Sony Health Insurance Society

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Family membership

A family member must be certified by the Sony Health Insurance Society to be named a dependent. A family member will not be automatically certified as a dependent simply because he or she is a dependent for tax purposes or is your spouse.
The most important conditions for dependent certification are that the dependent must have certain familial ties to the insured person and that his or her livelihood must depend primarily* on the income of the insured person. Other requirements apply as well.

  • * Depending primarily on the income of the insured person:

    As a general rule, the insured person must provide for at least one-half of the dependent’s cost of living. However, if the actual income status of the family member for which certification is requested and that of the insured person differ significantly from ordinary cases or if certification may be considered inappropriate in light of societal norms, the family member may not be certified as a dependent.

Differences from dependents for tax purposes

Tips
  • 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.

Dependent eligibility check flowchart

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.

  • ** Eliminated the provision that requires elder brothers and sisters to live with the insured person to be eligible as dependents, starting October 1, 2016.

Income standards

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.

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.

Income conditions for dependent certification

Even if the family member is eligible for certification as a dependent, the following income conditions must be met as well:

  • * Both income conditions [A] and [B] below must be met.
  • * For health insurance purposes, income includes all funds that can be used to pay for various life expenses.
    These include salary (including bonuses and salaries of family members employed full-time in a family business), standard pensions (including survivor and disability pensions), public employees’ pensions, interest, dividends, business income, injury and sickness allowance, childbirth allowance, allowances provided by others, and other cash income or income in kind.
  • * If multiple members of the household receive income
    For health insurance purposes, the person earning the highest income is considered to be the one on which the family member relies for his or her cost of living. If multiple members of the household receive income, their incomes will be compared. The family member will be considered a dependent of the person earning the highest income.
    However, if two or more family members earn roughly the same amount (i.e., the difference in their annual incomes does not exceed 10% of the higher income), the family member will be considered a dependent of the person applying for dependent certification.
    Note that even if the difference in annual incomes does not exceed 10%, the family member will not be certified as the dependent of an income earner if this income earner is deemed unlikely to be the primary provider for the family member.

Example: An application to certify a child as a dependent when both parents work

Insured person’s annual income >= spouse’s annual income ⇒ dependent of insured person
Insured person’s annual income <= spouse’s annual income ⇒ dependent of spouse

Note that a family member will not be automatically certified as a dependent simply because these conditions are met.

Dependent certification is based on other criteria beyond the above figures. The certification process will thoroughly assess specific circumstances, such as the incomes of other relatives responsible for the family member.

[A] Income status by age

Less than 60 years of age Annual income less than 1.3 million yen
Aged 60 or above or receiving disability pension Annual income less than 1.8 million yen

Example of calculating annual income

Annual income for one year from now is estimated based on income over the most recent three months.

Calculating annual income

  • Salary income {(total amount paid over most recent three months ÷ 3) × 12 months} + (bonus × number of times paid)
    • * For both salary and bonuses, the figure used is the total amount paid before withholding taxes, including commuting allowance.
    • * The salary income for a family member working full-time for a family business is the amount reported on the previous year’s income tax return.
    • * A certificate of income and withholding tax does not show the most recent income and therefore is not a valid proof of income.
  • Amount paid by standard pension, public employees’ pension × number of times paid <standard pension: 6 times; public employees’ pension: 4 times>
    • * Amount paid before withholding long-term care insurance premiums
  • Self-employment [net sales - (cost of sales + expenses)]
    • * Generally speaking, expenses exclude the following:
      • Depreciation (for purchases of assets and other property, expenses refer to actual cash payments only)
      • Basic deductions such as blue-form return deductions
      • Salaries, wages, and other personnel costs
      • Other expenses not recognized by the Sony Health Insurance Society as direct and necessary expenses
        • * Direct expenses refer to the cost of raw materials and other items needed in production activities (for example, in the case of a bakery, the cost of flour, eggs, and other ingredients).
        • * Submit a report on direct expenses for your expenses, as some expenses may be conditionally recognized as direct and necessary expenses.
  • Employment insurance benefits received (daily amount of base allowance × 360 days)
    • * In principle, a family member cannot be certified as a dependent while receiving employment insurance benefits. Nevertheless, you may apply for certification in the following case: when (daily amount of base allowance × 360 days) < 1.3 million yen (or 1.8 million yen as applicable)
    • * The daily amount of base allowance must not exceed 3,611 yen (or 4,999 yen, as applicable) to satisfy the above condition.

[B] Income status of those living together with or apart from the insured person

Living together Must earn less than one-half the insured person’s annual income.
Living apart Must earn less than one-half of the insured person’s annual income. The allowance provided by the insured person must be equal to or exceed the family member’s annual income and must be equal to or exceed the minimum remittance amount.*
The cost of living of the dependent living apart and receiving the remitted funds must not exceed the cost of living of the insured person.
[Dependent’s annual income + annual remittances from insured person] < [insured person’s annual income - annual remittances to dependent]
  • * Minimum remittance amount: The amount remitted per month must not be less than the amount indicated below, regardless of the dependent’s income:
  • For one dependent: 50,000 yen
  • For two dependents: 75,000 yen
  • For three dependents: 100,000 yen
For each additional dependent: add 25,000 yen

Note that a family member will not be automatically certified as a dependent simply because these conditions are met.
Dependent certification is based on other criteria beyond the above figures. The certification process will thoroughly assess specific circumstances, such as the incomes of other relatives responsible for the family member.

Date of certification

The date of certification of the dependent will be as shown below.

(1) If no documents need to be returned

If the employer (or other party to which the application is submitted) received the dependent certification application and related documents within five working days of the day after the date on which the applicant became eligible as an insured person or the family member became eligible for certification and were received by the Health Insurance Society within five working days thereafter

Remittance of funds to a family member living apart

If a dependent lives apart from his or her family, he or she must receive funds remitted from the insured person at least equal to his or her own income and must depend primarily on these funds for his or her living.

  • * In certain cases, simply remitting funds at least equal to the dependent’s income will not be sufficient for dependent certification, even if the amount remitted has been verified.
  • * Dependent certification will be based on a comparison of living costs of the dependent subject to the request for certification and others living with the insured person; a comparison of living costs to those of the insured person’s household after remittance; standard national figures for costs of living by prefecture based on a statistical survey by the National Personnel Authority; and other information. The family member will be certified as a dependent only if it is determined, based on a comprehensive review of the facts of the case, that he or she depends primarily on funds remitted from the insured person.

Checking the allowance

The Sony Health Insurance Society conducts an annual remittance review of family members living apart from insured persons to confirm whether or not such family members actually rely on the insured person for their living costs. This review requires proof of allowance. Please submit this proof as instructed by the Society.

The Sony Health Insurance Society does not consider cash handed over in person to cover the costs of living to constitute remittance.  Be sure to remit such funds in a form for which documentation can be provided.

As a rule, this review will not be conducted in the case of a child attending school in a remote location, since the parent is responsible for the child in such cases and remittance of funds is expected as a matter of course.

Caution

Be sure to retain proof of remittance. If you cannot provide such proof, the family member will lose his or her certification as a dependent. If you cannot provide such proof, the family member will lose his or her certification as a dependent.

Category 3 Insured Persons under the National Pension System

See below for more information on eligibility requirements for Category 3 Insured Persons under the National Pension System, exceptional cases, and other matters.

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