Act on Assurance of Medical Care for Elderly People

The amount of the fixed Young-Old Subsidy referred to in Article 33, paragraph (1) 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 5. from the sum of the amounts set forth in 1. through 4. (if the amount is less than zero, it is deemed to be zero):

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

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

the amount calculated pursuant to the provisions of Order of the Ministry of Health, Labour and Welfare, based on the amount of the physician allowance contribution pertaining to the relevant Insurer in the fiscal year before the previous fiscal year, in accordance with the ratio of the amount of young-old benefit expenses prescribed in item (i) of the following paragraph to the amount of expenses required for benefits by the relevant Insurer (hereinafter referred to in this Article and Article 39, paragraph (2) as the "fixed amount of physician allowance contribution pertaining to the young-old");

the amount calculated, as specified by Order of the Ministry of Health, Labour and Welfare, based on the amount of the contribution for securing medical care in the early phase of an epidemic under the Act on the Prevention of Infectious Diseases and Medical Care for Patients with Infectious Diseases (Act No. 114 of 1998) (hereinafter referred to as the "contribution for securing medical care in the early phase of an epidemic") pertaining to the relevant Insurer in the fiscal year before the previous fiscal year, in accordance with the ratio of the amount of young-old benefit expenses prescribed in item (i) of the following paragraph to the amount of expenses required for benefits by the relevant Insurer (hereinafter referred to as the "amount of contribution for securing medical care in the early phase of an epidemic pertaining to the young-old");

the fixed base amount subject to adjustment in the fiscal year before the previous fiscal year.

the amount equivalent to one third of the amount obtained by subtracting the fixed base amount subject to adjustment after remuneration adjustment in the fiscal year before the previous fiscal year from the sum of the amount of benefit expenses subject to adjustment 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 in the same fiscal year (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 fixed base amount subject to adjustment in the fiscal year before the previous fiscal year from the sum of the amount of benefit expenses subject to adjustment 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 in the same fiscal year (if the amount is less than zero, it is deemed to be zero).

The amount of benefit expenses subject to adjustment set forth in the items of the preceding paragraph is the amount obtained by multiplying the amount calculated, as specified by Order of the Ministry of Health, Labour and Welfare, as the average of the average amount of benefit expenses subject to adjustment per person pertaining to the relevant Insurer (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 number of participants who are young-old adults pertaining to the relevant Insurer in each fiscal year, calculated as specified by Order of the Ministry of Health, Labour and Welfare) in each of the fiscal year before the previous fiscal year, the fiscal year that includes April 1 of the year preceding the year in which the first day of the fiscal year before the previous fiscal year falls, and the fiscal year that includes April 1 of the year two years before the year in which the first day of the fiscal year before the previous fiscal year falls, by the number of participants who are young-old adults pertaining to the relevant Insurer in the fiscal year before the previous fiscal year, calculated as specified by 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 of expenses required for benefits by the insurer which pertain to subscribers who are young-old (hereinafter referred to as the "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 amount of young-old benefit expenses pertaining to the insurers if the insurers are the insurers in excess of the fixed standards (meaning the insurers for which the rate obtained by dividing the amount listed in (a) by the amount listed in (b) exceeds the rate specified by Cabinet Order set forth in paragraph (2), item (ii) of the preceding Article), which exceeds the amount obtained by multiplying the amount listed in (b) by the rate specified by the Cabinet Order:

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

the average per person young-old benefit cost.

The fixed base amount subject to adjustment set forth in the items of paragraph (1) is the amount obtained by multiplying the total 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 (in the case of Insurers of employee insurance, etc., the amount obtained by multiplying the amount by the fixed amount correction rate), 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, by the fixed participant adjustment rate.

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

the amount arrived at when the insurer's total standardized amount of compensation (meaning the total standardized amount of compensation as prescribed in paragraph (8) of the preceding Article; the same applies in the following item and in Article 121, paragraph (1), item (i), (a) and (b)) is divided by the number of participants associated with that insurer, as 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 total amount of standardized remunerations pertaining to all Insurers of employee insurance, etc. by the total number of subscribers pertaining to all Insurers of employee insurance, etc.

The fixed amount adjustment 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 arrived at when the final amount of the Medical Care Assistance for the Elderly Aged 75 and over pertaining to the Young-Old is multiplied by the final participant adjustment rate;

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

the amount obtained by multiplying the fixed amount of Medical Care Assistance for the Elderly Aged 75 and over pertaining to the Young-Old by the Fixed Participant Adjustment Rate when an Insurer of employee insurance, etc. is deemed to be an Insurer other than an Insurer of employee insurance, etc.;

the fixed 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.

The adjustment rate for fixed benefit expenses, etc. set forth 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 listed in item (i) pertaining to each of the Insurers of employee insurance, etc. is equal to the total of the amounts listed in item (ii):

the amount obtained by multiplying the sum of the amount of benefit expenses subject to adjustment set forth in the items of paragraph (1), 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 by the fixed remuneration adjustment rate and the fixed participant adjustment rate;

the amount obtained by multiplying the sum of the amount of benefit expenses subject to adjustment set forth in the items of paragraph (1), 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 by the fixed participant adjustment rate.

The fixed 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 of the insurers pursuant to the provisions of Order of the Ministry of Health, Labour and Welfare, based on the rate arrived at when the percentage of the total number of participants who are young-old to the total number of participants for all insurers in the fiscal year before the previous fiscal year is divided by the percentage of the number of participants who are young-old to the number of participants for the relevant insurers in the same fiscal year (if that percentage is less than the minimum percentage in the same fiscal year, the minimum percentage).

The per capita average 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 amount of young-old benefit expenses per one member who is a young-old pertaining to all insurers.

The Organization collects young-old payments and contributions for administrative expenses related to the young-old (hereinafter referred to as "young-old payments, etc.") from Insurers each fiscal year in order to cover the expenses required for the services listed in Article 139, paragraph (1), item (i) and the handling of affairs relating to the services.

An insurer is liable to pay young-old payments.

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

The Young-Old Payment 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 excess or deficiency between the estimated Young-Old Payments and the fixed Young-Old Payments pertaining to all of the Insurers in the fiscal year before the previous fiscal year and other circumstances.