Application form lists
- Health insurance eligibility and application-related forms
- After retirement health insurance-related forms
- Childbirth and Childcare Lump-Sum Grant/therapeutic accessory/ Charges forward/ Maternity Allowance/ injury and sickness allowance/ Funeral Expenses and application of other benefits and Maximum Copayment Amount
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- *Send to address recorded in each application forms.
Health insurance eligibility and application-related forms
After retirement health insurance-related forms
Childbirth/Death/Other benefit application
| form | Sample |
|---|---|
| Application Form for Medical Care /ExpensesDetails of treatment | |
| See this Procedures page to apply for medical care expenses for acupuncture/moxibustion or massage. | |
| Claim for Injury and Illness Allowance *Submit both sheets. Claim for Injury and Illness Allowance (for continuing benefits) *Submit both sheets. |
|
| Claim for Maternity Allowance | |
| Application for Payment of Childbirth and Childcare Lump-sum Grant | |
| Claim for Funeral Expenses | |
| Application Form for Transportation Expenses | |
| Application Form for Overseas Medical Care Expenses (Since this form is a five-sheet carbon-copy form, it is not available to download. Request it from the Health Insurance Association.) |
|
| Notification of Injury or Illness due to a Third-party Act(page1) Notification of Injury or Illness due to a Third-party Act(page2)*Submit both sheets. Attach the Written pledge below Written pledge |
|
| Request for issuance of Maximum Co-payment Certificate for Health Insurance | Sample |
When examination in the health insurance association is completed, the benefit mentioned above is transferred to the company in a total around 24th of the next month on the end of the month. The personal payment is transferred to the registered bank account.
If you apply using just your Social Security and Tax Number, you will be required to submit additional documents. Consult with the Association in advance. If you enter your Health Insurance Card Symbol and Number, you do not need to indicate your Social Security and Tax Number.