Guide to Japan’s National Health Insurance (NHI) System
Contents
How Japan’s National Health Insurance System (NHI) Works ······················

1

NHI Members ······················································································

2

Joining and Leaving the NHI System ··················································

3

Under such circumstances, report within 14 days ·······························

4

NHI Tax (Premium) Contributions Supporting NHI ······························

5

Pay Your NHI Tax (Premium) on Time··················································

7

NHI Benefits ························································································

8

Hospital Meal Costs ········································································ 10
Hospital Living Costs······································································· 11
Major Medical Costs········································································ 12
Injuries from Traffic Accident and Other Incidents ······························· 16
Long-Term Care Insurance System····················································· 17
Combined Copayments System for Major Medical and Long-Term Care Costs···· 18
Retiree Medical System······································································· 19Long Life Medical Care System··························································· 19
Disability Welfare Services ·································································· 20

How Japan’s National Health Insurance (NHI) System Works
Japan’s National Health Insurance (NHI) system is supported by the regular NHI tax (premium)contributions from healthy NHI members that allow them to be ready for serious illnesses andinjuries. NHI helps members pay incurred medical costs and maintain a healthy lifestyle.

Copayments made by members
Preschool infants ···················· 20%
School-age children through adults
up to 69 years old ··················· 30%
Adults aged
70 to 74 years old ··················· 10%(Wage-earners at their preretirement
income level pay 30%.)

Member(insured NHI subscriber)

Member pays
copayment.
Member receives
medical services.

Member applies to join NHI.
Member makes NHI tax(premium) payments.
City or town
receives
financial assistancefrom the national
government.

Member receives
NHI card.

Proportion of medical costs paid by
NHI for members
Preschool infants ···················· 80%
School-age children through adults
up to 69 years old ··················· 70%
Adults aged
70 to 74 years old ··················· 90%

NHI doctor

City or town

(Wage-earners at their preretirement
income level pay 70%.)(healthcare provider)(insurer)
City or town pays
medical costs to NHI.

NHI pays medical costs
to healthcare provider.
Healthcare provider bills
NHI for medical costs.

NHI reports the medical
costs incurred.

Federation of National Health Insurance Organizations
1

NHI Members
Every Japanese citizen and resident (except short-term residents) can subscribe to NHI,
unless they (1) are 75 years of age or older, (2) receive health insurance from their employer(such as through a health insurance association, mutual aid association, or seafarers’
insurance organization), or (3) receive public assistance (System of medical insurance for thewhole nation).

Single application for each household
To join NHI, each household (defined as a group of people living at the same
residence under the same household budget) submits a single application. The headof the household submits the application.

Each individual member is covered
While each household only submits one application to NHI, every member of thehousehold is insured individually, and each receives their own NHI card.

Non-citizens
Non-citizens deemed to have stayed in Japan at least one year and who have a
Certificate of Alien Registration can subscribe to NHI, unless they (1) receive healthinsurance from their employer, (2) receive public assistance, or (3) are a traveler orother temporary visitor to Japan.

Adults Aged 70 to 74 Receipt of Long Life Medical Care Card
You will receive your “long life medical care card” from your city or town. Your copayment(10% or 30%) will be checked using this card at the medical facility. Once you havereceived your card, guard it carefully.

2

Joining and Leaving the NHI System
Start or renew your NHI membershipwhen you:
Move from one city, ward, town or village to anotherTerminate your membership in another health insurance system
Are no longer a dependent of a household belonging to another
health insurance system
Give birth
No longer receive public assistanceYour NHI membership ends
when you:
Move from one city, ward, town or village to anotherBecome eligible for the Long Life Medical Care System (the Health
Insurance System for Latter-stage Elderly People) (see page 19)
Start a membership in another health insurance system
Become a dependent of a householdbelonging to another health insurance system
Die
Start receiving public assistance3

Under such circumstances, report within 14 days
Delayed reporting may cause problems such as you may be personallyliable for the full cost of your medical treatment, or be made to pay all backhealth insurance dues, so be careful.
When starting or renewing your NHI membership

Items needed to apply for NHI
membership

When you move from one city, ward, town or village to another

Hanko (personal name stamp) and change of addresscertificate

When you register as a resident alien (does not apply to short-term
residents)

Certificate of Alien Registration

When your membership in another health insurance system ends
When you are no longer a dependent of a household belonging toanother health insurance system

Hanko (personal name stamp) and/or certificate
proving you have ended a membership in another
health insurance system

When you give birth

NHI card and Maternal and Child Health Handbook

When you no longer receive public assistance

Letter indicating you have been taken off public
assistance

When your NHI membership ends

Items needed to renew your NHI
membership or register changes

When you become eligible for the Long Life Medical Care System(See Page 12)

NHI card

When you move from one city, ward, town or village to another

NHI card

When you are a non-citizen and move from one city, ward, town orvillage to another

NHI card and Certificate of Alien Registration

When you start a membership in another health insurance system
When you become a dependent of a household belonging to another
health insurance system

NHI card and other health insurance system’s card

Upon death

NHI card and death certificate

When you start receiving public assistance

NHI card and letter indicating you will start receiving
public assistance

Other

Items needed to make requiredchanges

When your address, head of household or name changes

NHI card

When your children move to another city, ward, town, or village for their
NHI card, student ID card, etc.
education
When you move from one city, ward, town or village to another in order NHI card, facility membership certificate, etc.
to move to another facility.
Personal identification and the unreadable NHI card
When your NHI card becomes lost* or unreadable(if applicable)
When you become eligible for the Retiree Medical System
NHI card, pension certificate(See Page 19)
When you are no longer eligible to be a member of a retiree healthinsurance system* If your cards are stolen or lost while out, notify the police.

For more information, contact the NHI section ofyour city or town office.

4

NHI Tax (Premium) Contributions Supporting NHINHI system and NHI tax (premium) contributions
NHI is an important support system in the lives of all Japanese residents, allowing
them to receive medical treatment for only a fraction of the full cost. Along withfinancial assistance from the national and prefectural governments, the NHI tax(premium) contributions of members provide a vital source of financing to keep NHI
running. NHI members must therefore always keep paying their NHI tax (premium)contributions.

NHI member NHI tax (premium) contributions
Members up to
39 years old

Members 40 to
64 years old

Are not Long-Term Care Insurance
System members.
Members up to the age of 39 only pay the NHI tax(premium), which includes a contribution for medicalcare and a contribution for the Health Insurance
System for Latter-stage Elderly People.

Are Type 2 Long-Term Care Insurance
System members.
Members between the ages of 40 and 64 pay a single
NHI tax (premium) which includes a contribution for
medical care, a contribution for the Health Insurance
System for Latter-stage Elderly People, and acontribution for the Long-Term Care Insurance System.

When turning 40 during your membership year
Your NHI tax (premium) will increase to include the contribution for theLong-Term Care Insurance System starting with the month in which you
turn 40. (The month in which you turn 40 is considered to be the monththat contains the day before your 40th birthday.)Members 65 to
74 years old

Are Type 1 Long-Term Care Insurance
System members.
Members between the ages of 65 and 74 only pay the
NHI tax (premium), which includes a contribution for
medical care and a contribution for the Health
Insurance System for Latter-stage Elderly People. The
premium for the Long-Term Care Insurance System isgenerally deducted from the member’s pension.
(Members with a yearly pension of less than 180,000
yen pay the premium for the Long-Term Care
Insurance System to their city or town separately.)* The NHI tax (premium) of households in which all NHI members are 65 to 74 years
old is deducted from the pension of the head of the household. (Excluding those
who make payments by account transfer.) However, the NHI tax (premium) must be
paid separately if any of the following cases applies: (1) the head of the household
is not an NHI member, (2) the head of the household receives a yearly pension ofless than 180,000 yen, or (3) the Long-Term Care Insurance System premium
deduction is more than half the yearly pension of the head of the household.

NHI tax (premium)Contribution for medical care
Contribution for Health Insurance
System for Latter-stage Elderly People

NHI tax (premium)Contribution for medical care
Contribution for Health Insurance
System for Latter-stage Elderly People

Contribution for Long-TermCare Insurance System

NHI tax (premium)Contribution for medical care
Contribution for Health Insurance
System for Latter-stage Elderly People

Long-Term Care Insurance
System premium
Contribution for Long-TermCare Insurance System

When turning 65 during your membership year
Your Long-Term Care Insurance System premium (the Long-Term Care Insurance System contribution ofyour NHI tax (premium)) for the period through the month before the month in which you turn 65 must be
paid separately from the NHI tax (premium) that must be paid by the end of your membership year.

5Start paying NHI tax (premium) contributions after becoming
eligible for NHI membership
You must start paying NHI tax (premium) contributions after becoming eligible for NHI
membership. You become eligible for NHI membership when (1) your membership in
the health insurance system provided by your employer ends, (2) you stop receiving
public assistance, or (3) you start living in your new residence after moving from one
city, ward, town or village to another. If you are late in applying to start or renew your
NHI membership, you will have to pay the delinquent amount of NHI tax (premium).

Head of the household is responsible for paying NHI tax(premium)
NHI tax (premium) letters are sent to the head of the household. Even if the head of
the household is a member of their employer’s health insurance system and not an
NHI member, the head of the household is still responsible for paying the NHI tax(premium) if any other member of the household is an NHI member.

Criteria used to set amount of NHI tax (premium)
The NHI tax (premium) is set in combination with the city or town, and calculated asshown on the below.

NHI member’s copayment

Financial assistancefrom national government

Forecast yearly medical costs(set individually by each city or town)

NHI tax (premium)

Uniformly
Calculated based on the number of members in the household.

Equally
Calculated based on the amount per household.

By incomeCalculated based on the member’s income.

By net worth
Calculated based on the member’s net worth.

6

Pay Your NHI Tax (Premium) on Time
The NHI tax (premium) is an important financial resource that pays forthe medical costs of all NHI members.
Be sure to pay your NHI tax (premium) on time. Unless there are extraordinary circumstances,
NHI may be forced to take the steps below for households late in making their NHI tax(premium) payments.

The delinquent NHI member may be issued a special short-term NHI card with a shorter
than normal validity period.
If an NHI tax (premium) is more than one year late, the delinquent NHI member may be
asked to return their NHI card, and be issued an NHI Eligibility Certificate in its place.

Members who are issued an NHI Eligibility Certificate must initially pay the fullamount of medical costs, and later receive the standard NHI refund of 70 to
90% of the medical costs.**Preschool infants···80%, school-age children through adults up to 69 years old···70%, adults aged
70 or older···90% (except for wage-earners at their preretirement income level, who receive a 70%
refund).

If an NHI member is more than 18 months delinquent in their NHI tax (premium) payments,
some or all of their NHI benefits may be stopped.
Members who receive NHI benefits and are still delinquent in their payments after thesesteps have been taken may have some or all of their costs (such as medical costs, major
medical costs, lump-sum birth/childcare benefits or funeral expenses) added to their late
NHI tax (premium) payment.

7

NHI Benefits
Once you become an NHI member, you are eligible to receive several types of benefits madepossible by the NHI tax (premium) contributions of all NHI members and other sources offinancial assistance.

Medical benefits

When received

Benefit received

Points to note

When you become ill
When you are injured
When you require dental care

Medical treatment for between 10
and 30%* of the original cost

You must present your NHI card at
a healthcare provider that accepts
NHI. Members aged 70 or older(excluding members eligible for theLong Life Medical Care System)must present their NHI card andSenior Benefit Card.

* Preschool infants ··················· 20%
School-age children through adults
up to 69 years old ·················· 30%
Adults aged from 70 to 74 ····· 10%(except for wage-earners at theirpreretirement income level, who pay
30%).

Reimbursement for medical costs (refunds received from NHI after applying)

When received
When you receive medical
treatment from a healthcare
provider that doesn’t accept NHI,
or must receive treatment when
not in possession of your NHI
card
When you receive traditionalanma massage or Western
massage therapy, acupuncture ormoxibustion with a doctor’s writtenconsent or medical certificate
When you incur expenses for acorset, crutches or other medical
appliance
When you pay for blood used ina blood transfusion

Benefit received

Points to note

After initially paying the full amount,the member makes a claim for the
incurred medical cost. NHI
investigates the case, and themember receives a refund of 70 to
90%* of the approved amount if theclaim is approved.

NHI investigates the circumstances
thoroughly before reimbursing
expenses. An invoice for the cost of
the medical treatment or a suitable
substitute is required.

* Preschool infants ··················· 80%
School-age children through adults
up to 69 years old ·················· 70%
Adults aged from 70 to 74 ····· 90%(except for wage-earners at theirpreretirement income level, who pay
70%).

A doctor’s certificate is required.
Expenses for blood used in bloodtransfusions between a parent andchild, siblings or other family
members are not reimbursed.

When expenses for hospitalizingor transporting a critical patient
have been incurred

The incurred transportation
expenses are reimbursed (no morethan the amount estimated fortransportation by the mosteconomical standard route andmethod) if the transportation was ofan emergency nature and wasdeemed necessary by a doctor.

Only when approved by NHI. A
written opinion from the doctor
deeming the transportationnecessary, and a receipt for the
incurred transportation expenses(indicating the distance, andstart/end points of the journey) are
required for application.

When you are treated for an
illness or injury by an overseas
healthcare provider (Overseas
Medical Cost)

NHI members can receive a refundof 70 to 90%* of the estimated costfor treatment of the same injury orillness in Japan (or of the amountactually paid overseas if less).

An itemized treatment description,
itemized receipt, and translation
are required.

* NHI reimburses Overseas Medical Costs only when they are for emergency treatment. NHI does not reimburse medical costs
on trips made overseas for the purpose of receiving organ transplants or other treatments not covered by NHI in Japan.

8Medical costs

When received

Benefit received

When you are treated by a
traditional jūdō therapist

Treatment for between 10 and
30%* of the original cost
* Preschool infants ··················· 20%
School-age children through adults
up to 69 years old ·················· 30%
Adults aged from 70 to 74 ····· 10%(except for wage-earners at theirpreretirement income level, who pay
30%).

Points to note
Bring your NHI card. In somecases you may also need yourhanko. Members aged 70 or older(excluding members eligible for theLong Life Medical Care System)must present their NHI card andSenior Benefit Card.

Reimbursement for major medical costs (See pages 12 to 15 for more information.)

When received
When your costs exceed thepreset deductible

Benefit received
If the costs paid at the hospitalbilling office exceed the preset
deductible, NHI reimburses theexcess.

Points to note
Does not apply to bed surcharges
and other items not covered by
NHI.

Other benefits
When received

Benefit received

Points to note

When you give birth
When you are pregnant for 85
days or longer, even in the caseof miscarriage or stillbirthLump-sum birth/childcare benefit

From October 2009, as a rule
lump-sum birth/childcare benefits
are paid directly by NHI to the
medical facility (direct payment
system) to assist the payment of
the cost of childbirth.

When an NHI member dies

Funeral expenses

Bring the deceased member’s NHI
card and death certificate.

Meal costs when hospitalized(see page 10)

Hospitalized NHI members pay 260
yen (per meal) for hospital meals.
NHI pays the remainder (Hospital
Meal Cost).

People in households that are
exempt from resident taxes should
apply to receive a “Certificate of
Eligibility for Payment of Deductible
or Reduction of Standard
Copayment”.

Living costs for members 65 orolder hospitalized in treatment
wards (see page 11)

Hospitalized NHI members pay 460
yen or 420 yen (per meal) for
hospital meals, and 320 yen (perday) for living costs. NHI pays theremainder (Hospital Living Cost).

People in households that are
exempt from resident taxes should
apply to receive a “Certificate of
Eligibility for Payment of Deductible
or Reduction of Standard
Copayment”.

When using a visiting nursing
station

NHI members pay part of the cost,and NHI pays the remainder(Visiting Nursing Care Cost).

Applies when a doctor has deemed
at-home treatment necessary.
Present your NHI card to thevisiting nursing station. (Thisbenefit is paid by the Long-TermCare Insurance System in somecases.)* For more information, contact the NHI section of your city or town office.

9

Hospital Meal Costs
Hospitalized NHI members pay only the standard copayments below for hospital meals. NHI
pays the remainder (Hospital Meal Cost).

General NHI members (members other than those below)

260 yen per meal

NHI members from Total number of days hospitalized
households exempt during past 12 months: 90 or lessfrom resident tax

210 yen per meal

(Type II low-income NHI
member*1 if 70 or older)

Total number of days hospitalized
during past 12 months: More than 90

160 yen per meal

Type I low-income NHI members*2 who are 70 or older

100 yen per meal

The following NHI members need to apply for and receive the Certificate of Eligibility for
Payment of Deductible or Reduction of Standard Copayment at the NHI section: (1) NHI
members less than 70 years old from households exempt from resident tax, and (2) Type I
or Type II low-income NHI members who are 70 or older.
*1: A member of a household in which the head of the household and all the NHI membersof the household are exempt from resident tax.
*2: A member of a household in which the head of the household and all the NHI membersof the household are exempt from resident tax and in which total incomes are less thanthe prescribed amount of income.

The standard copayments above are not included in the copayments used to
calculate the benefits for major medical costs.

10

Hospital Living Costs
NHI members who are 65 or older and hospitalized in a treatment ward pay only the standard
copayments below for hospital living costs. NHI pays the remainder (Hospital Living Cost).
(Check with your healthcare provider to determine whether your ward meets the definition of atreatment ward.)
Members hospitalized in an NHI
healthcare provider that uses Hospital
Living Cost I

General NHI
members
Members hospitalized in an NHI

healthcare provider that uses Hospital
Living Cost II

Total of 320 yen per day and 460
yen per meal
Total of 320 yen per day and 420
yen per meal

NHI members from households exempt fromresident tax(Type II low-income members)

Total of 320 yen per day and 210
yen per meal

NHI members from households exempt from resident
tax in which total incomes are less than the prescribedamount of income (Type I low-income members)

Total of 320 yen per day and 130
yen per meal

Members of households exempt from resident tax need to apply for and receive theCertificate of Eligibility for Payment of Deductible or Reduction of Standard Copayment at
the NHI section.

Members who require artificial respirators or central venous nutrition, or who have spinal
cord injury (with full paralysis) or terminal illnesses only pay for their food ingredients(standard Hospital Living Cost copayment).

The standard copayments above are not included in the copayments used to
calculate the benefits for major medical costs.

11

Major Medical Costs
When a copayment paid to a healthcare provider is high, NHI pays the amount in excess of
the NHI member’s deductible.
To receive major medical costs, you must fill out an application. Submit the Application to
Receive Major Medical Cost at the NHI section of your city or town office.

NHI members less than 70 years old
When your monthly copayment exceeds your deductible
If a copayment (for a single billing month) made by a single NHI member in a single
month to a single healthcare provider exceeds the deductible shown in the table below,
the NHI member can receive the excess by applying to the NHI section of their city or
town office (Reimbursement). By filling out an application for your NHI healthcare
provider beforehand, you can receive a certificate stating your deductible. This
procedure ensures that when you are hospitalized and have major medical costs, theamount you will pay at the billing office of an individual healthcare provider will be no
more than your deductible (On-the-Spot Payment).
* If you are delinquent in your NHI tax (premium) payments, you may not be able
to receive a certificate.
NHI member deductibles (monthly)

General members

80,100 yen + A

High-incomemembers*1

150,000 yen + B

A= (Total medical costs - 267,000 yen) x 1%
B= (Total medical costs - 500,000 yen) x 1%

Members exempt
from resident tax*2

35,400 yen

A is added if the medical cost is more than 267,000 yen. B is added if the medical cost is more than
500,000 yen.
*1: Applies to members of households in which the combined annual income of all the NHI membersof the household exceeds 6,000,000 yen.
*2: Applies to members of households in which the head of the household and all the NHI members of
the household are exempt from resident tax.
Example: A person is admitted to asingle hospital and incurred
medical costs of 1 million yen(general) in one month

Total medical costs 1 million yen
70% (paid by NHI)
30% (copayment)
700,000 yen
300,000 yen
Deductible
87,430 yen

Major medical costs
212,570 yen

Deductible= 80,100 yen + (1 million yen – 267,000 yen) x 1%= 87,430 yen
After applying for Reimbursement, it will take about
three months to receive payment.
NHI members who have difficulty paying high medical costs
may be able to use the Major Medical Cost Loan System.
Inquire at the NHI section of your city or town office.
* For more information, contact the NHI section of yourcity or town office.

12

If a single NHI household’s total copayments exceed the
deductible
A single NHI household that pays copayments of more than 21,000 yen two or moretimes in a single month (for the same billing month) can apply to their city or town office
to have these payments totaled, and receive the amount in excess of their deductible(Household Total).
* The above applies not only to families, but also to individual members who have madecopayments to multiple healthcare providers in the same month.

When receiving four or more benefits for major medical costs
per yearA single household that receives four or more benefits for major medical costs in thepast twelve months can apply to their city or town office after the fourth benefit, toreceive the amount by which the deductible below was exceeded in a single month(Frequent Benefits Provision).

Deductible (monthly)
after fourth benefit

General NHI members

44,400 yen

High-income members

83,400 yen

Households exempt fromresident tax

24,600 yen

When receiving long-term high-cost medical treatment
NHI members of any age who suffer from certain diseases that require long-termhigh-cost medical treatment can have their monthly deductible reduced to 10,000 yen by
presenting a Designated Illness Treatment Certificate, which members can apply tohave issued by the NHI system, to the hospital billing office. Only diseases designatedby the Minister of Health, Labour and Welfare are applicable (hemophilia, HIV infections
caused by blood coagulant factor agents, and chronic renal failure requiring dialysis).
Note that the monthly deductible is 20,000 yen for wage earners at their preretirement
income level who have chronic renal failure requiring dialysis.

bers
NHI mem ars oldyeunder 70

Points to note when calculating copayments
1. Copayments are calculated monthly (by calendar month), from the first to the last day ofthe month.
2. Bed surcharges not covered by insurance, standard Hospital Meal Cost copayments andother items not covered by NHI are not covered.
3. Copayments are calculated for each hospital or clinic.
4. Separate copayments are calculated for outpatient treatment and inpatient treatment,even if the hospital or clinic is the same.
5. The cost of medications prepared for out-of-hospital prescriptions is added to
copayments.

13

NHI members who are 70 or older (excluding members eligible
for the Long Life Medical Care System)
When your monthly copayment exceeds your deductible
If a copayment (for a single billing month; up to the inpatient deductible) made by asingle NHI member in a single month exceeds the deductible shown in the table below,
the member can receive the excess amount by applying to the NHI section of their cityor town office.

Copayment
ratio
General members
Wage earners attheir preretirement
income level*1
Type II*2
Members
exempt fromresident tax Type I*3

10%Outpatients(per individual)

12,000 yen

Outpatients +inpatients(per household)44,400 yen
80,100 yen + A

30%

44,400 yen

A= (Total medical costs– 267,000 yen) x 1%
(44,400 yen)*4

24,600 yen
10%8,000 yen
15,000 yen

A is added if the medical cost is more than 267,000 yen.
*1: An NHI member living in a household that includes an NHI member who is 70 or older andearns at least the prescribed level of income (taxable income of 1,450,000 yen). However, if
the member notes in their application that the combined incomes of members of thehousehold who are NHI members aged 70 or older is less than the prescribed level (annual
income below 3,830,000 yen for single-person households, or annual income below
5,200,000 yen for households of at least two people), the same conditions as the ‘General
members’ category apply.
*2: An NHI member living in a household in which the head of the household and all the NHI
members of the household are exempt from resident tax.
*3: An NHI member living in a household in which the head of the household and all the NHI
members of the household are exempt from resident tax and in which total incomes are lessthan the prescribed amount of income.
*4: The amount in parentheses is the member’s deductible for the fifth and subsequent
copayments for major medical costs paid four or more times in a single year.
*

The deductible for NHI members with hemophilia or chronic renal failure requiring dialysis is10,000 yen.

*Type I and Type II resident tax-exempt NHI members must apply for the Certificate of
Eligibility for Payment of Deductible or Reduction of Standard Copayment at the NHI sectionof their city or town office.

* For more information, contact the NHI section of your city or town office.

14

70 or olderthe
rs
e
b
m
e
m
I
H
r
N
ers eligible fo

emb(excluding m dical Care System)Long Life Me

Points to note when calculating copayments
1. Copayments are calculated monthly (by calendar month), from the first to the last day of the month.
2. Bed surcharges not covered by insurance, standard Hospital Meal Cost copayments and otheritems not covered by NHI are not covered.
3. Total the copayments paid by each outpatient to each healthcare provider, to calculate the amountby which the deductible has been exceeded.
4. The inpatient copayments to healthcare providers in a single month can not exceed thehousehold’s deductible. (A certificate of eligibility is required for Type I and Type II resident
tax-exempt NHI members.)
5. To calculate the total household benefits to be received, total the outpatient benefit for eachindividual and combine this total with the inpatient copayments to determine the amount by which
the household’s deductible has been exceeded.

You can still total your copayments if your NHI household includes both members
under 70 and members 70 or older (excluding members eligible for the Long Life
Medical Care System).
To total your copayments if your NHI household includes both members under 70 and members 70
or older (excluding members eligible for the Long Life Medical Care System), create separate
copayment totals for the members under 70 and for the members 70 or older. First add the
deductible of each outpatient of 70 or older (see the information on outpatient deductibles on page14), then include the inpatients and apply the deductibles of household members of 70 or older (Page 14 outpatients +inpatient deductible). Combine this figure with the total applicable standard copayment for the household members under 70,
and apply the deductible for the entire NHI household (see the information on deductibles on page 12).

Household members under 70
Total applicable standard
copayment

Household members 70 or older(excluding members eligible for the Long Life Medical
Care System)(Each copayment over 21,000 yen)

Outpatients

Outpatients(per individual)(per individual)

Outpatients + inpatients (per household)

Total

Household copayment for entire NHI household (no more than deductible given on page 12)15Injuries from Traffic Accident and Other Incidents
Always submit the required paperwork
If you use your NHI card to receive medical treatment after being injured in a traffic
accident or other incident in which another party is at fault, you will need to file a police
report right away and submit the proper form to the NHI section of your city or town
office at the same time.

Party at fault pays medical costs
As long as you were not negligent, the party at fault is generally obliged to pay your
medical costs. If you receive treatment under NHI, NHI will advance you the medical
costs to be paid by the party at fault.

Application procedure
File a police report.
If you are in a traffic accident, file a police
report right away and receive an Accident
Certificate.

Submit the required form at the
NHI section of your city or town
office.
Submit a Form for Disability Caused by
Other Party.

Documents needed tofill out forms
Form for Disability Caused by
Other Party
Accident Certificate
Your NHI card
Any other documents needed

You can submit a preliminary version of
the form even if you do not have all therequired paperwork ready.

Seek advice before settling out of court
You may no longer be able to use NHI if you settle out ofcourt such as by accepting medical costs directly from theparty at fault. Before settling out of court, be sure to seek
advice from the NHI section of your city or town office.

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Long-Term Care Insurance System
Upon turning 40, NHI members are also made members of the Long-Term Care Insurance(LTCI) System. The system provides members with recognized needs for long-term care or
nursing assistance with the LTCI services they need.

LTCI members are classified as
Type 1 or Type 2 members.
Type 1 members

LTCI members 65
or older living in acity or town

Type 2 members
LTCI members
aged 40 to 64
living in a city or
town who have
health insurance

Apply for acknowledgement of long-term care needs
To receive an LTCI service, you must apply for and receive recognition of yourlong-term care need (Long-Term Care Need Certification). You can start receiving theproper LTCI service for your need once your need has been recognized.

10% copayment for service costs
LTCI members are required to make copayments of 10% of the cost of services within
the deductible.
Living costs, residence costs, meal costs (LTCI facilities, short-term care facilities, daycare
facilities), and other services exceeding the deductible are generally borne entirely by theuser.

LTCI services
Degrees of need for long-term care are ranked. Members can use preventive,
long-term care, and local assistance provider services according to their degree ofneed.

* For more information, contact the LTCI section of your city or town office.

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Combined Copayments System for Major Medical and Long-Term Care Costs
As of April 2008, the deductibles described in the table below apply to costs that remain higheven after the total NHI member deductibles for both insurance systems have been deductedfrom medical costs and long-term care service costs.
Deductibles from August 1st of each year to July 31st of the following year are calculated as alump sum.
The combined copayments system for medical and long-term care costs is intended forhouseholds that have copayments for both NHI and LTCI. Meal costs, living costs, and bed
surcharges are not included in copayment totals.
All copayments are included in copayment totals for NHI members aged 70 or older. For NHI
members aged 69 or younger, only monthly medical cost copayments of 21,000 yen or moreare included in copayment totals.

NHI members under 70
High-incomemembers(Wage earners at theirpreretirement income level)

General members

Members
exempt fromresident tax

1,260,000 yen

670,000 yen(1,680,000 yen)(890,000 yen)

670,000 yen

560,000 yen(890,000 yen)

(750,000 yen)

310,000 yen

Type II
Type INHI members 70 or older(excluding members eligible for theLong Life Medical Care System)

340,000 yen(410,000 yen)

(450,000 yen)

190,000 yen(250,000 yen)

* See pages 12, 13, and 14 for details on how this applies to high-income members, wage-earners attheir preretirement income level, and members exempt from resident tax.
* Because the applicable period for 2008 will be sixteen months (from April 2008 to July 2009), NHI
member deductibles in parentheses indicate amounts equivalent to sixteen months.
However, if copayments are mainly concentrated in the twelve months from August 2008, regular NHI
member deductibles will apply.

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Retiree Medical System
People under 65 years of age who have retired from a company or the civil service and arereceiving a pension as members of NHI will receive treatment together with their families asretired NHI members under the “Retiree Medical System”.

Eligible People
People who satisfy both of the following criteria are eligible for the retiree medical
system.

Members of
NHI

People receiving long life (retirement) pensions such as
Employees’ Pensions and Mutual Aid Pensions, who have
either been members of the pension fund for 20 years or
longer, or who are aged 40 or over and have been members
for ten years or longer

Qualifications and Notification
The retiree medical system shall apply from the day you become eligible for a pension.
Report to your NHI office within 14 days of receipt of a pension certificate to receive
your “NHI retiree insurance card”.
This procedure will require your “pension card” and “NHI card”.

Copayments
Pre-school infants: 20%
Post pre-school to under 65: 30%

Long Life Medical Care System
NHI members aged 75 or older (and NHI members aged 65 or older who have certain
disabilities) will receive medical care under the Long Life Medical Care System (the Insurance
System for Latter-Stage Elderly People).
On reaching the age of 75 (i.e. on the day of their 75th birthday, or in the case of those aged
between 65 and 74 (inclusive) who have certain disabilities, on the day they receive
recognition of their disability from the regional council), current NHI members will no longer becovered by the NHI system; they will be covered by the Long Life Medical Care System (theInsurance System for Latter-Stage Elderly People).

Main operating body
Shiga Prefecture Regional Bureau for Medical Care for Latter-stage Elderly People(Collection of premiums and administrative work is conducted by the city or town.)

Premiums and insurance cards
All eligible parties (members) are required to pay premiums;
even non-working dependents who were not previously
paying premiums.
One NHI card will be issued per member.

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Disability Welfare Services
The Self-reliance Support Law for People with Disabilities was established in order tostandardize the system under which the disabled use disability welfare services and to further
promote this system. It also aims to ensure that disabled persons are able to access theservices they need, regardless of their disability.

Application and certification of degree of disability are required
Prospective users of disability welfare services are required to submit an applicationand obtain certification of their degree of disability. After receiving certification,
applicants are subject to further review before the decision is made as to whether
services will be provided.

Main services
Long-term care services......................... At-home care, visiting care for the severely
disabled
Provision of training and other services..... Work training assistance, group homes, etc.
Use of facilities for disabled children ...... Guardians of disabled children can apply tothe prefecture for a benefit. Once thepermission is granted, they sign a contract
with a facility.

Service costs
Copayments are generally 10% of service costs. However, there is a monthly upper
limit according to income.

* For more information, contact the disabled persons self-reliance support section of your city or town office.

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