Health Insurance Act

The purpose of this Act is to provide insurance benefits for sickness, injury or death other than employment injuries (meaning employment injuries as provided for in Article 7, paragraph (1), item (i) of the Industrial Accident Compensation Insurance Act (Act No. 50 of 1947)) or childbirth of a worker or a dependent thereof, thereby contributing to the stability of lives and the improvement of welfare of the people.

The health insurance system, in view of the fact that it is the basis for the medical insurance system, must be implemented in response to the aging of the population, changes in disease structure, changes in the socioeconomic situation, etc., by constantly examining the concept of the system in conjunction with other medical insurance systems and the medical care system for elderly persons as well as systems closely related thereto, through integrated efforts by streamlining the operation of the medical insurance, optimizing the details of benefits and sharing costs, and improving the quality of medical treatment that citizens undergo based on the results thereof.

The term "insured person" as used in this Act means a worker employed at an applicable place of business or an insured person with optional and continued coverage; however, a person who falls under any of the following items is ineligible to be an insured person except in the case of becoming a specially-insured day laborer:

an insured person covered by Seamen's Insurance (excluding insured persons with optional and continued disease coverage prescribed in the provisions of Article 2, paragraph (2) of the Seamen's Insurance Act (Act No. 73 of 1939));

a worker employed temporarily and listed below (excluding when continuous employment has exceeded one month if the worker falls under (a) and exceeded the fixed period listed in (b) if the worker falls under (b)):

a worker hired on a daily basis;

a worker employed for a fixed period of two months or less, who is not expected to be employed beyond that fixed period;

a worker employed at a place of business or office (hereinafter referred to simply as "place of business" except in Article 88, paragraph (1) and Article 89, paragraph (1)) the location of which is not fixed;

a worker employed in seasonal work (excluding continuous employment exceeding four months);

a worker employed at a place of temporary business (excluding continuous employment exceeding six months);

a worker employed at a place of business of a national health insurance society;

a person eligible for insurance under the late-stage elderly medical care system (meaning an insured person pursuant to the provisions of Article 50 of the Act on Assurance of Medical Care for Elderly People (Act No. 80 of 1982)) or a person who falls under any of the items in Article 50 of the Act on Assurance of Medical Care for Elderly People but is not eligible for that insurance pursuant to the provisions of Article 51 of the same Act (hereinafter referred to as "persons with late-stage elderly medical care insurance");

a person who has made a request to the Minister of Health, Labour and Welfare, a health insurance society or a mutual aid association to the effect that the person will become an insured person of National Health Insurance by not becoming an insured person of health insurance (limited to the period in which the person should be covered by National Health Insurance due to not being covered by other health insurance); or

a person employed at a place of business who is a part-time worker whose weekly prescribed working hours are less than three-quarters of the weekly prescribed working hours of an ordinary worker employed at the same place of business (for a person employed at that place of business who engages in the same type of work as an ordinary worker employed at that place of business, the ordinary worker who engages in the same type of work as that person, except in cases specified by Order of the Ministry of Health, Labour and Welfare; hereinafter simply referred to as "ordinary worker" in this item) ("part-time worker" meaning a person whose weekly prescribed working hours are shorter than the weekly prescribed working hours of an ordinary worker employed at the same place of business; the same applies hereinafter in this item), or a part-time worker whose monthly prescribed working days are less than three-quarters of the monthly prescribed working days of an ordinary worker employed at the same place of business, and who meets the requirements of either (a) or (b):

the prescribed weekly scheduled working hours are shorter than 20 hours;

a high school student prescribed by Article 50 of the School Education Act (Act No. 26 of 1947), a student at a university prescribed by Article 83 of the same Act, or another person specified by Order of the Ministry of Health, Labour and Welfare.

The term "specially-insured day laborer" as used in this Act means a day worker who is employed at an applicable place of business; however, this does not apply to persons with late-stage elderly medical care insurance or those approved by the Minister of Health, Labour and Welfare as a person who falls under any of the following items:

it is clear that the person will not be employed at the applicable place of business for 26 days or longer in total during the following two months;

the person is insured with optional and continued coverage; or

there is another special reason.

The term "applicable place of business" as used in this Act means a place of business which falls under any of the following items:

a place of business for any of the businesses listed below and at which five or more employees work regularly:

businesses of manufacturing, processing, selection, packaging, repair, or demolition of structures;

civil engineering businesses or business that builds or otherwise constructs, remodels, preserves, repairs, changes, destroys, or dismantles structures, or prepares therefor;

business of mining or collecting minerals;

business that generates, conducts, or transmits electricity or other power sources;

business that transports freight or passengers;

business that loads and unloads freight;

business of incineration or cleaning, or slaughterhouse business;

business that sells or supplies articles;

financial or insurance business;

business that retains or leases articles;

intermediary or brokerage business;

money-collecting, guiding, or advertising business;

educational, research, or survey business;

business that treats or nurses sick or injured people, or midwife or other medical services;

communication or reporting business;

social welfare services prescribed by the Social Welfare Act (Act No. 45 of 1951) and offenders rehabilitation services prescribed by the Offenders Rehabilitation Services Act (Act No. 86 of 1995); or

a business that performs work relating to law or accounting which attorneys, certified public accountants, or other persons specified by Cabinet Order are to perform pursuant to the provisions of laws and regulations;

beyond what is listed in the preceding item, any place of business that is operated by the government, a local government, or a juridical person and employs employees regularly;

The term "insured person with optional and continued coverage" as used in this Act means a worker who lost eligibility to be insured (excluding a specially-insured day laborer) due to no longer being employed at an applicable place of business or falling under the proviso to paragraph (1), had been continuously insured for two months or longer by the day immediately before the day on which the person lost eligibility (excluding a specially-insured day laborer or an insured person who is a member of a mutual aid association), and, by submitting a request to the insurer, continues to be insured by the insurer; however, this does not apply to an insured person covered by Seamen's Insurance or a person with late-stage elderly medical care insurance.

The term "remuneration" as used in this Act means the wage, salary, pay, allowance, bonus, and all other payments which the worker receives as compensation for labor under whatever name the compensation is known; however, this does not apply to extraordinary wages and wages received periodically for a period exceeding three months.

The term "bonus" as used in this Act means the wage, salary, pay, allowance, bonus, and all other payments which the worker receives as compensation for labor periodically for a period exceeding three months under whatever name the compensation is known.

The term "dependent" as used in this Act means a person listed below who has a domicile in Japan, or who does not have a domicile in Japan but is specified by Order of the Ministry of Health, Labour and Welfare as a person, such as a student studying abroad, who is found to have a basis of living in Japan in consideration of the purpose of travel and other circumstances; provided, however, that this does not apply to a person who is a person with late-stage elderly medical care insurance or any other person specified by Order of the Ministry of Health, Labour and Welfare as having a special reason to be excluded from the application of this Act.

a relative of the insured person (including a former specially-insured day laborer; hereinafter in this paragraph) that is the insured person's parent, spouse (including a person who has not made a notification of marriage but is in a de facto marital relationship with the insured person; the same applies hereinafter in this paragraph), child, grandchild or sibling who is financially supported mainly by the insured person;

any other relative of the insured person within the third degree of kinship who belongs to the same household as the insured person and who is financially supported mainly by the insured person;

if the insured person's spouse has not made a notification of marriage but is in a de facto marital relationship with the insured person, the spouse's father, mother, or child who belongs to the same household as the insured person and who is financially supported mainly by the insured person; or

if the spouse referred to in the preceding item has died, the spouse's father, mother, or child who continues to belong to the same household as the insured person and who is financially supported mainly by the insured person.

The term "day worker" as used in this Act means a person who falls under any of the following items:

a worker employed temporarily and listed below (in the same place of business, excluding cases of continuous employment which has exceeded one month if the person is listed in (a) or exceeded the fixed period listed in (b) if the person is listed in (b) (except for cases of continuous employment at a place of business whose location is not fixed));

a worker hired on a daily basis;

a worker employed for a fixed period of two months or less, who is not expected to be employed beyond that fixed period;

a worker employed in seasonal work (excluding cases of continuous employment exceeding four months); or

a worker employed at a place of temporary business (excluding cases of continuous employment exceeding six months).

The term "wage" as used in this Act means the wage, salary, allowance, bonus, and all other payments which a day worker receives as compensation for labor under whatever name the compensation is known; however, this does not apply to wages received periodically for a period exceeding three months.

The term "mutual aid association" as used in this Act means a mutual aid association organized pursuant to law.

The term "insurer number" as used in this Act means a number that the Minister of Health, Labour and Welfare determines for each insurer as a number for identifying the insurer in health insurance services.

The term "insured person's symbol and number" as used in this Act means a symbol, number, or other code that an insurer determines for each insured person or dependent for managing the eligibility of an insured person or dependent.

The insurers providing insurance (excluding insurance for specially-insured day laborers) are Japan Health Insurance Association and health insurance societies.

Of the services relating to health insurance businesses provided by Japan Health Insurance Association pursuant to the provisions of the preceding paragraph, the confirmation of acquisition and loss of eligibility to be insured, determination of standard monthly remuneration amount and standard bonus amount, collection of insurance premiums (excluding those from insured persons with optional and continued coverage), and operations incidental to these are conducted by the Minister of Health, Labour and Welfare.

A health insurance society administers insurance of the insured persons who are its members.

Persons who administers insurance for insured persons who are employed at two or more places of business at the same time are specified by Order of the Ministry of Health, Labour and Welfare, notwithstanding the provisions of Article 5, paragraph (1) and the preceding Article.

In order to provide health insurance services to insured persons who are not members of a health insurance society (hereinafter simply referred to as "insured persons"), Japan Health Insurance Association (hereinafter referred to as "JHIA") is established.

JHIA provides the services listed below:

operations related to 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;

operations related to healthcare services and welfare services pursuant to the provisions of Chapter VI;

beyond the services listed in the preceding two items, services related to a health insurance business administered by JHIA and other than services provided by the Minister of Health, Labour and Welfare pursuant to the provisions of Article 5, paragraph (2);

beyond the services listed in items (i) and (ii), services related to insurance for specially-insured day laborers that are not administered by the Minister of Health, Labour and Welfare pursuant to the provisions of Article 123, paragraph (2);

operations related to affairs pertaining to the authority prescribed in Article 204-7, paragraph (1); and

operations incidental to the operations listed in each of the preceding items.

When conducting the operations listed in paragraph (2), item (ii) of the preceding Article (limited to those related to healthcare services pursuant to the provisions of Chapter VI; referred to as "health services operations" in Article 7-29-2), JHIA must conduct them appropriately and effectively, taking into consideration the age, sex, state of health, and other circumstances of insured persons and their dependents.

JHIA is a corporation.

JHIA establishes a principal office in Tokyo and secondary offices (hereinafter referred to as "branches") in each prefecture.

JHIA's address is the location of its principal office.

The stated capital of JHIA is the amount contributed by the government pursuant to the provisions of Article 18, paragraph (2) of the Supplementary Provisions of the Act Partially Amending the Health Insurance Act, etc. (Act No. 83 of 2006; hereinafter referred to as "Amending Act").

JHIA must specify the particulars listed below in its articles of incorporation:

its purpose;

its name;

the locations of its offices;

particulars relating to its officers;

particulars relating to its management board;

particulars relating to its council;

particulars relating to healthcare services;

particulars relating to welfare services;

particulars relating to asset management and other finances; and

other important matters related to organization and operations as specified by Order of the Ministry of Health, Labour and Welfare.

No alternation to the articles of incorporation referred to in the preceding paragraph (except those pertaining to matters specified by Order of the Ministry of Health, Labour and Welfare) is effected without authorization by the Minister of Health, Labour and Welfare.

When JHIA makes any amendment to the articles of incorporation with regard to matters specified by Order of the Ministry of Health, Labour and Welfare referred to in the preceding paragraph, it must notify the Minister of Health, Labour and Welfare of the amendment without delay.

When JHIA is authorized for an amendment to the articles of incorporation referred to in paragraph (2) or makes any amendment to the articles of incorporation with regard to matters specified by Order of the Ministry of Health, Labour and Welfare referred to in the same paragraph, it must give publicly notice of the amendment without delay.

JHIA must complete its registration as specified by Cabinet Order.

The matters that must be registered pursuant to the provisions of the preceding paragraph cannot be asserted against a third party until after they are registered.

No person other than JHIA may use the name "Japan Health Insurance Association".

JHIA has one president, not more than six directors, and two auditors as its officers.

The president of JHIA represents JHIA and executes its operations.

If the president is incapacitated or the position of president is vacant, another director appointed by the president in advance represents the president or performs the president's duties.

The directors may assist the president in executing the operations of JHIA as determined by the president.

An auditor audits the execution of business and the financial status of JHIA.

The president and auditors are appointed by the Minister of Health, Labour and Welfare.

The Minister of Health, Labour and Welfare, when intending to appoint the president pursuant to the provisions of the preceding paragraph, must hear the opinions of the Management Board in advance as provided for by Article 7-18, paragraph (1).

The directors are appointed by the president.

When the president appoints a director pursuant to the provisions of the preceding paragraph, the president must notify the Minister of Health, Labour and Welfare of the appointment and publicize it without delay.

The term of office for an officer is three years; however, the term for a substitute officer is the remaining term of the predecessor.

An officer may be reappointed.

A government official or an official of a local public entity (excluding a part-time official) is ineligible to be an officer.

When an officer appointed by the Minister of Health, Labour and Welfare or the president becomes a person who is ineligible to be an officer pursuant to the provisions of the preceding Article, the Minister of Health, Labour and Welfare or the president, respectively, must dismiss the officer.

If an officer appointed by the Minister of Health, Labour and Welfare or the president falls under any of the following items or is otherwise found to be unfit to serve as an officer, the minister or the president, respectively, may dismiss the officer:

the officer is incapable of performing official duties due to physical or mental disability; or

the officer committed a violation of obligation in the course of duties.

If the president dismisses a director pursuant to the provisions of the preceding paragraph, the president must notify the Minister of Health, Labour and Welfare of the dismissal and publicize it without delay.

An officer (excluding a part-time officer) must not serve as an officer of an organization for profit or engage in a business for profit independently; however, this does not apply if the officer obtains approval from the Minister of Health, Labour and Welfare.

Regarding any matter in which the president or the director has a conflict of interest with the JHIA, the president or the director have no authority of representation. In this case, an auditor represents JHIA.

The president may appoint an agent from among the directors or employees and authorize the agent to conduct all judicial or extra-judicial acts concerning a part of the operations of JHIA.

In order to reflect opinions of employers (meaning employers of an applicable place of business at which insured persons are employed; the same applies hereinafter in this section) and insured persons, and to ensure that JHIA's operations are appropriate, JHIA has a management board.

The management board has nine or less members who are appointed by the Minister of Health, Labor and Welfare from among employers, insured persons, and persons with relevant knowledge and experience for properly operating JHIA.

The term of the members in the preceding paragraph is two years.

The proviso to Article 7-12, paragraph (1) and the provisions of paragraph (2) of the same Article apply mutatis mutandis to members of the management board.

With regard to the particulars listed below, the president must obtain a resolution at the management board in advance:

amendments to the articles of incorporation;

changes to the operation rules referred to in Article 7-22, paragraph (2);

JHIA's business plan as well as budget and settlement in each fiscal year;

disposition of important property or burden of significant debt;

changes to the standards for payment of remuneration and retirement allowance for officers prescribed in Article 7-35, paragraph (2); and

other important matters related to the organization and operations of JHIA as specified by Order of the Ministry of Health, Labour and Welfare.

Beyond the matters prescribed in the preceding paragraph, the management board may consult with the president and make proposals to the president when it finds it necessary.

Beyond the matters covered by the preceding two paragraphs, other matters relating to the organization and operation of the management board are specified by Order of the Ministry of Health, Labour and Welfare.

A member of the management board is deemed to be an official engaged in public service under acts and regulations, with respect to the application of the Penal Code (Act No. 45 of 1907) and other penal provisions.

In order to contribute to proper operations that meet prefectural demands, JHIA establishes a council for each branch and hears the opinions of each council about the operation status at its branch.

The council members are commissioned by the head of their branch (hereinafter referred to as "branch head") pursuant to the articles of incorporation from among employers and insured persons at an applicable place of business (including an applicable place of business prescribed in Article 34, paragraph (1); the same applies hereinafter) located in the prefecture in which the council is established as well as persons with relevant knowledge and experience for properly operating the branch.

JHIA is to determine operation rules with regard to matters necessary for the execution of duties specified by Order of the Ministry of Health, Labour and Welfare.

The president, when intending to make a change to the operation rules, must notify the Minister of Health, Labour and Welfare in advance.

JHIA's employees are appointed by the president.

The provisions of Article 7-20 apply mutatis mutandis to JHIA's officers and officials.

JHIA's business year begins on April 1 each year and ends on March 31 of the following year.

JHIA's accounting is to be conducted pursuant to corporate accounting principles, as a general rule, pursuant to Order of the Ministry of Health, Labour and Welfare.

JHIA must prepare a business plan and budget for every business year and obtain authorization from the Minister of Health, Labour, and Welfare prior to the beginning of the relevant business year. The same applies when JHIA intends to make a change to the business plan or budget.

JHIA must complete the settlement for each business year by May 31 in the following business year.

For each business year, JHIA must prepare a balance sheet, a profit and loss statement, documents concerning the appropriation of profits and the disposal of losses, other documents specified by Order of the Minister of Health, Labour and Welfare, and any annex statements thereof (hereinafter collectively referred to as "financial statements"), accompanied by the business report and statement of accounts for the relevant business year (referred to as "business reports" hereinafter in this Article and Article 217-2, item (iv)) and with statements by the auditor and the accounting auditor selected pursuant to the provisions of paragraph (2) of the following Article attached, and submit them to the Minister of Health, Labour and Welfare within two months after completion of the settlement to obtain approval from the minister.

Financial statements and business reports must contain required information to show the financial and business status of each branch as specified by Order of the Ministry of Health, Labour and Welfare.

When JHIA obtains the approval from the Minister of Health, Labour, and Welfare pursuant to the provisions of paragraph (2), it must provide public notice of the financial statements published in an official gazette without delay, maintain those financial statements and business reports as well as written statements by the auditor and accounting auditor referred to in the same paragraph at each office, and provide public access to them for a period specified by Order of the Ministry of Health, Labour, and Welfare.

JHIA must be audited by an accounting auditor, beyond being audited by an auditor, with regard to the financial statements, the business report (limited to the portion related to accounting), and the statement of accounts.

An accounting auditor is appointed by the Minister of Health, Labour and Welfare.

An accounting auditor must be a certified public accountant (including a foreign certified public accountant provided for in Article 16-2, paragraph (5) of the Certified Public Accountants Act (Act No. 103 of 1948)) or auditing corporation.

A person who is ineligible to audit financial statements pursuant to the provisions of the Certified Public Accountant Act is ineligible to become an accounting auditor.

The term of office of an accounting auditor is until the Minister of Health, Labour and Welfare gives approval under paragraph (2) of the preceding Article for financial statements for the first business year that ends after the date of the appointment.

If an accounting auditor falls under any of the following items, the Minister of Health, Labour and Welfare may dismiss the accounting auditor:

the accounting auditor has violated the obligations of the accounting auditor's duties or has been negligent in the performance thereof;

the accounting auditor has committed a conduct unbecoming of an accounting auditor; or

due to a mental or physical disorder, the accounting auditor is unable to perform the accounting auditor's duties or is incapable of bearing the demands of the duties.

JHIA must report the status of implementation of health services operations to the Minister of Health, Labour and Welfare for every business year.

The Minister of Health, Labour and Welfare must evaluate JHIA's operational performance in each business year.

When the Minister of Health, Labour and Welfare conducts the evaluation referred to in the preceding paragraph, the Minister must give notice of the results to JHIA and provide public notice thereof without delay.

JHIA may incur short-term debt with authorization from the Minister of Health, Labour and Welfare if it is necessary for the allocation of expenses for its operations.

Short-term debt pursuant to the provisions of the preceding paragraph must be repaid within the relevant business year; provided, however that if the short-term debt fails to be repaid due to a lack of funds, only the amount of funds lacking may be refinanced, after obtaining authorization from the Minister of Health, Labour, and Welfare.

Short-term debt that is refinanced pursuant to the proviso to the preceding paragraph must be repaid within one year.

Notwithstanding the provisions of Article 3 of the Act on Limitations of Government Financial Assistance to Corporations (Act No. 24 of 1946), when the national government determines it necessary for the smooth operation of its services, it may provide guarantees within the limit of an amount approved by the Diet and within the period determined to be necessary with regard to liabilities pertaining to short-term debt incurred by JHIA pursuant to the provisions of the preceding Article.

JHIA's operational surplus funds must be safely and efficiently operated according to the purpose and nature of the funds as specified by Cabinet Order.

When intending to transfer or provide as collateral important property specified by Order of the Ministry of Health, Labour and Welfare, JHIA must obtain authorization from the Minister of Health, Labour and Welfare.

The remuneration and retirement allowance for JHIA's officers must take into consideration the officers' performance.

JHIA must specify standards for the payment of the remuneration and retirement allowance for its officers, notify the Minister of Health, Labour and Welfare of the standards, and publicize them. The same applies when JHIA revises the standards.

The salaries of JHIA's employees must take into consideration the employees' work performance.

JHIA must specify standards for the payment of salaries and retirement allowance for its employees, notify the Minister of Health, Labour and Welfare of the standards, and publicize them. The same applies when JHIA revises the standards.

A current or former officer or official of JHIA must not divulge confidential information concerning the health insurance business learned in the course of duty without justifiable reasons.

The provisions of the preceding paragraph apply mutatis mutandis to a person who is, or has been, a member of JHIA's management board.

When the Minister of Health, Labour and Welfare finds it necessary in relation to JHIA, the Minister may collect reports on the status of its business or property, or have the ministry's officials enter JHIA's office to ask persons concerned questions or to inspect that status.

The relevant official who asks questions or conducts inspections pursuant to the provisions of the preceding paragraph must carry an identification card and present it at the request of any person concerned.

The authority under paragraph (1) must not be construed as being granted for criminal investigation.

If the Minister of Health, Labour and Welfare finds that JHIA's management or execution of its business or assets violates any law or regulation, its articles of incorporation, or any disposition of the Minister of Health, Labour and Welfare, or that JHIA has unjustly failed to secure income that it should have secured, has unjustly incurred expenses, has unjustly disposed of its assets or has otherwise significantly failed to appropriately manage or execute its business or assets, or that the officers of JHIA have evidently failed to manage or execute its business or assets, then the Minister may order JHIA or its officers to take measures necessary to rectify the violation or improve the management or performance of its business or assets within a specified period.

If JHIA or its officers violate an order referred to in the preceding paragraph, the Minister of Health, Labour and Welfare may order JHIA to dismiss all or some of its officers involved in the violation after a certain period.

If JHIA violates an order referred to in the preceding paragraph, the Minister of Health, Labour and Welfare may dismiss the officers to which the order pertained.

The rules for the dissolution of JHIA are provided separately by law.

Beyond what is provided for in this Act and any Cabinet Order based on this Act, matters concerning the finance and accounting of JHIA, and other necessary matters are specified by Order of the Ministry of Health, Labour and Welfare.

The Minister of Health, Labour, and Welfare must consult with the Minister of Finance in advance, in the following cases:

when intending to grant authorization pursuant to the provisions of Article 7-27, Article 7-31, paragraph (1), the proviso to Article 7-31, paragraph (2), or the Article 7-34; and

when intending to issue an Order of the Ministry of Health, Labour and Welfare pursuant to the provisions of the preceding Article;

A health insurance society is composed of employers of applicable places of business, insured persons employed at the applicable places of business, and insured persons with optional and continued coverage.

A health insurance society is a corporation.

The address of a health insurance society is at the location of its principal office.

A health insurance society must use the characters "健康保険組合" (pronounced "kenko hoken kumiai" and literally meaning "health insurance society") in its name.

No person other than a health insurance society may use the name "健康保険組合".

An employer who has one or more applicable places of business regularly employing a total number of insured persons equal to or above a figure specified by Cabinet Order may establish a health insurance society for those applicable places of business.

Employers of applicable places of business may jointly establish a health insurance society. In this case, the total number of insured persons must always be no less than the number specified by Cabinet Order.

When intending to establish a health insurance society, the employer of an applicable place of business must prepare a constitution with the consent of half or more of the insured persons employed at the applicable place of business for which the health insurance society is to be established, and obtain authorization from the Minister of Health, Labour and Welfare.

When intending to establish a health insurance society for two or more applicable places of business, the consent in the preceding paragraph must be obtained for each of those places of business.

If an application for the establishment of a health insurance society is submitted at the same time as an application pursuant to the provisions of Article 31, paragraph (1), the phrase "applicable place of business" in the preceding two Articles is replaced with "place that will be an applicable place of business" and "insured persons" with "persons to be insured".

The Minister of Health, Labour and Welfare may order an employer who has one or more applicable places of business (excluding those pursuant to Article 31, paragraph (1)) regularly employing a total number of insured persons equal to or above the figure specified by Cabinet Order to establish a health insurance society.

An employer who has been ordered to establish a health insurance society pursuant to the provisions of the preceding paragraph must prepare a constitution for the society and obtain authorization from the Minister of Health, Labour and Welfare for the establishment.

A health insurance society is incorporated when it receives authorization for its establishment.

A health insurance society must specify the particulars listed below in its constitution:

its name;

the location of its office;

the name and location of the applicable place of business related to the establishment of the health insurance society;

particulars relating to its meetings;

particulars relating to officers;

particulars relating to its members;

particulars relating to insurance premiums;

particulars relating to reserves and other particulars related to property management;

particulars relating to giving public notice; and

beyond the particulars listed in each of the preceding items, particulars specified by Order of the Ministry of Health, Labour and Welfare.

No change to the health insurance society's constitution referred to in the preceding paragraph (except those pertaining to matters specified by Order of the Ministry of Health, Labour and Welfare) has effect without the authorization of the Minister of Health, Labour and Welfare.

If a health insurance society makes an amendment to its constitution with regard to matters specified by Order of the Ministry of Health, Labour and Welfare referred to in the preceding paragraph, it must notify the Minister of Health, Labour and Welfare of the amendment without delay.

The employer of an applicable place of business for which a health insurance society is established (hereinafter referred to as the "establishment") and insured persons who are employed at the establishment are members of the health insurance society.

An insured person referred to in the preceding paragraph who has optional and continued coverage is a member of the health insurance society even if the person is no longer employed at the establishment.

A health insurance society has society meetings.

A society meeting is comprised of society meeting members.

The fixed number of society meeting members is an even number; half of the members are selected from among employers of establishments (including their agents) and workers employed at establishments, and the other half are elected by vote from among society members who are insured persons.

The matters listed below must be determined by a society meeting:

changes to the health insurance society's constitution;

budget for income and expenditure;

business reports and settlement; and

other particulars specified in the constitution.

A society meeting may inspect documents concerning the health insurance society's affairs, request reports from directors or auditors, or inspect the management of affairs, execution of decisions, or revenue and expenditure of the society.

A society meeting may have a person appointed from among the society meeting members carry out any of the matters under the authority of the society meeting as referred to in the preceding paragraph.

A health insurance society has directors and auditors as its officers.

The fixed number of directors is an even number; half of them are elected by votes cast by society meeting members selected by the employer of the establishment, and the other half are elected by votes cast by the society meeting members elected by vote from among society members who are insured persons.

The president is elected by the directors from among the directors who are society meeting members selected by the employer of the establishment.

At a society meeting, one auditor is elected by votes from among the society meeting members selected by the employers of the establishment, and the other auditor is elected from among society meeting members elected by vote from among society members who are insured persons.

An auditor may not act concurrently as a director or official of a health insurance society.

The president of a health insurance society represents the health insurance society and executes its operations. If the president is incapacitated or the position of president is vacant, another director who is a society meeting member selected by the employer of the establishment and appointed by the president in advance represents or performs the president's duties.

Unless otherwise specified in the constitution, the operations of the health insurance society are determined by the majority of the directors, and by the president in the event of a tie.

The directors may assist the president in executing the operations of the health insurance society as determined by the president.

An auditor audits the execution of business and the status of the property of the health insurance society.

The provisions of Article 7-37, paragraph (1) apply mutatis mutandis to officers and officials of the health insurance societies.

A merger of a health insurance society must be adopted through a resolution by a three-quarter majority of the fixed number of society meeting members in a society meeting and authorization therefore must be obtained from the Minister of Health, Labour and Welfare.

In order to establish a health insurance society by a merger, committee members selected by each health insurance society to be merged from among officers or society meeting members in each of the society meetings must jointly prepare the constitution and take other actions necessary for the establishment.

A health insurance society established by a merger or that remains after a merger succeeds to the rights and obligations of a health insurance society extinguished due to the merger.

Any split of a health insurance society must be adopted through a resolution by a three-quarter majority of the fixed number of society meeting members in a society meeting and authorization therefor must be obtained from the Minister of Health, Labour and Welfare.

A split of a health insurance society cannot be applied to a part of an establishment.

In performing a split, the number of insured persons who are to be society members of a health insurance society established by the split or insured persons who are society members of a health insurance society that remains after the split must be no less than the number specified by Cabinet Order under Article 11, paragraph (1) (paragraph (2) of the same Article if the health insurance society is jointly established).

In order to establish a health insurance society by a split, employers of applicable places of business that are to be an establishment must prepare the constitution and take other actions necessary for the establishment.

A health insurance society established by a split succeeds to some of the rights and obligations of a health insurance society extinguished due to the split or of a health insurance society that remains after the split.

The limit to the rights and obligations succeeded to pursuant to the provisions of the preceding paragraph must be decided as a part of the resolution on the split and authorization therefor must be obtained from the Minister of Health, Labour and Welfare.

When intending to increase or decrease its number of establishments, a health insurance society must obtain consent from all employers of applicable places of business to which the increase or decrease pertains and from half or more of the insured persons employed at the applicable places of business.

In the case of an application to make changes to the constitution relating to an increase in the number of establishments of a health insurance society which has applied for the authorization pursuant to the provisions of Article 31, paragraph (1), the phrase "insured persons" in the preceding paragraph is replaced with "persons to be insured".

When a health insurance society decreases its number of establishments pursuant to the provisions of paragraph (1), the number of members who are insured persons of the health insurance society must be no less than the number specified by Cabinet Order under Article 11, paragraph (1) (paragraph (2) of the same Article if the health insurance society is jointly established) even after the number of establishments has been decreased.

The provisions of Article 12, paragraph (2) apply mutatis mutandis when consent from insured persons is obtained under paragraph (1).

A health insurance society is dissolved for any of the reasons listed below:

a resolution by a three-quarter majority of the fixed number of society meeting members in a society meeting;

the impossibility of the continuation of the business of the health insurance society; or

a dissolution order pursuant to the provisions of Article 29, paragraph (2).

Authorization must be obtained from the Minister of Health, Labour and Welfare for the dissolution of a health insurance society for a reason listed in item (i) or (ii) of the preceding paragraph.

If a health insurance society is dissolved and it is unable to pay its debts in full with its property, the health insurance society may request the employers of the establishments to bear all or part of the expenses required to pay its debts in full as specified by Cabinet Order.

JHIA succeeds to the rights and obligations of a health insurance society extinguished due to dissolution.

Deleted

A health insurance society whose income and expenditure for health insurance services is imbalanced and which is designated by the Minister of Health, Labour and Welfare as meeting the requirements specified by Cabinet Order (hereinafter referred to as a "designated health insurance society" in this and the following Articles) must formulate a plan to improve its soundness (hereinafter referred to as "soundness improvement plan" in this Article) and obtain approval therefor from the Minister of Health, Labour and Welfare, as specified by Cabinet Order. The same applies when a health insurance society revises a soundness improvement plan.

A designated health insurance society that receives the approval referred to in the provisions of the preceding paragraph must provide health insurance services in accordance with the approved soundness improvement plan.

If the Minister of Health, Labour and Welfare finds it necessary to change a soundness improvement plan due to the status of business and property of a designated health insurance society that has received the approval referred to in paragraph (1), the Minster may request the designated health insurance society to change the soundness improvement plan within a specified period.

The provisions of Articles 7-38 and 7-39 apply mutatis mutandis to health insurance societies. In this case, the phrase "Minister of Health, Labour and Welfare" in Article 7-39, paragraph (1) is to be replaced with "Minister of Health, Labour and Welfare, when collecting reports, asking questions, or conducting inspections pursuant to the provisions of the preceding Article as applied mutatis mutandis to Article 29, paragraph (1)", and the phrase "articles of incorporation" is to be replaced with "constitution".

If a health insurance society violates an order pursuant to the provisions of Article 7-39, paragraph (1) as applied mutatis mutandis to the preceding paragraph, or if it is found that the continuation of business of a designated health insurance society which has violated the provisions of paragraph (2) of the preceding Article, of a designated health insurance society which fails to follow the request referred to in paragraph (3) of the same Article, or of another designated health insurance society as specified by Cabinet Order is difficult due to the status of services or property or other reasons, the Minister of Health, Labour and Welfare may order the dissolution of the health insurance society.

Beyond what is provided for in this Chapter, the management of health insurance societies, the retention of their assets, and other necessary matters concerning health insurance societies are specified by Cabinet Order.

An employer of a non-applicable place of business may operate the place of business as an applicable place of business with authorization from the Minister of Health, Labour and Welfare.

When intending to obtain the authorization referred to in the preceding paragraph, the employer of a place of business must, with the consent of half or more of the workers employed at the place of business (limited to those to be insured persons), apply to the Minister of Health, Labour and Welfare for the authorization.

If an applicable place of business no longer falls under the items of Article 3, paragraph (3), it is deemed to be authorized under paragraph (1) of the preceding Article.

An employer of a place of business under Article 31, paragraph (1) may make the place of business a non-applicable place of business with authorization from the Minister of Health, Labour and Welfare.

When intending to obtain the authorization referred to in the preceding paragraph, the employer of the place of business must, with the consent of three-quarters or more of the workers employed at the place of business (limited to insured persons), apply to the Minister of Health, Labour and Welfare for the authorization.

When the employer of two or more applicable places of business is the same, the employer may merge the two or more places of business into one applicable place of business with approval from the Minister of Health, Labour and Welfare.

When the approval referred to in the preceding paragraph is obtained, the relevant two or more places for business are no longer deemed to be applicable places for business.

An insured person (excluding insured persons with optional and continued coverage; the same applies hereinafter from this Article through Article 38) obtains eligibility as an insured person from the day on which the person has become an employee of an applicable place of business, the day on which the place of business employing the person has become an applicable place of business, or the day on which the provisions of the proviso to Article 3, paragraph (1) are no longer applicable.

An insured person loses eligibility as an insured person from the day immediately after the day on which the person falls under any of the following items (or the day on which the respective fact arises if the person also falls under the preceding Article):

the person dies;

the person is no longer employed at the place of business;

the person falls under the proviso to Article 3, paragraph (1); or

authorization under Article 33, paragraph (1) is obtained.

A request referred to in Article 3, paragraph (4) must be made within 20 days after the date on which eligibility as an insured person is lost; however, when finding a justifiable reason, the insurer may accept a request even after the day on which that period expires.

If the person who made a request referred to in Article 3, paragraph (4) fails to pay the first insurance premium by the due date, the person is deemed to not have become an insured person with optional and continued coverage, notwithstanding the provisions of the same paragraph; however, this does not apply if the insurer finds a justifiable reason for the delay in payment.

An insured person with optional and continued payment loses eligibility from the day immediately after the day on which the person fell under any of the following items (in the case any of the items (iv) through (vi) from the day on which the person fell under the item):

two years have elapsed since the day on which the person became an insured person with optional and continued coverage;

the person dies;

insurance premiums (excluding the first insurance premium) are not paid by the due date (excluding when the insurer finds a justifiable reason for the delay in payment);

the person becomes an insured person;

the person becomes an insured person covered by Seamen's Insurance; or

the person becomes a person with late-stage elderly medical care insurance.

the person has notified the insurer, pursuant to Order of the Ministry of Health, Labour and Welfare, of the person's wish to cease to be an insured person with optional and continued coverage, and the last day of the month that includes the day on which that notification was accepted arrives.

The acquisition or loss of eligibility as an insured person takes effect through confirmation by an insurer (meaning the Minister of Health, Labour and Welfare if the person is an insured person with optional and continued coverage under the health insurance program administered by JHIA; a health insurance society if the insured person is under the health insurance program administered by the health insurance society; or otherwise, the Minister of Health, Labour and Welfare; the same applies hereinafter excluding in Article 164, paragraphs (2) and (3), Article 180, paragraph (1), paragraph (2) and paragraph (4), and Article 181, paragraph (1)); however, this does not apply to the loss of eligibility as an insured person due to falling under Article 36, item (iv) or the acquisition or loss of eligibility as an insured person with optional continued coverage.

The confirmation referred to in the preceding paragraph is to be made by a notification pursuant to the provisions of Article 48, a request pursuant to the provisions of Article 51, paragraph (1), or sua sponte.

With regard to the confirmation referred to in paragraph (1), the provisions of Chapter III (excluding Articles 12 and 14) of the Administrative Procedure Act (Act No. 88 of 1993) do not apply.

If the ratio of the number of insured persons with the highest grade of standard monthly remuneration amount to the total number of insured persons on March 31 in a year exceeds 0.015 and that status is found to continue, the grading of the standard monthly remuneration amount may be revised by adding another grade to that highest grade by Cabinet Order from September 1 in the same year; provided, however, that the ratio of the number of insured persons with the highest grade of the revised standard monthly remuneration amount to the total number of insured persons must not be less than 0.005 on March 31 in the same year.

When planning the establishment or amendment of Cabinet Order referred to in the preceding paragraph, the Minister of Health, Labour and Welfare is to hear the opinions of the Social Security Council.

An insurer determines the standard monthly remuneration amount based on the monthly remuneration amount which is obtained by dividing the total amount of remuneration received by the insured person at the place of business at which the person is employed as of July 1 each year for the preceding three-month period (limited to a period of consecutive employment at the place of business, and excluding any month in which the number of days based on which remuneration is paid is less than 17 days (11 days for persons specified by Order of the Ministry of Health, Labour and Welfare; the same applies in Article 43, paragraph (1), Article 43-2, paragraph (1) and Article 43-3, paragraph (1))) by the number of months in that period.

A standard monthly remuneration amount determined pursuant to the provisions of the preceding paragraph is the standard monthly remuneration amount of each month from September in the relevant year until August in the following year.

Regarding persons who obtained eligibility as an insured person during the period between June 1 and July 1 or insured persons whose standard monthly remuneration amount has been or is to be revised in any month from July through September pursuant to the provisions of Articles 43, 43-2 or 43-3, the provisions of paragraph (1) do not apply during that year.

When a person who obtains eligibility as an insured person, the insurer determines the standard monthly remuneration amount with the amounts listed below as the monthly remuneration amount:

if the wages are determined on the basis of a monthly, weekly or other fixed period, the amount equivalent to thirty times the amount obtained by dividing the amount of the remuneration as of the day on which eligibility as an insured person is obtained by the total number of days in that period;

if the remuneration is determined on the basis of working days or hours, or in accordance with a piece rate or other contract price, the average of the amounts of remuneration received by persons engaged in similar work at the place of business for one month preceding the month in which eligibility as an insured person is obtained and who receive similar remuneration;

if it is difficult to calculate pursuant to the provisions of the preceding two items, the amount of remuneration received by a person engaged in similar work in the region for one month preceding the month in which eligibility as an insured person is obtained and who receives similar remuneration; or

in the case of receiving remuneration corresponding to two or more of the preceding three items, the total sum of the amounts calculated for each pursuant to the provisions of the preceding three items.

A standard monthly remuneration amount determined pursuant to the provisions of the preceding paragraph is the standard monthly remuneration amount of each month since the day on which the person obtained eligibility as an insured person until August in that year (August in the following year if the person obtained eligibility as an insured person between July 1 to December 31).

If the amount obtained by dividing the total amount of remuneration received for three consecutive months at the place of business employing an insured person (in each month, the number of days based on which remuneration is paid must be no less than 17 days) by three is significantly higher or lower than the person's monthly remuneration that is the basis of the standard monthly remuneration amount and the insurer finds it necessary, the insurer may revise the standard monthly remuneration amount by setting the first-mentioned amount as the monthly remuneration amount starting from the month following the months in which the monthly remuneration amount was significantly high or low.

A standard monthly remuneration amount revised pursuant to the provisions of the preceding paragraph is the standard monthly remuneration amount for each month until August in that year (until August in the following year for a revision in any month from July to December).

If childcare leave prescribed in Article 2, item (i) of the Act on the Welfare of Workers Taking Child Care or Family Care Leave to Care for Children or Other Family Members (Act No. 76 of 1991), leave through a measure equivalent to the system for childcare leave prescribed in Article 23, paragraph (2) of the same Act or a measure taken in the same manner as the system for childcare leave prescribed in item (ii) of the same paragraph pursuant to the provisions of Article 24, paragraph (1) of the same Act, or childcare leave based on laws and regulations specified by Cabinet Order (hereinafter referred to as "childcare leave") taken by an insured person ends and the person is taking care of a child less than three years of age to which the childcare leave pertains on the last day of the childcare leave (referred to as "last day of childcare leave" hereinafter in this Article) after submitting a request to the insurer via the employer of the place of business employing the person as specified by Order of the Ministry of Health, Labour and Welfare, the standard monthly remuneration amount is revised by setting the amount obtained by dividing the total amount of remuneration received for the three months beginning with the month which includes the day following the last day of childcare leave (limited to a period of consecutive employment at the place of business employing the person on the day following the last day of childcare leave; and excluding any month in which the number of days based on which remuneration is paid is less than 17 days) by the number of months in that period as the monthly remuneration amount, notwithstanding the provisions of Article 41; provided, however, that this does not apply to an insured person who commences the maternity leave prescribed in paragraph (1) of the following Article on the day following the last day of childcare leave.

A standard monthly remuneration amount revised pursuant to the provisions of the preceding paragraph is the standard monthly remuneration amount for each month since the month following the month which includes the day on which two years have elapsed since the day following the last day of childcare leave until August in that year (August in the following year if that following month is any of September to December).

If maternity leave (meaning not engaging in labor for the period from 42 days (98 days in the case of multiple fetuses) before the day of childbirth (the due date of childbirth if the day of childbirth is after the due date of childbirth) to 56 days after the day of childbirth (limited to not engaging in labor for reasons relating to pregnancy or childbirth); hereinafter the same applies) taken by an insured person ends and the person is taking care of a child to which the maternity leave pertains on the last day of the maternity leave (referred to as "last day of maternity leave" hereinafter in this Article) after submitting a request to the insurer via the employer of the place of business employing the person as specified by Order of the Ministry of Health, Labour and Welfare, the standard monthly remuneration amount is revised by setting the amount obtained by dividing the total amount of remuneration received for the three months beginning with the month which includes the day following the last day of maternity leave (limited to a period of consecutive employment at the place of business employing the person on the day following the last day of maternity leave; and excluding any month in which the number of days based on which remuneration is paid is less than 17 days) by the number of months in that period as the monthly remuneration amount, notwithstanding the provisions of Article 41; provided, however, that this does not apply to an insured person who commences childcare leave on the day following the last day of maternity leave.

A standard monthly remuneration amount revised pursuant to the provisions of the preceding paragraph is the standard monthly remuneration amount for each month since the month following the month which includes the day on which two years have elapsed since the day following the last day of maternity leave until August in that year (August in the following year if that following month is any of September to December).

If it is difficult to calculate an insured person's monthly remuneration amount pursuant to the provisions of Article 41, paragraph (1), Article 42, paragraph (1), Article 43-2, paragraph (1) or paragraph (1) of the preceding Article, or if the amount calculated pursuant to the provisions of Article 41, paragraph (1), Article 42, paragraph (1), Article 43, paragraph (1), Article 43-2, paragraph (1) or paragraph (1) of the preceding Article is found to be significantly unjustifiable, notwithstanding these provisions, the insured person's monthly remuneration amount is an amount determined by the insurer.

In the case of the preceding paragraph, if the insurer is a health insurance society, the calculation method in the same paragraph must be specified by the constitution.

In calculating the monthly remuneration amount for an insured person who receives remuneration at two or more places of business at the same time, the total sum of the amounts calculated pursuant to the provisions of Article 41, paragraph (1), Article 42, paragraph (1), Article 43, paragraph (1), Article 43-2, paragraph (1), or paragraph (1) of the preceding Article or paragraph (1) is the person's monthly remuneration amount.

An insurer determines the standard bonus amount in a month based on the amount of bonus received by the insured in the month in which the person received the bonus by rounding the amount down to the nearest 1,000 yen; provided, however, that if the cumulative amount of standard bonus during that fiscal year (from April 1 to the following March 31; the same applies hereinafter) exceeds 5,730,000 yen (an amount specified by Cabinet Order if the standard monthly remuneration amount grading has been revised pursuant to the provisions of Article 40, paragraph (2); the same applies in this paragraph) due to the bonus received by the insured person in that month, the standard bonus amount for the month is determined so that the cumulative amount is 5,730,000 yen and the standard amount of bonus received after the following month in the fiscal year is zero.

The provisions of Article 40, paragraph (3) apply mutatis mutandis to the establishment or amendment of Cabinet Order referred to in the preceding paragraph and the provisions of the preceding Article apply mutatis mutandis to the calculation of the amount of standard bonus.

When all or part of remuneration or bonus should be paid other than in currency, the amount is specified by the Minister of Health, Labour and Welfare based on the local market price.

A health insurance society may establish different standards in its constitution notwithstanding the provisions of the preceding paragraph.

Notwithstanding the provisions of Articles 41 through 44, with respect to the standard monthly remuneration amount of an insured person with optional and continued coverage, the smaller amount between the amounts listed in the following items is the person's standard monthly remuneration amount:

the standard monthly remuneration amount to be paid when the insured person with optional and continued coverage has lost eligibility as an insured person; or

the standard monthly remuneration amount calculated when the average standard monthly remuneration amount of all insured persons administered by the insurer (if the health insurance association has any amount specified in its constitution within the range of the average amount, that amount) that provided insurance to the insured person with optional and continued coverage on September 30 in the preceding year (for the standard monthly remuneration amount from January to March, the year prior to the preceding year) is deemed to be the monthly remuneration amount that is the basis of the standard monthly remuneration amount.

In the case where the insurer is a health insurance society, notwithstanding the provisions of the preceding paragraph, with respect to an insured person with optional and continued coverage for whom the amount listed in item (i) of that paragraph exceeds the amount listed in item (ii) of that paragraph, the health insurance society may, as provided in its constitution, make the amount listed in item (i) of that paragraph (if the health insurance society has an amount that its constitution specifies within the range exceeding the amount listed in item (ii) of that paragraph and less than the amount listed in item (i) of that paragraph, the standard monthly remuneration amount calculated when the amount so specified in its constitution is deemed to be the monthly remuneration amount that is the basis of the standard monthly remuneration amount) the person's standard monthly remuneration amount.

The employer of an applicable place of business must notify the insurer of particulars relating to the acquisition and loss of eligibility as an insured person as well as the monthly remuneration amount and bonus amount pursuant to Order of the Ministry of Health, Labour and Welfare.

When the Minister of Health, Labour and Welfare gives authorization pursuant to the provisions of Article 33, paragraph (1), the Minister must notify the employer to that effect, and the insurer, upon performing confirmation pursuant to Article 39, paragraph (1), or determining or revising the standard remuneration amount (meaning the standard monthly remuneration amount and standard monthly bonus amount; the same applies hereinafter), must notify the employer to that effect.

When a notice referred to in the preceding paragraph is given, the employer must promptly notify the person who is or was insured.

When an insured person loses eligibility as an insured person and a notice referred to in the preceding paragraph cannot be given since the whereabouts of the person are unknown, the employer must notify the Minister of Health, Labour and Welfare and the insurer to that effect.

When the notification referred to in the preceding paragraph is given, the Minister of Health, Labour and Welfare and the insurer must give public notice of the matters stated in the notification given to the employer pursuant to the provisions of paragraph (1) about the person whose whereabouts are unknown.

If the Minister of Health, Labour and Welfare and the insurer fail to give a notice referred to in paragraph (1) due to abolishment of the place of business or other unavoidable circumstances, they must make a public notice of the matters to be notified in lieu of the notice referred to in paragraph (1).

When a notification is given pursuant to the provisions of Article 48, if no fact pertaining the notice is found, the insurer must give notify to that effect the employer who gave the notification.

The provisions of paragraphs (2) through (5) of the preceding Article apply mutatis mutandis to the notice referred to the preceding paragraph.

A person who is or was an insured person may at any time demand confirmation pursuant to the provisions of Article 39, paragraph (1).

When an insurer receives a request referred to in the provisions of the preceding paragraph, the insurer must dismiss the request if no fact pertaining to it is found.

The Minister of Health, Labour and Welfare provides information to JHIA on matters concerning the eligibility of insured persons and standard remuneration, and necessary information concerning the provision of JHIA's services, pursuant to Order of the Ministry of Health, Labour and Welfare.

When an insured person or the insured person's dependent is in a situation where the insured person or dependent cannot undergo electronic eligibility confirmation, the insured person may, pursuant to Order of the Ministry of Health, Labour and Welfare, request the insurer to deliver a document stating the matters specified by Order of the Ministry of Health, Labour and Welfare as information relating to the eligibility of the insured person or the insured person's dependent who is in that situation, or to provide those matters by electronic or magnetic means (meaning a method using an electronic data processing system or another method using information and communications technology that is specified by Order of the Ministry of Health, Labour and Welfare; the same applies hereinafter in this Article). In this case, the insurer is, pursuant to Order of the Ministry of Health, Labour and Welfare, to promptly deliver the document to the insured person who has made the request for delivery of the document, and to provide the matters by electronic or magnetic means to the insured person who has made the request for provision by electronic or magnetic means.

Insurance benefits for an insured person provided by this Act are as follows:

benefits for medical treatment, as well as 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, and transport expenses;

If the insurer is a health insurance society, other benefits may be made as insurance benefits beyond the insurance benefits listed in the items of the preceding Article, as prescribed in the constitution.

If an insured person or a dependent thereof is an officer of a corporation (meaning an employee, director, executive officer who executes business, or person in an equivalent position, including those recognized as having the same or greater influence over a corporation as employees who execute business, directors, corporate officers, or person in an equivalent position, regardless of their titles, such as counselor, consultant, etc.; the same applies hereinafter in this Article), insurance benefits are not paid for sickness, injury or death resulting from the duty of the insured person or the person's dependent as an officer of the corporation (excluding duties as an officer of a corporation that is used as an applicable place of business in which the number of insured persons is less than five and is specified by Order of the Ministry of Health, Labor and Welfare).

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, injury and sickness allowance, burial charges, dependent's medical expenses, dependent's medical expenses for home-nursing, dependent's transport expenses, or dependent's burial charges in relation to an insured person are not paid if the insured person may receive payment corresponding to those for the same sickness, injury, or death pursuant to the provisions of the Industrial Accident Compensation Insurance Act, the National Public Officers' Accident Compensation Act (Act No. 191 of 1951; including when this is applied mutatis mutandis to other laws and the same rule governs; the same applies in the following paragraph and Article 128, paragraph (2)), the Local Public Officers Accident Compensation Act (Act No. 121 of 1967), or a Prefectural or Municipal Ordinance based on the same Act.

When an insurer finds it necessary for the payment of injury and sickness allowance, the insurer may request those who pay benefits pursuant to the provisions of the Industrial Accident Compensation Insurance Act, the National Public Officers' Accident Compensation Act, or the Local Public Officers Accident Compensation Act, or a Prefectural or Municipal Ordinance based on the same Act, to provide necessary materials about the status of payment of those benefits.

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, dependent's medical expenses, or dependent's medical expenses for home-nursing in relation to an insured person are not paid if the insured person is eligible for benefits equivalent thereto for the same illness or injury pursuant to the provisions of the Long-Term Care Insurance Act.

Injury and sickness allowance and childbirth allowance may be paid by a fixed date in every month notwithstanding the provisions of the preceding paragraph.

When the grounds for an expense claim is caused consist of an act by a third party and an insurer provides insurance benefits, the insurer obtains the right to claim compensation for damages held by the person entitled to receive the benefits (if the grounds for an expense claim lie with a dependent of the insured person, the dependent is included; the same applies hereinafter in the following paragraph) against the third party, to the extent of the amount of the benefits (when the insurance benefits are benefits for medical treatment, the amount calculated by deducting, from the cost of the benefits for medical treatment, the amount of co-payment to be borne by the person with respect to the benefits for medical treatment; the same applies hereinafter in paragraph (1) of the following Article).

In the case referred to in the preceding paragraph, if the person entitled to receive the insurance benefits receives compensation for damages on the same ground from the third party, the insurer is exempt from the responsibility to pay the insurance benefit to the extent of the amount of the compensation.

When a person receives an insurance benefit by means of deception or other wrongful conduct, the insurer may collect all or part of the amount of the benefit from the person.

In the case referred to in the preceding paragraph, if the insurance benefit is granted because the employer made a false report or certificate, or because a physician providing health insurance treatment as prescribed in Article 64 at a medical institution providing services covered by health insurance as prescribed in Article 63, paragraph (3), item (i) or an attending physician as prescribed in Article 88, paragraph (1) has made a false entry on the medical certificate to be submitted to the insurer, the insurer may order the employer, physician providing health insurance treatement, or attending physician to pay the money to be collected pursuant to the preceding paragraph jointly and severally with the person who received the insurance benefit.

When finding it necessary in relation to insurance benefits, an insurer may order a person who is to receive insurance benefits (including a dependent if the insurance benefits pertain to a dependent; the same applies in Article 121) to submit or present a document or other objects or may have the insurer's official question or diagnose the person.

The provisions of Article 7-38, paragraph (2) apply mutatis mutandis to questions pursuant to the provisions of the preceding two paragraphs, and the provisions of paragraph (3) of the same Article apply mutatis mutandis to the authority granted pursuant to the provisions of the preceding two paragraphs.

The right to receive an insurance benefit may not be transferred, pledged as collateral, or levied.

Taxes and other public charges may not be imposed on the basis of money and goods received as payment of insurance benefits.

With regard to sickness and injury of insured persons, benefits for medical treatment are paid as listed below:

medical examinations;

provision of medication or materials for medical treatment;

treatment, operations or any other medical treatment;

in-home medical care management as well as care and any other nursing involved in in-home medical care; and

hospitalization or visiting a clinic, and care and other nursing involved in medical treatment provided there.

Benefits for the following types of medical treatment are not included in the benefits referred to in the preceding paragraph:

medical treatment consisting of the provision of meals and given in combination with the type of medical treatment listed in item (v) of the preceding paragraph (excluding hospitalization in a sanatorium ward (hereinafter referred to as "sanatorium ward") as prescribed in Article 7, paragraph (2), item (iv) of the Medical Care Act (Act No. 205 of 1948), and care and other nursing involved in the medical treatment there which is provided to an insured person whose 65th birthday is in any month before the month in which the person receives the relevant medical treatment (hereinafter referred to as "insured person undergoing special long-term hospitalization"); hereinafter referred to as "dietary treatment");

the following types of medical treatment given in combination with the type of medical treatment listed in item (v) of the preceding paragraph (limited to medical treatment provided to an insured person undergoing special long-term hospitalization; hereinafter referred to as "living support"):

medical treatment consisting of the provision of meals;

medical treatment consisting of the creation of an appropriate environment for medical treatment in terms of temperature, lighting and water supply;

medical treatment using advanced medical care techniques specified by the Minister of Health, Labour and Welfare and other medical treatment which are specified by the Minister of Health, Labour and Welfare as treatment that requires evaluation to determine whether it should be subject to benefits referred to in the preceding paragraph from the viewpoint of efficiently providing appropriate medical care (excluding patient-requested treatment in the following item; hereinafter referred to as "evaluation treatment");

medical treatment using advanced medical care techniques and specified by the Minister of Health, Labour and Welfare as treatment that requires evaluation to determine whether it should be subject to benefits referred to in the preceding paragraph, based on a request by the person who intends to receive the medical treatment, from the viewpoint of efficiently providing appropriate medical care (hereinafter referred to as "patient-requested treatment"); and

the provision of a special ward pertaining to the selection of insured persons and other medical treatment prescribed by the Minister of Health, Labour and Welfare (hereinafter referred to as "selective treatment").

treatment that the Minister of Health, Labour and Welfare specifies as treatment, such as treatment using a drug that has particularly high substitutability for a pharmaceutical requiring guidance (meaning a pharmaceutical requiring guidance as prescribed in Article 4, paragraph (9), item (iii) of the Act on Securing Quality, Efficacy and Safety of Products Including Pharmaceuticals and Medical Devices (Act No. 145 of 1960)) or an over-the-counter pharmaceutical (meaning an over-the-counter pharmaceutical as prescribed in item (iv) of that paragraph), for which part of the cost is not covered by insurance benefits in view of the need to provide fair and efficient insurance benefits while ensuring the provision of appropriate medical care (hereinafter referred to as "partially uninsured treatment").

A person who intends to receive benefits under paragraph (1) is, pursuant to Order of the Ministry of Health, Labour and Welfare, to receive confirmation that the person is an insured person from a hospital, clinic, or pharmacy that the person selects from those listed below, by electronic eligibility confirmation or another method specified by Order of the Ministry of Health, Labour and Welfare (hereinafter referred to as "electronic eligibility confirmation, etc."), and to receive the benefits under that paragraph:

a hospital or clinic designated by the Minister of Health, Labour and Welfare (if the hospital or clinic has received a designation excluding all or some of its beds pursuant to the provisions of Article 65, excluding those beds; hereinafter referred to as "medical institution providing services covered by health insurance") or a pharmacy designated by the Minister of Health, Labour and Welfare (hereinafter referred to as "pharmacy providing services covered by health insurance");

a hospital, clinic, or pharmacy which provides medical care or prescriptions to an insured person administered by a specific insurer and which is specified by the insurer; and

a hospital, clinic, or pharmacy established by an insurer which is a health insurance society.

A request referred to in paragraph (2), item (iv), as prescribed by the Minister of Health, Labour and Welfare, is to be made to the Minister of Health, Labour and Welfare and accompanied by statements by the establisher of the core clinical research hospital provided for by Article 4-3 of the Medial Care Act (limited to a medical institution providing services covered by health insurance) which provides the medical treatment to which the request pertains and other necessary documents.

When the Minister of Health, Labour and Welfare receives a request under paragraph (2), item (iv), the Minister of Health, Labour and Welfare is to promptly examine the request and specify the medical treatment pertaining to the request as patient-requested treatment if it is found to require the evaluation provided for in that item.

If Minister of Health, Labour and Welfare determines that the medical treatment to which the application referred to in paragraph (2), item (iv) pertains pursuant to the provisions of the preceding paragraph is patient-requested treatment, the Minister is to promptly notify the applicant to that effect.

If the Minister of Health, Labour and Welfare examines the application referred to in paragraph (2), item (iv) pursuant to the provisions of paragraph (5) and determines that the medical treatment pertaining to the application is not to be specified as patient-requested treatment, the Minister is to promptly notify the applicant to that effect and the reason therefor.

In specifying matters under paragraph (2), item (vi), the Minister of Health, Labour and Welfare is to give consideration so that the treatment takes into account income status, extent of symptoms, contents of medical treatment, and other circumstances of the person receiving the treatment.

A physician or dentist engaged in medical treatment covered by health insurance at a medical institution providing services covered by health insurance or a pharmacist engaged in prescription covered by health insurance at a pharmacy providing services covered by health insurance must be a physician or dentist registered by the Minister of Health, Labour and Welfare (hereinafter collectively referred to as a "physician providing health insurance treatment") or a pharmacist registered by the Minister (hereinafter referred to as a "pharmacist filling health insurance prescriptions").

A designation referred to in Article 63, paragraph (3), item (i) is provided upon an application by the establisher who opened a hospital, clinic, or pharmacy, as specified by Cabinet Order.

In the case of the preceding paragraph, if the application pertains to a hospital or to a clinic that has beds, the application is to be made by specifying the number of beds for each classification of bed prescribed in Article 7, paragraph (2) of the Medical Care Act (simply referred to as "bed classification" in paragraph (4) and paragraph (1) of the following Article).

When an application referred to in paragraph (1) is filed and the application falls under any of the following items, the Minister of Health, Labour and Welfare may determine not to make the designation referred to in Article 63, paragraph (3), item (i):

the hospital, clinic, or pharmacy pertaining to the application is a place of business or facility whose designation under Article 63, paragraph (3), item (i) pertaining to a medical institution providing services covered by health insurance providing services covered by health insurance or a pharmacy providing services covered by health insurance has been rescinded pursuant to the provisions of this Act and five years have not elapsed from the date of the rescission;

the hospital, clinic or pharmacy pertaining to the relevant application has received repeated guidance due to a likelihood of inappropriate medical care or prescriptions with respect to insurance benefits pursuant to Article 73, paragraph (1) (including when applied mutatis mutandis to Article 85, paragraph (9), Article 85-2, paragraph (5), Article 86, paragraph (5), Article 110, paragraph (7), and Article 149);

When an application referred to in paragraph (1) is filed pertaining to a hospital or clinic referred to in paragraph (2) and the application falls under any of the following items, the Minister of Health, Labour and Welfare may make the designation prescribed in Article 63, paragraph (3), item (i) excluding all or some of the beds pertaining to the application:

the number of physicians, dentists, nurses and other employees at the hospital or clinic does not meet the requirements for the number specified by Order of the Ministry of Health, Labour and Welfare prescribed in Article 21, paragraph (1), item (i) or paragraph (2), item (i) of the Medical Care Act or the number calculated based on the standards specified by the Minister of Health, Labour and Welfare in consideration of the standards specified by Order of the Ministry of Health, Labour and Welfare prescribed in paragraph (3) of the same Article;

it is found that the number of beds, according to the bed classification related to the application, at a medical institution providing services covered by health insurance in a region prescribed by Article 7-2, paragraph (1) of the Medical Care Act will, as a result of the designation, exceed the number calculated as specified by the Minister of Health, Labour and Welfare in consideration of the standard number of beds specified in the medical care plan prescribed in Article 30-4, paragraph (1) of the same Act (including where that number is already exceeded), and the establisher or administrator of the hospital or clinic has received a recommendation from the prefectural governor pursuant to the provisions of Article 30-11, paragraph (1) of the same Act but does not comply with the recommendation;

if all of the following apply, and the establisher or administrator of the hospital or clinic has received a recommendation from the prefectural governor pursuant to the provisions of Article 30-11, paragraph (1) of the Medical Care Act and does not comply with it;

where it is found that, in accordance with the bed classification pertaining to the relevant application, the number of beds at medical institutions providing services covered by health insurance in the area prescribed in Article 7-2, paragraph (1) of the Medical Care Act would, as a result of the designation, fall short of the number calculated pursuant to the rules prescribed by the Minister of Health, Labour and Welfare taking into account the standard number of beds determined in the medical care plan prescribed in Article 30-4, paragraph (1) of that Act;

where it is found that, in accordance with the bed classification pertaining to the relevant application, the number of beds at medical institutions providing services covered by health insurance in the vision area prescribed in Article 30-3-3, paragraph (2), item (ii) of the Medical Care Act would, as a result of the designation, exceed the number calculated pursuant to the rules prescribed by the Minister of Health, Labour and Welfare taking into account the required number of beds in the future (meaning the required number of beds in the future prescribed in item (iv) of that paragraph; the same applies in the following item) determined in the regional medical care vision prescribed in paragraph (1) of that Article (including where that number has already been exceeded);