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National Health Insurance


About National Health Insurance

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National Health Insurance(NHI) is one of the two major types of insurance programs available in Japan. The other is Employees’ Health Insurance. NHI is designed for people who are not eligible to be members of any employment-based health insurance program. Although private insurance is also available, all Japanese citizens, permanent residents, and any non-Japanese residing in Japan with a visa lasting three months or longer are required to be enrolled in either NHI or Employees’ Health Insurance.  Thus, in Japan, anyone can join the NHI  program operated by municipalities throughout the nation, which is the base of Japan’s social security system.

NHI covers approximately 70 percent of medical expenses.  In case, patients fall sick or are hospitalized, all medical insurance schemes can be granted at their requests. In principle, the insured person only have to pay 30 percent of their medical costs. If they have no NHI cards, they are responsible for the total fee charged by the medical facility.  Residents enter the national insurance scheme through their local government office.  However, they must have knowledge of the limits of NHI.

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NHI premiums

There are three types of NHI premiums. The head of household is responsible for payment, even if they are not a NHI member. The rate at which the premiums are calculated is based on the Resident’s tax amount charged by the local municipal government.

Category 1 – The basic premium (for regular NHI members.)

Calculated by multiplying the total residents tax paid by all NHI members in the household by 0.80. This is the income levy. Then multiplying the number of insured household members by 31,200. This is the per capita levy. These two levies added together are the annual premium that must be paid. The maximum possible is 500,000 per year.

Category 2 – The premium for supporting the elderly (for people older than 75.)

Calculated by multiplying the total residents tax paid by all NHI members in the household by 0.23. This is the income levy. Then multiplying the number of insured household members by 8,700. This is the per capita levy. These two levies added together are the annual premium that must be paid. The maximum possible is 130,000 per year.

Category 3 – For nursing care (for people in long-term care)

Calculated by multiplying the total residents tax paid by all category 2 NHI members in the household by 0.11. This is the income levy. Then multiplying the number of category 2 household members by 12,000. This is the per capita levy. These two levies added together are the annual premium that must be paid. The maximum possible is 100,000 per year

NHI benefits

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Hospitalization expenses

For those under 70 years of age: If NHI members show their NHI card and a Maximum Ceiling Amount Applicable Certificate together the member will only have to pay the amount specified as their personally borne expense ceiling. For members who are exempt from residents tax, a Ceiling Applied/Standard Personally Borne Amount Reduction Certificate is required. These certificates must be applied for at the city office.

For those over 70 years of age: If NHI members over 70 years old who pay Resident’s tax show their NHI card and an Old Age Medical Insurance card they only have to pay the amount specified as their personally borne expense ceiling.
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Cash reimbursements

NHI members can go to their city office to apply for cash reimbursements for when they pay the full amount for medical services. It takes about three months.

Subsidies for high medical expenses

If the personally borne medical expenses exceed a certain amount NHI members can apply to have a certain amount reimbursed. Reimbursements are paid about four months after the medical service is provided.

NHI members under 70 years of age must show their NHI card and either their Maximum Ceiling Amount Applicable Certificate or Ceiling Applied/Standard Personally-Borne Amount Reduction Certificate to pay only their personally borne expense ceiling. Members under 70 years old are not eligible for the high-cost medical benefit.

NHI members over 70 and under 75 years of age are responsible for paying up to their expense ceiling as usual.

High Medical Expense Subsidy Application Procedures

An application kit should be sent three or four months after the month of the examination/treatment. The form should be completed and returned to the city office.

If the expenses were from hospitalization, members should apply for a Maximum Ceiling Amount Applicable Certificate or a Ceiling Applied/Standard Personally Borne Amount Reduction Certificate, whichever is appropriate. Members who have one of these certificates will only need to pay the maximum ceiling amount for the examination/treatment, and therefore have no need to apply for a High Medical Expense Subsidy.

Loans for High Medical Expenses

As it takes a long time for reimbursements for high medical expenses to be made, loans are available for those who have trouble paying their medical bills in the meantime.

Meal Expenses During Hospitalization

During hospitalization, members must bear a portion of the meal expense.

Childbirth allowance

When a NHI member gives birth, ¥420,000 will be provided for each child. This allowance is also paid in cases of miscarriage or stillbirth if this occurs after 85 days (4 months) of pregnancy. However, this will not be provided to those who receive a childbirth allowance from other health insurance programs. The mother presents her NHI card at the hospital, and NHI will pay the hospital directly. If the cost of childbirth is more than ¥420,000 the member must pay the remainder. If the cost is less than ¥420,000, the member will receive the balance. A form will be sent approximately 2 months after delivery, which must be returned to claim the balance.

Funeral Allowances

When a NHI member dies, ¥70,000 is paid for funeral services. However, if a person who was covered under Employees’ Health Insurance died within 3 months of resignation, Employees’ Health Insurance will pay for the funeral allowance, not NHI. Also, if the death was due to the act of a third party (such as a traffic accident) and their compensation is available, NHI will not provide the funeral allowance.

Injuries from Traffic Accidents or Attacks

Reports are required before receiving treatment with an NHI certificate. For injuries caused by a third party (for example a traffic accident or assault) the person who caused the injury is liable. However, it may be possible to use NHI if the person responsible does not pay and if the proper notifications are filed. The NHI will charge the responsible person afterwards. If you receive treatment using NHI, you must contact the NHI and Pension section of the city office before and submit “report of accident and sickness by the third party” later.

Long Life Health Insurance system

When NHI members reach 75 years old (or 65 for those with a certain degree of disability) they can receive medical care under the Long Life Health Insurance System. An insurance card is issued to all eligible members. Premiums are based on the member’s income.

Summary

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National Health Insurance is one of the two major types of insurance programs available in Japan.

The national health insurance covers approximately 70 persent of medical expenses.  In case, patients fall sick or are hospitalized, all medical insurance schemes can be granted at their requests. In principle, the insured person only have to pay 30 persent of their medical costs.

There are three types of NHI premiums. The head of household is responsible for payment,

There are many types of NHI benefits.

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