Health Insurance Act

• Premiums and cash allowances are worked out from each insured person's standard monthly remuneration (標準報酬月額): one of 50 grades, from 58,000 to 1,390,000 yen, matched to their monthly pay. It is set on joining, and set again every year from the pay for April to June at the place of business where they work on 1 July (leaving out months with fewer than 17 paid days, or 11 for some), to apply from September to the next August, though not in a year in which they joined from 1 June or are revised from July to September; it may be revised from the following month when the average of three months' pay, each month with at least 17 (or 11) paid days, is markedly higher or lower than the pay it was based on, and, on a request made through the employer, after childcare leave by someone still raising the child under three it was taken for, or after maternity leave by someone raising the child born, while for a person with optional and continued coverage it is instead the lower of their standard monthly remuneration when they lost coverage and the grade matching the average for all the insurer's insured persons, unless a society's rules provide otherwise. What is paid for work at intervals of more than three months is a bonus (賞与), counted as a standard bonus amount (標準賞与額) rounded down to the 1,000 yen and capped at 5,730,000 yen a fiscal year.(Art. 40(1), Art. 41(1), Art. 41(2), Art. 41(3), Art. 42(1), Art. 43(1), Art. 43-2(1), Art. 43-3(1), Art. 47(1), Art. 47(2), Art. 3(5), Art. 3(6), Art. 45(1), Art. 99(2), Art. 156(1)) (the provisions it rests on)
• Each month's premium is the standard monthly remuneration, and any standard bonus amount, multiplied by the general premium rate plus the child and child-rearing support rate (子ども・子育て支援金率), with the long-term care premium rate added for insured persons who are item (ii) insured persons under the Long-Term Care Insurance Act (介護保険第二号被保険者). The Association sets its general rate for each prefecture, and a health insurance society sets its own, both between 3% and 13%, and either needs the authorization of the Minister of Health, Labour and Welfare to change it. Insured person and employer each bear half, though a society's rules may raise the employer's share and a person with optional and continued coverage bears all of it; no premiums are collected for an insured person on childcare leave or maternity leave, for the months the Act sets, when the employer applies, though for childcare leave of a month or less only the premium on the standard monthly remuneration is waived.(Art. 156(1), Art. 156(1)(i), Art. 156(1)(ii), Art. 160(1), Art. 160(2), Art. 160(8), Art. 160(13), Art. 160-2(1), Art. 161(1), Art. 162(1), Art. 159(1), Art. 159-3(1)) (the provisions it rests on)
• Insured persons receive medical treatment (examination, medicine, procedures and surgery, care at home and in hospital) at a hospital, clinic or pharmacy of their choice among those the Act names, chiefly insurance medical institutions and insurance pharmacies (保険医療機関, 保険薬局) designated by the Minister of Health, Labour and Welfare, after having their coverage confirmed electronically with the individual number card (個人番号カード) or in another way an Order of the Ministry of Health, Labour and Welfare allows. They pay 30% of the cost as a co-payment (一部負担金), or 20% from the month after the month in which they reach 70 (in law, the day before their 70th birthday) unless their pay is at or above the level a Cabinet Order sets; for a dependent's treatment the insurer pays 70% of the covered cost, or 80% for a dependent up to the first 31 March after reaching six and for a dependent from the month after the month in which they reach 70, unless the insured person is in that higher-pay group or is another a Cabinet Order names. When co-payments become very high, the insurer pays high-cost medical expenses (高額療養費) on terms a Cabinet Order sets.This is the rule until 28 February 2027.(Art. 63(1), Art. 63(3), Art. 63(3)(i), Art. 3(13), Art. 74(1), Art. 74(1)(i), Art. 74(1)(ii), Art. 74(1)(iii), Art. 110(1), Art. 110(2)(i)(a), Art. 110(2)(i)(b), Art. 110(2)(i)(c), Art. 110(2)(i)(d), Art. 115(1), Art. 115(2)) (the provisions it rests on)
• Insured persons receive medical treatment (examination, medicine, procedures and surgery, care at home and in hospital) at a hospital, clinic or pharmacy of their choice among those the Act names, chiefly insurance medical institutions and insurance pharmacies (保険医療機関, 保険薬局) designated by the Minister of Health, Labour and Welfare, after having their coverage confirmed electronically with the individual number card (個人番号カード) or in another way an Order of the Ministry of Health, Labour and Welfare allows. They pay 30% of the cost as a co-payment (一部負担金), or 20% from the month after the month in which they reach 70 (in law, the day before their 70th birthday) unless their pay is at or above the level a Cabinet Order sets; for a dependent's treatment the insurer pays 70% of the covered cost, or 80% for a dependent up to the first 31 March after reaching six and for a dependent from the month after the month in which they reach 70, unless the insured person is in that higher-pay group or is another a Cabinet Order names. Treatment the Minister names as partly outside insurance (一部保険外療養), such as treatment with drugs closely substitutable for over-the-counter medicines, is paid instead as medical expenses combined with treatment outside insurance coverage (保険外併用療養費), less a portion the Minister sets, on which the co-payment share is then charged; and when co-payments become very high, the insurer pays high-cost medical expenses (高額療養費) on terms a Cabinet Order sets.This is the rule from 1 March 2027.(Art. 63(1), Art. 63(3), Art. 63(3)(i), Art. 3(13), Art. 74(1), Art. 74(1)(i), Art. 74(1)(ii), Art. 74(1)(iii), Art. 110(1), Art. 110(2)(i)(a), Art. 110(2)(i)(b), Art. 110(2)(i)(c), Art. 110(2)(i)(d), Art. 115(1), Art. 115(2), Art. 63(2)(vi), Art. 86(1), Art. 86(3), Art. 86(3)(i), Art. 86(3)(ii)) (the provisions it rests on)
• An insured person other than one with optional and continued coverage who cannot work because of medical treatment receives an injury and sickness allowance (傷病手当金) from the fourth day off work, for up to one year and six months in all for the same illness or injury, at two-thirds of 1/30 of their average standard monthly remuneration over the last 12 months (or, with fewer than 12 months, of the lower of their own average and the average for all insured persons). Such an insured person who gives birth receives a childbirth allowance (出産手当金) at the same daily rate for the days not worked from 42 days before the birth (counted from the expected date instead when the birth comes after it; 98 days for a multiple pregnancy) to 56 days after it. Neither is paid for days on which pay continues, apart from any amount by which the pay falls short, and someone continuously insured for a year or more before losing coverage (not counting optional and continued coverage or membership of a mutual aid association (共済組合)) who is receiving either when their coverage ends goes on receiving it from the same insurer for as long as they would have as an insured person.(Art. 99(1), Art. 99(2), Art. 99(2)(i), Art. 99(2)(ii), Art. 99(4), Art. 102(1), Art. 102(2), Art. 108(1), Art. 108(2), Art. 104(1)) (the provisions it rests on)
• When an insured person gives birth, they receive a lump-sum allowance for childbirth and childcare (出産育児一時金) of an amount a Cabinet Order sets, the insured person receives the same amount for a dependent's birth (家族出産育児一時金), and someone continuously insured for a year or more before losing coverage (counted as for continued allowances) who gives birth within six months after coverage ends receives it from their last insurer. When an insured person dies, the person they supported who arranges the burial receives burial charges (埋葬料) of an amount a Cabinet Order sets, or, if there is no such person, whoever arranges the burial is paid its cost up to that amount; the insured person receives the same amount on a dependent's death, and burial charges are also paid from the last insurer when a former insured person dies within three months after coverage ends, or while, or within three months after, receiving a continued allowance.This is the rule until the change takes effect, 4 June 2028 at the latest.(Art. 101(1), Art. 114(1), Art. 104(1), Art. 106(1), Art. 100(1), Art. 100(2), Art. 113(1), Art. 105(1), Art. 105(2)) (the provisions it rests on)
• On a day a Cabinet Order sets, no later than 4 June 2028, the insurer starts paying the cost of delivery care (分娩費), at an amount the Minister of Health, Labour and Welfare sets from its standard cost, when an insured person or a dependent, after having their coverage confirmed electronically or in another way the Act allows, has that care at a hospital or clinic of their choice that handles deliveries and is an insurance medical institution or another the Act names, or at a midwifery home designated by the Minister (指定助産所) or by the insurer, or run by a health insurance society; a birth after such care brings a childbirth lump sum (出産時一時金) of an amount a Cabinet Order sets, also from the last insurer for someone continuously insured for a year or more before losing coverage (not counting optional and continued coverage or membership of a mutual aid association (共済組合)) who gives birth after such care within six months after coverage ends. Births before that day, and for now births at a hospital, clinic or midwifery home already open on that day whose operator has notified the Minister that it keeps to the earlier system, stay under the lump-sum allowance for childbirth and childcare (出産育児一時金). When an insured person dies, the person they supported who arranges the burial receives burial charges (埋葬料) of an amount a Cabinet Order sets, or, if there is no such person, whoever arranges the burial is paid its cost up to that amount; the insured person receives the same amount on a dependent's death, and burial charges are also paid from the last insurer when a former insured person dies within three months after coverage ends, or while, or within three months after, receiving a continued allowance.This is the rule from a day still to be set, 4 June 2028 at the latest.(Art. 3(13), Art. 98-2(1), Art. 98-2(2), Art. 112-2(1), Art. 112-2(2), Art. 101(1), Art. 114(1), Art. 106(1), Art. 100(1), Art. 100(2), Art. 113(1), Art. 105(1), Art. 105(2), Suppl. Prov. Art. 1(1)(vi), Suppl. Prov. Art. 14(1), Suppl. Prov. Art. 15(1), Art. 98-24(1)) (the provisions it rests on)

• 1 October 2026

  The text on this site

  Act Partially Amending the Medical Care Act, etc.

  医療法等の一部を改正する法律

  Act No. 87 of 2025The text after this amendment, on e-Gov

• 1 October 2026

  Act Partially Amending the National Pension Act, etc., and Other Matters, to Strengthen the Functions of the Pension System in Light of Socioeconomic Changes

  社会経済の変化を踏まえた年金制度の機能強化のための国民年金法等の一部を改正する等の法律

  Act No. 74 of 2025The text after this amendment, on e-Gov

• 1 August 2026

  Act Partially Amending the Health Insurance Act, etc.

  健康保険法等の一部を改正する法律

  Act No. 31 of 2026The text after this amendment, on e-Gov

• 5 June 2026

  Act Partially Amending the Health Insurance Act, etc.

  健康保険法等の一部を改正する法律

  Act No. 31 of 2026The text after this amendment, on e-Gov

• 25 May 2026

  Act on the Promotion of Business Financing, etc.

  事業性融資の推進等に関する法律

  Act No. 52 of 2024The text after this amendment, on e-Gov

• 1 April 2026

  Act Partially Amending the Medical Care Act, etc.

  医療法等の一部を改正する法律

  Act No. 87 of 2025The text after this amendment, on e-Gov

• 1 April 2026

  Act Partially Amending the National Pension Act, etc., and Other Matters, to Strengthen the Functions of the Pension System in Light of Socioeconomic Changes

  社会経済の変化を踏まえた年金制度の機能強化のための国民年金法等の一部を改正する等の法律

  Act No. 74 of 2025The text after this amendment, on e-Gov

• 1 April 2026

  Act Partially Amending the Act on Support for Children and Child-rearing, etc.

  子ども・子育て支援法等の一部を改正する法律

  Act No. 47 of 2024The text after this amendment, on e-Gov

• 1 April 2026

  Act Partially Amending the Health Insurance Act, etc. to Establish a Sustainable Social Security System for All Generations

  全世代対応型の持続可能な社会保障制度を構築するための健康保険法等の一部を改正する法律

  Act No. 31 of 2023The text after this amendment, on e-Gov

• 12 December 2025

  Act Partially Amending the Medical Care Act, etc.

  医療法等の一部を改正する法律

  Act No. 87 of 2025The text after this amendment, on e-Gov

All 53 amendments already in force

• Insured persons employed by the national government, at a local government office, or by a corporation, who are members of a mutual aid association (共済組合) set up by an Act, receive no benefits under this Act and pay no premiums under it, and the association's benefits must be at least as good. The Promotion and Mutual Aid Corporation for Private Schools of Japan (日本私立学校振興・共済事業団) counts as a mutual aid association, and those in the private school teachers' mutual aid system (私立学校教職員共済制度) as its members.(Art. 200(1), Art. 200(2), Art. 202(1), Art. 3(10), Suppl. Prov. Art. 6(1)) (the provisions it rests on)
• No benefit is given for an illness, injury or death for which an equivalent benefit is available under the Industrial Accident Compensation Insurance Act (労働者災害補償保険法), the accident compensation Acts for national and local public employees (国家公務員災害補償法, 地方公務員災害補償法) or local ordinances (条例) under the latter, nor medical benefits where long-term care insurance under the Long-Term Care Insurance Act (介護保険法) gives an equivalent. Nor are benefits given for illness, injury or death arising from an insured person's or dependent's work as an officer (役員) of a corporation, except, at a place of business with fewer than five insured persons, for work an Order of the Ministry of Health, Labour and Welfare names.(Art. 1(1), Art. 55(1), Art. 55(3), Art. 53-2(1)) (the provisions it rests on)
• No benefit is given for what an insured person caused by an intentional crime or on purpose; benefits may be withheld in whole or part for what they caused by fighting, drunkenness or gross misconduct, and in part for not following treatment instructions without good reason. While an insured person is held in a juvenile training school, a penal institution or a similar facility, their own benefits stop (the injury and sickness and childbirth allowances only as an Order of the Ministry of Health, Labour and Welfare provides), and these rules apply to dependents in the same way; but an insured person's custody does not stop the dependents' benefits, and, unless they have optional and continued coverage, no premiums are collected for the months the Act sets.(Art. 116(1), Art. 117(1), Art. 119(1), Art. 122(1), Art. 118(1), Art. 118(2), Art. 158(1)) (the provisions it rests on)
• An insurer may reduce or waive the co-payment (一部負担金), or collect it itself and defer it, for an insured person who, because of a disaster or another special circumstance an Order of the Ministry of Health, Labour and Welfare names, would find it hard to pay, and may raise the share it pays for such a person's dependents, up to the whole cost.(Art. 75-2(1), Art. 75-2(2), Art. 110-2(1)) (the provisions it rests on)
• The injury and sickness allowance is not paid while a disability employees' pension (障害厚生年金) can be received for the same illness or injury, or only the amount by which the pension falls short of it; it is not paid until the allowance it would have paid adds up to a disability allowance (障害手当金) received for it; and, for someone receiving it after coverage ended who meets requirements a Cabinet Order sets, it is not paid while an old-age or retirement pension a Cabinet Order names can be received, apart from any shortfall.(Art. 108(3), Art. 108(4), Art. 108(5)) (the provisions it rests on)
• Where a third party caused what the benefit is paid for, the insurer takes over the person's claim for damages against that party up to the value of the benefit, and where the person has already been compensated by that party for the same thing, it need not give the benefit to that extent.(Art. 57(1), Art. 57(2)) (the provisions it rests on)
• The right to receive benefits cannot be transferred, pledged or seized, and no tax or other public charge may be levied on what is received as a benefit.(Art. 61(1), Art. 62(1)) (the provisions it rests on)

• Coverage begins on the day a person starts work at an applicable place of business, the day the place becomes one, or the day they stop falling into an excluded group, and ends on the day after they die, stop working there, fall into an excluded group or the place is authorized to leave coverage (or that same day if they are covered again on it). Gaining and losing coverage take effect when the insurer confirms them (for the Association's insured persons, the Minister of Health, Labour and Welfare; for a health insurance society's, the society), on the employer's report, on a request, or of its own motion, though optional and continued coverage, and loss of coverage because the Minister has let a place of business leave coverage, need no such confirmation. Anyone who is or was insured may ask for that confirmation at any time.(Art. 35(1), Art. 36(1), Art. 36(1)(i), Art. 36(1)(ii), Art. 36(1)(iii), Art. 36(1)(iv), Art. 39(1), Art. 39(2), Art. 51(1)) (the provisions it rests on)
• Where coverage, standard remuneration, premiums or benefits are concerned, the Minister of Health, Labour and Welfare may order an employer to produce documents and send officials into the place of business to question people and inspect books; officials carry identification and show it on request, and the power is not one of criminal investigation. Except as to health insurance societies, the Japan Pension Service (日本年金機構) uses this power for the Minister where coverage, standard remuneration or premiums are concerned, and the Association where benefits are, each with the Minister's prior authorization; the Minister may still use it directly.(Art. 198(1), Art. 198(2), Art. 7-38(2), Art. 7-38(3), Art. 204(1), Art. 204(1)(xix), Art. 204-5(1), Art. 204-5(2), Art. 204-7(1), Art. 204-8(1)) (the provisions it rests on)
• An insurer may order a person receiving benefits (and the dependent, where the benefit is for one) to produce documents or to be questioned or examined by its staff, and may withhold all or part of the benefit from one who refuses without good reason. It may recover benefits obtained by deception, making an employer who gave a false report or certificate, or a doctor who wrote a false medical certificate, jointly liable for the sum. It may also refuse all or part of the injury and sickness or childbirth allowance, for up to six months, to anyone who obtained or tried to obtain benefits by deception, unless a year has passed since.(Art. 59(1), Art. 121(1), Art. 58(1), Art. 58(2), Art. 120(1)) (the provisions it rests on)
• Unpaid premiums and other sums due under the Act are demanded by a notice setting a deadline at least 10 days away, unless collection is brought forward; if they are still not paid, the insurer may take enforcement action as for delinquent national taxes or ask the municipality to, with the Japan Pension Service (日本年金機構) acting for the Minister of Health, Labour and Welfare, and the Association or a health insurance society needing the Minister's authorization to act itself. Late-payment charges (延滞金) run from the day after the original deadline at 14.6% a year, or 7.3% for the first three months on premiums, but are not charged if the whole sum is paid by the deadline in the demand notice, if the sum is under 1,000 yen or the charge under 100 yen, or where there were unavoidable circumstances, among other cases; for now the Act's supplementary provisions (附則) replace both rates, in any year in which the special base rate for delinquency tax (延滞税特例基準割合), which the Act on Special Measures Concerning Taxation (租税特別措置法) defines, is below 7.3%, with that base rate plus 7.3% and plus 1% (no more than 7.3%). An employer who, without good reason, fails to pay a day laborer's premium on the day also owes a surcharge (追徴金) of 25% of the premium the Minister fixes, unless that premium is under 1,000 yen.(Art. 180(1), Art. 180(2), Art. 180(3), Art. 180(4), Art. 180(5), Art. 180(6), Art. 181(1), Art. 181(4), Suppl. Prov. Art. 9(1), Art. 204(1)(xv), Art. 170(1), Art. 170(2)) (the provisions it rests on)
• The Minister of Health, Labour and Welfare may order insurance medical institutions, insurance pharmacies and the doctors and pharmacists working there to report and produce records, summon them, and have officials question them and inspect premises and records. The Minister may revoke a designation or registration on grounds the Act lists, among them breaking the rules on treatment and dispensing, fraud in fee claims, refusing a report or inspection, certain convictions and breaches of other health laws, and may refuse a new designation or registration for five years after revoking one. An insurer may make a provider that obtained payments by deception repay them with 40% added.(Art. 78(1), Art. 80(1), Art. 81(1), Art. 65(3)(i), Art. 71(2)(i), Art. 58(3)) (the provisions it rests on)
• Anyone dissatisfied with a decision on coverage, standard remuneration or benefits may make a request for examination (審査請求) to a social insurance examiner (社会保険審査官), and then a request for re-examination (再審査請求) to the Social Insurance Examination Committee (社会保険審査会); if the examiner has not decided within two months, the person who made the request may treat it as dismissed. A lawsuit to cancel such a decision can be brought only after the examiner has decided on it, and a final decision on coverage or standard remuneration cannot be disputed again as a ground against a benefit decision based on it. A decision imposing or collecting premiums, or enforcement action for unpaid sums, may be taken straight to the Committee by a request for examination.(Art. 189(1), Art. 189(2), Art. 189(4), Art. 190(1), Art. 192(1)) (the provisions it rests on)
• An employer who, without good reason, fails to file or falsely files the reports on coverage and pay, fails to pass the insurer's notices on to employees, fails to pay premiums by the deadline in a demand notice, fails to pay a day laborer's premium, or refuses or obstructs an inspection faces up to six months' imprisonment (拘禁刑) or a fine of up to 500,000 yen, and where an employee or representative commits such a breach in a business's affairs, the business is fined as well. Anyone else who, without good reason, refuses or obstructs an inspection or answers its questions falsely, and anyone who makes a false application for a day laborer's insurance book, faces up to six months' imprisonment or a fine of up to 300,000 yen; a day laborer who does not apply for the book or hand it to the employer, and an insured person who without good reason disobeys an order to report on treatment received, face a fine of up to 300,000 yen, and officers and staff of the Association or a health insurance society who leak secrets learned at work face up to one year's imprisonment or a fine of up to 1,000,000 yen. An employer, insured person or benefit claimant who without good reason fails to make a report, notification or submission an insurer requires is liable to a non-criminal fine (過料) of up to 100,000 yen.(Art. 208(1), Art. 208(1)(i), Art. 208(1)(ii), Art. 208(1)(iii), Art. 208(1)(iv), Art. 208(1)(v), Art. 214(1), Art. 209(1), Art. 211(1), Art. 212(1), Art. 210(1), Art. 207-2(1), Art. 216(1), Art. 217(1)) (the provisions it rests on)
• The right to collect premiums and other sums due, to have them refunded, and to receive benefits lapses two years after it could first be exercised; a notice to pay or a demand for premiums restarts that period.(Art. 193(1), Art. 193(2)) (the provisions it rests on)