National Health Insurance Act

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 under the provisions of that Act (hereinafter referred to as "old-old aid, etc."), the physician allowance contributions, etc. under the provisions of the Act on Promotion of Comprehensive Securing of Medical and Long-Term Care in Communities (Act No. 64 of 1989) (hereinafter referred to as "physician allowance contributions, 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")).

In order to stabilize the finances of the national health insurance program provided by prefectures, etc., the national government shall, pursuant to Cabinet Order provisions, bear thirty-two hundredths of the total sum of the amounts listed in the following items for prefectures, with respect to the costs incurred by the Municipalities within each prefecture in providing benefits for medical treatment and paying expenses for Dietary Treatment for inpatients, expenses for Living Support for inpatients, medical expenses combined with treatment outside insurance coverage, medical expenses, medical expenses for home-nursing, special medical expenses, transport expenses, high-cost medical expenses and expenses for high-cost medical treatment combined with long-term care (in Article 73, paragraph (1), Article 75-2, paragraph (1), Article 76, paragraph (2) and Article 104 referred to as "cost incurred in providing benefits for medical treatment, etc.") and the costs incurred by the prefecture in paying the young-old payment under the provisions of the Act on Assurance of Medical Care for Elderly People (hereinafter referred to as "young-old payment"), the old-old aid under the provisions of that Act (hereinafter referred to as "old-old aid"), the physician allowance contribution under the provisions of the Act on Promotion of Comprehensive Securing of Medical and Long-Term Care in Communities (in item (ii) and Article 73 referred to as "physician allowance contribution"), the long-term care payment, the contribution for securing medical care in the early phase of an epidemic and the children and child-rearing support levy:

the amount of expenses incurred in paying the young-old payment, the old-old aid, the physician allowance contribution, the long-term care payment, the contribution for securing medical care in the early phase of an epidemic and the children and child-rearing support levy (or, where there is a young-old subsidy under the provisions of the Act on Assurance of Medical Care for Elderly People (hereinafter referred to as "young-old subsidy"), the amount calculated by deducting such young-old subsidy from such amount of expenses).

The national government may, pursuant to Cabinet Order provisions, provide assistance to each Society in the total sum of the amounts listed in the following items with respect to the cost incurred in providing benefits for medical treatment, etc. and the expenses incurred in paying young-old payments and old-old aid, physician allowance contributions, long-term care payments, contributions for securing medical care in the early phase of an epidemic and children and child-rearing support levies (referred to as "expenses required for benefits for medical treatment, etc." in paragraph (6)):

the amount calculated by deducting, from the amount of expenses incurred in paying young-old payments and old-old aid, physician allowance contributions, long-term care payments, contributions for securing medical care in the early phase of an epidemic and children and child-rearing support levies (or, where any young-old subsidy is payable, the amount calculated by deducting such young-old subsidy from such amount of expenses), the amount calculated pursuant to Cabinet Order provisions as the amount of such portion of said amount of expenses as relating to the Society's Specified Insured Persons (hereinafter referred to as the "Specified Amount of Payment Cost" in this Article);

The specified ratio as referred to in item (ii) of the preceding paragraph shall be a ratio less than thirty-two hundredths, calculated pursuant to Cabinet Order provisions separately for the Specified Benefit Amount and the Specified Amount of Payment Cost by taking into consideration the proportion of assistance provided by the national government with respect to expenses incurred in health insurance services under the Health Insurance Act (including expenses incurred in paying young-old payments and old-old aid, physician allowance contributions, long-term care payments, contributions for securing medical care in the early phase of an epidemic and children and child-rearing support levies) and the financial capability of the Society.

In addition to what is provided for in Article 72-3, paragraph (2), Article 72-3-2, paragraph (3), Article 72-3-3, paragraph (3) and Article 72-4, paragraph (3), a prefectural or municipal government may provide subsidies or loans with respect to expenses incurred in national health insurance services (including expenses incurred in paying young-old payments, etc. and old-old aid, etc., physician allowance contributions, etc., long-term care payments, contribution for securing medical care in the early phase of an epidemic, etc. under the provisions of the Act on the Prevention of Infectious Diseases and Medical Care for Patients with Infectious Diseases (hereinafter referred to as "contribution for securing medical care in the early phase of an epidemic, etc.") and children and child-rearing support levies).

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., physician allowance contributions, 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.

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., physician allowance contributions, 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., physician allowance contributions, 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).

amount of revenue subject to fund projects: the amount calculated as provided by Cabinet Order as being applied to the total sum of the amount obtained by deducting the amount equivalent to the co-payment relating to the benefits from the amount of costs spent on benefits for medical treatment by the Municipalities within the prefecture and the amount of costs spent on paying expenses for Dietary Treatment for inpatients, Living Support expenses for inpatients, medical expenses combined with treatment outside insurance coverage, medical expenses, medical expenses for home-nursing, special medical expenses, transport expenses, delivery expenses, lump-sum allowance at childbirth, high-cost medical expenses and expenses for high-cost medical treatment combined with long-term care by the Municipalities within the prefecture (referred to as "amount of costs spent on benefits for medical treatment, etc." in the following item), to the amount of expenses incurred in paying the contribution for the special high-cost medical expenses joint project, young-old payments, etc., old-old aid, etc., physician allowance contributions, 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, to the amount of expenses incurred in making the transfer under the provisions of paragraph (4) and the transfer under the provisions of paragraph (8) (referred to as "financial stabilization fund transfer" in the following item), and to other amounts of expenses specified by Cabinet Order, out of the total of the amounts received during the relevant fiscal year in the special account of the prefecture relating to national health insurance (excluding the amount transferred in pursuant to the provisions of paragraph (2));

amount of expenses subject to fund projects: the amount calculated as provided by Cabinet Order as the total of the amount of expenses incurred in granting subsidies for national health insurance benefit expenses, etc. borne during the relevant fiscal year by the special account of the prefecture relating to national health insurance (limited to those pertaining to the amount of costs spent on benefits for medical treatment, etc.), the amount of expenses incurred in paying the contribution for the special high-cost medical expenses joint project, young-old payments, etc., old-old aid, etc., physician allowance contributions, 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, the amount of expenses incurred in making the transfer under the provisions of paragraph (4) and the financial stabilization fund transfer, and other amounts of expenses specified by Cabinet Order.