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NATIONAL HEALTH INSURANCE PROGRAM
HEALTH
CARE DIVISION, SUBSECTION OF NATIONAL HEALTH INSURANCE & PENSION
Tel:0267-45-8540
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NATIONAL HEALTH INSURANCE PROGRAM
@The National Health Insurance (NHI) is a program to reduce the individual
financial strain of medical expenses and help people have easy access
to medical services at the time of sickness and injury. |
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PEOPLE WHO ARE REQUIRED TO JOIN THE NATIONAL HEALTH
INSURANCE PROGRAM
@Every person is required to join the NHI except for those who are covered
by a different medical insurance offered by their employer (Health Insurance,
Aid Society, Shipmen's Social Insurance etc) and those who are on welfare.
@Every person under the NHI is the individual insured regardless of head
of a household or dependent family member.
@Please notify the Health Care Division, Subsection of Health Insurance
& Pension within 14 days after the following situations occur.
WHEN NOTIFICATION IS REQUIRED 1
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WHEN NOTIFICATION IS REQUIRED |
REQUIRED ITEMS |
| JOINING
NHI |
When becoming a resident of Karuizawa Town |
Personal seal (inkan), Certificate of Moving, the
elderly beneficiaries aged 70 or older are required to bring a certificate
of expense share. |
| When you become ineligible to another health insurance
program due to leaving employment |
Personal seal (inkan), Certificate of withdrawal
of another health insurance program |
| When you have a baby |
Personal seal (inkan), NHI card, maternity handbook |
| When you stopped receiving welfare benefits |
Personal seal (inkan), Notification of the cease
of welfare benefits |
| When a foreign resident joins the Health Insurance
Program |
Foreign registration card |
Remarks)
In addition to the above, there are other notification requirements such
as for adoption, legitimatizing of a child, marriage registration, segregation
from family register etc. Please enquire to the subsection of residents
for details.
WHEN NOTIFICATION IS REQUIRED 2
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WHEN NOTIFICATION IS REQUIRED |
REQUIRED ITEMS |
| WITHDRAWING
FROM NHI |
When moving to another city |
Personal seal (inkan), NHI card, the
elderly beneficiaries aged 70 or older are required to bring a beneficiary
certificate |
| When joining another health insurance
program at a new employment etc |
Personal seal (inkan), Insurance card
for NHI and another insurance program |
| When the insured passed away |
Personal seal (inkan), NHI card, Death
certificate, the elderly beneficiaries aged 70 or older are required
to bring a beneficiary certificate |
| When you start receiving welfare benefits |
Personal seal (inkan), NHI card, Received
Notification of becoming a welfare beneficiary |
| When a foreign resident withdraw from
NHI |
NHI card, Foreign registration card
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| OTHERS |
When you become eligible to a medical
scheme for retirees |
Personal seal (inkan), NHI car, Pension
certificate |
| When there are changes in address,
name or household |
Personal seal (inkan), NHI card |
| When moving away from home due to
entering a school, or changing address temporarily due to a long
business trip |
Personal seal (inkan), NHI card, a
certificate to prove attendance at school |
| When you lose your NHI
card or the card becomes unusable due to damage or stain etc |
Personal seal (inkan),
an identification such as driver's license |
BENEFITS OF THE NHI
| CLASSIFICATION |
SITUATION |
BENEFITS |
REQUIRED ITEMS |
| Medical benefit |
When becoming sick or injured |
Patients under 3 years
old cover 20%, the elderly beneficiaries 10 or 20%, others 30% of
the medical expenses. The remaining 70`90% are covered by the NHI. |
Present your NHI card
to the medical institutions, the elderly beneficiaries aged 70 or
older are required to present their beneficiary certificate (except
for persons receiving medical care under the senior healthcare plan)
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| Payment of the medical
expense |
- When receiving medical treatment without NHI
card in unavoidable circumstances.
- When having a therapy by a ΤJudo' therapist
(osteopathic physician) and being unable to use your NHI card
- When having acupuncture, moxa or massage treatment
under your doctor's instructions.
- When ordering an assistive device like a corset
under your doctor's
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The 70`90% of the amount
calculated based on the medical treatment under insurance cover
will be reimbursed later. |
Personal seal (inkan),
NHI card, Medical service fee statement, Receipt, Doctor's medical
certificate, Bank account details |
| Lump-sum allowance or childbirth and
nursing |
When the insured give
birth to a baby |
The allowance of 300,000
will be provided per child (this allowance will also be provided
to a stillbirth and miscarriage in case of the pregnancy of 4 months
or longer). |
Personal seal (inkan),
NHI card, Bank account details |
| Funeral allowance |
When the insured passed
away |
The allowance of 1,8000
will be provided to a person who holds a funeral (host of the funeral)
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Personal seal (inkan),
NHI card |
| Overseas medical expense
benefits |
When receiving medical
treatment overseas |
The allowance will be
provided according to the NHI allowance regulations. |
1.Personal seal (inkan)
2.NHI card
3.Medical treatment statement
4.Receipt
5.Bank account details
(Japanese translation is required for the items 3 & 4) |
| Allowance for a complete
medical examination |
When undergoing a complete
medical examination |
When undergoing a complete
medical examination at Karuizawa Hospital, the allowance of 20,000
for overnight stay and 10,000 for a day visit will be provided.
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Personal seal (inkan),
NHI card, Bank account details for a deposit |
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WHEN THE MEDICAL EXPENSE EXCEEDS THE COPAYMENT MAXIMUM
LIMIT
@When the insured person's co-payment of the medical expenses
for duration of one month exceeds the maximum limit shown in the table
below, the amount exceeding the maximum limit will be reimbursed upon
application.
For persons under 70 of age
| SITUATION |
AVAILABLE BENEFITS |
REQUIRED ITEMS |
| When the insured person's
co-payment of the medical expenses exceeds the maximum limit shown
on the right. (expenses are classified for each hospital/clinic
on a per month basis for each individual) |
Residents tax exempt household |
When the co-payment
exceeds 35,400 |
The amount exceeding the maximum limit
will be reimbursed. |
Personal seal (inkan)
Receipt
Bank account details |
| General household |
When the co-payment exceeds 72,300 |
The amount exceeding the maximum limit
will be reimbursed.
However, when the medical expenses exceed 361,500, 1% of the exceeding
amount will be added to the maximum limit |
| High income household |
When the co-payment
exceeds 139,800. |
The amount exceeding the maximum limit
will be reimbursed. However, when the medical expenses exceed 699,000,
1% of the exceeding amount will be added to the maximum limit. |
| When the members in a household
received medical treatments that required high medical expenses
more than four times in the past year. |
Residents tax exempt
household |
When the co-payment
exceeds 24,600. |
The amount exceeding the
maximum limit will be reimbursed. |
Personal seal (inkan)
Receipt
Bank account details |
| General household |
When the co-payment
exceeds 40,200. |
| High income household |
When the co-payment
exceeds 77,700. |
| Persons who require expensive
medical treatment over a long period (for illnesses such as hemophilia
and receiving a dialysis treatment) |
The co-payment maximum will be reduced
to 10,000 per month, once a special disease medical treatment card
is presented at the hospital reception. |
Application for recognition of a special
disease case |
Remark 1) High income household is a household whose income exceeds 6,700,000
after basic exemption
Remark 2) Hospitalization and receiving regular outpatient treatment are
classified into separate expenses (the same applies to a dental surgery
and medical clinic)
Remark 3) Meals and extra bed charges during your hospitalization are
not subject to major medical expenses benefits.
For persons aged over 70 and under 75
| SITUATION |
AVAILABLE BENEFITS |
REQUIRED ITEMS |
Outpatient treatment (calculated
per each individual)
When the insured person's co-payment of the medical expenses exceeds
the maximum limit shown on the right. (expenses are classified for
each hospital/clinic on a per month basis for each individual) |
Low income earners I
Low income earners II |
When the co-payment
exceeds 8,000 |
The amount exceeding the
maximum limit will be reimbursed. |
Personal seal (inkan)
Receipt
Bank account details |
| General |
When the co-payment
exceeds 12,000 |
| Persons with income above a certain
level |
When the co-payment
exceeds 40,200 |
| Hospitalization per household |
Low income earners I |
When the co-payment
exceeds 15,000 |
The amount exceeding the
maximum limit will be reimbursed. |
Personal seal (inkan)
Receipt
Bank account details |
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Low income earners II |
When the co-payment
exceeds 24,600 |
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General |
When the co-payment
exceeds 40,200 |
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Persons with income above a certain
level |
When the co-payment
exceeds 72,300 |
The amount exceeding the maximum limit
will be reimbursed.
However, when the medical expenses exceed 361,500, 1% of the exceeding
amount will be added to the maximum limit. |
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| Persons who require expensive
medical treatment over a long period (for illnesses such as hemophilia
and receiving a dialysis treatment) |
The co-payment maximum will be reduced
to 10,000 per month, once a special disease medical treatment card
is presented at the hospital reception. |
Remark 1) Persons with income above a certain level indicates those households
with a person aged 70 or older whose taxable income exceeds 1,240,000
or with a person receiving medical care under the senior healthcare plan.
However, the total income of a household with more than two persons must
exceed 6,370,000 (the yearly income of more than 4,500,000 for a household
with one person only)
Remark 2) Low income earners I are households whose head and NHI insured
persons are exempted from residents tax.
Remark 3) Low income earners II are residents tax exempt households and
income of all members of these households are under a certain level.
Remark 4) When a person with income above a certain level receives major
medical expense benefits more than four times within the past year due
to their co-payment exceeding the maximum limit for hospitalization per
household, the maximum limit will be reduced to 40,200 from the fourth
time. |
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RETIREE HEALTH CARE SYSTEM
@While the normal co-payment of the medical expenses is 30%, persons who
are eligible for the Retiree Health Care System only need to pay 20%.
The nonworking dependent family members of the insured also cover only
20% of the hospitalization cost.
To join the Retiree Health Care System, you must meet all the following
three conditions.
- A person under NHI
- A person who does not receive medical care under the senior
healthcare plan
- A person who receive old-age (retirement) pension or total
old-age (retirement) pension and has been under these pension
schemes for over 20 years or more, or over 10 year or more after
the age of 40.
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@To be eligible for becoming a nonworking dependent family member, you
must meet one of the following conditions. In addition, you do not receive
medical care under the senior healthcare plan, and the yearly incomes
are under the standard amount and are covered by NHI.
- A person in direct line of ascent of the insured retiree,
a spouse or a relative up to the third remove who lives with
the insured retiree concerned in the same household and depends
mainly on the retiree concerned for a living.
- Parents or children of the illegitimate spouse of the insured
retiree who live with the insured retiree concerned in the same
household and depend on the retiree concerned for a living.
- 3. Parents or children of the deceased illegitimate spouse
and meet the other conditions mentioned in the No.2.
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@When you receive a pension certificate, please notify the Subsection
of National Health Insurance & Pension within 14 days and bring your
NHI card, personal seal (inkan) and pension certificate. |
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PAYMENT OF THE NHI TAX
@The insurance tax is determined based on the total amount of the income
levy etc calculated on the income from the previous year. Persons aged
over 40 and under 65 are also required to pay tax for a nursing-care insurance.
@The head of a household holds a responsibility for an insurance tax payment
if there is a person covered by NHI in their household. Tax payment can
be made at a nearest financial institution, town hall or tax payment local
office in ten installments between June and March in the following year.
An account transfer payment is also available.
Please click here to for
more details regarding the "National Health Insurance Tax". |
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