National Health Insurance Act

In addition to the amounts to be transferred pursuant to the provisions of Article 72-3, paragraph (1), Article 72-3-2, paragraph (1) and paragraph (1) of the preceding Article, each Municipality must, pursuant to Cabinet Order provisions, transfer from its general fund to the special account of that Municipality for its national health insurance program an amount calculated, pursuant to Cabinet Order provisions, in accordance with the number of persons with small income and by taking into consideration the financial condition of the national health insurance program and other circumstances.

The national government shall, pursuant to Cabinet Order provisions, bear an amount equal to one-half of the amount to be transferred pursuant to the provisions of the preceding paragraph.

Each prefecture shall, pursuant to Cabinet Order provisions, bear an amount equal to one-fourth of the amount to be transferred pursuant to the provisions of paragraph (1).

The national government shall, pursuant to Cabinet Order provisions, bear, for each prefecture, an amount equal to one-third of the costs specified by Cabinet Order out of the costs required for the specified health checkups pursuant to the provisions of Article 20 of the Act on Assurance of Medical Care for Elderly People (referred to simply as "specified health checkup" in Article 82, paragraph (2)) and the specified health guidance pursuant to the provisions of Article 24 of that Act (referred to as "specified health checkup, etc." in Article 82, paragraph (1) and Article 86) conducted by the Municipalities within that prefecture (referred to as the "amount of costs of specified health checkups, etc." in the following paragraph).

Each prefecture must, pursuant to Cabinet Order provisions, transfer from its general fund to the special account of that prefecture for its national health insurance program an amount equal to one-third of the amount of costs of specified health checkups, etc.

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 obtained by multiplying the total sum of the amounts listed in the following by the ratio specified by Cabinet Order within the range of thirteen hundredths to thirty-two hundredths by taking into consideration the financial capability of the Society:

the amount obtained by deducting, from (1) the total sum of: (i) the amount calculated by deducting, from the expenses incurred in providing benefits for medical treatment, the amount of co-payment relating to such benefits; and (ii) the amount of expenses incurred in paying the 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, high-cost medical expenses and expenses for high-cost medical treatment combined with long-term care, (2) an amount calculated pursuant to Cabinet Order provisions as the amount of such portion of said total sum as relating to the Society's Specified Insured Persons (meaning persons who are insured persons covered by such Society as a result of not being eligible as insured persons under the Health Insurance Act upon making the application under item (viii) of paragraph (1) of Article 3 of that Act or upon the approval under the proviso of paragraph (2) of that Article as well as insured persons covered by such Society who belong to the above insured persons' respective families; the same shall apply in (b)) (hereinafter referred to as the "Specified Benefit Amount" in this Article);

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 total sum of the amount obtained by multiplying the Specified Benefit Amount by a specified ratio and the amount obtained by multiplying the Specified Amount of Payment Cost by a specified ratio.

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.

With regard to the application of the provisions of paragraph (1) to a Society which has reduced the ratios for co-payment pursuant to the provisions of Article 43, paragraph (1) or to a Society which has chosen to bear all or part of the amount of the co-payment to be made by all or some of its insured persons, the amount listed in (a) of item (1) of the same paragraph and the Specified Benefit Amount shall be the amount listed in (a) of the same item and the Specified Benefit Amount, respectively, calculated pursuant to Cabinet Order provisions as if the relevant measures to reduce the ratios for co-payment or to bear all or part of the amount of co-payment were not taken.

In cases where providing assistance as set forth in paragraph (1), the national government may, pursuant to Cabinet Order provisions, increase the amount of assistance set forth in the same paragraph by taking into account the financial capability, etc. of the relevant Society.

The total amount by which the amount of assistance may be increased pursuant to the preceding paragraph shall be within the amount equal to 15.4/100 of the total estimated amount of: the amount listed in (a) of item (i) of paragraph (1) and the Specified Benefit Amount (or, where the provisions of paragraph (3) applies to these amounts, the amount calculated by applying the provisions of the same paragraph); and the total sum of the amount listed in (b) of the same item and the Specified Amount of Payment Cost.

When a Society falls under all of the following requirements, the national government may, notwithstanding the provisions of paragraph (1), as provided by Cabinet Order, provide that Society with assistance, with respect to the expenses required for benefits for medical treatment, etc., in the amount of the total sum of the amount obtained by multiplying the total sum of the amount listed in paragraph (1), item (i), (a) and the amount listed in (b) of that item by a ratio specified by Cabinet Order within the range of ten hundredths or more and less than thirteen hundredths in consideration of the financial capability of that Society, and the total sum of the amounts obtained by multiplying each of the Specified Benefit Amount and the Specified Amount of Payment Cost by the specified ratio:

the financial capability of the Society falls under the standards specified by Cabinet Order;

the state of the financial management of the Society falls under the standards specified by Cabinet Order;

the status of efforts to maintain and promote the health of the Society's insured persons, promote the efficient provision of medical care, and other efforts for the optimization of medical expenses, etc. falls under the standards specified by Cabinet Order.

The provisions of paragraphs (2) through (5) apply mutatis mutandis to the case of providing assistance under the provisions of the preceding paragraph. In this case, the phrase "item (ii) of the preceding paragraph" in paragraph (2) is deemed to be replaced with "paragraph (6)" and "thirty-two hundredths" with "thirteen hundredths"; the phrase "the provisions of paragraph (1) to" in paragraph (3) is deemed to be replaced with "the provisions of paragraph (6) to" and "(a) of item (1) of the same paragraph" with "(a) of item (1) of paragraph (1)"; the phrase "paragraph (1)" in paragraph (4) is deemed to be replaced with "paragraph (6)"; and the phrase "the preceding paragraph" in paragraph (5) is deemed to be replaced with "the preceding paragraph as applied mutatis mutandis by replacing terms pursuant to paragraph (7)" and "paragraph (3)" with "paragraph (3) as applied mutatis mutandis by replacing terms pursuant to paragraph (7)".

Part of the expenses required for the payment of delivery expenses and the lump-sum allowance at childbirth (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 54-11, 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 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 grants. In this case, any technical replacement of terms necessary for these provisions shall be specified by Cabinet Order.

In addition to what is provided for in Articles 69, 70 and 72, Article 72-3-2, paragraph (2), Article 72-3-3, paragraph (2), Article 72-4, paragraph (2), Article 72-5, paragraph (1) and Article 73, the national government may, within the limits of its budget, assist with one-third of the expenses for public health nurses and with part of the other expenses for national health insurance services.

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 ensure the smooth and reliable implementation of national health insurance services, including the provision of insurance benefits, and to adjust finances in accordance with the financial condition and other circumstances of the Municipalities within the prefecture, each prefecture shall, pursuant to Cabinet Order provisions, by Prefectural Ordinance, provide subsidies for national health insurance benefit expenses, etc. to the Municipalities within that prefecture with respect 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 required for national health insurance services borne in the special account of each such Municipality for national health insurance.

Efforts are to be made to ensure that the provision of subsidies for national health insurance benefit expenses, etc. under the preceding paragraph is carried out consistently with the prefectural national health insurance management policy.