Act on Assurance of Medical Care for Elderly People

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, the amount of the physician allowance contribution 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, the amount of the physician allowance contribution 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 benefit expenses subject to adjustment set forth in the items of Article 35, paragraph (1) pertaining to the Insurer, the fixed amount of aid for the old-old pertaining to the young-old, the fixed amount of physician allowance contribution pertaining to the young-old, and the amount of contribution for securing medical care in the early phase 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 fixed base amount subject to adjustment after remuneration adjustment 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 aid for the old-old pertaining to the young-old, the fixed amount of physician allowance contribution pertaining to the young-old, and the amount of contribution for securing medical care in the early phase 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 aid for the old-old pertaining to the young-old, the fixed amount of physician allowance contribution pertaining to the young-old, and the amount of contribution for securing medical care in the early phase 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.

The amount of contributions for administrative expenses related to the young-old to be collected from each Insurer pursuant to the provisions of Article 36, paragraph (1) is, 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, based on the estimated amount of expenses required for the handling of affairs concerning the services of the Organization set forth in Article 139, paragraph (1), item (i) in the relevant fiscal year, in accordance with the estimated number of participants pertaining to each Insurer.