National Health Insurance Act

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.