Order for Enforcement of the Health Insurance Act

A health insurance society must not draw down its reserves except to make up a shortfall in the expenses required for insurance benefits (including the expenses required for paying the young-old payments, etc. under the provisions of the Act on Assurance of Medical Care for Elderly People (Act No. 80 of 1982) (hereinafter referred to as "young-old payments, etc."), the aid for the old-old, the contribution for administrative expenses related to the old-old and the contribution for administrative expenses related to childbirth and childcare under the provisions of that Act (hereinafter referred to as "aid for the old-old, etc."), the contributions under Article 173 of the Act (hereinafter referred to as "day laborer contribution"), the Levy under the provisions of the Long-Term Care Insurance Act (Act No. 123 of 1997) (referred to as "long-term care payment" in Article 29 and Article 46), the contribution for securing medical care in the early phase of an epidemic, etc. under the provisions of 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 "contribution for securing medical care in the early phase of an epidemic, etc."), and the children and child-rearing support levy under the provisions of the Act on Support for Children and Child-rearing (Act No. 65 of 2012) (hereinafter referred to as "children and child-rearing support levy")).

When a health insurance society has a shortage of cash for payments, it may temporarily divert cash belonging to the reserves or make temporary borrowings.

The amount temporarily diverted and the temporary borrowings under the preceding paragraph must be returned within that fiscal year.

When a health insurance society intends to issue society bonds, or to change the method of issuing bonds, the interest rate or the method of redemption, it must obtain the authorization of the Minister of Health, Labour and Welfare; provided, however, that this does not apply when it intends to make a minor change specified by Order of the Ministry of Health, Labour and Welfare.

When a health insurance society has made a minor change specified by Order of the Ministry of Health, Labour and Welfare as referred to in the proviso to the preceding paragraph, it must notify the Minister of Health, Labour and Welfare to that effect without delay.

When a health insurance society intends to dispose of important property, it must obtain the authorization of the Minister of Health, Labour and Welfare.

A health insurance society must, within six months after the end of each fiscal year, prepare a report on its business and settlement of accounts, as provided by Order of the Ministry of Health, Labour and Welfare, and submit it to the Minister of Health, Labour and Welfare.

A health insurance society must keep the documents referred to in the preceding paragraph at the principal office of the health insurance society.

Members and persons who were members may request the health insurance society to allow inspection of the documents referred to in the preceding paragraph. In this case, the health insurance society must not refuse this, except where there is a justifiable reason.

When a health insurance society intends to obtain the authorization under Article 3, paragraph (1) of the Supplementary Provisions of the Act, or intends to have the authorization under that paragraph rescinded, it must adopt a resolution in a society meeting by a majority of two-thirds or more of the fixed number of society meeting members.

When a regional health insurance society prescribed in Article 3-2, paragraph (1) of the Supplementary Provisions of the Act intends to obtain the authorization under paragraph (2) of that Article, it is to set a non-uniform general premium rate with each health insurance society before the merger as a unit, and must adopt a resolution in the society meeting of that regional health insurance society, by a majority of two-thirds or more of the fixed number of society meeting members, on that general premium rate and the requirements for the insured persons to whom it is to apply and the period of its application.

When the Minister of Health, Labour and Welfare has granted authorization for the merger or split of a health insurance society, the Minister is to give public notice of the following matters regarding the health insurance societies established or extinguished by the merger or split and the health insurance societies that continue to exist after the merger or split:

the name of the health insurance society;

the location of its office;

the name and location of the establishment;

the date of the authorization of the merger or split.

The amount of expenses that may be requested to be borne by the employer of the establishment pursuant to Article 26, paragraph (3) of the Act is to be an amount equivalent to the whole of the expenses required to fully repay the debts; provided, however, that where that employer is unable to bear those expenses due to a decision to commence bankruptcy proceedings or other special reasons, the health insurance society may, with the approval of the Minister of Health, Labour and Welfare, reduce or waive them.

When a health insurance society has been dissolved, the Minister of Health, Labour and Welfare is to give public notice of the following matters:

the name of the health insurance society;

the location of its office;

the name and location of the establishment;

the date of the authorization of dissolution or of the order of dissolution.

The requirements specified by Cabinet Order referred to in Article 28, paragraph (1) of the Act are to be that, with regard to a health insurance society for which the state in which the amount of expenditure (limited to that specified by the Minister of Health, Labour and Welfare as recurring) exceeds the amount of income (limited to that specified by the Minister of Health, Labour and Welfare as recurring) in the settlement of accounts for one fiscal year continues, and for which the state in which the rate obtained by dividing the amount obtained by deducting the amount of expenses required for the other benefits prescribed in Article 53 of the Act from the amount of expenses required for the insurance benefits of the health insurance society in one fiscal year (including the amount of expenses required for the payment of young-old payments, etc., aid for the old-old, etc. and day laborer contribution, and contribution for securing medical care in the early phase of an epidemic, etc. (where there is a young-old subsidy under the provisions of the Act on Assurance of Medical Care for Elderly People (hereinafter referred to as the "young-old subsidy" in this Article, Article 46, Article 65, paragraph (1), item (i), (a) and Article 67, paragraph (3)), the amount after deducting it), and excluding the amount of expenses required for insurance benefits relating to medical treatment that an insured person or a dependent thereof received from a hospital, clinic or pharmacy listed in Article 63, paragraph (3), item (iii) of the Act and the amount of the childbirth and childcare grant prescribed in Article 152-2 of the Act (hereinafter referred to as the "childbirth and childcare grant")) by the total sum of the total amount of the standard monthly remuneration and the total amount of the standard bonus amounts of the insured persons who are members of that health insurance society in that fiscal year exceeds 95/1,000 continues, the amount of reserves and other property specified by the Minister of Health, Labour and Welfare has fallen below the total sum of the amount equivalent to 3/12 of the average per fiscal year of the amount of expenses required for the insurance benefits provided in the three fiscal years immediately preceding the fiscal year for which the designation under Article 28, paragraph (1) of the Act is to be made (excluding the amount of expenses required for insurance benefits relating to medical treatment that an insured person or a dependent thereof received from a hospital, clinic or pharmacy listed in Article 63, paragraph (3), item (iii) of the Act and the amount of the childbirth and childcare grant), the amount equivalent to 1/12 of the average per business year of the amount of expenses required for the payment of young-old payments, etc., aid for the old-old, etc. and day laborer contribution, long-term care payment, and contribution for securing medical care in the early phase of an epidemic, etc. made in those three fiscal years (where there is a young-old subsidy, the amount after deducting it), and the amount determined by the Minister of Health, Labour and Welfare in consultation with the Prime Minister, within a range not exceeding the amount equivalent to 1/12 of the amount of expenses required for the payment of the children and child-rearing support levy made in the fiscal year immediately preceding the fiscal year for which the designation under that paragraph is to be made, taking into consideration the expenses required for the insurer's payment of the children and child-rearing support levy in that immediately preceding fiscal year.

The soundness improvement plan prescribed in Article 28, paragraph (1) of the Act (referred to simply as the "soundness improvement plan" in the following paragraph and the following Article) is to be a three-year plan whose first fiscal year is the fiscal year following the fiscal year that includes the date of designation under Article 28, paragraph (1) of the Act.

The following matters must be stated in the soundness improvement plan:

the current state of operations and property;

the goal for improving financial soundness;

the specific measures necessary to achieve the goal referred to in the preceding item, and the estimated amounts of increases and decreases in revenue and expenditure that accompany them.

The designated health insurance societies specified by Cabinet Order as referred to in Article 29, paragraph (2) of the Act are as follows:

a designated health insurance society that does not apply for approval of a soundness improvement plan by the date designated by the Minister of Health, Labour and Welfare;

a designated health insurance society that cannot obtain approval of a soundness improvement plan.

Part of the authority of the Minister of Health, Labour and Welfare prescribed in this Chapter may be delegated to the Director-General of a Regional Bureau of Health and Welfare, as specified by Order of the Ministry of Health, Labour and Welfare.

The authority delegated to the Director-General of a Regional Bureau of Health and Welfare pursuant to the provisions of the preceding paragraph may be delegated to the Director-General of a Regional Branch Bureau of Health and Welfare as specified by Order of the Ministry of Health, Labour and Welfare.

In addition to what is prescribed in this Chapter, necessary matters concerning health insurance societies are specified by Order of the Ministry of Health, Labour and Welfare.