National Health Insurance Act

The date for assessment of insurance premiums collected by Municipalities as set forth in paragraph (1) of the preceding Article shall be the first day of the relevant fiscal year.

Collection of the insurance premiums set forth in Article 76, paragraph (1) by a Municipality must be by means of ordinary collection (meaning that the Municipality collects the insurance premiums by giving payment advice to the Householder pursuant to the provisions of Article 231 of the Local Autonomy Act (Act No. 67 of 1947); hereinafter the same shall apply), except in cases where a means of special collection (meaning that the Municipality has a person who pays the Old Age, etc. Pension Benefit collect the insurance premiums from a Householder who is an insured person receiving said Old Age, etc. Pension Benefit (excluding those prescribed by Cabinet Order) and pay to the Municipality the insurance premiums to be collected; hereinafter the same shall apply) is used.

The Old Age, etc. Pension Benefit as referred to in the preceding paragraph means the Old Age Basic Pension under the National Pension Act (Act No. 141 of 1959) and other benefits which are provided in the form of a pension due to old age, disability or death under the same Act or the Employees' Pension Insurance Act (Act No. 115 of 1954) and which are prescribed by Cabinet Order as well as benefits which are similar to these benefits provided in the form of a pension and are provided in the form of a pension due to old age, retirement, disability or death and which are prescribed by Cabinet Order.

The provisions of Articles 134 through 141-2 of the Long-Term Care Insurance Act shall apply mutatis mutandis to any special collection of insurance premiums implemented pursuant to the provisions of the preceding Article. In such a case, any necessary technical replacement of terms shall be specified by Cabinet Order.

Municipalities and Societies may, pursuant to the provisions of Municipal Ordinance or constitution, reduce insurance premiums or excuse payment or suspend collection thereof with respect to a person subject to special circumstances.

The provisions of Articles 9, 13-2, 20, 20-2 and 20-4 of the Local Tax Act shall apply mutatis mutandis to insurance premiums and other monies to be collected pursuant to the provisions of this Act.

With respect to any person who has become delinquent in the payment of insurance premiums or any other money to be collected pursuant to the provisions of this Act, the Society shall demand payment thereof by designating a due date; provided, however, that this shall not apply if any advanced collection is made pursuant to the provisions of Article 13-2, paragraph (1) of the Local Tax Act as applied mutatis mutandis pursuant to the preceding Article.

When intending to make a demand pursuant to the provisions of the preceding paragraph, the Society must issue a written demand to the person liable for the payment. In this case, the payment due date to be designated in the written demand must be a date at least ten days after the day on which such written demand is issued, except in cases falling under any of the items of paragraph (1) of Article 13-2 of the Local Tax Act.

When demand for payment is made pursuant to the provisions of the preceding paragraph, the Society may collect a delinquent charge pursuant to the provisions of its constitution.

Insurance premiums collected by Municipalities and other monies collected pursuant to the provisions of this Act shall constitute revenue specified by law as set forth in Article 231-3, paragraph (3) of the Local Autonomy Act.

When a person who is liable for payment and has received a demand pursuant to the provisions of Article 79 or notice of advanced collection as a result of falling under any of the items of paragraph (1) of Article 13-2 of the Local Tax Act fails to make, by the designated due date, full payment of the money to be collected, the Society may take action against such person upon the authorization of the prefectural governor or may request the Municipality in which the person liable for payment is domiciled or in which said person's assets are located to take such action.

In cases where the Society takes action pursuant to the provisions of the preceding paragraph, the provisions of the first sentence of paragraph (3) of Article 231-3 and paragraph (11) of the same Article of the Local Autonomy Act shall apply mutatis mutandis.

In cases where the Society requests the Municipality to take action against the relevant person pursuant to the provisions of paragraph (1), said Municipality shall take action against such person pursuant to the same rules as those for insurance premiums collected by such Municipality. In this case, the Society must provide an amount equal to four hundredths of the amount of money so collected to such Municipality.

Statutory lien assigned to insurance premiums and any other money collected by a Society pursuant to the provisions of this Act shall come after national tax and local tax.

A Municipality may entrust its affairs for the collection of insurance premiums by means of ordinary collection to a person designated pursuant to the provisions of Article 243-2, paragraph (1) of the Local Autonomy Act where and only where it is found that such entrustment will contribute to the assurance of income and to the promotion of the convenience of insured persons.

In addition to what is provided for in Article 76 through the preceding Article, the amount of assessment, insurance premium rates, due dates, reduced assessment and other matters concerning the assessment, collection, etc. of insurance premiums shall be prescribed by Prefectural or Municipal Ordinance or the Society's constitution in accordance with the standards specified by Cabinet Order.

A prefecture is to establish a financial stabilization fund in order to stabilize the finances of national health insurance, and to appropriate it to the expenses necessary for the following projects:

projects to lend to a Municipality with a shortfall in premium collection within the prefecture, as provided by Cabinet Order, funds in an amount within the range of an amount calculated as provided by Cabinet Order, taking into consideration the state of collection of insurance premiums in the Municipalities within the prefecture, etc., on the basis of the amount by which the amount of insurance premiums collected subject to fund projects falls short of the amount of insurance premiums required subject to fund projects;

projects to grant, as provided by Cabinet Order, to a Municipality with a shortfall in premium collection within the prefecture for which it is found that there are special circumstances in the amount of insurance premiums collected subject to fund projects falling short of the amount of insurance premiums required subject to fund projects, funds in an amount not exceeding one half of an amount calculated as provided by Cabinet Order, taking into consideration the state of collection of insurance premiums in the Municipalities within the prefecture, etc., on the basis of the amount by which the amount of insurance premiums collected subject to fund projects falls short of the amount of insurance premiums required subject to fund projects.

When the amount of revenue subject to fund projects falls short of the amount of expenses subject to fund projects, a prefecture is, as provided by Cabinet Order, to draw down the financial stabilization fund within the range of an amount calculated as provided by Cabinet Order, taking into consideration the state of insurance benefits provided by the Municipalities within the prefecture, etc., on the basis of that shortfall, and transfer an amount equivalent to that shortfall to the special account of the prefecture relating to national health insurance.

When a prefecture has drawn down the financial stabilization fund pursuant to the provisions of the preceding paragraph, it must, as provided by Cabinet Order, transfer an amount equivalent to the amount drawn down to the financial stabilization fund.

In addition to the case prescribed in paragraph (2), when it is found necessary for ensuring the stable financial management of the national health insurance program provided by prefectures, etc., such as restraining a significant rise in the payments for national health insurance services expenses, taking into consideration the outlook for the expenses required for medical care and the finances of national health insurance, a prefecture may, as provided by Cabinet Order, draw down the financial stabilization fund within the range of an amount calculated as provided by Cabinet Order as the amount required therefor, and transfer it to the special account of the prefecture relating to national health insurance.

In order to fund the financial stabilization fund, a prefecture is to collect financial stabilization fund contributions from the Municipalities within the prefecture, as provided by Cabinet Order.

Municipalities must pay the financial stabilization fund contributions under the preceding paragraph.

A prefecture must, as provided by Cabinet Order, transfer to the financial stabilization fund an amount equivalent to three times the total amount of financial stabilization fund contributions collected from the Municipalities within the prefecture pursuant to the provisions of paragraph (5).

The national government is to bear, as provided by Cabinet Order, an amount equivalent to one-third of the amount transferred by a prefecture pursuant to the provisions of the preceding paragraph.

All income arising from the financial stabilization fund must be appropriated to the financial stabilization fund.

The meanings of the terms listed in the following items, among the terms used in this Article, are as prescribed respectively in those items.

Municipality with a shortfall in premium collection: a Municipality for which the amount of insurance premiums collected subject to fund projects falls short of the amount of insurance premiums required subject to fund projects;

amount of insurance premiums collected subject to fund projects: the amount calculated as provided by Cabinet Order as having been applied to the amount of expenses incurred in paying payments for national health insurance services expenses, the amount of expenses incurred in paying the financial stabilization fund contribution, the amount of expenses incurred in repaying loans from the prefecture under the project set forth in paragraph (1), item (i) (referred to as "financial stabilization fund loans" in the following item) and other amounts of expenses specified by Cabinet Order, out of the amount of insurance premiums collected by a Municipality during the relevant fiscal year;

amount of insurance premiums required subject to fund projects: the amount calculated as provided by Cabinet Order as being applied to the amount of expenses required for paying payments for national health insurance services expenses, the amount of expenses required for paying the financial stabilization fund contribution, the amount of expenses required for repaying financial stabilization fund loans and other amounts of expenses specified by Cabinet Order, out of the amount of insurance premiums that a Municipality needs to collect during the relevant fiscal year;

amount of revenue subject to fund projects: the amount calculated as provided by Cabinet Order as being applied to the total sum of the amount obtained by deducting the amount equivalent to the co-payment relating to the benefits from the amount of costs spent on benefits for medical treatment by the Municipalities within the prefecture and the amount of costs spent on paying expenses for Dietary Treatment for inpatients, Living Support expenses for inpatients, medical expenses combined with treatment outside insurance coverage, medical expenses, medical expenses for home-nursing, special medical expenses, transport expenses, high-cost medical expenses and expenses for high-cost medical treatment combined with long-term care by the Municipalities within the prefecture (referred to as "amount of costs spent on benefits for medical treatment, etc." in the following item), to the amount of expenses incurred in paying the contribution for the special high-cost medical expenses joint project, young-old payments, etc., old-old aid, 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, to the amount of expenses incurred in making the transfer under the provisions of paragraph (3) and the transfer under the provisions of paragraph (7) (referred to as "financial stabilization fund transfer" in the following item), and to other amounts of expenses specified by Cabinet Order, out of the total of the amounts received during the relevant fiscal year in the special account of the prefecture relating to national health insurance (excluding the amount transferred in pursuant to the provisions of paragraph (2));

amount of expenses subject to fund projects: the amount calculated as provided by Cabinet Order as the total of the amount of expenses incurred in granting subsidies for national health insurance benefit expenses, etc. borne during the relevant fiscal year by the special account of the prefecture relating to national health insurance (limited to those pertaining to the amount of costs spent on benefits for medical treatment, etc.), the amount of expenses incurred in paying the contribution for the special high-cost medical expenses joint project, young-old payments, etc., old-old aid, 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, the amount of expenses incurred in making the transfer under the provisions of paragraph (3) and the financial stabilization fund transfer, and other amounts of expenses specified by Cabinet Order.

A Designated Association is to, as provided by Cabinet Order, carry out a project to provide grants to prefectures with respect to the expenses required for extremely high-cost benefits relating to medical services (hereinafter referred to as the "special high-cost medical expenses joint project" in this Article), in order to mitigate the impact of the expenses required for extremely high-cost benefits relating to medical services on the finances of national health insurance.

In order to cover the expenses required for the special high-cost medical expenses joint project, a Designated Association is to collect contributions for the special high-cost medical expenses joint project from prefectures, as provided by Cabinet Order.

A prefecture must pay the contribution for the special high-cost medical expenses joint project under the provisions of the preceding paragraph.

The national government is to bear, for prefectures, a part of the expenses required for paying the contribution for the special high-cost medical expenses joint project under the provisions of paragraph (2) (excluding that pertaining to the expenses required for handling the affairs relating to the special high-cost medical expenses joint project), within the limits of the budget, as provided by Cabinet Order.