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”. To be certified as dependents, family members must satisfy certain conditions related to "residency in Japan," "the extent of the family relationship," and "income," and they must also primarily live off of the insured person. The PwC Health Insurance Society screens people for eligibility and certifies them as dependents based on the "PwC Health Insurance Society Dependent Certification Standards."
- Dependents must be certified by the Health Insurance Society.If a current dependent no longer satisfies the conditions, it is necessary to apply to have them removed as a dependent.
- If there is any change in your dependents, submit notification within five days of the date on which a dependent was added or removed.
- Certification is performed based on the "PwC Health Insurance Society Dependent Certification Standards".
Conditions for recognition of supporter status
Supporter flow chart ：Check the following chart to see if someone qualifies as a supporter.
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.|
* The income includes social security benefits, etc.
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 perform specific procedures if family members who used to be certified as dependents no longer satisfy the dependent certification standards due to marriage, childbirth, adoption, an increase in dependents due to a decrease in family-member income, etc., coverage by different health insurance due to employment, an increase in income, divorce, living apart, reaching the age of 75, death, etc.The Health Insurance Society checks the eligibility status of dependents annually.