National Health Insurance FY2015 Shinjuku City Office Medical Insurance and Pension Division Health Affairs Department Tel: 3209-1111 (Switchboard)
Main Points (please be sure to read the main text) Enrollment in the National Health Insurance Program is mandatory *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 city office for more information. Don t forget to register any changes or extensions on your Status of Residence *Those whose Period of Stay is changed to three months and less generally lose their membership in the National Health Insurance Program, however, in some cases, they may be allowed to continue their membership by application. If you have overstayed your Period of Stay you are no longer qualified to be a member of the program. You must register your change of address within 14 days of moving *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 once you move out of Shinjuku City. Please pay your insurance premium by the due date *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 mail will reach you. *When you leave Japan or move out of Shinjuku City, please have your insurance premiums adjusted (pay them prior to your move). Table of Contents The National Health Insurance Program............. 3 National Health Insurance and Nursing Insurance...... 3 National Health Insurance Program Eligibility........ 3 Joining, Withdrawing and Other Procedures.......... 4 The National Health................ 4 Elderly Members Certificate....................... 5 Premiums..................................... 5 How Your Insurance Premium Is Calculated (FY2015).. 5 Notification Concerning Your Insurance Premiums..... 6 Premium Reduction and Exemptions................ 6 How To Pay Your Premium....................... 6 Consultation On Premium Payments................ 7 If You Default On Your Premium................... 7 Penalties for Non-Payment........................ 7 Your Insurance Benefits.......................... 7 Reimbursement for Medical Expenses............... 8 High-cost Medical Care Benefit.................... 8 Food Charges During Hospitalization................ 9 Consultation for Medical Expense Payment.......... 9 Payment of Lump-sum Childbirth and Childcare Allowance and Funeral Expense Allowance........ 9 Health Facilities............................... 10 Special Health Checkups/Special Health Guidance/ Non-Obese Health Guidance................... 10 Dental Checkup............................... 10 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 the cost of medical care Provides medical treatment Pays 30 percent of medical fees upon presentation of Kokuho-sho Medical institution Charges 70% of the cost of medical care Kokuho-sho is short for Kokumin Kenko Hoken Hihokensha-sho, or National Health 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. We never know when our parents or our spouse will need nursing care. Furthermore, since family members also get older, it is difficult for families to provide adequate care. There is also the 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 Nursing Insurance Program. 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. 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 Diplomatic or Designated Activity issued for medical purposes. Those who have overstayed. Those whose Period of Stay is less than three months. (However, exclude those whose Status of Residence is Entertainment, Technical Training, Stay with Family, Designated Activities and he or she can prove staying in Japan for three months or more.) 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 an employers health insurance plan. If you are eligible for National Health Insurance Program, you cannot cancel NHI without proper reasons. * Even though, you have coverage from your international student insurance, life insurance with medical options or travelers insurance, you cannot cancel National Health Insurance. (Those insurances are not considered as publicly-managed health insurance program) To ensure receiving items from the city office in mail. register your address to the post office and put your name plate on the door so that mail 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. 1. Joining the National Health Insurance Program When Necessary Documents Contact Location When you move into Shinjuku City from another city in Japan, or from another country Registration Card, and passport [ Notification of Move In] Census/Residence Division Residence Record Section (Shinjuku City Office Main Building 1st Floor 7th Window or Special Satellite Office [National Health Insurance Enrollment] Medical Insurance and Pension Division National Health Insurance Eligibility Section (Shinjuku City Office Main Building 4th Floor 7th Window) or Special Satellite Office *If you were a member of National Health Insurance at the previous residential address, you will be enrolled to National Health Insurance in Shinjuku City automatically after Move-In registration. 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, you will receive a lumpsum childbirth and childcare allowance. (See page 27) Registration Card, and the certification of withdrawal from your company s health insurance plan Registration Card, and Notification of Welfare Termination Registration Card, and your National Health Insurance Card Medical Insurance and Pension Division National Health Insurance Eligibility Section (Shinjuku City Office Main Building 4th Floor 7th Window) or Special Satellite Office [Registration for New Born] Census/Residence Division Census Section (Shinjuku City Office Main Building 1st Floor 9th Window or Special Satellite Office [National Health Insurance Enrollment] Medical Insurance and Pension Division National Health Insurance Eligibility Section (Shinjuku City Office Main Building 4th Floor 7th Window) or Special Satellite Office One National Health is issued to each member. Remember to take good care of this important (if small) card. 2. Withdrawing from the National Health Insurance Program When Necessary Documents Contact Location When you move out of Shinjuku City When you leave Japan When you join the health insurance plan at your place of employment When you begin receiving social welfare benefits When a member dies (the family is eligible to receive a funeral allowance [see page 27]) Foreign Resident Registration Card, and National Health Foreign Resident Registration Card, and National Health Health insurance card issued by your employer and National Health Insurance Card National Health Insurance Card and notification that you have started to receive social welfare benefits National Health Insurance Card Census/Residence Division Residence Record Section (Shinjuku City Office Main Building 1st Floor 7th Window or Special Satellite Office Medical Insurance and Pension Division National Health Insurance Eligibility Section (Shinjuku City Office Main Building 4th Floor 7th Window) or Special Satellite Office [Notification of Death] Census/Residence Division Census Section (Shinjuku City Office Main Building 1st Floor 9th Window or Special Satellite Office 3. Other Occasions When When you change residence inside Shinjuku City When the head of household or your name changes When Special Activities Visa is renewed When you lose your National Health Necessary Documents Contact Location Registration Card and National Health Registration Card and National Health Registration Card, Passport (specification) and National Health Registration Card [Notification of Move Out] Census/Residence Division Residence Record Section (Shinjuku City Office Main Building 1st Floor 7th Window or Special Satellite Office [Notification of Change of Head of Household] Census/Residence Division Residence Record Section (Shinjuku City Office Main Building 1st Floor 7th Window or Special Satellite Office Medical Insurance and Pension Division National Health Insurance Eligibility Section (Shinjuku City Office Main Building 4th Floor 7th Window) Medical Insurance and Pension Division National Health Insurance Eligibility Section (Shinjuku City Office Main Building 4th Floor 7th Window) or Special Satellite Office The National Health When you go to a medical institution, always bring your insurance card with you and present it to the reception desk to show that you are a member of the National Health Insurance Program. 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 resident status in Japan before its expiration day, the law allow you to stay in Japan and you may be able to extend your NHI eligibility. 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 or for the other reasons. (The National Health is void once you leave Japan. You must apply for a new one upon your reentry into Japan.) The National Health issued by Shinjuku City becomes void when you move out of Shinjuku City. (If you use an invalid National Health, you will be charged 70 percent of the medical fees for misusing the card.) Never let others use your National Health. (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) or 03-3502-2071 (calls from cellular phones) URL: http://www.joinw.or.jp 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. * According to the revision in the tax deduction for dependents in regional tax, the "Adjusted Deduction" was newly established as of August 1, 2012. If the households whose head is aged between 70 and 74 include an insured of NHI under the age of 19, the following amount will be deducted from the standard amount of taxation,, by which the self-pay portion is determined.: number of insured person under the age of 16 x 330,000 number of insured person aged between 16 and 19 x 120,000 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. These premiums, subsidies from the national and metropolitan governments, and money budgeted by Shinjuku City are used to operate the National Health Insurance, Late-elderly Persons Medical Systems, and Long-term Care Insurance. The head of the household is responsible for paying National Health Insurance 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. How Your Insurance Premium Is Calculated (FY2015) Insurance premiums include basic amount (for medical expenses), support for late-elderly persons (for support), and long-term care payment amount (for nursing care), and each have taxation on per capita basis and on income basis. The total of these amounts becomes the National Health Insurance premium. Annual Insurance Premiums Medical treatment expenses (portion for medical treatment) Per-capita amount 33,900 the number of NHI insured in the household + Income-based amount Amount of total Estimated base for FY 2015 imposed on all NHI insureds in the household*1 6.45 / 100 *2 The maximum ceiling is 520,000 + Support for late-elderly persons (portion for support) Per-capita amount 10,800 the number of NHI insured in the household + Income-based amount Amount of total Estimated base for FY 2015 imposed on all NHI insureds in the household *1 1.98 / 100 *2 The maximum ceiling is 170,000 + Long-term Care (portion for nursing care) Per-capita amount 14,700 The number of NHI insured in the household who are 40 to 64 years of age + Income-based amount Amount of total Estimated base for FY 2015 imposed on NHI insured in the household 1.40 / 100 *2 The annual ceiling is 160,000 *1 Estimated base amount is Gross earning in the previous year - Basicdeduction of 330,000). *2 Maximum ceiling: If the calculated annual insurance premium (portions for medical treatment, support, and nursing care) exceeds a certain amount, the maximum ceiling amounts will apply (this does not apply to previous years amounts). 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
Notification Concerning Your Insurance Premiums Premium statements are sent out in June. The percentage of income portion of the insurance premium is calculated based on the Estimated base amount. Thus, the annual premiums are calculated in June, after the estimated basic amount has been determined. The annual premium is paid in 10 installments between June and the following March. Households whose number of NHI members changes or whose Estimated base amount changes during the fiscal year will receive a notification each time there is a change in their insurance premium. Individuals who move into Shinjuku on or after January 2 and individuals who file their tax returns late will be notified only of their per capita levy amount. The Estimated base amount is notified once it is figured out. * A fiscal year is from April to March of the following year (FY2015 is from April 2015 to March 2016). Annual Insurance Premium Payment Term APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR Coverage Term Premium Reduction and Exemptions 1. 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. 2. 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. 3. 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 from the information of residents tax of the fiscal year.). In order to receive this service, the income from the previous year must be clear. It is also required of those who have no income (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. 4. Premium Reduction and Exemption System for involuntarily- unemployed persons Those who have lost their job due to disemployment, bankruptcy, or termination of employment contract may be able to secure lower premiums. To apply for this discount, Certificate of employment insurance eligibility is required. Please inquire for details. 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 (1) Under this system, your premium is withdrawn automatically from your saving account. If you are visiting Japan for a short-term such as for attending school, please make payments with the payment slips designated by Shinjuku City. The application forms for automatic transfer are distributed through: Mailing together with the Statement of Health Insurance Premium in June. Picking up at the Special Satellite Office. Requesting at the NHI Premium Collection Section. Submit to: Shinjuku City Office, Spcial Satellite Office, banks, post offices (you can mail your application, too). You need to bring: 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. * Receips are not issued. * In December, a post card will be mailed to notify you the withdrawal amount from your bank account for insurance premiums. 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 are 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. If the household deliberately fail to pay the premiums without any justifiable reasons such as natural disaster, etc, the household will be charged with certain penalties. The penalties are: 1. Issue of Short-Term Membership Card Before demanding the return of the National Health as described below, a membership card with a shorter validity period may be issued for the purpose of maintaining ties with the non-paying household and doing as much as possible to find out the reason for non-payment. 2. Suspension of the National Health The household who do not respond to repeated requests for payment or to recommended counseling will be asked to surrender their National Health. 3. Statement of Non-Eligibility for National Health Insurance Shinjuku City issues a statement of non-eligibility to the household whose National Health has been revoked. In this case, you must pay 100 percent of outstanding medical fees at the medical institutions instead of the 30 percent normally paid by the insured. (The medical fees paid by the insured will be reimbursed on a later day upon an application. However, if you have unpaid NHI premiums, 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 nonpayment status without any justifiable circumstances. * NHI Notification Call Center may contact you in case your payment is not confirmed by the due date. Your Insurance Benefits The major benefits of the National Health Insurance Program are partial subsidization of medical expenses and cash allowances for childbirth, funeral, and certain other occasions. In Japanese, "insurance benefit" is referred to as hoken kyufu. When you receive medical treatment, present your National Health at the reception counter of the medical facility, and pay your portion [20% (10% with the Special Measures) or 30%] of the medical expense. Preschool age children 20% School age to 69 years old 30% Individuals aged 70 and older 20% (Those whose birthday is April 2, 1944 or after) 20% (Special Measures: Those whose birthdays is between April 2, 1939 and April 1, 1994) 10% * 30% for those whose income is over a certain level * Those whose income exceeds a prescribed amount: Households with those aged 70 and older whose taxable income of 1,450,000 or more. Cases where National Health may not be used 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 When You Are Injured in a 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 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 National Health Insurance Program and then charged to the responsible person. 7
Reimbursement for Medical Expenses In the following cases, you will have to pay the medical fees in full and apply for reimbursement. Approximately three months after applying, 70 percent of the fees will be reimbursed to you. 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 become ill while traveling or there are the other reasons why you cannot present your National Health 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, family stamp 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. 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 fess 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 High-cost Medical Care Benefit When the amount of medical expenses paid in a single month is high and certain conditions are met, the amount exceeding the ceiling for the personally-borne amount will be reimbursed. This ceiling is determined on the basis of the person s age, household income, and medical expenses. 1. Individuals Aged Under 70 When the personally-borne 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 exceedthe designated ceiling Ceilings on Personally-borne Expenses (Table 1) 252,600 When medical expenses exceed 842,000, 1% of Households the exceeded amount over that limit is added with income of 9,010,000 or more 252,500+ (medical expenses minus 842,000)1% 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 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 Households exempt from the residential 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 Limited Liability The individual burden of the medical expenses in case of hospital admission will be the above amount by presenting the Certificate of Limited Liability. You may apply at the National Health Insurance Benefit Section. Please bring your NHI Card. 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) 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
Ceiling Applied/Standard Personally-borne Amount Reduction Certificate There will be a limit to the self-burden to be paid at the hospitals for households that are residential tax-exempt by presenting the "Ceiling Applied/Standard Personally-borne Amount Reduction Certificate." If you wish to receive this certificate, please apply at the NHI Benefits Section. Your NHI Certificate will be required for application. 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 after you become eligible. For more information, contact the NHI Benefits Section. Food 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 National Health Insurance. Category Basic cost (per meal) Households have resident taxable income 260 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 * Households with all members that are exempt from the residential tax must apply for a Standard Personally-Borne Amount Reduction Authorization Certificate. To learn how to apply, contact the NHI Benefits Section. Individual Burden for Long-term Hospitalization Seniors 65 or older who are under long-term hospitalization are responsible for the following individual burden and the rest will be covered by the National Health Insurance. Category Those whose income exceeds a prescribed amount General Residential tax exempt household II Residential tax exempt household I (Amount of pension: 800,000 or less) (Food cost + necessary living expense) 460 (Food cost) + 320 (Living expense) (per meal) (per day) 210 (Food cost) + 320 (Living expense) (per meal) (per day) 130 (Food cost) + 320 (Living expense) (per meal) (per day) 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. 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, a doctor s 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 of the person who gave birth. Claim for these benefits must be filed within two years from the next day of the 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. Claim for these benefits must be filed within two years from the next day of the funeral. 9
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. Summer Resort Facitities Shinjuku City contracts with traveler s agencies that are affiliated with some lodging facilities. When you use the lodging facilities that are affiliated with those traveler s agencies, Shinjuku City subsidies 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 the 5th Window on the 4th floor of City Office or at the Special Satelite Office 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
国 民 健 康 保 険 のご 案 内 平 成 27 年 度 版 平 成 27 年 4 月 発 行 編 集 発 行 新 宿 区 健 康 部 医 療 保 険 年 金 課 新 宿 区 歌 舞 伎 町 1-4-1 電 話 :03-3209-1111( 代 表 ) 印 刷 物 作 成 番 号 2015-3-3208