Long-Term Care Insurance Act

With regard to an Insured Person Requiring Long-Term Care, etc. who is a Secondary Insured Person that can receive an insurance benefit, in a case when there is an insurance premium (including National Health Insurance tax pursuant to the provisions of the Local Tax Act (Act No. 226 of 1950)) or contribution that said Insured Person Requiring Long-Term Care, etc. is obligated to pay or remit pursuant to the provisions of the Medical Insurance Acts and that was not paid by the payment deadline or remittance deadline (hereinafter referred to as "Unpaid Medical Insurance Premium, etc." in this paragraph and the following paragraph), except for a case when it is found that the existence of the Unpaid Medical Insurance Premium, etc. is due to a disaster or other special circumstance as determined by a Cabinet Order, a Municipality, pursuant to the provisions of Order of the Ministry of Health, Labour and Welfare, may request said Insured Person Requiring Long-Term Care, etc. to submit the Certificate of Insured Person and may enter on said Certificate of Insured Person that the provisions of Article 41, paragraph (6), Article 42-2, paragraph (6), Article 46, paragraph (4), Article 48, paragraph (4), Article 51-3, paragraph (4), Article 53, paragraph (4), Article 54-2, paragraph (6), Article 58, paragraph (4), and Article 61-3, paragraph (4) do not apply and that the whole or a part of the payment of an insurance benefit is to be suspended (hereinafter referred to as "Entry of Suspension of Insurance Benefit" in this Article).

When an Insured Person Requiring Long-Term Care, etc., that has received an Entry of Suspension of Insurance Benefit pursuant to the provisions of the preceding paragraph completes payment of an Unpaid Medical Insurance Premium, etc., or when it is determined that there is a significant decrease of an Unpaid Medical Insurance Premium, etc., pertaining to said Insured Person Requiring Long-Term Care, etc., or due to disaster or other special circumstance as provided by a Cabinet Order, said Entry of Suspension of Insurance Benefit is to be deleted.

The provisions of Article 66, paragraph (4) apply mutatis mutandis to an Insured Person Requiring Long-Term Care, etc., that has received an Entry of Suspension of Insurance Benefit pursuant to the provisions of paragraph (1).

With regard to an Insured Person Requiring Long-Term Care, etc., that has received an Entry of Suspension of Insurance Benefit pursuant to the provisions of paragraph (1), a Municipality is to temporarily suspend the whole or a part of an insurance benefit.

A Municipality, when it finds it necessary in relation to the Entry of Suspension of Insurance Benefit of an Insured Person Requiring Long-Term Care, etc., may, pursuant to the provisions of Order of the Ministry of Health, Labour and Welfare, request the medical insurer in which said Insured Person Requiring Long-Term Care, etc. is enrolled (the Minister of Health, Labour and Welfare, where said Insured Person Requiring Long-Term Care, etc. is an insured person of health insurance administered by the Japan Health Insurance Association (excluding a voluntary continuing insured person prescribed in Article 3, paragraph (4) of the Health Insurance Act) or a dependent thereof, or an insured person of mariners insurance (excluding a voluntary continuing insured person for sickness prescribed in Article 2, paragraph (2) of the Mariners Insurance Act) or a dependent thereof, and a Municipality, where said Insured Person Requiring Long-Term Care, etc. is an insured person of National Health Insurance conducted by a prefecture together with the Municipalities within that prefecture as provided in the National Health Insurance Act (hereinafter referred to as "National Health Insurance"); the same applies hereinafter in this Article) to provide information on the status of payment of insurance premiums (including National Health Insurance tax collected pursuant to the provisions of the Local Tax Act) or contributions collected pursuant to the provisions of the Medical Insurance Acts with regard to said Insured Person Requiring Long-Term Care, etc., and other matters as determined by Order of the Ministry of Health, Labour and Welfare.

When a Municipality has made a Certification of Needed Long-Term Care, a Renewal of Certification of Needed Long-Term Care, a Certification of Change of Category of Condition of Need for Long-Term Care pursuant to the provisions of Article 27, paragraph (7) as applied mutatis mutandis pursuant to Article 29, paragraph (2) or pursuant to the provisions of Article 30, paragraph (1), a Certification of Needed Support, a Renewal of Certification of Needed Support, or a Certification of Change of Category of Needed Support Condition pursuant to the provisions of Article 32, paragraph (6) as applied mutatis mutandis pursuant to Article 33-2, paragraph (2) or pursuant to the provisions of Article 33-3, paragraph (1) (hereinafter referred to simply as "Certification" in this paragraph), and there is a Period of Extinguished Right to Collect Insurance Premiums (meaning a period calculated pursuant to the provisions of a Cabinet Order regarding the period for which the right to collect the insurance premium pertaining to said period has been extinguished by prescription; the same applies hereinafter in this paragraph) with regard to an Insured Person Requiring Long-Term Care, etc. who is a Primary Insured Person pertaining to said Certification, the Municipality is to enter on the Certificate of Insured Person of said Insured Person Requiring Long-Term Care, etc., pursuant to the provisions of Order of the Ministry of Health, Labour and Welfare, in addition to the entry pursuant to the provisions of the second sentence of Article 27, paragraph (7) (including a case applied mutatis mutandis pursuant to Article 28, paragraph (4) and Article 29, paragraph (2)), the second sentence of Article 30, paragraph (1) or the second sentence of Article 35, paragraph (4), or the second sentence of Article 32, paragraph (6) (including a case applied mutatis mutandis pursuant to Article 33, paragraph (4) and Article 33-2, paragraph (2)), the second sentence of Article 33-3, paragraph (1) or the second sentence of Article 35, paragraph (2) or the second sentence of paragraph (6) of that Article, as pertaining to said Certification, that the amount of the Long-Term Care Benefit, etc. (excluding payment of an Allowance for In-Home Long-Term Care Service Plan, payment of an Exceptional Allowance for In-Home Long-Term Care Service Plan, payment of an Allowance for Preventive Long-Term Care Service Plan and payment of an Exceptional Allowance for Preventive Long-Term Care Service Plan, payment of an Allowance for High-Cost Long-Term Care Service, payment of an Allowance for High-Cost Medical and Long-Term Care Service Combined, payment of an Allowance for High-Cost Preventive Long-Term Care Service and payment of an Allowance for High-Cost Medical and Preventive Long-Term Care Service Combined, and payment of an Allowance for Long-Term Care Service to a Person Admitted to a Specified Facility, payment of an Exceptional Allowance for Long-Term Care Service to a Person Admitted to a Specified Facility, payment of an Allowance for Preventive Long-Term Care Service to a Person Admitted to a Specified Facility and payment of an Exceptional Allowance for Preventive Long-Term Care Service to a Person Admitted to a Specified Facility) is to be reduced, and that the Allowance for High-Cost Long-Term Care Service, the Allowance for High-Cost Medical and Long-Term Care Service Combined, the Allowance for High-Cost Preventive Long-Term Care Service and the Allowance for High-Cost Medical and Preventive Long-Term Care Service Combined, and the Allowance for Long-Term Care Service to a Person Admitted to a Specified Facility, the Exceptional Allowance for Long-Term Care Service to a Person Admitted to a Specified Facility, the Allowance for Preventive Long-Term Care Service to a Person Admitted to a Specified Facility and the Exceptional Allowance for Preventive Long-Term Care Service to a Person Admitted to a Specified Facility will not be paid, and the period during which these measures are taken (meaning a period determined by the Municipality, as specified by Cabinet Order, according to the Period of Extinguished Right to Collect Insurance Premiums; hereinafter referred to as the "Benefit Reduction Period" in this Article) (hereinafter referred to as "Entry of Benefit Reduction Amount, etc." in this Article); provided, however, that this does not apply when it is found that there is a special circumstance, such as a disaster, specified by Cabinet Order with regard to said Insured Person Requiring Long-Term Care, etc.

A Municipality, when it is determined that an Insured Person Requiring Long-Term Care, etc., that has received an Entry of Benefit Reduction Amount, etc., pursuant to the provisions of the preceding paragraph is subject to a special circumstance as provided by a Cabinet Order as set forth in the proviso of the same paragraph, and when the Benefit Reduction Period expires, is to delete said Entry of Benefit Reduction Amount, etc.

With regard to the Long-Term Care Benefit, etc. listed in the following items pertaining to In-Home Service (including equivalent service; the same applies hereinafter in this Article), Community-Based Service (including equivalent service; the same applies hereinafter in this Article), Facility Service, Preventive Long-Term Care Service (including equivalent service; the same applies hereinafter in this Article), and Community-Based Service for Preventive Long-Term Care (including equivalent service; the same applies hereinafter in this Article) used, and Home Modification carried out, by an Insured Person Requiring Long-Term Care, etc. who has received an Entry of Benefit Reduction Amount, etc. pursuant to the provisions of paragraph (1), from the first day of the month following the month that includes the day on which said entry was received until said Benefit Reduction Period has elapsed, in the case of applying the provisions specified in each of those items (excluding a case when the provisions are applied as replaced pursuant to the provisions of Article 49-2 or Article 59-2), the term "90 percent" in those provisions is deemed to be replaced with "70 percent":

payment of an Allowance for In-Home Long-Term Care Service:Article 41, paragraph (4), item (i) and item (ii), and Article 43, paragraph (1), paragraph (4) and paragraph (6);

payment of an Exceptional Allowance for In-Home Long-Term Care Service:Article 42, paragraph (4) and paragraph (5), item (i) and item (ii), and Article 43, paragraph (1), paragraph (4), and paragraph (6);

payment of an Allowance for Community-Based Long-Term Care Service:each item of Article 42-2, paragraph (2), and Article 43, paragraph (1), paragraph (4) and paragraph (6);

payment of an Exceptional Allowance for Community-Based Long-Term Care Service:Article 42-3, paragraph (2) and Article 43, paragraph (1), paragraph (4), and paragraph (6);

payment of an Allowance for Long-Term Care Facility Service:Article 48, paragraph (2);

payment of an Exceptional Allowance for Long-Term Care Facility Service:Article 49, paragraph (3) and paragraph (4);

payment of an Allowance for Preventive Long-Term Care Service:Article 53, paragraph (2), item (i) and item (ii), and Article 55, paragraph (1), paragraph (4), and paragraph (6);

payment of an Exceptional Allowance for Preventive Long-Term Care Service:Article 54, paragraph (4) and paragraph (5), item (i) and item (ii), and Article 55, paragraph (1), paragraph (4), and paragraph (6);

payment of an Allowance for Community-Based Preventive Service of Long-Term Care:Article 54-2, paragraph (2), item (i) and item (ii), and Article 55, paragraph (1), paragraph (4), and paragraph (6);

payment of an Exceptional Allowance for Community-Based Preventive Service of Long-Term Care:Article 54-3, paragraph (2) and Article 55, paragraph (1), paragraph (4), and paragraph (6);

payment of an Allowance for Purchasing Equipment for In-Home Long-Term Care Covered by Public Aid:Article 44, paragraph (3), paragraph (5), and paragraph (8);

payment of an Allowance for Purchasing Equipment for Preventive Long-Term Care Covered by Public Aid:Article 56, paragraph (3), paragraph (5), and paragraph (8);

payment of an Allowance for Home Modification for In-Home Long-Term Care:Article 45, paragraph (3), paragraph (4) and paragraph (7);

payment of an Allowance for Preventive Long-Term Care Home Modification:Article 57, paragraph (3), paragraph (4) and paragraph (7).

With regard to the Long-Term Care Benefit, etc. listed in the items of the preceding paragraph pertaining to In-Home Service, Community-Based Service, Facility Service, Preventive Long-Term Care Service, and Community-Based Service for Preventive Long-Term Care used, and Home Modification carried out, by an Insured Person Requiring Long-Term Care, etc. who has received an Entry of Benefit Reduction Amount, etc. pursuant to the provisions of paragraph (1), from the first day of the month following the month that includes the day on which said entry was received until said Benefit Reduction Period has elapsed, in the case of applying the provisions specified in each of those items (limited to a case when the provisions are applied as replaced pursuant to the provisions of Article 49-2, paragraph (1) or Article 59-2, paragraph (1)), the term "80 percent" in those provisions applied as replaced pursuant to the provisions of Article 49-2, paragraph (1) or Article 59-2, paragraph (1) is deemed to be replaced with "70 percent".

With regard to the Long-Term Care Benefit, etc. listed in the items of paragraph (3) pertaining to In-Home Service, Community-Based Service, Facility Service, Preventive Long-Term Care Service, and Community-Based Service for Preventive Long-Term Care used, and Home Modification carried out, by an Insured Person Requiring Long-Term Care, etc. who has received an Entry of Benefit Reduction Amount, etc. pursuant to the provisions of paragraph (1), from the first day of the month following the month that includes the day on which said entry was received until said Benefit Reduction Period has elapsed, in the case of applying the provisions specified in each of those items (limited to a case when the provisions are applied as replaced pursuant to the provisions of Article 49-2, paragraph (2) or Article 59-2, paragraph (2)), the term "70 percent" in those provisions applied as replaced pursuant to the provisions of Article 49-2, paragraph (2) or Article 59-2, paragraph (2) is deemed to be replaced with "60 percent".

The provisions of Article 51, paragraph (1), Article 51-2, paragraph (1), Article 51-3, paragraph (1), Article 51-4, paragraph (1), Article 61, paragraph (1), Article 61-2, paragraph (1), Article 61-3, paragraph (1) and Article 61-4, paragraph (1) do not apply to the expenses necessary for In-Home Service, Community-Based Service, Facility Service, Preventive Long-Term Care Service and Community-Based Service for Preventive Long-Term Care received by an Insured Person Requiring Long-Term Care, etc. who has received an Entry of Benefit Reduction Amount, etc. pursuant to the provisions of paragraph (1), from the first day of the month following the month that includes the day on which said entry was received until said Benefit Reduction Period has elapsed.