Order for Enforcement of the Health Insurance Act

The childbirth and childcare grant for each fiscal year is to be applied to a portion of the expenses required for the payment of the lump-sum allowance for childbirth and childcare, etc. prescribed in Article 152-2 of the Act for that fiscal year.

Where the provisions of Articles 41 and 42 of the Act on Assurance of Medical Care for Elderly People are applied mutatis mutandis pursuant to Article 152-6 of the Act, the term "Insurer" in Article 41 of that Act (including the heading) is deemed to be replaced with "health insurance society", and the phrase "to each Insurer" in Article 42, paragraph (1) of that Act with "to each Insurer (meaning the Japan Health Insurance Association and health insurance societies as insurers of health insurance (excluding insurance for specially-insured day laborers (meaning specially-insured day laborers prescribed in Article 3, paragraph (2) of the Health Insurance Act)); the same applies hereinafter)".

Except in the case referred to in the following paragraph, when the premiums and other amounts collected by the Minister of Health, Labour and Welfare pursuant to the provisions of the Act and the payments pursuant to the provisions of the Act on Payment of Government Charges with Stamps (Act No. 142 of 1948) (hereinafter referred to as "premiums, etc." in this paragraph and the following paragraph) have been received in the health account of the Pension Special Account (referred to as the "health account" in that paragraph), the Government is to deliver to JHIA, on each such occasion without delay, as the grant under Article 155-2 of the Act (hereinafter referred to as the "grant from premiums, etc." in this Article), the amount obtained by deducting, from the amount of the premiums, etc. so received, the amount calculated as provided by Order of the Ministry of Health, Labour and Welfare as an amount equivalent to the expenses required for the execution of the affairs of the health insurance business administered by the Minister of Health, Labour and Welfare (excluding the amount of the national treasury share for those expenses under Article 151 of the Act).

When the surplus in the final accounts of the previous fiscal year has been transferred to the health account for that fiscal year, the Government is to deliver to JHIA without delay, as the grant from premiums, etc., the amount so transferred (excluding the amount specified by the Minister of Health, Labour and Welfare as that other than relating to premiums, etc.).

For each month, the Government is to make clear to JHIA the basis for calculating the amount of the grant from premiums, etc. delivered in that month.

Beyond what is provided for in the preceding three paragraphs, necessary matters concerning the delivery of the grant from premiums, etc. are specified by Order of the Ministry of Health, Labour and Welfare.

The cases specified by Cabinet Order as referred to in the proviso to Article 156, paragraph (2) of the Act (including as applied mutatis mutandis pursuant to Article 7, paragraph (3) of the Supplementary Provisions of the Act) are cases where a person ceases to be an item (ii) insured person (meaning an insured person prescribed in Article 9, item (ii) of the Long-Term Care Insurance Act; the same applies hereinafter) in the month in which the person became an item (ii) insured person.

As specified by Order of the Ministry of Health, Labour and Welfare, JHIA is to calculate the premium rate for each prefecture (meaning the premium rate for each prefecture prescribed in Article 160, paragraph (2) of the Act; the same applies in the following Article and Article 45-4, paragraph (4), item (i)) to be used from March of a business year, by dividing the amount obtained by dividing the amount listed in item (i) by the projected premium payment rate (meaning the rate calculated, as specified by Order of the Ministry of Health, Labour and Welfare, as the proportion that the total amount of premiums expected to be paid in the business year following the business year represents of the estimated amount to be collected as premiums for the period from March of a business year to February of the business year following that business year (for premiums relating to insured persons with optional and continued coverage, premiums for the period from April to March of that following business year); the same applies in the following Article) by the amount listed in item (ii), for the business year following the business year.

the amount obtained by deducting the amount listed in (d) from the total sum of the amounts listed in (a) through (c);

the amount obtained by deducting, from the amount listed in Article 160, paragraph (3), item (i) of the Act, the estimated amount of the amount equivalent to the partial co-payment payable pursuant to the provisions of the Act out of the expenses required for the benefits for medical treatment, etc. prescribed in that item (referred to as "benefits for medical treatment, etc." in Article 45-4, paragraph (4), items (i) and (ii)) relating to the branch-insured person concerned (meaning the single branch-insured person prescribed in Article 160, paragraph (1) of the Act; the same applies hereinafter);

the amount obtained by adding together the amount obtained by deducting, from the amount listed in Article 160, paragraph (3), item (ii) of the Act, the estimated amount of the amount equivalent to the partial co-payment payable pursuant to the provisions of the Act out of the expenses required for the insurance benefits prescribed in that item relating to the branch-insured person concerned, and the amount obtained by multiplying by 0.1/1,000 the total sum of the total amount of the total remuneration (meaning the total of the standard monthly remuneration and the standard bonus amount; the same applies in this Article and the following Article) of the branch-insured person concerned (excluding insured persons with optional and continued coverage) for each month from March of the business year before the previous business year of a business year through February of the business year previous to that business year, and the total amount of the total remuneration of the branch-insured person concerned (limited to insured persons with optional and continued coverage) for each month from April through March of the business year previous to that business year;

the amount listed in Article 160, paragraph (3), item (iii) of the Act; and

the amount specified by JHIA as the amount to be deemed revenue in the finances of a business year of health insurance on the basis of the branch-insured person concerned, out of the estimated amount of revenue for expenses required for health insurance business, such as the amount of reserves expected to be drawn down in that business year, and the amount of incentive payment calculated, as specified by Order of the Ministry of Health, Labour and Welfare, taking into account the status of implementation of the special health examination prescribed in Article 18, paragraph (1) of the Act on Assurance of Medical Care for Elderly People and the specified health guidance prescribed in the same paragraph, and other efforts of the relevant branch (meaning the branch prescribed in Article 7-4, paragraph (1) of the Act) concerning the maintenance and promotion of the health of the branch-insured person concerned and the dependents of that person and the optimization of medical expenses;

the estimated amount of the total sum of the total amount of the total remuneration of the branch-insured person concerned (excluding insured persons with optional and continued coverage) for each month from March of a business year through February of the business year following that business year, and the total amount of the total remuneration of the branch-insured person concerned (limited to insured persons with optional and continued coverage) for each month from April through March of the business year following that business year.

Notwithstanding the provisions of the preceding Article, when JHIA intends to use a premium rate for each prefecture that it is about to change from a month other than March, JHIA is to calculate that premium rate for each prefecture, as specified by Order of the Ministry of Health, Labour and Welfare, by dividing the amount obtained by dividing the amount obtained by deducting the amount listed in item (ii) from the amount listed in item (i) by the projected premium payment rate by the amount listed in item (iii).

the amount listed in item (i) of the preceding Article in the business year to which the first month in which the premium rate for each prefecture after the change is to be used (referred to as the "month of application" in the following item and item (iii)) belongs;

the amount specified respectively in (a) through (c) in accordance with the classification of months of application listed in (a) through (c):

a month other than a month listed in (b) or (c): the amount obtained by multiplying the estimated amount of the total sum of the total amount of the total remuneration of the branch-insured person concerned (excluding insured persons with optional and continued coverage) for each month from March of the business year previous to the business year to which the month of application belongs through the month preceding the month of application, and the total amount of the total remuneration of the branch-insured person concerned (limited to insured persons with optional and continued coverage) for each month from April of the business year to which the month of application belongs through the month preceding the month of application, by the premium rate for each prefecture before the change, and then multiplying the amount so obtained by the projected premium payment rate in the business year to which the month of application belongs;

April: the amount obtained by multiplying the estimated amount of the total amount of the total remuneration of the branch-insured person concerned (excluding insured persons with optional and continued coverage) for the month preceding that April by the premium rate for each prefecture before the change, and then multiplying the amount so obtained by the projected premium payment rate in the business year to which that April belongs;

May: the amount obtained by multiplying the estimated amount of the total sum of the total amount of the total remuneration of the branch-insured person concerned (excluding insured persons with optional and continued coverage) for the month two months before that May and the month preceding that May, and the total amount of the total remuneration of the branch-insured person concerned (limited to insured persons with optional and continued coverage) for the month preceding that May, by the premium rate for each prefecture before the change, and then multiplying the amount so obtained by the projected premium payment rate in the business year to which that May belongs;

the estimated amount of the total sum of the total amount of the total remuneration of the branch-insured person concerned (excluding insured persons with optional and continued coverage) for each month from the month of application through February of the business year to which the month of application belongs (where the month of application is February, that February), and the total amount of the total remuneration of the branch-insured person concerned (limited to insured persons with optional and continued coverage) for each month from the month of application through March of the business year to which the month of application belongs.