Health Insurance Act

(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 amount; 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.