Health Insurance Act

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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