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[2] Health and Medical Services (1) Health Care Insurance

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[2] Health and Medical Services (1) Health Care Insurance [2] Health and Medical Services (1) Health Care Insurance Health Care Insurance System Overview Outline of Health Care Insurance System (As of June 2015) Number of Insurance benefits Financial resources Insurer subscribers (March 2014) System (as of the Medical care benefits end of March Insured Cash Premium State 2014) Families Co-payment High-cost medical care benefit, Unitary Hospital meal Hospital living benefits rate subsidy 1,000 persons high-cost medical/long-term care system expenses expenses (High-cost medical care benefit system) (Co-payment for (Co-payment for JHIA- • Maximum co-payment meal expenses) living expenses) • Sickness and General employees General Japan Health 35,643 (Persons younger than 70) injury allowance managed (average annual income: over approximately 11.60 10.00% 16.4% of benefit Insurance 20,303 • Lump-sum birth (national Health million yen) • Households with • General (I) expenses, etc. Association 15,340 ¥252,600 + (medical expenses – ¥842,000) x allowance, average) residential tax Per meal Insurance 1% etc. Health Insurance Health (average annual income: between about 7.70 Per meal ¥460 million yen and about 11.60 million yen) ¥260 + Per day ¥167,400 + (medical expenses – ¥558,000) x Society Health ¥320 Different among 29,273 1% Same as above Fixed amount -managed Insurance health (average annual income between about 3.70 • Household (with additional (subsidy from 15,598 million yen and about 7.70 million yen) • General (II) insurance Health Societies exempted from benefits) budget) 13,676 ¥80,100 + (medical expenses – ¥267,000) x 1% Per meal associations Insurance 1,419 (average annual income: under approximately 3.70 residence tax ¥420 million yen) Per meal first 90 + Per day ¥57,600 days ¥320 • Sickness and Per day The insured (exempted from residence tax) ¥210 16.4% of Japan Health 18 ¥35,400 injury allowance Class 1: under Article 3-2 benefit 12 • Household • Lump-sum birth ¥390 Insurance (Persons aged 70 or older but younger than 75) Per meal after 90 expenses, of the Health exempted from allowance, Class 11: Association 6 (More than a certain level of income) days etc. Insurance Act ¥80,100 + (medical fee - ¥267,000) × 1%, residence tax etc. ¥3,230 After reaching outpatient (per person) ¥44,400 ¥160 Per meal compulsory education (General) ¥44,400, outpatient (per person) ¥12,000 ¥210 9.60% Japan Health 127 (Household exempted from residence tax) • Lower income + Per day Seamen's age until age 70 ¥24,600, outpatient (per person) ¥8,000 (sickness household ¥320 Same as above Fixed amount Insurance 58 30% (Especially household with lower income insurance Insurance among household exempted from residence exempted from Association 69 premium rate) tax) residence tax • Lower income Before reaching ¥15,000, outpatient (per person) ¥8,000 Per meal household ¥100 Mutual aid associations aid Mutual National public 20 mutual aid compulsory education • Per-household standard amount exempted from If more than one person younger than 70 pay residence tax − employees associations age ¥21,000 or more in a single month, Per meal 20% per-household standard amount is added to the benefits paid ¥130 + Per day 8,914 Same as above Local public 64 mutual aid • Reduced payment for multiple high-cost medical ¥320 4,491 (with additional − None care employees, etc. associations 4,422 70 or older but younger For persons who have received high-cost care benefits) three times within a twelve-month period, the * Applicable to those than 75 maximum co-payment of the fourth time and up aged 65 or older in Private school 20% (*) will be reduced to: long-term care 1 Corporation (Persons younger than 70) beds − teachers/staffs (30% for persons with (average annual income: over approximately 11.60 million yen) more than a certain ¥140,100 * For patients with (average annual income: between about 7.70 intractable/rare level of income) 41% of Municipalities million yen and about 11.60 million yen) diseases, etc. and ¥93,000 benefit expenses, thus in high need 1,717 (average annual income between about 3.70 etc. Farmers, million yen and about 7.70 million yen) for inpatient self-employed, (*) 10% for those ¥44,400 medical care, the etc. (average annual income: under approximately 3.70 amount of 41% of National Health Insurance (NHI) Insurance Health National NHI associations already turned 70 million yen) years old by the end ¥44,400 co-payment is the benefit expenses, 164 (exempted from residence tax) same as standard etc. Calculated for of March2014 ¥24,600 co-payment for 36,927 each household meal expenses (People aged 70 and over with more than a certain according to the amount of income) benefits ¥44,400 • Lump-sum birth received allowance, Municipalities and ability to • Reduced payment for persons receiving • Funeral 33,973 high-cost medical care for a long period pay expenses Maximum co-payment for patients suffering from Retired persons hemophilia or chronic renal failure requiring under NHI associations dialysis, etc.: ¥10,000 Levy calculation Municipalities formulas differ Employees’ 2,954 (patient younger than 70 with over average annual None 1,717 income of 7.70 million yen, receiving dialysis: among insurers Health ¥20,000) Insurance (Unitary high cost medical/long-term care benefit system) Reduced payment for persons whose total co-payments of health care and long-term care insurances for a year (every year from August to July of the next year) is extremely high. Maximum co-payment is determined carefully according to their income and age. Same as above Same as above, •Funeral Calculated •Premium except for expenses, using the Approx. 10% •Recipients of etc. amount of the •Support [Implementing Maximum co-payment Outpatient (per person) old-age Welfare per capita coverage (Persons with more than a certain amount of rate and bodies] income) Pensions Approx. 40% Wide area ¥80,100 + (medical fee - ¥267,000) × 1% ¥44,400 Per meal income ratio Late-stage 10% •Public unions for the (Multiple high-cost medical care) ¥100 of insured medical care (30% for persons with ¥44,400 funding late-stage 15,436 (General) ¥44,400 ¥12,000 persons system for Approx. 50% medical care more than a certain (Household exempted from residence tax) provided by the elderly level of income) ¥24,600 ¥8,000 (Breakdown system for (Especially household with lower income wide area of public among household exempted from residence unions the elderly tax) funding) 47 ¥15,000 ¥8,000 National : Prefectural : Municipal 4 : 1 : 1 (Note) 1. Insured persons of the late-stage medical care system for the elderly include those aged 75 or older or 65-75 certified as having a specific disability by a wide area union. 2. Persons with a certain amount of income include those with a taxable income of ¥1.45 million(monthly income of ¥280,000 or more) or insured persons belonging to a household aged 70-74 whose total annual income is less than ¥2.10 million after a basic exemption, etc. Those in households of two or more elderly with a taxable income of ¥5.20 million, and those of a singly elderly household with a taxable income of 3.83 million are excluded. Those whose total old proviso income is less than ¥2.10 million are also excluded. Lower income household exempted from residence tax is considered to be those with a pension income of ¥800,000 or less, etc. 28 3. Fixed-rate national subsidy for National Health Insurance shall be at the same level as that for the Japan Health Insurance Association-managed Health Insurance for those exempt from application of Health Insurance and those newly subscribed to the National Health Insurance on and after September 1, 1997. 4. The sums in the breakdown may not equal the total due to rounding. 5. The premium rate of Seamen’s Insurance is the rate after the deduction resulting from the measure to reduce the burden of insurance premiums for insured persons (0.50). 29 Detailed Information 1 Outline of High-Cost Medical Care Benefit System The high-cost medical care benefit system is for use in avoiding co-payments made for medical costs becoming too expensive for family budgets. Under this system, households pay co-payments for medical costs at the reception desks of medical institutions but then get reimbursed by insurers for any amount exceeding the monthly maximum amount. (*1) In case of hospitalization, a benefit in kind system has been introduced in which the monthly payment at the reception desks of medical institutions is limited to the maximum co-payment (*2) In case of outpatient treatment, a benefit in kind system was introduced in April 2012 for use when the monthly payment exceeds the maximum co-payment at the same medical institution The maximum co-payment is set up according to insured persons’ income. (For example) Below 70 years old/annual income: about ¥3.7 million—about ¥7.7 million (co-payment of 30%) (Note) Per-household addition system Even when partial co-payment does not exceed the maximum co-payment in the same medical institution, partial co-payments (those under 70 is ¥21,000) during the same month at multiple medical institutions can be added up. If the added-up sum exceeds the maximum, the high cost medical care system is applied. Detailed Information 2 Response to Benefit in Kind for Outpatient Treatment A method (benefit in kind) of reducing the burden of patients paying high drug costs will be introduced for outpatient treatment in addition to conventional hospital treatment (enforced in April 2012). The method involves that when a patient receives outpatient treatment at the same medical institution and their monthly co-payment exceeds the maximum co-payment the insurer then makes the payment to the medical institution rather than the patient applying for the high-cost medical care benefits and receiving the benefits later, thus ensuring that the patient is only required to pay an amount which is capped at the maximum co-payment.
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