National Health Insurance Act

An insured person belonging to the same household as a Householder who has received the delivery of the document set forth in the preceding paragraph pursuant to the provisions of that paragraph, or who has been provided, by electronic or magnetic means, with the particulars specified by Order of the Ministry of Health, Labour and Welfare set forth in that paragraph, may receive the confirmation under the main clause of Article 36, paragraph (3) (including as applied mutatis mutandis pursuant to Article 52, paragraph (6), Article 52-2, paragraph (3), Article 53, paragraph (4) and Article 54-3, paragraph (7)) or, Article 54-2, paragraph (3) (including as applied mutatis mutandis pursuant to Article 54-3, paragraph (7)) or Article 54-5, paragraph (1) by presenting that document, or those particulars displayed by a method specified by Order of the Ministry of Health, Labour and Welfare.

When an insured person seeks to receive the benefits set forth in paragraph (1), the insured person is to receive confirmation of being an insured person from the health insurance-covered medical institutionHealth Insurance-Covered Medical Institution, etc. of the insured person's choice (meaning the health insurance-covered medical institution or health insurance-covered pharmacy a Health Insurance-Covered Medical Institution (meaning the Health Insurance-Covered Medical Institution prescribed in Article 63, paragraph (3), item (i) of the Health Insurance Act; hereinafter the same applies) or the health insurance-covered pharmacy prescribed in that item; hereinafter the same applies) by electronic eligibility confirmation (meaning that a person seeking to receive medical treatment from a health insurance-covered medical institutionHealth Insurance-Covered Medical Institution, etc., or a person seeking to receive designated home nursing prescribed in Article 54-2, paragraph (1) from a designated home-nursing provider prescribed in that paragraph, or a person seeking to receive delivery care from a delivery-handling medical institution providing services covered by health insurance (meaning the delivery-handling medical institution providing services covered by health insurance prescribed in Article 58, paragraph (3) of the Health Insurance Act; hereinafter the same applies) or a designated birthing center (meaning the designated birthing center prescribed in Article 98-2, paragraph (1), item (i) of the Health Insurance Act; hereinafter the same applies), makes an inquiry to a Municipality or Society about information pertaining to eligibility as an insured person (including information necessary for claims for expenses pertaining to insurance benefits) by a method of transmitting an electronic certificate for user verification (meaning the electronic certificate for user verification prescribed in Article 22, paragraph (1) of the Act on Certification Business of the Japan Agency for Local Authority Information Systems in Relation to Electronic Signatures, etc. (Act No. 153 of 2002)) recorded on an Individual Number Card (meaning the Individual Number Card prescribed in Article 2, paragraph (7) of the Act on the Use of Numbers to Identify a Specific Individual in Administrative Procedures (Act No. 27 of 2013)) or by any other method specified by Order of the Ministry of Health, Labour and Welfare, receives a response from the Municipality or Society by a method using an electronic data processing system or other method using information and communications technology, provides that information to the health insurance-covered medical institutionHealth Insurance-Covered Medical Institution, etc. or, designated home-nursing provider, or delivery-handling medical institution providing services covered by health insurance or designated birthing center, and receives confirmation of being an insured person from that health insurance-covered medical institutionHealth Insurance-Covered Medical Institution, etc. or, designated home-nursing provider, or delivery-handling medical institution providing services covered by health insurance or designated birthing center; hereinafter the same applies) or by any other method specified by Order of the Ministry of Health, Labour and Welfare (hereinafter referred to as "electronic eligibility confirmation, etc."), and then to receive the benefits set forth in paragraph (1); provided, however, that this confirmation is not required if the case falls under a case specified by Order of the Ministry of Health, Labour and Welfare.

Municipalities and Societies pay delivery expenses to the Householder or Society member of the household to which an insured person belongs, for the expenses required for the delivery care, when the insured person has received confirmation of being an insured person by electronic eligibility confirmation, etc. and has received delivery care at a delivery-handling medical institution providing services covered by health insurance or designated birthing center of the insured person's choosing.

The amount of delivery expenses is the amount of expenses calculated for that delivery care in accordance with the rules prescribed by the Minister of Health, Labour and Welfare pursuant to the provisions of Article 98-2, paragraph (2) of the Health Insurance Act.

When an insured person has received delivery care at a delivery-handling medical institution providing services covered by health insurance or designated birthing center, municipalities and Societies may, in place of the Householder or Society member of the household to which that insured person belongs, pay to that delivery-handling medical institution providing services covered by health insurance or designated birthing center the expenses required for the delivery care that the Householder or Society member is to pay to it, to the extent of the amount to be paid to that Householder or Society member as delivery expenses.

When payment has been made under the preceding paragraph, delivery expenses are deemed to have been paid to the Householder or Society member.

A delivery-handling medical institution providing services covered by health insurance or designated birthing center must, when receiving payment for the expenses required for delivery care, issue a receipt to the Householder or Society member who made that payment, as provided by Order of the Ministry of Health, Labour and Welfare.

When a claim has been made by a delivery-handling medical institution providing services covered by health insurance or designated birthing center for the expenses required for delivery care (limited to the amount to be paid to the Householder or Society member as delivery expenses; the same applies in paragraph (8)), municipalities and Societies are to make payment after examining the claim in light of the method of calculating the amount prescribed in paragraph (2), the rules prescribed in paragraphs (1) and (2) of the following Article, and the rules prescribed in Article 40 as applied mutatis mutandis in paragraph (3) of that Article.

The provisions of Article 45, paragraphs (5) through (7) apply mutatis mutandis to the examination and payment under the preceding paragraph. In this case, necessary technical replacement of terms for these provisions is specified by Cabinet Order.

In addition to what is provided for in each of the preceding paragraphs, necessary particulars concerning claims for the expenses required for delivery care by delivery-handling medical institutions providing services covered by health insurance or designated birthing centers are prescribed by Order of the Ministry of Health, Labour and Welfare.

Municipalities and Societies may, as provided by Order of the Ministry of Health, Labour and Welfare, pay an amount that the Municipality or Society determines, on the basis of the amount of expenses calculated in the same manner as the calculation under paragraph (2), as equivalent to the expenses required for that delivery care, when they find it difficult to pay delivery expenses under the provisions of paragraph (1) in the case where an insured person receives delivery care, or when the insured person has received delivery care from a person other than a delivery-handling medical institution providing services covered by health insurance or designated birthing center and the Municipality or Society finds it unavoidable; provided, however, that the amount must not exceed the amount of expenses actually required for that delivery care.

The same applies as in the preceding paragraph where an insured person has received delivery care at a delivery-handling medical institution providing services covered by health insurance or designated birthing center without receiving confirmation of being an insured person by electronic eligibility confirmation, etc., and municipalities and Societies find that the failure to receive that confirmation was due to an emergency or other unavoidable reason.

The rules for cases where a designated birthing center or registered midwife (meaning a registered midwife prescribed in Article 98-4 of the Health Insurance Act; the same applies hereinafter) is in charge of delivery care under a national health insurance program or provides that delivery care are governed by the Order of the Ministry of Health, Labour and Welfare pursuant to the provisions of Article 98-10, paragraph (1) and Article 98-13, paragraph (1) of that Act.

In the case referred to in the preceding paragraph, when it is difficult or is not found appropriate for the Order of the Ministry of Health, Labour and Welfare set forth in that paragraph to govern those rules, those rules are prescribed by Order of the Ministry of Health, Labour and Welfare.

The provisions of Article 40 apply mutatis mutandis to the rules for cases where a delivery-handling medical institution providing services covered by health insurance or a health insurance-covered physician engaged in delivery care at a delivery-handling medical institution providing services covered by health insurance (limited to a physician engaged in delivery care; the same applies in the following Article and Article 54-8) is in charge of delivery care under a national health insurance program or provides that delivery care. In this case, necessary technical replacement of terms is specified by Cabinet Order.

Guidance by the Minister of Health, Labour and Welfare or the prefectural governor must be received by delivery-handling medical institutions providing services covered by health insurance and designated birthing centers, and by the health insurance-covered physicians and registered midwives engaged in delivery care at them, with respect to delivery care under a national health insurance program.

In cases where the guidance set forth in the preceding paragraph is provided, the Minister of Health, Labour and Welfare or the prefectural governor is to, when finding it necessary, have a person(s) with knowledge and experience of delivery care attend such guidance in accordance with the designation by concerned organizations; provided, however, that this does not apply where such concerned organizations make no such designation or where the person(s) so designated fail to attend.

When the Minister of Health, Labour and Welfare or a prefectural governor finds it necessary in relation to delivery care pertaining to delivery expenses, said minister or governor may order a delivery-handling medical institution providing services covered by health insurance or designated birthing center, or any of the persons who were establishers or administrators, health insurance-covered physicians, registered midwives or other employees of a delivery-handling medical institution providing services covered by health insurance or designated birthing center (hereinafter referred to as "Former Establishers, etc." in this paragraph) to make a report or submit or present medical records, birth records or other books and other documents, may request any of the establishers or administrators, health insurance-covered physicians, registered midwives or other employees of a delivery-handling medical institution providing services covered by health insurance or designated birthing center (including Former Establishers, etc.) to appear, or may have personnel question persons involved or inspect any equipment or medical records, birth records, books and other documents or other articles of the delivery-handling medical institution providing services covered by health insurance or designated birthing center.

The provisions of Article 45-2, paragraph (2) and paragraph (2) of the preceding Article apply mutatis mutandis to questions asked or inspections conducted pursuant to the provisions of the preceding paragraph, and the provisions of Article 45-2, paragraph (3) apply mutatis mutandis to the authority under the preceding paragraph, respectively.

When a prefectural governor finds it necessary that a disposition be made pursuant to the provisions of Article 80 or Article 98-15 of the Health Insurance Act with respect to a delivery-handling medical institution providing services covered by health insurance or designated birthing center in relation to delivery care under this Act, or finds it necessary that a disposition be made pursuant to the provisions of Article 81 or Article 98-16 of the Health Insurance Act with respect to a health insurance-covered physician or registered midwife in relation to delivery care under this Act, said governor must notify the Minister of Health, Labour and Welfare thereof, together with the reason therefor.

The manager of a delivery-handling medical institution providing services covered by health insurance or designated birthing center is to, as provided by Order of the Ministry of Health, Labour and Welfare, provide in advance, to an insured person who intends to receive delivery care at that delivery-handling medical institution providing services covered by health insurance or designated birthing center, information specified by the Minister of Health, Labour and Welfare, such as the content and cost of the delivery care pertaining to the payment of delivery expenses and lump-sum allowance at childbirth provided at that delivery-handling medical institution providing services covered by health insurance or designated birthing center.

The provisions of Article 98-4 and Article 98-17, paragraph (1) of the Health Insurance Act apply mutatis mutandis to delivery care under a national health insurance program. In this case, necessary technical replacement of terms for these provisions is specified by Cabinet Order.

Municipalities and Societies pay, to the Householder or Society member of the household to which an insured person belongs, when the insured person has received delivery care under a national health insurance program at a delivery-handling medical institution providing services covered by health insurance or designated birthing center and has given birth, an amount specified by Municipal Ordinance or constitution in accordance with the standards specified by Cabinet Order, as a lump-sum allowance at childbirth.

When an insured person has received delivery care pertaining to delivery expenses under the provisions of Article 54-5, paragraph (1) at a delivery-handling medical institution providing services covered by health insurance or designated birthing center, Municipalities and Societies may, in place of the Householder or Society member of the household to which that insured person belongs, pay to that delivery-handling medical institution providing services covered by health insurance or designated birthing center the lump-sum allowance at childbirth set forth in the preceding paragraph (limited to the amount equivalent to the expenses required for childbirth that the Householder or Society member is to pay to that delivery-handling medical institution providing services covered by health insurance or designated birthing center (excluding the amount equivalent to the amount to be paid pursuant to the provisions of paragraph (3) of that Article; the same applies hereinafter in this paragraph and paragraph (4)); the same applies in the following paragraph and paragraph (6)). In this case, that delivery-handling medical institution providing services covered by health insurance or designated birthing center is to apply that lump-sum allowance to the satisfaction of the claim relating to the expenses required for childbirth that the Householder or Society member of that household is to pay to it.

When the amount of lump-sum allowance at childbirth paid under the preceding paragraph is less than the amount specified by Municipal Ordinance or constitution in accordance with the standards specified by Cabinet Order under paragraph (1), Municipalities and Societies are to pay the difference to the Householder or Society member of the household to which the insured person belongs, as provided by Order of the Ministry of Health, Labour and Welfare.

A delivery-handling medical institution providing services covered by health insurance or designated birthing center must, when receiving payment for the expenses required for childbirth, issue a receipt to the Householder or Society member who made that payment, as provided by Order of the Ministry of Health, Labour and Welfare.

Where an insured person has given birth but is unable to receive payment of lump-sum allowance at childbirth under the provisions of paragraph (1), Municipalities and Societies may, when they find that there are unavoidable circumstances, pay, as provided by Order of the Ministry of Health, Labour and Welfare, as a lump-sum allowance at childbirth, an amount specified by Municipal Ordinance or constitution in accordance with the standards specified by Cabinet Order.

The provisions of Article 45, paragraph (5) apply mutatis mutandis to the payment of lump-sum allowance at childbirth under the provisions of paragraph (2). In this case, the phrase "the examination and payment under the preceding paragraph" in paragraph (5) of that Article is deemed to be replaced with "the payment under the provisions of Article 54-11, paragraph (2)".

In addition to what is provided for in each of the preceding paragraphs, necessary particulars concerning the payment of lump-sum allowance at childbirth are prescribed by Order of the Ministry of Health, Labour and Welfare.

(Coordination with Benefits , etc. Relating to Medical Services Provided by Other Laws and Regulations)

Payment of benefits for medical treatment or expenses for Dietary Treatment for inpatients, expenses for Living Support for inpatients, medical expenses combined with treatment outside insurance coverage, medical expenses for home-nursing, special medical expenses or transportation expenses shall not be made in cases where the insured person is eligible for any benefit relating to medical services pursuant to the provisions of the Health Insurance Act, the Mariners Insurance Act, the National Public Officers Mutual Aid Association Act (including cases where applied mutatis mutandis pursuant to other Acts or where the same rule governs; the same applies in paragraph (5)), the Local Public Officers, etc. Mutual Aid Association Act or the Act on Assurance of Medical Care for Elderly People or where said person is eligible for any benefit corresponding to each of the above benefits pursuant to the provisions of the Long-Term Care Insurance Act, in each case with respect to said person's relevant illness or injury. The same shall apply when such person is eligible for any medical compensation pursuant to the provisions of the Labor Standards Act (Act No. 49 of 1947), any medical compensation benefits, medical treatment benefits for multiple-job workers or medical treatment benefits under the provisions of the Industrial Accident Compensation Insurance Act (Act No. 50 of 1947), any medical compensation under the provisions of the National Public Officers' Accident Compensation Act (Act No. 191 of 1951; including cases where applied mutatis mutandis pursuant to any other Act), any medical compensation under the provisions of the Local Public Officers Accident Compensation Act (Act No. 121 of 1967) or a Prefectural or Municipal Ordinance under the same Act or any other benefit relating to medical services under any law or regulation as prescribed by Cabinet Order, or when any benefit relating to medical care is provided at the expense of the national government or a local government pursuant to any law or regulation other than these laws and regulations.

Payment of delivery expenses (including the amount equivalent to the expenses required for delivery care that is paid under the provisions of Article 54-5, paragraph (9) or (10); the same applies hereinafter, except in Article 75-5, paragraph (1), Article 85-3, paragraph (1), Article 87, Article 89 and Article 121, paragraph (2)) or lump-sum allowance at childbirth (including the difference paid under the provisions of Article 54-11, paragraph (3); the same applies hereinafter, except in Article 85-3, paragraph (1)) is not made in the case where, with respect to that childbirth of an insured person, the insured person is able to receive benefits equivalent to the respective benefits under the provisions of the Health Insurance Act, the Mariners Insurance Act, the National Public Officers Mutual Aid Association Act or the Local Public Officers, etc. Mutual Aid Association Act (limited, with respect to delivery expenses prescribed in Article 98-24, paragraph (1) of the Health Insurance Act or the lump-sum allowance at childbirth prescribed in Article 106, paragraph (1) of that Act, to the case where those benefits have been received). The same applies where benefits equivalent to the respective benefits have been provided at the expense of the national government or a local government under laws and regulations other than these laws and regulations.

Where the benefits under the laws and regulations prescribed in the preceding paragraph are payments of an amount equivalent to delivery expenses or lump-sum allowance at childbirth, and the amount of those payments is less than the amount of delivery expenses or lump-sum allowance at childbirth in the case where delivery expenses or lump-sum allowance at childbirth were to be paid under this Act for that childbirth, Municipalities and Societies must pay the difference to the insured person.

In the case referred to in the preceding paragraph, when an insured person has received the relevant delivery care at a delivery-handling medical institution providing services covered by health insurance or designated birthing center, Municipalities and Societies may, to the extent of the amount to be paid to the insured person under that paragraph, pay to that delivery-handling medical institution providing services covered by health insurance or designated birthing center, in place of the insured person, the expenses required for that childbirth that the insured person is to pay to it.

When expenses have been paid to a delivery-handling medical institution providing services covered by health insurance or designated birthing center under the provisions of the preceding paragraph, payment under the provisions of paragraph (6) is deemed to have been made to the insured person to that extent.

In making any co-payment or in paying any difference or medical expenses pursuant to the provisions of paragraph (3) of Article 43 or paragraph (2) or (6) of the preceding Article, in paying any amount equivalent to the expenses required for delivery care pursuant to the provisions of Article 54-5, paragraph (9) or (10), or in paying lump-sum allowance at childbirth pursuant to the provisions of Article 54-11, paragraph (5), when the relevant illness , injury or injurychildbirth is of an insured person who is not the Householder or Society member, the Householder or Society member of the household to which such insured person belongs shall make, or be obligated to make, co-payment and shall receive payment of the difference or medical expenses pursuant to paragraph (3) of Article 43 or paragraph (2) or (6) of the preceding Article, or the amount equivalent to the expenses required for delivery care pursuant to the provisions of Article 54-5, paragraph (9) or (10), notwithstanding the provisions of the respective Articles pertaining to these matters.

With respect to an insured person's childbirth or death, Municipalities and Societies shall make a childbirth and childcare lump sum payment or pay funeral expenses or grant benefits for funeral services pursuant to the provisions of Municipal Ordinance or constitution; provided, however, that they may refrain from taking all or part of these measures when any special reason exists.

Where a current or former insured person falls under any of the following items, no benefits for medical treatment or benefit for medical expenses for Dietary Treatment for inpatients, Living Support expenses for inpatients, medical expenses combined with treatment outside insurance coverage, medical expenses for home-nursing, special medical expenses or transport expenses (hereinafter referred to as "Benefits for Medical Treatment, etc." in this Section), or delivery expenses or lump-sum allowance at childbirth, shall be provided for the relevant period:

In cases where a Householder or Society member who is eligible for insurance benefits (including the payment of a difference pursuant to the provisions of Article 43, paragraph (3) or Article 56, paragraph (2) or paragraph (6); hereinafter the same shall apply) has become delinquent in the payment of insurance premiums and where said person still fails to pay said insurance premiums during the period until the period specified by Order of the Ministry of Health, Labour and Welfare has elapsed from the due date for payment of said insurance premiums even though the Municipality or Society concerned has carried out encouragement of insurance premium payment, etc., Municipalities and Societies shall temporarily suspend the payment of insurance benefits in whole or in part, as provided by Order of the Ministry of Health, Labour and Welfare, unless a disaster or any other special circumstances specified by Cabinet Order are deemed to exist under which such insurance premiums failed to be paid.

When a health insurance-covered medical institution, etc. or, a designated home-nursing provider , or a delivery-handling medical institution providing services covered by health insurance or designated birthing center receives, by means of deception or other wrongful conduct, any payment of expenses relating to benefits for medical treatment or any payment pursuant to the provisions of Article 52, paragraph (3) (including cases where applied mutatis mutandis pursuant to Article 52-2, paragraph (3) and Article 53, paragraph (4)) or , any payment pursuant to the provisions of Article 54-2, paragraph (5), or any payment pursuant to the provisions of Article 54-5, paragraph (3) or Article 54-11, paragraph (2), Municipalities and Societies may cause saidthat health insurance-covered medical institution, etc. or, that designated home-nursing provider, or that delivery-handling medical institution providing services covered by health insurance or designated birthing center to refund the amount so paid and to pay, in addition, the amount obtained by multiplying the amount to be refunded by forty hundredths.

A prefecture may, upon entrustment from a Municipality, carry out, of the affairs of collecting or receiving the amounts that the Municipality causes a health insurance-covered medical institution, etc. or, designated home-nursing provider, or delivery-handling medical institution providing services covered by health insurance or designated birthing center to refund and to pay pursuant to the provisions of the preceding paragraph, those that require a wide-area response or are highly specialized.

With respect to insurance benefits that a Municipality provides pursuant to the provisions of Article 36, paragraph (1), Article 43, paragraph (3), Article 52, paragraph (1), Article 52-2, paragraph (1), Article 53, paragraph (1), Article 54, paragraphs (1) and (2), Article 54-2, paragraph (1), Article 54-3, paragraphs (1), (2), (5), (8) and (9), Article 54-4, paragraph (1), Article 54-5, paragraphs (1), (9) and (10), Article 54-11, paragraphs (1), (3) and (5), Article 55, paragraph (1), Article 56, paragraphparagraphs (2) and (6), Article 57-2, paragraph (1) and Article 57-3, paragraph (1), the Municipality is to provide them to persons who have a domicile within the area of the Municipality.

Pursuant to Cabinet Order provisions, the national government shall bear the costs incurred by Societies in executing their affairs for national health insurance programs (including affairs concerning the payment of the young-old payments, etc. under the provisions of the Act on Assurance of Medical Care for Elderly People (hereinafter referred to as "young-old payments, etc."), the old-old aid, the contribution for administrative expenses related to the old-old and the contribution for administrative expenses related to childbirth and childcare under the provisions of that Act (hereinafter referred to as "old-old aid, etc."), the payment under the provisions of the Long-Term Care Insurance Act (hereinafter referred to as "long-term care payment"), the contribution for securing medical care in the early phase of an epidemic under the provisions of the Act on the Prevention of Infectious Diseases and Medical Care for Patients with Infectious Diseases (Act No. 114 of 1998) (hereinafter referred to as "contribution for securing medical care in the early phase of an epidemic"), and the children and child-rearing support levy under the provisions of the Act on Support for Children and Child-rearing (Act No. 65 of 2012) (hereinafter referred to as "children and child-rearing support levy")).

Childbirth and Childcare Grants

Part of the expenses required for the payment of delivery expenses and the lump-sum allowance forat childbirth and childcare ((for the expenses required for the payment of the lump-sum allowance at childbirth, limited to the portion relating to the amount specified by Cabinet Order under Article 101 , paragraph (1) of the Health Insurance Act (or, where the amount specified by a Prefectural or Municipal Ordinance or constitution based on Article 5854-11, paragraph (1) is less than the amount specified by Cabinet Order under Article 101 , paragraph (1) of that Act, the amount specified by that Prefectural or Municipal Ordinance or constitution)) and the amount specified by Cabinet Order under Article 101, paragraph (6) of that Act (or, where the amount specified by a Prefectural or Municipal Ordinance or constitution based on Article 54-11, paragraph (5) is less than the amount specified by Cabinet Order under Article 101, paragraph (6) of that Act, the amount specified by that Prefectural or Municipal Ordinance or constitution)) is to be covered, pursuant to Cabinet Order provisions, by the childbirth and childcare grants that the organization provides to prefectures or Societies pursuant to the provisions of Article 124-4, paragraph (1) of the Act on Assurance of Medical Care for Elderly People.

The provisions of Articles 152-3 through 152-5 of the Health Insurance Act and Articles 41 and 42 of the Act on Assurance of Medical Care for Elderly People apply mutatis mutandis to childbirth and childcare grants. In this case, any technical replacement of terms necessary for these provisions shall be specified by Cabinet Order.