Act on Assurance of Medical Care for Elderly People

The estimated amount of Young-Old Payments referred to in paragraph (1) of the preceding Article is the amount specified in each of the following items in accordance with the category of Insurer set forth in the relevant item:

an insurer exceeding the estimated burden adjustment standard (meaning, among Insurers for which the amount equivalent to the estimated young-old payment before burden adjustment for the relevant fiscal year exceeds zero, an Insurer for which the sum total set forth in (a) exceeds the amount set forth in (b) (excluding an insurer exceeding the special estimated burden adjustment standard in the following item); the same applies hereinafter in this Article): the sum total of the amount obtained by deducting the estimated amount subject to burden adjustment (meaning the amount obtained by deducting the amount set forth in (b) from the sum total set forth in (a) (if that amount exceeds the amount equivalent to the estimated young-old payment before burden adjustment, the amount equivalent to the estimated young-old payment before burden adjustment); the same applies in paragraph (3)) from the amount equivalent to the estimated young-old payment before burden adjustment, and the estimated amount of burden adjustment;

the sum total of the following amounts:

the amount equivalent to the estimated young-old payment before burden adjustment for the relevant fiscal year;

the amount obtained by dividing the estimated amount of aid for the old-old under Article 119, paragraph (1) pertaining to the relevant Insurer in the relevant fiscal year by the estimated old-old aid adjustment rate set forth in the items of Article 120, paragraph (1) pertaining to the relevant Insurer in the same fiscal year;

the amount arrived at when the sum total of the following amounts is multiplied by the base rate for burden adjustment for the relevant fiscal year:

the sum total set forth in (a);

the amount calculated as specified by Order of the Ministry of Health, Labour and Welfare as the estimated amount of the expenses required for benefits by insurers in the relevant fiscal year (including the expenses required for the payment of the day laborer contribution prescribed in Article 173, paragraph (2) of the Health Insurance Act; referred to as "expenses required for benefits by insurers, etc." in the following item, (b), (2) and Article 39, paragraph (1), item (i), (b), (2) and item (ii), (b), (2));

an insurer exceeding the special estimated burden adjustment standard (meaning, among Insurers for which the amount equivalent to the estimated young-old payment before burden adjustment for the relevant fiscal year exceeds zero, an Insurer for which the sum total set forth in (a) exceeds the amount set forth in (b) and for which the estimated financial capacity in the same fiscal year, calculated as specified by Cabinet Order, falls short of the standard specified by Cabinet Order; the same applies hereinafter in this Article): the sum total of the amount obtained by deducting the estimated amount subject to special burden adjustment (meaning the amount obtained by deducting the amount set forth in (b) from the sum total set forth in (a) (if that amount exceeds the amount equivalent to the estimated young-old payment before burden adjustment, the amount equivalent to the estimated young-old payment before burden adjustment); the same applies in paragraph (3)) from the amount equivalent to the estimated young-old payment before burden adjustment, and the estimated amount of burden adjustment;

the sum total of the following amounts:

the amount equivalent to the estimated young-old payment before burden adjustment for the relevant fiscal year;

the amount obtained by dividing the estimated amount of aid for the old-old under Article 119, paragraph (1) pertaining to the relevant Insurer in the relevant fiscal year by the estimated old-old aid adjustment rate set forth in the items of Article 120, paragraph (1) pertaining to the relevant Insurer in the same fiscal year;

the amount arrived at when the sum total of the following amounts is multiplied by the base rate for special burden adjustment for the relevant fiscal year;

the sum total set forth in (a);

the amount calculated as specified by Order of the Ministry of Health, Labour and Welfare as the estimated amount of the expenses required for benefits by insurers, etc. in the relevant fiscal year.

an insurer other than an insurer in excess of the standard for estimated burden adjustment and an insurer in excess of the special standard for estimated burden adjustment:the sum of the amount equivalent to estimated young-old payments before burden adjustment and the estimated amount of burden adjustment.

The estimated amount equivalent to Young-Old Payments before burden adjustment referred to in the items of the preceding paragraph is the amount specified in the following items according to the categories of Insurers set forth in the respective items.

insurers of employee insurance, etc.: the sum of the amounts listed in (a) and (b):

the amount equivalent to two-thirds of the amount obtained by deducting the sum total of the estimated amount of benefit expenses subject to adjustment set forth in the items of Article 34, paragraph (1) pertaining to the relevant Insurer and the estimated amount of aid for the old-old pertaining to the young-old from the estimated base amount subject to adjustment set forth in the items of Article 34, paragraph (1) (if the amount is less than zero, it is deemed to be zero);

the amount equivalent to one third of the amount obtained by deducting the sum total of the estimated amount of benefit expenses subject to adjustment set forth in the items of Article 34, paragraph (1) pertaining to the relevant Insurer and the estimated amount of aid for the old-old pertaining to the young-old from the estimated base amount subject to adjustment after remuneration adjustment set forth in Article 34, paragraph (1), item (i), (b) (if the amount is less than zero, it is deemed to be zero).

insurers other than insurers covered by employee insurance, etc.:the amount obtained by deducting the sum of the estimated amount of benefit expenses subject to adjustment set forth in the items of Article 34, paragraph (1) pertaining to the relevant insurers and the estimated amount of Medical Care Assistance for the Elderly Aged 75 and over pertaining to the young-old (if the relevant amount is less than zero, it is deemed to be zero) from the estimated base amount subject to adjustment set forth in the items of the same paragraph.

The estimated amount of burden adjustment referred to in the items of paragraph (1) is the amount obtained by multiplying the amount obtained by first dividing the amount calculated as specified by Order of the Ministry of Health, Labour and Welfare on the basis of the sum of the amounts set forth in the following items for the relevant fiscal year by the estimated total number of participants for all Insurers in the relevant fiscal year calculated as specified by Order of the Ministry of Health, Labour and Welfare, then multiplying the product by the estimated number of participants for the relevant Insurers in the relevant fiscal year calculated as specified by Order of the Ministry of Health, Labour and Welfare, then multiplying the product by the estimated burden adjustment amount adjustment rate:

the total estimated amount subject to burden adjustment pertaining to all insurers in excess of the standard for estimated burden adjustment;

the total of the prospective amounts subject to burden adjustment pertaining to all insurers in excess of the special estimated burden adjustment standards;

one third of the total amount calculated by deducting the prospective amount subject to burden adjustment from the prospective amount subject to special burden adjustment pertaining to all insurers exceeding the special estimated burden adjustment standards (referred to as the "total amount, etc. of the prospective amount of special burden adjustment" in Article 93, paragraph (3)).

The base rate for burden adjustment referred to in paragraph (1), item (i), (b) is the rate specified by Cabinet Order for each fiscal year so that the ratio of insurers in excess of the estimated burden adjustment standard to all insurers is the ratio specified by Cabinet Order as being extremely small.

The standard rate for special burden adjustment referred to in paragraph (1), item (ii), (b) is a rate specified by Cabinet Order for each fiscal year so that the percentage of insurers exceeding the special estimated burden adjustment standard among all insurers is the percentage specified by Cabinet Order as being small.

The estimated burden adjustment adjustment rate referred to in paragraph (3) is calculated pursuant to the provisions of Cabinet Order within the range of 90 percent to 110 percent, taking into consideration the estimated amount of young-old benefit expenses per participant who is a young-old.

The amount of the final and binding young-old payments referred to in Article 37, paragraph (1) is the amount specified in the following items in accordance with the category of the insurer set forth in each of those items:

an insurer exceeding the fixed burden adjustment standard (meaning, among Insurers for which the amount equivalent to the fixed young-old payment before burden adjustment for the fiscal year before the previous fiscal year exceeds zero, an Insurer for which the sum total set forth in (a) exceeds the amount set forth in (b) (excluding an insurer exceeding the special fixed burden adjustment standard in the following item); the same applies hereinafter in this Article): the sum total of the amount obtained by deducting the amount subject to burden adjustment (meaning the amount obtained by deducting the amount set forth in (b) from the sum total set forth in (a) (if that amount exceeds the amount equivalent to the fixed young-old payment before burden adjustment, the amount equivalent to the fixed young-old payment before burden adjustment); the same applies in paragraph (3)) from the amount equivalent to the fixed young-old payment before burden adjustment, and the burden adjustment amount;

the sum total of the following amounts:

the amount equivalent to the fixed young-old payment before burden adjustment for the fiscal year before the previous fiscal year;

the amount obtained by dividing the fixed amount of aid for the old-old under Article 119, paragraph (1) pertaining to the relevant Insurer in the fiscal year before the previous fiscal year by the fixed old-old aid adjustment rate set forth in the items of Article 121, paragraph (1) pertaining to the relevant Insurer in the same fiscal year;

the amount arrived at when the sum total of the following amounts is multiplied by the base rate for burden adjustment referred to in paragraph (1), item (i), (b) of the preceding Article for the fiscal year before the previous fiscal year;

the sum total set forth in (a);

the amount of the expenses required for benefits by insurers, etc. of the relevant Insurer and the amount of the contribution for securing medical care in the early phase of an epidemic, in the fiscal year before the previous fiscal year;

an insurer exceeding the special fixed burden adjustment standard (meaning, among Insurers for which the amount equivalent to the fixed young-old payment before burden adjustment for the fiscal year before the previous fiscal year exceeds zero, an Insurer for which the sum total set forth in (a) exceeds the amount set forth in (b) and for which the financial capacity in the same fiscal year, calculated as specified by Cabinet Order, falls short of the standard specified by Cabinet Order; the same applies hereinafter in this Article): the sum total of the amount obtained by deducting the amount subject to special burden adjustment (meaning the amount obtained by deducting the amount set forth in (b) from the sum total set forth in (a) (if that amount exceeds the amount equivalent to the fixed young-old payment before burden adjustment, the amount equivalent to the fixed young-old payment before burden adjustment); the same applies in paragraph (3)) from the amount equivalent to the fixed young-old payment before burden adjustment, and the burden adjustment amount;

the sum total of the following amounts:

the amount equivalent to the fixed young-old payment before burden adjustment for the fiscal year before the previous fiscal year;

the amount obtained by dividing the fixed amount of aid for the old-old under Article 119, paragraph (1) pertaining to the relevant Insurer in the fiscal year before the previous fiscal year by the fixed old-old aid adjustment rate set forth in the items of Article 121, paragraph (1) pertaining to the relevant Insurer in the same fiscal year;

the amount arrived at when the sum total of the following amounts is multiplied by the base rate for special burden adjustment referred to in paragraph (1), item (ii), (b) of the preceding Article for the fiscal year before the previous fiscal year:

the sum total set forth in (a);

the amount of the expenses required for benefits by insurers, etc. of the relevant Insurer and the amount of the contribution for securing medical care in the early phase of an epidemic, in the fiscal year before the previous fiscal year.

an insurer other than an insurer in excess of the fixed burden adjustment standard and a special insurer in excess of the fixed burden adjustment standard:the sum of the amount equivalent to the determined young-old payments before burden adjustment and the burden adjustment amount.

The amount equivalent to the confirmed young-old payments before burden adjustment referred to in the items of the preceding paragraph is the amount specified in the following items in accordance with the category of insurer set forth in each of those items.

insurers of employee insurance, etc.: the sum of the amounts listed in (a) and (b):

the amount equivalent to two-thirds of the amount obtained by subtracting the sum of the amount of benefits expenses subject to adjustment set forth in the items of Article 35, paragraph (1) pertaining to the insurer, the fixed amount of Medical Care Assistance for the Elderly Aged 75 and over pertaining to the young-old, and the amount of contributions to ensure medical care in the early stage of an epidemic pertaining to the young-old (if the amount is less than zero, it is deemed to be zero) from the fixed base amount subject to adjustment set forth in the items of the same paragraph;

the amount equivalent to one third of the amount obtained by deducting, from the base amount for adjustment after adjustment of fixed compensation set forth in Article 35, paragraph (1), item (i), (b), the sum of the amount of benefit expenses subject to adjustment set forth in the items of the same paragraph pertaining to the insurer, the fixed amount of Medical Care Assistance for the Elderly Aged 75 and over pertaining to the young-old, and the amount of contributions to ensure medical care in the early stage of an epidemic pertaining to the young-old (if the amount is less than zero, it is deemed to be zero);

insurers other than insurers of employee insurance, etc.:the amount obtained by subtracting the sum of the amount of benefit expenses subject to adjustment set forth in the items of Article 35, paragraph (1) pertaining to the relevant insurers, the fixed amount of Medical Care Assistance for the Elderly Aged 75 and over pertaining to the young-old, and the amount of contributions to ensure medical care in the early stage of an epidemic pertaining to the young-old from the fixed base amount subject to adjustment set forth in the items of the same paragraph (if the amount is less than zero, it is deemed to be zero).

The burden adjustment amount set forth in the items of paragraph (1) is the amount obtained by multiplying the amount obtained by first dividing the amount calculated as specified by Order of the Ministry of Health, Labour and Welfare on the basis of the sum of the amounts set forth in the following items for the fiscal year before the previous fiscal year by the total number of participants for all Insurers in the same fiscal year calculated as specified by Order of the Ministry of Health, Labour and Welfare, and then multiplying the product by the number of participants for the relevant Insurers in the same fiscal year calculated as specified by Order of the Ministry of Health, Labour and Welfare, and then multiplying the product by the fixed burden adjustment amount adjustment rate:

the total amount subject to burden adjustment pertaining to all insurers in excess of the fixed burden adjustment standards;

the total amount subject to burden adjustment pertaining to all insurers in excess of the special standards for burden adjustment;

one third of the total amount (referred to as the "total amount of special burden adjustment, etc." in Article 93, paragraph (3)) arrived at when the amount subject to burden adjustment is deducted from the amount subject to special burden adjustment pertaining to all insurers in excess of the special established standard for burden adjustment.

The adjustment rate for the amount of settled burden adjustment referred to in the preceding paragraph is calculated pursuant to the provisions of Cabinet Order within the range of 90 percent to 110 percent, taking into consideration the amount of young-old benefit expenses per participant who is a young-old.