National Health Insurance Act

If a prefecture finds that there is a risk that insurance benefits by a Municipality within the prefecture have been provided in violation of the provisions of this Act or other relevant laws and regulations, or improperly, it may, giving reasons, request that Municipality (including, in a case of entrustment of affairs, the Federation of National Health Insurance Associations or the organization that received the entrustment) to re-examine the insurance benefits by that Municipality.

When a Municipality, or a Federation of National Health Insurance Associations or the organization, receives a request for re-examination under the preceding paragraph (hereinafter referred to as a "request for re-examination"), it must re-examine the insurance benefits relating to that request for re-examination and report the results to the prefectural governor.

A prefecture may recommend to the Municipality concerned that it cancel all or part of the insurance benefits, if, despite the prefecture having made a request for re-examination, that Municipality does not cancel all or part of the insurance benefits relating to the request for re-examination, and the prefecture finds that those insurance benefits were provided in violation of the provisions of this Act or other relevant laws and regulations, or improperly (excluding where the examination based on the request for re-examination was conducted by the National Health Insurance Medical Fees Review Committee prescribed in Article 87, paragraph (1) (including, where a Federation of National Health Insurance Associations has, pursuant to the provisions of Article 45, paragraph (6) or Article 45, paragraph (6) as applied mutatis mutandis pursuant to Article 54-5, paragraph (7), entrusted affairs concerning the review of medical bills or the review of bills for delivery expenses to a corporation designated by the Minister of Health, Labour and Welfare prescribed in Article 45, paragraph (6) (hereinafter referred to as a "Designated Association"), the person who conducts the review of those medical bills or the review of those bills for delivery expenses), or by the Review Committee prescribed in Article 19, paragraph (1) of the Act on the Medical Information Infrastructure and Medical Fee Examination and Payment Organization or the special Review Committee prescribed in Article 24, paragraph (1) of that Act).

In making the recommendation under the provisions of the preceding paragraph, the prefecture must in advance hear the opinion of the Municipality concerned.

When a prefecture has recommended, pursuant to the provisions of paragraph (1) of the preceding Article, that all or part of insurance benefits be canceled, and the Municipality concerned has not complied with the recommendation, the prefecture may, in granting the subsidy for national health insurance benefit expenses, etc., reduce, as provided by Cabinet Order, an amount equivalent to those insurance benefits (limited to the portion pertaining to the recommendation) from the amount of the subsidy for national health insurance benefit expenses, etc.

In order to cover the expenses required for national health insurance services, such as the expenses required for granting subsidies for national health insurance benefit expenses, etc. borne by the special account of the prefecture relating to national health insurance (including the expenses required for paying 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), a prefecture is to collect payments for national health insurance services expenses from the Municipalities within the prefecture each fiscal year (meaning the period from April 1 each year to March 31 of the following year; the same applies hereinafter), by Prefectural Ordinance, as provided by Cabinet Order.

Municipalities must pay the payments for national health insurance services expenses under the preceding paragraph.

A Municipality must collect insurance premiums from the Householder of the household to which an insured person belongs (limited to a Householder who has a domicile within the area of the Municipality) in order to cover the expenses required for paying payments for national health insurance services expenses borne by the special account of the Municipality relating to national health insurance (including the expenses required for paying 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 borne by the special account relating to national health insurance of the prefecture to which the Municipality belongs; the same applies hereinafter), the expenses required for paying the financial stabilization fund contribution and other expenses required for national health insurance services; provided, however, that this does not apply when national health insurance tax is imposed pursuant to the provisions of the Local Tax Act.

A Society shall collect insurance premiums from Society members to be allocated to the cost incurred in providing benefits for medical treatment, etc., the expenses required for the payment of delivery expenses and the lump-sum allowance at childbirth, and other expenses for national health insurance services (including expenses incurred in paying 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 and, in the case of a Society set forth in Article 179 of the Health Insurance Act, including expenses incurred in paying day worker contributions under the provisions of the same Act).

Of the insurance premiums under the provisions of the preceding two paragraphs, those to be allocated to expenses incurred in paying the long-term care payment shall be imposed with respect to insured persons who fall under the category of insured person as set forth in Article 9, item (ii) of the Long-Term Care 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.