Act on Assurance of Medical Care for Elderly People

Medical care for the elderly is to provide necessary benefits in relation to the illness, injury, or death of an elderly person.

A Municipality, in order to administer affairs concerning Old-Old Healthcare (excluding affairs concerning the collection of insurance premiums and affairs specified by a Cabinet Order as contributing to the promotion of the benefits of the insured), is to establish, for each area of a prefecture, a cross-regional federation to which all Municipalities within the relevant area belong (hereinafter referred to as a "Association of Medical Care Systems for the Elderly Aged 75 and older").

A Association of Medical Care Systems for the Elderly Aged 75 and older and a municipality, pursuant to the provisions of a Cabinet Order, must establish a special account for revenue and expenses related to medical care for the elderly.

A person who falls under any of the following items is to be an insured for medical care for the elderly provided by the Association of Medical Care Systems for the Elderly Aged 75 and older:

a person who is 75 years of age or older and has a domicile within the area of the Association of Medical Care Systems for the Elderly Aged 75 and older;

a person who is domiciled within the district of a Association of Medical Care Systems for the Elderly Aged 75 and older and is 65 years of age or older but under 75 years of age, who has been certified by the Association of Medical Care Systems for the Elderly Aged 75 and older, pursuant to the provisions of Order of the Ministry of Health, Labour and Welfare, as being disabled to the extent specified by Cabinet Order.

Notwithstanding the provisions of the preceding Article, a person who falls under any of the following items is not eligible to be an insured for medical care for the elderly provided by the Association of Medical Care Systems for the Elderly Aged 75 and older:

a person who belongs to a household receiving public assistance under the Public Assistance Act (Act No. 144 of 1950) (excluding a household for which public assistance has been suspended);

beyond what is set forth in the preceding item, a person who has a special reason to be excluded from the application of Old-Old Healthcare and who is specified by Order of the Ministry of Health, Labour and Welfare.

A insured for medical care for the elderly provided by a Association of Medical Care Systems for the Elderly Aged 75 and older acquires eligibility from the day on which the person comes to fall under any of the following items or the day on which the person no longer falls under any of the items of the preceding Article:

when a person who is domiciled within the area of the relevant Association of Medical Care Systems for the Elderly Aged 75 and older (excluding a person who has received the certification set forth in Article 50, item (ii)) has reached 75 years of age;

when a person who is 75 years of age or older has come to have a domicile within the area of the relevant Association of Medical Care Systems for the Elderly Aged 75 and older;

when a person who is 65 years of age or older and under 75 years of age and who has a domicile within the area of the relevant Association of Medical Care Systems for the Elderly Aged 75 and older has received the certification set forth in Article 50, item (ii).

A insured for medical care for the elderly provided by a Association of Medical Care Systems for the Elderly Aged 75 and older loses eligibility from the day following the day on which the person no longer has domicile in the area of the relevant Association of Medical Care Systems for the Elderly Aged 75 and older, no longer falls under the condition set forth in Article 50, item (ii), or comes to fall under the person set forth in Article 51, item (ii); provided, however, that if the person comes to have domicile in the area of another Association of Medical Care Systems for the Elderly Aged 75 and older on the day on which the person no longer has domicile in the area of the relevant Association of Medical Care Systems for the Elderly Aged 75 and older, the person loses eligibility from that day.

A insured for medical care for the elderly provided by a Association of Medical Care Systems for the Elderly Aged 75 and older loses eligibility as such from the day on which the person comes to fall under the category of a person provided for in Article 51, item (i).

A insured, pursuant to the provisions of Order of the Ministry of Health, Labour and Welfare, must notify the Association of Medical Care Systems for the Elderly Aged 75 and older of particulars concerning the acquisition and forfeiture of status as a insured and other necessary particulars.

The householder of a household to which an insured belongs may make a notification under the provisions of the preceding paragraph pertaining to the insured on behalf of the insured belonging to the household.

When an insured is in a situation where the insured cannot receive the electronic eligibility confirmation prescribed in Article 64, paragraph (3), the insured may, pursuant to the provisions of Order of the Ministry of Health, Labour and Welfare, request the Association of Medical Care Systems for the Elderly Aged 75 and older to deliver a document stating the matters specified by Order of the Ministry of Health, Labour and Welfare as information pertaining to the status of the insured in that situation, or to provide those matters by electronic or magnetic means (meaning a method using an electronic data processing system or any other method using information and communications technology, as specified by Order of the Ministry of Health, Labour and Welfare; the same applies hereinafter in this paragraph through paragraph (5)). In this case, the Association, pursuant to the provisions of Order of the Ministry of Health, Labour and Welfare, is to promptly deliver the document to an insured who has requested the delivery of the document, and is to provide those matters by electronic or magnetic means to an insured who has requested the provision by electronic or magnetic means.

A Order of the Ministry of Health, Labour and Welfare that has been issued a document as referred to in the preceding paragraph pursuant to the provisions of that paragraph or that has been provided with the information that Order of the insured prescribes which is referred to in that paragraph by electronic or magnetic means may obtain the confirmation referred to in the main clause of Article 64, paragraph (3) (including as applied mutatis mutandis pursuant to Article 74, paragraph (10), Article 75, paragraph (7), Article 76, paragraph (7), and Article 82, paragraph (7)) or Article 78, paragraph (3) (including as applied mutatis mutandis pursuant to Article 82, paragraph (7)) by presenting that document or something that indicates the information in a way that Order of the Ministry of Health, Labour and Welfare prescribes.

An insured may, for the confirmation of the facts pertaining to the qualifications of the insured, request the Association of Medical Care Systems for the Elderly Aged 75 and older, as specified by Order of the Ministry of Health, Labour and Welfare, to deliver a document stating those facts or to provide, by electronic or magnetic means, the matters to be stated in that document. In this case, the Association is to, as specified by Order of the Ministry of Health, Labour and Welfare, deliver that document to an insured who has requested delivery of the document, and provide the matters to be stated in the document by electronic or magnetic means to an insured who has requested provision by electronic or magnetic means.

If a notification under Articles 22 through 24, Article 25, Article 30-46, or Article 30-47 of the Act for Basic Register of Residents (Act No. 81 of 1967) has been filed (but only if a supplementary note under Article 28-2 of that Act has been added to a document connected with that notification), the notification under paragraph (1) is deemed to have been filed based on the same grounds as the notification.

Beyond what is provided for in the preceding paragraphs, matters necessary for notification concerning insured and confirmation concerning the qualifications of insured are specified by Order of the Ministry of Health, Labour and Welfare.

An insured who is found to have changed the insured's address to the place where a hospital, clinic or facility prescribed in the following items (hereinafter in this Article referred to as the "hospital, etc.") is located as a result of the hospitalization, admission or occupancy listed in the following items (hereinafter in this Article referred to as "hospitalization, etc.") (excluding a person who is deemed to be an insured for old-old medical care provided by the Association of Medical Care Systems for the Elderly Aged 75 and older of the previous domicile prescribed in paragraph (1) of the following Article pursuant to the provisions of that paragraph), and who is found to have had an address within the area of another Association of Medical Care Systems for the Elderly Aged 75 and older (meaning an Association of Medical Care Systems for the Elderly Aged 75 and older other than the Association of Medical Care Systems for the Elderly Aged 75 and older in whose area the hospital, etc. is located) at the time of the hospitalization, etc. in the hospital, etc., is, notwithstanding the provisions of Article 50, to be an insured for old-old medical care provided by that other Association of Medical Care Systems for the Elderly Aged 75 and older; provided, however, that this does not apply to an insured who is continuously hospitalized, etc. in two or more hospitals, etc. and who is found, as a result of being hospitalized, etc. in both the hospital, etc. in which the insured is currently hospitalized, etc. (hereinafter in this Article referred to as the "current hospital, etc.") and the hospital, etc. in which the insured was hospitalized, etc. immediately before being hospitalized, etc. in the current hospital, etc. (hereinafter in this paragraph referred to as the "last hospital, etc."), to have sequentially changed the insured's address to the places where the last hospital, etc. and the current hospital, etc. are respectively located (referred to as a "specified continuously hospitalized insured person" in the following paragraph).

admission to a hospital or clinic;

admission to a Support Facility for Persons with Disabilities prescribed in Article 5, paragraph (11) of the Act on Providing Comprehensive Support for the Daily Life and Life in Society of Persons with Disabilities (Act No. 123 of 2005) or a facility specified by order of the competent ministry as referred to in paragraph (1) of that Article;

admission to a facility established by the National Center for Persons with Severe Intellectual Disabilities, "Nozominosono," Independent Administrative Agency pursuant to the provisions of Article 11, item (i) of the Act on the National Center for Persons with Severe Intellectual Disabilities, "Nozominosono," Independent Administrative Agency (Act No. 167 of 2002);

admission to a nursing home for the elderly or an intensive care home for the elderly as prescribed in Article 20-4 or 20-5 of the Act on Social Welfare for the Elderly (Act No. 133 of 1963) (limited to the case where admission measures pursuant to the provisions of Article 11, paragraph (1), item (i) or (ii) of the same Act have been taken);

residence in a specified facility prescribed in Article 8, paragraph (11) of the Long-Term Care Insurance Act or a fee-based home for the elderly prescribed in Article 13, paragraph (1), item (v) of that Act, or admission to a long-term care insurance facility prescribed in Article 8, paragraph (25) of that Act or a specified regional long-term care insurance facility prescribed in that paragraph.

Notwithstanding the provisions of Article 50, an insured for specified continuous hospitalization, etc. that is set forth in each of the following items is an insured for late-stage elderly medical care provided by a Association of Medical Care Systems for the Elderly Aged 75 and older specified in each of the following items:

an insured whose address is found to have been sequentially changed to the location of two or more hospitals, etc., due to the fact that the person was hospitalized, etc. in each of the hospitals, etc., continuously, and who is found to have been domiciled in the area of another Association of Medical Care Systems for the Elderly Aged 75 and older (meaning a Association of Medical Care Systems for the Elderly Aged 75 and older other than the Association of Medical Care Systems for the Elderly Aged 75 and older where the current hospital, etc. is located) at the time of the hospitalization, etc. in the first of the two or more hospitals, etc.:the relevant other Association of Medical Care Systems for the Elderly Aged 75 and older;

an insured that is found to have changed its address from a place other than the location of one of the two or more hospitals, etc. in which the relevant person has been continuously hospitalized, etc. to a place where the relevant other hospital, etc. is located (hereinafter referred to as a "specified change of address" in this item) as a result of being continuously hospitalized, etc. from one of the hospitals, etc. to another (hereinafter referred to as "continuous hospitalization, etc." in this item), and that is found to have been domiciled in the area of another Association of Medical Care Systems for the Elderly Aged 75 and older (meaning a Association of Medical Care Systems for the Elderly Aged 75 and older other than the Association of Medical Care Systems for the Elderly Aged 75 and older where the current hospital, etc. is located) at the time of the last specified change of address pertaining to continuous hospitalization, etc.:the relevant other Association of Medical Care Systems for the Elderly Aged 75 and older.

Hospitals, etc. in which an insured to which the provisions of the preceding two paragraphs are applied is Hospitalized, etc. must provide necessary cooperation to the Association of Medical Care Systems for the Elderly Aged 75 and older where the Hospitals, etc. are located and the Association of Medical Care Systems for the Elderly Aged 75 and older which provides Old-Old Healthcare to the insured.

When an insured of National Health Insurance to whom Article 116-2, paragraphs (1) and (2) of the National Health Insurance Act apply, and who has an address within the area of an Association of Medical Care Systems for the Elderly Aged 75 and older other than the Association of Medical Care Systems for the Elderly Aged 75 and older to which the municipality in which the insured is deemed to have an address pursuant to those provisions (hereinafter in this paragraph referred to as the "municipality of the previous domicile") belongs (in the case of item (ii), limited to a person who is 65 years of age or older and less than 75 years of age), comes to fall under any of the following items, the person is, notwithstanding the provisions of Article 50, to be an insured for old-old medical care provided by the Association of Medical Care Systems for the Elderly Aged 75 and older to which the municipality of the previous domicile belongs (referred to as the "Association of Medical Care Systems for the Elderly Aged 75 and older of the previous domicile" in item (ii) and the following paragraph). In this case, notwithstanding the provisions of Article 52, the insured acquires the qualification from the day on which the insured comes to fall under any of those items.

when the person has reached 75 years of age;

if the person has been certified by the Association of Medical Care Systems for the Elderly Aged 75 and older of the previous domicile as having a disability of a degree of severity specified by Cabinet Order as referred to in Article 50, item (ii), pursuant to the provisions of Order of the Ministry of Health, Labour and Welfare.

The provisions of the preceding Article apply mutatis mutandis to a person who is deemed to be an insured for Old-Old Healthcare provided by the Association of Medical Care Systems for the Elderly Aged 75 and older of the Previous Domicile pursuant to the provisions of the preceding paragraph. In this case, the necessary technical replacement of terms is specified by Cabinet Order.