' Pension benefits
Handling for the 1.3 million yen annual income barrier
Although dependent certification is based on checking of taxation certificates and other documents from the previous year, if the worker’s annual income is expected to temporarily exceed 1.3 million yen due to longer hours because of labor shortage or other factors, the worker may choose to retain his or her dependent status simply by attaching a certificate from the employer.
(In principle, this handling is available no more than two consecutive times for a single worker.)
Those to whom the following conditions apply are ineligible for the support enhancement package for overcoming annual income barriers:
- Those for whom it is clear that the projected annual income will exceed 1.3 million yen on an ongoing basis, based on the terms of the employment contract or other conditions
- Those for whom it is clear that income will exceed 1.3 million yen not temporarily but on an ongoing basis due to a permanent increase in income, such as base pay rise or new permanent allowances
- Those unable to submit a certificate from their employer
- Those who become eligible for social insurance and covered by their employer’s health insurance
- Those whose livelihood is no longer recognized to depend mainly on the insured person due to the increase in the income they earn
>> In such cases, please complete procedures to remove the ineligible family member from your list of dependents promptly.
Extent of income
Dependent's income referred to herein means, not the earnings as defined in tax laws, but the total revenue before deduction of tax, etc. including transportation expenses. When the dependent obtains more than one incomes, each requirement shall be judged by the total amount thereof.
- (1) Salary income (total revenue before deduction of tax, etc. including transportation expenses) (*1)
- (2) Various types of pension income (national pension, employee pension, mutual aid pension, corporate pension, etc.)
- (3) Business income (independent enterprise, farming, fishery, forestry, income from real estate investment, etc.) (*2)
- (4) Unemployment benefits, etc. of employment insurance
- (5) Various types of benefits (invalidity benefit, maternity allowance, child allowance, childcare allowance, single-parent allowance, etc.)
- (6) Compensation benefits for absence from work, injury and disease compensation pension, etc. of the workman's accident compensation insurance
- (7) Continuous interest or dividend distribution (*3)
- (8) Sending money as an allowance by any person other than the insured person
- (9) Any other items to be recognized as continuous incomes
- *1 Annual income means, not any income in the past, but any income expected to obtain at the time of the application for certification as dependent or on and after the certification date thereof.
Expected annual income of salary shall be calculated by:
[Average amount of salary for the last three months × 12 months ＋ Total amount of bonus, transportation expenses and lump sum, etc.]
When the amount of the relevant income extremely differs from that of other month due to a temporary increase or decrease of the number of working days or working hours, payment slips for other months or work schedules may be required to additionally submit for confirmation of expected income.
When the object person is newly employed and therefore the income certificate for the last three months is not available, judgment will be made after confirmation of the expected income for after employment date through employment agreement, etc. When no income is obtained after retirement, he/she is deemed in the state of having no income.
- *2 In addition to a copy of the last final tax return, please submit a copy of the statement of income and expense and the blue return because a business income is not an income in final tax return but a total revenue less direct necessary expenses.
| Items not deemed as the direct necessary expenses | depreciation; allowance for bad debt; bad debts; special deduction of blue return; miscellaneous expense; taxes and dues; advertising expense; non-life insurance premium; interest reduced rate; welfare expense; salary or wage; various membership fees; supplies expenses/miscellaneous expense; books and subscription costs; communications expense, rent account, vehicle expense or parking fee that also serves as personal use; entertainment expenses, etc. |
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When the object person continuously conduct any business and obtains certain income therefrom, his/her ability to support himself/herself may also be taken into account in the judgment of dependent eligibility.
- *3 Earnings by conveyancing or retirement allowances shall,
- not be included in the income for the judgment of dependent eligibility, as temporary earnings, if they are paid in a lump-sum, however,
- be included in said income if they are accompanied by continuous profitability in nature, including the case where they are paid to the object person in monthly installments.
Certification date of dependent
The date of the day on which the submitted Notification of Health Insurance Dependent (Change) and a set of documents necessary for the review of dependent eligibility are accepted by the Health Insurance Society on the ground that the applicant is recognized as the supporter of said dependent, shall be the “Certification date” for dependent eligibility. However, the certification date shall be the date of birth of the dependent in instances where “birth” is marked as the reason for the application.
Deletion date of dependent
When the family member certified as dependent has become not to meet the requirement for dependent due to his/her getting employed, increase in income, separation, death, divorce or commencement of receiving unemployment benefits, etc., the procedure for deletion of dependent eligibility shall be taken. The date of the day on which the family member has become not to meet the requirement for dependent shall be the “Deletion date” for dependent eligibility. After the deletion date, the family member is not eligible to receive any health insurance treatment, benefit money or subsidy for medical checkup, etc.
When the family member receives any unauthorized benefits or subsidies after his/her deletion date due to delay in his/her notification or return of insurance card, he/she shall be subject to claims by the Health Insurance Society for reimbursement of its burden charge.
Examination of dependent eligibility (validation) after certification
The examination of dependent eligibility (validation) is a procedure for confirming that the dependent currently meets the requirement for certification. For also this health insurance, this procedure is being carried out every year pursuant to the notification of the Ministry of Health, Labour and Welfare, “Validation shall be carried out every year from the standpoint of optimization of insurance benefits.” Failure to submit any necessary documents in the examination of dependent eligibility for the validation may bring about deletion of the dependent eligibility by reason of non-existence of the fact satisfying the requirement. Therefore, please keep in custody the documents capable of confirming the state of income and the fact of sending money as an allowance (and the amount thereof), etc., including payment slip, pension notification and statement of sending money, at least for the past one year, for ensuring that you can submit those documents at any time.
Penalty for false application
When it is found that any family member made a false application and thereby certified as dependent, his/her dependent eligibility shall be retroactively revoked, and he/she shall be subject to claims by the Health Insurance Society for reimbursement of its burden charge arising on and after the deletion date, including costs of medical care and other benefits.
Other
If in the review for certification, it is difficult to judge whether or not the requirement for dependent is met or to determine the certification date, based on the prescribed documents alone, then the Health Insurance Society may require the applicant to submit additional documents, and comprehensively conduct the review based on the all of the submitted documents. If after the review for certification, it is decided that the case is out of the scope of this standards, then the case shall be individually judged in the light of the specific circumstances, after confirming details of the case.
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