Act on Assurance of Medical Care for Elderly People

A municipality must collect insurance premiums to cover the expenses required for old-old medical care (including expenses required for payment of the Fiscal Stability Fund contributions, the contributions and childbirth and childcare support benefitspayments pursuant to the provisions of Article 117, paragraph (2), the contribution for securing medical care in the early phase of an epidemic, etc. pursuant to the provisions of the Act on the Prevention of Infectious Diseases and Medical Care for Patients with Infectious Diseases (referred to as the "contribution for securing medical care in the early phase of an epidemic, etc." in paragraph (3) and Article 116, paragraph (2)), and the children and child-rearing support levy).

The insurance premiums rate referred to in the preceding paragraph must be able to maintain a balanced budget in general throughout two years in light of the estimated amount of expenses incurred in providing benefits for medical treatment, etc., the estimated amount of expenses required for payment of the Fiscal Stability Fund contributions, the contributions and childbirth and childcare support benefitspayments pursuant to the provisions of Article 117, paragraph (2), the contribution for securing medical care in the early phase of an epidemic, etc., and the children and child-rearing support levy, the estimated amount of expenses required for redemption of borrowings from the prefecture pursuant to the provisions of Article 116, paragraph (1), item (ii), the estimated amount of expenses required for health services for the elderly provided for in Article 125, paragraph (1) and for the services provided for in paragraph (5) of the same Article, the status of distribution of income of insured and its prospects, the national treasury burden, and the amount of the Old-Old Subsidy, etc. in Article 100, paragraph (1).

the estimated amount of insurance premiums received: the amount calculated pursuant to the provisions of Cabinet Order as the amount to be allocated to the amount of expenses incurred in providing benefits for medical treatment, etc., the amount of expenses required for payment of the Fiscal Stability Fund contributions, the contributions and childbirth and childcare support benefitspayments pursuant to the provisions of paragraph (2) of the following Article, the contribution for securing medical care in the early phase of an epidemic, etc., and the children and child-rearing support levy, and the amount of expenses required for redemption of borrowings from the prefecture pursuant to the provisions of item (ii) of the preceding paragraph (hereinafter referred to as "Borrowings for Fund Project" in this paragraph), out of the total amount of insurance premiums that are expected to be received, during the specified period (meaning every two-fiscal-year period from fiscal year 2008, which is the first year; the same applies hereinafter in this paragraph), by the municipalities that organize the Association of Medical Care Systems for the Elderly Aged 75 and older in that Association;

the actual amount of insurance premiums received: the amount calculated pursuant to the provisions of Cabinet Order as the amount to be allocated to the sum total of the amount obtained by deducting the amount equivalent to the co-payment for the benefits from the amount of expenses spent on benefits for medical treatment and the amount of expenses spent on payment of dietary treatment expenses for inpatients, living support expenses for inpatients, medical expenses combined with treatment outside insurance coverage, medical expenses, medical expenses for home-nursing, special medical expenses, transport expenses, high-cost medical expenses and sizable medical and nursing expenses (hereinafter referred to as the "amount of costs spent on benefits for medical treatment, etc." in this paragraph), the amount of expenses spent on payment of the Fiscal Stability Fund contributions, the contributions and childbirth and childcare support benefitspayments pursuant to the provisions of paragraph (2) of the following Article, the contribution for securing medical care in the early phase of an epidemic, etc., and the children and child-rearing support levy, and the amount of expenses spent on redemption of Borrowings for Fund Project, out of the total amount of insurance premiums received during the specified period by the municipalities that organize the Association of Medical Care Systems for the Elderly Aged 75 and older;

the amount of revenue subject to fund projects: the amount calculated pursuant to the provisions of Cabinet Order as the amount to be allocated to the amount of costs spent on benefits for medical treatment, etc., the amount of expenses spent on payment of the Fiscal Stability Fund contributions, the contributions and childbirth and childcare support benefitspayments pursuant to the provisions of paragraph (2) of the following Article, the contribution for securing medical care in the early phase of an epidemic, etc., and the children and child-rearing support levy, and the amount of expenses spent on redemption of Borrowings for Fund Project, out of the total of the amounts received during the specified period in the special account for old-old medical care of the Association of Medical Care Systems for the Elderly Aged 75 and older (excluding the amount of grants for fund business set forth in item (v) and the amount of Borrowings for Fund Project);

the amount of expenses subject to fund projects: the amount calculated pursuant to the provisions of Cabinet Order as the sum total of the amount of costs spent on benefits for medical treatment, etc., the amount of expenses spent on payment of the Fiscal Stability Fund contributions, the contributions and childbirth and childcare support benefitspayments pursuant to the provisions of paragraph (2) of the following Article, the contribution for securing medical care in the early phase of an epidemic, etc., and the children and child-rearing support levy, and the amount of expenses spent on redemption of Borrowings for Fund Project, during the specified period at the Association of Medical Care Systems for the Elderly Aged 75 and older;

Subsection 5 Childbirth and Childcare Support Benefits Payments, etc. of aan Association of Medical Care Systems for the Elderly Aged 75 and older

(Collection and Payment Obligation of Childbirth and Childcare Support Benefits)Payments

The Organization collects childbirth and childcare support benefitspayments from the Association of Medical Care Systems for the Elderly Aged 75 and older each fiscal year to cover the expenses required for the services listed in Article 139, paragraph (1), item (iii).

AAn Association of Medical Care Systems for the Elderly Aged 75 and older is liable to pay childbirth and childcare support benefitspayments.

(Amount of Childbirth and Childcare Support Benefits)Payments

The amount of childbirth and childcare support benefitspayments to be collected from each Association of Medical Care Systems for the Elderly Aged 75 and older pursuant to the provisions of paragraph (1) of the preceding Article is the amount obtained by multiplying the amount calculated, as specified by Order of the Ministry of Health, Labour and Welfare, on the basis of the total amount of expenses required for payment of lump-sum allowance delivery expenses under the provisions of the Medical Insurance Acts (including payment of an amount equivalent to the expenses required for childbirth care for delivery under the provisions of Article 98-2, paragraph (10) of the Health Insurance Act and childcare, family benefits equivalent thereto under the Medical Insurance Acts), payment of lump-sum allowance forpayments at childbirth (including payment of the difference under the provisions of Article 101, paragraph (3) of that Act and childcare, childbirth benefits equivalent thereto under the Medical Insurance Acts), payment of family delivery expenses (including payment of an amount equivalent to the expenses required for care for delivery under the provisions of Article 98-2, paragraph (10) of that Act as applied mutatis mutandis pursuant to Article 112-2, paragraph (3) of that Act and benefits equivalent thereto under the Medical Insurance Acts (excluding the National Health Insurance Act)), payment of family lump-sum payments at childbirth expenses (including payment of the difference under the provisions of Article 101, paragraph (3) of that Act as applied mutatis mutandis pursuant to Article 114, paragraph (2) of that Act and benefits equivalent thereto under the Medical Insurance Acts (referred excluding the National Health Insurance Act)) and payment of special delivery expenses (including payment of an amount equivalent to as "the expenses required for payment care for delivery under the provisions of lump-sum allowance Article 134-2, paragraph (6) or (7) of that Act as applied mutatis mutandis pursuant to Article 145-2, paragraph (4) of that Act) (referred to as "expenses required for childbirth and childcarepayment of delivery expenses, etc." in paragraph (1) of the following Article and Article 124-7, paragraph (1)), by the childbirth and childcare support payment rate and the ratio of the number of insured pertaining to that Association of Medical Care Systems for the Elderly Aged 75 and older to the total number of insured pertaining to all Associations of Medical Care Systems for the Elderly Aged 75 and older.

The childbirth and childcare support payment rate referred to in the preceding paragraph forin fiscal year 20242026 and fiscal year 2025subsequent fiscal years is 7 / 100.specified by Cabinet Order every two years based on the number obtained by dividing the rate set forth in item (i) by the number set forth in item (ii):

The childbirth and childcare support rate referred to in paragraph (1) in fiscal year 2026 and subsequent fiscal years is specified by Cabinet Order every two years based on the number obtained by dividing the rate set forth in item (i) by the number set forth in item (ii):

the rate arrived at when 7 percent is multiplied by the rate arrived at when the prospective total number of insured pertaining to all of the Association of Medical Care Systems for the Elderly Aged 75 and older in the relevant fiscal year is divided by the total number of insured pertaining to all of the Association of Medical Care Systems for the Elderly Aged 75 and older in fiscal 2024;

the number arrived at when the rate set forth in the preceding item is added to the rate arrived at when 93 percent is multiplied by the rate arrived at when the prospective total number of participants for all insurers in the relevant fiscal year is divided by the total number of participants for all insurers in fiscal 2024.

the rate arrived at when 7 percent is multiplied by the rate arrived at when the estimated total number of insured pertaining to all of the Association of Medical Care Systems for the Elderly Aged 75 and older in the relevant fiscal year is divided by the total number of insured pertaining to all of the Association of Medical Care Systems for the Elderly Aged 75 and older in fiscal 2024;

the number arrived at when the rate set forth in the preceding item is added to the rate arrived at when 93 percent is multiplied by the rate arrived at when the estimated total number of participants for all Insurers in the relevant fiscal year is divided by the total number of participants for all Insurers in fiscal 2024.

(Childbirth and Childcare Grants)

The Organization provides childbirth and childcare grants to Insurers in order to cover part of the expenses required for payment of lump-sum allowance for childbirth and childcaredelivery expenses, etc.

The childbirth and childcare grants referred to in the preceding paragraph are to be covered by the childbirth and childcare support benefitspayments collected by the Organization pursuant to the provisions of Article 124-2, paragraph (1).

The amount of childbirth and childcare grant to be granted to each insurerInsurer pursuant to the provisions of paragraph (1) is the amount calculated pursuant to the provisions of the Medical Insurance Acts.

(Collection and Payment Obligation of Contributions for Administrative Expenses Related to Childbirth and Childcare)

The Organization collects contributions for childbirth and childcareadministrative expenses related office expensesto childbirth from Insurers each fiscal year in order to cover the expenses required for the processing of affairs concerning the services listed in Article 139, paragraph (1), item (iii).

An insurerInsurer is liable to pay contributions for childbirth and childcareadministrative expenses related office expensesto childbirth.

(Amount of Contributions for Administrative Expenses Related to Childbirth and Childcare)

The amount of contributions for childbirth and childcareadministrative expenses related office expensesto childbirth collected from each Insurer pursuant to the provisions of paragraph (1) of the preceding Article is the amount calculated pursuant to the provisions of Order of the Ministry of Health, Labour and Welfare, based on the estimated amount of expenses required for the processing of affairs concerning the services of the Organization set forth in Article 139, paragraph (1), item (iii) in the relevant fiscal year, in accordance with the estimated number of participants pertaining to each Insurer, as specified by Order of the Ministry of Health, Labour and Welfare.

Insurers must, pursuant to the provisions of Order of the Ministry of Health, Labour and Welfare, notify the Organization of the amount of expenses required for payment of lump-sum allowance for childbirth and childcaredelivery expenses, etc. pertaining to the relevant Insurer in each fiscal year and other matters specified by Order of the Ministry of Health, Labour and Welfare.

The provisions of Article 41 and Articles 43 through 46 apply mutatis mutandis to childbirth and childcare support benefitspayments and contributions for childbirth and childcareadministrative expenses related office expensesto childbirth. In this case, the necessary technical replacement of terms is specified by Cabinet Order.

The Old-Old Subsidy granted by the Organization to each Association of Medical Care Systems for the Elderly Aged 75 and older pursuant to the provisions of Article 100, paragraph (1) and the childbirth and childcare support benefitspayments collected by the Organization from each Association of Medical Care Systems for the Elderly Aged 75 and older pursuant to the provisions of Article 124-2, paragraph (1) are to be offset.

Aid for the old-old, etc. and contributions for childbirth and childcareadministrative expenses related office expensesto childbirth collected by the Organization from Insurers pursuant to the provisions of Article 118, paragraph (1) and Article 124-5, paragraph (1) and childbirth and childcare grants granted by the Organization to Insurers pursuant to the provisions of Article 124-4, paragraph (1) are to be offset.

If the Minister of Health, Labour and Welfare or the prefectural governor finds it necessary for the calculation of the amount of Young-Old Paymentsyoung-old payments, etc., Medical Care Assistanceaid for the Elderly Aged 75 and overold-old, etc., and contributions for childbirth and childcareadministrative expenses related office expensesto childbirth, the Minister of Health, Labour and Welfare or the prefectural governor may collect reports on the services from Insurers (or prefectures in the case of national health insurance programsNational Health Insurance) or have the relevant officials inspect the situation on site.

operations to collect childbirth and childcare support benefitspayments from Associations of Medical Care Systems for the Elderly Aged 75 and older, to collect contributions for childbirth and childcareadministrative expenses related office expensesto childbirth from Insurers, and to provide childbirth and childcare grants to Insurers, and operations incidental thereto.

The Organization may, in addition to requesting reports from Insurers in each fiscal year on the number of participants, the implementation status of Special health examinations, etc., and other particulars specified by Order of the Ministry of Health, Labour and Welfare, request Insurers to submit documents and other items when it finds it necessary in relation to the business of collecting young-old payments, etc. from Insurers prescribed in Article 139, paragraph (1), item (i), the business of collecting aid for the old-old, etc. from Insurers prescribed in item (ii) of the same paragraph, and the business of collecting contributions for childbirth and childcareadministrative expenses related office expensesto childbirth from Insurers prescribed in item (iii) of the same paragraph.

The Organization, when it finds it necessary in relation to the business of collecting childbirth and childcare support benefitspayments from an Association of Medical Care Systems for the Elderly Aged 75 and older prescribed in Article 139, paragraph (1), item (iii), may request the Association to submit documents and other items.

The Organization, limited to the amount specified in the budget, may allocate the reserve fund under the provisions of paragraph (1) to the expenses required for the business of providing Young-Old Grants to Insurers prescribed in Article 139, paragraph (1), item (i), the business of providing Old-Old Subsidies to an Association of Medical Care Systems for the Elderly Aged 75 and older prescribed in item (ii) of the same paragraph, and the business of providing childbirth and childcare grants to Insurers prescribed in item (iii) of the same paragraph, or the business to be carried out by obtaining approval pursuant to the provisions of paragraph (2) of the same Article.

Notwithstanding the provisions of Article 3 of the Act on Restrictions on Financial Assistance by the Government to Corporations (Act No. 24 of 1946), the government may, within the amount approved by a resolution of the National Diet, when it finds it necessary for the smooth granting of the Young-Old Subsidies, the Old-Old Subsidies and the childbirth and childcare grants by the Organization, guarantee obligations pertaining to the long-term borrowings, short-term borrowings or bonds of the Organization pursuant to the provisions of the preceding Article, within the period found to be necessary.