Long-term Care Insurance System

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1 Long-term Care Insurance System The long-term care insurance system supports the independence of the elderly and aims at establishing the community that guarantees a secure life to all the people Tokyo Metropolitan Government

2 Structure of the Long-Term Key Policies The number of the elderly is going to increase rapidly to the year 2015, and the population of later stage elderly people (age 75 and over) is estimated to increase after the year In order to appropriately deal with nursing care issues peculiar to aging societies, the long-term care insurance system started in 2000 so that people who need nursing care can have enough social support. After its launch, there was a fast increase in the use of nursing care, especially home care service. Now, the long-term care insurance system has come to have an important role as a system to assure a comfortable life for elderly people and their family members. The long-term care insurance system gives those in need of long-term care due to a disease caused by an old age or for other reasons necessary services in a comprehensive and uniform way so that they can lead an independent life as much as possible. It is a user-oriented system where you can use the service you choose yourself. The population of elderly people in Tokyo Later stage elderly people (age 75 or over) Early stage elderly people (age 65-74) Source: Ministry of Internal Affairs and Communications Census (2000 to 2010) National Institute of Population and Social Security Research Population Projection for Japan Estimated as of May 2007 (2015 to 2035) The Number of Those who Use the Long-term Care Insurance System in Tokyo Facility services Community-oriented services Home care services Source: The Long-term Care Insurance Report

3 Care Insurance System Managing entity (insurer) The managing entity (insured) of the long-term care insurance system is your municipal office. The national government and the Tokyo Metropolitan Government provide support to the municipality to ensure an effective implementation of the long-term care insurance system. Members (insured individuals) Those aged 40 to 64 [Category 2 insured individuals] Those aged 65 and over [Category 1 insured individuals] Those whose mental or physical problem resulting in the care need condition, etc. is one of the 16 specified diseases caused by aging, such as dementia at the presenility and cerebrovascular disease. (For further details, see page 3.) Care (support) need certification Those not certified Elderly individuals likely to come to need care or support in the future Individuals Those certified as on the support 1 or 2 Those who need no continuous care but need some support in the daily life, such as support for dressing themselves. Those certified as on the care level 1 to 5 Those who need continuous care because of being bedridden, dementia, etc. Services available For more details of the service available, see page 5. Long-Term Care Prevention Services in a Community Secondary Prevention Service For elderly in danger of requiring Long-Term care, etc., provide services needed to prevent decline in mental, physical and lifestyle functions. Motor function improvement confinement, dementia, etc. Primary Prevention Service For all elderly: Lecture meetings, care prevention classes, training of volunteers for care prevention, etc. Preventive benefits Home care services help service service short-stay daily-life service, etc. (13 types) Community-oriented services life group care service for the elderly with Comprehensive Service by the municipality can be used. Care benefits Home care services etc. (13 types) Facility services requiring care (special nursing home for the elderly) elderly requiring care facilities for the elderly Community-oriented service Home help service at night. elderly with Foreign residents (living in Japan more than 3 months, special permanent residents, etc.) are subject to long-term care insurance.

4 The Flow of Long-Term Care Insurance System When you want to use the service of the long-term care insurance, you should first apply for a care need certification or a support need certification to your municipal office. If you get the certification, you can use the service according to the care plan the care manager, etc. draws up for you after consultation. Those who have not been certified and those whose life functions have become less active can use the care prevention service provided by the community support service. (For further details, see page 16.) Application for a certification The person who wants the service or his/her family member should apply to the municipal office directly. Those aged 65 and over These individuals are eligible for the benefits of the long-term care insurance regardless of the cause that necessitated long-term care. Those aged 40 to 64 These individuals are eligible for the benefits only when they came to need long-term care due to one of the specified diseases listed below. Long-term care insurance of your municipal office Cancer (at the terminal stage), Articular rheumatism, Amyotrophic lateral sclerosis, Ossification of posterior longitudinal ligament, Osteoporosis accompanied by fracture, Dementia at the presenility, Progressive supranuclear palsy, corticobasal degeneration or Parkinson s disease, Spinocerebellar degeneration, Spiral canal stenosis, Progeria, Multiple system atrophy, Diabetic neuropathy, diabetic nephropathy or diabetic retinopathy, Cerebrovascular disease, Arterioscerosis obliterans, Chronic obstructive lung disease, Arthrosis deformans accompanied by marked deformation in both of the knee joints or the hip joints Care (support) need certification Investigation by visit The (support need) certification makes judgment on the level of the need for care or support. Investigation by the visit After you applied for a certification, the investigator will visit you to give you an interview about your mental and physical conditions, the situation of your daily life and other related matters. First judgment The first judgment is carried out with a computer on the basis of the result of the investigation by the visit and part of the data contained in your doctor s opinion paper. Second judgment The second judgment is made by the care need certification committee composed of specialists in public health, medical care and welfare on the basis of the result of the first judgment, your doctor s opinion paper and the special matters found in the investigation by the visit. Notice of the judgment result The municipal office decides the level of the certified (support) need and other matters on the basis of the result of the second judgment and gives you notice of the decision.

5 Levels of the certified care (support) and services available Not certified Level of support Level of care need Preventive benefits service Care benefits service Long-Term Care Prevention Services in a Community Support Project There are cases in which a Care Prevention and Daily life Support Comprehensive Service by the municipality can be used. Drawing up a care plan When you want to use the service of the long-term care insurance, you and a care manager should first prepare a care plan, which is a combination of several types of service according to your need for care or support for an independent daily life. Those certified as on the care level 1, 2, 3, 4 or 5 Those certified as on the care level 1, 2, 3, 4 or 5 should request a care manager at the in-home care management office to draw up a care plan for them. You can also make a care plan by yourself. Those certified as on the support level 1 or 2 Those certified as on the support level 1 or 2 should request the comprehensive community support center to draw up a care plan for them. (For further details, see page 15.) You can also make a care plan by yourself. The upper limit to the cost of service you can receive from the long-term care insurance ( limit to benefits ) differs according to the level of care need or support need certified. (See page 14 for the limit to benefits.) Use of the service You use the service by signing a contract with a service provider on the basis of the care plan. When you sign this contract, check carefully the service hours, charges, contract clauses, cancellation procedures, settlement of complaints, and other related matters. You should bear 10% of the costs of long-term care service. But you should pay all the costs for the service you used beyond the limit to benefits. n some cases, those who have not been certified in the care of support need certification may use the service for helping you keep life functions offered by the community support service. For further details, contact the nearest comprehensive community support center. Instead of service use being the target, let s make the target be use of services to create suitable lifestyles. If you will enter a facility, apply to the facility you want to enter, and make a care plan at the facility entered.

6 Services Available from the Long- Term Care Insurance System Preparation of care plan Services given at home Two services are available in the long-term care insurance system. One is care benefits designed for those certified as on the care level 1, 2, 3, 4 or 5. The other is preventive benefits for those certified as on the support level 1 or 2. The aim of preventive benefits is to maintain and/or improve the vital functions of those who need some support in the daily life, in order to keep their condition from deteriorating. Community-oriented service meets comprehensively the needs of the elderly in the community where they have lived long. This service is available only to the residents of the municipality where the service provider or facility concerned exists. You can use services other than community-oriented service at facilities which exist in municipalities where you do not live. Preparation of care plan In-home care management (those certified as on the care level 1-5) The care manager will draw up a care plan according to the mental and physical condition, environment, wishes, etc. of the individual in need of care and contact the service provider to make necessary adjustments so that the individual may use in-home care service and other services properly. Care prevention management (those certified as on the support level 1 or 2) eed condition from worsening and the improvement, the comprehensive community support center will draw up a care prevention plan so that the individual may use in-home care which helps them to lead daily life independently. It is possible to make your own Care Plan. Services given at home Home help service For those certified as on the care level 1, 2, 3, 4, or 5 A caregiver visits the individual in need of care to provide care and household assistance such as meals, dressing, bathing cleaning, laundry, etc. For those certified as on the support level 1 or 2 A caregiver visits the individual and assists him or her with things such as bathing, excretion and housework in order to prevent them getting into the state of care need.

7 This is a community-oriented service, so it is available only to the residents of the municipality where the service provider or facility concerned exists. Home help service at night A caregiver periodically visits the home of the individual in need of care or the home that requested a visit at night to give them care or to look after them. Regular visits/on-call visits home help service The home helper or nurse visits homes periodically and when requested, to give care and medical treatment, etc. Only those certified as on the care level 1, 2, 3, 4, or 5 can use this service. Home-visit bathing service The staff visits those having difficult in taking a bath at their bathroom and helps them take a bath using, for example, a bathtub brought in the home. Home-visit nursing A nurse, etc. visits the individual in need of care to give them medical care service and supplementary medical examination service needed. Home-visit rehabilitation A specialist in therapy and rehabilitation will visit the individual in need of care to give them training for keeping or recovering their mental or physical functions and for leading daily life independently. Management guidance for in-home care A doctor, dentist, pharmacist, nurse or other medical professional will visit the home of insured members being treated at their home and provide health maintenance instruction.

8 Services Available Services given at a facility, etc. Services given at a facility, etc. Day service For those certified as on the care level 1, 2, 3, 4 or 5 The individual in need of care goes to a facility to have care for taking a bath, having a meal, etc. and to receive function restoring training. Some facilities offer services to improve oral function improvement, to achieve dietary improvement and services for those who have cancers or other serious diseases under the supervision of medical specialists. For those certified as on the support level 1 or 2 The individual go to places such as day service centers in order r to maintain and/or improve vital functions. Some facilities offer selective services: functional improvement through exercise e machines, dietary improvement, oral function improvement. Day service for the elderly with dementia have the care and function restoring training adapted to the characteristic needs of the elderly with dementia. The aim of this service is to enable the elderly with dementia to live independently at their home. Day rehabilitation service (day care) Those certified as on the care level 1, 2, 3, 4 or 5 can use the following service. The individual in need of care goes to a medical institution or health service facilities to have training for keeping or recovering their mental or physical functions and for leading daily life independently. Some facilities offer oral care or dietary improvement classes. For those certified as on the support level 1 or 2 The user receives a training for keeping and improving the life functions in order to live independently. Some facilities offer selective services: functional improvement through exercise machines, dietary improvement, oral function improvement.

9 This is a community-oriented service, so it is available only to the residents of the municipality where the service provider or facility concerned exis Short-stay daily-life service (welfare-oriented short-stay) The individual in need of care stays at a special nursing home for the elderly, etc. for a short period of time to have daily-life service and function restoring training. This can be used continuously for up to 30 days. Short-stay medical service (medical care-oriented short-stay) The individual in need of care stays at a medical institution, etc. to have medical care service and function restoring under the supervision of doctors and nurses. Users can stay 30 successive days or less. Care facility Small-scale and multifunctional in-home care The individual in need of care goes to a facility in the community where he or she is mainly involved. The facility offers services such as meal, bathing and functional improvement. This service allows for users to stay over at care facilities, or for staff to pay visits to the homes of users, which enables users to stay at home even if the care level progresses. There is also a service combining small multifunction in-home care with home-visit nursing. Short-stay Outpatient Care giver Home help service

10 Services Available Service given at a facility Service given at a facility Welfare facility for the elderly requiring care (special nursing home for the elderly) Those in need of continuous care who find difficulty in home life stay and live at this facility. This facility provides assistance with bathing, using the bathroom, eating, and daily chores. Only those certified as on the care level 1, 2, 3, 4, or 5 can use this service. Community-oriented welfare facility for the elderly requiring care (special nursing home for the elderly) Those in need of continuous care who find difficulty in home life receive care at a small-scale special nursing home for the elderly. The capacity is 30 or less. This facility provides assistance with bathing, using the bathroom, eating, and daily chores. Only those certified as on the care level 1, 2, 3, 4, or 5 can use this service. Health service facility for the elderly requiring care This facility provides for those who left hospital rehabilitation in order to assist them in being able to independently handle every day challenges. Only those certified as on the care level 1, 2, 3, 4, or 5 can use this service.

11 This is a community-oriented service, so it is available only to the residents of the municipality where the service provider or facility concerned exists. Sanatorium type medical care facility for the elderly requiring care This facility takes in those in need of daily medical care for a relatively long period of time, rehabilitation during the chronic period and long-term care. Only those certified as on the care level 1, 2, 3, 4, or 5 can use this service. Daily-life group care for the elderly with dementia (group home for the elderly with dementia) Five to nine people with dementia receive care while leading group life in a homely atmosphere. Those certified as on the support level 1 cannot use this service. Daily-life care service in specified facilities The individual in need of care receives care while living in a fee-charging home for the elderly, care house, etc. Some specified facilities outsource a certain amount of services to outside companies. So you can also use other care service in some specified facilities. Community-oriented daily-life care service e in specified facilities The individual in need of care receives care while living at a small-scale feecharging home for the elderly, care house, etc. Only those certified as on the care level 1, 2, 3, 4, or 5 and his/her spouse can stay at this facility. However, his/her spouse cannot receive care service Only those certified as on the care level 1, 2, 3, 4, or 5 can use this service.

12 Services available Other services Other services Rental of welfare equipment Those certified as on the care level 2, 3, 4, or 5 Insured members may rent welfare equipment such as special beds and wheelchairs to complete everyday activities. Those certified as on the care level or as on the support level 1 or 2 Insured members are only able to rent handrails, ramps, walkers, and walking sticks unless dictated otherwise in their Care Plan. Allowance for purchasing welfare equipment Since welfare equipment such as sitting-type toilets and bathing chairs come into direct contact with its user s skin, insured members can purchase them from a supplier specified by the municipal government. Insured members must first purchase the equipment using personal funds, then 90% of the amount is reimbursed (the maximum reimbursable amount is 90,000 per year). Allowance for home renovation n allowance for the small-scale home renovation such as installation of handrails and elimination of steps, is paid. Insure members must first pay the fee at full price using personal funds, the 90% of the cost is reimbursed (up to 180,000 a house). ersons are required to submit home renovation plans before beginning any renovation. Please contact your municipal office for details. What is community-oriented service? Community-oriented service is designed to provide a flexible service so that people can lead their lives at home or in their community. A. This service is available only to the residents of the municipality where the service provider or facility concerned exists. B. Your municipal office designates service providers. C. In accordance with local circumstances, your municipal office decides insurance premiums (only for visit care nursing with periodic visits and care as needed, home help service at night, small-scale and multifunctional in-home care, and combined services). D. Local citizens can participate in designation of service providers and decision of insurance premiums.

13 How to Choose a Service Provider When using a long-term care insurance system, the individual in need of care should use services with a company that best suits him/her. If you cannot decide which services and which service provider you should utilize, consult the municipal office or a Community Comprehensive Support Center. f you have your personal care manager, choose necessary services under his/her supervision. Under the Long-term Care Information Publication System, users are able to compare different providers and select one that appeals to them. Long-term Care Information Publication System You can easily find information about the services provided by facilities and their organization on the internet. Compare publicized information and choose the best service provider for you A Service provider Comparing information given by a provider and evaluation conducted by an assigned evaluation institution helps you to judge whether your service is appropriate or not. Users Effect of the information disclosure Care manager This system provides you with information shared by a care manager. Their families B Service provider Publicized information enables you to choose appropriate services for your parents who live separately. Evaluation conducted by Assigned Evaluation Institution Evaluation Institutions assigned by Tokyo Metropolitan Government conduct a number of evaluations on different providers, and ask user directly to confirm accuracy of reported information. You can check the Internet to see how each service providers are improving their services. Choosing an appropriate provider leads to the improvement of the service. Check Tokyo Fukushi Navigation for Long-term Care Information Publication System and assigned evaluation institutions

14 Facility Service Costs to Be Paid by the User 10% of service cost are borne by the user If insured members use service given at a facility(), the long-term care insurance system pays 90% of the costs, with the remaining 10% paid by the user. (Note): Welfare facility for the elderly requiring care, community-oriented welfare facility for the elderly requiring care, health service facility for the elderly requiring care, sanatorium type medical care facility for the elderly requiring care. Costs for meals, etc. to be paid by the user Cost for meals, for room, and for daily necessities are borne by the user. These amounts to be paid by the user are determined by the contract between the user and the service provider but are reduced based on the income bracket as shown in the table below. Rough amount of user payment (the care level 3)Ten thousand yen Welfare facility for the elderly requiring care (special nursing home for the elderly) Health service facility for the elderly requiring care Sanatorium type medical care facility for the elderly requiring care Unit-type private ward Multiple-bed ward (shared by two or more users) Multiple-bed ward (shared by two or more users) Multiple-bed ward (shared by two or more users) Level 1 Level 2 Level 3 Level 4 Level 1 Level 2 Level 3 Level 4 Level 1 Level 2 Level 3 Level 4 Level 1 Level 2 Level 3 Level 4 Care service costs (10% paid by the user) Food expenses Residential expenses Level 1: Welfare recipient or old-age welfare pension recipient who belong to non-taxed household Level 2: The insured member is exempt from paying municipal taxes and his or her total income and pension together is 800,000 or less. Level 3: The insured member is exempt from paying municipal taxes and don t belong to income bracket 1 or 2. Level 4: Taxed household Notes: 1. Figures are the rough estimates of the amount of the user payment per month (per 30 days), (before the application of the reduction by social welfare corporations and other organizations).actual figures can vary according to the region where a facility exists (the chart indicates the premium at the Tokyo wards). 2. The amounts in the Care service costs column are the amounts of payment by the user on the care level 3 after the high-cost care service benefits have been refunded. Total

15 Home Care Service Costs to Be Paid by the User 10% of service cost are borne by the user As for the home care service (services other than the facility services stated in the left page), the user has to pay 10% of the costs. The upper limit to the monthly amount of service use ( basic limit to benefits ) is determined for each care level. Costs for meals, etc. to be paid by the user As for the service given at a facility such as day service, the user has to pay both the food and living expenses at the facility. Care level Support level 1 Support level 2 Care level 1 Care level 2 Care level 3 Care level 4 Care level 5 Rough basic limits to benefits per month Rough amount of user payment (10% of the basic limit) when the insured members use services to the standard basic limit to benefits Note: The actual basic limit to benefits is determined by the number of units. The price per unit differs according to the municipality and the type of service. The figures in the table at left were calculated supposing the price per unit to be 10. As for a short-stay, the user has to pay both the food and living expenses. The amount of the user s payment is reduced according to the user's income level. Measures to reduce the payment by the user The following measures to reduce the payment of care service costs by the user are available. High-cost care service benefits When the user s total monthly payments of 10% of the care service provided exceed the prescribed upper limit, the amount exceeding is refunded to the user at their request according to the income bracket (see the table at right). If your payment for the medical insurance and the long-term care insurance is extremely high, you can receive high-cost care service benefits and high-cost medical/care service benefits. Welfare recipient Household exempted from municipal inhabitant tax Income bracket Old-age welfare pension recipient Household whose sum of taxable pension income and earned income is 800,000 or less Those who do not belong to bracket and Household on which municipal inhabitant tax is imposed Upper limit 15,000 per individual Measures to reduce the payment for those who live under difficult conditions As for those who are designated as living under difficult conditions by the municipalities, the payment of 10% of care service may be reduced to about 7.5%, and living and food expenses may be reduced to about 75%. Contact your municipal office for further details about measures available.

16 Community Support Service Community Support Service The Community Support Service aims to prevent the care need (support need) condition for elderly, and even if a person is in the care need condition, provides support to enable independent daily life as much as possible. It is provided by municipalities. Community Support Service Description Long-Term Care Prevention Services Care Prevention and Daily Life Support Comprehensive Service Comprehensive Support Service Voluntary Service See the next page. While using diverse manpower and social resources, this service comprehensively provides living support services (care prevention, food delivery, watching over, etc.) for people subject to the Support Need and Secondary Prevention Service. This service implements the Community Comprehensive Support Center. See 2. Community Comprehensive Support Center. This service supports stable operation of the Long-term Care Insurance Service, and independent daily lives of elderly the community. For and, the wards, cities, towns and villages decide which municipalities will provide the service. is provided by all wards, cities, towns and villages. is not provided by the municipality in some cases. Comprehensive community support center To assist the elderly in continuing to live in communities that have grown familiar to them, it is necessary to provide not only an insurance system, but comprehensive care which integrates various community resources: specialists in the field of health and medical support and welfare work, volunteers, etc. Municipalities set up Comprehensive Community Support Centers, where they assign staff such as head care managers, public health nurses and care workers. They use their expert knowledge and skills together to provide comprehensive support to elderly and their families, etc. Request for advice Those eligible for care Prevention service Management Cooperation Provision of support Care manager Caseworker Comprehensive community support center Support for activities Head care manager Community Comprehensive Support Center Description Care Management for Care Prevention, etc. To set up a care plan considering the motivation and the ability of the user for the purpose of successfully carrying out care prevention service. General consultation and guidance To build a network with related people in the community, offer consultation to the elderly and their family, and help them to receive proper services using appropriate systems and local resources. Protection of rights To functions as an information counter for protection of rights and prevention of cruelty to the elderly through introducing legal guardian system, finding out elder abuse in its early stage, or dealing with consumer issues in order that the elderly live with dignity. Extensive and continuous care management To support care manager and coordinate care manager and other medical facilities so that the elderly can receive appropriate services for their mental and health condition in a continuous way. can be offered by both municipal offices and comprehensive support centers.

17 Care Prevention Service The Care Prevention Service supports mental and physical improvements and environmental adjustments, to enhance the elderly s living functions and for participation in the community s social activities, with the aim of achieving meaningful lives and self-actualization in each person s life. There are two types. The first is the Primary Prevention Service for all elderly aged 65 or older. The second is the Secondary Prevention Service for specific elderly persons whose living functions decline and are likely to need care, etc. To participate in the Care Prevention Service, take the basic health check of decline in living functions. The flow of Care Prevention Service Those aged 65 and over Those certified as on the support level or on the care level cannot use this se Provision of Basic Health Check The decision is made based on the basic health check, which consists of questions such as Do you walk about 15 minutes continually? Those with declining life functions Those without declining life functions Secondary Prevention Service Specified elderly individuals take part in the following programs according to the care plan drawn up by a comprehensive support center. A. Exercise classes are set up for those whose physical strength has markedly deteriorated and are less active. Primary Prevention Service Lecture meetings, public relations programs at the section in charge of the municipal office, training of volunteers for care prevention and others. B. Lectures are held about nutrition for those who suffer from under nutrition. C. Lectures and training classes are held about brushing guidance, denture cleaning guidance, and rehabilitation so that people can continue to enjoy their food. D. A public health nurse visits specific elderly people for whom there is a risk of confinement to the home, senile dementia, or depression. In addition to these, some municipalities provide back pain and knee pain countermeasures programs, programs to prevent and support depression, self-confinement and dementia, etc. For more information, please contact your municipal office or comprehensive community support center.

18 Long-Term Care Insurance Premiums Insurance premiums for those aged 65 and over (Category 1 insurance premiums) Amount of insurance premiums The amount of insurance premiums for those aged 65 and over is calculated by multiplying the base amount determined by the municipality by the rate prescribed according to the income bracket, giving consideration to the income level of the insured. The amount of insurance premiums is based on the long-term care insurance plan made at each municipalities. The payment is calculated by dividing the 21% of the total cost by the population of those 65 and over. The long-term care insurance plan is revised every three years. Therefore, the present premiums are going to be applicable until fiscal Rough estimate of premium according to one s income bracket is as follows. For more details, please contact long-term care section of your municipal office. Income Level Applicable Persons Premium Level 1 Those who receive a livelihood protection allowance or an elderly welfare pension, and belong to a household in which all members of the household are exempt from paying municipal taxes. Standard amount X 0.5 Level 2 Level 3 Level 4 Level 5 Level 6 Those who belong to a household in which all members of the household are exempt from paying municipal taxes, and the insured Member s total income and pension together are less than 800,000. Those who don t belong to level 1 and level 2, and all the members of the household are exempt from paying municipal taxes. Insured member is exempt from paying municipal taxes but belong to a household in which someone must pay municipal taxes. Insured member is not exempt from paying municipal taxes and his or her total income is less than 1,900,000. Insured member is not exempt from paying municipal taxes and his or her total income is 1,900,000 or more. Standard amount X 0.5 Standard amount X 0.75 Standard amount Standard amount X 1.25 Standard amount X 1.5 Some municipalities charge lower insurance premiums for (a) people in Level 3 with previous year total income plus taxable pension income which totals 1,200,000 or less, or (b) people in Level 4 with previous year total income plus taxable pension income which totals 800,000 or less. Premiums can differ. For example, some municipalities divide income brackets into 7 categories. Others change how much the user has to pay according to its own calculation. How to pay insurance premium There are two methods for paying insurance premiums: special collection by which insurance premiums are deducted from the pension and ordinary collection by which insurance premiums are paid through a financial institution, etc. Special collection applies to those receiving 180,000 or more a year as an old-age retirement pension, survivor's pension or disability pension. Insurance premiums are deducted from the pension paid periodically (six times a year) to them. Ordinary collection applies to all the other people to whom special collection is not applicable, and a tax notice is mailed to them from the municipal office. The time and frequency of payment differ from municipality to municipality. Insurance premiums for those aged 40 to 64 (Category 2 insurance premiums) The amount of insurance premiums for those aged 40 to 64 is determined separately and collected as a part of the premiums for medical care insurance plans (e.g., National Health Insurance).

19 Total care benefits (hundred million yen) Delinquency in Payment of Premiums may impose Since the long-term care insurance is designed to mutually help the elderly people, even those who do not use this system have to pay premiums. When delinquent in making premium payments, certain restrictions are put on insurance benefits. Nonpayment for 1 yearchange in payment The insured Member must temporarily hear all necessary cost. Ninety percent of the cost that has been temporarily paid by the insured Member will be reimbursed to the Insured Member later if he or she files a claim with a local government. Nonpayment for 1 year and 6 monthstemporary Suspension of Benefits Payment of insurance benefits will be suspended. In some cases the amount of delinquent premiums will be deducted from the amount of suspended insurance benefits. Nonpayment for 2 yearsreduced Insurance Benefits Payment of premiums will not be possible after a period of 2 years has elapsed. In this case, the cost that must be personally borne by the Insured Member will be changed from the standard 10% to 30% over a set period of time. Furthermore, expenses for the high-cost care service benefits and others will not be reduced. Financial resources Insurance premiums (Category 2 insurance premiums) 29% Insurance premiums (Category 1 insurance premiums) 21% National Government 25% Tokyo metropolitan government 12.5% Municipalities 12.5% The chart above shows how financial resources of long-term care insurance are distributed. The national government provides 20% and Tokyo metropolitan government 17.5% of subsidies for welfare facilities. Since 5% of the total cost shared by the national government is used as a subsidy for adjustment and is distributed according to the financial situation of the insured, the percentage municipalities share can vary. Total care benefits and care premiums Total care benefits Monthly premium Year Source: Tokyo Elderly Health and Welfare Plan (Fiscal 2012 to 2014) Monthly payment is based on rough estimates of each municipalities. Average estimates of Tokyo municipality monthly premium (yen) Drawdown of Fiscal Stability Fund Metropolitan Tokyo set up a Fiscal Stability Fund, with the national, metropolitan and municipal governments each funding one-third. This provides fund grants and loans, to municipalities with care insurance fiscal shortages. Under the fiscal 2011 revision of the Long-term Care Insurance Act, in order to reduce increases in insurance premiums and to use long-term care insurance services, only in fiscal 2012, funds can be drawn down. The amount drawn down is returned one-third each to the national, metropolitan and municipal governments. Metropolitan Tokyo is using the returned amount for long-term care services: care service infrastructure development, obtain and maintain care staff, etc.

20 Points of Contact Points of contact of your municipality or comprehensive community support center Tokyo Metropolitan Federation of National Health Insurers' Associations Points of contact [complains about care services, etc.] Tokyo Metropolitan Government s points of contact Point of contact for the Tokyo Metropolitan [long-term care insurance system] Secretariat of the Tokyo Metropolitan Long-term Care Insurance Examination Committee [for complains about the result of care need certification, etc.] Tokyo Metropolitan Consumers Center [for consultation about contracts, etc.] General consultation Hotline for the elder who suffer from damage Hotline for the consumer of advanced years Tokyo Metropolitan Health and Medical Information Center [provides information about medical institutions, etc.] Publisher: Long-term Care Insurance Section, Aging Society Affairs Division, Bureau of Social Welfare and Public Health, Tokyo Metropolitan Government North side, 24th floor, First Building of the Tokyo Metropolitan Government Office, 8-1, Nishi Shinjuku 2-chome, Shinjuku-ku, Tokyo TEL: , FAX: Website of the Bureau of Social Welfare and Public Health:

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