Health Insurance Act

Beyond the operations listed in the items of the preceding paragraph, JHIA is responsible for operations related to Mariners Insurance business pursuant to the provisions of the Mariners Insurance Act (excluding those conducted by the Minister of Health, Labour and Welfare pursuant to the provisions of the same Act), and operations related to the payment of young-old payments, etc. pursuant to the provisions of the Act on Assurance of Medical Care for Elderly People (hereinafter referred to as "young-old payments, etc."), aid for the old-old, contributions for administrative expenses related to the old-old, and contributions for administrative expenses related to childbirth pursuant to the provisions of the same Act (hereinafter referred to as "aid for the old-old, etc."), physician allowance contributions, etc. pursuant to the provisions of the Act on Promotion of Comprehensive Securing of Medical and Long-Term Care in Communities (Act No. 64 of 1989) (hereinafter referred to as "physician allowance contributions, etc."), the payment pursuant to the provisions of the Long-Term Care Insurance Act (Act No. 123 of 1997) (hereinafter referred to as "long-term care payment"), contribution for securing medical care in the early phase of an epidemic, etc. pursuant to the provisions of the Act on the Prevention of Infectious Diseases and Medical Care for Patients with Infectious Diseases (Act No. 114 of 1998) (hereinafter referred to as "contribution for securing medical care in the early phase of an epidemic, etc."), and the children and child-rearing support levy pursuant to the provisions of the Act on Support for Children and Child-rearing (Act No. 65 of 2012) (hereinafter referred to as "children and child-rearing support levy").

A hospital prescribed in the preceding paragraph must, in order to contribute to the survey under that paragraph, report to the Minister of Health, Labour and Welfare information specified by the Minister of Health, Labour and Welfare, such as the content of medical care provided to patients admitted to that hospital (hereinafter referred to as "medical care-related information" in Article 150-2, paragraph (1) and Article 150-3).

In order to contribute to improving the health of the people, the Minister of Health, Labour and Welfare may use anonymized medical care-related information (meaning medical care-related information processed in accordance with the standards specified by Order of the Ministry of Health, Labour and Welfare so as to make it impossible to identify a specific insured person or other person specified by Order of the Ministry of Health, Labour and Welfare to whom the medical care-related information pertains (referred to as "the person themselves" in the following Article and Article 150-7, paragraph (1)) and to restore the medical care-related information used in producing it; the same applies hereinafter), or may, as specified by Order of the Ministry of Health, Labour and Welfare, provide it to a person listed in the following items who conducts the business specified respectively in those items as business found to have considerable public interest in being conducted upon receipt of anonymized medical care-related information:

In order to contribute to the improvement of the health of the people, the Minister of Health, Labour and Welfare may use pseudonymized medical care-related information (meaning medical care-related information processed in accordance with the standards specified by Order of the Ministry of Health, Labour and Welfare so that the person themselves to whom the medical care-related information pertains cannot be identified unless it is collated with other information; the same applies hereinafter).

In order to contribute to the improvement of the health of the people, when the Minister of Health, Labour and Welfare finds it necessary for a person listed in the following items who conducts the business specified in the relevant item as business found to have considerable public interest in being conducted with the provision of pseudonymized medical care-related information to use pseudonymized medical care-related information in order to conduct that business, the Minister may, pursuant to Order of the Ministry of Health, Labour and Welfare, provide that pseudonymized medical care-related information to that person.

other administrative organs of the national government and local governments: surveys concerning the planning and drafting of policies that contribute to the provision of appropriate health and medical services;

universities and other research institutions: research on the causes of diseases and on methods of preventing, diagnosing and treating diseases, and other research on the improvement and promotion of public health;

private business operators and other persons specified by Order of the Ministry of Health, Labour and Welfare: analysis contributing to research and development in the medical field and other business specified by Order of the Ministry of Health, Labour and Welfare (excluding that conducted for use in advertising or promoting specific goods or services).

When conducting the use or provision pursuant to the provisions of the preceding two paragraphs, the Minister of Health, Labour and Welfare may use the pseudonymized medical care-related information in linkage with pseudonymized medical insurance-related information, etc. prescribed in Article 16-7, paragraph (1) of the Act on Assurance of Medical Care for Elderly People, pseudonymized long-term care insurance-related information, etc. prescribed in Article 118-8, paragraph (1) of the Long-Term Care Insurance Act, or other information specified by Order of the Ministry of Health, Labour and Welfare, or may provide it in a state in which it can be used in linkage with such information.

When intending to provide pseudonymized medical care-related information pursuant to the provisions of paragraph (2), the Minister of Health, Labour and Welfare must hear the opinions of the Social Security Council in advance.

When providing pseudonymized medical care-related information pursuant to the provisions of paragraph (2) of the preceding Article, if the Minister of Health, Labour and Welfare finds it necessary, the Minister is to impose on a person who receives provision of pseudonymized medical care-related information pursuant to the provisions of that paragraph and uses it (hereinafter referred to as a "user of pseudonymized medical care-related information") restrictions on the purpose or method of use of the provided pseudonymized medical care-related information and other necessary restrictions.

The provisions of Article 68 and Articles 76 through 107 of the Act on the Protection of Personal Information (Act No. 57 of 2003) do not apply in the case where the Minister of Health, Labour and Welfare uses or provides pseudonymized medical care-related information pursuant to the provisions of paragraph (1) or (2) of the preceding Article.

The provisions of Article 150-3 through Article 150-6 apply mutatis mutandis to the handling of pseudonymized medical care-related information by a user of pseudonymized medical care-related information.

To the extent necessary for the enforcement of the provisions of this Chapter, the Minister of Health, Labour and Welfare may order a user of anonymized medical care-related information or a user of pseudonymized medical care-related information (excluding other administrative organs of the national government; the same applies hereinafter hereinafter referred to as a "user of anonymized or pseudonymized medical care-related information" in this paragraph and the following Article) to make a report or submit or present books and other documents, or may have an official enter the offices or other places of business of a user of anonymized or pseudonymized medical care-related information and question the persons involved or inspect books and other documents or other articles.

When the Minister of Health, Labour and Welfare finds that a user of anonymized or pseudonymized medical care-related information is in violation of the provisions of Articles 150-3 through 150-6 (including as applied mutatis mutandis pursuant to Article 150-9) or of the restrictions imposed pursuant to the provisions of Article 150-8, paragraph (1) (including as applied mutatis mutandis pursuant to paragraph (2) of the following Article), the Minister may order that person to take measures necessary to correct the violation.

The Minister of Health, Labour and Welfare may delegate all or part of the affairs concerning the survey prescribed in Article 77, paragraph (2), and the use orand provision under the provisions of Article 150-2, paragraph (1) and Article 150-7, paragraphs (1) and (2) to the Infrastructure Organization, an NHI federation, or any other person specified by Order of the Ministry of Health, Labour and Welfare (referred to as the "Infrastructure Organization, etc." in the following Article).

The provisions of Article 150-8, paragraph (1) apply mutatis mutandis in the case where a person entrusted pursuant to the provisions of the preceding paragraph provides pseudonymized medical care-related information based on that entrustment.

The provisions of Article 68 and Articles 76 through 107 of the Act on the Protection of Personal Information do not apply in the case where a person entrusted pursuant to the provisions of paragraph (1) uses or provides pseudonymized medical care-related information based on that entrustment.

A user of anonymized medical care-related information must pay a fee in the amount specified by Cabinet Order, taking actual expenses into consideration, to the national government (or, in the case where the Infrastructure Organization, etc., having been delegated by the Minister of Health, Labour and Welfare pursuant to the provisions of paragraph (1) of the preceding Article, performs all of the affairs concerning the provision of anonymized medical care-related information under the provisions of Article 150-2, paragraph (1), to the Infrastructure Organization, etc.).

The provisions of the preceding three paragraphs apply mutatis mutandis to fees in the case where a user of pseudonymized medical care-related information receives provision of pseudonymized medical care-related information pursuant to the provisions of Article 150-7, paragraph (2).

The national treasury bears the expenses required for the execution of the affairs of health insurance services each fiscal year (including affairs concerning the payment of young-old payments, etc., aid for the old-old, etc., the contributions under the provisions of Article 173, physician allowance contributions, etc., the long-term care payment, the contribution for securing medical care in the early phase of an epidemic under the provisions of the Act on the Prevention of Infectious Diseases and Medical Care for Patients with Infectious Diseases (referred to as "contribution for securing medical care in the early phase of an epidemic" in Article 153 and Article 154, paragraph (1)), and the children and child-rearing support levy), within the scope of the budget.

In addition to the expenses prescribed in Article 151, the national treasury subsidizes the amount obtained by multiplying, by a rate specified by Cabinet Order within a range from 0.13 to 0.20, the sum (or, if there is a young-old subsidy under the provisions of the Act on Assurance of Medical Care for Elderly People (hereinafter referred to as "young-old subsidy"), the amount obtained by deducting from that sum the amount specified by Cabinet Order on the basis of the amount of that young-old subsidy) of the following, from among the expenses required for the execution of health insurance services administered by JHIA: the amount of expenses required for payment of benefits for medical treatment pertaining to insured persons and of dietary treatment expenses for inpatients, living support expenses for inpatients, medical expenses combined with treatment outside insurance coverage, medical expenses, medical expenses for home-nursing, transport expenses, injury and sickness allowance, childbirth allowance, dependent's medical expenses, dependent's medical expenses for home-nursing, dependent's transport expenses, high-cost medical expenses and expenses for high-cost medical treatment combined with long-term care (in the case of benefits for medical treatment, an amount equivalent to the amount of co-payment is to be deducted) (excluding an amount equivalent to one third of the estimated benefit expenses subject to adjustment in each item of Article 34, paragraph (1) of that Act (referred to as "estimated benefit expenses subject to adjustment" in item (i) and Article 154, paragraph (1))); the amount obtained by multiplying the amount of expenses required for payment of the young-old payment under the provisions of that Act (hereinafter referred to as "young-old payment") by the ratio of the amount listed in that item to the amount listed in item (ii); and the amount of expenses required for payment of the physician allowance contribution under the provisions of the Act on Promotion of Comprehensive Securing of Medical and Long-Term Care in Communities (referred to as "physician allowance contribution" in paragraph (1) of the following Article) and the contribution for securing medical care in the early phase of an epidemic.

In addition to the expenses prescribed in Article 151 and the preceding Article, the national treasury subsidizes every fiscal year the amount obtained by multiplying, by the rate specified by Cabinet Order prescribed in the preceding Article, the amount obtained by multiplying by the following ratio the sum (or, if there is a young-old subsidy, the amount obtained by deducting from that sum the amount obtained by multiplying the amount of that young-old subsidy by the benefit expense ratio) of the amount of expenses required for payment of benefits for medical treatment pertaining to specially-insured day laborers and of dietary treatment expenses for inpatients, living support expenses for inpatients, medical expenses combined with treatment outside insurance coverage, medical expenses, medical expenses for home-nursing, transport expenses, injury and sickness allowance, childbirth allowance, dependent's medical expenses, dependent's medical expenses for home-nursing, dependent's transport expenses, special medical expenses, high-cost medical expenses and expenses for high-cost medical treatment combined with long-term care (in the case of benefits for medical treatment, an amount equivalent to the amount of co-payment is to be deducted), from among the expenses required for the execution of health insurance services, the amount obtained by multiplying the amount of expenses required for payment of the young-old payment by the benefit expense ratio (meaning the ratio of the estimated benefit expenses subject to adjustment to the total amount of the estimated benefit expenses subject to adjustment and the estimated amount of aid for the old-old pertaining to the young-old prescribed in Article 34, paragraph (1), item (i), (a)(2) of the Act on Assurance of Medical Care for Elderly People; the same applies hereinafter in this Article), and the amount of expenses required for payment of the physician allowance contribution and the contribution for securing medical care in the early phase of an epidemic: the ratio obtained by dividing the total number of payment days of insurance premiums relating to specially-insured day laborers paid in the relevant fiscal year by employers other than employers who establish a health insurance society (including insurers of national health insurance providing national health insurance to persons who have made the request referred to in Article 3, paragraph (1), item (viii); the same applies in Article 171, paragraphs (2) and (3)) by the total number of payment days of insurance premiums relating to specially-insured day laborers paid in that fiscal year.

An insurer, etc. collects insurance premiums to be allocated for the expenses required for health insurance services (including the expenses required for the payment of young-old payments, etc., aid for the old-old, etc., physician allowance contributions, etc., the long-term care payment, the contribution for securing medical care in the early phase of an epidemic, etc. and the children and child-rearing support levy, and, in the case of a health insurance society, the contributions pursuant to the provisions of Article 173).

the amount obtained by multiplying the estimated amount of expenses required for insurance benefits (excluding benefits for medical treatment, etc. pertaining to single branch-insured persons), young-old payments, etc., aid for the old-old, etc., physician allowance contributions, etc., and contributions for securing medical care in the early phase of an epidemic, etc. (excluding the amount of the childbirth grant prescribed in Article 152-2, the amount of national subsidies pursuant to the provisions of Articles 153 and 154 (excluding the amount of national subsidies referred to in the preceding item), and the amount of contributions pursuant to the provisions of Article 173) by the total remuneration proportion ratio (the ratio obtained by dividing the total amount of the total remuneration of single branch-insured persons in the relevant prefecture (meaning the total sum of the standard monthly remuneration and standard bonus; the same applies hereinafter) by the total amount of the total remuneration of insured persons covered by health insurance administered by JHIA);

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., the amount of physician allowance contributions, 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.

In order to allocate them to expenses required for health insurance services pertaining to specially-insured day laborers (including expenses required for payment of young-old payments, etc., aid for the old-old, etc., physician allowance contributions, etc., long-term care payments, contributions for securing medical care in the early phase of an epidemic, etc., and children and child-rearing support levies; the same applies in Article 175), the Minister of Health, Labour and Welfare, beyond collecting insurance premiums pursuant to the provisions of Article 155, collects contributions every fiscal year from health insurance societies established by employers of specially-insured day laborers (hereinafter referred to as "day laborer health societies").

The amount of fixed day laborer contributions referred to in Article 174 is the amount obtained by multiplying the amount calculated as specified by Order of the Ministry of Health, Labour and Welfare as the amount obtained by deducting an amount equivalent to insurance premiums relating to specially-insured day laborers in the previous fiscal year from the amount of expenses required for health insurance services in the previous fiscal year pertaining to specially-insured day laborers (including expenses required for payment of young-old payments, etc., aid for the old-old, etc., physician allowance contributions, etc., long-term care payments, contributions for securing medical care in the early phase of an epidemic, etc., and children and child-rearing support levies) by the rate obtained by dividing the total number of days of payment of insurance premiums relating to specially-insured day laborers paid in the previous fiscal year by the employer who established the relevant day laborer health society by the total number of days of payment of insurance premiums relating to specially-insured day laborers paid in the previous fiscal year.

where a in violation of the provisions of Article 150-6 as applied mutatis mutandis pursuant to Article 150-9, the person violates has divulged to another person without good reason, or used for an order pursuant unjust purpose, the content of pseudonymized medical care-related information that the person came to know in connection with the provisionsuse of Article 150-8.pseudonymized medical care-related information; or

where a person violates an order pursuant to the provisions of Article 150-11.

where a person fails to make a report or to submit or present record books or documents pursuant to the provisions of Article 150-7150-10, paragraph (1), makes a false report or submits or presents false record books or documents, fails to answer a question asked by the relevant official pursuant to the same paragraph or answers the question untruthfully, or refuses, obstructs, or evades an inspection pursuant to the same paragraph;