Accenture Health
Insurance Society

Application forms, Contact

Application forms

Form (A4) Applications obtained from Applications submitted to
  • Health Insurance Notification of Change of Covered Dependents (Addition)
  • Notification of Change of Covered Dependents (Removal)
(When the name of a dependent is changed)
  • Health Insurance Notification of Change of Covered Dependents (Addition)(Name Change Report)

1.accenture : HRS(HR Services) (DL from ES)

2.avanade : HR Support

3.UBS : Corporate Planning Office

4.Voluntary Continual Coverage : BPO ( for AHIS)

1.accenture : HR-LCM-ES(MM office)

2.avanade : HR

3.UBS : Corporate Planning Office

4.Voluntary Continual Coverage :BPO ( for AHIS)

  • Dependent certification record
Certificate of Conditions of Employment
Example
  • Notification of Change of Insured Person Name
Claim for Health Insurance Payment of Funeral Expenses (Costs)
Example

1.accenture : Posted on this homepage

  • *When a family member dies, procedures to delete dependents are required. (Employee Support (ES))

2.avanade : Posted on this homepage

3.UBS : Posted on this homepage

4.Voluntary Continual Coverage : Posted on this homepage

1.accenture :
If the insured person has died:HR-LCM-LoA for retirement(MM office)
If a family member has died:HR-LCM-ES(MM office)

2.avanade : HR

3.UBS : Corporate Planning Office

4.Voluntary Continual Coverage :BPO ( for AHIS)

  • Request for Payment of Maternity Allowance

1.accenture : HRS(HR Services) (DL from ES)

2.avanade : HR Support

3.UBS : Corporate Planning Office

4.Voluntary Continual Coverage : AHIS

1.accenture : HR-LCM-ES(MM office)

2.avanade : HR

3.UBS : Corporate Planning Office

4.Voluntary Continual Coverage : AHIS

  • Injury and Sickness Benefits Application
1.accenture :
HRS(HR Services)
APSSC.HR.SUPPORT
@accenture.com

2.avanade : HR Support

3.UBS : Corporate Planning Office

4.Voluntary Continual Coverage : AHIS

1.accenture : HR-LCM-LoA for Sick/injured(MM office)

2.avanade : HR

3.UBS : Corporate Planning Office

4.Voluntary Continual Coverage : AHIS

(When reissuing a certificate)
Insurance Card/Senior Benefit Card Loss/Damage, Reissue Request
Example

1.accenture : HRS(HR Services) (DL from ES)

2.avanade : Posted on this homepage

3.UBS : Posted on this homepage

4.Voluntary Continual Coverage : Posted on this homepage

1.accenture : HR-LCM-ES(MM office)

2.avanade : HR

3.UBS : Corporate Planning Office

4.Voluntary Continual Coverage : BPO ( for AHIS)

(No need to reissue)
Report loss of "Health insurance card" and "Elderly beneficiary certificate
Example
Posted on this homepage

1.accenture : HR-LCM-ES(MM office)

2.avanade : HR

3.UBS : Corporate Planning Office

4.Voluntary Continual Coverage : BPO (for AHIS)

(No need to reissue)
Report loss of "Certificate for limit Application"and"Certificate of limit application / standard burden reduction"and"Specific illness medical treatment certificate
Example
Posted on this homepage BPO ( for AHIS)

You can apply for the issuance of a Certificate of loss of qualification either electronically or by paper mail.
You need to enter your ID and password for electronic application.
Electronic Application

Date of Acquisition/Loss of Qualification as an Insured Person Certification Request Application
Example
Posted on this homepage BPO ( for AHIS)
Written Notice for Acquisition of Qualification as a Voluntarily and Continuously Insured Person
Example
Posted on this homepage BPO ( for AHIS)
Written Notice for Loss of Qualification as a Voluntarily and Continuously Insured Person
Example
Posted on this homepage BPO ( for AHIS)
Request for Payment of Medical Expenses for Insured Person or Dependent
[Advance Payment on Behalf of Third Party]

Example
Request for Payment of Medical Expenses for Insured Person or Dependent
[for therapeutic devices, therapeutic eye glasses, etc.]

Example
Posted on this homepage BPO ( for AHIS)
Request for Payment of Medical Expenses for Insured Person or Dependent
[for massages]

Example
Request for Payment of Medical Expenses for Insured Person or Dependent
[for acupuncture and moxibustion]

Example
Posted on this homepage BPO ( for AHIS)
A letter stating that you agree to the health insurance society making detailed inquiries to the overseas medical care institution or other organization about your treatment Posted on this homepage BPO ( for AHIS)

You can request certificate below electronically or by paper mail.
You need to enter your ID and password for electronic application.
Electronic Application

Request for Issue of Health Insurance Eligibility Certificate for Ceiling-Amount Application Form
Example
Posted on this homepage BPO ( for AHIS)
(Those with low income, such as those who are exempt from municipal inhabitant tax)
Health Insurance Application for Eligibility Certificate for Ceiling-Amount/Reduction of the Standard Amount of Patient Liability
Example
Posted on this homepage BPO ( for AHIS)
Application for Health Insurance Payment of Medical Care Costs for Insured Person or Dependent
[for overseas medical expenses]
BPO ( for AHIS)
Application for Health Insurance Payment of Transportation Expenses for Insured Person or Family Member BPO ( for AHIS)
Application for In-home Care Support AHIS
The Childbirth and Childcare Lump-Sum Grant additional benefits for Insured Person or Family Member
[If not using the system of direct payment to medical institutions, or if childbirth took place outside of Japan]
Example
Posted on this homepage BPO ( for AHIS)
  • The Childbirth and Childcare Lump-Sum Grant additional benefits for Insured Person or Family Member System of receipt of the Childbirth and Childcare Lump-sum Grant directly by the medical institutions on your behalf
BPO ( for AHIS)
Notice of accident involving bodily injury due to the actions of a third party AHIS
Application for certificate to receive treatment for specific diseases and disorders
Example
Posted on this homepage BPO ( for AHIS)
Notification of Succession of Rights
Example
1.accenture : Posted on this homepage

2.avanade : Posted on this homepage

3.UBS : Posted on this homepage

4.Voluntary Continual Coverage : Posted on this homepage

1.accenture : HR-LCM-LoA for retirement(MM office)

2.avanade : HR

3.UBS : Corporate Planning Office

4.Voluntary Continual Coverage :BPO ( for AHIS)

Contact

accenture

HRS(HR Services) Employee Support(ES)
APSSC.HR.SUPPORT
@accenture.com
 
HR Supervisor
for "HR-LCM-ES"
APSSC.HR.SUPPORT
@accenture.com
 
HR Supervisor
for "HR-LCM-LoA for Sick/injured"
APSSC.HR.SUPPORT
@accenture.com
 

avanade

HR Support hr.support@avanade.com  
HR japanhr@avanade.com Tel. 03-6234-0150

UBS SSC Corp.

Corporate Planning office Keikyu Second Bldg.11F, 3-25-23, Takanawa, Minatoku, Tokyo 108-0074
ubs-keieikikaku@unicharm.com
Tel. 03-3449-1664
FAX. 03-5420-3418

BPO (for AHIS)
(Accenture Health Insurance Society, Health Insurance Business Center, Value HR Co.,Ltd.)

Level 2 S-FRONT Yoyogi, 5-21-12 Sendagaya, Shibuya-ku, Tokyo 151-0051
info-bpo-acc@valuehr.com
Tel. 03-6709-8028
(Weekdays 9:30-12:00 / 13:00-18:00) *Japanese only

AHIS (Accenture Health Insurance Society)

  5-21-14 Sendagaya, Shibuya-ku, Tokyo Postcode:151-0051
kenpo@accenture-kenpo.jp
Tel. 03-6380-1601
  • *Japanese only
    Voice guidance will begin.
    About Health checkups and Cafeteria plan⇒“1”.
    About voluntary continuation, insurance cards, adding dependents, and various benefits ⇒“ 2”.
PAGE TOP