Article 69Exception of Insurance Benefit in a Case of Extinction of Right to Collect an Insurance Premium

①When 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.

②A 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.

③With 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":

④With 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".

⑤With 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".

⑥The 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.