National Health Insurance Act

• Membership of the insurance a prefecture runs with its municipalities begins on the day a person comes to have an address in the prefecture, or the day they stop falling under every exclusion in Article 6. It ends the day after they stop having an address there — that same day if on it they come to have an address in another prefecture — or the day after they come under an exclusion, except that receiving public assistance (item 9) or becoming insured by a National Health Insurance Society (item 10) ends it that same day.This is the rule until 31 March 2028.(Art. 7(1), Art. 8(1), Art. 8(2)) (the provisions it rests on)
• Membership of the insurance a prefecture runs with its municipalities begins on the day a person comes to have an address in the prefecture, or the day they stop falling under every exclusion in Article 6. It ends the day after they stop having an address there — that same day if on it they come to have an address in another prefecture — or the day after they come under the exclusion a Ministry of Health, Labour and Welfare Order makes (item 11), but on the very day they come under any other exclusion in Article 6, such as becoming insured under the Health Insurance Act (item 1). Where someone came under items 1 to 8 before this rule took effect, the earlier rule on when membership ends still applies to them.This is the rule from 1 April 2028.(Art. 7(1), Art. 8(1), Art. 8(2), Suppl. Prov. Art. 21(1), Suppl. Prov. Art. 1(1)(v)) (the provisions it rests on)
• Insured persons who are ill or injured receive benefits for medical treatment (療養の給付) — examination, medicine and materials, procedures and surgery, care at home, and hospital stays — from the health insurance-covered medical institution or pharmacy (保険医療機関等) they choose, after it confirms they are insured by electronic eligibility confirmation (電子資格確認) with their Individual Number Card (個人番号カード) or another method a Ministry of Health, Labour and Welfare Order sets, unless the Order excuses it. They pay that institution a co-payment (一部負担金) of 30% of the cost; 20% until the first 31 March after their 6th birthday, and 20% from the month after the month they turn 70, unless the income of the household's insured members past that age (and others a Cabinet Order names), worked out as a Cabinet Order provides, reaches an amount it sets, when it is 30%. Hospital meals are paid for separately, less a standard amount the patient bears, as expenses for inpatient meals (入院時食事療養費) — or, for a patient in a long-term care bed (療養病床) from the month after the month they turned 65, for inpatient living support (入院時生活療養費) — while home-visit nursing (訪問看護療養費, less the co-payment share) and transport to hospital (移送費) are paid only where the municipality or society finds them necessary, as a Ministry of Health, Labour and Welfare Order provides.(Art. 36(1), Art. 36(3), Art. 42(1), Art. 42(1)(i), Art. 42(1)(ii), Art. 42(1)(iii), Art. 42(1)(iv), Art. 36(2)(i), Art. 52(1), Art. 52(2), Art. 52-2(1), Art. 52-2(2), Art. 54-2(1), Art. 54-2(2), Art. 54-2(4), Art. 54-4(1), Art. 54-4(2)) (the provisions it rests on)
• When the co-payments and similar amounts for treatment are extremely high, the head of household or society member is paid high-cost medical expenses (高額療養費), on conditions and in amounts a Cabinet Order sets with regard to the burden on household finances, especially of people in long-term treatment; a further payment (高額介護合算療養費) is made when those amounts together with long-term care service charges are extremely high. A municipality or society may also pay injury and illness benefits (傷病手当金) and other benefits, if its local ordinance (条例) or rules (規約) provide for them.(Art. 57-2(1), Art. 57-2(2), Art. 57-3(1), Art. 58(2)) (the provisions it rests on)
• When an insured person gives birth or dies, the municipality or society pays a childbirth and childcare lump sum payment (出産育児一時金), or funeral expenses (葬祭費) or funeral services (葬祭の給付), as its local ordinance or rules provide, though it may withhold all or part of them for a special reason. This applies until a day a Cabinet Order sets, no later than 4 June 2028, when the rule below replaces it.This is the rule until the change takes effect, 4 June 2028 at the latest.(Art. 58(1), Suppl. Prov. Art. 1(1)(vi)) (the provisions it rests on)
• From a day a Cabinet Order sets, no later than 4 June 2028, when an insured person gives birth with care from an insurance-covered medical institution that handles childbirth (分娩取扱保険医療機関) or a designated midwifery home (指定助産所), the head of household or society member is paid childbirth care expenses (分娩費) — the cost of that care worked out as under the Minister of Health, Labour and Welfare's rule under the Health Insurance Act, where she was confirmed as insured — and a childbirth lump sum (出産時一時金) in an amount the local ordinance or rules set under standards a Cabinet Order gives; where paying childbirth care expenses is hard, or care elsewhere or care without that confirmation was for an emergency or otherwise unavoidable, or the lump sum cannot otherwise be received for an unavoidable reason, the municipality or society may pay an equivalent amount instead. On a death, the municipality or society pays funeral expenses (葬祭費) or provides funeral services (葬祭の給付) as its local ordinance or rules provide, and may withhold them for a special reason. A birth before that day, and for the time being a birth at a special childbirth facility (特例分娩取扱施設), is still covered by the earlier childbirth and childcare lump sum payment (出産育児一時金).This is the rule from a day still to be set, 4 June 2028 at the latest.(Art. 54-5(1), Art. 54-5(2), Art. 54-5(9), Art. 54-5(10), Art. 54-11(1), Art. 54-11(5), Art. 58(1), Suppl. Prov. Art. 1(1)(vi), Suppl. Prov. Art. 22(1), Suppl. Prov. Art. 23(1)) (the provisions it rests on)
• To meet its contribution to the prefecture and its other costs, a municipality must collect premiums (保険料) from the head (世帯主) of each household to which insured persons belong, where the head lives in the municipality — unless it levies a national health insurance tax (国民健康保険税) instead under the Local Tax Act (地方税法), a separate Act that governs that tax. A society collects premiums from its members, and the amounts, rates and due dates are set by local ordinance or the society's rules under standards a Cabinet Order gives. A municipality collects by having the payer of an old-age or other pension a Cabinet Order names collect the premium from a head of household who is insured and receives it, other than heads a Cabinet Order excludes (特別徴収), and otherwise by sending a payment notice (普通徴収).(Art. 76(1), Art. 76(2), Art. 81(1), Art. 76-3(1), Art. 76-3(2)) (the provisions it rests on)

• 1 October 2026

  The text on this site

  Act Partially Amending the Medical Care Act, etc.

  医療法等の一部を改正する法律

  Act No. 87 of 2025The text after this amendment, on e-Gov

• 1 August 2026

  Act Partially Amending the Health Insurance Act, etc.

  健康保険法等の一部を改正する法律

  Act No. 31 of 2026The text after this amendment, on e-Gov

• 5 June 2026

  Act Partially Amending the Health Insurance Act, etc.

  健康保険法等の一部を改正する法律

  Act No. 31 of 2026The text after this amendment, on e-Gov

• 1 April 2026

  Act Partially Amending the Health Insurance Act, etc. to Establish a Sustainable Social Security System for All Generations

  全世代対応型の持続可能な社会保障制度を構築するための健康保険法等の一部を改正する法律

  Act No. 31 of 2023The text after this amendment, on e-Gov

• 1 April 2026

  Act Partially Amending the Act on Support for Children and Child-rearing, etc.

  子ども・子育て支援法等の一部を改正する法律

  Act No. 47 of 2024The text after this amendment, on e-Gov

• 12 December 2025

  Act Partially Amending the Medical Care Act, etc.

  医療法等の一部を改正する法律

  Act No. 87 of 2025The text after this amendment, on e-Gov

• 1 October 2025

  Act Partially Amending the Act on Providing Comprehensive Support for the Daily Life and Life in Society of Persons with Disabilities, etc.

  障害者の日常生活及び社会生活を総合的に支援するための法律等の一部を改正する法律

  Act No. 104 of 2022The text after this amendment, on e-Gov

• 1 June 2025

  Act on the Arrangement of Related Acts upon the Enforcement of the Act Partially Amending the Penal Code, etc.

  刑法等の一部を改正する法律の施行に伴う関係法律の整理等に関する法律

  Act No. 68 of 2022The text after this amendment, on e-Gov

• 1 April 2025

  Act Partially Amending the Health Insurance Act, etc. to Establish a Sustainable Social Security System for All Generations

  全世代対応型の持続可能な社会保障制度を構築するための健康保険法等の一部を改正する法律

  Act No. 31 of 2023The text after this amendment, on e-Gov

• 2 December 2024

  Act Partially Amending the Act on the Use of Numbers to Identify a Specific Individual in Administrative Procedures, etc.

  行政手続における特定の個人を識別するための番号の利用等に関する法律等の一部を改正する法律

  Act No. 48 of 2023The text after this amendment, on e-Gov

All 42 amendments already in force

• A municipality or society may reduce the co-payment, waive it, or collect it directly and defer it, for an insured person with a special reason who is found to have difficulty paying. It may also lower the co-payment rates by local ordinance or rules, as a Cabinet Order provides; patients then pay the lower rate at the medical institutions it fixes with their operators' consent, and are paid the difference where they were treated elsewhere.(Art. 44(1), Art. 43(1), Art. 43(2), Art. 43(3)) (the provisions it rests on)
• A municipality or society may, under its local ordinance or rules, reduce or exempt the premium, or defer its collection, for a person with a special reason.(Art. 77(1)) (the provisions it rests on)
• Where some or all of a household's insured members cannot use electronic eligibility confirmation, the head of household may ask the municipality for a document, or an electronic record, of their eligibility, and a member can show it to be confirmed as insured instead. For the time being, the municipality or society may also issue it on its own initiative where it finds that necessary.(Art. 9(2), Art. 9(3), Suppl. Prov. Art. 15(1), Suppl. Prov. Art. 15(2)) (the provisions it rests on)
• An insured person who lives in one municipality to attend school, and who would otherwise belong to a household living in another, is treated as living in that other municipality and belonging to that household.(Art. 116(1)) (the provisions it rests on)
• An insured person who moved their address by entering a hospital, a clinic or one of the care or welfare facilities Article 116-2 lists is treated as still living in the municipality where they lived before, with its own rule for someone who has moved through more than one, and the facility must cooperate with the municipalities concerned.(Art. 116-2(1), Art. 116-2(2), Art. 116-2(3)) (the provisions it rests on)
• No benefits are given for treating an illness or injury where the person can get medical benefits for it under the Health Insurance Act, the Seaman's Insurance Act, the mutual aid Acts of national or local public servants or the Act on Assurance of Medical Care for Elderly People, or equivalent benefits under the Long-Term Care Insurance Act (介護保険法). The same holds where they can get compensation or benefits for medical treatment under the Labor Standards Act, the Industrial Accident Compensation Insurance Act, the accident compensation Acts for national or local public officers or another law a Cabinet Order names, or where treatment was given at public expense under another law. Where someone else caused the illness or injury, the municipality or society that gives benefits takes over the insured person's claim for damages against them up to the value of the benefits, and need not give benefits up to what that person has already paid in compensation for it.(Art. 56(1), Art. 64(1), Art. 64(2)) (the provisions it rests on)
• No benefits for treatment are given for the period someone is held in a juvenile training school, penal institution, workhouse or similar facility, or for an illness or injury caused by their own intentional crime or brought on intentionally. They may be withheld in whole or part for one caused by fighting, drunkenness or gross misconduct, and in part from someone who without good reason does not follow instructions about their treatment.(Art. 59(1), Art. 60(1), Art. 61(1), Art. 62(1)) (the provisions it rests on)
• Where an insured person is treated at an insurance-covered institution without being confirmed as insured, and the municipality or society finds that was for an emergency or other unavoidable reason, it pays medical treatment expenses (療養費) in place of the benefit; it may also pay them where it finds the benefit hard to give, or where treatment from a provider outside the scheme was unavoidable.(Art. 54(1), Art. 54(2)) (the provisions it rests on)

• If a head of household or society member still does not pay a premium — including, where the municipality levies it instead, the national health insurance tax (国民健康保険税) — by the end of a period a Ministry of Health, Labour and Welfare Order sets after the due date, despite the municipality's or society's reminders and offers of consultation, then — unless a disaster or other special circumstance a Cabinet Order names explains it — household members who are treated no longer receive benefits for medical treatment, and the head is instead paid special medical expenses (特別療養費), the cost less the co-payment share, after being told in advance. This may be done before that period ends too, and it does not reach children up to the first 31 March after their 18th birthday or people who can receive general medical expenses as atomic bomb survivors (原子爆弾被爆者) or other medical benefits a Ministry of Health, Labour and Welfare Order names. Ordinary benefits return once the arrears are paid in full, or a marked fall in them or another special circumstance a Cabinet Order names is found.(Art. 54-3(1), Art. 54-3(2), Art. 54-3(3), Art. 54-3, Art. 4(3)) (the provisions it rests on)
• Under the same conditions a municipality or society must suspend, in whole or in part, the payment of insurance benefits due to a head of household or member in arrears with a premium, the national health insurance tax included, and may do so before that period ends. Where special medical expenses already apply and the arrears are still unpaid, it may, after notice, deduct the unpaid premiums from the benefits it is holding back.(Art. 63-2(1), Art. 63-2(2), Art. 63-2(3), Art. 4(3)) (the provisions it rests on)
• Premiums and other money a municipality collects under the Act are, under the heading disposition for delinquency (滞納処分), revenues of the kind Article 231-3(3) of the Local Autonomy Act (地方自治法) names, and that separate Act governs how they are collected. A society must send a demand for payment (督促) with a deadline usually at least 10 days after it is sent, may charge a delinquency charge (延滞金) under its rules, and if payment is still not made may, with the prefectural governor's authorization, carry out the disposition itself or ask the municipality to do it. The right to collect premiums, like the right to receive benefits, lapses two years after it could first be exercised, but a notice of collection or a demand for payment starts that period again.(Art. 79-2(1), Art. 79(1), Art. 79(2), Art. 79(3), Art. 80(1), Art. 110(1), Art. 110(2)) (the provisions it rests on)
• A municipality or society may recover all or part of a benefit someone obtained by deception or other wrongful means, and from a medical institution or pharmacy paid that way, the amount paid plus 40% of it. A municipality may provide in its local ordinance for a non-criminal fine (過料) of up to 100,000 yen for failing to notify or notifying falsely, or for a head of household, past or present, who without good reason does not produce documents when ordered, or does not answer or answers falsely when questioned, and of up to five times the amount evaded for evading premiums by deception; a society may set the same in its rules as a penalty charge (過怠金).(Art. 65(1), Art. 65(3), Art. 127(1), Art. 127(2), Art. 127(3), Art. 128(1)) (the provisions it rests on)
• The penalty chapter (Chapter 12) punishes an insurer's officers and staff, past or present, who without good reason leak secrets learned in the work, with up to one year's imprisonment (拘禁刑) or a fine of up to 1,000,000 yen, and does the same to members of the medical fee review committees (審査委員会) and examination boards (審査会) and to officers and staff of the Federations of National Health Insurance Associations (国民健康保険団体連合会). An insured person, past or present, who without good reason disobeys an order of the Minister of Health, Labour and Welfare or a prefectural governor to report on the treatment received, or does not answer or answers falsely when questioned, faces a fine of up to 300,000 yen, as does anyone other than the applicant or a party notified who without good reason disobeys an examination board's order to appear, state, report or examine, or states or reports falsely. A doctor, dentist, pharmacist or other person who gave the care, or their employer, who without good reason disobeys the Minister's or governor's order to report or show records about it, or does not answer or answers falsely, faces a non-criminal fine (過料) of up to 100,000 yen.(Chapter 12, Art. 120-2(1), Art. 121(1), Art. 123(1), Art. 114(2), Art. 122(1), Art. 101(1), Art. 114(1), Art. 124(1)) (the provisions it rests on)
• A person dissatisfied with a decision on insurance benefits, or on premiums or other money collected under the Act, may file an application for examination (審査請求) with the National Health Insurance Examination Board (国民健康保険審査会) of the prefecture where the municipality or society that decided is located, in writing or orally, within three months from the day after they learned of the decision, unless they show good reason for missing it. A court action to revoke the decision can be brought only after the board has decided.(Art. 91(1), Art. 92(1), Art. 98(1), Art. 99(1), Art. 103(1)) (the provisions it rests on)
• A municipality or society may order a head of household or member, current or former, to produce documents and have its staff question them about membership, benefits and premiums, and may order an insured person to produce documents or be questioned or medically examined; it may withhold benefits for treatment in whole or part from someone who refuses without good reason. For membership, benefits and premiums a municipality may also ask public offices for documents or information, and ask banks, trust companies, an insured person's employer and others to report, on matters including the assets and income of insured persons and the head of household. Health insurance-covered medical institutions and pharmacies must accept guidance from the Minister of Health, Labour and Welfare or the prefectural governor, either of whom may, where needed in connection with benefits for treatment, order reports and have staff question people and inspect premises and records.(Art. 113(1), Art. 66(1), Art. 63(1), Art. 113-2(1), Art. 41(1), Art. 45-2(1)) (the provisions it rests on)
• A premium cannot be assessed once two years have passed from the day after that year's first premium due date, or from the day after it could first be levied if that is later; a decision lowering a premium, because overlap with employee health insurance or another scheme came to light afterwards through no fault of the insured person, may still be made for as long as the adjustment needs.(Art. 110-2(1), Art. 110-2(2)) (the provisions it rests on)