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 condition 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.

④While the Payment Fund collects the contributions (meaning the contributions prescribed in that paragraph) for fiscal year 2024 pursuant to the provisions of Article 10, paragraph (1) of the Supplementary Provisions of the Pre-Article 4 Amendment National Health Insurance Act that remain 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 fixed 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 amended 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 as it stood before the 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)".

A national plan for the optimization of medical expenses (meaning the national plan for the optimization of medical expenses prescribed in Article 8, paragraph (1) of the Act on Assurance of Medical Care for Elderly People; the same applies hereinafter in this Article) established pursuant to the provisions of Article 8 of the Act on Assurance of Medical Care for Elderly People as it stood before the amendment by the provisions of Article 6 (limited to the amending provisions set forth in that item; the same applies hereinafter in this Article) (referred to as the "item (i) Pre-amendment Elderly Medical Care Assurance Act" in the following Article) before the date of enforcement of the provisions set forth in Article 1, item (i) of the Supplementary Provisions (hereinafter referred to in this Article and the following Article as the "item (i) Effective Date") is deemed, during the period from the item (i) Effective Date until March 31, 2024, to be a national plan for the optimization of medical expenses established pursuant to the provisions of Article 8 of the Act on Assurance of Medical Care for Elderly People as amended by the provisions of Article 6 (referred to as the "item (i) Amended Elderly Medical Care Assurance Act" in the following Article).

A prefectural plan for the optimization of medical expenses (meaning the prefectural plan for the optimization of medical expenses prescribed in Article 9, paragraph (1) of the Act on Assurance of Medical Care for Elderly People; the same applies hereinafter in this Article) established pursuant to the provisions of Article 9 of the item (i) Pre-amendment Elderly Medical Care Assurance Act before the item (i) Effective Date is deemed, during the period from the item (i) Effective Date until March 31, 2024, to be a prefectural plan for the optimization of medical expenses established pursuant to the provisions of Article 9 of the item (i) Amended Elderly Medical Care Assurance Act.

The provisions of Articles 34, 35, 38 and 39 of the Revised Elderly Medical Care Assurance Act apply to the estimated young-old subsidy and fixed young-old subsidy, and the estimated young-old payment and fixed young-old payment, pertaining to Insurers for each fiscal year from fiscal year 2024 or later, and the provisions then in force continue to govern the estimated young-old subsidy and fixed young-old subsidy, and the estimated young-old payment and fixed young-old payment, pertaining to Insurers for each fiscal year of fiscal year 2023 or earlier.

The provisions of Article 93, paragraph (3) of the Revised Elderly Medical Care Assurance Act apply to the amount of the grant to the Payment Fund for each fiscal year from fiscal year 2024 or later, and the provisions then in force continue to govern the amount of the grant to the Payment Fund for each fiscal year of fiscal year 2023 or earlier.

The provisions of Article 100, paragraph (2) of the Revised Elderly Medical Care Assurance Act apply to the contribution rate for the old-old for each fiscal year from fiscal year 2024 or later, and the provisions then in force continue to govern the contribution rate for the old-old for each fiscal year of fiscal year 2023 or earlier.

The Payment Fund may, even before the Effective Date, carry out preparatory acts necessary for the implementation of the operations set forth in Article 139, paragraph (1), item (iii) of the Revised Elderly Medical Care Assurance Act.

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.