Insurance premium exemption for maternity leave and childcare leave!But how will it affect future pensions?
If you write the contents roughly
About childbirth In principle, 1 yen per child will be paid directly to medical institutions from health insurance.
Maternity leave and childcare leave are important systems for raising children.However, social insurance premiums are exempted during maternity and childcare leave, so ... → Continue reading
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JapanInHealth insurance(Health insurance,English: Employee Health Insurance) IsEmployer OfEmployee WelfareFor the purpose(I.e.Operated by methodmedical insuranceOf (employee insurance, occupational insurance)Health insurance lawBased on.Medical insurance office workThe abbreviation above isSocial securityIt is called (Shaho) and is called National Health Insurance (Kokuho).Regional insuranceIs distinguished from.In addition, such as civil servantsMutual aid associationRegarding employee insurance for subscribers, not the Health Insurance ActNational Civil Service Mutual Aid LawIt is covered by mutual aid associations based on.
|Publicly funded medical carePayment||3 billion yen (7.5%)|
|Medical care for the elderlyPayment||14 billion yen (33.6%)|
|medical insuranceEqual payment|
19 billion yen
9 billion yen
|Association Kenpo||5 billion yen (12.1%)|
|Health insurance association||3 billion yen (8.4%)|
|Seafarers insurance||195 billion yen (0.0%)|
|Mutual aid association||1 trillion583 billion yen ( 2.6%)|
|National Health Insurance||9 billion yen (22.6%)|
|MoreLabor accidentな ど||3049 billion yen (0.7%)|
|Patient burden||5 billion yen (12.2%)|
|Special mitigation measures||1119 billion yen (0.3%)|
|the amount||42 million yen (1381%)|
- Regarding the Health Insurance Law, only the number of articles is described below.
The health insurance systemWorker[*1] Or its dependents OfBusiness accidentOther thanIllness, injury or deathbirth[*2] With insurance benefitsThe stability of people's livesImproving welfareContribute toThe purpose is (Article 1).For work-related illnesses, etc.Work injury insuranceIs the target of.If it is unclear whether it is business or non-business, it will be treated as business, and if it is finally judged to be non-business, health insurance will be applied retroactively (April 28, 4, Hobun No. 9).Because there were cases where neither health insurance nor workers' accident compensation insurance was available.[*3], Article 25 was revised in 1, and from the viewpoint of guaranteeing medical care widely,If you cannot receive the workers' accident compensation insurance, you will be able to receive the health insurance benefits in principle.Is a thing[*4]..For the health insurance system, this isIt is the basis of the medical insurance systemIn particular, in response to the progress of aging, changes in disease structure, changes in socio-economic conditions, etc., other medical insurance systems andMedical system for elder senior citizensIn addition to the systems closely related to these, the ideal way of doing so is constantly being examined, and based on the results,medical insuranceIt must be implemented while comprehensively improving the efficiency of the operation of the medical care, the content of benefits and the burden of expenses, and the quality of medical care received by the people (Article 2).
Japan's health insurance systemGermanyUsing the disease insurance law of1926 (Taisho 15) (Regulations regarding insurance benefits and cost burdens1927 (Showa 2)) was enforced.Initially, it was an insurance that combined sickness insurance and accident compensation.Factory law-Mining lawIt was applied to business establishments to which.
According to the provisions of the Health Insurance LawMinister of Health, Labour and WelfareHas a wide range of authority, but the actual clerical work (the following clerical work) isJapan Pension Service(1,2),Regional Health BureauIt is delegated or entrusted to the director or the director of the local welfare bureau (3).
- Approval of insured exemption,Voluntary application businessApproval, confirmation of insured qualification,Standard monthly fee・ Determination of standard bonus amount,Delinquent taxesOffice work
- Pre- and post-business processing related to determination of the value of in-kind salary, collection of insurance premiums, etc.
- Insurance medical institutionEtc. andDesignated home-visit nursing care providerDesignation / cancellation of designation,Insurance doctorAuthority for registration, etc.
Insurers (those who carry out insurance benefits, etc. as the management entity of the insurance business)National Health Insurance Associationas well as the Health insurance association(Article 4).However,Special day insured personAs for, only the Japan Health Insurance Association will be the insurer, and the health insurance association will not be the insurer.
|Insurer||Number of subscribers||Number of unions|
|Subscriber total||Principal (insured person)||Family (Dependents)|
|National Health Insurance Association||34877 thousand people||19631 thousand people||15246 thousand people||N/A|
|Health insurance association||29504 thousand people||15533 thousand people||13951 thousand people||1443 union|
|Special day insured person||18 thousand people||12 thousand people||6 thousand people||N/A|
As a general rule, joinBusiness unit(Headquarters, branch offices, factories, etc.)[*5]..Business establishments covered by health insurance are those that are obliged to join (Mandatory offices)When,Minister of Health, Labour and Welfare OfAuthorizationBusiness establishments that receive and join (Applicable establishments).Applicable establishments are health insuranceEmployee pensionIs common with[*6].
- Mandatory offices
- National / local public organizations /Corporate office(Regardless of the type of corporation), which always uses employees (Article 3, Item 3)
- Private officeOut ofApplicable industryA business establishment that is a business establishment that always uses 5 or more employees (Article 3, Item 3)
- In calculating "5 people", not only those who should be insured, but also those who cannot be insured due to the exemption provisions but who are always used at the place of business. If this is included (No. 18 issued on April 4, 5).
- Applicable establishments
- A business establishment that does not fall under the compulsory application business establishmentApplication for voluntary applicationBusiness establishments approved by the Minister of Health, Labor and Welfare (Article 31)
- "Business establishments that do not fall under compulsory application business establishments" means that among individual business establishments, non-applicable industries (agriculture, forestry, fisheries, livestock industry, hairdressing and beauty industry, movie production and other entertainment businesses, customer service entertainment business, legal affairs) Businesses, religious businesses, etc.), or even business establishments in applicable industriesLess than 5 people at all timesRefers to establishments that use employees of.
- When seeking approval for voluntary application, the consent of at least half of the persons used at the business establishment is required. The calculation of "half" is limited to those who should be insured.
- If the compulsory application establishment no longer meets the requirements, it is considered that the voluntary application establishment has been approved.
- Specified applicable business establishment
- Since October 28, the same business owner (Corporate numberThe total number of insured persons (excluding part-time workers, including mutual aid association members) is expected to exceed 1 for 6 months or more in one year.The application to "short-time workers" described later will be expanded.
- Even if the number of insured persons falls below 500, the establishment that once became a specified application establishment will continue to be a specified application establishment.However, in this case, the business establishment may be exempted from the specified applicable business establishment by applying to the Minister of Health, Labor and Welfare with the consent of three-quarters of the insured persons used.
The "applicable industries" are the following industries.
- Manufacturing, processing, sorting, packaging, repair or dismantling of goods
- Construction, remodeling, preservation, repair, modification, destruction, demolition or preparation of civil engineering, construction and other structures
- Mineral mining or mining business
- Electricity or power generation, conduction or supply business
- Freight or passenger transportation business
- Freight loading and unloading business
- Incineration, cleaning or slaughter business
- Business of selling or distributing goods
- Financial or insurance business
- Goods storage or leasing business
- Mediation business
- Collection, guidance or advertising business
- Education, research or research business
- Disease treatment, midwifery and other medical businesses
- Communications or news business
- Social welfare lawSocial welfare business andRehabilitation Protection Business ActRehabilitation protection business specified in
Work injury insurance,employment insurance Unlike, a business establishment that is not an applicable business establishment is not obliged to be an applicable business establishment even if there is a request from a person who should be an insured person, and there is a request from an insured person used for a voluntary applicable business establishment. Even so, the employer is not obliged to apply for voluntary cancellation.
If two or more business owners are the same, the two or more business establishments can be designated as one applicable business establishment with the approval of the Minister of Health, Labor and Welfare.Batch application office, Article 34.Generally, it is applied in units of corporations), and it is necessary to meet all of the following requirements for approval.
- The affairs related to personnel, labor and salary of all persons used in multiple business establishments to be one applicable business establishmentCentrally managed by electronic computing organizationThe work to be done by the business owner of the applicable business establishment is properly performed within the specified period.
- At the business establishment that is going to be designated by the approval of batch application, the management of 1. is performed, and the business establishment is the main business establishment (head office) of the business owner who applies for approval of batch application. ..
- About applicable business establishments related to approval applicationThe insurer of health insurance is the sameこと.
- If the Japan Health Insurance Association is applicable, apply for approval for the collective application of health insurance and welfare pension.
- Approval of collective application should not significantly hinder the operation of the welfare annuity insurance business and the health insurance business.
However, in many cases, small and medium-sized business establishments cannot meet the requirements for obtaining approval from batch application business establishments in terms of personnel and equipment.[*7]For insured persons whose personnel and salary are managed at the head office, health insurance and welfare pension procedures are carried out at the head office regardless of the place of business where the person works (Treat as an insured person at the head office) Is recognized (Headquarters management, March 18, 3, issued by the Agency Insurance No. 15).In these cases, even if the insured person is transferred between the head office and branch offices, the procedure for acquiring or losing the insured person's qualification is not required each time.
The employer must retain the health insurance documents for two years from the date of completion (Rule 2).When there is a change in the business owner who became the first applicable business establishment, the business owner who is no longer applicable due to the abolition of the business, etc.[*8] Must make the prescribed notification within 5 days from the date of the fact.
被 保 険 者
The insured person is referred to as the "insured person" (hereinafter referred to as "general insured person") who is used by the applicable business establishment.[*9]),as well as"Special day insured person", Voluntarily join after it is no longer used by the applicable business establishment"Voluntary continuous insured"as well as"Special Retirement InsuredThere are four types (Article 4, 3, 1).As a general rule, the acquisition / loss of insured qualification takes effect by confirmation by the insurer, etc., and even if the accident occurs before the employer submits the notification of qualification acquisition, the qualification acquisition is confirmed retroactively. If it is, it will be an insurance accident.
A general insured person acquires the insured person's qualification from the day when any of the following applies (Article 35).If there is a person who has acquired general insured qualification, the employer should contact the Japan Pension Service if the insurer is the Japan Health Insurance Association, or the health insurance association if the insurer is a health insurance association, within 5 days. (Hereafter, abbreviated as "to the organization or union")Insured qualification acquisition notification(If the insured has dependentsDependent notificationAlso) must be submitted.From January 29, the insured person's qualification acquisition notification to be submitted to the health insurance associationpersonal numberFor the qualification acquisition notification to be submitted to the Japan Pension Service,Basic pension numberMust be filled in[*10].
- When it comes to be used in applicable business establishments
- "When it comes to be used" means the day when the de facto usage relationship occurred (July 3, 7, Hosho No. 3).Even if there is an omission of the qualification acquisition notification, all qualifications should be acquired by going back to the date of fact.In addition, it is not possible to delay the acquisition of qualifications due to reasons such as temporary or probationary periods, where employers frequently come and go and it is unclear whether they will be permanent.
- When the business establishment used becomes the applicable business establishment
- When it no longer falls under the exemption
Insured persons (excluding special daily employment insured persons) who are used for two or more business establishments at the same time shall be insured by the insured person within 2 days from the date when they are used for two or more business establishments. Select an insurer (if the business is divided into two or more pension offices at the Japan Health Insurance Association, that pension office).
If the business establishment becomes an applicable business establishmentWork injury insurance,employment insurance Unlike, if you receive compensation from a corporation for laborIncluding corporate representatives and officersAllEmployeeIs insured in principle (No. 24 issued on July 7, 28).Even if you are a foreigner, if you work legally, you will be a general insured person.However, sole proprietors are not considered to be "used" and therefore not insured.Insured persons and dependents are corporate officers (Director, Executive employee,Executive officer, Including those who are recognized to have the same or higher control power than those who are equivalent to these regardless of the name), because the business injury should be attributed to the user's responsibility. , It is not appropriate to provide insurance benefits from 53% labor-management health insurance, and in principle it is not covered by insurance benefits (Article 2-25, August 8, 14 administrative contact)[*11].
A representative of a corporation belonging to a small applicable business establishment with less than 5 insured personsPersons engaged in labor that is not significantly different from ordinary workersEven if you have an illness due to business reasons, you will be covered by health insurance benefits (Article 53-2, Rule 52-2).Previously, it was considered as a provisional measure for the time being (July 15, 7, No. 1), and furtherInjury and sickness allowanceHas been excluded from this measure, but the amendment in 25 added Article 53-2 and abolished the above-mentioned notice, making the measure permanent, including the injury and illness allowance.
For employees on leave, if the salary is paid during the leave period or if the payment of salary is only temporarily suspended, the insured status will be maintained.However, if no salary is paid during the leave and the usage relationship is virtually extinguished, the insured status will be lost (February 6, 2, No. 4).Even if the employment contract survives, if there is no de facto usage relationship, the insured status will be lost (April 59, 25, No. 4).
The insuredDismissalIf the dismissal is disputed, the dismissal is clearly a labor law orCollective agreementWhen a business owner submits a notification of disqualification, even if the case is in dispute, it is treated as having lost qualification for the time being (Showa). No. 25 issued on October 10, 9).
UnionFull-time employees lose their insured status in relation to their former employers, but become general insured persons as persons used by labor unions (July 24, 7, No. 7) ..In addition, it should be notedMutual aid associationAs a general rule, even ordinary insured members do not receive insurance benefits under the Health Insurance Act and do not collect insurance premiums.
At the same officeemploymentIf a person who has retired under the contract is re-employed without a gap of one day, the insured status will continue because the de facto usage relationship has continued.Even if a fixed-term employment contract or appointment is re-established after a day or several days, the next employment contract or appointment will be made between the employer and the insured in advance at the end of the employment contract or appointment. The fact that the schedule is clear is recognized, etc.The de facto usage relationship survives uninterruptedWhen,In light of the actual situation of employmentIf it is judged, it is necessary to handle it without losing the insured qualification (determine individually and concretely in light of the actual situation of employment. January 26, 1, Hoho No. 17 No. 0117).However, regarding the re-employment of persons aged 2 and over, it is permissible to treat them as if the usage relationship was temporarily suspended (May 60, 25, Hosho No. 5 No. 31).By doing so, in response to the decline in salary due to reemploymentEmployment old-age pensionThe amount of suspension of payment can be reduced and revised (Specially provided old-age welfare pensionCan increase the amount of money received) For example.
|Employment status||Ten thousand people|
|Labor contract with no fixed term||3,728|
|Over a yearFixed-term contract||451|
|Fixed-term contracts for one month to less than one year (temporary employment)||763|
|Fixed-term contract less than 1 month (Day labor）||15|
|I don't know the period||239|
Short-time workers(Part-time labor lawRegarding the participation of persons who are used as "short-time workers" in Article 2)Regular employment relationshipIs judged by whether it is recognized.For specific handling standards,Labor regulationsOr, based on the employment contract, if any of the following applies, you will be a general insured person.Until September 28, in addition to these requirements, "comprehensively considering working styles and job contents, etc."[*12] It was judged whether or not to acquire the insured qualification, but after October 28, it will be judged only by the prescribed number of working hours and the prescribed number of working days.
- One weekPrescribed working hoursHowever, the prescribed working hours of ordinary workers working at the same place of businessOne thousandthThat is all.
- Until September 28, it was set as "scheduled working hours per day or week", but after October 9, it will be judged only by "scheduled working hours per week".
- The prescribed number of working days per month is the same as the prescribed number of working days for regular workers working at the same place of business.One thousandthThat is all.
Even if the "three-quarters" requirement is not met, part-time workers who meet all of the following requirements will be general insured persons from October 4.
- Being working at a specific applicable business establishment
- Must have at least 20 hours of regular working hours per week
- If the weekly scheduled working hours fluctuate short-term and periodically and are not constant, etc., the weekly scheduled working hours in the cycle are averaged to calculate the weekly scheduled working hours.If the prescribed working hours are set in units of one month, calculate by dividing the prescribed working hours in one month by 1/1.If the prescribed working hours are set in units of one year, calculate by dividing the prescribed working hours in one year by 1.
- Expected employment period of one year or more
- The monthly wage is 88,000 yen or more
- When converted to annual income, it is 106 million yen (so-called ""106 million yen wall”), Whether or not to obtain the insured qualification is not judged by the annual income, but only by the monthly amount.
- Not a student (full-time course)
Even if the prescribed working hours and the prescribed number of working days are less than three-quarters, if the three-quarters standard is constantly met due to business reasons, etc., the actual working hours and the number of working days will continue in February. If you meet the three-quarters criteria and are expected to continue to do the same, you will be qualified as an insured person on the first day of the third month when you meet the three-quarters criteria.However, if all of the above five requirements are met, the insured qualification will be obtained from that time.In addition, even if a person who has acquired the insured qualification before September 4 does not meet the three-quarters requirement after October 3, he / she will continue to have the insured qualification.
Short-time regular employees (full-timeA regular worker whose regular working hours are shorter than those of regular employeesLabor contract with no fixed termIf any of the following applies, the person is a general insured person.
- There are provisions related to the short-time regular employees in the collective agreement, work regulations, salary regulations, etc.
- A labor contract with no fixed term has been concluded.
- Basic salary per hour and salary regulationsBonus-Severance payThe calculation method, etc., is the same as that of full-time full-time workers of the same type employed at the same place of business, and the actual employment status is also in line with the relevant regulations.
Dispatched workers are insured at the place of business of the dispatching agency.
The waiting period between employment of registered temporary workers isIf it is definitely expected not to exceed JanuaryMay continue to retain insured status during the waiting period. If the next employment contract (limited to January or more) is not concluded within one month, the day when it is certain that the employment contract will not be concluded or the day when the month has passed is earlier. You will be disqualified as if the usage relationship has ended on a daily basis.
Persons who fall under any of the following are insured for special day labor (1 to 4 in principle. For details, seeDaily health insuranceYou cannot be insured except (see)Exemption, Article 3 proviso). 1 to 1 are common to the welfare pension.
- Those who are used temporarily and are hired daily
- However, that personBeyond JanuaryWhen it comes to be used continuouslyFrom the day it passedBecome a general insured person.
- Persons who are temporarily used and who are used for a period of up to 2 months
- However, that personBeyond the prescribed periodWhen it comes to be used continuouslyFrom the day it passedBecome a general insured person.
- Persons used for seasonal work
- However, that personContinued from the beginning beyond AprilusedplansIfFrom the beginningBecome a general insured person (from the day it is used).Even if it happens to be used for more than April due to business reasons, it will not be a general insured person.
- A business that is busy depending on the season due to demand is not a "seasonal business", so the person used for the business is a general insured person.
- Person used for temporary business establishment
- However, that personContinued from the beginning beyond AprilIf it will be usedFrom the beginningBecome a general insured person (from the day it is used).Even if it happens to be used for more than April due to business reasons, it will not be a general insured person.
- Persons used for offices whose location is not fixed
- In this case, the person is not insured even if it is used for a long time at the place of business.
- Part-time workers who do not meet the three-quarters requirements and are used at applicable establishments other than specified applicable establishments
- It is considered as a "for the time being" measure (Article 46 of the Supplementary Provisions)
- Seafarers insuranceCompulsory insured person
- This person is eligible for benefits from seafarer insurance and is therefore exempt from health insurance coverage.The sickness voluntary continuous insured person of the sailor insurance (equivalent to the voluntary continuous insured person in the health insurance) is not excluded from the application of the health insurance (if used at the business establishment covered by the health insurance, the insured person of the health insurance) And loses the qualification of a voluntary continuous insured person for illness).
- National Health Insurance SocietyPersons used in business establishments
- Since this person can receive benefits from the National Health Insurance, the coverage of the health insurance is excluded.
- Insured person of medical care for the elderly
- This person is exempt from health insurance because he / she can receive benefits from medical care for the elderly.
- Persons approved by the Minister of Health, Labor and Welfare, Health Insurance Association or Mutual Aid Association
- Persons who are necessary for the business operation of the National Health Insurance can be transferred to the insured of the National Health Insurance by the approval (limited to the period when they should be insured by the National Health Insurance).
By the insuredThose who maintain their livelihoodThose who meet the prescribed requirements will be covered by the insurer's certification.SupportYou can be covered by the insurance as a person.This is a type of insurance premium exemption (special contract), and there is no burden on dependents, and there is no change in the insurance premiums of the insured depending on the presence or absence of dependents and the increase or decrease.Children who originally couldn't earn incomehandicapped, Long-term inpatients, full-timeHousewife, Elderly parents, etc. were assumed, but the mode has changed due to changes in the family and social environment (full-time husband, restructuring husband, etc.)Qualification testCandidates, so-calledPart-time workerSuch). 20 to 60 years oldspouseWhen there is a dependent certificationNational pensionIt will be treated as the third insured person (April 3, 61, No. 4 issued by the Agency Insurance).When the general insured person who uses it comes to have dependents, the employer shallWithin 5 DateDependent transfer notification must be submitted to the Organization or Union.If the voluntary insured person has dependents, the insured person will submit it.
The requirements for being certified as a dependent are as follows (Article 3).However,Living in Japanas well as the Not being insured for medical care for the elderlyis necessary.
- Insured persons (including those who were special day labor insured persons. The same shall apply hereinafter)Direct descent,spouse, Children, grandchildren and siblings who maintain their livelihood mainly by their insured (so-called)130 million yen wall）
- In order to be certified as "livelihood maintenance", if the certified person is in the same household as the insured person, the annual income of the certified person is less than 130 million yen (the certified person is 60 years old or older or a disabled person (person with a disability)Disability welfare pensionIf the disability is such that it meets the requirements for receiving the insurance, the annual income is less than 180 million yen) and less than half of the insured's annual income (issued on March 1, 2). No. 5).Even if this requirement is not met, if the annual income of the certified person is less than 3 million yen and does not exceed the annual income of the insured person, the insured person will maintain the livelihood of the household. If it is recognized that it plays a central role, it will be recognized as a dependent.
- Regarding "brothers and sisters", until September 28, only "brothers and sisters" were added, but after October 9, "brothers and sisters" were also added.
- The person to be certified is the insured personDo not belong to the same householdIf the annual income is less than 130 million yen andAnnual income is less than the amount of income from assistance from the insured.
- "Annual income" means salary, pension,Unemployment benefits,pension,Real estateIt is a regular income such as income.In the case of salary, everything paid as compensation for labor is covered, including various allowances and transportation expenses, and the amount before tax (similar to the compensation in calculating the insured's insurance premium).Deposits and savings,inheritanceTemporary income, debt, etc. due to income are excluded from the judgment of income conditions.
- A person who belongs to the "same household"Persons who share housing and household budget with the insured(No. 27 issued by Hobun on June 6, 23).Family registerAre the same, and the insuredHead of householdIt doesn't matter if it is.Even if they are temporarily separated due to illness or school attendance, they are recognized as the same household.Even if you are in a designated facility for the elderly or disabled as required by law, it is considered as a "temporary separation" and treated as if you are living together (March 11, 3, No. 19, Insurance).
- In the case of joint support of married couples (double-income couples, etc.), the amount of annual income is used as a judgment material, and the actual situation of households, social conventions, etc. are comprehensively taken into consideration (June 60, 6, Insurance No. 13, 66 June 16, 6 Agency Insurance No. 17).As a general rule, the dependents with the highest annual income are selected.If the annual income of both husband and wife is about the same, the dependents will be mainly those who maintain their livelihood by notification.If a couple jointly supports a family living together, it is necessary to determine who will mainly maintain the family's livelihood as a couple in one household unit, regardless of the number of dependents. In principle, one of the couples will be treated as the person who mainly maintains the livelihood of the family, and therefore each dependent (family) will live on the income of one of the couples, and clearly the basis of that livelihood. Dependents cannot be recognized separately for both husband and wife, unless it is recognized that the dependents are placed on either side.
- Insured 3RelativeThose who are relatives other than those listed in the previous item, belong to the same household as the insured person, and maintain their livelihood mainly by the insured person.
- The same household requirement is not required for "parents of the insured", but the same household requirement is required for "parents of the spouse of the insured".
- Insured spouseI haven't reported it, but in fact婚姻Things that are in the same circumstances as relationshipsParents and children who belong to the same household as the insured and maintain their livelihood mainly by the insured
- The "same household" requirement is not required for parents / children of the spouse on the notification, but the "same household" requirement is required for the parents / children of the spouse who does not report.
- Unlike the spouse on the notification, the grandparents, grandchildren, brothers and sisters of the spouse who do not report are not recognized as dependents even if they are in the same household and maintain their livelihood.
- Those parents and children after the death of the spouse in the previous item who continue to belong to the same household as the insured and maintain their livelihood mainly by the insured.
"Resident in Japan" will be newly added to the requirements by the enforcement of the revised law in April 2nd year of Reiwa, and the confirmation will be made based on the description in the Basic Resident Register in principle.Exceptionally, "those who do not have an address in Japan but are recognized as having a basis of life in Japan in consideration of the purpose of travel and other circumstances specified by the Ordinance of the Ministry of Health, Labor and Welfare" will be certified as dependents. , The following persons are certified as "specified by the Ordinance of the Ministry of Health, Labor and Welfare".
- Students studying abroad
- A family member who accompanies an overseas assignment from Japan
- Persons who can be regarded as a new accompanying family member due to changes in status during overseas assignment (children of the insured born during the overseas assignment, spouse of the insured who got married during the overseas assignment, etc.)
- Those who are temporarily traveling from Japan to overseas for purposes other than employment, such as sightseeing, recreation and volunteering (working holiday,Japan Overseas Cooperation VolunteersSuch)
- Those who are judged by the insurer to have other special circumstances that are recognized as having the basis of life in Japan
The following persons are not certified as dependents even if they have an address in Japan.However, the qualifications of dependents who are no longer dependents due to the introduction of domestic residence requirements and who have been admitted to an insurance medical institution as of April 2, 4nd year of Reiwa will continue during the hospitalization period. There is a transitional measure to make it.
- Those who came to Japan with a "medical stay visa"
- Those who came to Japan with a "long stay visa for sightseeing and recreation" (up to one year visa for wealthy people)
In order to confirm the status of dependents, the insurer is said to be able to confirm the dependents (survey of the current status of dependents) (Rule 50).Submit the answer to the questionnaire and the income and proof of residence status to the insurer.If you do not meet the above statutory certification conditions such as high income, or if you do not submit a survey form, your employer(I.e.If you have subscribed to, you will no longer be eligible for dependents (subscribe to National Health Insurance, etc.).Dependent status surveys play an important role in the proper application of health insurance (preventing unreasonable exemptions from social insurance premiums), but insurers struggling to respond because they confirm a huge number of dependents. There are also many.Ministry of Health, Labor and WelfareAt least once a yearThe insurer is instructed to implement it (with a fixed date each year).
In the past, the certification of dependents, the annual income, and the judgment of whether or not they were in the same household were certified without any strict examination if the insured requested that they meet the requirements. The handling has changed from October 30, and official certificates (,Family registerWhen the insurer or business owner has already obtained the information to certify the status (such as)personal number(For example, when confirming using) is excluded.August 30, 8 Hoho Departure 29 No. 0829).
Voluntary continuous insured
Those who meet all of the following requirementsInsurerBy applying to, you will continue to be an insured person of the insured person even after losing the insured status (Article 37. "Voluntary continuous insured person", "Voluntary continuous member", "Voluntary continuous member" However, in this section, "Voluntary continuous insured”).Voluntary continuous insuredDate of loss of general insured statusTo get that qualification.Family members can also join as dependents, and the requirements are basically the same as in the case of certification of dependents during employment.
- Being a person who has lost general insured status because it is no longer used by applicable business establishments or because it falls under the exemption provisions.
- If you lose your qualification due to the cancellation of a voluntary application establishment, you cannot become a voluntary continuous insured person (August 3, 8, Hosei No. 17).
- Until the day before the day of disqualificationkeep working on itBeing a general insured person (excluding insured persons who are members of mutual aid association) for 2 months or more
- Members of mutual aid associations cannot be voluntary continuous insured persons because they are subject to the voluntary continuous membership system of mutual aid associations.For mutual aid associations, etc., "February or more" is often "2 year and 1 day or more".
- "February and above" isIt's more than February in a row, not more than February in total..As a general rule, they are the same insurer, but if the health insurance association that they were enrolled in is dissolved, the insurer will be automatically taken over by the Japan Health Insurance Association. It turns out that.
- Not insured by seafarers' insurance or insured by medical care for the elderly
- A person who can receive benefits from each of these systems cannot be a voluntary continuous insured person.
- Apply within 20 days from the date of disqualification (the day after the retirement date)
- The first premium to be paid has been paid by the due date.
- If the insurance premium to be paid for the first time is not paid by the due date, the personIt is considered that the person did not become a voluntary continuous insured person..
- The insurer may, when he / she finds that there is a justifiable reason, accept the delay in the offer / payment after the expiration of the period.
- But in principleEarthquakeFor reasons such as natural disasters, such as when the function of a financial institution is paralyzed due to[*13] Since it is not allowed except for non-paymentLaw ignorance, Simple forgetting to pay, misunderstanding,Account transferIn the case ofBalanceShortage, of the nearest financial institutionTMJThe insured status cannot be reinstated due to reasons such as a breakdown.This is a voluntary continuation systemVoluntary continuationTherefore, in addition to paying insurance premiums, you are responsible for various notifications, etc., and all the results (results of forgetting to pay insurance premiums, etc.) belong to you.responsibilityAccording to the legal theory of.Because I lost my qualification at my own risk or willRequest for examinationLegal complaints are not admitted against justice.It should be noted that although some insurers have made it easier to approve the reinstatement of qualifications for the first time because of a mediation request to the Ministry of Internal Affairs and Communications, this does not necessarily mean that they will be admitted.
The voluntary continuous insured person is the day after the day when any of the following applies (Bold textIn the case of, the qualification will be lost on the day) (Article 38).
- When two years have passed since the day of becoming a voluntary continuous insured person
- In other words, it is the longest that you can continue to take out health insurance after retirement.2 年 間It turns out that.
- When you die
- When the insurance premium (excluding the insurance premium that should be paid for the first time) is not paid by the due date
- You cannot pay the premium after the loss of the premium delinquency (no reminder is sent), and once you lose your qualification, you cannot become a voluntary continuous insured again, but there is a good reason for the insurer to be unpaid. This does not apply if it is found to exist.
- When you become a general insured person
- When you become an insured person of sailor insurance
- When you become an insured person of medical care for the elderly
For voluntary renewal premiums,Eliminate the burden on business ownersTherefore, the insured will be fully liable and will be obliged to pay the insurance premiums borne by him / herself.Basically, it will be about 2 to 2.5 times the amount of deduction (some insurers have set an upper limit on the premiums to be collected).Various notifications must be made by oneself, not through the business owner.
Just because you take out other insurance as a dependent or the premium of National Health Insurance is cheapCannot be switched arbitrarilyHowever, in reality, payment of insurance premiumsPurposelyMany people lose their insured status and switch to National Health Insurance by not doing so (especially in April).[*14]..There are some health insurance associations and mutual aid associations that can voluntarily lose their qualifications.Insurance premiums for a certain period (June or 6 year) in the future can be paid in advance, in which case the interest rate is 1 minutes per year.interestA considerable amount is discounted.
After payment, if you become an insured person of health insurance (association health insurance, mutual aid association, health insurance association, national health insurance association (limited to business establishments covered by welfare pension)) within the same month, you will be refunded at a later date (however, qualification) Excluding the month of acquisition).
Special Retirement Insured
With the approval of the Minister of Health, Labor and Welfare, "Special Retirement InsuredHealth insurance association with a system (Specified health insurance association) (Article 3 of the Supplementary Provisions).Those who are entitled to receive the welfare pension and have an insured period of 20 years or more or 40 years or older and 10 years or more can continue to enroll (unlike voluntary continuous insured persons, there is no time limit such as "2 years").Those who are going to become will start from the day after the day when the pension certificate etc. arrives.Within 3 months(This does not apply if the health insurance association is newly approved by the specified health insurance association. Rule 168, Paragraph 4).The date the offer was acceptedTo obtain the qualification of a special retirement insured person.A person who is a voluntary continuous insured person cannot be a special retirement insured person.Since it is voluntary insurance, it is common with voluntary continuous insured persons in terms of premium payment and disqualification.However, only a little less than 1,500 of the approximately 70 health insurance unions nationwide have this system.Some unions are considering abolishing or abolishing it because it will put pressure on the working generation.
The insurance premiums for general insured persons are the same as the welfare annuity insurance premiums.The insurance premium is shared between the business owner and the insured.(Article 161, Paragraph 1).The employer is obliged to pay the insured person who uses it and the insurance premiums borne by him / herself (Article 161, Paragraph 2) and should pay the insured person.RemunerationEven if there is no insurance, the employer is obliged to pay the full amount including the insured person (February 2, 2, Insurance No. 18).As a general rule, the employer should bear the insuredFor the previous month(If you retire on the last day of the month and the remuneration is paid in that month, the premium for the previous month and the current month) can be deducted from the remuneration (Article 167).The due date is the end of the following month (no advance payment).
The insurance premium for the voluntary continuous insured person must be paid in full by the person himself / herself., The due date is the 10th of the month (the date specified by the insurer for the first premium to be paid) (Article 164).In addition, the voluntary continuous insured person can pay the premium for a certain period (1 year or 6 months) in advance (Article 165).
Health insurance associations can increase the burden ratio of business owners for both general insurance premiums and long-term care insurance premiums (Article 162), and many associations have lower insurance premium rates than the Japan Health Insurance Association. There are unions with a fragile financial base that exceed the insurance premium rate of the Japan Health Insurance Association.If the employer increases the burden ratio, the amount equivalent to the increase ratio is not included in the "remuneration".
General insurance premium = standard monthly salary x general insurance premium rate
(For long-term care insurance No. 2 insured persons, the long-term care insurance premium amount (standard monthly salary x long-term care insurance premium rate) is added and collected together.)
Insurance premium rate
- General premium rate: The sum of the specified premium rate and the basic premium rate.
- Specified insurance premium rate: Insurance premiums allocated to expenses used to support medical care for the elderly (Japan Health Insurance Association's uniform 2019% nationwide in FY3.51).
- Basic insurance premium rate: Insurance premiums for expenses required for health insurance business other than medical care for the elderly (set for each prefecture at the Japan Health Insurance Association).
- Long-term care insurance premium rate: Set based on the long-term care payment that the insurer should pay (at the Japan Health Insurance Association, 2019% is uniform nationwide in FY1.73).
- Adjusted premium rate: The premium that the union contributes to the federation to adjust for the imbalance in the financial resources of the union health insurance.
From October 2008 (Heisei 20)National Health Insurance AssociationAs a result, the general insurance premium rate, which was uniform nationwide, was 3.0% to 13.0% (initially 3.0% to 10.0%, until March 28, 3% to 3.0) for each prefecture according to medical expenses. %) Will be decided by the association..However, only regional medical disparities are reflected, and differences in financial strength between prefectures due to differences in age composition and income level are adjusted between prefectures, so they are reflected in the insurance premium rate. Not done.The association needs the approval of the Minister of Health, Labor and Welfare to change the insurance premium rate, and the minister orders the association to apply for approval of the change when it finds that the insurance premium rate is inappropriate and hinders the sound operation of the business. Can be done (Article 160).
Actually, from September 2009, the insurance premium rate for each prefecture will be 9% (8.26%).Hokkaido) ~ 8.15% (Nagano) Was determined.Six months later, in March 2010, the national average premium rate was raised significantly by 3% to 1.14% (Hokkaido) to 9.42% (Nagano Prefecture), and the premium rate has continued to rise since then. .. 9.26% after April 2018 (Saga) ~ 9.63% (Niigata) Has become.
Even in health insurance associations, the general insurance premium rate is determined for each association within the range of 3.0 to 13.0%, and in principle, approval from the Minister of Health, Labor and Welfare must be obtained when making changes.[*15]..In the health insurance union established by the merger, a non-uniform general insurance premium rate can be set with the approval of the Minister of Health, Labor and Welfare only in the five years following the merger.
Insurance premium collection
As a general rule, insurance premiums start from the month of acquisition of insured qualification.The month before the disqualification monthHowever, if you lose your qualification in the month of qualification, the insurance premium for that month will be collected.If you qualify more than once in the same month, you may be required to collect more than February premiums per January.
In the following cases, all insurance premiums can be collected even before the delivery date (advance collection, Article 172).
- When the payer falls under any of the following
- When the payment obligor who is a corporation dissolves
- When the business establishment where the insured person (including the day labor special insured person) is used is abolished (including the case where the business owner is changed)
Exemption from insurance
Continued from the previous monthGeneral insuredWho isJuvenile training,Penal institution,Labor officeIf you are detained or detained in a facility equivalent to these, insurance premiums will not be collected from that month until the month before the month when it is no longer applicable (Article 158).However, insurance premiums will be collected if the person is no longer accommodated during the same month.If the insured person falls under (disappears) in these cases, the employer shall apply "Article 118, Paragraph 1 Applicable Notification (Non-Applicable Notification)".[*16] Must be submitted to the Organization or Union within 5 days.
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[*17])General insuredWhen the employer of the business establishment where is used makes an offer to the insurer, etc., the insurance premium for the insured person is from the month to which the childcare leave start date belongs to the month before the month to which the day after the end date belongs. Not collected (Article 159).If the insured changes the period of childcare leave, etc., or if the insured person finishes childcare leave, etc. by the day before the scheduled end date of childcare leave, etc., he / she must promptly notify the Organization or the union.Insured persons who are representative directors and full-time officers of corporations are not allowed to be exempted from insurance premiums due to childcare leave, etc. (Because the Childcare Leave Law limits the target to "workers". 21 No. 12).It should be noted thatLabor-management agreementEven if childcare leave, etc. is provided after the day when the child reaches the age of 3, the exemption is limited to childcare leave, etc. for raising children under the age of 3.
After April 26, 4Maternity leaveWhen the employer of a business establishment where a general insured person is used makes a request to the insurer, etc., the period from the month to which the prenatal and postnatal leave start date belongs to the month before the month to which the day after the end date belongs. , Insurance premiums for the insured are not collected (Article 159-3).If the insured changes the prenatal and postnatal leave period, or if the insured completes the prenatal and postnatal leave by the day before the scheduled end date of the prenatal and postnatal leave, promptly send a "Notice of Change (End) of Prenatal and Postnatal Leave Taker". Submit to the union.Unlike childcare leave, insured persons who are representative directors and full-time officers of corporations are also exempted from insurance premiums due to maternity leave.
ExemptIs paid for both the employer's share and the insured's share.In addition, it should be notedNo exemption is given to voluntary continuous insured persons and special retirement insured persons(Insurance premiums will be collected even if these are applicable).
Measures against delinquency
If there is a person who is behind in paying insurance premiums or other fees collected under the Health Insurance Act, the insurer, etc. must specify a deadline and urge them.The deadline specified by the reminder must be 10 days or more from the date of issuance of the reminder (Article 180, Paragraphs 1 to 3).The reminder is given in the form of the reminder letter (Form No. 20) stipulated in the rules, and is not given verbally, by telephone or in ordinary writing (Rule Article 153).Even if it falls under the prepayment, you must reminder the premiums that have already passed the delivery date (in this case, the delinquent charge will not be collected).
If the insurer, etc. does not pay the insurance premiums or other collections pursuant to the provisions of this Act by the designated deadline, the insurer, etc.National tax delinquencyIt is possible to dispose of this according to the example of, or request the disposition from the place of residence of the delinquent or the municipality of the property location of the delinquent (Article 180, Paragraph 5).When a municipality disposes of it according to the example of municipal tax, the amount equivalent to 4% of the collected money will be delivered to the municipality by the Minister of Health, Labor and Welfare (Article 180, Paragraph 6).If an organization, association, or union disposes of delinquent payments, it must obtain approval from the Minister of Health, Labor and Welfare in advance.Also, if the delinquent is malicious, the relevant authorityMinister of FinanceThroughCommissioner of the National Tax AgencyCan be delegated to. A "malicious case" is a case where any of the following requirements are satisfied.
- The payer has been delinquent in insurance premiums for more than 24 months.
- The payer may be concealing the property for the purpose of avoiding execution.
- The amount of insurance premiums and other collected money that the obligee is behind is 5,000 million yen or more.
- It is not recognized that the payer has a sincere intention to pay.
When urging, if there are unavoidable circumstances,Public serviceExcept in the case of a reminder by, the insurer, etc. will be charged the collected amount (fractions less than 1,000 yen will be rounded down).From the day after the delivery deadline14.6% per year (XNUMX% per year, depending on the number of days until the day before the date of full payment or property seizureWhen the reminder is related to insurance premiumsIs the amount calculated by multiplying the ratio of 3% per year for the period from the day after the delivery deadline to the day when March passes.Overdue money(Fraction less than 100 yen is rounded down) is collected (Article 181).In addition, in order to reduce the burden on business owners, etc., from the awareness of the problem that the annual delinquency charge of 14.6% is too high under the current low interest rate situation.Special exceptions will be set up for the time being, Each yearSpecial standard ratio(Tax Special Measures ActBased on the provisions of Paragraph 93, Paragraph 2, as "the ratio obtained by dividing the total average interest rate of new short-term lending contracts of banks in each month from October of the previous year to September of the previous year by 10".Minister of FinanceIf the annual rate (1% per year is added to the rate notified by) is less than 7.3% per year,
- For the period of "7.3% per year",Add 1% per year to the special standard ratio(If the added ratio exceeds 7.3% per year, 7.3% per year)
- For the period of "14.6% per year",Add 7.3% per year to the special standard ratioPercentage
Is said to be.In the case of 3 years of Reiwa, the special standard ratio was 1.5% per year (0.5% per year plus 1% per year)., Actually it is as follows.
- For the period of "7.3% per year", 2.5% per year
- For the period of "14.6% per year", 8.8% per year
Insurance premiums, etc.LienThe ranking shall be next to national tax and local tax (Article 182).
National treasury burden / subsidy
The national treasury isWithin budgetIn, bear the expenses required for the execution of the affairs of the health insurance business (Article 151).Therefore, all administrative expenses are borne by the national treasury.In addition, the national treasury contribution to be delivered to the health insurance association isBased on the number of insured persons in each health insurance association, The Minister of Health, Labor and Welfare is supposed to calculate, and this national treasury contribution can be roughly paid (Article 152).
For the Japan Health Insurance Association, the national treasury will subsidize 13 to 20% of the total amount obtained by multiplying the amount required for the payment of major insurance benefits by the benefit cost ratio (Article 153, Paragraph 1). For the time being, the national treasury subsidy rate is16.4%(Article 5 of the Supplementary Provisions)[*18][*19].
In addition to these, the national treasury is one of the expenses required to execute the health insurance business within the budget.Specific health checkAnd a part of the cost required for the implementation of specific health guidance can be subsidized (Article 154-2).
In addition to the items listed below, in the case of a health insurance association, by stipulating the rulesAdditional benefitsCan be done (Article 53).As long as the insured person's qualification is appropriate, insurance benefits will be provided for illnesses, injuries, etc. before the qualification (October 26, 10, Hobun No. 16).Even if the accident occurs before the employer submits the notification of qualification acquisition, if the qualification acquisition is confirmed retroactively, it will be an insurance accident and will be covered by the benefit (November 4111, 31, Hobun No. 11). ).
See each article for details.
- Medical treatment benefits(Article 63)
- Medical expenses for hospitalization(Article 85)
- Medical expenses at the time of hospitalization(Article 85-2)
- Out-of-insurance combined medical expenses(Article 86)
- Medical expenses(Article 87)
- Home-visit nursing care expenses(Article 88)
- Transport cost(Article 97)
- Injury and sickness allowance(Article 99)
- Burial fee-Burial expenses[*20](Article 100)
- Lump-sum birth allowance(Article 101)
- 出産 手 当 金(Article 102)
Insurance benefits (family benefits) for dependents are provided only to the insured who bears the premium.Therefore, if the insured dies, family benefits will be discontinued the next day.In addition, continuous benefits after the insured's disqualification will not be provided to dependents (December 31, 12, Hobun No. 24).
- Family medical expenses
Medical benefits, meal medical expenses at admission, living medical expenses at admission, combined medical expenses not covered by insurance, and benefits equivalent to medical expenses are all for dependents.Family medical expensesIt is paid as (Article 110).
- Family visit nursing medical expenses
- Family transfer fee
- Family burial fee
- Family birth and childcare lump sum
Benefits similar to those of the insured are provided (Articles 111-114).However, the family burial fee is not paid to dead children (December 23, 12, Hobun No. 2).
Payment to reduce copayment
See each article for details.
Protection of entitlement
The right to receive insurance benefits isHanding over,collateralOrForeclosureCannot be done (Article 61).Taxes and other public charges cannot be levied on the basis of money received as insurance benefits (Article 62).Documents related to health insuranceStamp taxDoes not impose (Article 195).
- When an insurer, etc. provides medical treatment benefits, receiving medical treatment fees from the insurer is not immediately interpreted as receiving insurance benefits, but the purpose is to the insured. On the other hand, it is clear that it is about securing insurance benefits.Therefore, the payment of medical fees made through the fund, like other insurance benefits, is not subject to seizure or transfer (June 25, 6, Hobun No. 13).
In addition, the Health Insurance LawThere is no provision for unpaid benefitsSo, if the insured dies leaving unpaid benefits,Civil lawAccording to the principle ofBeneficiaryHeirBecomes the claimant of unpaid benefits(February 2, 2, Hosho No. 18).
Benefit restrictions / collection of unjust enrichment
The insured person or the person who was the insured personPurposely OfcrimeIf a reason for benefit is caused by an act or intentionally, the insurance benefit related to the reason for the benefit will not be provided (Absolute benefit restrictions, Article 116).The same applies to dependents (Article 112).However, even in these cases, the burial fee (burial fee) is treated as being paid.
- In order to impose absolute benefit restrictions, it is not enough to have an accident during the execution of an act, and we believe that the act is the main cause of the accident.Considerable causalityIs required to be between the two (April 35, 4, Hobun No. 27).
- Attempted suicideIn the case of, insurance benefits will not be provided, but for attempted suicide due to mental illness, etc., insurance benefits will be provided as not being "intentional".
- If the insured injures a dependent by "self-intentional criminal activity", the dependent is not covered by the insurance benefits in principle.HoweverViolence of insured spouseIf a dependent who is injured in the above offers an offer, he / she will be covered by insurance if he / she receives an emergency medical examination before he / she is removed from the dependent.
When the insured causes a benefit event due to struggle, drunkenness or significant misconduct, the insurance benefit related to the benefit event may not be provided in whole or in part (relative benefit restriction, Article 117).The same applies when a person receiving insurance benefits does not comply with the submission or submission order of documents or other properties without a justifiable reason, or refuses to answer or receive a medical examination in response to an employee's question or diagnosis.
- The term "reason for benefit" as used herein means a reason for benefit caused by "struggle, drunkenness or significant misconduct".Therefore, although he was an insured person and had fought a few days ago, fortunately, one of them was suddenly harmed a few days later in an attempt to dispel this anger after no cause of benefit occurred at that time. Does not apply to the case of "causing a benefit event due to a struggle" (April 2, 4, Insurance No. 27).
If the insured person or the person who was the insured person does not follow the instructions regarding medical treatment without a justifiable reason, he / she may not provide a part of the insurance benefits (partial restriction, Article 119).
The insurerFalsehood and other misconductFor those who receive or intend to receive insurance benefits, a period of up to 6 months should be set and paid to that person.Injury and illness allowance or maternity allowanceIt is possible to decide not to pay all or part of.However, if one year has passed from the date of deception or other misconduct, the benefit cannot be restricted (Article 1).
Falsehood and other wrongdoingIf there is a person who has received insurance benefits by, the insurer may collect all or part of the value of the benefits from that person.(Article 58, Paragraph 1).In this case, the employer makes a false report or proof, or the insurer orAttending physicianHowever, if the medical certificate to be submitted to the insurer makes a false statement and the insurance benefit is provided, the insurer receives the insurance benefit from the business owner, the insurer or the attending physician. To those whosolidarityThen, it is possible to order that the collection fee set forth in the preceding paragraph should be paid (Article 58, Paragraph 2).
The insurer is an insurance medical institutionInsurance pharmacy・ Designated home-visit nursing care provider is false and othersInjusticeWhen the expenses related to medical treatment benefits, etc. are paid, the insurance medical institution, insurance pharmacy, or designated home-visit nursing care provider will be refunded for the amount paid and 40% of the refunded amount will be paid. Can be done (Article 58, Paragraph 3).
Since the qualifications of the insured in health insurance and the payment of insurance premiums are bundled with the welfare pension, the welfare pension and procedures are unified for complaints.
Those who are dissatisfied with the insured's qualifications, standard remuneration or disposition regarding insurance benefits will be placed at each local health bureau.Social insurance examinerAgainstRequest for examinationCan be done (Article 189).This request for examination must be made within 3 months from the day following the day when the disposition was learned (Social Insurance Examiner and Social Insurance Examination LawArticle 4).In addition, a request for examination of the disposition regarding the insured's qualification or standard remuneration cannot be made when two years have passed from the day following the day of the original disposition.With regard to the above dispositions, an action for cancellation can only be filed after the decision of the social insurance inspector for the examination request has been passed ().Examination request prefix, Article 192,Administrative case lawArticle 8 proviso).
Those who are dissatisfied with the decision of the social insurance examinerSocial insurance review boardAgainstRequest for re-examinationCan be done (two-trial system).This request for reexamination must be made within two months from the day following the day when the copy of the decision of the social insurance examiner is sent (Article 2 of the Social Insurance Examiner and the Social Insurance Examination Board Law).In addition, if there is no decision within two months from the date of requesting examination, the requester for examination shall consider that the social insurance examiner has rejected the request for examination and file a request for reexamination with the Social Insurance Examination Board. Can be done.In either case, the request for reexamination can be made orally. The 32 amendment made it up to the petitioner to choose between requesting reexamination and filing an action to cancel the disposition.
A person who is dissatisfied with the disposition of imposition or collection of insurance premiums or the disposition of delinquent payment may request an examination from the Social Insurance Examination Board (first-instance system, Article 190).In this case, due to the revision of the law in 2016, the pre-examination request principle is no longer applied, so it is possible to file an action to cancel the disposition without requesting examination.
Request for examination/re-examination request isPrescriptionSuspension is considered a judicial claim.
The right to collect or refund insurance premiums and the right to receive insurance benefits shall be granted when two years have passed since they could be exercised.PrescriptionDisappears by (Article 193, Paragraph 1).Since this is a regulation related to the collection and benefits of money, in-kind benefits such as medical treatment benefitsAnnihilation prescriptionDoes not apply.Notification or reminder of payment of insurance premiums has the effect of renewing the prescription (Article 193, Paragraph 2).
The Health Insurance Act does not apply to the insured's right to claim the refund of the overpaid premium that should be refunded from the employer to the insured.Civil lawIt takes 10 years to expire according to the general principle of (Civil Code Article 167).
Relationship between health insurance and other medical insurance systems
Because illness or injury is caused by work or commutingWorkers' compensation insurance(Workers' accident compensation insurance) orPublic affairs disasterIf compensation is applied, andLong-term care insuranceIf payment is made by applying the above, health insurance may not be applied to the same illness / injury and the payment may be cut in full.For exampleInjury and sickness allowanceIs not paid in full (Article 55).
In principle, no insurance benefits will be provided for illness, injury, or childbirth for insured persons or persons who were detained or detained in juvenile training schools, penal institutions, labor offices, or other similar facilities.Public treatmentCoordination with, Article 118).However, even in this case, death benefits and insurance benefits for dependents will be provided.In addition, it should be noted.Undecided detentionInjury and illness allowances and maternity allowances will be paid to persons.Also,tuberculosis,Mental illness,Atomic bombetc,Publicly funded treatmentHealth insurance benefits will not be provided for illnesses and injuries covered by the above, within the scope of public expenditure.However, when there is a conflict between health insurance and public expenditure, health insurance is generally given priority and public expenditure is paid for the self-pay portion.
Regarding the relationship between health insurance and other insurance / medical systems (work accidents, public affairs accidents, long-term care insurance, publicly funded treatment, publicly funded treatment), one of the systems will be selected and payment will be adjusted. You must get benefits from one of the other insurances, not the ones.For example, if you receive a health insurance benefit despite an industrial accident, you will have to return the amount equivalent to the benefit to the insurer and then apply for the industrial accident (even if you apply for the industrial accident, you will be paid immediately. It will not be done), so it will be troublesome twice and you will have to pay for medical expenses even temporarily.Regarding the problem of "hidden work-related accidents"Industrial accidentSee item.
Relationship with third party acts
Illness or injury is a traffic accident, etc.third partyIf the cause is an act, it does not mean that health insurance can be applied immediately.If the patient wishes to receive health insurance benefits for injury or illness caused by a third party act, the insurer will provide medical benefits by reporting the damage caused by the third party act (commonly known as "notification of third party act"). Is done..Medical expenses paid by the insurer are transferred from the perpetrator to the insurer through reimbursement.RepaymentIs supposed to be..Specifically, the insurer has the right to claim damages against the other party of the third party act, up to the amount paid.SubrogationAcquire (Article 57, Paragraph 1).It is stipulated that the person obliged to submit the notification of third party act is the insured person (not necessarily the patient himself / herself) and submits it without delay (Article 65 of the Enforcement Regulations).
In the case of injury or illness caused by a third party, we will work with the other party until the insurance benefits are terminated due to the complete cure of the illness or the fixation of symptoms.TalksEtc. should not be done, and there is guidance from the insurer to that effect.By first making a settlement between the victim and the other party (including oral promises), the victim's right to claim damages is fixed (limited), and the insurer can also obtain a substitute right to claim damages. This is because it is limited.If the amount of compensation is received by prior compensation outside the proceedings (personal injury of automobile insurance, etc.), or if the amount of compensation is fixed by a proceeding, etc. and the receipt is received, the benefit from health insurance will be limited to the amount received. Payment adjustments will be made to this (Article 57, Paragraph 2).Regarding the relationship between third-party acts and various types of insurance, see Workers' Accident Compensation Insurance.Public affairs disasterThe same applies to insurance and long-term care insurance.
- ^ Due to the revision in 14, the notation in the text was changed from "insured" to "worker".
- ^ In the Health Insurance Act, "childbirth" means delivery over April (4 days) of pregnancy, and if it is normal delivery, stillbirth, premature birth,abortion,AbortionIt does not matter whether it is (No. 27 issued by Hobun on June 6, 16).
- ^ If the insured is injured during the contract work performed as a side business, or if the dependents perform the contract workInternshipIt is possible that you were injured while you were injured (August 25, 8, administrative contact).
- ^ As for work accidents under the Industrial Accident Compensation Law, health insurance benefits are not covered, and for commuting accidents under the Industrial Accident Compensation Law, benefits from industrial accident insurance are prioritized. You can prompt a claim and reserve health insurance benefits.However, the insurer should give due consideration to the reservation of health insurance benefits, such as contacting related medical institutions (business contact on August 25, 8).However, as a general rule, illnesses caused by the execution of business as a corporate officer will not be covered by health insurance or workers' accident compensation insurance (Article 14-53 of the Health Insurance Act).
- ^ If the location of the business office moves beyond the prefecture, the branch of the Japan Health Insurance Association will change, so the insurance card will be exchanged.In addition, the location of business offices will be relocated within the same prefecture, and the insured will be (regardless of whether or not they cross the prefecture).TransferIf you do, basically you will not exchange your insurance card.
- ^ In the welfare pension, "Sailor LawAs a sailor as stipulated in Article 1Ship ownerUsed byShipIs also a compulsory application establishment.
- ^ As of 18, only about 440 companies have been approved by the batch application establishments.
- ^ The changed business owner will be notified.In the past, both business owners before and after the change were supposed to report at the joint signing, but due to the revision of the law, only the business owners after the change are obliged to report.
- ^ The term "insured person" refers to all four types of insured persons in the provisions of the Health Insurance Act, so the provisions "insured persons (special insured persons for day labor, voluntary continuous insured persons and special retirement insured persons)". The notation ")" has been simplified.
- ^ It is not necessary to enter these numbers in the case of a disqualification report.
- ^ "Business as an officer of a corporation" refers to all the business performed by an officer of a corporation for the corporation, and does not mean that the scope of the business is particularly limited (business communication on August 25, 8). ..
- ^ As of June 55, 6, Chief of Insurance Division, Insurance Bureau, Ministry of Health, Health Insurance Division, Medical Insurance Department, Social Insurance Agency, Chief of Health Insurance Division, Pension Insurance Department, Social Insurance Agency.This inner can was abolished in October 6.
- ^ In the event of an earthquake that caused great damageMinistry of Health, Labor and WelfareTherefore, at the request of the insured, the insurer will be notified to allow the reinstatement of the qualification.recentlyNiigata Chuetsu-oki Earthquake(2007 ),Iwate-Miyagi Inland Earthquake(2008 ),Foot-and-mouth disease epidemic in Miyazaki Prefecture(2010 ) Was issued.
- ^ Since the calculation method of insurance premiums for National Health Insurance differs depending on the municipality, it cannot be said unconditionally which is more advantageous than voluntary continuation.You should always compare the premiums and benefits of both in advance.
- ^ As an exception, for changes in the general insurance premium rate that do not result in a change in the combined rate of the general insurance premium rate and the adjusted insurance premium rate, it is sufficient for the union to notify the Minister of Health, Labor and Welfare of the changed general insurance premium rate.
- ^ These persons have such a name because their insurance benefits are restricted by Article 118 (1).
- ^ According to the lawNursing care leaveAlternatively, it does not apply to measures such as shortening of prescribed working hours due to nursing care.
- ^ As one of the financial support measures for the Japan Health Insurance Association, it was implemented as a three-year time-limited measure from 22 to strengthen and stabilize the financial base of the Japan Health Insurance Association, but it was extended for two years and the law was revised. It was decided that it would be implemented without a deadline.
- ^ Due to the revision of the law, the national treasury subsidy for the amount of expenses required for payment of the support for the elderly aged 29 or over will be from April 4, and the national treasury subsidy for the amount of expenses required for payment of the long-term care payment that the association should contribute will be 30/4. It will not be done from the month.
- ^ "Burial cost" is a practical term, and legally "amount equivalent to the cost of burial".
- ^ Overview of national medical expenses in 28 (Report). Ministry of Health, Labor and Welfare. (2018-09-21) .
- ^ 25 White Paper on Health, Labor and Welfare (Report). Ministry of Health, Labor and Welfare. Document p26.
- ^ Labor Force Survey (Basic tabulation) National Annual 2019 (Report). Ministry of Internal Affairs and CommunicationsStatistics Bureau(2019-01-31). Basic tabulation Table II-10 .
- ^ If it is difficult to submit a certificate, etc. due to living overseas, etc., it is necessary to submit a statement of status (March 30, 3, Hoho No. 22 No. 0322).
- ^ About certification of health insurance dependents Japan Pension Service
- ^ Supreme Court decision February 36, 2
- ^ OECD 2009, p. 118.
- ^ The insurance premium rate for the Japan Health Insurance Association in 31 will be revised from March (paid in April). National Health Insurance Association
- ^ Reiwa November 2, 11nd Ministry of Finance Notification No. 30
- ^ "All or part" means all or part of what was received by deception or other fraudulent activity, and was received by fraud or other fraudulent activity. Minutes are all (No. 32, issued on September 9, 2).
- ^ a b Shiro Yamasaki: Third Party Act (1). National Health Insurance, 30 (7): 32-34, 1979
- OECD Economic Surveys: Japan 2009 (Report). OECD. (2009-08-13). Chapt.3. two:10.1787 / eco_surveys-jpn-2009-en. ISBN 9789264054561.
- Employee Welfare
- National Health Insurance - National Health Insurance Act - National Health Insurance tax
- Insurance medical institution - Insurance pharmacy
- Doctor - Dentist - pharmacist
- Medical economics
- Medical fee - Receipt
- Health insurance card
- Japan's medical care # medical system reform
- Health insurance union # financial problem
- Japan Health Insurance Association #Association Kenpo's financial deterioration
- Visit a convenience store
- Medical fraud
- Health insurance fraud
- Unauthorized billing of medical expenses