Health Insurance Act

The amount of insurance premium relating to an insured person is the amount per month prescribed respectively in the following items in accordance with the classification of persons listed in the items:

an insured person who is an insured person prescribed in Article 9, item (ii) of the Long-Term Care Insurance Act (hereinafter referred to as an "item (ii) insured person"): the sum of the amount of general insurance premium, etc. (meaning the amount obtained by multiplying the standard monthly remuneration and standard bonus amount of each insured person respectively by the combined rate of the general insurance rate (meaning the combined rate of the basic insurance rate and the specified insurance rate) and the children and child-rearing support payment rate; hereinafter the same applies) and the amount of long-term care insurance premium (meaning the amount obtained by multiplying the standard monthly remuneration and standard bonus amount of each insured person respectively by the long-term care insurance rate; hereinafter the same applies); or

an insured person other than an item (ii) insured person: the amount of general insurance premium, etc.

Notwithstanding the provisions of item (i) of the preceding paragraph, when an insured person who is an item (ii) insured person ceases to fall under the category of item (ii) insured person, the amount of insurance premium for that month is the amount of general insurance premium, etc.; provided, however, that this does not apply if the person becomes an item (ii) insured person again within the same month or in other cases specified by Cabinet Order.

Notwithstanding the provisions of the preceding two paragraphs, when a person who continues to be insured from the previous month loses the eligibility, the insurance premium for the month is not included in the calculation of premium amount.

Insurance premiums related to an insured person with optional and continued coverage are calculated starting from the month in which the person became an insured person with optional and continued coverage.

In the case of the preceding paragraph, the method for calculating monthly insurance premiums is governed by the preceding Article.

If a person who has continued to be an insured person from the preceding month (excluding an insured person with optional and continued coverage; hereinafter the same applies to the following Article and Article 159-3) or who becomes eligible to be an insured person falls under any of the items in Article 118, paragraph (1), insurance premiums are not collected from the month in which the person first falls under the item until the month preceding the month in which the person no longer falls under any of the items of the same paragraph; however, this does not apply if the insured person falls under any of the items of the same paragraph and then no longer falls under any of those items in the same month.

When the employer of the place of business at which an insured person who is taking childcare leave (excluding insured persons to whom the provisions of Article 159-3 apply; the same applies in the following paragraph) is employed makes a request to an insurer, etc. as specified by Order of the Ministry of Health, Labour and Welfare, insurance premiums relating to the insured person for the month specified in each of the following items in accordance with the classification of cases listed in those items (for a person whose period of childcare leave is one month or less, limited to insurance premiums on the standard monthly remuneration) are not collected.

in the case where the month including the date on which the childcare leave begins differs from the month including the day after the last day of the childcare leave: the months from the month including the date on which the childcare leave begins until the month preceding the month including the day after the last day of the childcare leave;

in the case where the month including the date on which the childcare leave begins is the same as the month including the day after the last day of the childcare leave, and the number of days of childcare leave in that month, calculated as specified by Order of the Ministry of Health, Labour and Welfare, is 14 days or more: that month.

With regard to the application of the provisions of the preceding paragraph in the case where an insured person takes two or more consecutive periods of childcare leave (including cases specified by Order of the Ministry of Health, Labour and Welfare as equivalent thereto), all of them are deemed to be a single period of childcare leave.

When the Minister of Health, Labour and Welfare collects insurance premiums and the employer of an applicable place of business pays part of the insurance premiums, the premiums prescribed in Article 81 of the Employees' Pension Insurance Act (hereinafter referred to as "employees' pension insurance premiums") and the contributions prescribed in Article 69 of the Act on Support for Children and Child-rearing (hereinafter referred to as "children and child-rearing contributions"), it is deemed that an amount of insurance premiums equivalent to an amount proportional to the amounts of insurance premiums, employees' pension insurance premiums, and children and child-rearing contributions to be paid by the employer has been paid.

When the employer of an insured person who is taking maternity leave applies to an insurer as specified by Order of the Ministry of Health, Labour and Welfare, no insurance premiums relating to the insured person are collected during the period from the month including the date on which the maternity leave begins until the month preceding the month including the day after the last day of the maternity leave.

The general insurance premium rate for insured persons covered by health insurance administered by JHIA is to be determined in the range from 0.03 to 0.13 by JHIA on the basis of a single branch-insured person (meaning insured persons employed at a place of business located in the same prefecture as the relevant branch office and insured persons with optional and continued coverage with a domicile or residence in the prefecture; the same applies hereinafter).

The general insurance rate determined on the basis of a single branch-insured person pursuant to the provisions of the preceding paragraph (hereinafter referred to as "insurance premium rate for each prefecture") applies to the relevant branch-insured persons.

The insurance premium rate for each prefecture is calculated on the basis of a single branch-insured person in light of the amounts listed below in order to be able to maintain the fiscal balance of revenue and expenses as specified by Cabinet Order:

the amount expected to be obtained by adjusting, based on the provisions of the following paragraph, the amount of expenses required for those of the benefits for medical treatment listed in Article 52, item (i) and other insurance benefits specified by Order of the Ministry of Health, Labour and Welfare (referred to as "benefits for medical treatment, etc." hereinafter in this paragraph and the following paragraph) that pertain to the relevant single branch-insured persons (excluding the amount of national subsidies pursuant to the provisions of Article 153 with respect to benefits for medical treatment, etc. pertaining to the single branch-insured persons);

the amount of expenses required for healthcare and welfare business (excluding the amount of national subsidies pursuant to the provisions of Article 154-2) as well as expenses required for the execution of affairs concerning health insurance business and the estimated amount of reserve funds pursuant to the provisions of Article 160-3, paragraph (1) (excluding the amount of national treasury benefits pursuant to the provisions of Article 151) as determined by JHIA as the amount to be shared among the relevant single branch-insured persons.

JHIA is to adjust finances for health insurance on the basis of a single branch-insured person as specified by Cabinet Order in order to correct any imbalances in the share of the amount of expenses required for benefits for medical treatment, etc., caused by differences in distribution status by age group of branch-insured persons and their dependents and in distribution status by age of insured persons and their dependents administered by JHIA or any imbalances in financial capability caused by differences in the average amount of total remuneration of branch-insured persons and their dependents and the average amount of total remuneration of insured persons and their dependents administered by JHIA.

JHIA is to create and publicize, in each fiscal year, the outlook of revenues and expenditures of health insurance services, including the estimated number of insured persons and total remuneration for health insurance administered by JHIA, the amount of expenses required for insurance benefits, and the amount of insurance premiums (including the level of insurance premium rate that would enable the fiscal balance of revenue and expenditure in each business year to be maintained) for a five-year period starting from the following business year.

When JHIA intends to alter the insurance premium rate for a prefecture, the president must in advance hear the opinion of the chief of the branch office located in that prefecture and then undergo discussion at the management board.

Other than when being asked for an opinion referred to in the preceding paragraph, when the chief of a branch office finds it necessary to change the insurance premium rate for a prefecture, the chief is to hear the opinion of the council established at the branch, and then offer an opinion about the insurance premium rate for the prefecture to the president of the JHIA.

When JHIA intends to make a change to the insurance premium rate for a prefecture, the president of JHIA must obtain authorization for the change from the Minister of Health, Labour and Welfare.

The Minister of Health, Labour, and Welfare gives the authorization referred to in the preceding paragraph, the Minister must make publicize that fact without delay.

When the Minister of Health, Labour and Welfare finds that the insurance premium rate for a prefecture is inappropriate from the viewpoint of balancing the revenue and expenditure of health insurance services or finds that there is a hindrance to the sound operation of health insurance business administered by JHIA, the Minister may order JHIA to apply for authorization to change the insurance premium rate for the prefecture within a specified reasonable period.

If JHIA does not apply as referred to in the preceding paragraph during the period referred to in the same paragraph, the Minister of Health, Labour and Welfare may change the insurance premium rate for the prefecture by undergoing discussion at the Social Security Council.

The provisions of paragraph (9) apply mutatis mutandis to changes in insurance premium rate for a prefecture made pursuant to the provisions of the preceding paragraph.

The provisions of paragraphs (1) and (8) apply mutatis mutandis to the general insurance premium rate for health insurance administered by a health insurance society. In this case, the phrase "is determined in the range from 0.03 through 0.13 by JHIA on the basis of a single branch-insured person (meaning insured persons employed at a place of business located in the same prefecture as the relevant branch office and insured persons with optional and continued coverage with a domicile or residence in the prefecture; the same applies hereinafter)" in paragraph (1) is replaced with "is determined in the range from 0.03 through 0.13", "insurance premium rate for a prefecture" in paragraph (8) with "general insurance premium rate for health insurance administered by a health insurance society".

The insurer specifies the specific insurance rate based on the rate obtained by dividing the sum of the amount of young-old payments, etc., the amount of aid for the old-old, etc., and the amount of contributions for securing medical care in the early phase of an epidemic, etc. to be paid by the insurer each fiscal year (in the case of health insurance and insurance for specially-insured day laborers administered by JHIA, the amount remaining after deducting the amount of national subsidies pursuant to the provisions of Articles 153 and 154 from that amount) (if there is a young-old subsidy, the amount remaining after deducting it) by the estimated total amount of the total remuneration of insured persons administered by the insurer in the relevant fiscal year.

The insurer specifies a basic insurance rate based on the rate obtained by deducting the specific insurance rate from the general insurance rate.

The insurer determines a long-term care insurance rate based on the rate obtained by dividing the amount of long-term care payments to be paid by the insurer each fiscal year (excluding those pertaining to specially-insured day laborers) by the estimated total amount of the total remuneration of the insured persons administered by the insurer who are item (ii) insured persons in the relevant fiscal year.

When JHIA specifies a basic insurance rate or specific insurance rate pursuant to the provisions of paragraphs (14) and (15), or a long-term care insurance rate pursuant to the provisions of the preceding paragraph, it must notify the Minister of Health, Labour and Welfare to that effect without delay.