Application forms
- Health insurance eligibility and application-related forms
- Benefit forms
- Dependent-related/Congratulatory or Condolence-related Forms
- Retirement-related/Nursing Care-related Forms
Health insurance eligibility and application-related forms
| Application Form for Issue/Reissue of Health Insurance Eligibility Certificate | (137KB) | (26KB) |
| Notification of Name Change (Correction) of Insured Person | (128KB) | (151KB) |
| Notification of Name Change (Correction) of Dependent | (132KB) | (59KB) |
| Notification of Address Change | (72KB) | (34KB) |
| Request for issuance of Maximum Co-payment Certificate for Health Insurance | (119KB) | (94KB) |
| Request for issuance of a certificate | (8KB) | (32KB) |
| Statement on the income earned from engaging in COVID-19 vaccine administration services | (84KB) | (20KB) |
| Application Form for Cancellation of Myna Health Insurance Card | (39KB) |
Benefit forms
| Application form for Patient Cost-Sharing Reimbursements and Additional Benefits | (131KB) | (53KB) |
| Claim for Dependents' Medical Care Additional Sum | (138KB) | (54KB) |
| Application form for Combined High-Cost Medical Care Benefits | (138kB) | (165KB) |
| Application for Loan of High-cost Medical Expenses | (75KB) | (38KB) |
| Certificate on Borrowing of Money for High-cost Medical Expenses | (53KB) | (30KB) |
| Application for Payment of High Aggregate Cost for Long-Term Care Service | (241KB) | (51KB) |
| Claim for Injury and Sickness Allowance/Additional Sum | (267KB) | (128KB) |
| Application Form for Medical Care Expenses | (159KB) | (111KB) |
| Application Form for Overseas Medical Care Expenses | (387KB) | (107KB) |
| Application Form for Transportation Expenses | (138KB) | (81KB) |
| Notification of Injury or Sickness due to a Third-party Act | (242KB) | (144KB) |
| Report on Status of an Accident (for Single-Vehicle Accidents or Accidents Not Caused by an Act of a Third Party) | (120KB) | (48KB) |
| Letter of Understanding-cum-Letter of Consent | (97KB) | (35KB) |
| Application Form for Medical Care Expenses/Letter of Consent on Medical Care Expenses/Medical Certificate (for Anma Therapy/Massage) | (272KB) | (110KB) |
| Application Form for Medical Care Expenses/Letter of Consent on Medical Care Expenses/Medical Certificate (for Moxibustion/Acupuncture) | (261KB) | (98KB) |
| Memo on Reservation for Complete Check-up, etc. (for Non-contracted Hospitals) | (43KB) | |
| Application for a subsidy of complete check-up, etc. (for non-contracted hospitals) | (48KB) |
Dependent-related/Congratulatory or Condolence-related Forms
| Notification of Health Insurance Dependent (Change) | (198KB) | (32KB) |
| Letter of Understanding and Consent on Dependent Application | (96KB) | (43KB) |
| Claim for Childbirth and Childcare Lump-sum Grant/Additional Sum | (178KB) | (78KB) |
| Request for Partial Payment of Childbirth and Childcare Lump-sum Grant | (141KB) | (98KB) |
| Application for Payment of Childbirth and Childcare Lump-sum Grant (for Receipt on Your Behalf) | (272KB) | (159KB) |
| Claim for Maternity Allowance/Additional Sum | (172KB) | (76KB) |
| Application for Loan of Childbirth Money | (69KB) | (38KB) |
| Certificate on Borrowing of Childbirth Money | (53KB) | (30KB) |
| Notification of Intention to Take Maternity Leave/Change (End) of Maternity Leave | (190KB) | |
| Notification of Intention to Take Childcare Leave, etc. (New/Extension)/End of Childcare Leave, etc. | (271KB) | |
| Statement on Current Circumstances, Letter of Understanding and Consent | (204KB) | (94KB) |
| Claim for Funeral Expenses/Additional Funeral Expenses | (182KB) | (150KB) |