Chapter IX Application for Examination

①A person who is dissatisfied with any action with respect to an insurance benefit (including action in response to a request pursuant to the provisions of Article 9, paragraphs (2) and (4)) or any action with respect to insurance premiums or any other money collected pursuant to the provisions of this Act may file an application for examination with the National Health Insurance Examination Board.

②An application for examination as referred to in the preceding paragraph shall be deemed to be a judicial claim in terms of postponement of the completion and renewal of prescription.

Each prefecture shall have a National Health Insurance Examination Board (hereinafter referred to as an "Examination Board").

①Examination Boards shall be composed of three committee members representing insured persons, three committee members representing Insurers, and three committee members representing the public interest.

②Committee members shall serve on a part-time basis.

①The term of office of committee members shall be three years; provided, however, that the term of office of a substitute committee member shall be the remaining term of said member's predecessor.

②Committee members may be reappointed.

①The Examination Board shall have one chairperson to be elected by the committee members from among the committee members representing the public interest.

②When the chairperson is unable to perform their duties, a person elected in accordance with the provisions of the preceding paragraph shall perform the duties of the chairperson on their behalf.

The Examination Board may not commence proceedings or make any resolution without the attendance of a majority of committee members including one or more committee members representing insured persons, one or more committee members representing Insurers and one or more committee members representing the public interest.

Examination Board decisions shall be made by a majority of the committee members present and, in the case of a tie, the chairman shall reach a verdict on said tie.

①An application for examination must be filed with the Examination Board of the prefecture governing the location of the Municipality or Society which took the relevant action (or, in the case of action taken pursuant to the provisions of Article 80, paragraph (3), the Municipality which took such action).

②When an Examination Board lacks jurisdiction over the matters for which an application for examination has been filed with said Examination Board, it must promptly transfer the case to the Examination Board of the competent jurisdiction and must also notify the person who filed the application for examination of such transfer.

③When a case is transferred, the application for examination shall be deemed to have been filed originally with the Examination Board to which such case is transferred.

An application for examination must be filed in writing or orally within a period of three months from the day following the date that the relevant action was taken, to the applicant's knowledge; provided, however, that this shall not apply if the applicant makes a prima facie showing that an application could not have been filed within such period for a justifiable reason.

When an application for examination has been filed, the Examination Board must, except in the case where it dismisses the application for examination pursuant to Article 24 of the Administrative Complaint Review Act (Act No. 68 of 2014), notify the Municipality or Society that took the original action and other interested persons.

①When the Examination Board finds it necessary to conduct proceedings, it may request a report or an opinion from the person who filed the application for examination or any person concerned, may order any of these persons to appear for inquiry, or may direct a physician or dentist to perform a diagnosis or examination.

②To any person concerned who appeared at the Examination Board or any physician or dentist who performed diagnosis or examination pursuant to the provisions of the preceding paragraph, the prefecture must pay said person's travel expenses, daily expenses and accommodation expenses or remuneration pursuant to Cabinet Order provisions.

In addition to what is provided for in this Chapter and the Administrative Complaint Review Act, necessary particulars concerning the Examination Board and the procedures for filing an application for examination shall be prescribed by Cabinet Order.

No action for revocation of the action set forth in Article 91, paragraph (1) may be filed until a determination has been made on an application for examination of such action.