Order for Enforcement of the Health Insurance Act

The Acts specified by Cabinet Order as referred to in Article 65, paragraph (3), item (iii), Article 71, paragraph (2), item (ii), Article 80, item (viii), Article 81, item (v), Article 89, paragraph (4), item (v) and Article 95, item (viii) of the Act are as follows:

Mariners Insurance Act (Act No. 73 of 1939);

Medical Practitioners' Act (Act No. 201 of 1948);

Dental Practitioners Act (Act No. 202 of 1948);

Act on Public Health Nurses, Midwives and Nurses (Act No. 203 of 1948);

Medical Care Act (Act No. 205 of 1948);

Private School Personnel Mutual Aid Association Act (Act No. 245 of 1953);

National Public Officers Mutual Aid Association Act (Act No. 128 of 1958);

National Health Insurance Act (Act No. 192 of 1958);

Act on Securing Quality, Efficacy and Safety of Products Including Pharmaceuticals and Medical Devices (Act No. 145 of 1960);

Pharmacists Act (Act No. 146 of 1960);

Local Public Officers, etc. Mutual Aid Association Act (Act No. 152 of 1962);

Act on Assurance of Medical Care for Elderly People;

Act on the Safety of Regenerative Medicine (Act No. 85 of 2013);

Clinical Trials Act (Act No. 16 of 2017).

The Acts specified by Cabinet Order as referred to in Article 80, item (x), Article 81, item (vii) and Article 95, item (x) of the Act are as follows:

Mariners Insurance Act;

Medical Practitioners' Act;

Dental Practitioners Act;

Act on Public Health Nurses, Midwives and Nurses;

Medical Care Act;

Private School Personnel Mutual Aid Association Act;

National Public Officers Mutual Aid Association Act;

National Health Insurance Act;

Act on Securing Quality, Efficacy and Safety of Products Including Pharmaceuticals and Medical Devices;

Pharmacists Act;

Local Public Officers, etc. Mutual Aid Association Act;

Act on Assurance of Medical Care for Elderly People;

Act on the Safety of Regenerative Medicine;

Clinical Trials Act.

The amount of remuneration calculated as specified by Cabinet Order as referred to in Article 74, paragraph (1), item (iii) of the Act is the standard monthly remuneration for the month in which the person receives benefits for medical treatment, and the amount specified by Cabinet Order as referred to in that item is 280,000 yen.

The provisions of the preceding paragraph do not apply to a person who falls under any of the following items:

a person for whom the amount of income calculated as specified by Order of the Ministry of Health, Labour and Welfare for the insured person and the insured person's dependents (limited to those falling under the case of being on or after the month following the month that includes the day on which they reach the age of 70) is less than 5,200,000 yen (3,830,000 yen for a person who has no such dependent);

a person for whom the amount of income calculated as specified by Order of the Ministry of Health, Labour and Welfare as referred to in the preceding item for the insured person (limited to one who has no dependents (limited to those falling under the case of being on or after the month following the month that includes the day on which they reach the age of 70) and who has a person who was a dependent (meaning a person who has ceased to be a dependent by coming to fall under the proviso to Article 3, paragraph (7) of the Act and who, only until the month in which five years have elapsed from the month that includes the day on which the person came to fall under that proviso, has continuously fallen under the proviso to that paragraph on and after that day; the same applies hereinafter in this item)) and that person who was a dependent is less than 5,200,000 yen.

The amount specified by Cabinet Order as referred to in Article 100, paragraph (1) of the Act is 50,000 yen.

The amount specified by Cabinet Order as referred to in Article 101 of the Act is 488,000 yen; provided, however, that when the insurer finds that the childbirth takes place under the medical management of a hospital, clinic, birthing center or other person that meets all of the requirements listed in the following items, the amount is 488,000 yen plus an amount determined by the insurer within a range not exceeding 30,000 yen, based on the amount of additional expenses that the insured person necessarily incurs in relation to the insurance contract prescribed in item (i).

that, for childbirth under the medical management of that hospital, clinic, birthing center or other person, an insurance contract that meets the requirements specified by Order of the Ministry of Health, Labour and Welfare has been concluded, to provide for the expenditure of the costs required for paying compensation intended to reduce the financial burden of raising the person born, in the case where a specified childbirth accident (meaning an accident relating to childbirth (limited to childbirth that meets the standards specified by Order of the Ministry of Health, Labour and Welfare) (excluding one that has occurred due to a reason specified by Order of the Ministry of Health, Labour and Welfare) as a result of which the person born has contracted cerebral palsy and has come to be in a state of disability of a degree specified by Order of the Ministry of Health, Labour and Welfare; the same applies in the following item) has occurred;

that, in order to ensure the safety of medical care relating to childbirth and improve its quality, measures have been taken, as specified by Order of the Ministry of Health, Labour and Welfare, for the proper and reliable implementation of the collection, organization, analysis and provision of information on specified childbirth accidents.

The cases specified by Cabinet Order in the proviso to Article 108, paragraph (4) of the Act are the cases listed in the following items, and the difference specified by Cabinet Order in the proviso to that paragraph is the amount specified in each of those items in accordance with the classification of the cases listed in it.

a case where the person cannot receive remuneration and cannot receive payment of childbirth allowance: the difference between the total amount of injury and sickness allowance (meaning the total, as of the day on which it reaches the amount of the disability allowance, of the amounts calculated under Article 99, paragraph (2) of the Act if the person were to receive injury and sickness allowance on or after the day on which the person comes to receive payment of the disability allowance under the Employees' Pension Insurance Act (Act No. 115 of 1954); the same applies hereinafter in this Article) and the amount of the disability allowance;

a case where the person cannot receive remuneration and can receive payment of childbirth allowance: the lesser of the difference between the amount calculated under Article 99, paragraph (2) of the Act and the amount of childbirth allowance (where that amount exceeds the amount calculated under that paragraph, that amount), and the difference between the total amount of injury and sickness allowance and the amount of the disability allowance;

a case where the person can receive all or part of remuneration and cannot receive payment of childbirth allowance: the lesser of the difference between the amount calculated under Article 99, paragraph (2) of the Act and the amount of all or part of the remuneration that the person can receive (where that amount exceeds the amount calculated under that paragraph, that amount), and the difference between the total amount of injury and sickness allowance and the amount of the disability allowance;

a case where the person can receive all or part of remuneration and can receive payment of childbirth allowance: the lesser of the difference between the amount calculated under Article 99, paragraph (2) of the Act and the total sum of the amount of all or part of the remuneration that the person can receive and the amount of childbirth allowance calculated under the proviso to Article 108, paragraph (2) of the Act (where that total sum exceeds the amount calculated under Article 99, paragraph (2) of the Act, that amount), and the difference between the total amount of injury and sickness allowance and the amount of the disability allowance.

The requirements specified by Cabinet Order as referred to in Article 108, paragraph (5) of the Act are that the person is not a specially-insured day laborer who can receive injury and sickness allowance under Article 135, paragraph (1) of the Act (including a person who was a specially-insured day laborer; the same applies hereinafter in this Chapter, except in Article 41-2, Article 43-3 and Article 44, paragraphs (2) through (8)).

The pension benefits with aging or retirement as the grounds for payment, as referred to in Article 108, paragraph (5) of the Act, that are specified by Cabinet Order are as follows; provided, however, that this excludes a benefit whose payment is suspended in its entirety.

the old-age basic pension under the National Pension Act (Act No. 141 of 1959) and the old-age pension under Article 9-3, paragraph (1) of the Supplementary Provisions of that Act, and the old-age pension (excluding the old-age welfare pension) and the aggregated old-age pension under the National Pension Act prior to its amendment by Article 1 of the Act Partially Amending the National Pension Act, etc. (Act No. 34 of 1985; referred to as the "1985 National Pension Amendment Act" in the following item and item (iii));

the old-age employees' pension and the special old-age pension under the Employees' Pension Insurance Act, and the old-age pension, the aggregated old-age pension and the special old-age pension under the Employees' Pension Insurance Act prior to its amendment by Article 3 of the 1985 National Pension Amendment Act;

the old-age pension, the aggregated old-age pension and the special old-age pension under the Mariners Insurance Act prior to its amendment by Article 5 of the 1985 National Pension Amendment Act;

those among the occupational addition amounts under the pre-amendment National Public Officers Mutual Aid Association Act prescribed in Article 36, paragraph (5) of the Supplementary Provisions of the Act Partially Amending the Employees' Pension Insurance Act, etc. to Unify, etc. the Employees' Pension Systems (Act No. 63 of 2012; hereinafter referred to as the "2012 Pension Unification Act") that have retirement as the ground for benefit, and those among the benefits prescribed in Article 37, paragraph (1) of the Supplementary Provisions of the 2012 Pension Unification Act that have retirement as the ground for benefit;

the retirement mutual aid pension under Article 41, paragraph (1) of the Supplementary Provisions of the 2012 Pension Unification Act;

those among the occupational addition amounts under the pre-amendment Local Public Officers, etc. Mutual Aid Association Act prescribed in Article 60, paragraph (5) of the Supplementary Provisions of the 2012 Pension Unification Act that have retirement as the ground for benefit, and those among the benefits prescribed in Article 61, paragraph (1) of the Supplementary Provisions of the 2012 Pension Unification Act that have retirement as the ground for benefit;

the retirement mutual aid pension under Article 65, paragraph (1) of the Supplementary Provisions of the 2012 Pension Unification Act;

those among the benefits prescribed in Article 78, paragraph (3) of the Supplementary Provisions of the 2012 Pension Unification Act that have retirement as the ground for benefit, and those among the benefits prescribed in Article 79 of the Supplementary Provisions of the 2012 Pension Unification Act that have retirement as the ground for benefit;

those among the benefits that are pensions to be paid by the government, as the administrator of Employees' Pension Insurance, pursuant to Article 16, paragraph (3) of the Supplementary Provisions of the Act for Abolishing the Mutual Aid Association Act for Employees of Agricultural, Forestry and Fishery Organizations, etc. to Integrate the Employees' Pension Insurance System and the Mutual Aid Association System for Employees of Agricultural, Forestry and Fishery Organizations (Act No. 101 of 2001) that have retirement as the ground for benefit;

those among the benefits that are pensions paid by the mutual aid association prescribed in Article 28 of the Supplementary Provisions of the Employees' Pension Insurance Act that have retirement as the ground for payment;

those among the benefits that are pensions paid by the federation of National Public Service Personnel Mutual Aid Associations under the Act on Special Measures concerning Beneficiaries of Pension of Mutual Aid Association Established under Former Ordinances (Act No. 256 of 1950) that have retirement as the ground for payment.