An Overview of the Medical Care System for Older Senior Citizens

Transcription

1 An Overview of the Medical Care System for Older Senior Citizens For those 75 years of age and older and those between 65 and 74 years of age recognized by the Association as having a designated level of disability June 2018 Tokyo Metropolitan Association of Medical Care Services for Older Senior Citizens (Tokyoto Koki Koreisha Iryo Koiki Rengo)

2 Table of Contents Contact Us If You Have Any Questions About the Medical Care System for Older Senior Citizens What Is the Medical Care System for Older Senior Citizens? Health Insurance Card Percentage of Personally Borne Expenses for Receiving Treatment at Medical Institutions Ceiling of Personally Borne Expenses Reimbursement for Medical Expenses Proper Way of Receiving Therapy from Judo Therapists When Receiving a Massage, Acupuncture, Moxibustion or Similar Treatment Cost of Transportation to Change Hospitals under a Physician s Orders (Transportation Benefit) When an Enrolled Member Dies (Funeral Benefit) When You Are Involved in a Traffic Accident Notice About Health Checkups Insurance Premiums Current Medical Expenses Operation of the Medical Care System for Older Senior Citizens. 33

3 Contact Us If You Have Any Questions About the Medical Care System for Older Senior Citizens Association Call Center Telephone number: Weekdays from 9 a.m. to 5 p.m. Notes: 1. To accurately understand your questions and requests while improving and maintaining service quality, we record all incoming calls. 2. When contacting us from a PHS or IP phone, please use: Telephone number: Fax number: address: call@tokyo-kouikicenter.jp 3. We accept faxes and s on a 24-hour basis. 4. If you have inquiries related to specific personal information such as the amount of your insurance premiums please contact the service counter in charge of the Medical Care System for Older Senior Citizens at your local municipal office. You can also access the Association s website. To find the website, search for Tokyo-ikiiki.net. 1

4 1. What Is the Medical Care System for Older Senior Citizens? The Medical Care System for Older Senior Citizens is for residents 75 years of age and older and those between 65 and 74 years of age with a designated level of disability. Residents of Tokyo are automatically switched from their prior medical health insurance plan (National Health Insurance, employee health insurance, mutual aid association, etc.) to the Medical Care System for Older Senior Citizens on their 75th birthday. There is no need to complete any enrollment procedures. Residents between 65 and 74 years of age with a designated level of disability who complete application procedures are enrolled in the system from the day they receive approval from the Association. If you would like to enroll, please present your physical disability certificate, intellectual disability certificate, mental disability certificate, or National Pension enrollment certificate as well as a notification card or other document showing your individual number (My Number) and complete the application procedures at the appropriate service counter of your local municipal office. (Please note that applications cannot be backdated.) Once you are approved for enrollment in this insurance plan, please immediately withdraw from your existing medical insurance plan. You can renounce your authorized disability before 74 years of age, but the renouncement cannot be backdated. Frequently Asked Questions Q: A husband turns 75 years of age and switches from social insurance to the Medical Care System for Older Senior Citizens. What happens to his wife (74 years of age), who is a dependent? A: Since he will be enrolled in the Medical Care System for Older Senior Citizens, he must withdraw from his current insurance. His wife, who is a dependent covered by that insurance, must also withdraw and enroll 2

5 in another insurance plan, such as National Health Insurance. Q: Please tell me more about the designated level of disability. A: Designated level of disability refers to the following: 1. Physical disability certificate levels 1 to 3, and some of level 4* 2. Tokyo intellectual disability certificate levels 1 and 2 3. Mental disability certificate levels 1 and 2 4. National Pension enrollment certificate (disability pension levels 1 and 2) * Some of level 4 refers to lower limb disability level 4-1 (lacking all toes on both feet), lower limb disability level 4-3 (lacking more than half of a lower leg), lower limb disability level 4-4 (significant functional disability of one limb), and vocal/language dysfunction. 3

6 2. Health Insurance Card Each enrolled member receives a health insurance card. Please be sure to present your card when receiving medical treatment at a hospital or other medical institution. The card is updated every two years. Light purple cards are valid until July 31, 2018, while light blue cards are valid until July 31, The card is sent before your 75th birthday via simple registered, nontransferable mail from the local municipal office. If you will be away from home for a long period of time around your 75th birthday, please contact the appropriate service counter at your local municipal office in advance. Even within the period of validity, you will be sent a new card if your personally borne expense percentage changes, for example, due to the annual assessment in August, a change in household composition, or a correction in income of the previous year. When you receive your new new card, please be sure to turn in the old one to the appropriate service counter of your local municipal office. Please note that if you use your old health insurance card after your personally borne expense percentage rate changes or you lose eligibility because you move out of Tokyo, you must complete the necessary procedures to arrange payment of the difference or make reimbursement. If you lose your health insurance card or it is damaged, please apply at the appropriate service counter of your local municipal office to receive a new card. When completing these procedures, you must present an official form of valid ID, such as a passport or physical disability certificate, as well as a notification card or other document showing your individual number (My Number). 4

7 3. Percentage of Personally Borne Expenses for Receiving Treatment at Medical Institutions For residents with an income at the actively working level receiving medical treatment, the personally borne expense percentage is 30 percent, and 10 percent for others. An income at the actively working level refers to households with at least one enrolled member whose taxable income (for residents tax) is 1,450,000 or more. If you are born on January 2, 1945 or later, enroll with disability approval, and the total income of your household members enrolled in the Medical Care System for Older Senior Citizens is 2,100,000 or less which serves as the basis for the insurance premium assessment your personally borne expense will be 10 percent. Even if your taxable income (for residents tax) is 1,450,000 or more, you can apply at the appropriate service counter of your local municipal office to have the standard income used if you fulfill any of the income conditions noted below. If approved, your personally borne expense percentage will change to 10 percent from the month following the application date. (1) Only one member of your household is enrolled in the Medical Care System for Older Senior Citizens, and revenue (income before expenses and deductions) for the previous year is below 3,830,000. Even when total revenue is 3,830,000 or more, your personally borne percentage will be 10 percent if your household includes a person between 70 and 74 years of age and the total revenue of the person and the enrolled member is below 5,200,000. (2) Two or more members in your household are enrolled in the Medical Care System for Older Senior Citizens, and the total revenue of the enrolled members for the previous year is below 5,200,000. You need to apply to have standard income used every year. When completing the application procedures, you must present an official form of 5

8 valid ID, such as a passport or physical disability certificate, as well as a notification card or other document showing your individual number (My Number). 6

9 4. Ceiling of Personally Borne Expenses For High Medical Expenses When monthly medical expenses (from the first to the end of the month) are high, the amount exceeding the designated ceiling amount (see Limits on Personally Borne Expenses for Medical Treatment on page 8) will be reimbursed. If you are entitled to a reimbursement, the Association will send you an application around four months after the month in which your medical expenses exceeded the limit. Advance application is not required. When you apply, you must present an official form of valid ID, such as a passport or physical disability certificate, as well as a notification card or other document showing your individual number (My Number). Please note that once you complete the application, your bank account will be registered and future reimbursements will be sent there automatically. 7

10 Limits on Personally Borne Expenses for Medical Treatment The expense limits will be updated starting with treatments received in August Below are the income categories, their respective limits for outpatient care (for one individual), and limits for outpatient care + hospitalization (for the whole household), in order: The limits for treatments received between August 2017 and July 2018: For a member with income at the actively working level (personally borne rate: 30 percent): up to 57,600; up to 80,100. (If total medical expenses are over 267,000, one percent of the excess amount plus 80,100.) Note: If a member has been reimbursed for high medical expenses four or more times in the past twelve months, he/she will become a multiple-use patient. The limit from the fourth time onward drops to 44,400. Please note that outpatient treatment (for one individual) is not counted in the number of times required to become a multiple-use patient. General (personally borne rate: 10 percent): Up to 14,000 (annual limit of 144,000); up to 57,600 Note: If a member has been reimbursed for high medical expenses four or more times in the past twelve months, he/she will become a multiple-use patient. The limit from the fourth time onward drops to 44,400. Please note that outpatient treatment (for one individual) is not counted in the number of times required to become a multiple-use patient. Category II (personally borne rate: 10 percent): up to 8,000; up to 24,600 Category I (personally borne rate: 10 percent): up to 8,000; up to 15,000 Limits for treatments in August 2018 and beyond: 8

11 The category outpatient care (for one individual) for those with an income at the actively working level will be discontinued. The income categories will be further broken down as follows, and new limits will be set. Income at actively working level 3 (personally borne rate: 30 percent; taxable income: 6,900,000 or more): up to 252,600. (If total medical expenses are over 842,000, one percent of the excess amount plus 252,600.) Note: If a member has been reimbursed for high medical expenses four or more times in the past twelve months, he/she will become a multiple-use patient. The limit from the fourth time onward drops to 140,100. Income at actively working level 2 (personally borne rate: 30 percent; taxable income: 3,800,000 or more): up to 167,400 (If total medical expenses are over 558,000, one percent of the excess amount plus 167,400) Note: If a member has been reimbursed for high medical expenses four or more times in the past twelve months, he/she will become a multiple-use patient. The limit from the fourth time onward drops to 93,000. Income at the actively working level 1 (personally borne rate: 30 percent; taxable income: 1,450,000 or more): up to 80,100. (If total medical expenses are over 267,000, one percent of the excess amount plus 80,100.) Note: If a member has been reimbursed for high medical expenses four or more times in the past twelve months, he/she will become a multiple-use patient. The limit from the fourth time onward drops to 44,400. General (personally borne rate: 10 percent): Up to 18,000 (annual limit of 144,000); up to 57,600 Note: If a member has been reimbursed for high medical expenses four or more times in the past twelve months, he/she will become a 9

12 multiple-use patient. The limit from the fourth time onward drops to 44,400. Please note that outpatient treatment (for one individual) is not counted in the number of times required to become a multiple-use patient. Category II (personally borne rate: 10 percent): up to 8,000; up to 24,600 Category I (personally borne rate: 10 percent): up to 8,000; up to 15,000 Category II refers to members whose entire household is not subject to residents tax and who do not fall under Category I. Category I refers to members whose entire household is not subject to residents tax and all household members have a pension income of 800,000 or less with no other source of income, or a member whose entire household is not subject to residents tax and is a recipient of the old-age welfare pension. The term for the annual limit for outpatient treatment (for one individual) is August 1 to July 31 of the next year. If the total personally borne expense for months you had an income category of General, Category 1, or Category 2 exceeds 144,000, the excess amount will be reimbursed. If you are receiving subsidies for monthly high medical expenses, the total personally borne expense is the amount after the subsidy is subtracted. Please note that reimbursement does not apply to meal expenses during hospitalization or to additional fees for special beds that insurance does not cover. If you turn 75 years old in the middle of the month, both the limit for your prior medical health insurance and for the Medical Care System for Older Senior Citizens will be halved for the month of your birthday (except when your birthday is the first of the month). 10

13 Joint Personally Borne Expense Limit for Medical Health Insurance and Nursing Care Insurance (High Medical and Nursing Care Joint Expenses) If the sum of the personally borne expenses for the Medical Care System for Older Senior Citizens and for Nursing Care Insurance in one household for a year (from August 1 through July 31 of the following year) exceeds the designated limit on personally borne expenses for your household, you can apply to have the excess amount from each insurance plan reimbursed. When completing such procedures, you must present an official form of valid ID, such as a passport or physical disability certificate, as well as a notification card or other document showing your individual number (My Number). Annual Joint Personally Borne Expense Limit for Medical Health Insurance and Nursing Care Insurance Here are the income categories and their respective ceilings: Income at the actively working level: 670,000 General: 560,000 Category II: 310,000 Category I: 190,000 Cost of Meals For Standard Hospitalization (Non-Long-Term Care Hospitalization) If you are hospitalized as an ordinary patient (non-long-term care), the standard limits for personally borne expense per meal are as follows: 11

14 Standard Personally Borne Expenses Per Meal (Standard Hospitalization) The following lists the income categories and their respective cost per meal: Income at the actively working level and general: 460 Category II, when hospitalized in the past 12 months for 90 days or fewer: 210 Category II, when hospitalized in the past 12 months for over 90 days (long-term hospitalization): 160 Category I: 100 The personally borne expense per meal for patients with income at the actively working level and in general categories with designated intractable diseases remains at 260. The personally borne expense per meal for patients who remain hospitalized in psychiatric wards from April 1, 2015 or before also remains at 260. If you fall under Category II and were hospitalized in the past 12 months for over 90 days, please bring your hospital invoice or receipt documenting the number of days of hospitalization and complete the application procedures at the appropriate service counter of your local municipal office. (You may add up hospitalization periods covered by other health insurance if you have received a payment reduction equivalent to Category II.) If the date listed on your certificate of payment reduction pertains to long-term hospitalization, however, you do not have to apply again. Long-term hospitalization will apply from the first of the following month after the date you apply. The difference will be paid for the period between the application date and the end of the application month. 12

15 The Cost of Meals, Living, etc. during Long-Term Care Hospitalization If you are hospitalized for long-term care, the standard ceilings for the personally borne expense for meals and living are as outlined below: The personally borne cost for meals for those with a designated intractable disease will be the same as for a patient in standard hospitalization mentioned above, and will be exempt from living cost payment. Standard Personally Borne Expenses for Meals and Living for Those with Low Need for Hospital Treatment (Long-Term Care Patient) The following lists income categories and their respective costs per meal and living expenses per day, in order: Income at the actively working level and general: 460; 370 Category II: 210; 370 Category I: 130; 370 Old-age welfare pension recipient: 100; 0 Standard Personally Borne Expenses for Meals and Living for Those with High Need for Hospital Treatment (Long-Term Care Patient) The following lists income categories and their respective costs per meal and living expenses per day, in order: Income at the actively working level and general: 460; 370 Category II when hospitalized in the past 12 months for 90 days or less: 210;

16 Category II when hospitalized in the past 12 months for over 90 days (long-term hospitalization): 160; 370 Category I: 100; 370 Old-age welfare pension recipient: 100; 0 Please note that regardless of the level of need for hospital treatment, in some cases the expense for meals for members with an income at the actively working level and those in the general category may be 420, depending on the standards of the medical institution. Additionally, if you have a high need for hospital treatment, fall under Category II and were hospitalized in the past 12 months for over 90 days, please bring your hospital invoice or receipt documenting the number of days of hospitalization and complete the application procedures at the appropriate service counter of your local municipal office. (You may add up hospitalization periods covered by other health insurance if you have received a payment reduction equivalent to Category II.) If the date listed on your certificate of payment reduction pertains to long-term hospitalization, however, you do not have to apply again. Long-term hospitalization will apply from the first of the following month after the application date. The difference will be paid for the period between the application date and the end of the application month. Certificate of Personally Borne Expense Ceiling and Payment Reduction If everyone in your household is exempt from residents tax, present the certificate of personally borne expense ceiling and payment reduction at the service counter of a medical institution. Your personally borne expense for health insurance-applicable medical treatment and hospital meals will be reduced. If you do not have this certificate, please apply at the appropriate service counter of your local municipal office. If you qualify, you will receive one. 14

17 Even if you have been issued an equivalent certificate by a prior health insurance plan, you must complete the application procedure again when enrolling in the Tokyo Medical Care System for Older Senior Citizens. When completing such procedures, you must present an official form of valid ID, such as a passport or physical disability certificate, as well as a notification card or other document showing your individual number (My Number). Treatment Certificate for Those with Special Illnesses If you have a special illness and need expensive long-term medical treatment, apply at your local municipal office for a treatment certificate for those with special illnesses. If you qualify, you will receive one. If you present this certificate at the service counter of a medical institution, your personally borne expenses will be limited to 10,000 per month at each medical institution. Special illnesses refer to the following: (1) Some congenital blood coagulation factor disorders (e.g., hemophilia) (2) Chronic kidney disorders requiring artificial dialysis (3) HIV (human immunodeficiency virus) infections caused by the injection of blood coagulants (blood derivatives) Even if you have an equivalent certificate from your prior health insurance plan, you must complete the application procedure again when enrolling in the Tokyo Medical Care System for Older Senior Citizens. When completing such procedures, you must present an official form of valid ID, such as a passport or physical disability certificate, as well as a notification card or other document showing your individual number (My Number). 15

18 5. Reimbursement for Medical Expenses If you pay for all medical costs in the following cases, you can apply at a later date at your local municipal office for reimbursement for the amount that the insurer should pay. Items Required for All Cases Your health insurance card, personal seal (a type that requires an inkpad), and documentation to confirm your bank account When completing such procedures, you must also present an official form of valid ID, such as a passport or physical disability certificate, as well as a notification card or other document showing your individual number (My Number). (1) When you have received medical treatment without showing your health insurance card, or at a medical institution where the treatment is not covered by insurance. Please note that this is restricted to situations that the Association recognizes as being unavoidable. You will need a document equivalent to a statement of medical expenses and a receipt, as well as the items required for all cases mentioned above. (2) When you have received treatment from a judo therapist for injuries such as a broken/fractured bone or dislocated joint. Please note that this only applies to treatment within the range designated by insurance. Reimbursement is not offered for treatment received during hospitalization. You will need a receipt for the treatment fee, as well as the items required for all cases mentioned above. (3) When you have received a massage, acupuncture, moxibustion or similar treatment that a physician recognizes as necessary. Please note 16

19 that this only applies if you receive the treatment with the approval of your physician, but does not apply to treatment received during hospitalization. You will need a receipt for the treatment fee and a letter of consent from the physician, as well as the items required for all cases mentioned above. (4) When you have purchased therapeutic items such as a corset, or paid for a blood transfusion, that the physician recognizes as necessary. Please note that, as a rule, this does not apply to ready-made therapeutic items. You will need a written statement (medical certificate) concerning the need for the adaptive equipment, a receipt, as well as the items required for all cases mentioned above. For a blood transfusion, you will also need a certificate from the physician and a receipt. (5) When you have received treatment overseas. Please note that this does not apply to overseas travel for treatment purposes. Only treatments within the range designated by insurance in Japan are covered. You will need a statement of medical treatment, an itemized receipt, translation of these documents, passport or other document that provides proof of your travel, a consent form for the investigation of medical treatment details, as well as the items required for all cases mentioned above. 17

20 6. Proper Way of Receiving Therapy from Judo Therapists Please note that insurance covers treatment by judo therapists only when a physician or licensed judo therapist diagnoses or determines that certain conditions are satisfied. Cases covered by insurance: Acute bruises, sprains, muscle strains, broken/fractured bones and dislocated joints. For broken/fractured bones and dislocated joints, the consent of a physician is required, except in emergencies. Examples of cases not covered by insurance: (1) Simple stiff shoulder and muscle wasting (2) Chronic disease such as the aftereffects of cerebropathy (3) Long-term treatment that does not lessen symptoms (4) When the same injury is being treated at a different hospital, clinic or other medical institution Points to Note when Receiving Treatment (1) Medical health insurance only covers treatment for therapeutic purposes. You must accurately explain the cause of your injury (when, where and how you became injured, and your symptoms). (2) Judo therapists are allowed to accept two payment methods: reimbursement, meaning the patient pays all medical costs and later claims reimbursement at the appropriate service counter of his/her local municipal office; and receipt delegation, meaning the patient pays his/her personally borne expense to the judo therapist, who claims the remaining amount from the insurer. When a judo therapist makes a patient-related insurance claim, he/she must check the details of the application for medical 18

21 expense payment (cause of the injury, name of the injury, days of treatment, cost) and have the patient complete the representative recipient field (address, name, delegation date). If the patient cannot write due to a wrist injury or other reason, the judo therapist may write in the patient s stead, provided that the patient affixes his/her personal seal. (3) When you receive treatment for a long period of time, your injury may be aggravated by medical factors. Consult with the judo therapist and receive an examination at a hospital or clinic. (4) Please keep the receipts that your judo therapist issues (free of charge) in a safe place. (5) The Tokyo Metropolitan Association of Medical Care Services for Older Senior Citizens may contact you to check the dates and details of treatment or other information. Thank you for your cooperation. 19

22 7. When Receiving a Massage, Acupuncture, Moxibustion or Similar Treatment You need the approval of a physician to receive a massage, acupuncture, moxibustion or similar treatment using your medical health insurance, so please consult your physician before receiving treatment. Please note that medical health insurance may only be used for cases that meet designated conditions. 20

23 8. Cost of Transportation to Change Hospitals under the Physician s Orders (Transportation Benefit) Insurance may cover the cost of transportation if a seriously ill patient with limited mobility must change hospitals under the orders of a physician, and when such a transfer is urgent and unavoidable. This benefit is provided if the Association approves the transfer as necessary after you apply at the appropriate service counter of your local municipal office. Insurance does not cover the cost of transportation for examination purposes, location changes due to the patient s desire or for the convenience of the family, daily transportation from home to the hospital or at the time of discharge from hospitalization, or other non-emergencies. The transportation benefit provided is calculated based on the transportation cost of the most ordinary and economical route and means. Items required for application: You will need a written statement from your physician concerning the need for transportation, a receipt, your health insurance card, personal seal (one that requires an inkpad), and documentation to confirm your bank account. When completing procedures, you must present an official form of valid ID, such as a passport or physical disability certificate, as well as a notification card or other document showing your individual number (My Number). 21

24 9. When an Enrolled Member Dies (Funeral Benefit) The person who hosts a funeral for an enrolled member can apply for up to a 50,000 reimbursement for funeral expenses. (The amount of the funeral benefit and items required for application may differ between municipalities.) For details, please contact the appropriate service counter at the enrolled member s local municipal office. Items Required for Application The applicant s personal seal (one that requires an inkpad); a receipt for the funeral expenses (must confirm that the applicant hosted the funeral); documentation to confirm the applicant s financial institution, account number and name on the account; and a notification card or other document showing the individual number (My Number) of the deceased. 22

25 10. When You Are Involved in a Traffic Accident/Other Incident If you are injured by a third party in a traffic accident or other incident, please tell the hospital that your injury was the result of an accident/incident when receiving treatment. Also be sure to file a report with the police, and notify the appropriate service counter at your local municipal office as soon as possible. You may use your health insurance card for treatment once you file these notifications. The staff in charge at your local municipal office will tell you which documents are required for application. Please file the notification within thirty days of the accident/incident as a rule. The Association will cover the medical expense temporarily, and later bill the person who caused the accident. Please be careful when settling the case out of court, because an unfavorable settlement may make it difficult to bill the person who caused the accident. 23

26 11. Notice About Health Checkups Remember to receive a health checkup once a year For the early detection and early treatment of illness, please receive a health checkup once a year. For details, please contact the appropriate service counter of your local municipal office. The personally borne expense for the checkup is 500. Some municipalities offer health checkups free of charge. Note that those who are institutionalized may be ineligible for health checkups. 24

27 12. Insurance Premiums Enrolled members pay insurance premiums calculated as a percentage of the total medical expenses so that the Association can allocate funds to pay for treatment that members receive for illness or injury. Insurance premiums are an important financial resource for supporting the Medical Care System for Older Senior Citizens. Insurance premium rates are reviewed/revised every two years, and the rates are the same throughout Tokyo. Notices about insurance premiums are sent to enrolled members from their local municipal offices. How Insurance Premiums Are Calculated Every enrolled member pays an insurance premium. This premium is the sum of the per capita amount of 43,300 per member, plus the income ratio amount determined by the income the member earned during the previous year (income that serves as the basis for assessment income ratio of 8.8 percent). The per capita amount of 43,300 and the income ratio of 8.8 percent are applicable for two years from fiscal 2018 through fiscal The ceiling for annual insurance premiums is 620,000, and fractions smaller than 100 are omitted in the final insurance premium figures. If you turn 75 years old in the middle of the fiscal year or move from another prefecture, your insurance premiums will be calculated on a monthly basis from that month. Income as the basis for insurance premium assessment refers to the basic deduction of 330,000 subtracted from the total of gross income earned during the previous year, forestry income, and income from the transfer of stocks or long- and short-term assets. (Carried-forward miscellaneous losses cannot be deducted, however.) 25

28 How to Pay Your Insurance Premiums You pay your insurance premiums to your local municipal office, and can either make these payments through special collection or regular collection, as outlined below. Special Collection (deducted from your public pension/pension from which Nursing Care insurance premiums are deducted) Members whose annual public pension is 180,000 or greater and the sum of the Nursing Care Insurance premiums and Medical Care System for Older Senior Citizens premiums is 50 percent or less of the amount of one payment of the public pension are eligible. Special collection is separated into tentative collection and finalized collection. Until your income in the previous year is finalized, insurance premiums for tentative collection in April, July and August are calculated based on your insurance premiums in the previous year. The total insurance premiums for finalized collection are the finalized yearly insurance premium based on your finalized income in the previous year, minus the amount already collected for special collection. That amount is separately collected over three terms (October, December and February). Regular Collection (payment by invoice or bank transfer) If you are ineligible for special collection, you pay premiums by invoice or bank transfer. The number of terms for payment differs between municipalities. For details, please contact the appropriate service counter at your local municipal office. Note: Those who just became eligible for the Medical Care System for Older Senior Citizens or have just moved from another municipality must pay for premiums through regular collection for a period of time. 26

29 You Can Pay by Bank Transfer Whether you are eligible for special collection or paying by invoice, you may also apply to pay by bank transfer. The account you designate does not have to be your own; you may also use the account of the head of your household, your spouse or another account. Information of the bank account you used to pay your National Health Insurance premiums (tax) will not be transferred, so you will have to complete new procedures to pay by bank transfer. Insurance Premium Reduction or Exemption If you have difficulty paying your insurance premiums due to exceptional circumstances such as suffering serious damage in a disaster or the suspension/abandonment of a business, you may apply for a reduction or exemption of your insurance premiums. Please consult the appropriate service counter of your local municipal office as soon as possible. If You Fall Behind in Your Premium Payments If you fall behind in your insurance premium payments, we will send you a reminder. You may also receive a formal demand by phone or in writing. If you still do no pay, you may be sent a health insurance card with a shorter validity period (short-term health insurance card), or your property may be seized. If you have difficulty paying your insurance premiums for certain reasons, please consult the appropriate service counter of your local municipal office as soon as possible. Reduction of Insurance Premiums If your income is low, you may be able to have your insurance premiums 27

30 reduced. You may have to declare your income when you apply for such a reduction. Reduction of the Per Capita Amount Your per capita amount of insurance premiums can be reduced depending on the total income of all members enrolled in the Medical Care System for Older Senior Citizens in your household and the head of the household. The percentage of the reduction in the per capita amount can be 90 percent, 85 percent, 50 percent or 20 percent. The following lists the income categories and their respective reduction percentages: (1) A household with a total income of 330,000 or less, with all enrolled members receiving a pension of 800,000 or less, and having no other type of income: 90 percent reduction (2) A household with a total income of 330,000 or less, but not fulfilling the 90 percent reduction standards stated above: 85 percent reduction (3) A household whose total income is equal to or less than 330,000 + ( 275,000 no. of enrolled household members): 50 percent reduction (4) A household whose total income is equal to or less than 330,000 + ( 500,000 no. of enrolled household members): 20 percent reduction Notes: 1. For the public pension income of members 65 years of age or older (as of January 1, 2018), the reduction assessment is made based on the income minus 150,000 (special deduction for senior citizens). 2. Even when the head of the household is not an enrolled member, his/her income is taken into consideration in the reduction assessment. 28

31 Households will be determined based on the household situation as of April 1 of the fiscal year. Reduction of the Income Ratio Amount The income ratio amount of insurance premiums can be reduced depending on the enrolled members income (the amount after subtracting the basic deduction of 330,000 from total income), which serves as the basis for insurance premium assessment. If the income amount assessed is 200,000 or less, the enrolled member is eligible for a reduction in insurance premiums. This is a special reduction measure of the Tokyo Metropolitan Association of Medical Care Services for Older Senior Citizens. The percentage of reduction in the income ratio amount can be 50 percent or 25 percent. The following lists the income categories and their respective reduction percentages: 1) If the income amount assessed is 150,000 or less: Reduced by 50 percent (50 percent imposed) (2) If the income amount assessed is 200,000 or less: Reduced by 25 percent (75 percent imposed) Reduction for Former Dependents The reduction rate for the per capita amount for former dependents of someone in an employee insurance program (excluding the National Health Insurance and National Health Insurance Union systems) until the day before you enrolled in the Medical Care System for Older Senior Citizens has been revised as follows: 29

32 - 50 percent reduction for fiscal For fiscal 2019 and beyond, a 50 percent reduction until the month when two years have passed since enrollment Those who became eligible for this deduction by March 31, 2017 will not be eligible for reductions in fiscal 2019 and beyond. If you are eligible for a reduction for the per capita amount due to low income, the higher reduction rate will be prioritized. Additionally, the income ratio amount will not be charged for the time being. Calculation Example for Annual Insurance Premiums Case: A single-person household with an enrolled member whose annual income is only 1,700,000 from a public pension Calculation of per capita amount: The member s eligibility for a reduction in the per capita amount will be assessed. Pension income of 1,700,000 pension deduction of 1,200,000 special deduction for senior citizens of 150,000 = 350,000 The 350,000 amount falls under the 50 percent reduction category, so the per capita amount will be: 43,300 ( 43, percent) = 21,650 Calculation of income ratio amount: The member s eligibility for a reduction in the income ratio amount will be assessed. Pension income of 1,700,000 pension deduction of 1,200,000 basic deduction of 330,000 = 170,000 The amount of 170,000 falls under the 25 percent reduction category, so the income ratio amount is: ( 170,000 income ratio of 8.8 percent) [( 170,000 income ratio of 8.8 percent) 25 percent] = 11,220. The resulting annual insurance premium is 32,800, as the sum of the per 30

33 capita amount of 21,650 and the income ratio amount of 11,220, with the fraction below 100 being omitted. 31

34 13. Current Medical Expenses Medical expenses are increasing year by year. Medical expenses for older senior citizens in Tokyo rose from 1,102.9 billion yen in fiscal 2011 to 1,318.3 billion yen in fiscal Per capita medical expenses also increased from 902,000 in fiscal 2011 to 923,000 in fiscal An increase in medical expenses leads to an increase in insurance premiums that enrolled members pay, as well as in the costs actively working generations must pay. Every individual is encouraged to help lower medical expenses by improving his/her lifestyle habits and receiving proper checkups. Use Generic Medicines Generic medicines are certified as having the quality, beneficial effects and safety equivalent to those of the original name-brand products, and are generally offered at a lower price. That helps reduce the medication expenses patients pay and reduce overall medical expenses. If you prefer to use generic medicines, please consult your physician or pharmacist. A sticker to indicate your intention to use generic medicines is enclosed with the health insurance card sent to you. If you are willing to use generic medicines, you can demonstrate your intention by placing the sticker on a part of your insurance card without text, or in your prescription record book. 32

35 14. Operation of the Medical Care System for Older Senior Citizens The Tokyo Metropolitan Association of Medical Care Services for Older Senior Citizens which comprises all municipalities in Tokyo operates the Medical Care System for Older Senior Citizens. The Association runs the insurance program system, handling aspects such as the authorization of enrolled members, determination of insurance premium rates, billing of insurance premiums, provision of medical benefits, and planning of health checkups. Municipal offices serve as the reception counters for enrollment, and handle notifications of loss of eligibility and changes of address as well as applications for benefits. In addition, they act as service counters that distribute health insurance cards, collect insurance premiums, and offer advice concerning payment. Medical expenses, excluding expenses borne by patients, are financed by insurance premiums that enrolled members pay (which finances about 10 percent), public funds from the government of Japan, the Tokyo Metropolitan Government and municipal offices in Tokyo (about 50 percent), and contributions from other medical health insurance systems (from actively working generations; about 40 percent). Starting in January 2016, you are required to provide your individual number (My Number) when completing various procedures. You must present an official form of valid ID, such as a passport or physical disability certificate, as well as a notification card or other document showing your individual number (My Number). For details of the procedures, please contact the Association or the appropriate service counter at your local municipal office. 33

36 Contact information for the responsible section of the Tokyo Metropolitan Association of Medical Care Services for Older Senior Citizens For inquiries about health insurance cards, personally borne expense or insurance premiums: Eligibility and Assessment Section, Tel: or For inquiries about the provision of benefits: Benefit Section, Tel: For inquiries about the notification of medical expenses, etc.: Inspection Section, Tel: For inquiries about health checkups and proper medical expenses: Health Service/Proper Medical Expenses Section, Tel: Please beware of expense reimbursement fraud Employees of the Association or municipalities will never ask you to operate an ATM (automated teller machine). If you receive a suspicious phone call, please consult the nearest police station, the Association, or the appropriate service counter at your local municipal office. The content of this pamphlet is based on laws and reference materials produced by the Ministry of Health, Labour and Welfare. Please note that this information is subject to change, depending on revisions in the system and other factors. 34