• Application forms related to the health insurance card and applications
• Application forms related to insurance benefits
• Documents required for health center/Physical education encouragement

Application forms related to the health insurance card and applications

form	example
Notification of dependent (s)(transfer)	Example(Add) Example(removal)
Application Form for Issue/Reissue of Eligibility Verification Certificate	Example
Application Form for unregistration of Myna health insurance cards
Application for Reissuance of Health Insurance Eligibility Information	Example
Notification of Lost or Nonrecoverable Health Insurance Card	Example
Notification of a Change (Correction) of Name of the Insured	Example
Notification (Change) of Health Insurance Insured Address	Example
Notification of a Correction of Date of Birth of the Insured	Example
Notification of Acquisition of Eligibility
Notification of Loss of Eligibility
Notification of Change of Insured Person Category
Notice of payment	Example
Notification of Change in Monthly Remuneration of Insured Person
Notification of Basis for Calculating Monthly Remuneration of Insured Person
Notification of Payment of Bonus of Insured Person
Report on Circumstances of Health Insurance Dependent	Example (【Child 】born) Example (【Child】other than born) Example (【Other than child / spouse】) Example (【Spouse】)
Notifications regarding Voluntary and Continuously insured persons	Example
Notification of Disqualification for Voluntary and Continuous Insurance
Notification Form for Exemption (eligible/ineligible) of Long-term Care Insurance
Application Form for Persons Taking Childcare Leave, etc. (New/Extension): Notification of Completion
Notification of Change in Monthly Remuneration on Completion of Childcare Leave, etc.
Application Form for Persons Taking Maternity Leave: Notification of Change (Completion)
Notification of Change in Monthly Remuneration on Completion of Maternity Leave

Application forms related to insurance benefits

form	example
Payment Application Form of Injury and Sickness Benefits / Supplemental Injury and Sickness Benefits	Example
Payment Application Form of Supplemental Injury and Sickness Benefits [Extension]	Example
Application Form for Medical Care Expenses	Example
Application Form for Medical Care Expenses (Therapeutic equipment) and Orthotic Confirmation Form ①②	Example
Application Form for Medical Care Expenses (for Acupuncture or Moxibustion)	Example
Application Form for Medical Care Expenses (for massage and shiatsu)
Application Form for Overseas Medical Care Expenses	Example
Table of International Classification of Diseases
A medical care statement or the like (medical)
Itemized Receipt (Medical)
A medical care statement or the like (dental)
Agreement of Authorization and Signature (Fill in both Japanese and English)	Example
Application for Payment of Childbirth and Childcare Lump-Sum Grant	Example
Application for Payment of Maternity Allowance	Example
Application for Childbirth and Childcare Lump-sum Grant for dependents	Example
Application for Partial Payment of and Payment of Difference in Childbirth and Childcare Lump-Sum Grant, etc.	Example
Application for Payment of Childbirth and Childcare Lump-sum Grant (for Receipt on Your Behalf)	Example
Application for Payment of Funeral Expenses	Example
Request for issuance of Maximum Co-payment Certificate for Health Insurance Reference link *Cases in which no Certificate of Application of Maximum Copayment Amount is needed	Example
Medical care cost information (details)	Example
Application for Payment of High Aggregate Cost for Long-Term Care Service
Notification of Sickness and Injury due to a Third-party Act	Example
Human Dock (Comprehensive Medical Examination), Brain Dock (Medical Examination of Brain) & PET Expense Bill	Example
Health Service Expense Bill	Example
Influenza Vaccination Subsidy Application	Example
Gynecological Examination Subsidy Bill	Example
Stomach cancer screening Subsidy Bill	Example
Application Form for Transportation Expenses	Example
Notification of Cause of Health Insurance Injury	Example

Documents required for health center/Physical education encouragement

form
Application for (Planned) Implementation of Physical exercise encouragement Event
Report on Implementation of Physical exercise encouragement Event
Application for (Planned) Implementation of Walkathon
Report on Implementation of Walkathon