Accenture Health
Insurance Society

Application forms

List of Locations where application forms should be obtained from and be submitted

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, IMJ : Dalian HR (DL from ES)

2.avanade : HR

3.Voluntary Continual Coverage : BPO ( for AHIS)

1.accenture, IMJ
  • Regular Employees :
    HR-LCM-ES
  • SP Employees :
    HR Supervisor for "SP Employees"
  • Fixed-Term Employees :
    HR Supervisor for "Fixed-Term Employees"

2.avanade : HR

3.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)
  • Request for Payment of Maternity Allowance

1.accenture, IMJ : Dalian HR (DL from ES)

2.avanade : HR

3.Voluntary Continual Coverage : AHIS

1.accenture, IMJ
  • Regular Employees :
    HR-LCM-ES
  • SP Employees :
    HR Supervisor for "SP Employees"
  • Fixed-Term Employees :
    HR Supervisor for "Fixed-Term Employees"

2.avanade : HR

3.Voluntary Continual Coverage : AHIS

  • Injury and Sickness Benefits Application
1.accenture, IMJ :
Dalian HR
APSSC.HR.SUPPORT
@accenture.com

2.avanade : HR

3.Voluntary Continual Coverage : AHIS

1.accenture, IMJ
  • Regular Employees :
    HR-LCM-LoA for Sick/injured
  • SP Employees :
    HR Supervisor for "SP Employees"
  • Fixed-Term Employees :
    HR Supervisor for "Fixed-Term Employees"

2.avanade : HR

3.Voluntary Continual Coverage : AHIS

(When reissuing a certificate)
Insurance Card/Senior Benefit Card Loss/Damage, Reissue Request
Example
Posted on this homepage 1.accenture, IMJ
  • Regular Employees :
    HR-LCM-ES
  • SP Employees :
    HR Supervisor for "SP Employees"
  • Fixed-Term Employees :
    HR Supervisor for "Fixed-Term Employees"

2.avanade : HR

3.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, IMJ
  • Regular Employees :
    HR-LCM-ES
  • SP Employees :
    HR Supervisor for "SP Employees"
  • Fixed-Term Employees :
    HR Supervisor for "Fixed-Term Employees"

2.avanade : HR

3.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)
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)
We’re sorry, but the electronic application service is only available in Japanese. To apply in English, please mail a paper application form to Accenture Health Insurance Society.
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)

Contact

accenture, IMJ

Dalian HR Employee Support(ES)
APSSC.HR.SUPPORT
@accenture.com
Tel. 045-330-8333(Ext.8333)
HR Supervisor
for "SP Employees"
APSSC.HR.SUPPORT
@accenture.com
Tel. 045-330-8333(Ext.8333)
HR Supervisor
for "Fixed-Term Employees"
APSSC.HR.SUPPORT
@accenture.com
Tel. 045-330-8333(Ext.8333)

avanade

HR japanhr@avanade.com Tel. 03-6234-0155

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

Level 4 A-PLACE Yoyogi, 5-23-15 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 (excIuding sickness benefits)⇒“ 2”.
    About others ⇒“3”.
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