Act on Assurance of Medical Care for Elderly People

Among the expenses borne in the special account for old-old medical care of the Association of Medical Care Systems for the Elderly Aged 75 and older, the amount obtained by adding, to the sum total of the amount obtained by multiplying the Amount Subject to Sharing by the rate obtained by deducting the contribution rate for the old-old and 50 percent from one and the amount obtained by multiplying the amount of specified expenses by the rate obtained by deducting the contribution rate for the old-old from one (hereinafter referred to as the "amount subject to insurance payment" in this Section), the sum total of the amount obtained by multiplying the contribution Amount Subject to Sharing by the rate obtained by deducting the contribution rate for the old-old and 50 percent from one and the amount obtained by multiplying the amount of specified contribution for securing medical care in the early phase of an epidemic by the rate obtained by deducting the contribution rate for the old-old from one (referred to as the "total amount subject to insurance payment" in Article 121, paragraph (1)) is to be covered by the Old-Old Subsidy granted by the Organization to the Association of Medical Care Systems for the Elderly Aged 75 and older, pursuant to the provisions of Cabinet Order.

The contribution rate for the old-old set forth in the preceding paragraph is specified by Cabinet Order every two years based on the rate obtained by multiplying the number set forth in item (i) by the rate set forth in item (ii) and then dividing the product by the number set forth in item (iii):

the number obtained by adding, to one half, a rate equivalent to one half of the ratio of the amount of specified expenses to the amount of expenses required for benefits for medical treatment, etc. in the relevant fiscal year.

The rate obtained by multiplying 11.72 percent by the rate obtained by dividing the prospective total number of insured pertaining to all Association of Medical Care Systems for the Elderly Aged 75 and older in the relevant fiscal year by the total number of insured pertaining to all Association of Medical Care Systems for the Elderly Aged 75 and older in fiscal year 2022.

the number arrived at when the rate set forth in the preceding item is added to the rate arrived at when the rate set forth in (a) is multiplied by the rate set forth in (b):

the rate obtained by dividing the amount subject to insurance payment in fiscal year 2022 by the amount of expenses required for benefits for medical treatment, etc. in the same fiscal year;

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 2022.

The Old-Old Subsidy referred to in paragraph (1) is to be covered by the aid for the old-old collected by the Organization pursuant to the provisions of Article 118, paragraph (1).

If the Association of Medical Care Systems for the Elderly Aged 75 and older unjustly fails to secure the revenue that it should have secured or unjustly incurs expenses that it should not incur, the Minister of Health, Labour and Welfare may, pursuant to the provisions of Cabinet Order, order the Organization to reduce the amount of the Old-Old Subsidy referred to in the same paragraph that is granted to that Association pursuant to the provisions of paragraph (1) of the preceding Article.

The amount to be reduced pursuant to the provisions of the preceding paragraph may not exceed the amount which has unjustly failed to be secured or the amount which has unjustly been expended.

In addition to what is provided for in Article 93, Articles 95 and 116, paragraph (6), the national government may subsidize part of the expenses required for medical care for elderly people within the scope of the budget.

Beyond what is provided for in Article 96, Article 98, Articles 99 and 116, paragraph (5), a prefecture, municipality, and Association of Medical Care Systems for the Elderly Aged 75 and older may provide subsidies or loans for expenses required for medical care for elderly persons.

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 support payments 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 referred to in the preceding paragraph are imposed by the Association of Medical Care Systems for the Elderly Aged 75 and older on an insured in the amount of insurance premiums calculated using the insurance premium rate calculated as provided by Ordinance of the Association of Medical Care Systems for the Elderly Aged 75 and older in accordance with the standards specified by Cabinet Order, such as the insurance premium rate being uniform throughout the entire area of the Association of Medical Care Systems for the Elderly Aged 75 and older; provided, however, that the insurance premiums of an insured who has an address in an area, within the area of the relevant Association of Medical Care Systems for the Elderly Aged 75 and older, such as a remote island, where securing medical care is extremely difficult and which falls under the standards specified by the Minister of Health, Labour and Welfare, may be imposed in the amount of insurance premiums calculated using an insurance premium rate separately calculated as provided by Ordinance of the Association of Medical Care Systems for the Elderly Aged 75 and older in accordance with the standards specified by Cabinet Order.

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 support payments 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).

A Municipality is to pay to a Association of Medical Care Systems for the Elderly Aged 75 and older the amount to be transferred pursuant to the provisions of Article 99, paragraphs (1) and (2) and insurance premiums and any other money to be collected pursuant to the provisions of this Chapter (limited to those collected by the Municipality) pursuant to the provisions of the constitution of the Association of Medical Care Systems for the Elderly Aged 75 and older, in order to cover the expenses required for the Old-Old Healthcare provided by the Association of Medical Care Systems for the Elderly Aged 75 and older.

The assessment date for insurance premiums is the first day of the relevant fiscal year.

The collection of the insurance premiums under Article 104 by a municipality must be done by the method of ordinary collection (meaning that a municipality collects insurance premiums by giving notice of payment pursuant to the provisions of Article 231 of the Local Autonomy Act (Act No. 67 of 1947) to an insured on whom the insurance premiums are imposed, to the head of the household to which that insured belongs, or to the spouse of that insured (including a person who has not filed a notification of marriage but is in a situation equivalent to a marital relationship in fact; the same applies hereinafter); the same applies hereinafter), except where it is done by the method of special collection (meaning that a municipality causes a person who pays Old Age, etc., pension benefits (hereinafter referred to as a "Pension Insurer") to collect insurance premiums from an insured who receives Old Age, etc., pension benefits (excluding persons specified by Cabinet Order) and to pay in the insurance premiums to be collected; the same applies hereinafter).

The Old Age, etc. pension benefit set forth in the preceding paragraph means the Old Age Basic Pension under the National Pension Act (Act No. 141 of 1959) and other pension benefits under the same Act or the Employee's Pension Insurance Act (Act No. 115 of 1954) for which the grounds for payment are old age, disability, or death, which are specified by Cabinet Order, and pension benefits similar to these pension benefits for which the grounds for payment are old age, retirement, disability, or death, which are specified by Cabinet Order.

Insured must pay the insurance premiums when a Municipality intends to collect the person's insurance premiums by the method of general collection.

When a Municipality intends to collect insurance premiums of an insured belonging to a household by the method of general collection, the Householder is liable to jointly and severally pay the insurance premiums.

If a Municipality intends to collect insurance premiums of the other party that is an insured by the method of general collection, one of the spouses is liable to pay the insurance premiums jointly and severally.

The due date of payment of insurance premiums collected by the method of general collection is specified by Municipal Ordinance.

The provisions of Articles 134 through 141-2, Long-Term Care Insurance Act apply mutatis mutandis to the special collection of insurance premiums conducted pursuant to the provisions of Article 107. In this case, the necessary technical replacement of terms is specified by Cabinet Order.

The Association of Medical Care Systems for the Elderly Aged 75 and older may, pursuant to the provisions of its Ordinances, reduce or exempt insurance premiums or suspend the collection thereof for persons with special reasons.

The provisions of Article 9, Article 13-2, Article 20, Article 20-2, and Article 20-4 of the Local Tax Act (Act No. 226 of 1950) apply mutatis mutandis to insurance premiums and any other money to be collected pursuant to the provisions of this Chapter (limited to those to be collected by municipalities and Association of Medical Care Systems for the Elderly Aged 75 and older).

Insurance premiums collected by a municipality, co-payment for which collection has been suspended and which is collected by a Association of Medical Care Systems for the Elderly Aged 75 and older, and any other money to be collected pursuant to the provisions of this Chapter are revenues specified by laws as prescribed in Article 231-3, paragraph (3) of the Local Autonomy Act.

A Municipality may entrust the affairs of the collection of insurance premiums collected by the method of general collection to a person designated pursuant to the provisions of Article 243-2, paragraph (1) of the Local Autonomy Act, only when it is found that the entrustment will contribute to the assurance of revenue and the promotion of the benefits of the insured.

Beyond what is provided for in this Subsection, the amount of insurance premiums to be imposed and other particulars concerning the imposition of insurance premiums are prescribed by Ordinance of the Association of Medical Care Systems for the Elderly Aged 75 and older in accordance with the standards specified by Cabinet Order.

Beyond what is provided for in this Subsection, the notification of the amount of insurance premiums and other matters concerning the collection of insurance premiums (excluding those concerning special collection) are specified by Municipal Ordinance in accordance with the standards specified by Cabinet Order, and necessary matters concerning special collection are specified by Cabinet Order or Municipal Ordinance in accordance with the standards specified by Cabinet Order.