[Created in May 2023]

For Persons aged 75+
and persons aged 65+ who are
certified as being disabled

The Medical Care System
for Elderly People

The Medical Care System for Elderly People covers persons
aged 75+ and those aged 65–74 who are certified as being
disabled under the program’s criteria.
Thank you for your understanding.

The Wider-Area Union for the Medical Care System
for Elderly People in Osaka PrefectureTable of Contents○ Operational Flow and Financial Sources ................................................................... 2○ Please Contact the Local Municipal Office on the Following Occasions. ................... 2○ Persons to Be Insured ............................................................................................... 3○ Insurance card ........................................................................................................... 4• Section for Indicating Intention to Donate Organs .................................................. 5○ Insurance Premiums .................................................................................................. 7• Method of Calculating Insurance Premiums ........................................................... 7• Reduction of Insurance Premiums .......................................................................... 8• Example of Calculating Insurance Premiums ....................................................... 10• How to Pay Insurance Premiums ......................................................................... 12• Insurance Premiums Exemption/Reduction and Postponing of Collection ........... 14• What HappensCo-payment
If I Fall...........................
14
Co-payment
rate ofrate Behind in Paying Insurance Premiums?
medical expenses
of medical
Category○ Medical Treatments.................................................................................................
15
expenses• Co-payment Rates of Medical Expenses .............................................................. 15• High-Cost Medical Care Benefit ........................................................................... 17• Hospital Meal Fees ............................................................................................... 20• Inpatients Using Long-Term Care Beds ................................................................ 20• Unitary High-Cost Medical/Long-Term Care System ............................................ 21• When You Need to Receive High Cost Medical Treatment for a Long Period ...... 22• Traffic Accidents ................................................................................................... 22○ Reimbursement of Medical Expenses ..................................................................... 23○ How to Receive Treatment from Judo Therapists, Acupuncturists,
Moxibustion Practitioners, and Massage/Shiatsu Practitioners................................ 24○ Other Benefits .......................................................................................................... 25○ Healthcare Programs ............................................................................................... 26• Medical Examinations (Free of Charge) ............................................................... 26• Dental Examinations (Free of Charge) ................................................................. 27• Subsidy Program of Comprehensive Medical Examinations ................................ 28○ Use of the Individual Number Card as an insurance card ........................................ 29○ List of Municipal Offices ........................................................................................... 30

In Osaka Prefecture, the Medical Care System for Elderly People is operated by the Wider-Area Union for
the Medical Care System for Elderly People in Osaka Prefecture (hereinafter, the “Wider-Area Union”), which
comprises all municipalities within Osaka Prefecture.
Meanwhile, each municipality offers various counter services, such as the acceptance of applications
and notifications.

Wider-Area Union
Operates the Medical Care System for Elderly People● Authorizes eligibility status for the medical careprogram and certifies insured persons● Issues insurance cards and related certificates● Determines the amounts of insurance premiums● Provides various medical and other related benefits● Implements various healthcare programs, including
medical examinations, etc.

Municipalities
Collect insurance premiums and provide various
counter services, such as the acceptance of
applications and notifications● Collect insurance premiums● Deliver and collect insurance cards and related
certificates● Accept notification regarding acquisition/loss ofeligibility● Offer consultation services on the program, etc.

Operational Flow and Financial Sources
Operational Flow

Presenting insurance cards
Making co-payments

Insured persons

Medical institutions

Municipalities

Charging medical
expenses

Paying medical
expenses

Delivering insurance
cards

Paying insurance
premiums and filing
applications/notifications

Offering medical services

The Medical Care
System for Elderly
PeopleOffering information
Paying insurance premiums
collected from insured persons

Wider-Area
Union(comprising all
municipalities)

Issuing insurance cards

Financial Sources
The Whole Society Supports the Medical
Care System for Elderly People
The Medical Care System for Elderly People
is the scheme under which the whole nation
supports medical care for the people aged 75
and over. The expense of medical care, fromwhich the co-payment portion is excluded, ispaid out of public funds, financial support
from the younger generations (people aged
below 75), and insurance premiums paid by
insured persons.

[Composition of financial sources]
Insurance
premiums
paid byinsuredpersons:
About 10%

Insurance premiums paidby younger generations(aged below 75):
About 40%

Public funds (tax): About 50%<Share ratio>

Nation: Prefectures:
Municipalities = 4 : 1 : 1

Co-payment

Please Contact the Local Municipal Office on the
Following Occasions
OccasionsMoving to another municipality
Moving infrom another municipality

Procedures / What to Take
Return of insurance card
Certificate of burden class (Futan kubun toshomeisho)(if you move in from a municipality outside
Osaka Prefecture)
National pension certificate/physical disability
certificate and documents regarding yourIndividual Number

Becoming disabled (at the age of 65
to 74)(See page 3.)
Withdrawing the disability certification
Return of insurance card /(at the age of 65 to 74 years old)
Documents regarding your Individual Number(See page 3.)
Return of insurance card
Death of an insured person

When
Upon decision to move out
Within 14 days from the day you
start to reside in your new
residence
When you desire a disability
certificate given by the Wider-Area
Union
When you desire to withdraw
disability certificate given by the
Wider-Area Union
After submitting a notification of
death

Application for the funeral expense benefit (SeeAfter the funeralp. 25.)
Return of insurance card / Certificate of public
Receiving public assistanceWithin 14 days from the day you
assistance reception and documents regarding
start receiving public assistanceyour Individual Number
Notification of public assistanceWithin 14 days from the date of
Stopping receiving public assistancesuspension/discontinuance decision andpublic assistance
documents regarding your Individual Number
suspension/discontinuance* Confirm with the division in charge at your local municipal office, in case that the requisite or necessary proceeding other than what is
mentioned above might be needed.

2Persons to Be Insured
Who will be insured by this program?

When to start?

Persons aged 75 or overOn their 75th birthday

Persons aged 65 to 74 who are certified as being
disabled by the Wider-Area Union on application

On the day of certification by the WiderArea Union① Persons aged 75 or over
Basically, all persons aged 75+ are insured, regardless of the types of medical insurance programs they werepreviously covered under, by the Medical Care System for Elderly People.
* Please note, however, that public assistance recipients are not covered.
○ To those who had enrolled in medical insurance programs other than National Health Insurance
When the persons previously covered by employee’s health insurance or their dependents enroll in the Medical
Care System for Elderly People, they must submit a notification regarding the loss of eligibility for theemployee’s health insurance. The notification must be submitted to the municipal office through the place of
employment.
In such a case, dependent family members aged below 75 need to enroll in the National Health Insurance orsimilar other programs. If this is applicable to your case, please take the necessary procedures at your local
municipal office. For details about the procedures, please contact the division in charge at your local municipal
office.
② Persons aged 65 to 74 who are certified as being disabled by the Wider-Area Union on application
Persons aged 65 to 74 having a specific disability can enroll in the Medical Care System for Elderly People byfiling an application for disability certification.
○ To those who are intending to receive disability certification
Eligibility for disability certification● Recipients of the disability pension (classes 1 and 2) based on the National Pension Act● Holders of physical disability certificates (classes 1, 2 and 3 and partly class 4)● Holders of mental disability certificates (classes 1 and 2)● Holders of intellectual disability certificates (class A)<Necessary items for filing an application>● National pension certificate, certificate of physical disability, etc.
● Documents regarding your Individual Number
Those who have once received disability certification can withdraw from the Medical Care System for Elderly People
until they are 75 years old by submitting a notification of withdrawal. In such a case, they will be treated as not coveredby the System from the day after they submit the notification. If you switch to another social insurance plan, submit a
notification of withdrawal before the date of your enrolment in the new insurance. Withdrawal does not mean loss ofphysical or other disability certificates or loss of eligibility for disability pensions. Those who have become ineligible forthe disability certification after receiving the certification are required to submit a notification for loss of eligibility. For
details about the procedure, please consult the division in charge at your local municipal office.

Domicile exemption
If persons covered by the Medical Care System for Elderly People in one prefecture move into anotherprefecture, they will basically need to enroll in the program operated by the Wider-Area Union of that prefecture.
If such a change in residence results from admission to facilities subject to domicile exemption (certain kinds ofnursing homes), long-term hospitalization or similar reasons, the persons will continue to be covered by the
Wider-Area Union for the Medical Care System for Elderly People in Osaka Prefecture. In addition, if persons
who enroll in the Medical Care System for Elderly People for reason ① or ② above after April 1, 2018 haveaddresses at facilities subject to domicile exemption (certain kinds of nursing homes) or hospitals in otherprefectures and had enrolled in the National Health Insurance Program of Osaka Prefecture, they will becovered by the Wider-Area Union for the Medical Care System for Elderly People in Osaka Prefecture.

3

Insurance card
① Insurance card
One card is issued to each insured person. To receive
medical treatment at a medical institution, insured
persons must be electronically authenticated using theIndividual Number Card or present the insurance card
to the institution. (The medical institution may require
you to present a photo ID, such as a driver’s license,
along with your insurance card if the institution
determines that it is necessary.)② Expiration date
As a general rule, the insurance cards are valid until
July 31 every year. A new insurance card is deliveredby late July. Every time a new card is issued, it isdifferent in color. The new card can be used from theday of arrival. (When you become insured by turning
75 years old, it will be effective from your birthday.)③ Expired insurance card
No expired insurance card is valid. We ask you to
return your expired insurance card to your local
municipal office or to destroy it by yourself.

* If you turn 75 years old, your insurance card is to be delivered in the previous month ofyour birthday. After the 75th birthday, you will not be able to use any insurance card
issued by the National Health Insurance Program, employee’s health insurance programor others by which you had been covered previously. Please check with the issuer
regarding the handling of the old insurance card.

■ Important matters concerning the insurance card○

If you find any errors on your insurance card, please ask for correction at the division in
charge at your local municipal office.

○

Never use another person’s insurance card. (If you do so, you will be punished by law.)○

You cannot use copies of your insurance card.

○

If your insurance card is lost, you can request that it be reissued.
If you lose or accidentally destroy the card, ask the local municipal office to reissue the card.

○

If any change in your co-payment rate, your address or other important matters has been
made, a new insurance card that carries the revised information will be delivered. Pleasebe sure to use the new insurance card.
When you receive the new card, please return the old one to the division in charge at your local municipal office.

○If you move into another prefecture, please return your insurance card.
Upon loss of eligibility due to moving into another prefecture, please return your insurance card immediately to the division in charge at your local
municipal office.

4

Insurance card
■ Section for Indicating Intention to Donate Organs
Based on the Act on Organ Transplantation, national and local public authorities are required totake measures for education and diffusion of knowledge concerning medical transplantations,and as a result, the “Section for indicating intention to donate organs” was added to healthinsurance cards, driver’s licenses, etc. starting in July 2010.
The Wider-Area Union for the Medical Care System for Elderly People in Osaka Prefecture has
included a section for indicating intention to donate organs on the back of its insurance card topromote better understanding of medical transplantation. We would like to ask for yourunderstanding and support.

◎ Indication of intention to donate organs○ Whether or not to indicate intention to donate organs is left to the judgment of each insured
person, and therefore we do not require you to fill out that section. Furthermore, whether
you fill out the section and what you fill in do not affect the contents of treatment, etc.
○ There is no age limit for indicating intention to donate organs. Anyone, including elderly
persons and those on medication due to illness, can fill out the section. Organs havepreviously been donated by persons in their 70s. However, there is a possibility that those
who die of cancer or other specific illness cannot donate their organs. The judgment will bebased on the results of medical analysis conducted when organs are actually donated.
○ Organs are donated on a bona fide basis and without compensation. Donors do not have tobear any costs regarding donation.
○ If you want to keep the content of your intention confidential, please hide the section with asticker provided at the counter in charge of the Wider-Area Union for the Medical Care
System for Elderly People in Osaka Prefecture or the local municipal offices. (In the cases
where the insurance card is mailed, a sticker is enclosed.)

For details of organ donation, please contact
the Japan Organ Transplant Network.
Japan Organ Transplant Network
Toll-free: 0120-78-1069 (9:00–17:30 on weekdays)
Website: https://www.jotnw.or.jp/en/5◎ How to fill out the section

備考※ 以下の欄に記入することにより、臓器提供に関する

１．私は、脳死後及び心臓が停止した死後のいずれでも、移植の為に臓器を提供します。

①
３．私は、臓器を提供しません。

じん

②

すい

〔特記欄：

③

〕

署名年月日：
本人署名（自筆）：④

家族署名（自筆）：①

Select the statement that represents your intention
Please circle only the number for the statement that represents your intention.
• If you intend to donate your organ(s), please circle 1 or 2. ⇒ To ②, ③ and ④• If you do not intend to donate your organ(s), please circle 3. ⇒ To ④②

Select organs that you do not want to donate
If you circled 1 or 2 and you do not want to donate any particular organs, mark with anx the organs that you do not want to donate. Organs that you can donate are as
follows:[After brain death: heart, lung, liver, kidney, pancreas, small intestine andeyeball][After cardiac death: kidney, pancreas and eyeball]③ Fill out the special note section• If you circled 1 or 2 and intend to donate other tissues such as skin, cardiac valve,blood vessel and bone, you can write “All” or name specific organ(s), such as “skin,”“cardiac valve,” “blood vessel” and “bone.”• If you want to donate your organs preferentially to a relative, you can write “Givepreference to my relative.” (Since some requirements are necessary to donate yourorgans preferentially to a relative, your organs may not necessarily be transplanted to
the relevant relative.)④

Write your signature and the date
Please sign your name and write the date of signature by yourself. If possible, please
have one of your family members who knows your intention to donate your organs sign
his/her name for confirmation.
6

Insurance Premiums■ Method of Calculating Insurance Premiums
An insurance premium is charged to each insured person and consists of the per capita
amount and income ratio amount. The former comprises a fixed amount to be paid by all
insured persons; the amount of the latter is determined based on the income of respective
insured persons.
The Wider-Area Unions of respective prefectures determine insurance premium rates
every other year by ordinances. Within Osaka Prefecture, insurance premium rates are
uniform, regardless of the municipality where the insured person lives.

◎ Method of calculating insurance premiums (fiscal year 2022 and 2023)

Annual sum of

insurance
premiums*1

Income ratio amount
Assessable income*2

Per capita amount

54,461 yen
per insured person[Total income*3 − Basic Deduction*4]

11.12%)

× Income ratio (*1*2

The annual sum of insurance premiums is up to 660,000 yen.
Assessable income denotes the amount remaining after making the basic deduction fromtotal income (the sum of non-forestry income, forestry income and other separately
calculated incomes [stock transfer income, dividend income, property transfer income,etc., subject to separate self-assessed taxation] in the previous year). (Carryforward ofcasualty loss is not deducted.)*3 Total income = Revenue − Deductions** “Deductions” here denote a public pension deduction, an employment income deduction,
an income adjustment deduction, necessary expenses, etc. and do not include income
deductions, such as deductions for medical expenses, persons with disabilities, or
dependents.
*4 The basic deduction is as shown by the table below, according to Paragraph 2, Article314-2 of the Local Tax Act.
Total Income*5

Basic deduction

24.0 million yen or less

430,000 yen

More than 24.0 million yen and up to 24.5 million yen

290,000 yen

More than 24.5 million yen and up to 25.0 million yen

150,000 yen

More than 25.0 million yen

Not applicable

In cases where income has not been ascertained (e.g., undeclared income, moving infrom another municipality, etc.), the annual insurance premium is first calculated based on
the per capita amount, and then changed to an income-based annual insurance premium
after the month in which income is ascertained.
*6 If there is a change in your income due to a revised return or other circumstances, theamount of your insurance premium may change retroactively. In such a case, please
consult with the division in charge of the Medical Care System for Elderly People of yourlocal municipal office.
7

■ Reduction of Insurance Premiums
Per capita amount for insured persons with low incomes(fiscal year 2023)
The per capita insurance premium will be reduced by any of the following rates in accordance with the income
level of an individual household.
Income level(Level of the total net income of all insured persons within a household, including the householder)

Reduction rate of percapita amount

Total income amount equal to or lower than [basic deduction (430,000 yen)+ 100,000 yen × (number of persons with employment income − 1)]70

Total income amount equal to or lower than [basic deduction (430,000 yen) + 290,000 yen ×(number of insured persons) + 100,000 yen × (number of persons with employment income − 1)]50

Total income amount equal to or lower than [basic deduction (430,000 yen) + 535,000 yen ×(number of insured persons)+ 100,000 yen × (number of persons with employment income − 1)]20 The item underlined with a wavy line must be included in calculation if the household includes two or
more persons including insured persons and the householder, with employment or other incomes(those who fall under any of conditions (1) to (3) below).
(1) Persons with a revenue of over 550,000 yen from salary(2) Persons aged below 65 with a public pension revenue of over 600,000 yen(3) Persons aged 65 or over with a public pension revenue of over 1,250,000 yen
 The reduction rate will be determined based on the household status as of April 1 (or as of the date ofenrollment if you enroll in the System on or after April 2). Even if the status of your household changes
after the date of determination, the reduction rate will not be redetermined within the fiscal year.
 Special deduction in capital gains and that for family employees is NOT applicable to the calculation of
total net income, based on which to determine the reduction rate.
 For the time being, 150,000 yen will be deducted from the income of pensioners (limited to those aged65+) who have a public pension deduction for their pensions when the reduction rate for them isdetermined.
 The reduction rate is determined in accordance with the householder’s income, whether or not thehouseholder is insured by the Medical Care System for Elderly People.
Notify the local municipal office of your income.
Since insurance premium reduction rates are determined in accordance with income levels,
please submit a declaration form to the department in charge of the Medical Care System for
Elderly People at your local municipal office by April 15 (within 15 days of the date you
acquired eligibility if it was in the middle of the fiscal year) even if you have no income.

One Point Q&A
If I enroll in the Medical Care System for Elderly People during a fiscal year, how much ininsurance premiums should I pay?
In such a case, insurance premiums will be calculated on a monthly basis, and you have to pay
the premiums from the month of your enrollment.
Also, if you lose eligibility for the System during a fiscal year, you will be charged a monthly
premium up to one month before your withdrawal.

8Insurance Premiums
Those who were dependent family members
Dependent family members who were covered by the employee’s health insurance, ororganizations such as mutual aid associations or seamen’s insurance programs until the
day before the enrollment in the Medical Care System for Elderly People should also
pay insurance premiums. No income ratio amount will be levied for the time being, and
50% of the per capita amount will be reduced for two years after enrollment.

Income ratio amountNot levied

Per capita amount2 years after enrollment:
50% reduction* Persons who were covered by the National Health Insurance Program or the National Health
Insurance Association Program until the day before the enrollment in the Medical Care System
for Elderly People are not eligible.
* To former dependent family members in households eligible for a 70% reduction of insurance
premiums (see page 8), the per capita reduction rate of 70% applies.

One Point

Q&A

Until I was recently enrolled in the Medical Care System for Elderly People, I had
been covered by the employee health insurance of my child’s company. However, I
received a notice of the insurance premiums to which no reduction was applied. Why
did I receive such a notice?

Even if you are a dependent family member who was covered by employee health insurance,
the insurance premiums of the Medical Care System for Elderly People indicated in the first
notice you receive is the amount to which no reduction is applied. This is because it takes
two to three months for the Wider-Area Union to receive information from your former insurer.
As soon as after your former dependent status is confirmed, the amount of insurance
premiums will be recalculated, and you will be informed of the new premium amount.
* You can shorten the period required to have your insurance premiums reduced by notifying
your local municipal office’s division in charge of the Medical Care System for Elderly
People about your former status as a dependent. When you give notification, you must
present documentary proof of your former dependent status. Please make inquiries aboutsuch documents to the former employer, health insurance association, etc. of your financial
supporter whose health insurance formerly covered you).

9■ Example of Calculating Insurance Premiums (fiscal year 2023)◎ Single-person household (with revenue comprising pensions only)
Pensions

1,530,000 yen

1,680,000 yen

1,970,000 yen

2,215,000 yen

3,000,000 yen

430,000 yen

580,000 yen

870,000 yen

1,115,000 yen

1,900,000 yen

Total net income after
basic deduction

0 yen

150,000 yen

440,000 yen

685,000 yen

1,470,000 yen

Income ratio amount
(1)

0 yen

16,680 yen

48,928 yen

76,172 yen

163,464 yen

Reduction rate of percapita amount for an
insured person

70% reduction

50% reduction

20% reduction

Total income

Per capita amountafter reduction for an
insured person (2)16,338 yen

16,338 yen

27,230 yen

43,568 yen

54,461 yen

Total insurance
premiums:(1) + (2)16,338 yen

33,018 yen

76,158 yen

119,740 yen

217,925 yen* Each of the figures shown above is an annual amount.
* The calculation was made with a per capita amount of 54,461 yen and an income ratio of 11.12%.
* Fractions below 1 yen have been rounded down for both per capita amount and income ratio amount.

<Reference> Example of income ratio amount calculation (in the case of a person only with apension revenue of below 3.3 million yen)(Pension revenue – 1.1 million yen – 430,000 yen) × 11.12%(public pension deduction) (basic deduction) (income ratio)* For public pension deduction, please refer to the table below.
* Bereaved family pensions and other nontaxable pensions are excluded from theamount of revenue based on which insurance premiums are determined.

Public pensions

Public pension deduction

Below 3.3 million yen

1,100,000 yen

3.3 million yen to below 4.1 million yen

Public pensions × 0.25 + 275,000 yen

4.1 million yen to below 7.7 million yen

Public pensions × 0.15 + 685,000 yen

7.7 million yen to below 10 million yen

Public pensions × 0.05 + 1,455,000 yen

10 million yen or above

1,955,000 yen* The public pension deductions in the table above are for pension recipients aged 65 or over as ofDecember 31 of the year they received the pension, who had a total income of 10 million yen or lessexcluding miscellaneous income from public pensions.

97

10
88

Insurance Premiums◎ Two-person household of wife and husband who are both
aged 75 or over(with revenue comprising pensions only)● For wife’s pension, the amount of basic pension (800,000 yen) is used.
Husband1,530,000 yen

1,680,000 yen

2,260,000 yen

2,750,000 yen

3,000,000 yen

Wife

800,000 yen

800,000 yen

800,000 yen

800,000 yen

800,000 yen

Husband430,000 yen

580,000 yen

1,160,000 yen

1,650,000 yen

1,900,000 yen

Wife

0 yen

0 yen

0 yen

0 yen

0 yen

Husband0 yen

150,000 yen

730,000 yen

1,220,000 yen

1,470,000 yen

Wife

0 yen

0 yen

0 yen

0 yen

0 yen

Husband

0 yen

16,680 yen

81,176 yen

135,664 yen

163,464 yen

Wife

0 yen

0 yen

0 yen

0 yen

0 yen

50% reduction

20% reduction

Pensions

Total income

Total net income
after basic
deduction

Income ratio
amount (1)Reduction rateof per capita
amount for an
insured person
Per capita
amount after
reduction for an
insured person(2)

Total insurance
premiums:(1) + (2)70% reduction

Husband16,338 yen

16,338 yen

27,230 yen

43,568 yen

54,461 yen

Wife

16,338 yen

16,338 yen

27,230 yen

43,568 yen

54,461 yen

Husband16,338 yen

33,018 yen

108,406 yen

179,232 yen

217,925 yen

Wife

16,338 yen

16,338 yen

27,230 yen

43,568 yen

54,461 yen

Total

32,676 yen

49,356 yen

135,636 yen

222,800 yen

272,386 yen* Each of the figures shown above is an annual amount.
* The calculation was made with a per capita amount of 54,461 yen and an income ratio of 11.12%.
* Fractions below 1 yen have been rounded down for both per capita amount and income ratio amount.

11

■ How to Pay Insurance Premiums
Insurance premiums should be paid to your local municipal office.
As a general rule, insurance premiums are collected by the special payment method(automatically collected from public pensions), but the municipality in which you live will
decide whether to collect them by special or ordinary payment method.

Special payment
method• Persons annually receiving 180,000 yen or above as public pensions*• Persons whose long-term care insurance premiums have been collected by the special payment
method and whose total amount of the premiums for the Medical Care System for Elderly People
and those for long-term care insurance does not exceed 1/2 of the amount of public pensions*subject to the special payment method.
* For those who receive multiple kinds of pensions, the amount of pension with the highest priority
determined by Cabinet Order.
● The premiums will be automatically collected from the public pensions provided six times a year.
April(1st term)June(2nd term)

August(3rd term)

October(4th term)

Provisional collection
Until the income of the previous year is finalized,
insured persons will be required to pay the insurance
premiums provisionally calculated based on theinsurance premiums of the previous year.

December(5th term)

February(6th term)

Finalized collection
Insured persons are required to pay the finalized
amount of insurance premiums (after deducting theprovisionally collected amount) in three installments.

* In some municipalities, the amount for the provisional collection of premiums in the first term may differ fromthose for the second- and third-term provisional collections.

Ordinary payment
method• Persons to whom the special payment method is not applied• Persons who have just turned 75 years old or have just moved in(They have to pay insurance premiums by the ordinary payment method for a certain period until the special payment
starts.)● Payment should be made by account transfer or with the payment notice sent from your local
municipality office.
Please note that information about the transfer account used to pay the National Health Insurance
premium (tax) will not be inherited. You need to newly apply for the account transfer.
Please contact the division in charge at your local municipal office to ask how to use bank transfer.
○ You may select account transfer instead of the special payment method by filing an application.
If you desire to pay through account transfer instead of the special payment method (when you havebeen paying the insurance premiums by the special payment method or you have been notified of thestart of the premium payment by the special payment method), your payment method can be changed
after you file an application. The time to stop the payment by the special payment method is determinedaccording to the time of the application. Please ask how to file an application at the division in charge atyour local municipal office.
* Changes may not be accepted due to past payment status or other reasons.
* If you fall behind in the payment several times after selecting account transfer, you may be required
to pay with the special payment method again.

12Insurance Premiums
Example of Determining the Insurance
Premiums Payment Method
Mr. A receives the Old-Age Basic Pension (0.8 million yen) and the Old-Age Employees’ Pension (2 million
yen; total 2.8 million yen) and has income from real estate (1.2 million yen). His premiums for long-termcare insurance (140,000 yen/year*) are automatically collected from his pensions.
* Premiums for long-term care insurance differ depending on the municipality you live in.

(1) Based on the pension revenue of 2.8 million yen and real estate income of 1.2 million yen, Mr. A’sannual insurance premiums for the Medical Care System for Elderly People amount to 329,125
yen.
(2) Mr. A receives two types of annual pensions, both exceeding 180,000 yen. Since the Old-Age
Basic Pension has the highest priority among the pensions subject to the special payment
method, the payment method (special payment method or ordinary payment method) is
determined based on the Old-Age Basic Pension.
(3) To determine the payment method, the amount of the Old-Age Basic Pension (0.8 million yen) is
compared with the total of the insurance premiums for the Medical Care System for Elderly
People and the premiums for long-term care insurance (total: 469,125 yen).

469,125 yen(premiums for the Medical Care System for
Elderly People + premiums for long-term careinsurance)

400,000 yen(Old-Age Basic Pension [800,000 yen] × 1/2)

Result: The ordinary payment method will be applied to Mr. A.
* Determination made by a municipality will be based on whether or not a pension received exceeds 1/2 ofthe sum of a long-term care insurance premium and an insurance premium for the Medical Care System for
Elderly People to be actually collected.

—Deduction for Social Insurance Premiums—
Those who have paid insurance premiums for the Medical Care System for Elderly People
may receive deduction for social insurance premiums at the time of income tax/individual
residence tax filing. By this, the amounts of income tax and individual residence tax for thewhole household may change.
Regarding details in income tax filing, please contact the relevant tax office, while
regarding details in individual residence tax filing, please contact the relevant municipal
office.

13

■ Insurance Premiums Exemption/Reduction and Postponing of Collection
If the insured persons or their joint guarantors are certified as being unable to pay part or all of
the insurance premiums for the reasons specified below (➊ to ➌), part of their insurance
premiums may be exempted or reduced up to the amount that they are unable to pay.
If the insured persons or their joint guarantors are certified as being unable to pay part or allof the insurance premiums for the same reasons as above, their payment of the portion they areunable to pay may be postponed by up to one year.
For details, please consult the division in charge at your local municipal office.

➊ The insured persons’ houses, household goods or other properties have beensignificantly damaged by an earthquake, storm, fire or other similar disasters.
➋ The revenue of either the insured persons or their joint guarantors* has remarkably
diminished due to failure, suspension or closing of their businesses, or loss of their jobs.
➌ The insured persons are detained at a prison or similar facility.
* Joint guarantors: Either the householders of the insured persons or spouses of the insured
persons (only for the ordinary payment method)■ What Happens If I Fall Behind in Paying Insurance Premiums?
○ When you are behind on a payment, a reminder notice will be delivered to you based on
relevant laws.
Delinquent charge may be added to ensure fairness for those who made payment by
the deadline.
○ If you continually fall behind in paying premiums, you will receive a demand for payment
by phone or mail, or in person. In addition, you may be subject to enforcement measures,and your property, such as pension benefits, deposits and savings, salaries, and realestate, may be confiscated after a property inspection.
○ If you continue falling behind in paying without exceptional circumstances that makepayments difficult, a short-term insurance card (which expires earlier than an ordinary
insurance card) will be issued to you.
○ If premiums are past due for one year, the individual’s insurance card may have to be
returned and replaced with an Eligibility Certificate for the Insured.
If you receive medical treatment by presenting your Eligibility Certificate for the
Insured, you must pay the full amount (100%) at one time.
○ If premiums are unpaid for one year and a half without any specific reason, part or all of
the insurance benefits may be suspended.

Therefore, please pay premiums before the due date. If you find it difficult to pay the
insurance premiums, consult the division in charge at your local municipal office at theearliest possible occasion.

14

Medical Treatments
The co-payment rate refers to the"percentage of co-payment" on theinsured person's health insurance card.

■ Co-payment Rates of Medical Expenses
Ordinary
insured persons

10%

Insured persons
who fall undercertain conditions

Insured persons
with more than acertain amount ofincome20%30%

Co-payment rates for medical expenses are 10% for ordinary insured persons, 20% for persons who fall under certain
conditions and 30% for persons with more than a certain amount of income. For details, please refer to the chart below and topage 16.
The co-payment rate is determined on August 1 of each year using the amount of your reference fiscal-year income on which residence
tax is imposed (hereinafter referred to as "assessable annual income"*1). (The assessable annual income for the period from April to July
2023 is the taxable year 2022, and the assessable annual income for the period from August 2023 to March 2024 is the taxable year
2023.)
Even before the expiration date, your co-payment rate is subject to change due to changes in the composition of your household,adjustments to your assessable income, or other circumstances. Accordingly, you may be charged or reimbursed for the 10% or
20% difference later.

Co-payment rate determination flow chart
The co-payment rate is determined on the basis of the insured person's assessable annual income*1 and public pensions,*2 etc., on
the basis of the household unit on the residence certificate.
If there are multiple insured persons in the same household, assessable annual income*1 will be determined based on the higherof the insured persons, and "public pensions*2 + other total income*3" will be determined based on the total amount of all insured
persons.
*If all members of the household, including those who are not insured, are exempt from taxation, the insured person(s) are required
to pay 10% of the total amount.

Does the household include an insured person whose assessable annual income *1 exceeds 1.45
million yen?*4*5
Yes

No

Does the household include an insured person whose
assessable annual income*1 exceeds 280,000 yen?

*

If condition *4 or*5 is applicable

Yes

No

Does the household include
two or more insured persons?

Do public pensions*2
and all other incomes*3
total 2.0 million yen or
more?
Below
2.0 million yen

30%
for allhouseholdmembers

15

10%
for allhouseholdmembers

2.0 million yen
or more10%

Do public pensions*2 andall other incomes*3 total
3.2 million yen or more?

Below
3.2 million yen

20%

3.2 million yen
or more10%
for allhouseholdmembers20%
for allhouseholdmembers

*1 “Assessable income” denotes the amount shown as the “Tax base” in the Notice of Municipal andPrefectural Taxes (the amount obtained by making an employment income deduction, a public pension
deduction, and/or other income deductions [including a basic deduction and a deduction for social
insurance premiums] from the previous year’s income). If a household that is headed by an insured
person includes persons aged below 19 whose annual income is 380,000 yen or less each and to whom
deductions for a dependent apply, the sum of prescribed amounts (330,000 yen for person aged below
16 and 120,000 yen for person aged 16 to 18) multiplied by the numbers of relevant persons will be
deducted from the insured person’s assessable income on which municipal tax is imposed.
*2 “Public pensions” denote the amount of received pensions before a public pension deduction is made,and they do not include bereaved family pensions or disability pensions.
*3 “All other incomes” denote the amount calculated by subtracting necessary expenses and the amount ofan employment income deduction from the sum of business income, employment income, etc. (or after
special deductions for long-term (short-term) transfer income if special deductions are available), but
before deducting income tax exemptions (basic deductions, deductions for social insurance premiums,etc.).
*4 If your household falls under any of the following conditions, the co-payment rate of 30% will not
apply.
If the total amount of income (Note 2 on page 7) on which the imposition of premiums is based for the
insured born on or after January 2, 1945 and the insured in the same household is 2.1 million yen or
less, the co-payment rate will be either 20% or 10%.

*5 Your co-payment may be changed from 30% to 20% or 10%.
If your income amount during the year meets the following requirements, you can apply (Application for
the Standard Income Amount) to your local municipal office for a change to either 20% or 10% of thecost from the month following the month of application. *There are cases in which an application is not
required. Please contact your local municipal office to find out if you need to apply or not.
Requirements for changing the co-payment rate from 30% to 20% or 10%(Application for Standard Income Amount)

If there is only one insured person in the same household→When the amount of revenue* of the insured person is less than 3.83 million yen
If there are two or more insured persons in the same household→When the total amount of revenue* of the insured persons is less than 5.2 million yen
If the household includes only one insured person and person(s) aged between 70
and 74 and if the revenue* of the insured person equals or exceeds 3.83 million yen→When the total amount of the revenue* of the insured person and other family member(s) aged
between 70 and 74 is less than 5.2 million yen* The “amount of revenue” means the sum of the amount that should be included in revenue whencalculating the amount of various incomes (excluding retirement income) that are stipulated in the
Income Tax Act. The amount of revenue is the amount before withdrawing public pension
deduction and necessary expenses, and it is not the amount of income. Even if the amount ofincome is "0" or "minus" due to necessary expenses or special deductions, the amount of revenue
before deductions is added together. (This includes all revenue for which a tax return is filed.
However, it does not include dividend income from listed stocks, etc. and transfer income fromlisted stocks, etc. for which the individual inhabitant taxpayer has opted for the tax filing exemption
system.)[e.g., operational revenue, termination amount of life insurance, sell-out price of listing shares etc.
for which separate taxation is applied by filing a final tax return]
Necessary items for filing an application● Application form

● Documents indicating the amount of revenue ● Insurance card
16

Medical Treatments■ High-Cost Medical Care Benefit
If you have paid significantly high medical expenses in a single month (exceeding thespecified monthly cap for co-payment), you will be reimbursed for the amount exceeding thecap for co-payment after filing an application for high-cost medical care benefit. For copayment at a single medical institution, outpatients need to pay up to the co-payment cap on
the basis of each individual, and inpatients need to pay up to the co-payment cap on the basisof each household. However, dental/non-dental and hospitalization/outpatient treatments will
be calculated separately. The meal fees at the time of hospitalization and the room charges
not covered by insurance are not included in the calculation.
Monthly Cap for Co-payment
Copayment
Rate

Income-based Category

Persons withmore than acertain amountof incomeIII

Assessable incomeof 6.9 million yen or
more

II

Assessable incomeof 3.8 million yen or
moreI

Assessable incomeof 1.45 million yen or
more

Outpatient(on an individual basis)

Outpatient +Hospitalization(on a householdbasis)

252,600 yen + 1%*1
(140,100 yen*4)30%

167,400 yen +1%*2(93,000 yen*4)
80,100 yen +1%*3(44,400 yen*4)

20%

Ordinary insured persons

6,000 yen + (Total medical expenses of
outpatient individual - 30,000 yen) x 0.1
or 18,000 yen, whichever is less(up to 144,000 yen per year)

57,600 yen(44,400 yen*4)

18,000 yen(up to 144,000 yen per year)

Low-income class*5

II

10%

24,600 yen
8,000 yenI

15,000 yen

For insured persons with a co-payment rate of 10% or 20% as of the reference date (the last day of thecalculation period), the co-payment amount for each month when their co-payment rate was 10% or
20% within the calculation period of one year (August 1 to July 31 of the following year) will be added up(excluding the high-cost medical care benefit already provided), and when the amount exceeds 144,000
yen, the excess amount will be refunded at a later date.
For three years from October 1, 2022 to September 30, 2025, for those who pay 20%, the increase inmonthly outpatient medical expenses will be limited to 3,000 yen (inpatient medical expenses are notcovered).
*If the patient receives medical care at the same medical institution, he/she does not have to pay morethan the maximum amount at the counter. In the case of multiple medical institutions, the difference tolimit the monthly cost increase to 3,000 yen will be reimbursed as high-cost medical care expenses at alater date.
*1
*2
*3
*4
*5

17

“1%” here means the amount equivalent to 1% of the excess of medical expense over 842,000 yen.
“1%” here means the amount equivalent to 1% of the excess of medical expense over 558,000 yen.
“1%” here means the amount equivalent to 1% of the excess of medical expense over 267,000 yen.
This is the monthly cap to be paid on the fourth time and after, when the household had received high-cost
medical care benefit three times or more in one year from the month when the insured person used high-cost
medical care. (Number of times of benefit of other medical insurance is not included.)
For the description of low-income classes II and I, see page 18.

* When you are receiving high-cost medical care benefit for the first time, file an application for it with the division in
charge at your local municipal office as the Wider-Area Union will send you the application form in or after three months
from when you received the medical care.
* You do not have to file an application again as long as your account number and related information remain unchanged.
* Provision of information regarding application and reimbursement may be delayed due to late submission ofcertificates of medical remuneration from medical institutions, re-examination, or other reasons.
* Even after you receive the high-cost medical care benefit, the amount of the benefit may be reduced due to reexamination of certificates of medical remuneration or other reasons. In this case, the reduced amount may be deductedfrom the subsequent benefits or you may be required to repay the reduced amount.

[Persons with more than a certain amount of income in categories II and I]
Persons with more than a certain amount of income in categories II and I can apply for an Eligibility Certificate for
the Application of the Ceiling-Amount. If you obtain the Certificate, present it with your insurance card to thereception at the medical institution to receive medical treatment.
* The application form for issuance is to be taken to the division in charge at your local municipal office.
[Necessary item for an application for issuing the Eligibility Certificate for Ceiling-Amount Application]● Insurance card

(Note) If you do not present the certificate at a medical institution, a co-payment cap for category III will beapplied, and the excess of the amount you pay over the amount for categories II and I will be refunded
as a high-cost medical care benefit at a later date.

[Low-income classes II and I]
Insured persons who meet the following conditions can apply for the Eligibility Certificate for the
Application of the Ceiling-Amount and Reduction of the Standard Amount of Patient Liability.
Present the certificate together with your insurance card when you use medical institutions.
Low-income
class II

Insured person who is in a household where every household member is
exempt from residence tax and who is not categorized in class I

Low-income
class I

• Insured person who is in a household whose members are all exempt fromresidence tax and have zero income (A public pension deduction of 800,000
yen is included in the calculation.)• Insured person who is in a household where every household member is
exempt from residence tax and receives Old-Age Welfare Pensions* For the judgment of low-income classes II and I, periodical judgment shall be conducted based on
the income and taxation situation of total household members as of August 1 every year.
The judgment may be changed due to changes in household composition and correction of income
besides the periodical judgment. The income subject to the judgment is income on which theresidence tax is imposed of the previous fiscal year for April to July and that of the relevant fiscal
year for August to next March.
* The application form for issuance is to be taken to the division in charge at your local municipal
office.
[Necessary items for an application for issuing the Eligibility Certificate for CeilingAmount Application and Reduction of the Standard Amount of Patient Liability]● Insurance card
● Old-Age Welfare Pension Certificate if you are applying for low-income class I (recipient of
Old-Age Welfare Pensions)*If you do not present the certificate at a medical institution, the co-payment cap for “ordinary
insured persons: 10%” will be applied, and the excess of the amount you pay over the amountfor low-income classes II and I will be refunded as the high-cost medical care benefit at a later
date.
Meal fees and room charge described on page 20 are not covered by high cost medical carebenefit or reimbursement, so please apply for a "Eligibility Certificate for the Application of theCeiling-Amount and Reduction of the Standard Amount of Patient Liability" in advance.

18Medical Treatments
Example (in the case of a household whose income-based category is “ordinary: 10%”)Calculating total medical expenses of
the household (inpatient + outpatient)

Wife (aged 75)

At Hospital B(Outpatient)
Co-payment:
18,000 yen

At Hospital C(Outpatient)
Co-payment:
5,000 yen

At Hospital D(Inpatient)
Co-payment:
57,600 yen

Medicalexpenses:
100,000 yen

Medicalexpenses:
200,000 yen

Medicalexpenses:
50,000 yen

Medicalexpenses:
800,000 yen

Co-payment:
10,000 yen

Co-payment:
18,000 yen

Benefit for
Cap of co-payment for
outpatients
outpatients
10,000 yen (1)18,000 yen

Final co-payment for
outpatient care
18,000 yen

Co-payment for
outpatient care
5,000 yen

Total benefits (inpatient +outpatient)
23,000 yen (2)Co-payment:
5,000 yen
No benefit will be
provided since the copayment does notexceed the cap of copayment as outpatients(18,000 yen).

* The amount to be paid at
the reception is up to thecap of co-payment for thehousehold.

At Hospital A(Outpatient)
Co-payment:
10,000 yen* The amount to be paid at
the reception is up to thecap of co-payment for eachindividual.

Calculating co-payment
as outpatients on thebasis of an individual

Husband (aged 78)

Co-payment for
inpatient care
57,600 yen

Cap of co-payment for the household
57,600 yen

A finalized high-cost medical care benefit of(1) 10,000 yen + (2) 23,000 yen = 33,000 yen
will be given later.
* The High-Cost Medical Care Benefit is allocated to the husband and the wife inaccordance with their actual expenses.

◎ In your 75-year-old birth month
When you become 75 years old and enroll in the Medical Care System for Elderly People
in the month of your 75th birthday, the cap for the co-payment in that month will behalved for the health insurance program you were covered by before your birthday andfor the Medical Care System for Elderly People (see page 17).
* Special amounts in the 75-year-old birth month are applied on the basis of anindividual. However, if there is an amount that other insured persons should bear in thesame household, the amount will be calculated using the usual household unit cap.

19

■ Hospital Meal Fees
Inpatients must pay the standard meal fees as shown below.
Meal Fee(per meal)

Income-based Category
Persons with more than a certain amount of income
Ordinary insured persons

Lowincomeclass II

460 yenDesignated intractable/rare disease patients*1

260 yen

Hospitalization within 90 days (in the past 12 months)

210 yen

Hospitalization exceeding 90 days*2 (in the past 12
months)

160 yen*3

Low-income class I
100 yen*In principle, the "Eligibility Certificate for the Application of the Ceiling-Amount and Reduction of the Standard
Amount of Patient Liability" must be issued in order for low-income classes II/I residents to be eligible for theabove amount. Please see page 18 for details.
*1 Those who have been hospitalized continuously for one year or longer in a psychiatric ward as of March
31, 2016 and will continue to be hospitalized in a medical institution will also be eligible for this category.
*2 It is required that the hospitalization period has exceeded 90 days from the day when you are certified to
be in low-income class II.
*3 Those who have an " Eligibility Certificate for the Application of the Ceiling-Amount and Reduction of theStandard Amount of Patient Liability" are also required to apply separately. The meal fee will become 160
yen from the month following the month of the application date. Please see page 18 for details.

[Necessary items for applying for a meal fee of 160 yen as mentioned in *3]● Insurance card
● Eligibility Certificate for Ceiling-Amount Application and Reduction of the Standard
Amount of Patient Liability● Any document attesting that hospitalization period has exceeded 90 days (receipt, forinstance)■Inpatients Using Long-Term Care Beds
Inpatients using long-term care beds must pay part of the meal fees and room charge.
* Intractable/rare disease patients will have their fee reduced to the meal fee only. For persons
with substantial needs for hospitalization, the meal fee listed above and the room charge will
also be applied.

Standard Meal Fees and Room Charge
Income-based Category

Meal Fee per Meal

Persons with more than a certain amount of income
Ordinary insured persons

460 yen*1

Low-income class II

210 yen

Low-income class I

130 yen*1*2

Room Charge per Day

370 yenRecipients of Old-Age Welfare Pensions

100 yen

0 yen

Persons on the boundary*2

100 yen

0 yen

Applied to the case where nutrition management is implemented by a dietician (whether
registered or not) as prescribed in the Dietitians Act. For other cases, it is 420 yen.
A person who does not need welfare stipulated in the provisions of the Public Assistance Act(Act No. 144 of 1950) when this is applied.

20

Medical Treatments■ Unitary High-Cost Medical/Long-Term Care System
A household that has to pay the co-payment under the Medical Care System for Elderly People
and the Long-Term Care Insurance Program can file an application for benefits for overruns
beyond the combined annual total of the specified annual cap for the co-payment (August to
the end of July of the following year; indicated in the table below).

Annual cap for the co-payment of [The Medical
Care System for Elderly People + Long-Term Care
Insurance Program]

Income-based Category

Personswith
morethan acertainamountofincomeIII

Assessable incomeof 6.9 million yen or
more

2,120,000 yen

IIAssessable incomeof 3.8 million yen or
more

1,410,000 yen

I

Assessable incomeof 1.45 million yen
or more

670,000 yen

Ordinary insured persons
Low-income class*1

560,000 yenII

310,000 yen

I

190,000 yen*1

For households categorized in low-income class I with more than one person who receives
long-term care service, the benefit from the long-term care insurance program will be based on
the co-payment cap of 310,000 yen (the cap for households categorized in low-income class II).

We encourage the use of generic drugs.
Generic drugs are drugs sold after the patents of the original drugs (drugs that havebeen used) expire. Generic drugs have been recognized by the government as having
the same efficacy and constitution of the original drugs. Since the development period ofgeneric drugs are short and therefore the development costs are low, they are more
affordable and economical than the original drugs.
Notes
•
•

Not all original drugs have corresponding generic drugs.
Some patients cannot switch to generic drugs because, for example, some generic drugs aredifferent from the original drugs in terms of indications.
• Some generic drugs are different in color, size, shape, etc. from the original drugs.
☆ If you prefer generic drugs, please consult with your doctor or pharmacist. Please be
sure to make a prior inquiry with the medical institution or pharmacy on whether it
uses the generic drugs and has stocks thereof.
☆ We recommend using generic drugs because they will reduce the burden of
medications, improve medical insurance finances, and reduce the increase ininsurance premiums.

21

■ When You Need to Receive High Cost Medical Treatment for a Long
PeriodFor patients with diseases specified by the Ministry of Health, Labour and Welfare, the maximum copayment of medical expenses is up to 10,000 yen/month per medical institution (total of treatment andmedicine costs; counted separately as outpatient and inpatient at one medical institution). However,these fees must be paid normally at the pharmacy and hospital reception.

[In your 75-year-old birth month]
The maximum co-payment in your 75-year-old birth month is 5,000 yen for the Medical Care
System for Elderly People.

[Diseases specified by the Ministry of Health, Labour and Welfare]● Part of congenital disorders of blood coagulation factor (resulting from Factors VIII or IX)● Chronic renal failure entailing artificial dialyses● HIV-infection caused by blood coagulation factor products
To receive the benefit, please apply for a Certificate for a Patient with Specified Disease at
the division in charge at your local municipal office.
[Necessary items for filing an application for the Certificate for a Patient with
Specified Disease]● Insurance card
● Medical rehabilitation service coupon or other materials that attest to the applicant being
inflicted by a specified disease● Certificate for a Patient with Specified Disease used by the applicant before enrolling in
the Medical Care System for Elderly People (if available)■ Traffic Accidents
You can receive medical care under the Medical Care System for Elderly People should you
become injured by a third party in a traffic or other accident. In this case, the Wider-Area Union
advances the medical expense temporarily (excluding co-payment) and will charge the third
party (perpetrator) for it.
(1) Go to the police and ask for the issuance of an Accident Certificate.
(2) Bring the Traffic Accident Certificate, your personal seal and your insurance card to thedivision in charge at your local municipal office and follow the procedures for“Notification of Injury or Sickness due to a Third-party Act.”

Precaution

If you receive cost of treatment from a perpetrator or settle a case out of court, you might
not be able to receive medical care under the Medical Care System for Elderly People.
Hence, you are strongly advised to consult with the division in charge at your local
municipal office before settling out of court.

22

Reimbursement of Medical Expenses(Medical Expense Benefit)
If you pay the full amount of medical expenses as in the cases listed below (❶ to ❺) and filean application with the division in charge at your local municipal office, part of theexpenses (after deducting co-payment) is reimbursed at a later date by the Wider-Area Union,
provided that it approves the reimbursement.
Your application, however, must be filed within two years from the day after completion of
the full-amount payment.

➊ When you have a compelling reason (acute illness, for instance) for being unable to fetch yourinsurance card before receiving medical treatment* The Wider-Area Union reimburses only when it certifies that the situation is compelling.

➋ When you receive treatment by judo therapists due to a bruise, ligament rupture, etc.

➌ When you receive treatment by acupuncturists, moxibustion practitioners, or massage/shiatsu
practitioners in accordance with a doctor’s instructions➍ When you buy braces, such as corsets or casts, in accordance with a doctor’s instructions, or when
you receive a blood transfusion➎ When you necessarily receive medical services outside Japan[Necessary items for applying for benefit in the cases ➊ to ➎]● Insurance card ● Application form ● Receipt ● Account information of the applicant* The applicant’s personal seal will be necessary if a bank account of a person other than the applicant isused for bank transfer and if the applicant does not fill out the application form himself/herself.

In case ➊: ●In case ➋: ●In case ➌: ●In case ➍: ●Statement of medical expenses or attending doctor’s statement
Detailed statement or the like
Detailed statement or the like
● Doctor's consent form
Detailed statement or the like
● Doctor's statement of opinion, Certificate of
instruction for the production of therapeutic orthotic devices and fitting, etc.
* When applying for shoe-type orthotic equipment, it is necessary to attach a photoof the equipment to be worn.
In case ➎: ● Attending doctor’s statement (with Japanese translation attached)● Letter of consent to the investigation● Itemized receipt (with Japanese translation attached)● Documentation of travel records (passport, etc.)

23How to Receive Treatment by Judo Therapists,
Acupuncturists, Moxibustion Practitioners, andMassage/Shiatsu Practitioners➊ When you receive treatment by judo therapists[Cases covered by health insurance]• Fracture, dislocation, bruise, ligament rupture, etc. (including so-called muscle strain)* In case of fracture or dislocation, except for first aid, prior approval by the doctor isrequired.
[Precautions in receiving the treatment]• Treatment cost for shoulder discomfort, muscle fatigue and other minor symptoms is
not covered by health insurance; all costs for such treatment must be paid by thepatient.
➋ When you receive treatment by acupuncturists, moxibustion practitioners, or
massage/shiatsu practitioners that the doctor deems necessary[Cases covered by health insurance]● Acupuncture and moxibustion• Nerve pain, rheumatism, cervico-omo-brachial syndrome• Frozen shoulder syndrome, low back pain, aftereffect of cervical sprain• Other conditions whose main symptom is chronic pain
● Massage/shiatsu
Cases where massage is required for medical reasons, including muscle paralysis
and articular contracture[Precautions in receiving the treatment]• To have treatment covered by health insurance, you need to obtain a certificate ofconsent or a medical certificate issued by the doctor beforehand.
• Cost for treatment or massage aimed at mere recovery from fatigue, consolation ordisease prevention is not covered by health insurance; all the cost for suchtreatment must be paid by the patients.
• While you receive treatment for a condition or symptom at an authorized insurance
medical institution (hospital, clinic, etc.), receipt of acupuncture, moxibustion
treatment, etc. for the same condition elsewhere is not covered by health insurance.

The cost for judo therapy etc. is subject to medical expenses deduction. Please makesure to receive receipts.
Since judo therapists are permitted to make insurance claims on behalf of theirpatients, you can receive judo therapy by making the co-payment. When you receive
judo therapy, check the description of the therapy on the Application for Medical
Expense Grant and affix your signature and seal to the application.

24

Other Benefits
For details, please consult the divisionin charge at your local municipal office.

25◎

Home nursing care medical expense benefit
If insured persons use home nursing care services in accordance with a doctor’s instructions,they can receive medical expense benefit by presenting their insurance cards.

◎

Uncovered medical-treatment-related expense benefit
When insured persons receive advanced medical treatment, part of the advanced treatment thatis common to ordinary medical treatments is covered by the Medical Care System for Elderly
People. To receive the benefit, please present your insurance card at the medical institutions
concerned.

◎

Funeral expense benefit
When an insured person dies, 50,000 yen is provided as part of the funeral fee.
* Please note that eligibility for this benefit expires after two years from the day after thefuneral.
[Necessary items for filing an application]● Insurance card ● Application form ● Account information of the applicant● Receipt for the funeral fee● Document attesting that the applicant held the funeral (if the applicant’s name is not on thereceipt of the funeral fee, etc.)* The applicant’s personal seal will be necessary if a bank account of a person other than theapplicant is used for bank transfer and if the applicant does not fill out the application form
himself/herself.

◎

Transfer expense benefit
When a person with serious illness with difficulty of travel is transferred urgently by a doctor’s
instruction, the cost is paid if the Wider-Area Union deems the transfer to be necessary and thefollowing three reasons are met.
➊ When the necessary treatment at the destination is covered by health insurance➋ When transfer is extremely difficult due to a disease or injury that requires the treatment➌ In case of emergency or absolute necessity[Necessary items for filing an application]● Insurance card ● Application form ● Account information of the applicant● Receipt● Doctor’s statement of opinion ● Document indicating the transfer route (map,etc.)* The applicant’s personal seal will be necessary if a bank account of a person other than theapplicant is used for bank transfer and if the applicant does not fill out the application form
himself/herself.

◎

Exemption from co-payments (up to 6 months)
The insured persons may be exempt from co-payments if the household that they belong to fell
under any of the following conditions ➊ to ➌ within the past one year and meets certain
conditions.
➊ When the house, household goods or other property have been damaged significantly due toa natural disaster➋ When revenue has been reduced significantly due to the closing of a business or loss of
employment➌ When the householder or equivalent has died or suffered significant physical or mental
damage or has had to be hospitalized for a long periodHealthcare Programs■ Medical Examinations

You can undergo this kind of
examination free of charge.

The medical examination program aims to detect not only lifestyle-related diseases, such as diabetes
and hypertension, but also mental and physical frailty caused by aging. We recommend that you be
subject to a healthcare examination even if you periodically visit a medical institution for treatment of alifestyle-related disease. The examination card will be delivered to all insured persons in late April every
year. Those who reach 75 years of age in the current year will receive the examination card in the monthafter their birthday.
Those who have had a comprehensive medical examination within the current year do not have toundergo a medical examination as described in this paragraph.

Scheduling and Getting a Medical Examination
Examination period: From the date of receipt of the examination ticket to March 31 of the current fiscal year (once during the fiscal year)

1

Select a medical institution that offers medical
examinations

Medical Institutions Registered to
Conduct Health Examinations

Please check the "List of Medical Institutions Registered to Conduct Health
Examinations (Medical Department)" enclosed with the examination ticket orthe "Wider-Area Union for the Medical Care System for Elderly People
Website".
*You can also receive a medical checkup at medical institutions in Osaka
Prefecture other than those in your city, ward, town, or village.

2
3

Apply in advance (by phone, etc.) to
the organization conducting the
medical examination.
Go for your medical examination<What to bring on the day of theexamination>① Insurance Card for the Medical Care
System for Elderly People② Medical examination ticket

Eligible persons

Examination items

Notes

It's better to makean inquiry!

FOR
FREE!

Persons who are insured by the Wider-Area Union for the Medical Care System for
Elderly People in Osaka Prefecture at the time of undergoing a medical examination* Those who have been in support facilities for persons with disabilities or facilities
covered by long-term care insurance or those who have been hospitalized at
hospitals or other medical institutions for six consecutive months or longer are notsubject to this program.
<Basic items>◎ Questionnaire (frailty checklist) ◎ Physical measurement◎ Blood pressure measurement◎ Physical examination ◎ Urinalysis◎ Blood test (lipid test, blood sugar test, liver function test, renal function test)<Detailed examination items (Implemented at the doctor’s discretion)>◎ ECG ◎ Fundus examination◎ Anemia examination
・If you have lost your medical examination ticket, it can be reissued. Please contact
the Wider-Area Union for the Medical Care System for Elderly People or your local
municipal office.
・During the medical examination, if you are found to have an injury or illness, you will
be required to pay a part of the cost of the treatment.

26

Healthcare Programs■ Dental Examinations

You can undergo this kind of
examination free of charge.

The dental examination program aims to check not only the condition of the teeth but also oral
functions. We recommend that you be subject to a dental examination even if you use artificial
teeth.
Guidance is delivered to all the insured persons annually in late April. For those who
become 75 years old during the fiscal year, it will be delivered in the month following theirbirthday. (No examination ticket is issued.)
Scheduling and Getting a Dental Examination
Examination period: From April 1 to March 31 of the current fiscal year (once during the fiscal year)

Select a dental clinic that offers dental examinations

Dental Clinics Registered to
Conduct Dental Examinations

Please check the " List of Dental Clinics Registered to Conduct
Dental Examinations" enclosed with the letter or the "Wider-Area
Union for the Medical Care System for Elderly People Website".
*You can also receive a dental checkup at dental clinics in Osaka Prefectureother than those in your city, ward, town or village.

Apply in advance (by phone, etc.)
to the organization conducting thedental examination.

It's better to makean inquiry!

Go for your dental examination<What to bring on the day of theexamination>
Insurance Card for the Medical Care
System for Elderly People(No dental examination ticket)

Eligible
persons

FOR
FREE!

Persons who are insured by the Wider-Area Union for the Medical Care System for Elderly
People in Osaka Prefecture at the time of undergoing a medical examination* Those who have been in support facilities for persons with disabilities or facilities covered bylong-term care insurance or those who have been hospitalized at hospitals or other medical
institutions for six consecutive months or longer are not subject to this program.

◎ Interview ◎ Teeth condition◎ Occlusion condition◎ Oral hygiene condition
Examination ◎ Periodontal tissue condition
items◎ Oral dryness ◎ Chewing ability◎ Tongue and lip functions ◎ Swallowing
function ◎ Temporomandibular joint (jaw movement)◎ Oral mucosa

Notes

27
9

・If you are having treatments at the same time as this dental examination, there may be an
additional fee. Please consult your dentist for details.
・Please note that house calls are not covered by this dental examination.

Healthcare Programs■ Subsidy Program of Comprehensive Medical Examinations
The Wider-Area Union subsidizes part of the cost for comprehensive medical examinations for insured
persons.
Please apply to the division in charge at your local municipal office.
Please note that eligibility for this subsidy expires after two years from the day following the date when
you received medical examinations.
Eligible persons

Persons who are insured by the Wider-Area Union for the Medical Care System for Elderly
People in Osaka Prefecture at the time of undergoing a comprehensive medical examination

Examination items

PhysicalBody height, weight, obesity, BMI,
measurement abdominal circumference

Hematologicalexamination

Red blood cells, white blood cells,
hemoglobin, hematocrit, platelet
count, MCV, MCH, MCHC

Physiologicalexamination

Blood pressure, ECG, heart rate,
fundus, intraocular pressure, visualacuity, hearing, respiratory function

Serological CRP (blood type and HBs antigen)examination

X-ray andultrasoundChest X-ray (or chest CT scan),upper GI X-ray (or endoscopy),
abdominal ultrasound (or abdominal
CT scan)Urinalysis

Protein, urinal sugar, occult blood(urinary sediment)

Biochemical
examination

Total protein, albumin, creatinine,eGFR, uric acid, TC, HDL-C, LDL-C,
Non-HDL-C, neutral fat, total
bilirubin, AST, ALT, ɤ-GT, ALP,
fasting blood sugar, HbA1c

OthersFecal occult blood, questionnaire,interview, explanation of results,
health guidanceNotes(1) The cost of medical examinations other than those listed above, such as brainscans and various cancer tests, are not covered by the subsidy.
(2) If more than one of the above examination items is missing, or if multiple
examinations are combined, it may not be considered a comprehensive medical
examination and may not be subsidized.

Necessary items
for filing anapplication

Subsidy
Valid period● Receipt for the comprehensive medical examination● All sheets of the examination report (photocopy accepted)● Insurance card ● Account information of the applicant ● Application form
* The applicant’s personal seal will be necessary if a bank account of a person otherthan the applicant is used for bank transfer and if the applicant does not fill out theapplication form himself/herself.
* If you are unable to submit a copy of the checkup results, please contact the office towhich it should be submitted.
Up to 26,000 yen
From April 1 to March 31 of the following year (once a year)

Let’s make good use of the medication record book
The medication record book is a notebook for recording the medicines you are using.
Checking of this record book by doctors or pharmacists will help prevent damage to your health.
If you do not have a record book, please request the pharmacist to issue one.
• You can check for duplicate medication and reduce the risk of side effects and drug interaction.
• You will be able to accurately convey your drug information when traveling or in the event of adisaster.
Be sure to bring the medication record book to the medical institutions.
Do not have it for each hospital/pharmacy; have one record book per person.

28
9Use of the Individual Number Card as an
Insurance Card
Poster■ The Individual Number Card can serve as an insurance
card.
This service is available at medical institutions andpharmacies displaying the sticker and/or poster shownon the right, which indicate that the Individual Number
Card is acceptable as an insurance card. To use thisservice, you will need to apply for it on the Mynaportal
website after obtaining your Individual Number Card.
* Medical institutions and pharmacies that do not display
the sticker and/or poster may not be able to take yourIndividual Number Card as an insurance card, so
please check before using the card.
* Regardless of whether you apply for the issuance of a
Individual Number Card or for use of the card as aninsurance card, you can still use your existing insured
person's identification card just as before.

Sticker

For how to apply for the
Individual Number Card, scan
this QR code or access the
URL.

Inquiries about application for the use of the Individual Number Card as an insurance card and about the
Individual Number Card itself

0120-95-0178 (Toll-free number for general inquiries about the Individual Number)
https://myna.go.jp/html/index_en.html (URL of the Mynaportal website)■ Benefits of use of the Individual Number Card as an insurance card
〇 Even if you change to another insurer due to moving or other circumstances, you can use your Individual
Number Card as your insurance card without waiting for the issuance of your new insurance card. (*)(*Please note that you may be required to take your insurance card to the medical institution in some cases, forexample, if you have a medical consultation on the day of your change to another health insurance system.)〇 Even if you do not have the Eligibility Certificate for Ceiling-Amount Application, your Individual Number Card
will exempt you from temporary payment of an excess of medical expenses over the ceiling amount under thehigh-cost medical care benefit system.
〇 Information on medical treatment, medicine, medical expenses, and medical examinations can be checked on
the Mynaportal website.

Use of Public Money Receiving AccountSince January 2023, those who have registered a public money receiving account for
benefits with the government through Mynaportal website, or with some other method havebeen able to select their public money receiving account when applying for the payment ofbenefits. If you use a public money receiving account, you do not need to enter your accountinformation on the application form. However, you will need to submit an application form fora public money receiving account, so please contact your local municipality.
*Only insured persons themselves can use the account. For the premium benefits from theMedical Care System for Elderly People, the public money receiving account cannot be usedby anyone other than the insured persons themselves.
*Funeral expenses and subsidies for comprehensive medical examinations are not covered.

29

List of Municipal Offices* The division in charge and the telephone number are subject to change due to organizational reforms.
Municipality
Osaka City
Kita Ward
Fukushima Ward
Chuo Ward
Minato Ward
Tennoji Ward
Nishiyodogawa Ward
Higashiyodogawa Ward
Ikuno Ward
Joto Ward
Abeno Ward
Sumiyoshi Ward
Hirano Ward
Sakai City
Sakai Ward
Higashi Ward
Minami Ward
Mihara Ward
Kishiwada City
Toyonaka City
Ikeda City
Suita City
Izumiotsu City
Takatsuki City
Kaizuka City
Moriguchi City
Hirakata City
Ibaraki City
Yao City
Izumisano City
Tondabayashi City
Neyagawa City
Kawachinagano City
Matsubara City
Daito City
Izumi City
Minoh City
Kashiwara City

Division in charge
Health Insurance & Pension
Div.
Health Insurance & Pension
Div.
Counter Services Dept.
Counter Services Dept.
Counter Services Dept.
Counter Services Dept.
Counter Services Dept.
Counter Services Dept.
Counter Services Dept.
Counter Services Dept.
Counter Services Dept.
Health Insurance & Pension
Div.
Health Insurance & Pension
Div.
Medical Assistance & Pension
Div.
Health Insurance & Pension
Div.
Health Insurance & Pension
Div.
Health Insurance & Pension
Div.
Health Insurance & Pension
Div.

TEL

Municipality

Division in charge

TEL

06-6313-9956

Miyakojima Ward

Counter Services Dept.

06-6882-9956

06-6464-9956
06-6267-9956
06-6576-9956
06-6774-9956
06-6478-9956
06-4809-9956
06-6715-9956
06-6930-9956
06-6622-9956

Konohana Ward
Nishi Ward
Taisho Ward
Naniwa Ward
Yodogawa Ward
Higashinari Ward
Asahi Ward
Tsurumi Ward
Suminoe Ward

Counter Services Dept.
Counter Services Dept.
Counter Services Dept.
Counter Services Dept.
Counter Services Dept.
Counter Services Dept.
Counter Services Dept.
Counter Services Dept.
Counter Services Dept.

06-6466-9956
06-6532-9956
06-4394-9956
06-6647-9956
06-6308-9956
06-6977-9956
06-6957-9956
06-6915-9956
06-6682-9956

06-6694-9956

Higashisumiyoshi Ward

Counter Services Dept.

06-4399-9956

06-4302-9956

Nishinari Ward

Counter Services Dept.

06-6659-9956

06-6208-7996

072-228-7375
072-228-7413

Naka Ward072-287-8108

Nishi Ward072-290-1808

Kita Ward

Health Insurance & Pension
Div.
Health Insurance & Pension
Div.
Health Insurance & Pension
Div.

072-270-8189
072-275-1909
072-258-6740

072-363-9314
Health Insurance & Pension
Div.
Health Insurance Div.
National Health Insurance &Pension Div.

Health Insurance Div.

072-423-9468

Habikino City

Insurance Delivery Div.

06-6858-2295

Kadoma City

Insurance Consultation Div.

06-6858-2301

Settsu City

072-754-6258

Takaishi City

Health Promotion Div.

072-275-6392

050-1807-2183

Fujiidera City

Health Insurance & Pension
Div.

072-939-1186

0725-33-1131

Higashiosaka City

Insurance Management Div.

06-4309-3051

072-674-7079

Sennan City

072-433-7282

Shijonawate City

06-6992-1545

Katano City

072-841-1221

Osakasayama City

072-620-1630

Hannan City

072-924-3997

Shimamoto Town

072-463-1212

Toyono Town

Health Insurance Div.

072-739-3422

0721-25-1000

Nose Town

Citizens Affairs Div.

072-731-3202

072-813-1190

Tadaoka Town

Health Insurance Div.

0725-22-1122

0721-53-1111

Kumatori Town

072-334-1550

Tajiri Town

072-870-9629

Misaki Town

0725-99-8127

Taishi Town

072-724-6739

Kanan Town

Health Insurance & Pension
Div.

0721-93-2500

072-972-1580

Chihaya-akasaka Village

Citizens Affairs Div.

0721-72-0081

Health Insurance & Medical
Welfare Div.
National Health Insurance
Div.
Health Insurance & Pension
Div.
National Health Insurance
Div.
Health Insurance & Pension
Div.
Health Insurance Div.
Division for the Medical Care
System for the Elderly
Health Insurance & Pension
Div.
Health Insurance Div.
National Health Insurance &Pension Div.
Welfare & Medical AssistanceDiv.
Citizens Service Dept.
(Section for the Medical Care System for the
Elderly)

Health Insurance & Medical
Welfare Div.
Medical Assistance Div.
Health Insurance & Pension
Div.
Health Insurance & Pension
OfficeLong-Term Care Insurance,
Medical Subsidies & Pension
Div.
Health Insurance & Pension
Div.

Health Insurance & Pension
Div.
Health Insurance & Pension
Div.
Medical Assistance & Health
Insurance Div.
Health Insurance & Pension
Group
Health Insurance & Pension
Div.
Health Insurance & Pension
Div.

Health Insurance & Pension
Div.
Citizens Affairs Div.
Health Insurance & Pension
Div.
Health Insurance & Medical
Welfare Div.

072-958-1111
06-6902-5697
06-6383-1387

072-483-3455
072-877-2121
072-892-0121
072-366-0011
072-489-4529
075-962-7462

072-452-6195
072-466-5004
072-492-2705
0721-98-5516

30
9◇ Request for Attention ◇● Medical consultation and drug preparation
These days, more and more mildly ill patients are visiting the emergency room onholidays and during nighttime, which makes it harder to give medical treatment topatients with urgency and serious illness. To ensure appropriate medical care for every
citizen, we will ask you for careful attention to the following.
★ Reconsider whether you can see a doctor during regular hours on weekdays.
★ Have a family doctor and consult with him/her first if you have any concerns.
★ Duplicate examination and medication may worsen your physical condition. Avoid
visiting several medical institutions to treat the same disease.
★ When you have surplus drugs or you would like to use generic drugs (which are more
affordable in most cases), please consult with a doctor or pharmacist.

Emergency Consultation Center Osaka
If you waver on whether or not you should call an ambulance,
whether or not you should rush to the hospital immediately,
which hospital is the nearest to you, or how you can give firstaid

Warning from the Osaka Prefectural Police
Monetary losses caused by communications
fraud in Osaka Pref.:Approx. 3.2 billion yen(a provisional figure for 2022)

In 2022, the amount of losses caused by refund fraud aloneamounted to approximately 1 billion yen, setting an all-time
record!
○ “You can receive a refund.”○ “Please go to an ATM.”

If the above line is busy
* Please note that this line cannot respond to inquiries about how to use
medicines, policies on treatment for the disease you currently suffer from,health consultation, childcare consultation, or long-term care consultation.

In case of an emergency, call 119 without hesitation.

Contact
Information☑ You can never receive a refund on an ATM!
☑ Do not use your mobile phone while on an ATM!
If someone calls you and talks about money, consult with your family members or
the police, instead of feeling concerned alone.

The Wider-Area Union for the Medical Care System for
Elderly People in Osaka Prefecture

Insurance cards, services concerning insurance
premiums, etc.

Eligibility Information
Management Div.

Services concerning high-cost medical carebenefit, medical examinations, notification of
medical expenses, etc.

Benefit Service Div.

Information relating to Wider-Area Union
budgets, public relations, council, etc.

General Affairs & Planning
Div.

8F Chuo-odori FN Bldg., 1-3-8 Tokiwa-machi, Chuo-ku, Osaka 540-0028
Fax: 06-4790-2030 (common to all divisions)Website: https://www.kouikirengo-osaka.jp/
Or contact the division in charge of the Medical Care System for Elderly
People of your local municipal office (see page 30)

The Wider-Area Union for the Medical
Care System for Elderly People in Osaka
Prefecture Website

The information in this booklet is current as of May 1, 2023. Please note that, if any revision is madeto the program in the future, this booklet may not accurately describe the program contents.
This booklet is printed with ecofriendly vegetable oil ink.

Unauthorized reproduction prohibited ©