National Health Insurance Act

Prefectures or Municipalities, or Societies may establish a Federation of National Health Insurance Associations (hereinafter referred to as a "Federation") in order to jointly achieve their purposes.

A Federation shall be a corporation.

A Federation shall use the characters "国民健康保険団体連合会" (pronounced "kokumin kenko hoken dantai rengo kai" (literally meaning "federation of national health insurance associations")) in its name.

No person other than a Federation may use the name "kokumin kenko hoken dantai rengo kai" or any name similar thereto.

Establishment of a Federation is subject to the authorization of the prefectural governor governing the prefecture whose area includes the district of such Federation.

A Federation shall be incorporated at the time of authorization of its establishment.

When the membership of a Federation whose district covers the area of a prefecture has reached two-thirds or more of the prefectures, Municipalities and Societies within such district, all other prefectures, Municipalities and Societies within such district shall automatically become members of such Federation.

The constitution of a Federation must state the particulars listed in the following items:

services;

name;

location of the office;

district of the Federation;

particulars pertaining to the joining and withdrawal of members;

particulars pertaining to the sharing of expenses;

particulars pertaining to carrying out business and accounting;

particulars pertaining to officers;

particulars pertaining to general meetings or the board of representatives;

particulars pertaining to reserves and other assets;

means for giving public notice;

in addition to the particulars listed in the preceding items, particulars specified by Ordinance of the Ministry of Health, Labour and Welfare.

A Federation must endeavor to improve the health and medical care of the people and promote their welfare through ensuring fairness and neutrality in the review of medical bills, to improve the health and medical care of the people, promote their welfare and achieve optimization of medical expenses through analysis, etc. of medical bill information, etc. (meaning the operations prescribed in paragraph (3) of the following Article), to promote greater efficiency of business operation through the use of information and communications technology, and to ensure transparency in business operation, and must also endeavor, so as to contribute to the stable and efficient administration of the medical insurance system, to provide support contributing to the proper claiming of medical fees and to undertake other initiatives, in organic cooperation with the organization.

A Federation conducts the operations of examination and payment, performed as entrusted by Municipalities and Societies pursuant to the provisions of Article 45, paragraph (5) (including as applied mutatis mutandis pursuant to Article 52, paragraph (6), Article 52-2, paragraph (3), Article 53, paragraph (4) and Article 54-2, paragraph (12)), concerning claims for the expenses required for benefits for medical treatment and for expenses for Dietary Treatment for inpatients, expenses for Living Support for inpatients, medical expenses combined with treatment outside insurance coverage and medical expenses for home-nursing.

In addition to the operations prescribed in the preceding paragraph, a Federation may conduct the operations listed in the following items in order to contribute to the smooth administration of national health insurance services.

affairs, performed as entrusted by Municipalities and Societies pursuant to the provisions of Article 58, paragraph (3), of payment of the insurance benefits under paragraph (1) of that Article and the injury and sickness allowances under paragraph (2) of that Article;

affairs of collection or receipt of compensation for damages from third parties, performed pursuant to the provisions of Article 64, paragraph (4) as entrusted by Municipalities and Societies and by prefectures that perform the affairs under paragraph (3) of that Article as entrusted by Municipalities;

operations incidental to the operations in the preceding two items.

projects, other than those listed in the preceding three items, that contribute to the smooth administration of national health insurance services.

In addition to the operations prescribed in the preceding two paragraphs, a Federation may conduct operations concerning the collection, organization and analysis of information pertaining to records of medical bills and specified health checkups, etc. (meaning the specified health checkups, etc. prescribed in Article 18, paragraph (2), item (i) of the Act on Assurance of Medical Care for Elderly People) and other information that contributes to the improvement of the health and medical care of the people, the promotion of their welfare and optimization of medical expenses, and concerning the promotion of the use of the results thereof.

In addition to the operations that a Federation is to conduct under the provisions of this Act and other laws and regulations, a Federation may conduct the operations listed in the following items to the extent that they do not hinder the performance of those operations.

health, medical care and welfare operations performed as entrusted by the national government, prefectures, Municipalities, corporations or other organizations;

operations incidental to the operations in the preceding item.

The provisions of Article 16, Articles 23 through 25, Article 26, paragraph (1), Articles 27 through 35 and Article 82 (excluding those relating to specified health checkups, etc. and paragraphs (5) through (8), paragraph (13) and paragraph (14) of that Article) apply mutatis mutandis to a Federation. In this case, the terms "Society member" and "Society members" in these provisions are deemed to be replaced with "person representing a prefecture or Municipality, or a Society, that is a member" and "persons representing prefectures or Municipalities, or Societies, that are members," respectively; the term "Society meeting" in these provisions is deemed to be replaced with "general meeting or the board of representatives"; the terms "Society council member" and "Society council members" in these provisions are deemed to be replaced with "member of a general meeting or board of representatives" and "members of a general meeting or board of representatives," respectively; the term "insured persons" in Article 82, paragraph (2) is deemed to be replaced with "prefectures or Municipalities, or Societies, or insured persons"; the term "又は" (or) in that paragraph is deemed to be replaced with "若しくは" (or, joining a smaller group of alternatives); the term "that Act" in that paragraph is deemed to be replaced with "medical insurance-related information (meaning the medical insurance-related information prescribed in Article 16, paragraph (1) of the Act on Assurance of Medical Care for Elderly People; the same applies in the following paragraph and paragraph (4)) retained by the relevant prefecture or Municipality, or Society, respectively, or the Industrial Safety and Health Act"; the term "Industrial Safety and Health Act" in Article 82, paragraph (3) is deemed to be replaced with "prefecture or Municipality, or Society, that was requested to provide medical insurance-related information, or the Industrial Safety and Health Act"; the term "the relevant" in that paragraph is deemed to be replaced with "the relevant medical insurance-related information or the relevant"; and the phrase "prescribed in Article 16, paragraph (1) of the Act on Assurance of Medical Care for Elderly People" in Article 82, paragraph (4) is deemed to be replaced with "provided by prefectures or Municipalities, or Societies".