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Health insurance system
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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 “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 Association.
  • When there was a change in a dependent, please make the notification prompt.

Note: If the Health Insurance Association has received the documents and certifies dependency within one month, certification will be retroactive to the date on which the reason for dependency arose. If the documents are received after more than one month, the date of certification will be the date on which the Health Insurance Association received the documents and certifies dependency. (The date of certification for a newborn child is the child’s date of birth.)

Dependent certification flowchart

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. For more information, click in the chart below on the relationship of the family member for whom you wish to apply for dependent certification.

Health insurance dependents

To be certified as a dependent, a family member must live primarily off the income of the insured person.
Certification of a family member as a dependent entails application procedures and a screening process. Start by checking the dependent certification criteria, then prepare the necessary documents and submit them to the Health Insurance Association.

Note: The system for certification as a dependent under health insurance differs from the system for certification for the dependent allowance paid by your employer or for certification as a dependent under tax law.
You cannot complete health insurance procedures from the Payroll Self-Service Menu.

Not all family members will be certified as dependents

Keep in mind that not every family member will be certified as a dependent and issued a health insurance card.
Eligibility for dependent certification is determined by reviewing the family member’s income to see if it meets dependent certification criteria, based on applicable laws and regulations, and through a rigorous, fair, and impartial screening of whether or not the family member actually depends on the income of the insured person, his or her livelihood, whether he or she could be the dependent of any other family member, and whether naming the family member as a dependent would be appropriate in light of socially accepted norms.
Medical care costs and other insured costs for dependent family members are covered by insurance premiums paid by the employer and the insured person (employee).
Strict certification of dependents is essential to ensure the financial soundness of the Health Insurance Association. For these reasons, please keep in mind that some family members may not be certified as dependents.

The insured person is responsible for completing various procedures related to dependents

The insured person is responsible for various procedures from applying for dependent certification of family members to tracking the state of their income at all times after certification and taking appropriate action when needed.

Review of dependent certification

Eligibility for dependent certification is reviewed at specified intervals. The insured person must retain documents such as certificates of allowance remittance for submission at any time when requested to do so. Inability or failure to submit the necessary documents during this review may result in revocation of dependent certification.

Penalties for false applications

If an insured person is determined to have had a family member who is not dependent on his or her income certified as a dependent through a false application, certification of the dependent will be canceled retroactively, and the insured person will be required to repay all medical care costs incurred during that period as well as other benefits provided.

See here for procedures.

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