National Health Insurance FY2017 Medical Insurance and Pension Division Health Department, Shinjuku City Tel: 03-3209-1111 (Switchboard)
Main Points (please be sure to read the main text) Enrollment in the National Health Insurance Program is mandatory (P1~2) Foreign residents who are not enrolled in an employer's health insurance program must join the National Health Insurance Program as same as Japanese Nationals. Even though you have a coverage with insurance programs operated by corporations or foreign organizations, you must enrolled to National Health Insurance. Individuals employed by a corporation (K.K., private limited company, school corporation, etc.), a branch/business office of a foreign corporation in Japan which fall under any of the Japanese laws must be enrolled in the health insurance program at their workplace. If you are enrolling to the health insurance program in your home country, you may be considered for an exemption. Please ask to the NHI Eligibility Section for more information. Please renew your Period of Stay (P7~8) The expiration day of the NHI Card is set on the expiration day of the Period of Stay. Even though, your NHI Card validity has expired or your Period of Stay has changed to three months or less, you may be able to extend your NHI membership if you apply for renewing your Period of Stay before its expiration day. If you wish to continue your NHI membership, please inquire the NHI Eligibility Section. You must register your change of address within 14 days of moving (P5~8) If you have moved into Shinjuku City or moved out of Shinjuku City, you must bring your National Health Insurance Card to the City Office and register your new address within 14 days of moving. You cannot use your Shinjuku City National Health Insurance Card once you move out of Shinjuku City. Please pay your insurance premium by the due date (P9~16) Please pay your insurance premium at the time of enrollment procedures or by using the payment slips, which will be mailed to you. Register your address at the post office and write your name on your home mail box so that mails will reach you. When you leave Japan or move out of Shinjuku City, please pay off your outstanding insurance premiums prior to your move. My Number (Individual Number) is required My Number (Individual Number) is required for enrolling to the National Health Insurance Program. Please bring your Individual Number Notification Card or My Number Card in addition to your Residence Card. (There are some exceptions such as for Diplomatic Visa holders.) Table of Contents The National Health Insurance Program... 1 National Health Insurance and Nursing Insurance... 1 National Health Insurance Program Eligibility... 3 Joining, Withdrawing and Other Procedures... 5 The National Health Insurance Card...7 Elderly Members Certificate... 9 Premiums... 9 Notification Concerning Your Insurance Premiums... 9 How Your Insurance Premium Is Calculated (FY2017)... 11 Premium Reduction and Exemptions... 13 How To Pay Your Premium... 15 Consultation On Premium Payments... 17 If You Default On Your Premium... 17 Penalties for Non-Payment... 19 Your Insurance Benefits... 19 Reimbursement for Medical Expenses... 21 High-cost Medical Care Benefit... 21 Meal Charges During Hospitalization.................. 25 Consultation for Medical Expense Payment... 27 Payment of Lump-sum Childbirth and Childcare Allowance and Funeral Expense Allowance... 27 Health Facilities... 29 Special Health Checkups/Special Health Guidance/ Non-Obese Health Guidance... 29 Dental Checkup... 29 2
The National Health Insurance Program Everyone who lives in Japan, regardless of citizenship, must participate in at least one health insurance program. Japanese medical insurance is divided into two categories: employee s health insurance and resident health insurance. Employee s health insurance covers medical expenses for company employees. Resident health insurance is for those who are not eligible to join company health insurance. It is called Kokumin Kenko Hoken (National Health Insurance) or Kokuho for short. Each member pays premiums based on his/her income. This pooled fund can then be used to defray the medical expenses of members when they become ill or injured. Similar to their Japanese counterparts, foreign residents also must participate in one of the insurance plans. Issues inurance card Pays insurance Premiums Insurer (Shinjuku City) The Insured (Participants) Covers 70% of the cost of medical care Provides medical treatment Charges 70% of the cost of medical care Pays 30 percent of medical fees upon presentation of Kokuho-sho Medical institution Kokuho-sho is short for Kokumin Kenko Hoken Hihokensha-sho, or National Health Insurance Card National Health Insurance and Nursing Insurance While Japan boasts one of the longest life-span in the world with its high quality medical healthcare, the number of elderly people who are bedridden or suffering from dementia is increasing. As family members get older, it is difficult for families to provide adequate care. Furthermore, there is a chance that we ourselves may need nursing for an illness associated with aging, such as cerebral apoplexy. With these considerations in mind, the system of Nursing Insurance Program was launched. The purpose of this program is for society as a whole to support each other and bear the cost of nursing for the elderly. Members of the National Health Insurance Program who are 40 to 64 years old pay premiums for the Nursing Insurance Program together with the Health Insurance premium. If you become ill with any of the designated illnesses, such as cerebral apoplexy, you can take advantage of the services available as a member of the Nursing Insurance Program, after obtaining approval for your nursing needs. National Health Insurance Program Eligibility Registered residents in Shinjuku can enroll to National Health Insurance Program in Shinjuku City. Who May Not Join the National Health Insurance Program: Those who are obliged to enroll in the heath insurance plan at their place of employment. Those who can be the dependent member of the health insurance plan at their family memberʼs place of employment. Those who are receiving welfare benefits. Those whose visa category is Designated Activity issued for medical purpose. Those whose visa category is Designated Activity issued for tourism, vacation and other similar activities. Those who have overstayed. Those whose Period of Stay is less than three months. (However, those whose visa is for Entertainment, Technical Training, Stay with Family or Designated Activities and who can prove staying in Japan for more than three months may be able to enroll the NHI.) Those who are enrolled in the Late-elderly Persons Medical Care System. (Note) If you are an employee of a corporation or a small business office of 5 or more employees, you must be enrolled to the health insurance plan at the place of employment. If you are eligible for National Health Insurance Program, you cannot withdraw from the National Health Insurance without proper reasons. * Even if you have coverage from your international student insurance, life insurance with medical options or travelers insurance, you cannot withdraw from the National Health Insurance. (Those insurances are not considered to be a publicly-managed health insurance program in Japan.) To ensure receiving items from the city office in mail, register your address to the post office and put your name plate on your mail box at home so that mails will reach you. The city will investigate and may cancel your residence and National Health Insurance eligibility in Shinjuku City when mailed items from the city office are returned several times. 3
Joining, Withdrawing, and Other Procedures The head of the household must register within 14 days if any of the followings occur: In case of delayed notification, the NHI only covers the medical care received on or after the day of the issuance of Kokuho-sho. Furthermore, you must bring a proof document for your My Number (Individual Number) in addition to the following documents. (except notifications for childbirth or move-in to Shinjuku City from another county.) 1. Joining the National Health Insurance Program For enrollment procedures of National Health Insurance Program, you must bring the following documents in addition to your Resident Card or your Special Permanent Resident Certificate. Each of insured members will receive their own National Health Insurance (NHI) Card. Please keep this small NHI Card in a safe location. When Necessary Documents Contact Location *1 When you move into Shinjuku City from another city in Japan passport or from another country When you withdraw from the health insurance plan at your place of employment When you become ineligible to receive welfare benefits When you give birth *2 Notification of Move In Family and Resident Registration Division Resident Registration Section National Health Insurance Enrollment Medical Insurance and Pension Division National Health Insurance Eligibility Section Certification of withdrawal from your company s health Medical Insurance and Pension Division insurance plan National Health Insurance Eligibility Section Notification of Welfare Termination Your National Health Insurance Card Registration for Newborn Family and Resident Registration Division Family Register Section National Health Insurance Enrollment Medical Insurance and Pension Division National Health Insurance Eligibility Section *1 Branch Offices also handle the above notification procedures. *2 When you gave birth, you would receive the Payment of Lamp- Sum Childbirth and Childcare Allowance. (Refer page 27) 2. Withdrawing from the National Health Insurance Program For withdrawal procedure of National Health Insurance Program, you must bring the following documents in addition to your Resident Card or your Special Permanent Resident Certificate. When Necessary Documents Contact Location When you move out of Shinjuku City When you leave Japan and/or return to your country When you join the health insurance plan at your place of employment When you begin receiving social welfare benefits When a member dies *2 No additional documents are required The health insurance card issued by your employer Notification that you have started to receive social welfare benefits National Health Insurance card Family and Resident Registration Division Resident Registration Section Medical Insurance and Pension Division National Health Insurance Eligibility Section Family and Resident Registration Division Family Register Section *1 Branch Offices also handle the above notification procedures. *2 When a member dies, his/her family can receive a funeral allowance. (Refer Page 29) 3. Other Occasions When Necessary Documents Contact Location When you change residence inside Shinjuku City When the head of household or your name was changed When Designated Activity Visa was renewed When you lost your National Health Insurance Card Resident Card or Special Permanent Resident Certificate, and National Health Insurance Card Resident Card, passport, (specification) and National Health Insurance Card Resident Card or Special Permanent Resident Certificate Family and Resident Registration Division Resident Registration Section, and Branch Offices Medical Insurance and Pension Division National Health Insurance Eligibility Section Medical Insurance and Pension Division National Health Insurance Eligibility Section and Branch Offices For enrolling or withdrawing procedures of National Health Insurance Program or procedures of other notifications are handled at the following locations: Family and Resident Registration Division Resident Registration Section Shinjuku City Office Main Building 1 st Floor 7 th Window Family and Resident Registration Division Family Register Section Shinjuku City Office Main Building 1 st Floor 9 th Window Medical Insurance and Pension Division National Health Insurance Eligibility Section Shinjuku City Office Main Building 4 st Floor 7 th Window The National Health Insurance Card The National Health Insurance Card is your proofing document for your insurance coverage. When you go to a medical institution, always bring your insurance card with you and show it to the reception desk of medical facility. Make sure that your name, address, and the other entries on the card are correct. If you find an incorrect entry, do not alter it yourself; notify the National Health Insurance Division. Information printed on your National Health Insurance card is based on the information from your Residence Registration. NHI card will expire on the same day when your resident status in Japan will expire. If you apply for the renewal of your Period of Stay in Japan before its expiration day, the law allows you to stay in Japan and you may be able to extend your NHI eligibility without your renewed Resident Card on hand. Please contact the NHI Eligibility Section for more information. Report any changes in household member status. Make sure to submit a moving-out notification when you leave Japan to return to your home country. (The National Health Insurance Card is void once you leave Japan. You must apply for a new one upon your reentry into Japan.) The National Health Insurance Card issued by Shinjuku City becomes void when you move out of Shinjuku City. (If you use an invalid National Health Insurance Card, you will be charged 70 percent of the medical fees for misusing the card.) Never let others use your National Health Insurance Card. (Those who illegally use the National Health Insurance Card will be charged with fraud and punished.) * A space is provided on the back of the Health Insurance Card for to write your wishes as to whether or not you want to donate your organs. Japan Organ Transplant Network Tel.: 0120-78-1069 (toll-free number) URL: https: //www.joinw.or.jp (in Japanese and English only) 4
Elderly Members Certificate From the next month following a person s 70th birthday (or the birth month if the birthday falls on the first of the month) until he/she becomes eligible for the Late-elderly Persons Medical System, the person holds eligibility for the Elderly Members Certificate. This certificate will be mailed out to those who are eligible. The percentage of fees for which the individual is responsible [20% (10% for those who are eligible for the special measure) or 30%] depends on the standard amount of taxation. Be prepared to present both your Kokuho-sho (NHI Card) and your Elderly Members Certificate when you visit a medical institution. Premiums To cover medical expenses in case of illness or injury, a designated portion of the total cost for medical treatment is charged to members in the form of insurance premiums. Also, members of the National Health Insurance Program who are 40 to 64 years old pay premiums for the Nursing Insurance Program together with their National Health Insurance Program premiums. Members of the National Health Insurance Program (the Insured) must pay premiums. Even those who are late in applying to join the program must pay the premiums retroactive to the day they became eligible to join, not just starting the month they made the application. The premiums are calculated on per-household basis, and the head of the household is responsible for premium payments for his or her household. The head of the household is also responsible for the premium payment for other members of the household even if the head of the household himself/herself is not a member of the National Health Insurance Program. Notification Concerning Your Insurance Premiums Premium statements are sent out in June. The insurance premium for 2017 (April 2017 to March 2018) is calculated in June after the base amount for calculation is determined. The annual premium is paid in 10 installments between June and the following March. Households whose number of NHI members changes or whose base amount for calculation changes during the fiscal year will receive a notification for premium changes. Individuals who move into Shinjuku City on or after January 2, 2017 and individuals who file their tax returns late will be notified only of their per capita levy amount. The base amount for calculation is notified once it is figured out. Annual Insurance Premium Payment Term APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR Coverage Term How Your Insurance Premium Is Calculated (FY2017) Premium for Medical Insurance Premium for Elderly Health Care Support Premium for Nursing Insurance = Premium for National Health Insurance FY2017 Annual Insurance Premiums Medical treatment expenses (portion for medical treatment) Per-capita amount 38,400 the number of NHI insured in the household Income-based amount FY 2017 base amount for calculation imposed on all NHI insureds in the household*1 7.47 / 100 The maximum ceiling is 540,000 *2 Support for late-elderly persons (portion for support) Per-capita amount 11,100 the number of NHI insured in the household Income-based amount FY 2017 base amount for calculation imposed on all NHI insureds in the household *1 1.96 / 100 The maximum ceiling is 190,000 *2 Long-term Care (portion for nursing care) Per-capita amount 15,600 The number of NHI insured in the household who are 40 to 64 years of age Income-based amount FY 2017 base amount for calculation imposed on NHI insured in the household who are 40 to 64 years of age 1.46 / 100 The annual ceiling is 160,000 *2 *1 Base amount for calculation is Gross earning in the previous year - Basic deduction of 330,000). *2 Maximum ceiling: If the calculated annual premiums for Medical Insurance, Elderly Health Care Support, and Nursing Insurance exceed each annual ceiling amount as indicated above, the annual premium amount will be same as the annual ceiling amount. (However, this does not apply to previous years' premiums.) When a Member Turns 40 or 65 Years Old during the fiscal year Members of the National Health Insurance Program who are 40 to 64 years old must also pay the insurance premium portion for nursing. For those who turn 40 years old during the fiscal year, the premiums for nursing insurance are imposed from the birth month and the amount will be added from the following month. For those who turn 65 years old during the fiscal year, the premiums for nursing insurance are imposed until the month before the birth month. Such members pay the premiums for nursing insurance in installment payments by March of the following year. 5
Premium Reduction and Exemptions 1. Pro-Rated Per Capita Sum Reduction If a household s income from the previous year is below a certain level, the pro-rated per capita sum will be partially reduced depending on the amount of income (It is automatically calculated according to the residents tax of the fiscal year.). In order to receive this service, the head of household's and all insured family members' income in the previous year must be filed. Those who have no income must file a tax return, too. (Except for those under age 20). If you have not filed your tax, please file your income-tax return or residents tax, or declare information regarding the National Health Insurance. 2. Premium Reduction System for involuntarilyunemployed persons Those who have lost their job due to being laid-off, bankruptcy, or termination of employment contract may be considered for reduced premiums. To be qualified for this discount, you need to submit your certificate of eligibility for unemployment insurance benefit. Please inquire for details. 3. General Reduction and Exemptions If disaster, disemployment, failure in business, illness, or the other circumstances threaten your livelihood and your income falls below a certain level, leaving you unable to pay your premium, you may be eligible for reduction and/or exemption in paying the premium. Please contact the National Health Insurance Division early on. 4. Premium Reduction or Exemption Due to Shift to the Longevity Medical Care System for the Elderly Those aged 65 or older who was a dependent family of an individual whose insurance changed from an employer-sponsored health insurance to the Longevity Medical Care System for the Elderly may join the National Health Insurance and apply for the premium reduction. for International Students Please apply for Premium Reduction every fiscal year. (The fiscal year is April to the following March.) International Students need to bring 1NHI Card, 2Student ID or their permit for entering school, 3Resident Card to apply for NHI Premium Reduction at the NHI Eligibility Section of Medical Insurance and Pension Division (Shinjuku City Office Main Building 4th Floor 7th Window) during April and May every year. If you move into Shinjuku City in June or after, you can apply for it when you just move in. If your income during the previous year exceeded 980,000 yen, you must file a tax return. Those who complete Income Tax Return (Income Tax Return or Local Resident Tax Return) do not need to apply for NHI premium reduction. Even if you apply for NHI premium reductions, the premium reduction may be cancelled during the year in according to the income information from the tax return. How To Pay Your Premium For more information, contact the NHI Premium Collection Section. Available methods for premium payment are: automatic transfer from your bank account, payment with the premium statement, automatic withdrawal from your pension or Mobile Register (mobairu reji). 1. Payment by Automatic Transfer Under this system, your premium is withdrawn automatically from your saving account. If you are visiting Japan for a shortterm such as for attending school, please make payments with the payment slips designated by Shinjuku City. The application forms for automatic transfer: Mailing together with the Statement of Health Insurance Premium in June. Also, you can pick it up at the Shinjuku City Office or the Branch Offices. Submit to: Shinjuku City Office, Branch Offices, banks, post offices. (You can mail your application to the Shinjuku City Office, too.) You need to bring: National Health Insurance card, bankbook, registerd seal for your bank account or post office saving account. * A couple of months after your application submission, a post card will be mailed to notify you the starting day of the automatic transfer. * In late December, a post card will be mailed to notify you the withdrawal amount from your bank account for insurance premiums of that year instead of issuing receipts. 2. If You Choose to Pay With the Payment Slips (1) Pay at one of the following financial institutions by the end of the month: Shinjuku City Office or Branch Offices Banks, credit banks, and credit unions in Tokyo Post offices and Japan Post Banks in Tokyo, Chiba, Saitama, Kanagawa, Yamanashi, Gunma, Tochigi or Ibaraki prefectures Convenience stores designated on the back of the payment slips (2) Your premium statements are mailed semi-annually. * June (Annual total and June through September) * October (October through March next year) 3. Automatic Withdrawal from Pension Premiums are automatically withdrawn from your pension on the predetermined months (6 times a year). This method is only available if: the head of the household is a member of the National Health Insurance and all NHI member of the household are aged between 65 and 74 who fulfill certain requirements (Except those under the Automatic Bank Transfer System.). 6
4. When using Mobile Register (mobairu reji) You may also pay the premiums from your cell phone or smart phone through Mobile Register service. How to use: * Apply at a financial institution to use the Mobile Register service. * Download the application for cellular phone and smart phone when you use the service for the first time. Access by QR code or https://bc-pay.jp/mobile/a/wa01.html * Take a picture of the bar-code on the payment slips using the camera on your cell phone or smart phone and follow the instructions. * Please note that no receipt will be issued. Consultation on Premium Payments For more information, contact the NHI Premium Payment Consultation Section. If you have difficulty in making premium payments due to special circumstances, please consult with us at the consultation counter as soon as possible. The Consultation about premium payments is available on the holiday service day (normally fourth Sundays). If You Default on Your Premium For more information, contact the NHI Premium Payment Consultation Section. The collection notice will be sent when the insurance payment is past due. Furthermore, collection calls and collection letters will be sent. If no payment is received, the following actions may be taken: 1. Issue of Short-Term Membership Card To communicate with the non paying household, NHI Card with a shorter validity period will be issued. 2. Suspension of the National Health Insurance Card The household who do not respond to repeated requests for payment or to recommended counseling will be asked to surrender their National Health Insurance Card. You have to return the National Health Insurance Card if you will be requested to surrender it by Shinjuku City. 3. Certificate of Eligibility for National Health Insurance Shinjuku City issues a Certificate of Eligibility for National Health Insurance to the household whose National Health Insurance Card has been revoked. If you show this card at the medical facility, you will receive medical services provided by the National Health Insurance. However, you must pay 100 percent of outstanding medical fees at the medical facilities. (The medical fees paid by the insured will be reimbursed on a later day upon a request. However, if you have unpaid NHI premiums, some or all of this reimbursement may be used to cover the delinquent amounts.) The regular NHI card will be re-issued after the delinquent amount will be paid off. 4. Denial of National Health Insurance Benefit All or a portion of benefits such as the major medical expenses or special medical expenses may be suspended. Being charged with the above penalties does not absolved the tax liabilities. Penalties for Non-Payment For more information, contact the NHI Premium Payment Consultation Section. Shinjuku City will impose other penalties (such as seizure of property) according to the law if the household continues non-payment status without any justifiable circumstances. Your Insurance Benefits When you get sick or injured, you pay a portion of your medical costs (co-insurance payment) at the medical facilities for your medical services through your National Health Insurance (NHI) Card. The rest of cost will be paid from the insurer directly to medical facilities. Persons aged 70 through 74 need to show both NHI and Elderly Benefit Certificate. Co-Insurance Payment Preschool aged children 20% School aged to 69 years old 30% Individuals aged 70 and older (Those whose birthday is April 2, 1944 or after) 20% (Special Measures: Those whose birthdays is on or before April 1, 1944.) 10% (Those whose income exceed a prescribed amount*) 30% * Those whose income exceeds a prescribed amount: Households with those aged 70 and older whose taxable income of 1,450,000 or more. Cases which National Health Insurance Card may not be used for Medical check-ups, Inoculations; Normal pregnancy and delivery, Abortion for economic reasons; Cosmetic surgery; Injury or illness caused by fighting, drunkenness, or the other destructive behaviors; Injury or illness which occurs during work; Bed surcharges at hospitals In case of Traffic Accident, etc. The established principle is that whoever is responsible for inflicting the injuries in traffic accidents and other incidents bears the costs of medical treatment required. However, when circumstances compel you to use your own National Health Insurance Card for the treatment of your injuries, be sure to submit a Report of Injury Caused by Another Person to the National Health Insurance and Pension Division of the Shinjuku City Office. The money to pay the medical expenses is advanced by the insurer and then charged to the responsible person. To report, a proof document of identity (ID), and proof documents of Individual Numbers of the person who received medical treatments and the head of his/her household. (Please inquire for more details.) 7
Reimbursement for Medical Expenses In the following cases, you will have to pay the medical fees in full and apply for reimbursement. Your reimbursement application will be reviewed. You may receive approved reimbursement in approximately three months. Some treatments may be determined to be inappropriate for coverage by the National Health Insurance Program. Claims for reimbursement must be filed within two years from the following day of your medical treatment. (1) If you suddenly got ill while traveling or there are the other reasons why you cannot show your National Health Insurance Card at the time of medical treatment (2) If you have therapeutic equipment (such as a corset) made on the advice of a physician (3) Acupuncture or moxibustion expenses on the advice of a physician (4) If you receive medical treatment while traveling overseas for reasons beyond your control, such as a sudden illness (Not subject to the reimbursement if the purpose of your overseas travel was to receive treatment). In addition to the following documents, please present your National Health Insurance Card, family stamp (a seal uses with vermilion ink) of the head of the household, and a document such as a bank passbook which identifies the bank, branch name, and account number of the head of the household. An applicant must bring a proof document for his/her identity. (Please inquire for more details.) 1 2 3 4 Categories of Claims When you could not present your National Health Insurance Card Corset and other therapeutic devices Treatment by acupuncture or moxibustion When you receive medical treatment while overseas Documents to Submit Receipts of all medical fee you paid, and an itemized statement of medical expenses (issued by the medical institution) Physician s statement to document the need for the device, and the receipt showing the amount paid Physician s statement documenting that the treatment was required, and receipt for payment of fee Itemized statement of treatments rendered and itemized receipts (translated into Japanese if the originals are in a foreign language) The passport of the person who had got medical treatment and the consent form to be investigated. High-cost Medical Care Benefit When the amount of medical expenses paid within a single month exceeds the ceiling for an individual's out-of-pocket limits and certain conditions are met, the amount accrued will be reimbursed accordingly. This ceiling is determined on the basis of the person s age, household income, and medical expenses. 1. Individuals Aged Under 70 When the individual out-of-pocket amount paid to a single hospital in a given month by the same person exceeds the ceilings shown in the table 1 When a self-payment of 21,000 or more is paid by a single household two or more times in a single month, and the sum of those payments exceed the designated ceiling Ceilings on Personally-borne Expenses (Table 1) Households with income of 9,010,000 or more Households with income of 6,000,000 or more but less than 9,010,000 Households with income of 2,100,000 or more but less than 6,000,000 Households with income of 2,100,000 or less Households exempt from the residential 252,600 When medical expenses exceed 842,000, 1% of the exceeded amount over that limit is added 252,600 (medical expenses minus 842,000)1% 167,400 When medical expenses exceed 558,000 1% of the exceeded amount over that limit is added 167,400 (medical expenses minus 558,000) 1% 80,100 When medical expenses exceed 267,000 1% of the exceeded amount over that limit is added 80,100 (medical expenses minus 267,000) 1% 57,600 35,400 * Gross income minus basic deductions ( 330,000) is defined as income. * Households that include any member whose amount of income is unknown are categolized as Huseholds with income of 9,010,000 or more. Notes: * Figures are calculated separately for hospitalization and outpatient care, even if care is received at the same hospital. * Medical expenses not covered by National Health Insurance, such as hospital bed surcharges, are excluded from these computations. Certificate of Maximum Out-of-Pocket Expenses When you present your Certificate of Maximum Out-of-Pocket Expenses at the medical facility, your payment at the medical facility will be no more than your out-of-pocket maximum amount. You may request for issuing the Certificate of Maximum Out-of- Pocket Expenses at the National Health Insurance Benefit Section. An applicant must bring a proof document for his/her identity and proof documents for the Individual Numbers of head of household and the eligible person in addision to the eligible person's NHI card. (Please inquire for more details). If you have past due insurance premium payment, the Certificate of Limited Liability will not be issued. Please ensure your premium payment s status. 2. Individuals Aged 70 and Older (Excluding Those Eligible for the Late-elderly persons Medical System) For those who are aged 70 and older, ceiling B is applied after ceiling a for outpatient care as Table 2. For hospitalization, ceiling B is applied. Ceilings on Personally-borne Expenses (Table 2) (until July 2017) Category Those whose income exceeds a prescribed amount Residential Tax Exe pt Individual burden Outpatient Total for outpatient and care A hospitalization care B (per individual) 30% 44,400 General income 20 (10)% 12,000 44,400 Low income 20 (10)% earner II 8,000 24,600 Low income 20 (10)% earner I 8,000 15,000 80,100 (Medical expenses 267,000) 1% It varies depending on the composition and income of the household. Please inquire for details. 8
For outpatient cares from August 2017, the maximum coinsurance amount for individuals aged 70 or older (except those who are qualified for the Late-Elderly Medical Insurance) will be changed as the following table. Amounts may differ according to your household structure and household income. Please inquire for more information. Ceilings on Personally-borne Expenses (Table 2) (Effective August 2017) Category Those whose income exceeds a prescribed amount Individual burden Outpatient care A (per individual) 30% 57,600 General income 20 (10)% * 14,000 57,600 Low income 20 (10)% 8,000 24,600 earner II Residential Tax Exempt Low income earner I 20 (10)% 8,000 15,000 Total for outpatient and hospitalization care B 80,100 (Medical expenses - 267,000) x 1% Changes are bold framed parts. * 144,000 is an annual ceiling for total of co-insurance cost during a year (Aug. ~ Jul.) for outpatient cares. Individual Burden for Long-term Hospitalization Seniors 65 or older who are under long-term hospitalization are responsible for the following basic costs and the rest will be covered by the insurer. Category Households have resident taxable income Residential tax exempt household II Residential tax exempt household I Basic cost 460 (Meal cost) 320 (Living expense) (per meal) (per day) 210 (Meal cost) 320 (Living expense) (per meal) (per day) 130 (Meal cost) 320 (Living expense) (per meal) (per day) * From October, 2017, Living Expenses during medical treatments will be changed from 320 yen per day to 370 yen. Also, Living Expenses of 200 yen per day will be charged for the Category II and III of hospitalized medical treatments (except those who have designated incurable diseases). Please inquire for more details. Ceiling Applied/Basic Cost Reduction Certificate There will be a limit to the individual out-of-pocket medical cost to be paid at the hospitals for households that are residential tax-exempt by presenting the Ceiling Applied/Basic cost Reduction Certificate. If you wish to receive this certificate, please apply at the NHI Benefits Section. For application, in addition to the eligible person s NHI Card, a proof document for the applicant's identity and proof documents for the Individual Numbers of head of household and the eligible person. (Please inquire for more details). The eligibility starts from the first day of the month you applied. 3. Procedure If you or your household is eligible for this benefit, the statement of eligibility and application for payment will be mailed to you within two to three months after medical treatment. Fill out the form, put your seal impression on it and take it to the Benefits Section. Claim for the benefit must be filed within two years from the next day you received medical cares. An applicant must bring a proof document for his/her identity and proof documents for the Individual Numbers of head of household and the patient. (Please inquire for more details.) Meal Charges During Hospitalization Basic Cost Basic cost (per meal) of the hospital meal must be self-paid and the rest will be covered by the insurer. Category Basic cost (per meal) Households have resident taxable income 360 * Households exempt from the residential tax Hospitalization of up to 90th day 210 Hospitalization exceeding 90 days 160 Those with a Reduction Certificate [I] in a household exempt from the residential tax 100 * The basic cost is 260 yen for patients with designated intractable diseases or pediatric patients with designated chronic diseases and whose households are exempted from the resident tax. Households with all members that are exempt from the residential tax must apply for a Basic Cost Reduction Certificate. To learn how to apply, contact the NHI Benefits Section. 9 Consultation for Medical Expense Payment If you have difficulty in paying your part of the medical expenses due to natural disaster or loss of job, there is a program to help you; the portion you are responsible for paying may be reduced, or you may be exempted from such payment. If you have a difficulty, please consult the NHI Benefit Section before being admitted to hospital. An applicant must bring a proof document for his/her identity. Please inquire for more details. Payment of Lump-sum Childbirth and Childcare Allowance and Funeral Expense Allowance 1. The amount of Lump-sum Childbirth per person is 420,000 The Lump-sum Childbirth is paid directly to the medical institution as the childbirth expense from thenational Health Insurance member who gave birth (Direct payment system). It is also applicable in case of stillbirth or miscarriage for pregnancy over 12 weeks and 1 day (85 days) (Both cases require a doctor's certificate). To use this system, you need to go through the procedure at the medical institution. For more details, please inquire with the medical institution or the NHI Benefits Section. Please inquire with the NHI Benefits Section if you do not wish to use the Direct Payment System. If you give birth while overseas, an original birth certificate is required for coverage. If the original certificate is in a foreign language, it should be submitted with a Japanese translation. Also, the passport (original) of the person who gave birth is required (Please inquire for more details in Japanese). Please inquire to the NHI Benefits Section about processing of an application beforehand. Claim for these benefits must be filed within two years beginning the day after childbirth.
2. Funeral Expense Allowance When a participant dies, the National Health Insurance Program will pay 70,000 to the person who is responsible for arranging the funeral. Application requirements The original copy of the receipt for the funeral, bank information of the person who paid for the funeral, name seal, and the Health Insurance Certificate of the deceased. An applicant must bring a proof document for his/her identity (Please inquire for more details). Claim for these benefits must be filed within two years beginning after the day of the funeral. To promote and maintain the good health of National Health Insurance Program members, Shinjuku City conducts the following programs: Health Facilities For more information, contact the Public Affair Subsection, 1. Subsidizing Portion of Summer Resort Lodging Fees When you use the lodging facilities that are affiliated with traveler's agencies contracting with Shinjuku City, Shinjuku City subsidizes the portion of fees. Additional information can be found in the Shinjuku Town News (In Japanese). 2. Recreation Facilities You can use Kanpo no Yado in nation wide with 500 yen discounted price per night per person. Please refer a panphlet distributing at Shinjuku City Office Main Building 4th Floor the 5th Window or Branch Offices and make a reservation directly to each facility. Special Health Checkups/Special Health Guidance/ Non-Obese Health Guidance For more information, contact the Health Checkup Subsection, Health Promotion Section. Special Health Checkups, Special Health Guidance, and Non-obesity Health Guidance are offered to those aged between 40 and 74. Please inquire for further details. Dental Checkup For more information, contact the Health Checkup Subsection, Health Promotion Section. Those who are over the age of 20 will be offered a dental checkup at designated dental clinics and institutions in Shinjuku during the period from June to December. Check for cavities and gum diseases and consult about your oral health. Please inquire for details. 10
こくみんけんこうほけんあんない国民健康保険のご案内 へいせい平成へいせい ねん 29 年 ど度 ばん版がつ ねんはっこう平成 29 年 4 月発行へんしゅうはっこう編集 発行しんじゅくくけんこうぶいりょうほけんねんきんか新宿区健康部医療保険年金課しんじゅくくかぶきちょう 160-8484 新宿区歌舞伎町 1-4-1 でんわだいひょう電話 :03-3209-1111( 代表 ) FAX:03-3209-1436 印刷物作成番号 2017-3-3208