Health Insurance Act

When an insured person (excluding an insured person with optional and continued coverage; the same applies in Article 102, paragraph (1)) is unable to engage in labor due to medical treatment, the injury and sickness allowance is paid for the period during which the person is unable to engage in work, starting from the day on which three days elapsed after the day on which the person becomes unable to engage in work.

The amount of injury and sickness allowance per day is an amount equivalent to two-thirds of the amount equivalent to 1/30th of the average standard monthly remuneration (limited to the amount specified by the relevant insured person's insurer; the same applies hereinafter in this paragraph) of each month in the most recent 12 consecutive months before the month in which the payment of injury and sickness allowance starts (if the 1/30 amount is a figure with less than five yen in the ones place, it is to be rounded down, and if it is a figure with at least five yen but less than ten yen in the ones place, it is to be rounded up to the nearest ten yen; if the two-thirds amount is a figure with less than 0.5 yen in the ones place, it is rounded down, and if it is a figure with at least 0.5 yen but less than one yen in the ones place, it is to be rounded up to the nearest one yen); provided, however, that if the number of consecutive months for which the average standard monthly remuneration is determined is less than 12, an amount equivalent to two-thirds of an amount equivalent to smaller of the amounts listed in the following items (if the amount is a figure with less than 0.5 yen in the one place, it is to be rounded down, and if it is a figure with at least 0.5 yen but less than one yen in the ones place, it is to be rounded up to the nearest one yen).

an amount equivalent to 1/30th of the average standard monthly remuneration for each consecutive month before the month which includes the day on which the payment of injury and sickness allowance starts (if the amount is a figure with less than five, it is to be rounded down, and if it is a figure with at least five yen but less than ten yen, it is to be rounded up to the nearest ten yen); or

an amount equivalent to 1/30th of the standard monthly remuneration calculated when the average standard monthly remuneration of all insured persons on September 30 in the year preceding the fiscal year which includes the day on which payment of injury and sickness allowance starts is deemed as the monthly remuneration amount which is the basis of the standard monthly amount remuneration (if the amount is a figure with less than five yen, it is to be rounded down, and if it is a figure with at least five yen but less than ten yen, it is to be rounded up to the nearest 10 yen).

Beyond what is provided for in the preceding paragraph, necessary matters concerning calculation of the amount of injury and sickness allowance are specified by Order of the Ministry of Health, Labour, and Welfare.

The payment period for injury and sickness allowance is, with regard to the same sickness or injury as well as any sickness or injury caused thereby, one year and six months in total, counted from the day on which the payment starts.

In the case of the death of an insured person, an amount specified by Cabinet Order is paid as burial charges to the person whose livelihood depends on the income of the insured person and who arranged the burial.

If there is no one to receive burial charges pursuant to the provisions of the preceding paragraph, an amount equivalent to the expenses required for the burial within the range of the amount in the same paragraph is paid to the person who arranged the burial.

When an insured person gives birth, childbirth allowance is paid in the period during which the person does not engage in work, including 42 days (98 days in the case of multiple fetuses) preceding the day of childbirth (the scheduled date of childbirth if the day of childbirth is after the scheduled date of childbirth) and 56 days following the day of childbirth.

The provisions of Article 99, paragraphs (2) and (3) apply mutatis mutandis to the payment of childbirth allowance.

Injury and sickness allowance is not paid during the period in which childbirth allowance is paid (excluding cases falling under Article 108, paragraph (3) or (4)); provided, however, that if the amount of childbirth allowance to be received (in the case of the proviso to paragraph (2) of the same Article, the total sum of the amount of remuneration prescribed in the proviso and the amount of childbirth allowance calculated pursuant to the proviso) is less than the amount calculated pursuant to the provisions of Article 99, paragraph (2), the difference between those amounts is paid.

If injury and sickness allowance is paid when childbirth allowance is to be paid, the injury and sickness allowance (excluding an allowance paid pursuant to the proviso to the preceding paragraph) is deemed as part payment of childbirth allowance.

When a person receiving insurance benefits pursuant to the provisions of the preceding Article dies, a person who had been receiving insurance benefits pursuant to the provisions of the same Article dies within three days after the day of loss of the benefits, or a person who was an insured person dies within three days after the day of loss of a eligibility as an insured person, a person whose livelihood depends on the income of the insured person and who arranges the burial may receive burial charges from the last insurer of the insured person.

The provisions of Article 100 apply mutatis mutandis to a case in which no one is eligible to receive burial charges pursuant to the provisions of the preceding paragraph and to the amount of burial charges referred to in the same paragraph.

Notwithstanding the provisions of the preceding three Articles, when a person who was an insured person becomes an insured person covered by Seamen's Insurance, insurance benefits are not paid.