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.
- Dependents must be certified by the Health Insurance Society.
- If there is any change in your dependents, submit notification of the change within five days.
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.
- ** Plans call for eliminating the provision that requires elder brothers and sisters to live with the insured person to be eligible as dependents, starting October 1, 2016.
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.|
Income for self-employed persons
Income for salary earners is based on gross income. For the self-employed, the portion qualifying as income can vary at the various stages of revenue accounting. Thus, the Rakuten KENPO applies the following standards for self-employed persons:
- Income is defined as revenue before deductions for necessary expenses, not final taxable income amount. (The rationale behind this approach is that the income of salary earners is also regarded as the amount before deductions for necessary expenses—in their case, salary deductions.)
- However, purchasing costs are deducted for self-employed persons involved in businesses involving merchandise sales or food service, since the direct cost of purchasing stock cannot be considered revenue. Income in this case is defined as net sales minus purchasing costs—or what is generally referred to as gross profit on sales.
Requirements when applying to have a parent, mother-in-law, father-in-law, or grandparent recognized as a dependent
As a matter of course, married couples are assumed to live together and to have primary responsibility for mutual aid and support, so they strongly rely on the income of each other for their livelihood.
For this reason, if a parent or grandparent for whom you are applying for dependent certification has a spouse, the actual conditions of the couple’s household and livelihood will be assessed to determine whether or not the subject of the application depends mainly on the income of the insured person for his or her livelihood on a continual basis.
Specifically, even if one of the spouse’s incomes is below the standard amount, if the other spouse earns enough for both spouses to live on, that spouse is regarded as the person with primary responsibility for the couple’s livelihood, and the parent or grandparent may not be named a dependent of the insured person.
If a dependent family member is not Japanese
In principle, a family member must live in Japan to be considered a dependent. Applicants lacking a family visa or resident card will be regarded as ineligible for dependent certification. (Family members staying in Japan for short periods are not considered to live in Japan because such arrangements are temporary and their primary residence remains unchanged.)
Date of certification
In principle, the notification must be submitted within five days after the reason for adding the family member arises. However, notifications submitted more than five days later will be handled as follows:
- Notifications received (by the Association) within one month after the date the reason for adding the family member arose:
certified retroactive to the date on which the reason for adding the family member arose
- Notifications received (by the Association) more than one month after the date the reason for adding the family member arose:
certified effective from the date on which the notification was received
- ** Note that certification in both cases 1 and 2 above requires verification of all documents attached and other materials.
If there has been a change in dependents
You must take specific steps if the number of dependents increases due to marriage or childbirth or a family member is no longer eligible as a dependent for reasons such as employment, living apart from the insured person, or death. The Health Insurance Society checks the eligibility status of dependents annually.