[2] Health and Medical Services (1) Health Care Insurance Health Care Insurance System Overview Outline of Health Care Insurance System (As of April 2020) Number of Insurance benefits Financial resources Insurer subscribers (as of the (March 2019) System Medical care benefits end of March Insured Cash Premium State 2019) Families benefits rate subsidy Co-payment High-cost medical care benefit, Unitary high- Hospital meal Hospital living 1,000 persons cost medical/long-term care system expenses expenses (High-cost medical care benefit system) (Co-payment (Co-payment • • Maximum co-payment for meal for living Sickness (Persons younger than 70) expenses) expenses) and injury (average annual income: allowance • • over approximately 11.60 million yen) Households • General (I) (II) (III) Lump-sum 16.4% of General employees employees General JHIA- Japan Health 39,400 10.00% benefit managed Insurance 23,757 ¥252,600 + (medical expenses – ¥842,000) x1% with residential Per meal birth (national expenses, Health Association 15,643 tax Per meal ¥460 allowance, average) (average annual income: etc. Insurance between about 7.70 million yen and about 11.60 ¥460 + Per day etc ¥370 . million yen) • Household Health Insurance Health Insurance ¥167,400 + (medical expenses – ¥558,000) x1% • (average annual income: exempted Household from exempted between about 3.70 million yen and about 7.70 Different residence tax from Fixed Society Health million yen) Same as among 29,539 Per meal first residence tax amount -managed Insurance ¥80,100 + (medical expenses – ¥267,000) x 1% above (with health 16,718 90 days Per meal (subsidy Health Societies (average annual income: ¥210 ¥210 additional insurance 12,821 from Insurance 1,391 under approximately 3.70 million yen) ¥57,600 + Per day benefits) associations budget) (exempted from residence tax) ¥35,400 Per meal after ¥370 90 days • (Persons aged 70 or older but younger than 75) ¥160 Lower income • Sickness (average annual income: household and injury The insured • Per day over approximately 11.60 million yen) Lower exempted from allowance 16.4% of under Article Japan Health 16 Class 1: ¥252,600 + (medical expenses – ¥842,000) x1% income residence tax • Lump-sum benefit 3-2 of the Insurance 11 ¥390 (average annual income: household Per meal birth expenses, Health Association 5 Class 11: between about 7.70 million yen and about 11.60 exempted ¥130 allowance, etc. Insurance Act from • ¥3,230 million yen) Per day etc residence ¥370 ¥167,400 + (medical expenses – ¥558,000) x1% tax Per meal . (average annual income: ¥100 • Applicable to between about 3.70 million yen and about 7.70 9.60% Japan Health 119 those aged 65 or million yen) (sickness Seamen's Insurance 58 older in long-term Same as Fixed ¥80,100 + (medical expenses – ¥267,000) x 1% insurance Insurance Association 61 care beds above amount (average annual income: premium After under approximately 3.70 million yen) ¥57,600 • rate) reaching For patients with outpatient (per person) ¥18,000(¥144,000/year) intractable/rare 20 mutual compulsory National public (Household exempted from residence tax) diseases, etc. − Mutual aid associations associations Mutual aid aid education ¥24,600, outpatient (per person) ¥8,000 employees and thus in high associations age until age (Especially household with lower income among need for 70 household exempted from residence tax) inpatient Same as 30% ¥15,000, outpatient (per person) ¥8,000 medical care, 8,575 above (with Local public 64 mutual aid • the amount of − 4,537 Per-household standard amount additional None employees, etc. associations Before If more than one person younger than 70 pay co-payment is 4,038 benefits) reaching ¥21,000 or more in a single month, per- the same as compulsory household standard amount is added to the standard co- education benefits paid payment for − Private school 1 age • meal expenses teachers/staffs Corporation 20% Reduced payment for multiple high-cost medical care For persons who have received high-cost care 70 or older three times within a twelve-month period, the maximum co-payment of the fourth time and up will 41% of Municipalities but younger benefit than 75 be reduced to: 1,716 (Persons younger than 70) expenses, 20% (average annual income: etc. Farmers, self- (30% for over approximately 11.60 million yen) employed, persons with ～ ¥140,100 (average annual income: 28.4 etc. more than a NHI between about 7.70 million yen and about 47.4% of certain associations 11.60 million yen) benefit amount of 162 ¥93,000 (average annual income: income) expenses, between about 3.70 million yen and about 7.70 etc. million yen) ¥44,000 (average annual income: under approximately 3.70 million yen) ¥44,000 (exempted from residence tax) ¥24,600 Calculated National Health Insurance (NHI) Insurance National Health for each (Persons aged 70 or older but younger than 75) household (average annual income: according 30,256 over approximately 11.60 million yen) to the None ¥140,100 (average annual income: benefits • Lump-sum between about 7.70 million yen and about received Municipalities birth 11.60 million yen) and ability 27,517 allowance, ¥93,000 (average annual income: • to pay between about 3.70 million yen and about 7.70 Funeral NHI million yen) expenses associations Levy Retired ¥44,000 (average annual income: calculation persons under 2,739 Municipalities under approximately 3.70 million yen) ¥44,000 formulas Employees’ differ 1,716 • Reduced payment for persons receiving Health among Insurance high-cost medical care for a long period Maximum co-payment for patients suffering from insurers hemophilia or chronic renal failure requiring dialysis, etc.: ¥10,000 (patient younger than 70 with over average annual income of 7.70 million yen, receiving dialysis: ¥20,000 (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. 28 (average annual income: Same as above Same as above, • Funeral Calculated •About10% over approximately 11.60 million yen) except for expenses using the of benefits, [Implementing ¥252,600 + (medical expenses – ¥842,000) x1% • Recipients of , etc. amount of expenses, bodies] (average annual income: old-age Welfare the per etc. are between about 7.70 million yen and about 11.60 Pensions capita rate borne as million yen) Per meal and insurance ¥167,400 + (medical expenses – ¥558,000) x1% ¥100 income premiums (average annual income: ratio of (Breakdown between about 3.70 million yen and about 7.70 insured of public million yen) persons funding) ¥80,100 + (medical expenses – ¥267,000) x 1% provided National : (average annual income: by wide Prefectures Wide area 10% under approximately 3.70 million yen) ¥57,600 area Municipalities unions for unions (30% for outpatient (per person) ¥18,000(¥144,000/year) 4 : 1 : 1 Medical care medical care persons with (Household exempted from residence tax) system for the system for the ¥24,600, outpatient (per person) ¥8,000 17,718 more than a In addition, elderly aged 75 elderly aged (Especially household with lower income among About10% certain household exempted from residence tax) about 40% and over 75 and over of benefits, amount of ¥15,000, outpatient (per person) ¥8,000 of the income) expenses, benefits 47 • Reduced payment for multiple high-cost medical etc. are will be care borne as borne by (average annual income: insurance the working over approximately 11.60 million yen) ¥140,100 premiums generation (average annual income: as support between about 7.70 million yen and about 11.60 for the million yen) ¥93,000 latter-stage (average annual income: between about 3.70 million yen and about 7.70 elderly. million yen) ¥44,000 (average annual income: under approximately 3.70 million yen) ¥44,000 (Note) 1. Insured persons of medical care system for the elderly aged 75 and over 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 persons whose total amount of gross income, etc. after deducting the basic amount of insured persons belonging to the 70-74 age group households is ¥2.10 million or more. However, those in households of two or more elderly with a taxable income of less than ¥5.20 million, and those of a elderly single-person household with a taxable income of 3.83 million and those with a total old income not more than ¥2.10 million are excluded. Lower income households exempted from residence tax is considered to be those with a pension income of ¥800,000 or less, etc. 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). 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.