Supplementary Provisions

This Act comes into effect as of April 1, 2024; provided, however, that the provisions set forth in the following items come into effect as of the dates specified respectively in those items.

①After the promulgation of this Act, in order to build a sustainable social security system that serves all generations, the government is to promptly examine further reforms to establish a social security system in which benefits and burdens are balanced, in response to changes in economic and social conditions and the needs of Society, and take required measures based on the results.

②The government is to, with a target of five years after the enforcement of this Act, taking into account the conditions of enforcement, etc. of the respective Acts as amended by this Act (referred to as "the respective Acts as amended" in this paragraph), examine the provisions of the respective Acts as amended where it finds it necessary, and take required measures based on the results.

A prefecture is to, by the day before the date of enforcement of this Act (hereinafter referred to as the "Effective Date"), in the same manner as under the provisions of Article 82-2 (excluding paragraphs (6) and (9)) of the National Health Insurance Act as revised by the provisions of Article 4 (excluding the amending provisions set forth in Article 1, items (iv) and (vi) of the Supplementary Provisions; the same applies in paragraph (1) of the following Article), establish the prefectural national health insurance management policy prescribed in paragraph (1) of that Article.

①With respect to the cost required for the provision of benefits for medical treatment and the payment of 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 that are provided on or after the Effective Date to a person who, on the day before the Effective Date, is a retired insured person, etc. (meaning a retired insured person, etc. prescribed in Article 7, paragraph (1) of the Supplementary Provisions of the National Health Insurance Act before amendment by the provisions of Article 4 (referred to as the "National Health Insurance Act Before the Article 4 Amendment" in the following paragraph through paragraph (5)); the same applies hereinafter in this paragraph) (hereinafter referred to as the "cost incurred in providing benefits for medical treatment, etc." in this paragraph), and with respect to the portion claimed on or after the Effective Date of the cost incurred in providing benefits for medical treatment, etc. provided before the Effective Date to a person who was a retired insured person, etc. before the Effective Date, the provisions of Chapter V of the National Health Insurance Act apply by deeming them to be the cost incurred in providing benefits for medical treatment, etc. borne by the prefecture and the Municipality (including special wards) in which those persons have their domicile.

②With respect to the portion claimed on or after the Effective Date of the cost required for the provision of benefits for medical treatment and the payment of 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, transport expenses, dependent medical expenses, dependent medical expenses for home-nursing, dependent transport expenses, high-cost medical expenses and expenses for high-cost medical treatment combined with long-term care that were provided before the Effective Date to a person who was a special retired insured person, etc. (meaning a special retired insured person prescribed in Article 21, paragraph (1) of the Supplementary Provisions of the National Health Insurance Act Before the Article 4 Amendment and that person's dependents) before the Effective Date (hereinafter in this paragraph referred to as the "costs of benefits for medical treatment, etc. for special retired insured persons, etc."), the provisions of Chapter VII of the Health Insurance Act apply by deeming it to be the costs of benefits for medical treatment, etc. for special retired insured persons, etc. borne by the health insurance Society to which those persons belong.

③With regard to the subsidy for medical treatment benefit expenses, etc. (meaning the subsidy for medical treatment benefit expenses, etc. under Article 7, paragraph (1) of the Supplementary Provisions of the National Health Insurance Act Before the Article 4 Amendment) for the prefecture of residence of retired insured persons, etc. (meaning the prefecture of residence of retired insured persons, etc. prescribed in that paragraph; the same applies hereinafter in this paragraph) and the contribution for medical treatment benefit expenses, etc. (meaning the contribution for medical treatment benefit expenses, etc. under Article 10, paragraph (1) of the Supplementary Provisions of the National Health Insurance Act Before the Article 4 Amendment) for an insurer of employee insurance, etc. (meaning an insurer of employee insurance, etc. prescribed in Article 7, paragraph (3) of the Act on Assurance of Medical Care for Elderly People) in fiscal year 2022, as for the retiree medical care operations (meaning the retiree medical care operations prescribed in Article 17 of the Supplementary Provisions of the National Health Insurance Act Before the Article 4 Amendment; the same applies in paragraph (5)) carried out by the Health Insurance Claims Review and Reimbursement Services under the Act on Social Insurance Medical Fee Payment Fund (hereinafter referred to as the "Health Insurance Claims Review and Reimbursement Services") pursuant to the provisions of that Article, the notification given by the prefecture of residence of retired insured persons, etc. pursuant to the provisions of Article 15, paragraph (1) of the Supplementary Provisions of the National Health Insurance Act Before the Article 4 Amendment, and the notification given by a specified health insurance Society (meaning a specified health insurance Society prescribed in Article 3, paragraph (1) of the Supplementary Provisions of the Health Insurance Act) pursuant to the provisions of Article 21, paragraph (2) of the Supplementary Provisions of the National Health Insurance Act Before the Article 4 Amendment, the provisions of Articles 6 through 21 of the Supplementary Provisions of the National Health Insurance Act Before the Article 4 Amendment (including orders under those provisions) remain in force. In this case, necessary technical replacement of terms in applying those provisions and other necessary matters concerning those provisions are specified by Cabinet Order.

④While the Health Insurance Claims Review and Reimbursement Services collects the contributions (meaning the contributions prescribed in Article 10, paragraph (1) of the Supplementary Provisions of the National Health Insurance Act Before the Article 4 Amendment) for fiscal year 2024 pursuant to the provisions of that paragraph that remains in force pursuant to the provisions of the preceding paragraph, the provisions of Article 4-3 of the Supplementary Provisions of the Health Insurance Act before amendment by the provisions of Article 1, the provisions of Article 7 of the Supplementary Provisions of the Mariners Insurance Act before amendment by the provisions of Article 2 (excluding the amending provision set forth in Article 1, item (vi) of the Supplementary Provisions), the provisions of Article 13, paragraph (2) of the Supplementary Provisions of the Act on Assurance of Medical Care for Elderly People before amendment by the provisions of Article 6 (excluding the amending provisions set forth in Article 1, items (i), (iv) and (vi) of the Supplementary Provisions; the same applies in paragraph (6)) (referred to as the "Former Elderly Medical Care Assurance Act" in the following paragraph and paragraph (6)), the provisions of paragraph (25) of the Supplementary Provisions of the Private School Personnel Mutual Aid Association Act before amendment by the provisions of Article 19 of the Supplementary Provisions (excluding the amending provision set forth in Article 1, item (vi) of the Supplementary Provisions), the provisions of Article 11-3 of the Supplementary Provisions of the National Public Officers Mutual Aid Association Act before amendment by the provisions of Article 20 of the Supplementary Provisions (excluding the amending provision set forth in Article 1, item (vi) of the Supplementary Provisions), the provisions of Article 40-3-2 of the Supplementary Provisions of the Local Public Officers, etc. Mutual Aid Association Act before amendment by the provisions of Article 21 of the Supplementary Provisions (excluding the amending provision set forth in Article 1, item (vi) of the Supplementary Provisions), and the provisions of Article 13-2, paragraph (1) of the Supplementary Provisions of the Act on the Promotion and Mutual Aid Corporation for Private Schools of Japan (Act No. 48 of 1997) before amendment by the provisions of Article 22 of the Supplementary Provisions remain in force. In this case, necessary technical replacement of terms in applying those provisions and other necessary matters concerning those provisions are specified by Cabinet Order.

⑤With respect to the rights and obligations that belong, as of April 1, 2025, to the special account pertaining to the retiree medical care operations that is actually subject to the provisions of Article 143 of the Former Elderly Medical Care Assurance Act as applied mutatis mutandis in Article 19 of the Supplementary Provisions of the National Health Insurance Act Before the Article 4 Amendment that remains in force pursuant to the provisions of paragraph (3), they are to, as specified by Cabinet Order, vest as of that day in the special account pertaining to the operations listed in Article 139, paragraph (1), item (i) of the Act on Assurance of Medical Care for Elderly People.

⑥In the case of calculating, in fiscal year 2025, the amount of the finalized young-old payment for an insurer for fiscal year 2023 (meaning an insurer prescribed in Article 7, paragraph (2) of the Act on Assurance of Medical Care for Elderly People; the same applies in Article 9 of the Supplementary Provisions) pursuant to the provisions of Article 39 of the Act on Assurance of Medical Care for Elderly People as revised by the provisions of Article 6 (hereinafter referred to as the "Revised Elderly Medical Care Assurance Act"), the provisions of Article 13, paragraph (2) of the Supplementary Provisions of the Former Elderly Medical Care Assurance Act remain in force. In this case, the phrase "and the National Health Insurance Act" in that paragraph is deemed to be replaced with "and the National Health Insurance Act before amendment by the provisions of Article 4 of the Act Partially Amending the Health Insurance Act, etc. to Establish a Sustainable Social Security System for All Generations (Act No. 31 of 2023)".

Beyond what is provided from Article 3 of the Supplementary Provisions to the preceding Article, any transitional measures (including those concerning penal provisions) necessary for the enforcement of this Act are provided by Cabinet Order.