Health Insurance Act

The term "electronic eligibility confirmation" as used in this Act means that a person who intends to receive medical treatment from a medical institution providing services covered by health insurance, etc. (meaning a hospital, clinic, or pharmacy listed in the items of Article 63, paragraph (3); the same applies hereinafter) or, a person who intends to receive designated home nursing prescribed in Article 88, paragraph (1) from a designated home-nursing provider prescribed in that paragraph , or a person who intends to receive delivery care from a hospital or clinic listed in the items of Article 63, paragraph (3) (limited to those that handle deliveries; hereinafter referred to as a "delivery-handling medical institution providing services covered by health insurance, etc.") or a designated birthing center, etc. prescribed in Article 98-2, paragraph (1) makes an inquiry to the insurer about information relating to the eligibility of an insured person or dependent (including information necessary for claims for expenses relating to insurance benefits), by a method such as transmitting the electronic certificate for user verification (meaning the electronic certificate for user verification prescribed in Article 22, paragraph (1) of the Act on Certification Business of the Japan Agency for Local Authority Information Systems in Relation to Electronic Signatures, etc. (Act No. 153 of 2002)) recorded on an Individual Number Card (meaning an Individual Number Card prescribed in Article 2, paragraph (7) of the Act on the Use of Numbers to Identify a Specific Individual in Administrative Procedures (Act No. 27 of 2013)) or by another method specified by Order of the Ministry of Health, Labour and Welfare, receives a response from the insurer by a method using an electronic data processing system or another method using information and communications technology and provides that information to the medical institution providing services covered by health insurance, etc. or, the designated home-nursing provider, or the delivery-handling medical institution providing services covered by health insurance, etc. or designated birthing center, etc., and receives confirmation from that medical institution providing services covered by health insurance, etc. or, designated home-nursing provider, or delivery-handling medical institution providing services covered by health insurance, etc. or designated birthing center, etc. that the person is an insured person or dependent.

Japan Health Insurance Association administers insurance for insured persons who are not members of a health insurance society (excluding specially-insured day laborers; the same applies hereinafter in the main provisions except for the following Section, Article 51-2, Article 63, paragraph (3), item (ii), Article 98-2, paragraph (1), item (ii), Article 150, paragraph (1), Article 172, item (iii), and Chapters X and XI).

Beyond the operations listed in the items of the preceding paragraph, JHIA is responsible for operations related to Mariners Insurance business pursuant to the provisions of the Mariners Insurance Act (excluding those conducted by the Minister of Health, Labour and Welfare pursuant to the provisions of the same Act), and operations related to the payment of young-old payments, etc. pursuant to the provisions of the Act on Assurance of Medical Care for Elderly People (hereinafter referred to as "young-old payments, etc."), aid for the old-old, contributions for administrative expenses related to the old-old, and contributions for administrative expenses related to childbirth and childcare pursuant to the provisions of the same Act (hereinafter referred to as "aid for the old-old, etc."), the payment pursuant to the provisions of the Long-Term Care Insurance Act (Act No. 123 of 1997) (hereinafter referred to as "long-term care payment"), contribution for securing medical care in the early phase of an epidemic, etc. pursuant to 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 pursuant to 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").

An insured person or the insured person's dependent who has received the document referred to in the preceding paragraph pursuant to the provisions of that paragraph, or who has been provided by electronic or magnetic means with the matters specified by Order of the Ministry of Health, Labour and Welfare referred to in that paragraph, may receive the confirmation referred to in Article 63, paragraph (3) (including as applied mutatis mutandis pursuant to Article 110, paragraph (7)), Article 85, paragraph (1), Article 85-2, paragraph (1), Article 86, paragraph (1), or Article 88, paragraph (3) (including as applied mutatis mutandis pursuant to Article 111, paragraph (3)), Article 98-2, paragraph (1), or Article 112-2, paragraph (1) by presenting the document, or a display of those matters made by a method specified by Order of the Ministry of Health, Labour and Welfare.

payment of injury and sickness allowancedelivery expenses;

payment of burial chargesinjury and sickness allowance;

payment of lump-sum allowance for childbirth and childcareburial charges;

payment of childbirthlump-sum allowance at childbirth;

payment of dependent's medical expenses, dependent's medical expenses for home-nursing, and dependent's transport expenseschildbirth allowance;

payment of dependent's burial chargesmedical expenses, dependent's medical expenses for home-nursing, and dependent's transport expenses;

lump-sum allowance forpayment of dependent's childbirth and childcare; anddelivery expenses;

payment of high-cost medical expenses and expenses for high-cost medical treatment combined with long-term caredependent's burial charges;

payment of lump-sum allowance at dependent's childbirth; and

payment of high-cost medical expenses and expenses for high-cost medical treatment combined with long-term care.

Dependent's medical expenses (including medical expenses paid pursuant to the provisions of Article 87, paragraph (1) as applied mutatis mutandis pursuant to Article 110, paragraph (7)), dependent's medical expenses for home-nursing, dependent's transport expenses, dependent's delivery expenses (including an amount equivalent to the cost required for delivery care paid pursuant to the provisions of Article 98-2, paragraph (10) as applied mutatis mutandis pursuant to Article 112-2, paragraph (3); the same applies in paragraph (4) of the following Article and Article 60, paragraph (2)), dependent's burial charges, or lump-sum allowance forat dependent's childbirth and childcare (including the difference paid pursuant to the provisions of Article 101, paragraph (3) as applied mutatis mutandis pursuant to Article 114, paragraph (2); the same applies in Article 56, paragraph (1)) in relation to an insured person are not paid to that extent if the insured person has received medical , for the same sickness, injury, death, or childbirth, pursuant to the provisions of the following Chapter, benefits for medical treatment, or dietary treatment expenseexpenses for inpatients, living support expenses for inpatients, medical expenses combined with treatment outside insurance coverage, medical expenses, medical expenses for home-nursing, transport expenses, burial charges, or lump-sum allowance for childbirth and childcare delivery expenses (including an amount equivalent to the cost required for delivery care paid pursuant to the same sickness, injury, deathprovisions of Article 134-2, paragraph (6) or (7)), burial charges, or lump-sum allowance at childbirth (including the difference paid pursuant to the provisions of the following ChapterArticle 101, paragraph (3) as applied mutatis mutandis pursuant to Article 149).

Benefits for medical treatment, or expenses for dietary treatment for inpatients, living support expenses for inpatients, medical expenses combined with treatment outside insurance coverage, medical expenses, medical expenses for home-nursing, transport expenses, delivery expenses (including an amount equivalent to the cost required for delivery care paid pursuant to the provisions of Article 98-2, paragraph (10) (including when applied mutatis mutandis to Article 98-24, paragraph (2)); the same applies in Article 60, paragraph (2)), dependent's medical expenses, dependent's medical expenses for home-nursing, dependent's transport expenses, or dependent's transportdelivery expenses in relation to an insured person are not paid to that extent if the insured person has received , for the same sickness, injury, or childbirth, medical treatment or payment of medical expenses for the same sickness or injury from, or delivery care, at the expense of the national government or a local government pursuant to the provisions of other laws and regulations.

Dietary treatment expenses for inpatients, living support expenses for inpatients, medical expenses combined with treatment outside insurance coverage, medical expenses, medical expenses for home-nursing, transport expenses, delivery expenses, injury and sickness allowance, burial charges, lump-sum allowance forat childbirth and childcare, (including the difference paid pursuant to the provisions of Article 101, paragraph (3) (including when applied mutatis mutandis to Article 106, paragraph (2))), childbirth allowance, dependent's medical expenses, dependent's medical expenses for home-nursing, dependent's transport expenses, dependent's delivery expenses, dependent's burial charges, and lump-sum allowance forat dependent's childbirth and childcare must be paid on each occasion. This also applies to the payment of an amount equivalent to the cost ofrequired for delivery care pursuant to the provisions of Article 98-2, paragraph (10) (including when applied mutatis mutandis to Article 98-24, paragraph (2) and Article 112-2, paragraph (3)) and an amount equivalent to the cost required for burial pursuant to the provisions of Article 100, paragraph (2) (including when applied mutatis mutandis to Article 105, paragraph (2)).

If a medical institution providing services covered by health insurance or a pharmacy providing services covered by health insurance as prescribed in Article 63, paragraph (3), item (i) or, a designated home-nursing provider as prescribed in Article 88, paragraph (1) , or a medical institution providing services covered by health insurance as prescribed in that item (limited to one that handles delivery; hereinafter referred to as a "delivery-handling medical institution providing services covered by health insurance") or a designated birthing center as prescribed in Article 98-2, paragraph (1), item (i) receives, by means of deception or other wrongful conduct, any payment of expenses relating to benefits for medical treatment or any payment pursuant to the provisions of Article 85, paragraph (5) (including when applied mutatis mutandis to Article 85-2, paragraph (5) or Article 86, paragraph (5)), or Article 110, paragraph (4), any payment pursuant to the provisions of Article 88, paragraph (6) (including when applied mutatis mutandis to Article 111, paragraph (3)), or any payment pursuant to the provisions of Article 11098-2, paragraph (4), 3) (including when applied mutatis mutandis to Article 98-24, paragraph (2) and Article 112-2, paragraph (3)) or Article 101, paragraph (2) (including when applied mutatis mutandis to Article 106, paragraph (2) and Article 114, paragraph (2)), the relevant insurer may cause the medical institution, or pharmacy, orthe designated home-nursing provider, or the delivery-handling medical institution providing services covered by health insurance or designated birthing center to refund the amount so paid and to pay, in addition, an amount obtained by multiplying the amount to be refunded by four-tenths.

If the Minister of Health, Labour and Welfare finds it necessary in relation to the payment of insurance benefits, the Minister may order a physician, dentist, pharmacist , midwife or person who provided medical care or a person who employs any of these to make a report or to present medical records, birth records, record books, and other documents or other objects concerning the provided medical care, provision of drugs, or medical treatment, or delivery care, or may order the ministry's official to ask the person questions.

If the Minister of Health, Labour and Welfare finds it necessary, the Minister may order a person who is or was an insured person and who received payment of benefits for medical treatment, or expenses for dietary treatment for inpatients, living support expenses for inpatients, medical expenses combined with treatment outside insurance coverage, medical expenses, medical expenses for home-nursing, delivery expenses, dependent's medical expenses, or dependent's medical expenses for home-nursing , or dependent's delivery expenses to make a report on or have the Ministry's official ask questions about the medical care or, prescription pertaining to the insurance benefits, or , designated home-nursing home nursing as prescribed in Article 88, paragraph (1), or delivery care pertaining to the insurance benefits.

the establisher or administrator of the hospital, clinic or pharmacyclinic pertaining to the application has been sentenced to a fine (limited to one that handles deliveries) has repeatedly received guidance pursuant to the provisions of this Act or other laws pertaining Article 98-19, paragraph (1) (including when applied mutatis mutandis pursuant to citizen's health and medical care which are specified by Cabinet Order andArticle 98-24, paragraph (2), Article 112-2, paragraph (3), and Article 149) on the execution of the sentence has not yet been completed or the execution of the sentence still appliesgrounds that there is a likelihood of inappropriate content of delivery care with respect to insurance benefits;

the establisher or administrator of the hospital, clinic or pharmacy pertaining to the application has been sentenced to imprisonment a fine pursuant to the provisions of this Act or a more severe penalty other laws pertaining to citizen's health and medical care which are specified by Cabinet Order and the execution of the sentence has not yet been completed or the execution of the sentence still applies;

the establisher or administrator of the hospital, clinic, or pharmacy pertaining to the application has received a disposition of delinquency pursuant to this Act, the Seamen's Insurance Act, National Health Insurance Act (Act No. 192 of 1958), Act on Assurance of Medical Care for Elderly People, Local Public Employees Mutual Aid Association Act (Act No. 152 of 1962), Private School Personnel Mutual Aid Association Act (Act No. 245 of 1953), Employees' Pension Insurance Act (Act No. 115 of 1954), or National Pension Act (Act No. 141 of 1959) (referred to as "the social insurance laws" in Article 89, paragraph (4), item (vii)) with regardbeen sentenced to the insurance premiums, contribution charges,imprisonment or premiums (including national insurance tax pursuant to the provisions of the Local Tax Act (Act No. 226 of 1950); referred to as "social insurance premiums" hereinafter in this item, Article 89, paragraph (4), item (vii)a more severe penalty and Article 199, paragraph (2)) which the establisher or administrator is obliged to pay pursuant to the provisionsexecution of those Acts, before the application was filed, andsentence has continued to be delinquent, without justifiable grounds, for three months or more from the date on which the establishernot been completed or administrator received the disposition with respect to all social insurance premiums the due datesexecution of which came after the date on which the establisher or administrator received the disposition (limited to social insurance premiums which the person who received the disposition is obliged to pay pursuant to laws specifying the obligation to pay social insurance premiums to which the disposition pertains; the samesentence still applies in Article 89, paragraph (4), item (vii)); or;

beyond what is provided the establisher or administrator of the hospital, clinic, or pharmacy pertaining to the application has received a disposition of delinquency pursuant to this Act, the Mariners Insurance Act, National Health Insurance Act (Act No. 192 of 1958), Act on Assurance of Medical Care for in Elderly People, Local Public Officers, etc. Mutual Aid Association Act (Act No. 152 of 1962), Private School Personnel Mutual Aid Association Act (Act No. 245 of 1953), Employees' Pension Insurance Act (Act No. 115 of 1954), or National Pension Act (Act No. 141 of 1959) (referred to as "the preceding items, hospitals, clinics, social insurance laws" in Article 89, paragraph (4), item (vii) and Article 98-6, paragraph (2), item (v)) with regard to the insurance premiums, contribution charges, or pharmacies premiums (including National Health Insurance tax pursuant to the provisions of the Local Tax Act (Act No. 226 of 1950); referred to as "social insurance premiums" hereinafter) which the establisher or administrator is obliged to pay pursuant to the provisions of those Acts, before the application pertains are deemed was filed, and has continued to be extremely inappropriate as a medical institution providing services covered by health delinquent, without justifiable grounds, for three months or more from the date on which the establisher or administrator received the disposition with respect to all social insurance premiums the due dates of which came on or pharmacy providing services covered by health after the date on which the establisher or administrator received the disposition (limited to social insurance. premiums which the person who received the disposition is obliged to pay pursuant to laws specifying the obligation to pay social insurance premiums to which the disposition pertains; the same applies in Article 89, paragraph (4), item (vii) and Article 98-6, paragraph (2), item (v)); or

beyond what is provided for in the preceding items, hospitals, clinics, or pharmacies to which the application pertains are found to be extremely inappropriate as a medical institution providing services covered by health insurance or pharmacy providing services covered by health insurance.

a physician providing health insurance treatment at a medical institution providing services covered by health insurance (including a physician providing health insurance treatment who engages in delivery care) or a pharmacist filling health insurance prescriptions at a pharmacy providing services covered by health insurance has violated the provisions of Article 72, paragraph (1) (including when applied mutatis mutandis pursuant to Article 85, paragraph (9), Article 85-2, paragraph (5), Article 86, paragraph (5), Article 98-5, Article 98-24, paragraph (2), Article 110, paragraph (7), Article 112-2, paragraph (3), and Article 149; excluding when the medical institution providing services covered by health insurance or pharmacy providing services covered by health insurance had made efforts to provide reasonable care and supervision so as to prevent that violation);

the administrator of a medical institution providing services covered by health insurance has violated the provisions of Article 70-2, paragraph (2) (including when applied mutatis mutandis pursuant to Article 98-5) (excluding when the administrator has exercised reasonable care and supervision as the administrator of that medical institution providing services covered by health insurance in order to prevent that violation);

beyond the preceding two items, a medical institution providing services covered by health insurance or pharmacy providing services covered by health insurance has violated the provisions of Article 70, paragraph (1) (including when applied mutatis mutandis pursuant to Article 85, paragraph (9), Article 85-2, paragraph (5), Article 86, paragraph (5), Article 98-5, Article 98-24, paragraph (2), Article 110, paragraph (7), Article 112-2, paragraph (3), and Article 149);

the establisher or administrator of the a registered midwife prescribed in Article 98-4 who is engaged in delivery care at a delivery-handling medical institution providing services covered by health insurance or pharmacy providing services covered by health insurance has been sentenced to a finehas violated the provisions of Article 98-13, paragraph (1) (including when applied mutatis mutandis pursuant to the provisions of this Act or other laws concerning citizens' health and medical care which are specified by Cabinet Order, and the execution of the sentence has not yet been completed or the execution of the sentence still appliesArticle 98-24, paragraph (2), Article 112-2, paragraph (3), and Article 149) (except if the delivery-handling medical institution providing services covered by health insurance had made efforts to provide reasonable care and supervision so as to prevent that violation);

the establisher or administrator ofwith respect to a delivery-handling medical institution providing services covered by health insurance or pharmacy providing services covered by health insurance has come to fall under, wrongdoing is found with regard to a claim for payment pursuant to the categoryprovisions of a person who has been sentenced Article 98-2, paragraph (3) (including when applied mutatis mutandis pursuant to imprisonment or a severer punishment, Article 98-24, paragraph (2), Article 112-2, paragraph (3), and the execution of the sentence has not yet been completed or the execution of the sentence still applies; orArticle 149) or Article 101, paragraph (2) (including when applied mutatis mutandis pursuant to Article 106, paragraph (2), Article 114, paragraph (2), and Article 149);

beyond what is provided for in the preceding items, the establisher of the medical institution providing services covered by health insurance or pharmacy providing services covered by health insurance has violated the delivery-handling medical institution providing services covered by health insurance is requested to make a report, or to submit or present medical records, birth records and other record books and documents pursuant to the provisions of this Act or other medical insurance laws which are specified by Cabinet Order, or an Article 98-20, paragraph (1) (including the cases where the same provision is applied mutatis mutandis pursuant to Article 98-24, paragraph (2), Article 112-2, paragraph (3), and Article 149; the same applies in the following item) but fails to comply with the order or disposition based thereonsubmits a false report;

the establisher or an employee of the delivery-handling medical institution providing services covered by health insurance has been requested to appear pursuant to the provision of Article 98-20, paragraph (1) but failed to comply with the order or answer questions pursuant to the provisions of the same paragraph, answered untruthfully, or refused, obstructed, or evaded an inspection pursuant to the same paragraph (except if, where an employee of the delivery-handling medical institution providing services covered by health insurance committed that act, the delivery-handling medical institution providing services covered by health insurance had made efforts to provide reasonable care and supervision so as to prevent that act);

the establisher of the delivery-handling medical institution providing services covered by health insurance has violated an order pursuant to the provisions of Article 98-23, paragraph (3) (including when applied mutatis mutandis pursuant to Article 98-24, paragraph (2), Article 106, paragraph (2), Article 112-2, paragraph (3), Article 114, paragraph (2), and Article 149);

there are grounds that correspond to any of items (i) through (iii) or item (viii) through the preceding item with respect to delivery care of an insured person or dependent under medical insurance laws other than this act;

the establisher or administrator of the medical institution providing services covered by health insurance or pharmacy providing services covered by health insurance has been sentenced to a fine pursuant to the provisions of this Act or other laws pertaining to citizen's health and medical care which are specified by Cabinet Order, and the execution of the sentence has not yet been completed or the execution of the sentence still applies;

the establisher or administrator of a medical institution providing services covered by health insurance or pharmacy providing services covered by health insurance has come to fall under the category of a person who has been sentenced to imprisonment or a severer punishment, and the execution of the sentence has not yet been completed or the execution of the sentence still applies; or

beyond what is provided for in the preceding items, the establisher of the medical institution providing services covered by health insurance or pharmacy providing services covered by health insurance has violated the provisions of this Act or other laws pertaining to citizen's health and medical care which are specified by Cabinet Order, or an order or disposition based thereon;

the physician providing health insurance treatment or pharmacist filling health insurance prescriptions has violated the provisions of Article 72, paragraph (1) (including when applied mutatis mutandis to Article 85, paragraph (9), Article 85-2, paragraph (5), Article 86, paragraph (5), Article 98-5, Article 98-24, paragraph (2), Article 110, paragraph (7), Article 112-2, paragraph (3), and Article 149);

the administrator of a medical institution providing services covered by health insurance has violated the provisions of Article 70-2, paragraph (2) (including when applied mutatis mutandis pursuant to Article 98-5) (excluding when the administrator has exercised reasonable care and supervision as the administrator of that medical institution providing services covered by health insurance in order to prevent that violation);

the physician providing health insurance treatment or pharmacist filling health insurance prescriptions has (limited to a physician engaged in delivery care; the same applies in the following item) had been sentencedrequested to a fineappear pursuant to the provisions of this Act and other laws concerning citizens' health and medical care which are specified by Cabinet Order, Article 98-20, paragraph (1) (including when applied mutatis mutandis pursuant to Article 98-24, paragraph (2), Article 112-2, paragraph (3), and Article 149; the execution of the sentence has not yet been completed same applies hereinafter in this item) but failed to respond or to reply to questions pursuant to the executionprovisions of Article 98-20, paragraph (1), or answered untruthfully, or refused, obstructed, or evaded an inspection pursuant to the sentence still appliesprovisions of the same paragraph;

with respect to the physician providing health insurance treatment or pharmacist filling health insurance prescriptions has come, there are grounds that correspond to fall under the categoryany of a person who has been sentenced to imprisonmentitem (i), item (ii) or a severer punishment, and the execution of the sentence has not yet been completed or the execution of the sentence still applies; orpreceding item with respect to delivery care based on medical insurance laws other than this act;

beyond the cases listed in the preceding items, the physician providing health insurance treatment or pharmacist filling health insurance prescriptions violates has been sentenced to a fine pursuant to the provisions of this Act, medical insurance and other laws other than this act concerning citizens' health and medical care which are specified by Cabinet Order, or an order and the execution of the sentence has not yet been completed or disposition based on these Acts.the execution of the sentence still applies;

the physician providing health insurance treatment or pharmacist filling health insurance prescriptions has come to fall under the category of a person who has been sentenced to imprisonment or a severer punishment, and the execution of the sentence has not yet been completed or the execution of the sentence still applies; or

beyond the cases listed in the preceding items, the physician providing health insurance treatment or pharmacist filling health insurance prescriptions violates this Act or other laws concerning citizens' health and medical care which are specified by Cabinet Order, or an order or disposition based on these Acts.

When intending to issue the Order of the Ministry of Health, Labour and Welfare referred to in Article 70, paragraph (1) (including when applied mutatis mutandis pursuant to Article 85, paragraph (9), Article 85-2, paragraph (5), Article 86, paragraph (5), Article 98-5, Article 98-24, paragraph (2), Article 110, paragraph (7), Article 112-2, paragraph (3), and Article 149) or Article 70, paragraph (3), Article 70-2 (including when applied mutatis mutandis pursuant to Article 98-5), or Article 72, paragraph (1) (including when applied mutatis mutandis pursuant to Article 85, paragraph (9), Article 85-2, paragraph (5), Article 86, paragraph (5), Article 98-5, Article 98-24, paragraph (2), Article 110, paragraph (7), Article 112-2, paragraph (3), and Article 149), or intending to make a determination under Article 63, paragraph (2), item (iii), (v) or (vi), or Article 76, paragraph (2) (including when these provisions are applied mutatis mutandis pursuant to Article 149), the Minister of Health, Labour and Welfare is to consult with the Central Social Insurance Medical Council; provided, however, that this does not apply to a determination under Article 63, paragraph (2), item (iii) pertaining to advanced medical care techniques.

Section 2-2 Payment of Delivery Expenses

When an insured person, pursuant to Order of the Ministry of Health, Labour and Welfare, receives confirmation that the person is an insured person by electronic eligibility confirmation, etc., and receives delivery care, from a delivery-handling medical institution providing services covered by health insurance, etc. or a birthing center listed in the following items (hereinafter referred to as "designated birthing centers, etc.") that the insured person selects, delivery expenses are paid for the expenses required for the delivery care.

a birthing center designated by the Minister of Health, Labour and Welfare (hereinafter referred to as "designated birthing center");

a birthing center which provides delivery care to an insured person administered by a specific insurer and which is specified by the insurer; and

a birthing center established by an insurer which is a health insurance society.

The amount of delivery expenses is the amount of expenses calculated for the relevant delivery care as specified by the Minister of Health, Labour and Welfare in consideration of the standard amount of expenses required for delivery care.

When an insured person receives delivery care from a hospital or clinic listed in Article 63, paragraph (3), item (i) or (ii) (limited to one that handles deliveries) or a birthing center listed in paragraph (1), item (i) or (ii), the insurer may, on behalf of the insured person, pay to the hospital or clinic or the birthing center the expenses required for the delivery care payable by the insured person to the hospital or clinic or the birthing center within the limit of the amount payable to the insured person as delivery expenses.

When a payment pursuant to the provisions of the preceding paragraph is made, it is deemed that delivery expenses are paid to the insured person.

When an insured person receives delivery care from a hospital or clinic listed in Article 63, paragraph (3), item (iii) (limited to one that handles deliveries) or a birthing center listed in paragraph (1), item (iii), if the insurer exempts the insured person from payment of an amount equivalent to the amount to be paid to the insured person as delivery expenses among the expenses required for the delivery care to be paid by the insured person, it is deemed that delivery expenses are paid.

Upon acceptance of the payment of expenses required for delivery care, a delivery-handling medical institution providing services covered by health insurance, etc. or designated birthing center, etc. must issue a receipt therefor to the insured person who made the payment, pursuant to Order of the Ministry of Health, Labour and Welfare.

When an insurer receives a claim from a delivery-handling medical institution providing services covered by health insurance or a designated birthing center for the expenses required for delivery care (limited to the amount payable to the insured person as delivery expenses; the same applies in paragraph (9)), the insurer is to make payment after examination in light of the provisions of paragraph (2), the Order of the Ministry of Health, Labour and Welfare referred to in Article 70, paragraph (1) and Article 72, paragraph (1) as applied mutatis mutandis pursuant to Article 98-5, and the Order of the Ministry of Health, Labour and Welfare referred to in Article 98-10, paragraph (1) and Article 98-13, paragraph (1).

An insurer may delegate the affairs concerning examination and payment pursuant to the provisions of the preceding paragraph to the Infrastructure Organization or an NHI federation.

Beyond what is provided for in the preceding paragraphs, necessary matters concerning claims for expenses incurred in providing delivery care at a delivery-handling medical institution providing services covered by health insurance or designated birthing center are specified by Order of the Ministry of Health, Labour and Welfare.

When an insurer finds it difficult to pay delivery expenses pursuant to the provisions of paragraph (1) in cases where an insured person receives delivery care, or finds it unavoidable in cases where an insured person has received delivery care from a person other than a delivery-handling medical institution providing services covered by health insurance, etc. or designated birthing center, etc., the insurer may pay, pursuant to Order of the Ministry of Health, Labour and Welfare, an amount equivalent to the cost required for that delivery care, determined by the insurer based on the amount of expenses calculated in accordance with the example of the determination under paragraph (2); however, that amount must not exceed the amount of expenses actually required for that delivery care.

The Minister of Health, Labour and Welfare is to conduct necessary surveys in order to ensure the appropriateness of the determination under paragraph (2) of the preceding Article.

A delivery-handling medical institution providing services covered by health insurance or designated birthing center must report to the Minister of Health, Labour and Welfare, in order to contribute to the survey referred to in the preceding paragraph, the details of the delivery care provided at that delivery-handling medical institution providing services covered by health insurance or designated birthing center and other information specified by the Minister.

A physician or midwife engaged in delivery care covered by health insurance at a delivery-handling medical institution providing services covered by health insurance or designated birthing center must be a physician providing health insurance treatment (limited to a physician) or a midwife registered by the Minister of Health, Labour and Welfare (hereinafter referred to as a "registered midwife").

The provisions of Article 70, paragraphs (1) and (2) apply mutatis mutandis to delivery-handling medical institutions providing services covered by health insurance, the provisions of Article 70-2, paragraph (2) apply mutatis mutandis to administrators of delivery-handling medical institutions providing services covered by health insurance, and the provisions of Article 72 apply mutatis mutandis to physicians providing health insurance treatment (limited to physicians) who are engaged in delivery care at delivery-handling medical institutions providing services covered by health insurance, respectively.

A designation referred to in Article 98-2, paragraph (1), item (i) is provided upon an application by the establisher of a birthing center, as specified by Cabinet Order.

If an application referred to in the preceding paragraph is filed and falls under any of the following items, the Minister of Health, Labour and Welfare may decline to make the designation referred to in Article 98-2, paragraph (1), item (i):

the birthing center pertaining to the application has had its designation referred to in Article 98-2, paragraph (1), item (i) pertaining to designated birthing centers rescinded pursuant to the provisions of this Act and five years have not elapsed from the date of the rescission;

the birthing center pertaining to the application has received repeated guidance due to a likelihood of inappropriate content of delivery care with respect to insurance benefits pursuant to Article 98-19, paragraph (1) (including when applied mutatis mutandis to Article 98-24, paragraph (2), Article 112-2, paragraph (3), and Article 149);

the establisher or administrator of the birthing center pertaining to the application has been sentenced to a fine pursuant to the provisions of this Act or other laws concerning citizens' health and medical care which are specified by Cabinet Order, and the execution of the sentence has not yet been completed or the execution of the sentence still applies;

the establisher or administrator of the birthing center pertaining to the application has been sentenced to imprisonment or a heavier punishment, and the execution of the sentence has not yet been completed or the execution of the sentence still applies;

the establisher or administrator of the birthing center pertaining to the application is a person who, with regard to social insurance premiums, has received, by the day before the day on which the application was filed, a disposition of delinquency pursuant to the provisions of the social insurance laws, and has continued, without justifiable grounds, for three months or more from the date on which the person received the disposition, to be delinquent in all social insurance premiums the due dates of which came on or after the date on which the person received the disposition; or

beyond what is provided for in the preceding items, the birthing center pertaining to the application is deemed significantly inappropriate as a designated birthing center.

If the Minister of Health, Labour and Welfare determines not to make the designation referred to in Article 98-2, paragraph (1), item (i) pertaining to a designated birthing center, the Minister must undergo discussion at the relevant local social insurance medical council.

A designation referred to in Article 98-2, paragraph (1), item (i) expires when six years have elapsed after the day of designation.

With regard to a designated birthing center that is specified by Order of the Ministry of Health, Labour and Welfare, unless otherwise notified during the period from six months before the expiration date of the designation pursuant to the provisions of the preceding paragraph until three months before that date, the application referred to in Article 98-6, paragraph (1) is deemed to have been made.

In the case where a birthing center is one established by a midwife and only the midwife who is the establisher engages in delivery care, if the registration under Article 98-4 is made for that midwife, the designation referred to in Article 98-2, paragraph (1), item (i) is deemed to have been made for that birthing center; provided, however, that this does not apply if that birthing center falls under the requirements prescribed in Article 98-6, paragraph (2) and the Minister of Health, Labour and Welfare finds it inappropriate to deem that the designation referred to in the same item has been made.

In addition to putting registered midwives who are engaged in delivery care at the designated birthing center in charge of delivery care pursuant to Order of the Ministry of Health, Labour and Welfare referred to in Article 98-13, paragraph (1), a designated birthing center must be responsible for delivery care pertaining to delivery expenses pursuant to Order of the Ministry of Health, Labour and Welfare.

Beyond the provisions of the preceding paragraph (including when applied mutatis mutandis to Article 98-24, paragraph (2), Article 112-2, paragraph (3), and Article 149), a designated birthing center is to be responsible for delivery care pertaining to delivery expenses pursuant to medical insurance laws other than this act.

An administrator of a designated birthing center must be a person who satisfies all of the following requirements:

being a registered midwife; and

being a person who meets the requirements specified by Order of the Ministry of Health, Labour and Welfare, such as having experience of engaging in delivery care as a registered midwife at a delivery-handling medical institution providing services covered by health insurance or a designated birthing center for three or more years.

A manager of a designated birthing center must, pursuant to Order of the Ministry of Health, Labour and Welfare, in order to ensure the efficient provision of appropriate delivery care, supervise the midwives and other employees working at the designated birthing center and exercise necessary care in the management and operation of the designated birthing center.

The registration under Article 98-4 is made upon application by a midwife.

In the case where an application under the preceding paragraph is filed, the Minister of Health, Labour and Welfare may refuse to make the registration under Article 98-4 if any of the following items applies.

the applicant is a person whose registration under Article 98-4 has been revoked pursuant to the provisions of this Act and for whom five years have not elapsed from the date of the revocation;

the applicant has been sentenced to a fine pursuant to the provisions of this Act or other laws concerning citizens' health and medical care which are specified by Cabinet Order, and the execution of the sentence has not been completed or the applicant has not ceased to be subject to execution;

the applicant has been sentenced to imprisonment or a more severe penalty and the execution of the sentence has not been completed or the execution of the sentence still applies; or

beyond what is provided for in the preceding three items, the applicant is deemed significantly inappropriate as a registered midwife.

If the Minister of Health, Labour and Welfare determines not to make the registration under Article 98-4, the Minister must undergo discussion at the local social insurance medical council.

In addition to what is prescribed in paragraph (1) or (2), necessary matters concerning the registration under Article 98-4 are specified by Cabinet Order.

A registered midwife engaged in delivery care at a delivery-handling medical institution providing services covered by health insurance or a designated birthing center must, pursuant to Order of the Ministry of Health, Labour and Welfare, provide delivery care under health insurance.

A registered midwife engaged in delivery care at a delivery-handling medical institution providing services covered by health insurance or a designated birthing center is to, in addition to what is provided pursuant to the preceding paragraph (including when applied mutatis mutandis pursuant to Article 98-24, paragraph (2), Article 112-2, paragraph (3) and Article 149), provide delivery care under the medical insurance laws other than this act.

A designated birthing center may decline its designation by giving notice not less than one month in advance.

A registered midwife may request deregistration by giving notice not less than one month in advance.

The Minister of Health, Labour and Welfare may rescind the designation under Article 98-2, paragraph (1), item (i) pertaining to the relevant designated birthing center in the case where any of the following items applies.

a registered midwife engaged in delivery care at the designated birthing center has violated the provisions of Article 98-13, paragraph (1) (including when applied mutatis mutandis pursuant to Article 98-24, paragraph (2), Article 112-2, paragraph (3) and Article 149) (except if the designated birthing center had made efforts to provide reasonable care and supervision so as to prevent the violation);

the administrator of the designated birthing center has violated the provisions of Article 98-11, paragraph (2) (except if the administrator had made efforts to provide reasonable care and supervision as the administrator of the designated birthing center so as to prevent the violation);

beyond what is provided for in the preceding two items, the designated birthing center has violated the provisions of Article 98-10, paragraph (1) (including when applied mutatis mutandis pursuant to Article 98-24, paragraph (2), Article 112-2, paragraph (3) and Article 149);

there has been fraud in a claim relating to payment pursuant to the provisions of Article 98-2, paragraph (3) (including when applied mutatis mutandis pursuant to Article 98-24, paragraph (2), Article 112-2, paragraph (3) and Article 149) or Article 101, paragraph (2) (including when applied mutatis mutandis pursuant to Article 106, paragraph (2), Article 114, paragraph (2) and Article 149);

the designated birthing center is ordered to make a report, or to submit or present medical records, birth records or other books and documents pursuant to the provisions of Article 98-20, paragraph (1) (including when applied mutatis mutandis pursuant to Article 98-24, paragraph (2), Article 112-2, paragraph (3) and Article 149; the same applies in the following item) but fails to comply with the order or submits a false report;

the establisher or an employee of the designated birthing center has been requested to appear pursuant to the provisions of Article 98-20, paragraph (1) but failed to comply, failed to answer questions pursuant to the provisions of the same paragraph, answered untruthfully, or refused, obstructed, or evaded an inspection pursuant to the same paragraph (except if, where an employee of the designated birthing center did that act, the designated birthing center had made efforts to provide reasonable care and supervision so as to prevent that act);

the establisher of the designated birthing center has violated an order pursuant to the provisions of Article 98-23, paragraph (3) (including when applied mutatis mutandis pursuant to Article 98-24, paragraph (2), Article 106, paragraph (2), Article 112-2, paragraph (3), Article 114, paragraph (2) and Article 149);

in relation to delivery care pertaining to delivery expenses under the medical insurance laws other than this act, there has been a ground corresponding to any of the preceding items;

the establisher or administrator of the designated birthing center has come to fall under the category of a person who has been sentenced to a fine pursuant to the provisions of this Act or other laws concerning citizens' health and medical care which are specified by Cabinet Order, and for whom the execution of the sentence has not been completed or who has not ceased to be subject to execution; or

the establisher or administrator of the designated birthing center has come to fall under the category of a person who has been sentenced to imprisonment or a more severe penalty, and for whom the execution of the sentence has not been completed or who has not ceased to be subject to execution.

beyond what is provided for in the preceding items, the establisher of the designated birthing center has violated the provisions of this Act or other laws concerning citizens' health and medical care which are specified by Cabinet Order, or an order or disposition based thereon.

The Minister of Health, Labour and Welfare may rescind the registration under Article 98-4 pertaining to the relevant registered midwife (in the case set out in item (ii), the registration under that Article pertaining to the registered midwife who is the administrator of the relevant designated birthing center) in the case where any of the following items applies.

the registered midwife has violated the provisions of Article 98-13, paragraph (1) (including when applied mutatis mutandis pursuant to Article 98-24, paragraph (2), Article 112-2, paragraph (3) and Article 149);

the administrator of the designated birthing center has violated the provisions of Article 98-11, paragraph (2) (except if the administrator had made efforts to provide reasonable care and supervision as the administrator of the designated birthing center so as to prevent the violation);

the registered midwife has been requested to appear pursuant to the provisions of Article 98-20, paragraph (1) (including when applied mutatis mutandis pursuant to Article 98-24, paragraph (2), Article 112-2, paragraph (3) and Article 149; hereinafter the same applies in this item) but failed to comply, failed to answer questions pursuant to the provisions of Article 98-20, paragraph (1), answered untruthfully, or refused, obstructed, or evaded an inspection pursuant to the same paragraph;

in relation to delivery care under the medical insurance laws other than this act, there has been a ground corresponding to any of the preceding three items;

the registered midwife has come to fall under the category of a person who has been sentenced to a fine pursuant to the provisions of this Act or other laws concerning citizens' health and medical care which are specified by Cabinet Order, and for whom the execution of the sentence has not been completed or who has not ceased to be subject to execution;

the registered midwife has come to fall under the category of a person who has been sentenced to imprisonment or a severer punishment, and the execution of the sentence has not been completed or the execution of the sentence still applies; or

beyond what is provided for in the preceding items, the registered midwife has violated the provisions of this Act or other laws concerning citizens' health and medical care which are specified by Cabinet Order, or an order or disposition based thereon.

When intending to specify the Order of the Ministry of Health, Labour and Welfare under Article 98-10, paragraph (1) (including when applied mutatis mutandis pursuant to Article 98-24, paragraph (2), Article 112-2, paragraph (3) and Article 149), Article 98-11, or Article 98-13, paragraph (1) (including when applied mutatis mutandis pursuant to Article 98-24, paragraph (2), Article 112-2, paragraph (3) and Article 149), or when intending to make the determination under Article 98-2, paragraph (2) (including when applied mutatis mutandis pursuant to Article 149), the Minister of Health, Labour and Welfare is to consult with the Central Social Insurance Medical Council.

When intending to make the designation under Article 98-2, paragraph (1), item (i) or to rescind that designation, or when intending to rescind the registration under Article 98-4, the Minister of Health, Labour and Welfare is to consult with the local social insurance medical council, as specified by Cabinet Order.

When the Minister of Health, Labour and Welfare determines not to make the designation under Article 98-2, paragraph (1), item (i), or determines not to make the registration under Article 98-4, the Minister must grant the establisher of the birthing center seeking that designation, or the midwife seeking that registration, an opportunity to hear an explanation. In this case, the Minister must give notification of the date, time, and place for the explanation and the circumstances thereof in writing, in advance.

A delivery-handling medical institution providing services covered by health insurance and a designated birthing center, and a physician providing health insurance treatment (limited to a physician engaged in delivery care; the same applies in paragraph (1) of the following Article) and a registered midwife who are engaged in delivery care at them, must receive guidance from the Minister of Health, Labour and Welfare with respect to delivery care under health insurance.

When the guidance referred to in the preceding paragraph is provided, and the Minister of Health, Labour and Welfare finds it necessary, the Minister is to have persons with knowledge and experience concerning delivery care attend during the guidance pursuant to designation by related organizations; provided, however, that this does not apply if related organizations make no designation or the designated persons do not attend.

When the Minister of Health, Labour and Welfare finds it necessary in relation to delivery care pertaining to delivery expenses, the Minister may order a delivery-handling medical institution providing services covered by health insurance or designated birthing center, or a person who was an establisher or manager, physician who provided health insurance treatment, registered midwife or other employee of a delivery-handling medical institution providing services covered by health insurance or designated birthing center (hereinafter referred to as "former establisher, etc." in this paragraph) to make a report or submit or present medical records, birth records or other books and documents, may request an establisher, manager, physician providing health insurance treatment, registered midwife or other employee of a delivery-handling medical institution providing services covered by health insurance or designated birthing center (including former establishers, etc.) to appear, or may have an official question persons involved or inspect any equipment or medical records, birth records, books and documents or other objects of a delivery-handling medical institution providing services covered by health insurance or designated birthing center.

The provisions of Article 7-38, paragraph (2) and paragraph (2) of the preceding Article apply mutatis mutandis to questions or inspections pursuant to the provisions of the preceding paragraph, and the provisions of Article 7-38, paragraph (3) apply mutatis mutandis to the authority pursuant to the provisions of the preceding paragraph, respectively.

Rules on delivery care under health insurance provided at hospitals or clinics listed in Article 63, paragraph (3), items (ii) and (iii) (limited to those that handle deliveries) are governed by Order of the Ministry of Health, Labour and Welfare referred to in Article 70, paragraph (1) and Article 72, paragraph (1) as applied mutatis mutandis pursuant to Article 98-5.

Rules on delivery care under health insurance provided at birthing centers listed in Article 98-2, paragraph (1), items (ii) and (iii) are governed by Order of the Ministry of Health, Labour and Welfare referred to in Article 98-10, paragraph (1) and Article 98-13, paragraph (1).

An administrator of a delivery-handling medical institution providing services covered by health insurance, etc. or a designated birthing center, etc. is to, pursuant to Order of the Ministry of Health, Labour and Welfare, provide in advance to an insured person who intends to receive delivery care from the delivery-handling medical institution providing services covered by health insurance, etc. or designated birthing center, etc. the information specified by the Minister of Health, Labour and Welfare, such as the content of and expenses for the delivery care pertaining to the payment of delivery expenses and lump-sum allowance at childbirth provided at that delivery-handling medical institution providing services covered by health insurance, etc. or designated birthing center, etc.

An administrator of a delivery-handling medical institution providing services covered by health insurance or a designated birthing center must, pursuant to Order of the Ministry of Health, Labour and Welfare, report to the Minister of Health, Labour and Welfare the information specified by the Minister, such as the content of and expenses for the delivery care pertaining to the payment of delivery expenses and lump-sum allowance at childbirth provided at that delivery-handling medical institution providing services covered by health insurance or designated birthing center, and to benefits corresponding thereto under the medical insurance laws other than this act.

Upon receiving a report pursuant to the provisions of the preceding paragraph, the Minister of Health, Labour and Welfare must, pursuant to Order of the Ministry of Health, Labour and Welfare, publish it in a form that is easy for insured persons to understand and endeavor to make it widely known.

If an administrator of a delivery-handling medical institution providing services covered by health insurance or a designated birthing center fails to make the report pursuant to the provisions of paragraph (1) or makes a false report, the Minister of Health, Labour and Welfare may, by specifying a period, order the establisher of that delivery-handling medical institution providing services covered by health insurance or designated birthing center to have the administrator make the report or correct the content of the report.

A person who was an insured person (excluding an insured person with optional and continued coverage or an insured person who is a member of a mutual aid association) continuously for one year or more until the day preceding the day on which the person lost eligibility as an insured person (for a person who lost eligibility as an insured person with optional and continued coverage, the day on which the person acquired that eligibility) (hereinafter referred to as a "person who was insured for one year or more" in this Article, Article 104 and Article 106, paragraph (1)) may, if within six months after the day of loss of eligibility as an insured person the person receives, from a delivery-handling medical institution providing services covered by health insurance, etc. or designated birthing center, etc. that the person selects, confirmation that the person is a person who was insured for one year or more by a method specified by Order of the Ministry of Health, Labour and Welfare, such as the presentation of documents certifying the loss of that eligibility, and receives delivery care, receive from the last insurer, as the delivery expenses that the person would have been able to receive as an insured person, payment of the amount of expenses calculated for that delivery care in accordance with the determination under Article 98-2, paragraph (2). However, this does not apply if the person who was an insured person has become an insured person of Mariners Insurance.

The provisions of Article 98-2, paragraphs (3) to (9) apply mutatis mutandis to the payment of delivery expenses after loss of eligibility under the preceding paragraph, the provisions of paragraph (10) of that Article apply mutatis mutandis to the payment of an amount equivalent to the expenses required for delivery care pertaining to a person who was insured for one year or more, and the provisions of Article 98-3, Article 98-4, Article 98-10, paragraph (1), Article 98-13 and Article 98-19 through the preceding Article, and the provisions of Article 70, paragraph (1) and Article 72, paragraph (1) as applied mutatis mutandis pursuant to Article 98-5, apply mutatis mutandis to delivery care pertaining to delivery expenses after loss of eligibility under the preceding paragraph, respectively.

Section 3 Payment of Injury and Sickness Allowance, Burial Charges, Lump-Sum Allowance forat Childbirth and Childcare Benefits, and Childbirth Allowance

(Lump-sum Allowance forat Childbirth and Childcare)

When an insured person receives delivery care under health insurance from a delivery-handling medical institution providing services covered by health insurance, etc. or designated birthing center, etc. and gives birth, the amount specified by Cabinet Order is paid as a lump-sum allowance forat childbirth and childcare.

When an insured person receives delivery care pertaining to delivery expenses pursuant to Article 98-2, paragraph (1) from a delivery-handling medical institution providing services covered by health insurance, etc. or designated birthing center, etc., the insurer may, on behalf of the insured person, pay to that delivery-handling medical institution providing services covered by health insurance, etc. or designated birthing center, etc. the lump-sum allowance at childbirth under the preceding paragraph (limited to an amount equivalent to the expenses required for childbirth that the insured person is to pay to that delivery-handling medical institution providing services covered by health insurance, etc. or designated birthing center, etc. (excluding an amount equivalent to the amount paid pursuant to paragraph (3) of that Article; hereinafter the same applies in this paragraph and paragraph (4)); the same applies in the following paragraph and paragraph (5)). In this case, that delivery-handling medical institution providing services covered by health insurance, etc. or designated birthing center, etc. is to apply the amount to the satisfaction of the claim relating to the expenses required for childbirth that the insured person is to pay to that delivery-handling medical institution providing services covered by health insurance, etc. or designated birthing center, etc.

If the amount of the lump-sum allowance at childbirth paid pursuant to the provisions of the preceding paragraph is less than the amount specified by Cabinet Order referred to in paragraph (1), the insurer is to, pursuant to Order of the Ministry of Health, Labour and Welfare, pay the difference to the insured person.

Upon acceptance of the payment of expenses required for childbirth, a delivery-handling medical institution providing services covered by health insurance, etc. or designated birthing center, etc. must issue a receipt therefor to the insured person who made the payment, pursuant to Order of the Ministry of Health, Labour and Welfare.

When making payment of the lump-sum allowance at childbirth pursuant to the provisions of paragraph (2), an insurer may delegate the affairs concerning that payment to the Infrastructure Organization or an NHI federation.

If an insured person is unable to receive payment of the lump-sum allowance at childbirth pursuant to the provisions of paragraph (1) despite having given birth, and the insurer finds that there are unavoidable circumstances, the insurer may, pursuant to Order of the Ministry of Health, Labour and Welfare, pay the amount specified by Cabinet Order as the lump-sum allowance at childbirth.

Beyond what is provided for in the preceding paragraphs of this Article, other necessary matters pertaining to the payment of the lump-sum allowance at childbirth are specified by Order of the Ministry of Health, Labour and Welfare.

A person who continued to have been an insured person for one year or more until the day preceding the day of loss of eligibility (in case of an insured person with optional and continued coverage, by the day of acquisition of eligibility) as an insured person (excluding insured persons with optional and continued coverage who are members of a mutual aid association) (referred to as a "person who was insured for one year or more" in Article 106) and who received payment of injury and sickness allowance or childbirth allowance at the time of loss of the eligibility may continue to receive the benefits from the same insurer for the period in which the person was eligible for the payment as an insured person.

(Payment of Lump-sum Allowance forat Childbirth and Childcare after Loss of Eligibility)

A person who was an insured person for one year or more and gives birthwho, within six months after the date of loss of the eligibility as an insured person , receives delivery care from a delivery-handling medical institution providing services covered by health insurance, etc. or designated birthing center, etc. and gives birth may be paid , as the lump-sum allowance forat childbirth and childcare that should have been received as an insured person, the amount specified by Cabinet Order referred to in Article 101, paragraph (1) from the person's last insurer.

The provisions of Article 98-22 and Article 98-23 apply mutatis mutandis to delivery care pertaining to the lump-sum allowance at childbirth after loss of eligibility under the preceding paragraph, and the provisions of Article 101, paragraphs (2) to (7) apply mutatis mutandis to the payment of the lump-sum allowance at childbirth after loss of eligibility under the preceding paragraph, respectively. In this case, the phrase "Article 98-2, paragraph (1)" in paragraph (2) of that Article is deemed to be replaced with "the main clause of Article 98-24, paragraph (1)", the phrase "paragraph (3) of that Article" with "Article 98-2, paragraph (3) as applied mutatis mutandis pursuant to Article 98-24, paragraph (2)", and the phrase "paragraph (1)" in paragraph (6) of that Article with "Article 106, paragraph (1)".

Section 4 Payment of Dependent's Medical Expenses, Dependent's Medical Expenses for Home-Nursing, Dependent's Transport Expenses, Dependent's Delivery Expenses, Dependent's Burial Charges, and Lump-Sum Allowance forat Dependent's Childbirth and Childcare

When a dependent of an insured person, pursuant to Order of the Ministry of Health, Labour and Welfare, receives confirmation that the person is a dependent by electronic eligibility confirmation, etc. from a delivery-handling medical institution providing services covered by health insurance, etc. or designated birthing center, etc. that is selected by the dependent, and receives delivery care, dependent's delivery expenses are paid to the insured person for the expenses required for the delivery care.

The amount of dependent's delivery expenses is the amount of expenses calculated for the relevant delivery care in accordance with the determination under Article 98-2, paragraph (2).

The provisions of Article 98-2, paragraphs (3) to (9) apply mutatis mutandis to the payment of dependent's delivery expenses, the provisions of paragraph (10) of that Article apply mutatis mutandis to the payment of an amount equivalent to the expenses required for delivery care pertaining to a dependent, and the provisions of Article 98-3, Article 98-4, Article 98-10, paragraph (1), Article 98-13 and Articles 98-19 through 98-23, and the provisions of Article 70, paragraph (1) and Article 72, paragraph (1) as applied mutatis mutandis pursuant to Article 98-5, apply mutatis mutandis to delivery care pertaining to dependent's delivery expenses, respectively.

(Lump-SumLump-sum Allowance forat Dependent's Childbirth and Childcare)

When a dependent of an insured person receives delivery care under health insurance from a delivery-handling medical institution providing services covered by health insurance, etc. or designated birthing center, etc. and gives birth, an amount specified by Cabinet Order referred to in Article 101 , paragraph (1) is paid to the insured person as lump-sum allowance forat dependent's childbirth and childcare.

The provisions of Article 98-22 and Article 98-23 apply mutatis mutandis to delivery care pertaining to the lump-sum allowance at dependent's childbirth, and the provisions of Article 101, paragraphs (2) to (7) apply mutatis mutandis to the payment of the lump-sum allowance at dependent's childbirth, respectively.

payment of injury and sickness allowancedelivery expenses;

payment of burial chargesinjury and sickness allowance;

payment of lump-sum allowance for childbirth and childcareburial charges;

payment of childbirthlump-sum allowance at childbirth;

payment of dependent's medical expenses, dependent's medical expenses for home-nursing, and dependent's transport expenseschildbirth allowance;

payment of dependent's burial chargesmedical expenses, dependent's medical expenses for home-nursing, and dependent's transport expenses;

lump-sum allowance forpayment of dependent's childbirth and childcaredelivery expenses;

payment of special medical expenses; anddependent's burial charges;

payment of high-cost medical expenses and expenses for high-cost medical treatment combined with long-term care.lump-sum allowance at dependent's childbirth;

payment of special medical expenses;

payment of special delivery expenses; and

payment of high-cost medical expenses and expenses for high-cost medical treatment combined with long-term care.

Benefits for medical treatment, or dietary treatment expenses for inpatients, living support expenses for inpatients, medical expenses combined with treatment outside insurance coverage, medical expenses, medical expenses for home-nursing, transport expenses, delivery expenses (including an amount equivalent to the expenses required for delivery care paid pursuant to the provisions of Article 134-2, paragraph (6) or (7); the same applies hereinafter in this Article), injury and sickness allowance, burial charges, lump-sum allowance forat childbirth (including the difference paid pursuant to the provisions of Article 101, paragraph (3) as applied mutatis mutandis pursuant to Article 149; the same applies in paragraphs (3) and childcare(4)), or childbirth allowance, pertaining to a specially-insured day laborer, are not paid if the specially-insured day laborer may receive payment equivalent to these for the same sickness, injury, death, or childbirth pursuant to the provisions of the preceding Chapter, medical insurance laws other than this Actact (excluding the National Health Insurance Act; the same applies hereinafter in this Article), the laws and regulations prescribed in Article 55, paragraph (1), or the Long-Term Care Insurance Act.

Benefits for medical treatment, or expenses for dietary treatment for inpatients, expenses for living support for inpatients, medical expenses combined with treatment outside insurance coverage, medical expenses, medical expenses for home-nursing, transport expenses, delivery expenses, burial charges, or lump-sum allowance forat childbirth and childcare, pertaining to a specially-insured day laborer, are not paid, to thatthe extent, if that the relevant person has received , for the same sickness, injury, death or childbirth, pursuant to the provisions of the preceding Chapter or the provisions of medical insurance laws other than this act, a benefit equivalent to payment under this Chapter of dependent's medical expenses (including medical expenses paid pursuant to the provisions of Article 132 as applied mutatis mutandis pursuant to Article 140, paragraph (2); the same applies in the following paragraph), dependent's medical expenses for home-nursing, dependent's transport expenses, dependent's burial charges, or lump-sum allowance for dependent's childbirth and childcaredelivery expenses (including an amount equivalent to the expenses required for delivery care paid pursuant to the same sickness, injury, death provisions of Article 134-2, paragraph (6) or childbirth (7) as applied mutatis mutandis pursuant to Article 142-2, paragraph (3); the provisions of same applies in the preceding Chapter following paragraph and paragraphs (6) and (7)), dependent's burial charges, or lump-sum allowance at dependent's childbirth (including the difference paid pursuant to the provisions of medical insurance laws other than this ActArticle 101, paragraph (3) as applied mutatis mutandis pursuant to Article 149; the same applies in the following paragraph).

Dependent's medical expenses, dependent's medical expenses for home-nursing, dependent's transport expenses, dependent's delivery expenses, dependent's burial charges, or dependent's lump-sum allowance for childbirth and childcareat dependent's childbirth, pertaining to a specially-insured day laborer, are not paid if the relevant person may receive a benefit equivalent , for the same sickness, injury, death or childbirth, pursuant to payment the provisions of the preceding Chapter, medical insurance laws other than this act, or the Long-Term Care Insurance Act, a benefit equivalent to those expenses or allowances, or a benefit equivalent to benefits for medical treatment, or payment of dietary treatment expenses for inpatients, living support expenses for inpatients, medical expenses combined with treatment outside insurance coverage, medical expenses, medical expenses for home-nursing, transport expenses, delivery expenses, burial charges, or lump-sum allowance forat childbirth and childcare under this Chapter for the same sickness, injury, death or childbirth pursuant to the provisions of the preceding Chapter, medical insurance laws other than this act, or the Long-Term Care Insurance Act.

Benefits for medical treatment, orSpecial delivery expenses for dietary treatment for inpatients, expenses for living support(including an amount equivalent to the expenses required for inpatients, medical expenses combined with treatment outside insurance coverage, medical expenses, medical expenses for home-nursing, transport expenses, dependent's medical expenses, dependent's medical expenses for home-nursing, dependent's transport expenses, or special medical expenses, pertaining to a specially-insured day laborer, are not made to that extent if the specially-insured day laborer received medical treatment delivery care paid pursuant to the provisions of Article 134-2, paragraph (6) or (7) as applied mutatis mutandis pursuant to Article 145-2, paragraph (4); the same applies in the following paragraph) are not paid for the same childbirth if the relevant person may receive a benefit equivalent to payment of delivery expenses or medical dependent's delivery expenses for the same sickness or injury borne byunder this Chapter pursuant to the provisions of the national governmentpreceding Chapter or a local government pursuant to the provisions of other Actsthe provisions of medical insurance laws other than this act.

Benefits for medical treatment, or expenses for dietary treatment for inpatients, expenses for living support for inpatients, medical expenses combined with treatment outside insurance coverage, medical expenses, medical expenses for home-nursing, transport expenses, delivery expenses, dependent's medical expenses, dependent's medical expenses for home-nursing, dependent's transport expenses, dependent's delivery expenses, special medical expenses, or special delivery expenses, pertaining to a specially-insured day laborer, are not made to that extent if the specially-insured day laborer received medical treatment or medical expenses for the same sickness or injury, or delivery care for the same childbirth, borne by the national government or a local government pursuant to the provisions of other laws and regulations.

When a specially-insured day laborer submits the laborer's qualified recipient card to one that the laborer selected from among the hospitals or clinics listed in Article 63, paragraph (3), item (i) or (ii) (limited to those that handle deliveries; the same applies in paragraphs (6) and (7), Article 137, paragraph (1), Article 142-2, paragraph (1), Article 144, paragraph (1) and Article 145-2, paragraph (1)) and the birthing centers listed in Article 98-2, paragraph (1), item (i) or (ii), and receives delivery care from it, delivery expenses are paid for the expenses required for the delivery care.

In order for a specially-insured day laborer to receive delivery expenses, insurance premiums must have been paid for the specially-insured day laborer for 26 days or more in total during the four months preceding the month including the day of childbirth (the scheduled date of childbirth if the day of childbirth is after the scheduled date of childbirth).

When a specially-insured day laborer proves that the laborer falls under the preceding paragraph with a specially-insured day laborer's insurance book and applies, the insurer must issue a qualified recipient card which shows confirmation of the proof or add the confirmation to a qualified recipient card which has already been issued.

The qualified recipient card referred to in paragraph (1) must be one that has received the confirmation pursuant to the provisions of the preceding paragraph.

The form of a qualified recipient card, the confirmation pursuant to the provisions of paragraph (3), and other necessary matters concerning a qualified recipient card are specified by Order of the Ministry of Health, Labour and Welfare.

If an insurer finds it difficult for a specially-insured day laborer who receives delivery care to receive payment of delivery expenses pursuant to the provisions of paragraph (1), or if a specially-insured day laborer receives delivery care from a person other than a hospital or clinic listed in Article 63, paragraph (3), item (i) or (ii) or a birthing center listed in Article 98-2, paragraph (1), item (i) or (ii) and the insurer finds it unavoidable, the insurer may, pursuant to Order of the Ministry of Health, Labour and Welfare, pay an amount equivalent to the expenses required for the delivery care, determined by the insurer on the basis of the amount of expenses calculated in accordance with the provisions of paragraph (2) of the same Article; provided, however, that the amount must not exceed the amount of expenses actually required for the delivery care.

The same applies as in the preceding paragraph also when a specially-insured day laborer, without receiving the confirmation pursuant to the provisions of paragraph (3), receives delivery care from a hospital or clinic listed in Article 63, paragraph (3), item (i) or (ii) or a birthing center listed in Article 98-2, paragraph (1), item (i) or (ii), and the insurer finds that the failure to receive the confirmation was due to urgent and unavoidable reasons.

(Lump-sum Allowance forat Childbirth and Childcare)

When a specially-insured day laborer gives birth and receives delivery care under health insurance premiums have been paid for the laborer for 26 days from a hospital or clinic listed in Article 63, paragraph (3), item (i) or more in total during the two months preceding the month including the day of childbirth(ii) or a birthing center listed in Article 98-2, paragraph (1), item (i) or (ii) and gives birth, an amount specified by Cabinet Order referred to in Article 101 , paragraph (1) is paid as a lump-sum allowance forat childbirth and childcare.

The provisions of Article 134-2, paragraph (2) apply mutatis mutandis to the payment of lump-sum allowance at childbirth.

Childbirth allowance is paid toWhen a specially-insured day laborer eligible for payment of lump-sum allowance for childbirthgives birth, and childcare in the period during whichinsurance premiums have been paid for the laborer does not engage in labor, starting 42for 26 days (98 daysor more in the case of multiple fetuses)total during the four months preceding the month including the day of childbirth (the scheduled date of childbirth if the day of childbirth is after the scheduled date of childbirth), childbirth allowance is paid in the period during which the laborer does not engage in labor, starting 42 days (98 days in the case of multiple fetuses) preceding that day of childbirth and ending 56 days following the day of childbirth.

When a dependent of a specially-insured day laborer submits a qualified recipient card to one that the dependent selected from among the hospitals or clinics listed in Article 63, paragraph (3), item (i) or (ii) and the birthing centers listed in Article 98-2, paragraph (1), item (i) or (ii), and receives delivery care from it, dependent's delivery expenses are paid to the specially-insured day laborer for the expenses required for the delivery care.

In order for a specially-insured day laborer to receive dependent's delivery expenses, insurance premiums must have been paid for the specially-insured day laborer for 26 days or more in total during the two months preceding the month including the day of childbirth (the scheduled date of childbirth if the day of childbirth is after the scheduled date of childbirth) or for 78 days or more in total during the six months preceding that month.

The provisions of Article 134-2, paragraphs (3) through (5) apply mutatis mutandis to the payment of dependent's delivery expenses, and the provisions of paragraphs (6) and (7) of that Article apply mutatis mutandis to the payment of an amount equivalent to the expenses required for delivery care pertaining to a dependent of a specially-insured day laborer, respectively. In this case, the phrase "the preceding paragraph" in paragraph (3) of that Article is deemed to be replaced with "Article 142-2, paragraph (2)", and the phrase "paragraph (1)" in paragraph (4) of that Article is deemed to be replaced with "Article 142-2, paragraph (1)".

(Lump-sum Allowance forat Dependent's Childbirth and Childcare)

When a dependent of a specially-insured day laborer receives delivery care under health insurance from a hospital or clinic listed in Article 63, paragraph (3), item (i) or (ii) or a birthing center listed in Article 98-2, paragraph (1), item (i) or (ii) and gives birth to a child, lump-sum allowance for dependent's childbirth and childcare an amount specified by Cabinet Order referred to in Article 101, paragraph (1) is paid to the specially-insured day laborer as lump-sum allowance at dependent's childbirth.

In order for a specially-insured day laborer to receive lump-sum allowance for dependent's childbirth and childcare, insurance premiums must have been paid for the specially-insured day laborer for 26 days or more in total in the two months preceding the month includingThe provisions of Article 142-2, paragraph (2) apply mutatis mutandis to the daypayment of childbirth or for 78 days or more in total in the six months preceding that monthlump-sum allowance at dependent's childbirth.

The amount of lump-sum allowance for dependent's childbirth and childcare is the amount specified by Cabinet Order referred to in Article 101.

the relevant specially insured a person who first receives issuance of a specially-insured day laborer's insurance book after the book no longer contains blank space for affixing stamps for proof of health insurance in the month in which insurance premiums for 26 days or more have been paid in total in the previous one month or in two consecutive months, or insurance premiums for 78 days or more have been paid in total in the previous three to six consecutive months, have been paid, or after the book was returned within the following month pursuant to the provisions of Article 126, paragraph (3), and the specially-insured day laborer then received a new specially-insured day laborer's insurance book; or

the specially-insured day laborera person who receives issuance of a specially-insured day laborer's insurance book after one year or more has elapsed since , counting from the day on which the specially-insured day laborer's previous insurance book previously issued to the person (if the person has previously been issued a specially-insured day laborer's insurance book on two or more occasions, the one most recently issued) ceased to contain blank space for affixing stamps for proof of health insurance or the day on which the laborer's previousthat insurance book was returned pursuant to the provisions of Article 126, paragraph (3) (the most recent specially-insured day laborer's insurance book if two or more insurance books have been issued).

When a specially-insured day laborer who falls under any of the following items and for whom five months (four months if the day on which the laborer fell under the item is the first day of a month; the same applies in the following paragraph) have not elapsed since the first day of the month including the day on which the laborer fell under the item, or the dependent of such a laborer, submits a special delivery expenses card to one that the person selected from among the hospitals or clinics listed in Article 63, paragraph (3), item (i) or (ii) and the birthing centers listed in Article 98-2, paragraph (1), item (i) or (ii), and receives delivery care from it, special delivery expenses are paid to the specially-insured day laborer for the expenses required for the delivery care; provided, however, that this does not apply if, with respect to the delivery care, the specially-insured day laborer is eligible for payment of delivery expenses (including an amount equivalent to the expenses required for delivery care paid pursuant to the provisions of Article 134-2, paragraph (6) or (7)) or dependent's delivery expenses (including an amount equivalent to the expenses required for delivery care paid pursuant to the provisions of Article 134-2, paragraph (6) or (7) as applied mutatis mutandis pursuant to Article 142-2, paragraph (3)):

a person who receives issuance of a specially-insured day laborer's insurance book for the first time;

a person who first receives issuance of a specially-insured day laborer's insurance book after the book no longer contains blank space for affixing stamps for proof of health insurance in the month in which insurance premiums for 26 days or more in total in four consecutive months (in the case pertaining to the childbirth of a dependent, insurance premiums for 26 days or more in total in one month or in two consecutive months, or for 78 days or more in total in three to six consecutive months) have been paid, or after the book was returned within the following month pursuant to the provisions of Article 126, paragraph (3); or

a person who receives issuance of a specially-insured day laborer's insurance book after one year or more has elapsed, counting from the day on which the specially-insured day laborer's insurance book previously issued to the person (if the person has previously been issued a specially-insured day laborer's insurance book on two or more occasions, the one most recently issued) ceased to contain blank space for affixing stamps for proof of health insurance or the day on which that insurance book was returned pursuant to the provisions of Article 126, paragraph (3).

A special delivery expenses card is issued by the insurer upon application by a specially-insured day laborer who falls under any of the items of the preceding paragraph and for whom five months have not elapsed since the first day of the month including the day on which the laborer fell under the item.

The form and issuance of the special delivery expenses card and other necessary matters concerning the special delivery expenses card are specified by Order of the Ministry of Health, Labour and Welfare.

The provisions of Article 134-2, paragraphs (6) and (7) apply mutatis mutandis to the payment of an amount equivalent to the expenses required for delivery care pertaining to a specially-insured day laborer or the laborer's dependent referred to in paragraph (1). In this case, the phrases "the confirmation pursuant to the provisions of paragraph (3)" and "the confirmation" in paragraph (7) of that Article are deemed to be replaced with "the issuance of the special delivery expenses card".

Cases Where a Person No Longer Becomes a Specially-Insured Day Laborer

No English for the wording before the change.

Special medical expenses or special delivery expenses (including an amount equivalent to the expenses required for delivery care paid pursuant to the provisions of Article 134-2, paragraph (6) or (7) as applied mutatis mutandis pursuant to paragraph (4) of the preceding Article; the same applies in Article 148) for a specially-insured day laborer who received approval pursuant to the proviso to Article 3, paragraph (2) are not paid from the day on which the laborer becomes no longer a specially-insured day laborer, and special medical expenses or special delivery expenses for a specially-insured day laborer who returns the relevant specially-insured day laborer's insurance book pursuant to the provisions of Article 126, paragraph (3) are not paid from the day following the day on which that insurance book was returned.

A person who intends to receive payment of dietary treatment expenses for inpatients, living support expenses for inpatients, medical expenses combined with treatment outside insurance coverage, medical expenses, medical expenses for home-nursing, transport expenses, delivery expenses (including an amount equivalent to the expenses required for delivery care paid pursuant to the provisions of Article 134-2, paragraph (6) or (7)), injury and sickness allowance, burial charges, lump-sum allowance forat childbirth and childcare, (including the difference paid pursuant to the provisions of Article 101, paragraph (3) as applied mutatis mutandis pursuant to the following Article), childbirth allowance, dependent's medical expenses, dependent's medical expenses for home-nursing, dependent's transport expenses, dependent's delivery expenses (including an amount equivalent to the expenses required for delivery care paid pursuant to the provisions of Article 134-2, paragraph (6) or (7) as applied mutatis mutandis pursuant to Article 142-2, paragraph (3)), dependent's burial charges, lump-sum allowance forat dependent's childbirth and childcare, or (including the difference paid pursuant to the provisions of Article 101, paragraph (3) as applied mutatis mutandis pursuant to the following Article), special medical expenses or special delivery expenses pertaining to a specially-insured day laborerlaborers must submit an application for the payment with a specially-insured day laborer's insurance book, qualified recipient card, or other documents that prove that the person meets the recipient requirements pursuant to Order of the Ministry of Health, Labour and Welfare.

Childbirth and Childcare Grants

Part A part of the expenses required for the payment of delivery expenses (including an amount equivalent to the expenses required for delivery care paid pursuant to the provisions of Article 98-2, paragraph (10) (including when applied mutatis mutandis pursuant to Article 98-24, paragraph (2)) and Article 134-2, paragraph (6) or (7)), lump-sum allowance forat childbirth (including the difference paid pursuant to the provisions of Article 101, paragraph (3) (including when applied mutatis mutandis pursuant to Article 106, paragraph (2) and childcare Article 149); hereinafter the same applies in this Article and Article 152-5), dependent's delivery expenses (including an amount equivalent to the lump-sum allowanceexpenses required for dependent's childbirth and childcare (referred delivery care paid pursuant to the provisions of Article 98-2, paragraph (10) as applied mutatis mutandis pursuant to Article 112-2, paragraph (3) and Article 134-2, paragraph (6) or (7) as "applied mutatis mutandis pursuant to Article 142-2, paragraph (3)), lump-sum allowance for at dependent's childbirth (including the difference paid pursuant to the provisions of Article 101, paragraph (3) as applied mutatis mutandis pursuant to Article 114, paragraph (2) and childcare, Article 149; hereinafter the same applies in this Article and Article 152-5) and special delivery expenses (including an amount equivalent to the expenses required for delivery care paid pursuant to the provisions of Article 134-2, paragraph (6) or (7) as applied mutatis mutandis pursuant to Article 145-2, paragraph (4)) (referred to as "delivery expenses, etc." in Article 152-4 and Article 152-5) (with regard to the expenses required for the payment of lump-sum allowance at childbirth and lump-sum allowance at dependent's childbirth, limited to the portion pertaining to the amount specified by Cabinet Order inunder Article 101, paragraphs (1) and (6) (including when applied mutatis mutandis pursuant to Article 106, paragraph (2), Article 114, paragraph (2) and Article 149; the same applies in Article 152-5); the same applies in Article 152-4) is to be covered, as specified by Cabinet Order, by the childbirth and childcare grant that provided by the Infrastructure Organization grants to insurers pursuant to the provisions of Article 124-4, paragraph (1) of the Act on Assurance of Medical Care for Elderly People.

Amount of Childbirth and Childcare Grants

The amount of the childbirth and childcare grant prescribed in the preceding Article is the amount of the estimated childbirth and childcare grant for the relevant fiscal year; provided, however, that where the amount of the estimated childbirth and childcare grant for the fiscal year before last exceeds the amount of the finalized childbirth and childcare grant for that fiscal year, it is to be the amount obtained by deducting from the amount of the estimated childbirth and childcare grant for the relevant fiscal year the total amount of the excess amount and the childbirth and childcare grant adjustment amount pertaining to the excess amount, and where the amount of the estimated childbirth and childcare grant for the fiscal year before last falls short of the amount of the finalized childbirth and childcare grant for that fiscal year, it is to be the amount obtained by adding to the amount of the estimated childbirth and childcare grant for the relevant fiscal year the total amount of the shortfall and the childbirth and childcare grant adjustment amount pertaining to the shortfall.

The childbirth and childcare grant adjustment amount in the proviso to the preceding paragraph is the amount calculated for each insurer, as specified by Order of the Ministry of Health, Labour and Welfare, taking into consideration interest and other circumstances arising from the excess or shortfall between the amount of the estimated childbirth and childcare grant and the amount of the finalized childbirth and childcare grant for all insurers prescribed in Article 7, paragraph (2) of the Act on Assurance of Medical Care for Elderly People (in the case of national health insurance operated by a prefecture together with the municipalities (including special wards) within that prefecture as provided for in the National Health Insurance Act, the prefecture) in the fiscal year before last.

Estimated Childbirth and Childcare Grants

The amount of the estimated childbirth and childcare grant in paragraph (1) of the preceding Article is the amount obtained by multiplying the amount calculated as specified by Order of the Ministry of Health, Labour and Welfare as the prospective amount of expenses required for payment of the lump-sum allowance for childbirth and childcaredelivery expenses, etc. pertaining to the insurer in the relevant fiscal year by the childbirth and childcare support payment rate under Article 124-3, paragraph (1) of the Act on Assurance of Medical Care for Elderly People for that fiscal year (referred to simply as the "childbirth and childcare support payment rate" in the following Article).

Finalized Childbirth and Childcare Grants

The amount of the finalized childbirth and childcare grant in the proviso to Article 152-3, paragraph (1) is the amount obtained by multiplying the amount of expenses required for payment of the lump-sum allowance for childbirth and childcaredelivery expenses, etc. pertaining to the insurer in the fiscal year before last (with respect to expenses required for payment of the lump-sum allowance at childbirth and the lump-sum allowance at dependent's childbirth, limited to the portion pertaining to the amount specified by Cabinet Order in Article 101) , paragraphs (1) and (6)) by the childbirth and childcare support payment rate for that fiscal year.

The provisions of Articles 41 and 42 of the Act on Assurance of Medical Care for Elderly People apply mutatis mutandis to childbirth and childcare grants. In this case, the necessary technical replacement of terms is specified by Cabinet Order.

the amount obtained by multiplying the estimated amount of expenses required for insurance benefits (excluding benefits for medical treatment, etc. pertaining to single branch-insured persons), young-old payments, etc., aid for the old-old, etc., and contributions for securing medical care in the early phase of an epidemic, etc. (excluding the amount of the childbirth and childcare grant prescribed in Article 152-2, the amount of national subsidies pursuant to the provisions of Articles 153 and 154 (excluding the amount of national subsidies referred to in the preceding item), and the amount of contributions pursuant to the provisions of Article 173) by the total remuneration proportion ratio (the ratio obtained by dividing the total amount of the total remuneration of single branch-insured persons in the relevant prefecture (meaning the total sum of the standard monthly remuneration and standard bonus; the same applies hereinafter) by the total amount of the total remuneration of insured persons covered by health insurance administered by JHIA);

The Minister of Health, Labour and Welfare, insurers, medical institutions providing services covered by health insurance, etc., designated home-nursing providers, designated birthing centers, etc., and other persons specified by Order of the Ministry of Health, Labour and Welfare as persons who use the insurer number and insured person's symbol and number (hereinafter in this Article referred to as "insured person's symbol and number, etc.") for the performance of health insurance services or affairs related to those services (hereinafter in this Article referred to as the "Minister of Health, Labour and Welfare, etc.") must not request anyone to disclose the insured person's symbol and number, etc. pertaining to that person or a person other than that person, except where necessary for the performance of those services or affairs.

When the Minister of Health, Labour and Welfare finds it necessary in relation to a designation referred to in Article 63, paragraph (3), item (i) , Article 88, paragraph (1) or Article 8898-2, paragraph (1), item (i), the Minister may request the person who collects the social insurance premiums to provide access to necessary documents or to provide materials about the status of payment of the social insurance premiums ofby the establisher or administrator to which the designation pertains or by the applicant.

Beyond the affairs prescribed in Article 76, paragraph (5) (including when applied mutatis mutandis pursuant to Article 85, paragraph (9), Article 85-2, paragraph (5), Article 86, paragraph (5), Article 110, paragraph (7), and Article 149; the same applies in item (i)) , Article 88, paragraph (11) (including when applied mutatis mutandis pursuant to Article 111, paragraph (3) and Article 149; the same applies hereinafter in the same item), Article 8898-2, paragraph (118) (including when applied mutatis mutandis pursuant to Article 11198-24, paragraph (32), Article 112-2, paragraph (3) and Article 149; the same applies hereinafter in the same item) and Article 101, paragraph (5) (including when applied mutatis mutandis pursuant to Article 106, paragraph (2), Article 114, paragraph (2) and Article 149; the same applies hereinafter in the same item), an insurer may delegate the following affairs to the Infrastructure Organization or an NHI federation:

among insurance benefits pursuant to the provisions of Chapter IV and insurance benefits pertaining to specially-insured day laborers pursuant to the provisions of Chapter V, Section 3, affairs pertaining to payment specified by Order of the Ministry of Health, Labour and Welfare (excluding affairs pursuant to the provisions of Article 76, paragraph (5) and, Article 88, paragraph (11), Article 98-2, paragraph (8) and Article 101, paragraph (5));

If a physician, dentist, pharmacist , midwife or a person who provided medical care or the employer thereof is ordered to make a report or present a medical record, birth record , record book or other document pursuant to the provisions of Article 60, paragraph (1) (including when applied mutatis mutandis pursuant to Article 149), and disobeys the order without justifiable grounds, or without justifiable grounds fails to answer a question asked by the relevant official pursuant to the provisions of the same paragraph, or answers the question untruthfully, the person is subject to a civil fine of not more than 100,000 yen.