Application forms

* Check here for where to send the application form.

Insurance card and application-related forms

  • Please download the format from here and submit it on print.
  • * Do not download the form from here. Please apply on the HC web Service (Applying for Change of Personal Information) as instructed by the Human Resources Department. A complete set of required documents will then be sent to you by Otsuki Management & Labor Consulting Office. (This excludes Voluntarily and Continuously Insured Persons.)

Benefit and claims-related forms

  • Please download the format from here and submit it on print.
  • * Do not download the form from here. Please apply on the HC web Service (Applying for Change of Personal Information) as instructed by the Human Resources Department. A complete set of required documents will then be sent to you by Otsuki Management & Labor Consulting Office. (This excludes Voluntarily and Continuously Insured Persons.)
form Example
  •  There are two types of requests for issuing the Maximum Co-Payment Certificate for health insurance: electronic application and paper mail.
    Please apply by either method. In addition, ID and password are required for electronic application.

電子申請サービス

 
 
 
 
 
 
 
 
 
 

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