Health Insurance Act

Affairs concerning the authorities of the Minister of Health, Labour and Welfare for ordering, questioning, and inspection pursuant to the provisions of Article 198, paragraph (1) (excluding those concerning health insurance societies and limited to those concerning insurance benefits) are administered by JHIA; provided, however, that this does not preclude the Minister of Health, Labour and Welfare from personally exercising the authorities.

Beyond what is provided for in the preceding paragraph, necessary matters concerning JHIA administering of affairs pertaining to the authorities prescribed in the same paragraph are specified by Order of the Ministry of Health, Labour and Welfare.

When JHIA administers affairs pertaining to the authorities prescribed in paragraph (1) of the preceding Article, it must obtain authorization from the Minister of Health, Labour and Welfare in advance.

When applying the provisions of Article 198, paragraph (1) in the case prescribed in the preceding paragraph, the phrase "insured person's eligibility, standard remuneration, insurance premiums, or insurance benefits" in the same paragraph is replaced with "insurance benefits", and "the ministry's official" with "an employee of JHIA".

The authorities of the Minister of Health, Labour and Welfare as prescribed in this Act (excluding the authorities of the Minister of Health, Labor and Welfare provided for in Article 204-2, paragraph (2) and in Article 100-5, paragraph (2) of the Employees' Pension Insurance Act as applied mutatis mutandis to Article 204-2, paragraph (1)) may be delegated to the chief of a relevant regional bureau of health and welfare as specified by Order of the Ministry of Health, Labour and Welfare.

The authorities delegated to the chief of a regional bureau of health and welfare pursuant to the provisions of the preceding paragraph, as specified by Order of the Ministry of Health, Labour, and Welfare, may be delegated to a branch manager of the regional bureau of health and welfare.

The Minister of Health, Labour and Welfare is to have JPS administer the affairs listed below (excluding those to be administered by JHIA pursuant to the provisions of Article 181-3, paragraph (1) and those to be administered by the mayor of a municipality pursuant to the provisions of Article 203, paragraph (1)):

affairs pertaining to approval pursuant to the proviso to Article 3, paragraph (2) (limited to the portion pertaining to item (iii) of the same paragraph) (excluding the approval);

affairs concerning valuation pursuant to the provisions of Article 46, paragraph (1) and Article 125, paragraph (2) (including when applied mutatis mutandis to Article 168, paragraph (2));

affairs pertaining to the provision of information pursuant to the provisions of Article 51-2 (excluding the provision of the information);

affairs pertaining to the provision of materials pursuant to the provisions of Article 108, paragraph (6) (excluding the provision of the materials);

affairs concerning the collection of insurance premiums pursuant to the provisions of Article 155, paragraph (1), Article 158, Article 159, Article 159-3, and Article 172 (excluding affairs concerning the exercise of the authorities listed in Article 204, paragraph (1), items (xii), (xiii), and (xv) through (xvii), collection executed by JPS pursuant to the provisions of Article 204-6, paragraph (1), demands for payment pursuant to the provisions of Article 180, paragraph (1), other affairs concerning the exercise of authorities specified by Order of the Ministry of Health, Labour and Welfare, and the affairs listed in the following item and items (vii), (ix) and (xi));

affairs pertaining to payment pursuant to the provisions of Article 164, paragraphs (2) and (3) (including when applied mutatis mutandis to Article 169, paragraph (8)) (excluding a notice of advance payment or determination of payment and notice to that effect);

affairs concerning the determination and notification of the amount of insurance premiums pursuant to the provisions of Article 170, paragraph (1) (excluding the determination and notification of the amount of insurance premiums), affairs concerning the collection of penalty fees pursuant to the provisions of paragraph (2) of the same Article (excluding affairs concerning the exercise of the authorities listed in Article 204, paragraph (1), items (xv) through (xvii), collection executed by JPS pursuant to the provisions of Article 204-6, paragraph (1), demands for payment pursuant to the provisions of Article 180, paragraph (1), other affairs concerning the exercise of the authorities specified by Order of the Ministry of Health, Labour and Welfare, and the affairs listed in items (ix) and (xi));

affairs concerning the collection of contributions pursuant to the provisions of Article 173, paragraph (1) (excluding affairs concerning the exercise of the authorities listed in Article 204, paragraph (1), items (xv) through (xvii), collection executed by JPS pursuant to the provisions of Article 204-6, paragraph (1), demands for payment pursuant to the provisions of Article 180, paragraph (1), other affairs concerning the exercise of authorities specified by Order of the Ministry of Health, Labour and Welfare, and affairs listed in the following item and item (xi));

affairs concerning demands for payment pursuant to the provisions of Article 180, paragraphs (1) and (2) (excluding the demands and issuance of demand notes (excluding affairs concerning the sending of a demand note));

affairs concerning collection of delinquent charges pursuant to the provisions of Article 181, paragraphs (1) and (4) (excluding affairs concerning the exercise of the authorities listed in Article 204, paragraph (1), items (xv) through (xvii), collection executed by JPS pursuant to the provisions of Article 204-6, paragraph (1), demands for payment pursuant to the provisions of Article 180, paragraph (1), other affairs concerning the exercise of authorities specified by Order of the Ministry of Health, Labour and Welfare affairs, and affairs listed in the preceding and following items);

affairs concerning authorities specified by Order of the Ministry of Health, Labour and Welfare prescribed in Article 204, paragraph (1), item (xvi) (excluding affairs concerning the exercise of those authorities);

affairs concerning the provision of information held by the Minister of Health, Labour and Welfare relating to the enforcement of this Act required by the provisions of Acts prescribed by Article 68, paragraph (5) of the Long-Term Care Insurance Act and other Orders of the Ministry of Health, Labour and Welfare (excluding the provision of information and affairs specified by Order of the Ministry of Health, Labour and Welfare); and

beyond what is provided for in the preceding items, affairs specified by Order of the Ministry of Health, Labour and Welfare.

The provisions of Article 100-10, paragraphs (2) and (3) of the Employee's Pension Insurance Act apply mutatis mutandis to the delegation of administration to JPS pursuant to the provisions in the preceding paragraph. In this case, the necessary technical replacement of terms is specified by Cabinet Order.

JPS is to provide information to the Minister of Health, Labour and Welfare on matters concerning the eligibility of insured persons, matters concerning standard remuneration, and necessary matters concerning the exercise of authorities of the Minister of Health, Labour and Welfare, as specified by Order of the Ministry of Health, Labour and Welfare.

The Minister of Health, Labour and Welfare and JPS are to endeavor to ensure mutual close cooperation, including the exchange of necessary information, to ensure the appropriate and smooth administration of health insurance services by JHIA based on this Act.

affairs pertaining to the collection or compilation of information on persons who are or were insured or their dependents (referred to as "insured persons, etc." in the next item) and to whom the following pertain: the payment of 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; the provision of insurance services and welfare services pursuant to the provisions of Chapter VI: the collection of insurance premiums pursuant to the provisions of Article 155; and other affairs specified by Order of the Ministry of Health, Labour and Welfare; and

affairs pertaining to the use or provision of information on insured persons, etc. to whom the following pertain: the payment of 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; the implementation of healthcare services and welfare services pursuant to the provisions of Chapter VI; the collection of insurance premiums pursuant to the provisions of Article 155; and other affairs specified by Order of the Ministry of Health, Labour and Welfare.

When an insurer delegates the affairs listed in item (ii) or (iii) of the preceding paragraph pursuant to the provisions of that paragraph, the insurer is to delegate them jointly with other insurers prescribed in Article 1 of the Medical Information Infrastructure and Medical Fee Examination and Payment Organization Act, persons specified by Order of the Ministry of Health, Labour and Welfare as persons who perform affairs pertaining to benefits relating to medical care pursuant to laws and regulations, and municipalities and special wards that operate long-term care insurance pursuant to the provisions of Article 3 of the Long-Term Care Insurance Act and other persons specified by Order of the Ministry of Health, Labour and Welfare.

The national government, JHIA and health insurance societies, medical institutions providing services covered by health insurance, etc., and other persons concerned are to cooperate with one another while coordinating among themselves, through the introduction of a system of electronic eligibility confirmation and otherwise promoting the use of information and communications technology in procedures, so that affairs carried out pursuant to the provisions of medical insurance laws, etc. (meaning the medical insurance laws prescribed in Article 7, paragraph (1) of the Act on Assurance of Medical Care for Elderly People and the Act on Assurance of Medical Care for Elderly People) and other laws and regulations providing for benefits relating to medical care are implemented smoothly.

When an order is enacted, revised or abolished based on this Act, a required transitional measure (including a transitional measure concerning penal provisions) may be determined by the order to the extent that it is judged to be rationally necessary in relation to the enactment, revision or abolition.

Beyond the special provisions in this Act, procedures for the enforcement of this Act and other detailed regulations necessary with regard to the enforcement are specified by Order of the Ministry of Health, Labour and Welfare.