Supplementary Provisions

This Act comes into effect on April 1, 2018; provided, however, that the provisions set forth in the following items come into effect as of the days specified respectively in those items.

①After the promulgation of this Act, from the perspective of building a sustainable medical insurance system, the government is to conduct a review of optimizing the costs required for medical care, the scope of insurance benefits of medical insurance, and how the costs required for medical care are to be shared in accordance with the ability of subscribers, etc. to bear costs, and to take necessary measures based on the results.

②After this Act comes into effect, the government, while verifying the state of operation of national health insurance services, including the factors behind the increase in the costs required for medical care under national health insurance, the efforts of the national government, prefectures and Municipalities toward optimizing those costs, and the efforts of prefectures and Municipalities toward the standardization and greater efficiency of national health insurance services, is to work to further promote those efforts, and, from the perspective of ensuring the sustainable operation of national health insurance, in light also of the state of promotion of those efforts, including how the roles of prefectures and Municipalities are to be divided, is to conduct a review of national health insurance as a whole while paying attention to fairness among medical insurance systems, and to take necessary measures based on the results.

A National Health Insurance Society that, at the time of enforcement of the provisions listed in Article 1, item (iii) of the Supplementary Provisions, is specified by the Minister of Health, Labour and Welfare pursuant to Article 10, paragraph (3) of the Supplementary Provisions of the National Health Insurance Act prior to the amendment by the provisions of Article 3 (hereinafter referred to as the "National Health Insurance Act Before the item (iii) Amendment") is deemed to be a National Health Insurance Society specified by the Minister of Health, Labour and Welfare pursuant to Article 7, paragraph (3) of the Act on Assurance of Medical Care for Elderly People as amended by the provisions of Article 10 (hereinafter referred to as the "item (iii) Amended Elderly Medical Care Assurance Act").

①The provisions of Articles 10, 12, 13 and 21 of the Supplementary Provisions of the National Health Insurance Act as amended by the provisions of Article 3 apply to the estimated contributions for medical treatment benefit expenses, etc. and the finalized contributions for medical treatment benefit expenses, etc. for insurers of employee insurance, etc. (meaning the insurers of employee insurance, etc. prescribed in Article 7, paragraph (3) of the item (iii) Amended Elderly Medical Care Assurance Act) for each of fiscal year 2017 and subsequent fiscal years, and the provisions then in force continue to govern the estimated contributions for medical treatment benefit expenses, etc. and the finalized contributions for medical treatment benefit expenses, etc. for insurers of employee insurance, etc. (meaning the insurers of employee insurance, etc. prescribed in Article 10, paragraph (1) of the Supplementary Provisions of the National Health Insurance Act Before the item (iii) Amendment, and excluding the health insurance Societies prescribed in Article 3, paragraph (1) of the Supplementary Provisions of the Health Insurance Act (referred to as "specified health insurance Societies" in the following paragraph)) for each of fiscal year 2016 and earlier fiscal years.

②The provisions then in force continue to govern the estimated contributions for medical treatment benefit expenses, etc. and the finalized contributions for medical treatment benefit expenses, etc. concerning specified health insurance Societies for each of fiscal year 2014 and earlier fiscal years.

The council for the administration of national health insurance that, at the time of enforcement of this Act, has been established in a Municipality (including special wards; the same applies hereinafter) pursuant to Article 11, paragraph (1) of the National Health Insurance Act prior to the amendment by the provisions of Article 4 (hereinafter referred to as the "National Health Insurance Act Before the 2018 Amendment") is deemed to be the council for the administration of the national health insurance services of the Municipality established pursuant to Article 11, paragraph (2) of the National Health Insurance Act as amended by the provisions of Article 4 (hereinafter referred to as the "National Health Insurance Act as Amended in 2018").

①A prefecture may establish a financial stabilization fund even before the date of enforcement of this Act (hereinafter referred to as the "Effective Date"), in accordance with the provisions of Article 81-2, paragraph (1) of the National Health Insurance Act as Amended in 2018.

②Where a prefecture has established a financial stabilization fund pursuant to the preceding paragraph, the prefecture is not to be able to use the fund to cover the expenses necessary for the projects listed in the items of Article 81-2, paragraph (1) of the National Health Insurance Act as Amended in 2018 until the day before the Effective Date.

③The national government may, for the time being, within the scope of the budget, subsidize a prefecture for the funds necessary to be appropriated to the financial resources of the financial stabilization fund prescribed in Article 81-2 of the National Health Insurance Act as Amended in 2018 (including a fund established pursuant to paragraph (1)).

A prefecture is to establish, by the day before the Effective Date, the prefectural national health insurance management policy prescribed in paragraph (1) of that Article, in accordance with the provisions of Article 82-2 of the National Health Insurance Act as Amended in 2018 (excluding paragraph (8)).

A prefecture is to calculate, by the day before the Effective Date, the standard insurance premium rate prescribed in paragraph (3) of that Article for fiscal year 2018, in accordance with the provisions of Article 82-3 of the National Health Insurance Act as Amended in 2018.

Beyond what is provided for in Article 5 through the preceding Article of the Supplementary Provisions, the enactment or amendment of Prefectural or Municipal Ordinances and other acts necessary for the enforcement of the National Health Insurance Act as Amended in 2018 may be carried out even before the Effective Date.

Applications, notifications and other acts that, at the time of enforcement of this Act, have been made to a prefecture or Municipality pursuant to the provisions of the National Health Insurance Act Before the 2018 Amendment (including orders based on it) are deemed, for the purpose of the application of the National Health Insurance Act as Amended in 2018 (including orders based on it; the same applies hereinafter in this Article) on or after the Effective Date, to be applications, notifications and other acts made to a prefecture or Municipality pursuant to the corresponding provisions of the National Health Insurance Act as Amended in 2018.

①The provisions of the National Health Insurance Act as Amended in 2018 apply to medical treatment provided on or after the Effective Date, and the provisions then in force continue to govern medical treatment provided before the Effective Date.

②With regard to, among the insurance benefits provided by Municipalities pursuant to the provisions of the National Health Insurance Act Before the 2018 Amendment, the expenses required for benefits for medical treatment claimed on or after the Effective Date and the expenses required for the payment of insurance benefits (excluding benefits for medical treatment) paid on or after the Effective Date, the provisions of Chapter V of the National Health Insurance Act as Amended in 2018 apply, deeming them to be expenses required for insurance benefits provided by Municipalities pursuant to the provisions of the National Health Insurance Act as Amended in 2018.

The provisions of Article 76 of the National Health Insurance Act as Amended in 2018 apply to national health insurance premiums for fiscal year 2018 and subsequent fiscal years, and the provisions then in force continue to govern those premiums for fiscal year 2017 and earlier fiscal years.

A person who, at the time of enforcement of this Act, is subject to the provisions of Article 116 or Article 116-2, paragraph (1) or (2) of the National Health Insurance Act Before the 2018 Amendment, or Article 5-2, paragraph (1) or (2) of the Supplementary Provisions of that Act, is deemed to be a person subject to the provisions of Article 116 or Article 116-2, paragraph (1) or (2) of the National Health Insurance Act as Amended in 2018, or Article 5-2, paragraph (1) or (2) of the Supplementary Provisions of that Act.

①The provisions then in force continue to govern the subsidy for medical treatment benefit expenses, etc. concerning the Municipality to which retired insured persons, etc. belong (meaning the Municipality to which retired insured persons, etc. belong prescribed in Article 7, paragraph (1) of the Supplementary Provisions of the National Health Insurance Act Before the 2018 Amendment) for each of fiscal year 2017 and earlier fiscal years.

②The provisions then in force continue to govern the estimated contributions for medical treatment benefit expenses, etc. and the finalized contributions for medical treatment benefit expenses, etc. concerning insurers of employee insurance, etc. (meaning the insurers of employee insurance, etc. prescribed in Article 7, paragraph (3) of the Act on Assurance of Medical Care for Elderly People) for each of fiscal year 2017 and earlier fiscal years.

With regard to the application of penal provisions to conduct engaged in before this Act (or, for the provisions set forth in the items of Article 1 of the Supplementary Provisions, those respective provisions; the same applies hereinafter in this Article) comes into effect and to conduct engaged in after this Act comes into effect in the case where the provisions then in force are to remain applicable pursuant to the provisions of these Supplementary Provisions, the provisions then in force continue to govern.

Beyond what is provided for in these Supplementary Provisions, transitional measures necessary in connection with the enforcement of this Act (including transitional measures concerning penal provisions) are specified by Cabinet Order.