Health Insurance Act

The children and child-rearing support payment rate is determined by the insurer within the range of the rate specified by Cabinet Order on the basis of the rate obtained by dividing the total amount of children and child-rearing support levies to be paid by all insurers each fiscal year by the estimated total amount of the total remuneration of insured persons administered by all insurers in the relevant fiscal year.

When JHIA has determined the children and child-rearing support payment rate pursuant to the provisions of the preceding paragraph, it must notify the Minister of Health, Labour and Welfare to that effect without delay, as specified by Order of the Ministry of Health, Labour and Welfare.

An insurer must fund reserves to be spent for expenses for health insurance services at the end of each business year as specified by Cabinet Order.

Based on the outlook for the revenue and expenditure of health insurance services prescribed in Article 160, paragraph (5), if it is expected that, at least within two years from the time when the outlook for revenue and expenditure is publicized, the state of funding of reserves pursuant to the provisions of the preceding paragraph will cause a hindrance to the operation of health insurance services, JHIA is to report to that effect to the Minister of Health, Labour and Welfare and take necessary measures.

Insured persons and their employers each bear half of the amount of insurance premiums; however, insured persons with optional and continued coverage bear the entire amount.

An employer is obliged to pay the insurance premiums shared between itself and the insured persons it employs.

An insured person with optional and continued coverage is obliged to pay the insurance premiums the person shares.

The amount of insurance premiums to be borne by each employer and the payment obligation for insurance premiums when an insured person is employed at two or more places of business at the same time are specified by Cabinet Order.

Notwithstanding the provisions of paragraph (1) of the preceding Article, a health insurance society may increase the percentage of the burden of the amount of general insurance premium, etc. or the amount of long-term care insurance premium to be borne by an employer, as prescribed in the society's constitution.

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Monthly insurance premiums related to insured persons must be paid by the last day of the following month; provided however, that insurance premiums relating to insured persons with optional and continued coverage must be made by the 10th day of the following (a day specified by the insurer for the first payment of an insurance premium).

When an insurer (meaning JHIA if the relevant insured person has optional and continued coverage under the health insurance program administered by JHIA; a health insurance society if the relevant insured person is covered by a health insurance program administered by a health insurance society; or otherwise, the Minister of Health, Labour and Welfare; the same applies in the following paragraph) finds that the notified amount of insurance premium exceeds the amount to be paid for the insurance premium after the notice of insurance premium payment concerning an insured person is given, or that an insured person has paid an amount of insurance premium that exceeds the amount to be paid for the insurance premium, the notice of payment or the payment of the excessive amount may be deemed as prepayment for the insurance premium to be paid before the due date within six months after the day of the notice or payment.

When a notice of payment or payment of an excessive amount may be deemed as prepayment, the insurer must notify the person obliged to pay to that effect.

An insured person with optional and conditional coverage may prepay insurance premiums for a certain period.

The amount of tax to be prepaid in the case of the preceding paragraph is the amount of monthly insurance premiums for the period after deducting the amount specified by Cabinet Order.

With respect to insurance premiums prepaid pursuant to the provisions of paragraph (1), the insurance premium for each month is deemed to have been paid on the first day of each month in the period pertaining to the prepayment.

Beyond what is provided for in the preceding three paragraphs, the procedure for prepaying insurance premiums, contribution refunds, and other necessary matters relating to prepaid insurance premiums are specified by Cabinet Order.

When the Minister of Health, Labour and Welfare receives a request, from a person obliged to pay, for deposits or savings be deposited and for the payment of insurance premiums with the money paid out to be delegated to a financial institution with which the related deposit or savings account is held, the Minister may approve the request only when the payment is ensured and the approval is found to be advantageous for the collection of insurance premiums.

When paying remuneration to an insured person in currency, an employer may deduct the insurance premium pertaining to the standard monthly remuneration to be borne by the insured person for the preceding month (insurance premiums pertaining to the standard monthly remuneration for the preceding month and the current month if the insured person is no longer employed at the place of business) from the remuneration.

When paying a bonus to an insured person in currency, an employer may deduct an amount equivalent to the insurance premium pertaining to the standard bonus amount to be borne by the insured person from the bonus.

In case of an insurance deduction pursuant to the provisions of the preceding two paragraphs, the employer must prepare financial statements on insurance premium deduction and notify the insured person of the amount of the deduction.

The amount of insurance premium per day relating to a specially-insured day laborer is the sum of the amounts listed below:

the amount calculated as specified by Cabinet Order based on the sum of the amounts listed below according to the specially-insured day laborer's standard daily wage grade:

the amount obtained by multiplying the standard daily wage amount by the combined rate of the average insurance rate, etc. (meaning the rate obtained by combining the children and child-rearing support payment rate with the rate obtained by dividing the total amount of the amounts obtained by multiplying the insurance premium rate for each prefecture by the total amount of the total remuneration of single branch-insured persons by the total amount of the total remuneration of insured persons covered by health insurance administered by JHIA; the same applies hereinafter) and the long-term care insurance rate (in the case of specially-insured day laborers who are not item (ii) insured persons, the average insurance rate, etc.); and

the amount obtained by multiplying the amount listed in (a) by 0.31; and

the amount obtained by multiplying the amount of bonus (the amount is to be rounded down to the nearest 1,000 yen; if the amount exceeds 400,000 yen (an amount specified by Cabinet Order if the grades of the standard daily wages have been altered pursuant to the provisions of Article 124, paragraph (2); the same applies hereinafter in this item) the amount is to be 400,000 yen) by the combined rate of the average insurance rate, etc. and the long-term care insurance rate (by the average insurance rate, etc. in the case of specially-insured day laborers who are not item (ii) insured persons);

The provisions of Article 40, paragraph (3) apply mutatis mutandis to the establishment or amendment of Cabinet Order referred to in item (ii) of the preceding paragraph, the provisions of Article 48 apply mutatis mutandis to particulars relating to the amount of bonus for specially-insured day laborers, and the provisions of Article 125, paragraph (2) apply mutatis mutandis to the calculation of the amount of bonus in cases where all or part the bonus is to be paid by means other than currency.

A specially-insured day laborer bears the sum of the amount calculated as specified by Cabinet Order as an amount equivalent to half the amount referred to in paragraph (1), item (i), sub-item (a) of the preceding Article and an amount which is half the amount referred to in item (ii) of the same paragraph, and an employer of specially-insured day laborers bears the sum of the calculated amount, the amount calculated as prescribed by Cabinet Order as an amount equivalent to half the amount referred to in paragraph (1), item (i), (b) of the preceding Article and an amount which is half the amount referred to in item (ii) of the same paragraph;

An employer (if the specially-insured day laborer is employed at two or more places of business on the same day, the first employer employing the laborer; the same applies in paragraphs (4) through (6) of this Article, paragraphs (1) and (2) of the following Article, and Article 171) is obliged to pay insurance premiums to be borne by the employer and a specially-insured day laborer for each day on which the laborer is employed.

The payment of insurance premiums pursuant to the provisions of the preceding paragraph must be made by affixing a health insurance stamp to the specially insured day laborer's insurance book submitted by a specially-insured day laborer and apply a cancelation mark thereto.

A specially-insured day laborer who possesses a specially insured day laborer's insurance book must submit it to the employer every day of the laborer's employment at the applicable place of business.

An employer must request a specially-insured day laborer to submit the specially insured day laborer's insurance book that the laborer possesses every day of the laborer's employment.

When an insurance premium is paid pursuant to the provisions of paragraph (2), an employer may deduct an amount equivalent to the insurance premium to be borne by the specially-insured day laborer from the laborer's wages. In this case, the employer must notify the specially-insured day laborer to that effect.

An employer is obliged to pay insurance premiums pertaining to the amount of bonus for a day to be borne by a specially-insured day laborer and the employer by the last day of the month following the month which includes the date on which the bonus is paid to the laborer.

The provisions of Article 164, paragraphs (2) and (3), and Article 166 apply mutatis mutandis to payment of insurance premiums pursuant to the provisions of the preceding paragraph, and the provisions of Article 167, paragraphs (2) and (3) apply to payment of a bonus to a specially-insured day laborer in currency.

If an employer fails to pay insurance premiums pursuant to the provisions of paragraph (2) of the preceding Article, the Minister of Health, Labour and Welfare determines the amount of insurance premiums to be paid by the employer based on the Minister's investigation and notifies the employer of the amount.

If an employer fails to pay insurance premiums pursuant to the provisions of paragraph (2) of the preceding Article despite no justifiable grounds being found, the Minister of Health, Labour and Welfare collects penalty fees, as specified by Order of the Ministry of Health, Labour and Welfare, in an amount equal to one-quarter of the amount of the insurance premiums determined pursuant to the provisions of the preceding paragraph; however, this does not apply is the settled amount of insurance premium is less than 1,000 yen.

In calculations of the penalty fees, the amount of determined insurance premium is to be rounded down to the nearest 1,000 yen.

The penalty fees prescribed in paragraph (2) must be paid to the Minister of Health, Labour and Welfare within 14 days from the day on which they were determined.

Employers must keep record books for each of their places of business relating to the receipt and payment of health insurance stamps and payment of insurance premiums to which the notification prescribed in paragraph (1) of the preceding Article pertains (referred to as "receipts and payments" hereinafter in this Article), state the status of all receipts and payments on each occasion of receipts and payments, and report the status to the Minister of Health, Labor and Welfare by the last day of the following month.

In the case of the preceding paragraph, an employer who has established a health insurance society must make a report referred to in the preceding paragraph to the health insurance society as well.

Each fiscal year, the health insurance society which received a report pursuant to the provisions of the preceding paragraph must report on the previous fiscal year's payments and receipts of the employer who established the health insurance society to the Minister of Health, Labour and Welfare, as specified by Order of the Ministry of Health, Labour and Welfare.