Send the application form
Send the application form
- * 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.)
| Society insured persons | Voluntarily and Continuously Insured Persons | |
|---|---|---|
| Notice of dependent transfer, Dependent charge sheet, Dependent charge sheet * (Including other documents, etc. that must be submitted for dependent certification) |
HR department (If there is a guidance from the HR department, submit it to the outsourcee.) |
Health Insurance Society |
| Injury and Sickness Benefits Application | ||
| Maternity Lump Sum Allowance/ Additional Maternity Lump Sum Allowance Application * | ||
| Maternity Allowance Application * | ||
| Claim for Funeral Expenses * | ||
| Insurance card/ Elderly beneficiary card Loss, destroyed and reissue application | ||
| Request for Voluntary Continued Caverage Status | Health Insurance Society | |
| Notice of Disqualification for Voluntary Continued Caverage Status | ||
| Application Form for Medical Care Expenses, Detailed medical fee statement | ||
| Application for Co-payments | ||
| for Overseas Medical Care Expenses | ||
| Application Form for Transportation Expenses | ||
| Documents related to “medical expenses due to injuries or sickness resulting from the act of a third party” | ||
| Application for certificate to receive treatment for specific diseases and disorders |