Health Insurance Act

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 amount 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 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 bonus amount 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 amount.

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 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:

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

the standard monthly remuneration calculated when the average standard monthly remuneration 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 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.

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 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) the person's standard monthly remuneration.

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 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.