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💴 | What to do when both medical and long-term care costs are high


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What to do when both medical and long-term care costs are high

 
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* The standard monthly salary is simply the total income for April, May, and June divided by 4 to rank.
 

High-priced medical care / high-cost long-term care combined medical expenses system "The high-priced medical care / high-priced long-term care combined medical expenses system is medical insurance + long-term care insurance for each household ... → Continue reading

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Standard reward

Standard reward(Hyojunhoshu) means Japanese(I.e.(EspeciallyEmployee insurance), the insured receives the compensation, etc. calculated according to a predetermined category, or refers to the amount or standard amount calculated in that way. It is the basis for calculating insurance premiums for each insurance.

In Japan, when calculating insurance premiums,Labor insuranceIf actually paidwageIn contrast to the amount used, in social insurance, a standard amount is set in advance, and all insured persons who receive a reward around the standard amount calculate the insurance premium and the like using the standard amount.

Definition of terms

  • "Reward" means "wage,salary,Salary,allowance,BonusRegardless of what the other names are,Everything a worker receives as compensation for laborSay. However, this does not apply to those who receive extraordinary services and those that receive each period of more than three months" (Health Insurance Act, Article 3, paragraph 3).
  • "Bonus" means "of all that a worker receives as compensation for work, regardless of what name they are, wages, salaries, salaries, allowances, bonuses, etc.What is received every period beyond March"(Health Insurance Act, Article 3-6). When wages calculated for reasons exceeding one month are divided and paid monthly, they are treated as "bonuses". Whether or not it corresponds to a “bonus” is determined by the actual payment as of July 1st every year, and even if there is a revision of the salary regulations in the middle of the year, it will beRevised from time to timeUnless you do the followingScheduled decisionDo not change the treatment until.
    • Included in "remuneration" is basic salary, as well as efficiency salary, incentive salary, working allowance, position allowance, special work allowance, work place allowance, price allowance, commuting allowance, housing allowance, separate allowance, early leave overtime allowance. , Daily allowance, overnight pay, etc. are all interpreted as rewards. Even if the commuting allowance is paid every three or six months as a method of payment, the actual amount of commuting is basically paid for commuting every month and covers a portion of the insured's normal living expenses. Therefore, it should be understood as a reward based on the actual conditions of these payments (December 3, 6, Hobunbun No. 27). In addition, if the insured pays the business trip travel expenses that should be borne by the employer and the business trip travel expenses are paid to the insured for the purpose of reimbursing the actual expenses, the business trip travel expenses shall be considered as compensation for labor. Is not recognized as a “remuneration” (business communication on June 12, 4).
    • "Temporarily received" is defined as "a thing other than the remuneration that the insured receives as a normal condition in a narrow sense" (July 23, 7, issue 12). In particular,Large bagAnd souvenir money, farewell, etc. These are neither "rewards" nor "bonuses" in the calculation of standard rewards.
    • If all or part of the reward or bonus is paid in something other than currency (salary in kind), the value isThe region(Working place of insured person (working place not head office even in case of head office management).Dispatch originLocation)Depending on the market price of,Minister of Health, Labour and WelfareStipulated by HoweverHealth insurance associationIn the case of, you can make other provisions in the regulations (Article 46 of the Health Insurance Act). Currently, "the value of the actual salary set by the Minister of Health, Labor and Welfare" (24 Ministry of Health, Labor and Welfare Notification No. 36, final revision 30 Ministry of Health, Labor and Welfare Notification No. 39) is announced, and "meal" "for each prefecture" The value of the in-kind salary is determined by applying this value defined for "house" and "other". Regarding the authority of this Minister of Health, Labor and Welfare,Delegation-ConsignmentHas not been done.
    • Dismissal notice allowance(Labor Standards ActArticle 20)Injury and sickness allowance-出産 手 当 金Is not included in the "remuneration", so insurance premiums cannot be deducted from these (for the dismissal notice allowance, June 24, 6 Hoho 24)[1].Severance payIs not a remuneration or a bonus in principle (No. 24 issued on June 6, 24), but when the insured is in employment, all or part of the retirement allowance is added to salary or bonus in advance. In this case, since the nature of compensation for labor is clear and it has meaning as ordinary income that is allocated to the insured's normal livelihood, it falls under “reward” or “bonus” in principle. Yes (October 1175, 15, Hokkaido 10, Agency Honor 1).

Standard monthly fee

InsuredRemunerationThe monthly amount ofIt is decided by the insurer, etc. by applying For insured persons who receive remuneration at two or more business sites at the same time, calculate the monthly remuneration for the remuneration received from each business site, and determine the standard monthly remuneration as the sum of the remuneration monthly sums for that person. (Health Insurance Act, Article 2, Paragraph 44).

Health insurance-Seafarers insurance
  • 2016(平成28年)4月の改定により、現在、第1級58,000円(報酬月額が63,000円以下)〜第50級1,390,000円(報酬月額が1,355,000円以上)の50等級(健康保険法第40条1項)。
  • In health insurance, when the ratio of the number of insured persons that correspond to the highest standard monthly remuneration class on March 3st to the total number of insured persons exceeds 31%, it is recognized that the state continues,Minister of Health, Labour and Welfare TheSocial Security CouncilFrom September 9st of that yearCabinet OrderBy the above, it is possible to revise the grade classification by adding more grades to the highest grade, as long as the proportion of persons with the highest grade does not fall below 0.5% (Health Insurance Act Article 40, paragraphs 2 and 3). According to seafarers' insurance, if there is a significant change in the level of compensation received by the insured, it shall be promptly revised in light of the level after the change (Seafarers insurance lawArticle 16 paragraph 2).
Employee pension
  • 2016年(平成28年)10月の改定により、現在、第1級88,000円(報酬月額が93,000円未満)〜第31級620,000円(報酬月額が605,000円以上)の31等級(厚生年金保険法第20条1項)。厚生年金の1級~31級は、健康保険等の4級~34級に相当する。
  • When the amount equivalent to twice the average monthly standard remuneration of all insureds on March 3 of each year exceeds the highest standard monthly remuneration of the standard monthly remuneration class, and the status is deemed to continue. Started from September 31st of that year, taking into consideration the classification of standard remuneration monthly amount prescribed in the Health Insurance Act,Cabinet OrderThen, you can revise the classification of standard monthly remuneration to add more grades to the highest grade (Welfare Pension Insurance ActArticle 20 paragraph 2).

Determination of standard monthly remuneration

Unless otherwise specified, health insurance and seafarers' insurance and welfare annuity are common, and this section will be described below based on the provisions of the Health Insurance Act.

Scheduled decision

At a business establishment used as of July 7, every year, for three months before the same day (only for the period of continuous use at that business establishment, and the basic number of days for payment of compensation is 1 days (Three quarter requirements11 days for short-time workers who do not meet. The same shall apply hereafter) Except when there is a month that is less than), based on the amount (monthly remuneration) obtained by dividing the total amount of remuneration received in that month by the number of months in that period, the grade classification of the standard remuneration monthly amount table (Article 41). In other words, usually in April to JuneWages actually paidCalculate using (not the number of months).

  • "Basic days to pay compensation" is usually the monthly salary systemLabor regulationsThe prescribed number of working days specified in the etc. will be the "basic payment basic number of days", but if the salary is deducted according to the number of absentee days, it will be the number of days deducted from the prescribed working days.
  • If the basic payment days are less than 3 days or if no remuneration was received for all three months, the previous monthly remuneration will continue to be used (the previous standard monthly remuneration will remain).
  • A temporary leave is given in the month subject to the scheduled decision(I.e.In principle, when paid, the leave allowance will be used for the calculation. However, if the state of temporary leave has already been resolved at the time of the decision, it will be calculated with the remuneration to be received after September of the year in which the scheduled decision is made. If the temporary leave is resolved after the decision, it will be subject to revision at any time.
  • Nursing care leaveIf it is during the period, it is calculated using the monthly remuneration amount immediately before the start of leave (the standard monthly remuneration amount immediately before the start of leave will remain the same).
  • For short-time workers, the following is done depending on the basic number of days of payment of compensation in April to June.
    • If it is 3 days or more in all three months, it will be decided based on the average amount of monthly rewards for three months.
    • If there is a month with 1 days or more, it will be decided based on the average amount of monthly rewards for the month with 17 days or more.
    • If all three months have 3 days or more and less than 15 days, it will be decided based on the average amount of monthly rewards for three months.
    • If there is a month with 1 days or more but less than 15 days even in one month, it will be decided based on the average amount of monthly remuneration for the month with 17 days or more but less than 15 days.
    • If all three months are less than 3 days, the standard monthly fee will be used.
  • Persons who have acquired the insured qualification from June 6st to July 1st, those who plan to revise at any time from July to September, revisions at the end of childcare leave, etc. Will not be subject to the regular decision.
  • When it is extremely unreasonable to calculate using this method, the insurer, etc. calculates the monthly remuneration (insurer, etc. calculation). Specifically, it is as follows. Note thatHealth insurance associationIn the case of, the calculation method for the insurer, etc. shall be specified in the regulations.
    • If there is a late or retroactive increase in salary before March, and you receive the difference in a lump sum from April to June, subtract the difference and calculate.
    • Low leave pay from April to JunestrikeIf there is a wage cut due to, the calculation will be made excluding that month. If it is also in March, continue to use the previous monthly remuneration (remaining the previous standard monthly remuneration).
    • A difference of 4 or more between the standard monthly salary calculated from the monthly average monthly salary from April to June and the standard monthly salary calculated from the monthly average monthly salary from July to June of the previous year In the event of the above, if the difference is expected to occur every year due to the nature of the business, the annual remuneration shall be calculated as the average.

The standard monthly salary decided on a regular basis is valid from September of the current year to August of the following year. The business owner shall pay the insured person (excluding the person who is not subject to the fixed-time decision) to use as of July 9 every year by July 8Japan Pension ServiceEtc. (For health insurance, the Japan Pension Service if the insurer is an association, and the Health Insurance Society if it is a health insurance association. The Japan Pension Service for seafarers' insurance. Each executing agency for welfare annuities. (Regulation Article 25). It is called "basic calculation report".

Determined when acquiring qualification

The standard monthly remuneration determined when the insured qualifies, such as when newly hired, if the remuneration is fixed by a certain period (monthly salary, weekly salary, etc.), the amount of the remuneration is the total number of days in that period 30 times the amount divided by is the monthly remuneration (Article 42). If remuneration is set by daily wage system, hourly wage system, turnover, or contracting, it is the average amount of the same remuneration received by those who engaged in similar work during the month before the insured qualification. For items that are difficult to calculate using these methods, the remuneration received by a person who was engaged in the same business in that area and received the same remuneration during the month before the month when the insured qualification was acquired. Will be the monthly salary.

  • Due to the company's circumstances(I.e.When is paid, the monthly remuneration is calculated based on the leave allowance. If the home waiting is canceled after that, it will be subject to revision at any time.

The standard monthly salary determined by the qualification is valid until August of the year when it is decided from January to May, and to August of the next year when it is decided from June to December. .. The business owner submits the insured qualification acquisition notification to the institution within 1 days (within 5 days for the ship owner) from the date of acquiring the insured qualification, and reports the monthly remuneration (Regulation No. Article 8).

Revised from time to time

If the monthly remuneration changes significantly, the standard monthly remuneration can be revised even during the year (Article 43). HoweverOnly for fixed wage changesTherefore, even if there are large fluctuations in variable wages such as excess allowances, revisions will not be made from time to time.Starting from the month when wages were actually paid for raising or lowering salariesThe amount obtained by dividing the total amount of remuneration received in March by 3 will be used as the monthly remuneration after revision (after the 3th month from the month when the wages for the actual pay raise/fall are actually paid). No. 4 issued on January 36, 1.If there are months when the basic number of days for payment of compensation is less than 17 days, revision will not be made from time to time..

  • "Significant fluctuation" refers to when there is a difference equivalent to two or more grades, but the following cases are treated as "significant fluctuation".
    • When the average monthly salary for a person in the 49th grade is 1,415,000 yen or more and the person is in the 50th grade
    • When a person in the 1,415,000th class with monthly salary of 50 yen or more is in the 1,355,000th class because the average monthly salary is 49 yen or less
    • When a person in the 53,000st class with a monthly salary of 1 yen or less is in the 63,000nd class due to an average monthly salary of 2 yen or more
    • When the average monthly salary for a second-grade person is 2 yen or less
  • If a leave allowance that is lower than the compensation that would have been received if you were working after the temporary leave was considered, this is considered to be a change in fixed wages, and that condition continues for 3 years. If it exceeds the month, it will be subject to revision as needed. If the temporary leave is resolved after that, it will be subject to revision at any time.

The standard monthly salary determined is valid until August of the year if it is revised from January to June, and until August of the following year if it is revised from July to December. When the business owner meets the requirements,Promptly(The ship owner must submit a monthly remuneration change notification to the Organization etc. within 10 days). It is called "Monthly Change Notification".

Revised at the end of childcare leave, etc.

The insured who raises a child under the age of 3 may take childcare leave (Childcare Nursing Care Leave ActbyChildcare leaveOr it means measures such as shortening of prescribed working hours due to childcare pursuant to the same law. same as below[2]), and if there is a decline in remuneration when returning to work, the standard monthly remuneration will be revised upon request (Article 43-2). Unlike the case of revisions from time to time, it is not always necessary to have fluctuations of 2nd grade or higher and fluctuations of fixed wages. The standard monthly remuneration will be revised from the month following the month in which February has passed since the day following the completion of childcare leave. Three months after the month to which the next day of the childcare leave, etc. belongs, (only for the period of continuous use at the place of business,Less than 17 daysIf there is a month, that month is excluded), the total amount of remuneration received in that month is divided by the number of months in that period, and the amount obtained is the monthly remuneration.

  • Insured persons who have started the following maternity leave on the day following the end of childcare leave are not eligible.

The standard monthly salary determined is valid until August of the year if it is revised from January to June, and until August of the following year if it is revised from July to December. When the business owner meets the requirements,Promptly(The ship owner must submit a monthly remuneration change notification to the Organization etc. within 10 days).

Revised at the end of maternity leave

Labor Standards ActupperMaternity leaveIf there is a decline in the remuneration when the employee returns to work after the end date of April 26, 4 or later, the standard monthly remuneration will be revised upon request (Article 1-43. ). Unlike the case of revisions from time to time, it is not always necessary to have fluctuations of 3nd grade or higher and fluctuations of fixed wages. The standard monthly remuneration will be revised from the month following the month in which February has passed since the day after the maternity leave. Three months after the month to which the next day before and after maternity leave ends belongs (only for the period of continuous use at the business site used the day after the maternity and maternity leave endsLess than 17 daysIf there is a month, that month is excluded), the total amount of remuneration received in that month is divided by the number of months in that period, and the amount obtained is the monthly remuneration.

  • The insured who started the childcare leave mentioned above on the day after the maternity leave is not covered.

The standard monthly salary determined is valid until August of the year if it is revised from January to June, and until August of the following year if it is revised from July to December. When the business owner meets the requirements,Promptly(The ship owner must submit a monthly remuneration change notification to the Organization etc. within 10 days).

Voluntary continuous insured

"The standard monthly salary for the voluntary discontinuance of the voluntary insured person" and the "standard monthly salary of all insureds to which the voluntary continuous insured person belongs as of September 9, the previous year In this case, if there is an amount specified by the agreement, the amount specified by the agreement) is regarded as the monthly remuneration standard salary”.FewForehead (Article 47). In principle, no revision will be made during the period of voluntary continuous insured. The same applies to those who are continuously insured for illness in seafarers' insurance (Article 23 of the Seafarers Insurance Act).

  • As of September 30, 9,Association KenpoThe average monthly standard remuneration in30 million yenIt has become.

Special Retirement Insured

On September 1 of the previous year (two months before the standard monthly salary for January to March) under the control of the specified health insurance association,All insured except special retirement insuredWithin the range of the average monthly standard remuneration of the same month, the standard monthly remuneration when the amount stipulated in the rules is considered as the basic monthly remuneration of the standard monthly remuneration.[3](Supplementary Provisions Article 3).

Standard bonus amount

Insured actualBonusThe amount will be rounded down to the nearest 1,000 yen. The actual salary amount is not applied to the range of compensation divided into a certain grade like the standard monthly salary. The maximum amount is set. (Health insurance and welfare annuity insurance have different upper limits.) When bonuses are paid four times or more a year (which is objectively determined), the bonuses are basically “remuneration”. To do.

Within 5 days (10 days for ship owners) from the date of payment of the bonus, the business ownerBonus payment notificationMust be submitted to the institution. If you have paid bonuses more than once in the same month, submit them all at once on the last bonus payment date. Even if a bonus is paid to a person whose insurance premium is exempted during the maternity leave, childcare leave, etc. during that period, a bonus payment notification must be submitted and the standard bonus amount is also determined. (Premium related premiums are exempted).

The bonus paid before the disqualification of the insured qualification month is not subject to the premium levy (that is, unless the employee retires at the end of the month, the premium related to the bonus even if he/she retires in the month when the bonus was received Is not collected). However, it is included in the cumulative amount for the year. Even in this case, the bonus payment notification must be submitted.

Health insurance and crew insurance

The bonus amount年度Cumulative amount573 million yen[4]If it exceeds the amount, the premium will not be charged for the excess amount for that month, and theNext monthThe standard bonus amount for subsequent bonuses will be zero (Article 45). If all salaries are paid as bonuses, insurance premiums will not be applied to the portion where the cumulative total for the year exceeds 573 yen. In addition, since the cumulative total is calculated for each insurer, if the insurer in charge changes during the year, the bonus amount up to that point will not be accumulated under the new insurer.[5].

Employee pension

Received a bonusMonthIn that amount150 million yenWhen it exceeds, it is calculated as 150 million yen (Employee Welfare Pension Insurance Law, Article 24-4).

footnote

  1. ^ The deduction of insurance premiums from injury and sickness allowances and childbirth allowances conflicts with Article 61 of the Health Insurance Act ("The right to receive insurance benefits cannot be transferred, collateralized, or seized.").
  2. ^ According to the lawNursing care leaveAlternatively, it does not apply to measures such as shortening of prescribed working hours due to nursing care.
  3. ^ 2016年3月までは、当該特定健康保険組合が管掌する、「前年(1~3月の標準報酬月額については前々年)の9月30日における、特例退職被保険者以外の全被保険者の同月の標準報酬月額を平均した額」と、「前年の全被保険者の標準賞与額を平均した額の1/12に相当する額」との合算額の1/2に相当する額の範囲内において、規約で定めた額、とされていた。
  4. ^ Until March 2016, 3 million yen.
  5. ^ If the association changes from kenpo to sailor insurance, both insurers willNational Health Insurance AssociationHowever, they are not accumulated.

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