Obtaining coverage as a dependent
This page describes how to obtain coverage for dependents. Some family members may not be eligible as dependents. Please read this page carefully and use caution to avoid making mistakes when undertaking these procedures.


Minimum conditions for eligibility (authorization)

Family members must be approved by Sony Health Insurance to become "dependents." A family member is not automatically eligible simply "because he or she is designated as a dependent for taxation purposes" or "is the spouse of an insured individual."
The most important criterion for approval of an individual as a dependent is "being in a certain familial relationship with the insured"; "subsisting primarily(*) of the income of the insured." Other requirements must be met as well.

* “Primarily” refers to the following cases:
Although this is merely a figure to be used as a guideline, at least one-half of your living expenses should be covered by assistance from the insured. Eligibility may be denied in certain cases in which the actual circumstances of the eligible individual's income and the insured individual's income differ significantly from the circumstances under which eligibility was determined, and if such eligibility would be deemed inappropriate from a commonsense perspective.



Kinship of family members eligible as dependents

You must be within 3 degrees of relationship from the insured individual.


Illustration Family members eligible as dependents
(scope of dependents considered to fall within the third degree of relationship)

Illustration:Family members eligible as dependents


Income conditions for approval as a dependent

To be approved as a dependent, a family member must meet the following income conditions:
* The family member must meet both income conditions [A] and [B] below to be approved.
* Income for health insurance purposes includes all funds that may be used to pay for living expenses.
Salary (including bonuses and income of family members employed full-time), pensions (including pension payments for surviving family members and disability), public employee pensions, interest, dividends, business income, injury and sickness allowance, remittances from other individuals, other income received in cash and in kind, etc.


[A] Income conditions by age
Individuals less than 60 years of age Annual income of less than 1.3 million yen
Individuals aged 60 or above, or disabled individuals Annual income of less than 1.8 million yen
Overview of annual income calculations
Your annual income for the coming year will be estimated based on your income over the most recent 3 months.



[Calculating annual income]
Salary income ([total amount paid over the most recent 3 months / 3] x 12 months) + (bonus x number of times paid)
* The salary and bonus amounts used are gross amounts before tax deductions, including commuting costs reimbursed by the company.
* For the income of family members employed full-time, the amount from the previous tax year's income tax return is used.
* Note that figures from "withholding allowance certificates" are not acceptable because they cannot be used to confirm your most recent income.

Amount paid in ordinary pension and public-employee pension payments x number of times paid <6 times for ordinary pensions; 4 times for public-employee pensions>
* The figures used are before deductions for long-term care insurance premiums.

For self-employment income: [sales figure – (sales costs + general expenses) + depreciation] + other income (e.g., pension income, real-estate income)
* Since depreciation is an expense that does not require cash payments, it is generally not counted as part of the general expenses.
However, general expenses include actual cash payments made, such as those for acquisition of assets.

Unemployment insurance income (basic daily benefit amount x 365 days)
* Although you cannot in principle become a dependent while receiving unemployment insurance benefits (this also applies to the waiting period between the time you leave the company and the time you receive benefits and periods in which benefits are restricted), you may apply in the following cases: when your basic daily benefit amount x 365 days is less than 1.3 million yen (or 1.8 million yen).
*Beginning October 2006, you are able to apply for health insurance coverage for a dependant before receiving unemployment insurance benefits. See here for details.
[B] Income conditions for family members living together or separately
Living together The dependent's income must be less than 50% that of the insured.
Living separately In addition to the requirement that the dependent's income be less than 50% that of the insured, the amount remitted by the insured must be no less than the dependent's annual income.


Application documents and deadlines for submission

Family members who meet all conditions may apply for eligibility as dependents. Submit the Dependent (Change) Notice for Health Insurance System, the Survey form for individuals eligible for medical assistance (public funds), and all required documents (see the List) along with your health insurance card.

In addition, please complete dependent application procedures with the individual in charge of health insurance matters at your workplace within 5 actual working days in reference to the Sony Health Insurance Society Calendar following the day on which the reason for eligibility application arises. If these procedures are completed more than 5 days later, the date of approval will be the day on which they were received, and provision of health insurance benefits will also begin from this date.

health insurance card code number submit to
101、302、318、349、350、367、431、703、714、719、720 Eligibility, Health Insurance Group SCOS Social Insurance Center, 11th Floor, Shinagawa Intercity B
In case other than those above The individual in charge of health insurance matters at your workplace



In view of the time required to register the birth of an infant, the infant's eligibility as a dependent will be retroactive to the date of birth if the required procedures are completed promptly. When completing the procedures after 3 months from the dat of birth, please attach a certificate indicating the date of birth.

Dependent Notice (Notice of Change)
Survey form determining eligibility for dependent status

 


Attached documents

Purpose of use
The attached documents are required in the Sony Health Insurance Society's examination to confirm the annual income and residence status of the individual subject to authorization and to determine whether another individual with the ability to provide financial support lives within the same household.
Please click here to read about the purpose of use of the attached documents.

Submit originals of all documents unless “copy” is indicated. Documents other than originals will not be accepted. Note that no examination can be performed if documents are incomplete.
The documents submitted will not be returned. If necessary, make your own copies in advance.
Please note that you will be asked in some cases to submit documents other than those listed below as necessary for examination purposes. If you cannot consent to this condition, the examination will not proceed.

If you would prefer that the individual in charge of health insurance matters at your facility not see the personal information provided on these documents, please submit the documents in a sealed envelope.

PDF: List of documents required for "authorization" of eligibility



Authorization date

The authorization date for dependent status will be one of the following:

(1) If the documents do not need to be returned

When the dependent application documents have been received by the employer (i.e., the individual in charge of health insurance matters at your workplace) within 5 working days of the day after the date insurance eligibility was attained or reason for eligibility arose, and have been received by the Sony Health Insurance Society within 5 actual working days:

If there are no problems with the content of the application, the authorization date will be the date on which insurance eligibility was attained.

  

 (2) If the documents do not need to be returned
 

When the dependent application documents have been received by the employer (i.e., the individual in charge of health insurance matters at your workplace) 6 or more actual working days following the day after the date insurance eligibility was attained or reason for eligibility arose, and have been received by the Sony Health insurance Society within 5 actual working days:

If there are no problems with the application, the authorization date will in principle be the date on which the Dependent Notice (including attached documents) was received by the employer.

  

 (3) When not returned
 

When the dependent application documents have been received by the employer (i.e., the individual in charge of health insurance matters at your workplace) within 5 working days of the day after the date insurance eligibility was attained or reason for eligibility arose, and have been received by the Sony Health Insurance Society within 5 actual working days:

  

If the Sony Health Insurance Society receives the application for the second time within one calendar month following the date on which the reason for eligibility arose:
The authorization date will be set retroactively to the date on which the reason for eligibility arose.

If the Sony Health Insurance Society cannot accept the documents a second time within one calendar month following the date on which the reason for eligibility arose:
The entire set of application documents will be returned to the insured, and the authorization date will become the next occasion on which they are received by the Sony Health Insurance Society.
 (4) If the documents need to be returned
 

When the dependent application documents have been received by the employer (i.e., the individual in charge of health insurance matters at your workplace) 6 or more actual working days following the day after the date insurance eligibility was attained or reason for eligibility arose, and have been received by the Sony Health insurance Society within 5 actual working days:

  

If the Sony Health Insurance Society receives the application for the second time within one calendar month following the date on which it was received by the employer:
The authorization date will set retroactively to the date the documents were received by the employer.

If
the Sony Health Insurance Society cannot accept the documents a second time within one calendar month following the date on which they were received by the employer:
The entire set of application documents will be returned to the insured, and the authorization date will become the next occasion on which they are received by the Sony Health Insurance Society.
  (5) In cases other than those above, the authorization date will in principle be the date on which the Sony Health Insurance Society grants to the applicant eligibility as a dependent.

Reference Procedures for no.3 insured persons under the National Pension
If your spouse has been authorized as a dependent spouse, by conducting the required procedures he or she can be authorized as a no. 3 insured person under the National Pension. In such a case, there is no need to pay insurance premiums separately.
Documents to submit
Application for no. 3 insured person status under the National Pension
 
Documents to attach
Your spouse’s pension booklet (copy)
Note: When changing the name on the pension booklet, submit the original.
<When applying due to expiration of unemployment insurance benefits>
Also attach a copy of the Unemployment Insurance Benefits Eligibility Certificate (both sides)

Where to submit these To the same recipient as the Dependent (Change) Notice

Remittances to family members living apart from your family

If any dependent lives apart from your family, the insured must remit an amount greater than the dependent's income to him or her, and he or she must subsist primarily on such remitted funds. Sony Health Insurance will verify the status of such remittances each year through remittance audits. Please click here for detailed information.

Audits for verifying remittance status
Around June of each year, an audit will be performed to confirm that "any dependent family members living apart from the insured subsist primarily on funds provided by the insured." This audit requires certification that the insured remits funds to the family member(s) in question for living expenses. Submit this certification as instructed by Sony Health Insurance.

Living expenses provision via in-person cash delivery is not accepted as a remittance by Sony Health Insurance. Make sure that fund provisions are performed in a way that can be certified.

Since children attending school in distant locations are naturally considered dependents of their parents, their status is not subject to such audits.

*! Caution
If evidence of remittance provided at the audit is insufficient, the family member may lose his or her eligibility as a dependent. Be sure to retain any documents that prove remittance.



When a family member loses his or her status as a dependent

A family member will generally lose his or her status as a dependent in the following cases:
1. He or she gains insurance coverage under another health insurance plan, as when beginning a new job
2. He or she no longer meets the conditions for approval as a dependent, as when his or her income exceeds the levels permissible under these conditions
3. The dependent dies
4. The insured is no longer eligible for coverage due to his or her retirement from the company or upon death.

In cases 1 to 3, immediately following the date on which the case arises, attach the health insurance card to the "Dependent (Change) Notice" and submit to Sony Health Insurance. In case 4, immediately return the health insurance card to Sony Health Insurance.

Health insurance coverage ceases on the day on which the dependents are no longer eligible. In cases 2 and 4 above, immediately take the steps necessary to join another health insurance plan.


Loss of eligibility due to inspections of the status of all dependents

Every few years (in principle, every 3 years), Sony Health Insurance will perform "inspections of the status of all dependents" under the plan. This involves checking the status of dependents in regard to the requirements for approval and reapproval of such dependents. In certain cases, dependents will lose their eligibility following this audit. Please click here for detailed information.


Questions & Answers
After losing coverage eligibility (for example, after leaving the company), I applied to join the National Health Insurance system. But I was told "I needed a certificate of non-eligibility for my previous health insurance." What should I do?
Ask for "a certificate of health insurance coverage termination/elimination" by submitting a "Certificate Issuance Application."
"Certificate Issuance Application"
We request your cooperation with our comprehensive dependent investigation