List of application forms Forms related to health insurance cards and eligibility Forms related to benefits and claims Forms related to third-party actions (including traffic accidents) Forms related to traffic accidents caused by your own negligence Forms related to health insurance cards and eligibility Title of formDownload notice/application formDownload example of completed notice/form Application Form for Reissue of Health Insurance Card (Card loss/Damage)FormExample of completed form Notification of Health Insurance Card LossFormExample of completed form Notification of Loss of Eligibility as Health Insurance DependentFormExample of completed form Notification of Loss of Eligibility as Health Insurance Dependent (for period of receipt of unemployment benefits)FormExample of completed form Application Form for Dependent CertificationFormExample of completed form Unemployment Benefits Receipt Confirmation FormFormExample of completed form Unemployment Benefits Waiver Confirmation Form.FormExample of completed form Survey Form of Livelihood Dependency on Insured PersonFormExample of completed form Notice of Change to Registered Health Insurance InformationFormExample of completed form Application Form for Certification as Health Insurance Voluntarily and Continuously Insured PersonFormExample of completed form Notification of Long-term Care Insurance (Qualification/Disqualification) (Insured Person)FormExample of completed form Application form for reissue of specified health diagnosis examination ticket/health guidance ticketFormExample of completed form Forms related to benefits and claims Title of formDownload notice/application formDownload example of completed notice/form Claim for Medical Care Expenses (Insured Person, Dependent)FormExample of completed form Letter of Consent to InvestigationForm- Dental consultation details (for dental care)Form- Medical consultation details (for non-dental care)Form- Itemized receiptForm- Request for issuance of Maximum Co-payment Certificate for Health InsuranceFormExample of completed form Application Form for Approval of TransportationFormExample of completed form Application Form for Transportation ExpensesFormExample of completed form Claim for Injury and Sickness Allowance/Additional SumFormExample of completed form Claim for Maternity Allowance/Additional SumFormExample of completed form Claim for Childbirth and Childcare Lump-sum Grant (Insured Person, Dependent)FormExample of completed form Claim for Funeral Expenses/Funeral Costs (Insured Person, Dependent)FormExample of completed form Application for Payment of High Aggregate Cost for Long-Term Care ServiceFormExample of completed form Application Form for Issuance of Copayment Certificate (Aggregation for Long-Term Care Service for the Aged)FormExample of completed form Health Insurance Application for Payment of Benefits (Outpatient Annual Aggregate)/Issuance of Copayment Certificate for High-cost Medical Expenses FormExample of completed form Application Form for Certificate Issued for Specific Disease TreatmentFormExample of completed form Forms related to third-party actions (including traffic accidents) Title of formDownload notice/application formDownload example of completed notice/form Notification of Injury or Sickness due to a Third-party Act FormExample of completed form Written PledgeFormExample of completed form Interim Report on Traffic AccidentFormExample of completed form Notice of Completion of TreatmentFormExample of completed form Application Form for Exemption from Refunding of Insurance BenefitsFormExample of completed form Forms related to traffic accidents caused by your own negligence Title of formDownload notice/application formDownload example of completed notice/form Notice of Accident Due to Own NegligenceFormExample of completed form
Forms related to health insurance cards and eligibility
notice/application form
completed notice/form
Forms related to benefits and claims
notice/application form
completed notice/form
High-cost Medical Expenses
Forms related to third-party actions (including traffic accidents)
notice/application form
completed notice/form
Forms related to traffic accidents caused by your own negligence
notice/application form
completed notice/form