National Health Insurance Act

In order to promote stable financial management of the national health insurance program provided by prefectures, etc. and wide-area and efficient administration of national health insurance services by the Municipalities within the prefecture, a prefecture is to establish, approximately every six years, a policy on the administration of national health insurance services of the prefecture and the Municipalities within the prefecture (hereinafter referred to as the "prefectural national health insurance management policy").

The prefectural national health insurance management policy is to prescribe the following matters:

the outlook for the expenses required for medical care and for the finances of national health insurance;

matters concerning the standard method of calculating insurance premiums in the Municipalities within the prefecture and the equalization of the level thereof;

matters concerning the proper implementation of the collection of insurance premiums in the Municipalities within the prefecture;

matters concerning the proper implementation of insurance benefits in the Municipalities within the prefecture;

matters that the prefecture finds necessary for promoting optimization of medical expenses in the prefecture, concerning the stable financial management of national health insurance program provided by prefectures, etc. and the promotion of maintaining the health of insured persons;

matters concerning the promotion of wide-area and efficient administration of national health insurance services of the Municipalities within the prefecture.

In the prefectural national health insurance management policy, in addition to the matters prescribed in the preceding paragraph, the matters listed in the following items are, in general, to be specified.

matters concerning coordination with measures concerning health and medical services and welfare services and other related measures;

liaison and coordination among the relevant Municipalities that are necessary for implementing the matters listed in the items of the preceding paragraph (excluding item (i)) and in the preceding item, and other matters that the prefecture finds necessary.

In consideration of the financial condition and outlook of the special accounts for national health insurance of the prefecture and of the Municipalities within the prefecture, and other circumstances, the prefecture is to endeavor to specify, in the prefectural national health insurance management policy that it establishes, the measures necessary to maintain balance in the finances of the special accounts for national health insurance of the Municipalities within the prefecture.

The prefectural national health insurance management policy must be one in which consistency with the prefectural plan for optimization of medical expenses prescribed in Article 9, paragraph (1) of the Act on Assurance of Medical Care for Elderly People is ensured.

Approximately every three years, the prefecture is to endeavor to analyze and evaluate the matters listed in the items of paragraph (2) (including, if the matters listed in the items of paragraph (3) have been specified pursuant to the provisions of that paragraph, those matters), and is to change the prefectural national health insurance management policy of the prefecture when it finds it necessary in order to ensure stable financial management of national health insurance program provided by prefectures, etc., to promote the equalization of the level of insurance premiums of the prefecture, and otherwise to achieve the smooth and reliable implementation of national health insurance services.

When the prefecture is to establish or change the prefectural national health insurance management policy, it must in advance hear the opinions of the Municipalities within the prefecture.

When a prefecture has established or changed the prefectural national health insurance management policy, it shall endeavor to announce the same without delay.

A Municipality is to endeavor to carry out the administration of national health insurance in line with the prefectural national health insurance management policy.

When the prefecture finds it necessary in relation to the preparation of the prefectural national health insurance management policy and the implementation of the measures specified in the prefectural national health insurance management policy, it may request necessary cooperation from the Federation of National Health Insurance Associations and other persons involved.

The prefecture is to calculate, for each fiscal year, as provided by Order of the Ministry of Health, Labour and Welfare, a numerical value representing the standard level of the insurance premium rate for each Municipality within the prefecture (referred to as the "municipal standard insurance premium rate" in paragraph (3)).

The prefecture is to calculate, for each fiscal year, as provided by Order of the Ministry of Health, Labour and Welfare, a numerical value representing the standard level of the insurance premium rate for all Municipalities within the prefecture (referred to as the "prefectural standard insurance premium rate" in the following paragraph).

When the prefecture has calculated the municipal standard insurance premium rate and the prefectural standard insurance premium rate (hereinafter referred to as the "standard insurance premium rate" in this Article), it is to notify the Municipalities within the prefecture of the standard insurance premium rate, as provided by Order of the Ministry of Health, Labour and Welfare.

In the case prescribed in the preceding paragraph, the prefecture is to endeavor to make the standard insurance premium rate public without delay, as provided by Order of the Ministry of Health, Labour and Welfare.