Act on Assurance of Medical Care for Elderly People

The Organization is to provide Insurers with Young-Old Subsidies, pursuant to the provisions of Cabinet Order, in order to adjust the imbalances in the burden related to the proportion of participants who are young-old adults (meaning participants who are in or after the month following the month in which they reach 65 years of age (if that day is the first day of a month, the month in which that day falls) and in or before the month in which they reach 75 years of age, and other persons specified by Order of the Ministry of Health, Labour and Welfare; the same applies hereinafter) in the number of participants pertaining to each Insurer (in the case of National Health Insurance, the prefecture; the same applies hereinafter in this Chapter).

The Young-Old Subsidies referred to in the preceding paragraph are to be covered by the young-old payments collected by the Organization pursuant to the provisions of Article 36, paragraph (1).

The amount of the Young-Old Subsidy to be provided to each Insurer pursuant to the provisions of paragraph (1) of the preceding Article is to be the estimated amount of the Young-Old Subsidy for the relevant fiscal year; provided, however, that when the estimated amount of the Young-Old Subsidy for the fiscal year before the previous fiscal year exceeds the fixed amount of the Young-Old Subsidy for that fiscal year, it is to be the amount obtained by deducting from the estimated amount of the Young-Old Subsidy for the relevant fiscal year the sum total of the excess amount and the Young-Old Subsidy Adjustment Amount pertaining to the excess amount, and when the estimated amount of the Young-Old Subsidy for the fiscal year before the previous fiscal year is less than the fixed amount of the Young-Old Subsidy for that fiscal year, it is to be the amount obtained by adding to the estimated amount of the Young-Old Subsidy for the relevant fiscal year the sum total of the shortfall and the Young-Old Subsidy Adjustment Amount pertaining to the shortfall.

The Young-Old Subsidy Adjustment Amount prescribed in the preceding paragraph is the amount calculated for each of the Insurers pursuant to the provisions of Order of the Ministry of Health, Labour and Welfare by taking into consideration the interest arising from the difference between the estimated amount of the Young-Old Subsidy and the fixed amount of the Young-Old Subsidy pertaining to all of the Insurers in the fiscal year before the previous fiscal year and other circumstances.

The estimated amount of the Young-Old Subsidy referred to in paragraph (1) of the preceding Article 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 amount set forth in 3. from the sum of the amounts set forth in 1. and 2. (if the amount is less than zero, it is deemed to be zero):

the estimated amount of benefit expenses subject to adjustment pertaining to the relevant Insurer in the relevant fiscal year;

the amount obtained by multiplying 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, by a rate calculated for each Insurer on the basis of the ratio of the estimated number of participants who are young-old adults to the estimated number of participants pertaining to the relevant Insurer in the same fiscal year (hereinafter referred to as the "estimated amount of aid for the old-old pertaining to the young-old");

the estimated base amount subject to adjustment in the relevant fiscal year.

the amount equivalent to one third of the amount obtained by deducting the estimated base amount for adjustment after adjustment of remunerations in the relevant fiscal year from the sum of the estimated amount of benefit expenses subject to adjustment pertaining to the insurer and the estimated amount of Medical Care Assistance for the Elderly Aged 75 and over pertaining to the young-old in the relevant fiscal year (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 estimated base amount for adjustment in the relevant fiscal year from the sum of the estimated amount of benefit expenses subject to adjustment 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 in the relevant fiscal year (if the amount is less than zero, it is deemed to be zero).

The estimated amount of benefits expenses subject to adjustment referred to in the items of the preceding paragraph is the amount obtained by multiplying the amount calculated pursuant to the provisions of Order of the Ministry of Health, Labour and Welfare as the average of the estimated average per person amount of benefits expenses subject to adjustment (meaning the amount obtained by dividing the amount obtained by deducting the amount set forth in item (ii) from the amount set forth in item (i) in each fiscal year by the estimated number of subscribers who are young-old adults pertaining to the insurer in each fiscal year calculated pursuant to the provisions of Order of the Ministry of Health, Labour and Welfare) pertaining to the insurer in each fiscal year of the relevant fiscal year, the fiscal year preceding the relevant fiscal year, and the fiscal year before the fiscal year preceding the relevant fiscal year by the estimated number of subscribers who are young-old adults pertaining to the insurer in the relevant fiscal year calculated pursuant to the provisions of Order of the Ministry of Health, Labour and Welfare:

the amount calculated pursuant to the provisions of Order of the Ministry of Health, Labour and Welfare as the amount pertaining to subscribers who are young-old among the prospective amount of expenses required for benefits of the relevant insurers (in the case of national health insurance, benefits of municipalities within a prefecture) which fall under those specified by Order of the Ministry of Health, Labour and Welfare among benefits concerning medical care pursuant to the provisions of medical insurance acts (excluding other benefits prescribed in Article 53 of the Health Insurance Act and benefits equivalent thereto) (hereinafter referred to as "expenses required for benefits by insurers") (hereinafter referred to as "prospective amount of young-old benefit expenses");

the amount calculated pursuant to the provisions of Order of the Ministry of Health, Labour and Welfare as the portion of the prospective Young-Old Benefit pertaining to the Insurers if the Insurers are Insurers in Excess of the Estimated Standard (meaning Insurers for which the rate obtained by dividing the amount set forth in (a) by the amount set forth in (b) exceeds the rate specified by Cabinet Order in consideration of the distribution, etc. of the prospective Young-Old Benefit per participant who is a Young-Old Person pertaining to all Insurers), which exceeds the amount obtained by multiplying the amount set forth in (b) by the rate specified by Cabinet Order:

the amount calculated pursuant to the provisions of Order of the Ministry of Health, Labour and Welfare as the prospective amount of young-old benefit expenses per Participant who is a young-old pertaining to a single Insurer;

the estimated average per person of young-old benefit expenses.

The estimated base amount subject to adjustment set forth in the items of paragraph (1) is the amount obtained by multiplying the sum of the estimated amount of benefit expenses subject to adjustment set forth in the items of the same paragraph pertaining to the relevant insurer and the estimated amount of Medical Care Assistance for the Elderly Aged 75 and over pertaining to the young-old (in the case of an insurer of employee insurance, etc., the amount obtained by multiplying the relevant amount by the estimated amount adjustment rate) by the estimated participant adjustment rate.

The estimated base amount subject to adjustment after remuneration adjustment set forth in paragraph (1), item (i), (b) is the amount obtained by multiplying by the estimated participant adjustment rate the sum total of the amount obtained by multiplying the estimated amount of benefit expenses subject to adjustment set forth in the items of that paragraph pertaining to the relevant Insurer by the rate obtained by dividing the amount set forth in item (i) for the relevant fiscal year by the amount set forth in item (ii) (referred to as the "estimated remuneration adjustment rate" in paragraph (6), item (i)) and the estimated benefit expense correction rate, and the amount obtained by multiplying the estimated amount of aid for the old-old pertaining to the young-old by the estimated amount correction rate.

the amount obtained by dividing the amount calculated pursuant to the provisions of Order of the Ministry of Health, Labour and Welfare as the prospective amount of the total amount of standardized remunerations pertaining to the insurer (referred to as the "prospective amount of the total amount of standardized remunerations" in the following item and Article 120, paragraph (1), item (i), (a) and (b)) by the prospective number of subscribers pertaining to the insurer calculated pursuant to the provisions of Order of the Ministry of Health, Labour and Welfare;

the amount calculated pursuant to the provisions of Order of the Ministry of Health, Labour and Welfare as the amount obtained by dividing the sum of the prospective amounts of the total amount of standardized remunerations pertaining to all Insurers of employee insurance, etc. by the prospective total number of subscribers pertaining to all Insurers of employee insurance, etc.

The estimated amount correction rate referred to in the preceding two paragraphs is the rate calculated pursuant to the provisions of Order of the Ministry of Health, Labour and Welfare so that the sum of the amounts obtained by subtracting the amount set forth in item (ii) from the amount set forth in item (i) pertaining to each of the Insurers of employee insurance, etc. is equal to the sum of the amounts obtained by subtracting the amount set forth in item (iv) from the amount set forth in item (iii):

the amount obtained by multiplying the estimated amount of Medical Care Assistance for the Elderly Aged 75 and over pertaining to the Young-Old by the estimated participant adjustment rate;

the estimated amount of Medical Care Assistance for the Elderly Aged 75 and over pertaining to the Young-Old;

the amount obtained by multiplying the estimated amount of Medical Care Assistance for the Elderly Aged 75 and over pertaining to the Young-Old, when an Insurer of employee insurance, etc. is deemed to be an Insurer other than an Insurer of employee insurance, etc., by the estimated participant adjustment rate;

the estimated amount of Medical Care Assistance for the Elderly Aged 75 and over pertaining to the Young-Old when Insurers of employee insurance, etc. are deemed to be insurers other than Insurers of employee insurance, etc.

The estimated benefit expense adjustment rate referred to in paragraph (4) is the rate calculated pursuant to the provisions of Order of the Ministry of Health, Labour and Welfare so that the total of the amounts set forth in item (i) pertaining to each of the Insurers of employee insurance, etc. is equal to the total of the amounts set forth in item (ii):

the amount arrived at when the estimated amount of the covered benefit expenses referred to in the items of paragraph (1) is multiplied by the estimated remuneration adjustment rate and the estimated participant adjustment rate;

the amount arrived at when the estimated amount of the covered benefit expenses referred to in the items of paragraph (1) is multiplied by the estimated participant adjustment rate.

The estimated participant adjustment rate referred to in paragraph (3), paragraph (4), paragraph (5), items (i) and (iii), and the items of the preceding paragraph is the rate calculated for each insurer based on the rate arrived at when the prospective total number of subscribers who are young-old adults accounts for the prospective total number of subscribers for all insurers in the relevant fiscal year is divided by the prospective total number of subscribers who are young-old adults accounts for the prospective total number of subscribers for the relevant insurers in the same fiscal year (or, if that rate is less than the minimum rate in the same fiscal year (meaning the rate specified by Cabinet Order in consideration of trends in the rate of the prospective total number of subscribers who are young-old adults accounts for the prospective total number of subscribers for all insurers in the same fiscal year; hereinafter the same applies in this paragraph and paragraph (7) of the following Article), the minimum rate), pursuant to the provisions of Order of the Ministry of Health, Labour and Welfare.

The total standardized amount of remuneration referred to in paragraph (4), item (i) is the amount obtained by correcting, pursuant to the provisions of Cabinet Order, the total sum of the amounts specified in the following items for each fiscal year in accordance with the category of insurer set forth in each of those items:

a Japan Health Insurance Association or health insurance society:the standard remuneration (meaning the standard monthly remuneration amount and the Bonus Amount) prescribed in the Health Insurance Act or the Mariners Insurance Act for each insured;

Mutual aid association: the standard monthly remuneration amount and the standard amount of end-of-term allowances, etc. prescribed in the National Public Officers Mutual Aid Association Act or the Local Public Officers, etc. Mutual Aid Association Act for each member;

the standard monthly remuneration amount and the Bonus Amount prescribed in the Private School Teachers Mutual Aid Act for each member of the Promotion and Mutual Aid Corporation for Private Schools of Japan;

national health insurance societies (limited to those who are insurers of employee insurance, etc.):the amount specified by Order of the Ministry of Health, Labour and Welfare as equivalent to the amounts specified in the preceding three items for each member.

The per capita average estimated amount of young-old benefit expenses referred to in paragraph (2), item (ii), (b) is the amount calculated pursuant to the provisions of Order of the Ministry of Health, Labour and Welfare as the average of the estimated amount of young-old benefit expenses per Participant who is a young-old pertaining to all Insurers.