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

1

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

2

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

3

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

4

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

6

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

7

Meal and Living Costs During Hospitalization ·····································

9

Major Medical Costs ············································································ 11
Combined Copayments System for Major Medical and Long-Term Care Costs ···· 15
Long-Term Care Insurance System ····················································· 16
Disability Welfare Services ·································································· 17Long Life Medical Care System ··························································· 18
Injuries from Traffic Accident and Other Incidents································ 19
Receive Your Specialized Medical Examination and Specialized Medical Advice!····· 20
To Individuals Who Do Not Receive the Specialized Examination ······ 21
Let's Make Use of Generic Medication!··············································· 22
Please Declare Your Intentions Regarding Organ Donation ················ 23

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····· (20% or 30%)
(The copayment percentage that is written
on your NHI card.)

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.

NHI doctor

Insurer(healthcare provider)(prefecture, city, or town)
NHI pays medical costs
to healthcare provider.

Healthcare provider bills
NHI for medical costs.

City or town pays
medical costs to NHI.
NHI reports the medical
costs incurred.

Federation of National Health Insurance Organizations
There are systems that you can use to apply for collection postponements and exemptions
to your copayments in the event that it is difficult for you to pay your copayments due tospecial reasons such as the occurrence of a disaster. → For details, contact your Japannational health insurance office.
1

NHI Members
Every Japanese citizen and resident (except short-term residents) can subscribe to NHI, unlessthey (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’ insuranceorganization), or (3) receive public assistance (System of medical insurance for the whole 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 head of 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.
* If you misuse your NHI, you will be punished with imprisonment for fraud under the criminal code.

Foreign residents
Foreigners to whom the Basic Resident Registration Act applies (medium to long-term
residents [residents whose stay exceeds three months], special permanent residents, persons
granted permission for provisional stay, persons granted permission for temporary refuge, or
persons who may continue to stay transitionally in Japan) are eligible to subscribe to NHI.
Also, persons whose stay is three months or less but whose stay is recognized to exceed
three months on the basis of objective documents are eligible to subscribe to NHI.
Discontinuation of NHI cards
Use of NHI cards will be discontinued as of December 2, 2024, and theIndividual Number Card* and NHI card will be combined into the Individual
Number Health Insurance Card. (Transitional measures will be enacted.)
For details, please check the Ministry of Health, Labour and Welfare website(https://www.mhlw.go.jp/english/).
* The Individual Number Card is also referred to as the My Number Card.

2

Under such circumstances, report within 14 days
Delayed reporting may cause problems such as you may be personally liable for the full cost of
your medical treatment, or be made to pay all back health insurance dues, so be careful.
Reporting is also necessary by a person who has registered to use the Individual Number Card
as a health insurance card.
* If you fail to carry out the procedure to cancel your national health insurance even though you havebeen employed by a company and have joined your company’s health insurance system and then use
your NHI card at a healthcare provider, you will be required to return the medical costs.
* If you have yet to receive your new insurance card from your employing company at the time that you
want to visit a healthcare provider, contact your employer.

* Either documents A or B below are required for the procedure.
A. ID that can be used to verify your identity, and a document bearing your individual number(certificate of residence or certificate of items stated in resident register)B. Individual Number Card
* The items required for notification may vary by city or town. For more information, contact the
NHI section of your city or town office.

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

Change of address certificate

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

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 a foreign national entered Japan (excepting short-term visitors)

Passport or residence card

If you are a foreign national

Special Permanent Resident Certificate or Residence Card

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
(For those members that are 65 to 74 years old) (see page 18)

NHI card

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

NHI card

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

NHI card and other health insurance system’s card

Upon death

NHI card

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 education

NHI card, student ID card, etc.

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

NHI card, facility membership certificate, etc.

When your NHI card becomes lost* or unreadable

ID that can identify the individual* If your cards are stolen or lost while out, notify the police.

3

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 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, andthe premium for the Long-Term Care Insurance Systemseparately.

* 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 apply: (1) the head of the household is not an
NHI member, (2) the head of the household receives a yearly pension of less than
180,000 yen, or (3) the NHI tax (premium) and Long-Term Care Insurance System
premium combined 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.

4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) you withdraw from thehealth insurance system provided by your employer; (2) you stop receiving public
assistance; or (3) you move from one city, ward, town, or village to another. If you arelate in applying to start or renew your NHI membership, you will have to pay thedelinquent 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.
Forecast yearly medical costs(set individually by each city or town)

NHI member’s
copayment

Financial assistancefrom national
government

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.

There are systems that you can use to apply for postponements and exemptions to your
NHI tax (premium) payments in the event that it is difficult for you to pay your NHI tax(premium) due to special reasons such as the occurrence of a disaster. → For details,
contact a representative in charge of the NHI tax (premium).

Pay your insurance taxes (premiums) using convenient
and reliable automatic withdrawal!
For other tax (premium) payment methods, please check the back of thepayment statement, the website of your city or town, or other materials.
5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.
Late fees may be imposed on NHI taxes (premiums) that are not paidby the payment deadline.
NHI may 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.

Unless there are extraordinary circumstances, if an NHI tax (premium) is not paid within acertain period, an NHI Eligibility Certificate may be issued.

If you receive an NHI Eligibility Certificate, you will be responsible for paymentof the full amount of medical expenses, and will receive a refund of the medical
expenses minus the copayment at a later date.

The receipt of Japan’s national health insurance may be stopped in part or in whole. Also, if
you receive NHI benefits (medical care, high cost medical car, funeral expenses, etc.), theamount you have received may be applied in part or in whole to your unpaid NHI tax(premium).
Note that, as required by law, the seizure of assets (salary, savings, real estate, etc.) andother similar methods may be used in the event that you fail to pay your NHI tax (premium).

If you expect to have difficulty in paying your NHI tax (premium),contact the representative in charge of the NHI tax (premium) at
your city or town office as soon as possible.

6

NHI Benefits
Once you become an NHI member, you are eligible to receive several types of benefits made possibleby the NHI tax (premium) contributions of all NHI members and other sources of financial 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* ata healthcare provider that accepts
NHI.

* Preschool infants ·················(20%)
School-age children through adults
up to 69 years old ················(30%)
Adults aged from 70 to 74··········· (20% or 30%)
(The copayment percentagethat is written on your NHI card.)* Insured Individual and Recipient Card for Seniors for individuals between 70 and 74 years old

Reimbursement for medical costs (refunds received from NHI after applying)* The statute of limitations on your right to apply for refunds to medical costs is two years after the day following the day thatyou pay for the corresponding medical costs. However, the day to use in evaluating refunds for reimbursement of major
medical costs shall be the first day of the month following the month in which the medical care was received. If the copayment
is made in the month following the month in which medical care was received or in a later month, the day following the daythat the copayment was made shall be used in evaluating the refund.

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

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 theapproved amount.

NHI investigates the circumstances
thoroughly before reimbursing
expenses. An invoice or receipt forthe cost of medical treatment or asuitable substitute is required.

When you incur expenses for acorset, crutches or other medical
appliance
When you pay for blood used ina blood transfusion

HOSPITAL

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 more than theamount estimated for transportation by
the most economical standard routeand method) if the transportation wasof an emergency nature and wasdeemed necessary by a doctor.

Only when approved by NHI. A written
opinion from the doctor deeming thetransportation necessary, 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 a portion of the estimated cost
determined by NHI for treatment of
the same injury or illness in Japan(or of the amount actually paid
overseas if less).

An itemized treatment description,
itemized receipt, translation, yourpassport, a copy of your airline ticket or asimilar document that can be used toprove that you have traveled overseas,
and a form indicating your consent to havethe treatment investigated 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.

7Medical costs for judo therapy, acupuncture, moxibustion,
traditional anma massage, and Western massage therapy

When received● When you are treated by a traditional
judo therapist(for bone fractures, dislocations,blows to the body, and sprains)● When you receive acupuncture,
moxibustion, traditional anma
massage, or Western massage
therapy with a doctor’s writtenconsent or medical certificate

Benefit received

Points to note

Treatment for a portion of the original
cost* paid by the member.

Present your NHI card to the locationthat you will receive medical treatment.
In some cases you may also need yourhanko.
When receiving judo therapy:
The following are not covered byinsurance based on the diagnosis ordetermination of a physician or judo
therapist.

* Preschool infants ........................(20%)
School-age children through adults up to
69 years old ................................(30%)
Adults aged from 70 to 74.............(20% or 30%)
(The copayment percentage that is
written on your NHI card.)●• Simple (fatiguing or chronic) stiffness inthe shoulders or muscle fatigue• Chronic illnesses such as brain disease
sequelae, and long-term treatment that
does not improve symptoms• Injuries that are currently being treated at
a medical institution (hospital, clinic, etc.)*M ust be carried out at a designatedrepresentative treatment facility.
Verify that your desired treatment facility
is a designated representative facility.
The information can also be found on the
Regional Bureau of Health and Welfare
website.

* Designated representative facilities: A practitioner performs a treatment specified under health insurance (as a medical cost). A portion of the
medical expense is received from the patient, etc., and then the practitioner prepares and submits a medical expense payment application
on behalf of the patient to the insurer or applicable institution (Federation of National Health Insurance Organization in Shiga Prefecture). The
practitioner, as designated representative for the patient, then receives the remaining amount. If the treatment facility is not a designated representative facility, patients are responsible for being reimbursed for payments.

Reimbursement for major medical costs

When received● When your costs exceed the preset
deductible

Benefit received

Points to noteSee pages 11 to 15.

Other benefits

When received● Meal costs during hospitalization● Meal and living costs for members

aged 65 or older hospitalized in longterm care facilities● When using a visiting nursing station

Benefit received

Points to noteSee page 9.
See page 10.
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 the visiting nursing
station. (This benefit is paid by theLong-Term Care Insurance System insome cases.)● When you give birth● When you are pregnant for 85

Lump-sum birth/childcare benefit

In principle, payments are made directlyfrom Japan’s national health insurance
to healthcare providers so that the
lump-sum birth/childcare benefits canbe applied to the cost of childbirth.

● When an NHI member dies

Funeral expenses

Payments are made to the chiefmourner.
The chief mourner may be required topresent something that proves they are
the chief mourner.

days or longer, even in the case of
miscarriage or stillbirth

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

8

Meal and Living Costs During Hospitalization
The standard copayments for meal costs during hospitalization and meal and living costs formembers aged 65 or older admitted to long-term care facilities are as follows. The remaining
costs will be covered by NHI.
The following NHI members need to apply for and receive the Eligibility Certificate for
Ceiling-Amount Application and Reduction of the Standard Amount of Patient Liability 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.
* There is no need to apply for the eligibility certificate if you provide consent at a healthcare provider
equipped with an online system for checking qualifications and if your classification can be checked
via your Individual Number Card (Individual Number Health Insurance Card), NHI card, or similar
document. (Excluding NHI members from households exempt from resident tax and whose total
number of days hospitalized during the past 12 months is more than 90 days)

1. Meal costs during hospitalization(As of March 31, 2024)

General NHI members (members other than those below)

460 yen per meal*1

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

210 yen per meal

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

160 yen per meal

Type I low-income NHI members*3 who are 70 or older

100 yen per meal

(Type II low-income NHI
member*2 if 70 or older)*1: 260 yen (per meal) for individuals with designated intractable diseases and children with specificpediatric chronic diseases.
*2: A member of a household in which the head of the household and all the NHI members of thehousehold are exempt from resident tax.
*3: A member of a household in which the head of the household and all the NHI members of thehousehold are exempt from resident tax and in which the total income of the head of the household
and of all the NHI members of the household is less than the prescribed amount.

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

9

2. Meal and living costs for members aged 65 or older hospitalized inlong-term care facilities(As of March 31, 2024)
Income classification, etc.

Meal costs

Members hospitalized in an NHI healthcare

Generalprovider that uses Hospital Living Cost I
NHI
members Members hospitalized in an NHI healthcare
provider that uses Hospital Living Cost II

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

Medical careclassification

NHI members from households
exempt from resident tax inMedical carewhich total incomes are less thanclassification
the prescribed amount of income(Type I low-income members)

I

460 yenper meal

420 yenper meal

210 yenper meal

210 yenII·III

per meal*I

130 yen

II·
III

Living costs

370 yenper day

per meal

100 yenper meal

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).
* 160 yen per meal if the total number of days hospitalized during the past 12 months is more than 90 days.

Check with the medical facility to see if you qualify for hospitalization in along-term care facility.
The standard copayments above are not included in the copayments used to
calculate the benefits for major medical costs.
Meal costs will be raised from June 2024.

10

Major Medical Costs
When a copayment paid to a healthcare provider is high, NHI pays the amount in excessof 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.
In the month that you change your address from one city/town in Shiga prefecture toanother city/town in Shiga prefecture and only if there are no changes to the configuration of your household, the deductible value will be split evenly between that prior to thechange of address and that after the change of address.

When your monthly copayment exceeds your deductible
Members who pay copayments to a single medical institution for medical treatment from the first day of themonth to the end of the month that exceed the deductible shown in Tables 1 (below) and 2 (page 12) can apply
to their NHI office to have the excess amount paid back to them (reimbursement).
Reimbursements for payments generally take 3 to 4 months from the application date.
If you have previously made a request to the NHI system and have received a Eligibility Certificate for CeilingAmount Application (or, for Type I and Type II resident tax–exempt NHI members, an Eligibility Certificate for
Ceiling-Amount Application and Reduction of the Standard Amount of Patient Liability) that covers yourcopayment deductible, your payment to each healthcare provider (handled separately for inpatient treatment/
outpatient treatment and for medical treatment/dental treatment) can be limited to your copayment deductible.
In addition, for Type III members aged 70 or older with income comparable to the current workforce and general
members, there is no need to apply for the Eligibility Certificate for Ceiling-Amount Application because themember’s income classification can be confirmed on their NHI card (benefit in kind).
* There is no need to apply for the eligibility certificate if you provide consent at a healthcare provider equippedwith an online system for checking qualifications and if your classification can be checked via your Individual
Number Card (Individual Number Health Insurance Card), NHI card, or similar document.
If you are delinquent in your NHI premiums (taxes), you may not be able to receive a certificate.

1. NHI members less than 70 years old
Applicableclassification

Income classification

NHI member deductibles (monthly)

252,600 yen + a

AIncome greater than 9.01 million yen

BIncome between 6 million yen
and 9.01 million yen

CIncome between 2.1 million yen
and 6 million yen

DIncome of 2.1 million yen or less

57,600 yen

E

Members exempt from resident tax*1

35,400 yen

a = (Total medical costs - 842,000 yen) × 1%
(Corresponding to multiple times: 140,100 yen*2)

167,400 yen + b

b = (Total medical costs - 558,000 yen) × 1%
(Corresponding to multiple times: 93,000 yen*2)

80,100 yen + c

c = (Total medical costs - 267,000 yen) × 1%
(Corresponding to multiple times: 44,400 yen*2)(Corresponding to multiple times: 44,400 yen*2)(Corresponding to multiple times: 24,600 yen*2)

The values a, b, and c are each added if the total medical cost is more than 842,000 yen, 558,000 yen, or
267,000 yen (respectively).
* Income classifications are updated every August based on the income of the previous year. In addition, all
tax return amendments and changes in household are assessed individually.
* Income refers to the standard yearly income of all NHI members of the same household.
*1: Applies to members of households in which the head of the household and all the NHI members of thehousehold are exempt from resident tax.
*2: Deductible after fourth benefit for a single household that receives three or more benefits for major medical
costs within the past twelve months.

11

Example: A person is admitted to a single hospital and incurred medical costs of 1 million yen(general) in one month (Income between 2.1 million yen and 6 million yen)
Total medical costs 1 million yen
70% (paid by NHI)
30% (copayment)
700,000 yen
300,000 yen
Deductible
Major medical costs
87,430 yen
212,570 yen
Deductible= 80,100 yen + (1 million yen – 267,000 yen) x 1%= 87,430 yen

2. NHI members who are 70 or older (excluding members eligible for the Long
Life Medical Care System)
NHI member deductibles (monthly)

Copayment
percentage

Outpatients(per individual)

Wage earners at theirpreretirement income level*2

30%

Income classification*

1

III Base taxation amount:
6.9 million yen or more
II Base taxation amount:
3.8 million yen or more
I Base taxation amount:
1.45 million yen or more

20%
Members exempt
from resident tax(Total medical costs – 842,000 yen) x 1%
(Corresponding to multiple times: 140,100 yen*6)

167,400 yen +(Total medical costs – 558,000 yen) x 1%
(Corresponding to multiple times: 93,000 yen*6)

80,100 yen +(Total medical costs – 267,000 yen) x 1%
(Corresponding to multiple times: 44,400 yen*6)(yearly upper limit:
144,000 yen*5)

Type II*3
Type I*4(per household)252,600 yen +18,000 yen

General members

Outpatients + inpatients

8,000 yen

57,600 yen(44,400 yen*6)

24,600 yen
15,000 yen*1: Income classifications are updated every August based on the income of the previous year. In addition, all
tax return amendments and changes in household are assessed individually.
*2: An NHI member living in a household that includes an NHI member who is 70 or older and earns at least
the prescribed level of income (income after deductions attributable to local tax laws, that is, the basetaxation amount) of 1,450,000 yen. However, if the member notes in their application that the combined
incomes of members of the household 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 member can change to the ‘General members’
category. If it is determined that the conditions are met, the member shall be judged as being in the‘General members’ category even if no application is made.
*3: An NHI member living in a household in which the head of the household and all the NHI members of thehousehold are exempt from resident tax.
*4: A member of 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 the total income of the head of the household and of all the NHI
members of the household is less than the prescribed amount.
*5: The term year refers to the period from August of one year to July of the subsequent year.
*6: Deductible after fourth benefit for a single household that receives three or more benefits for major medical
costs within the past twelve months.
* The ceiling amounts for NHI and the Long Life Medical Care System are both halved in the month anindividual will turn 75.

12Points to note when calculating copayments
1. Copayments are calculated monthly, from the first to the last day of the month.
2. B
 ed surcharges not covered by insurance, standard Hospital Meal Cost copayments and otheritems not covered by NHI are not covered.
3. Copayments are calculated for each individual at each hospital or clinic.
4. C opayments are calculated separately for outpatient and inpatient treatment for both medical anddental, even for the same hospital or clinic.
5. The cost of medications prepared for out-of-hospital prescriptions is added to copayments.
6. This calculation applies to individuals under 70 years old whose copayment at a healthcare
provider (handled separately for inpatient treatment/outpatient treatment and for medical
treatment/dental treatment) is 21,000 yen or more.

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

When receiving long-term high-cost medical treatment
NHI members of any age who suffer from certain diseases that require long-term high-cost medical treatment
can have their monthly deductible reduced to 10,000 yen by presenting a Designated Illness Treatment
Certificate, which members can apply to have issued by the NHI system, to the hospital billing office. Only
diseases designated by the Minister of Health, Labour and Welfare are applicable (hemophilia, HIV infections
caused by blood coagulant factor agents, and chronic renal failure requiring dialysis). However, for individuals
under 70 years old in income classification A or B requiring dialysis treatment for chronic renal failure, themonthly copayment amount is limited to 20,000 yen.

	If the total copayments for a single NHI household exceed the deductible
Even if an individual’s (one-time) copayment cannot be considered a copayment for major medical costs, if theindividual undergoes multiple medical examinations or other members of the NHI household undergo medical
examinations, the individual copayments for each month (calendar month) may be totaled. If the total
copayments exceed the specified amount, individuals can apply to their city or town office to have the amount inexcess of their deductible reimbursed (Household Total).
* The household total applies not only when combining partial payments of family members but also whencombining an individual’s partial payments to multiple medical institutions in the same month.

• Total amount for individuals under 70 years old
In a single NHI household, an individual who pays copayments of 21,000 yen or more to a healthcare provider
two or more times in a single month (for the same billing month) can apply to their city or town office to havethese payments totaled, and receive the amount in excess of their deductible (Household Total) (page 11).

• Total amount for individuals aged 70 or older (not including individuals covered by
the Long Life Medical Care System)
Copayments for healthcare benefits and other benefits paid within the same month in the same NHI
household are subject to totaling. Individuals can apply to their city or town office to have these payments
totaled, and receive the amount in excess of their deductible (Household Total) (page 12).
(1) The amount in excess of the deductible is calculated by applying the maximum outpatient copayment
amount for individuals aged 70 or older to the total outpatient copayment amount for each individual.
(2) The amount in excess of the deductible is calculated by applying the maximum household copayment
amount for individuals aged 70 or older to the total of the copayment amount for hospitalization and the
copayment amount remaining after (1) above.
The total amount calculated in (1) and (2) above is the amount to be paid.

13

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 deductibleof each outpatient of 70 or older (see the information on outpatient deductibles on page 12), theninclude the inpatients and apply the deductibles of household members of 70 or older (Page 12 outpatients + inpatientdeductible). Combine this figure with the total applicable standard copayment for the household members under 70, andapply the deductible for the entire NHI household (see the information on deductibles on page 11).

Household members under 70
Total applicable standard
copayment

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

Outpatients(per individual)

Outpatients + inpatients (per household)

Total

Household copayment for entire NHI household (no more than deductible given on page 11)* There may be changes to this information according to future revisions to laws.

14

Combined Copayments System for Major Medical and Long-Term Care Costs
Even after the copayment deductible for medical costs and the copayment deductible forlong-term care service costs are both applied, if the copayment value that is the sum of both
insurances is still high, the deductibles shown in the following table are applied.
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.

•

Combined ceiling amounts (Annual amounts; From August 1 to July 31 the following year)
NHI members 70 or older

NHI members under 70
Income classification(old proviso)(excluding members eligible forthe Long Life Medical Care System)

Income classification

Income greater than
9.01 million yen

2,120,000 yen

Base taxation amount:
6.9 million yen or more

2,120,000 yen

Income between
6 million yen and9.01 million yen

1,410,000 yen

Base taxation amount:
3.8 million yen or more

1,410,000 yen

Income between
2.1 million yen and6 million yen

670,000 yen

Base taxation amount:
1.45 million yen or more

670,000 yen

Income of
2.1 million yen or less

600,000 yen

General members

560,000 yen

Members exempt
from resident tax

340,000 yen

Members exempt
from resident tax

Type II

310,000 yen

Type I

190,000 yen* See page 11 and 12 for information on income classifications.

15

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.
Members aged 65 or older(Type 1 members)

Members aged 40 to 64(Type 2 members)

Eligible
Members aged 65 or older
individuals

Health insurance members aged 40 to
64 enrolled in health insurance societies,
Japan Health Insurance Association,
Municipal National Health Insurance, etc.
(Qualification is automatic upon turning 40,
and Type 1 membership is automaticallyapplied upon turning 65.)

• In need of care
Requirements• In need of assistance• Limited to the need for care(assistance) due to aging-related
illness (specific illness)

Insurance
premium
collection• Collected by municipalities(Generally deducted from pension)• Collectable from month in which
member turns 65• Collected together with healthinsurance premium• Collectable from month in which
member turns 40

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 (in principle)
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.
* The rate is 20% for those individuals who earn the prescribed income or higher. Among thoseindividuals for which the rate is 20%, the rate will be increased to 30% for those who have an
exceptionally high income.

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.
16

Disability Welfare Services
The Comprehensive Support Law for People with Disabilities was established in order tostandardize the system under which people with disabilities use disability welfare services andto further promote this system. This law also aims to ensure that people with disabilities areable to access the services they need regardless of their disabilities.

An application and a certification of disability supportclassification are required
Prospective users of disability welfare services are required to submit an application.
After the application is made, the applicant's disability support classification must be
certified before the decision is made as to whether services will be provided.
(Depending on the type of service, the certification of disability support classification
may not be required.)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.
Support for the use of facilities for disabled children............................................................... Guardians of children with disabilities canmake an application at the appropriate office
for a benefit.*1 Once permission for the benefit
is granted, the guardians sign a contract withthe facility.
*1: The city or town serves as the office for applications to facilities for children with disabilities.
Family consulting centers serve as offices for admissions of children with disabilities.

Service costs
Service costs shall be determined according to the amount of services used, but
consideration shall be given so as to assign a burden that corresponds to factors suchas the user's income. That is, the burden shall be assigned according to the user's
ability to pay.

For details, contact the disability welfare office of your city or town.

17

Long Life Medical Care System
Members aged 75 or older (members who are not yet 75 years old will fall under this categoryon their 75th birthday) or members between the age of 65 and 74 who have certain disabilities(in this case, an application is required) shall be covered by the Long Life Medical Care System.
However, members between the age of 65 and 74 who have certain disabilities and whose
application to be covered by the Long Life Medical Care System is approved can also opt out of
this system by withdrawing their disability recognition application. (These members are able tochoose their medical care system, but they cannot change their selection once it has been
assigned.)

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 NHI members are required to pay premiums, including
household members (dependents) who have not previously
paid premiums.
One NHI card will be issued per member.

When a person who has enrolled in health insurance through a workplacetransfers to the Long Life Medical Care System, the persons who weredependents of that person (persons aged less than 75) also lose their healthinsurance qualification, and therefore must complete the procedure for enrollingin NHI or other health insurance.

18

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 orother 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 a Traffic
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
Accident occurrence status reportAny other documents
neededYou can submit a preliminary version of the form
even if you do not have all the required 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.

You'll feel reinvigorated in both body and soul!

Let's go to a
hot spring resort!
Making use of hot spring resorts to improve
one's health has gained a lot of attention
lately. The natural environment, the clean air,and the effect of the hot spring soothe and relax
the participant's mind and body. As such, it's said that hot springs are effective in
improving one's health.
Through the warmth of the water, interactions with nature, other people, and culture
provide a comfortable stimulation to the mind and body. Why don't you try to make useof hot spring resorts to improve your health?
* The conference of insurers in Shiga prefecture has made members of NHI in Shiga prefecture eligible for
special discounts at hot spring resorts. For details, see the "Hot Spring Tour" pamphlet available at your NHI
office and the National Health Insurance Organization website (in Japanese, https://www.shigakokuho.or.jp/).

19

Receive Your Specialized Medical Examinationand Specialized Medical Advice!
Specialized medical examinations and medical advice that are focused on the prevention of
the metabolic syndrome and other lifestyle related diseases are being carried out.
Be sure to receive at least one medical examination a year to periodically check your healthand to improve your lifestyle.

The key points are:
All NHI members between the age of 40 and 74 are eligible.
All people between the age of 40 and 74 are eligible for the specialized medical examinations.

How to receive the medical examination
After you receive a medical examination card and an explanation from Japan's national
health insurance, take the medical examination card and your NHI card with you to thehealthcare provider or group medical examination site where you will receive yourspecialized examination. Prior to receiving the medical examination, confirm the times
that the examinations will be held and, if necessary, reserve the day and time.

Along with some additional items, the items that make up the
medical examination are focused on the metabolic syndrome.
By examining your cholesterol and blood sugar level, measuring your abdomen's girth, andchecking other items, the examination focuses on identifying the people that are affectedwith metabolic syndrome and those for who lifestyle related diseases can be prevented.
In addition, tests of items such as uric acid, serum creatinine, and urinary occult blood arealso added to the examination to increase the areas covered.

There are simultaneous examinations for diseases such as cancer.
There are locations in which you can receive examinations for diseases such as cancer
simultaneously with the specialized examination. Please feel free to use these locations.

Medical advice that matches your examination results will be provided.
All individuals that receive the specialized examination can receive the results of their
examination and information about how to lead a healthy life.
In addition, you can receive assistance (specialized medical advice), which is tailored toyour examination results and matches your personal medical situation, in improving yourlifestyle. Please feel free to make use of this assistance.
We recommend that you proactively make use of this assistance to maintain your health.
A primary characteristic of the majority of lifestyle related diseases is that they
will progress without symptoms.
You can understand your own body by receiving an examination.
Even if you are healthy and busy, try to receive an examination once per year.
For details, contact the medical examination office of your city or town.

To Members Who Possess an Individual Number Card
You can view the information of your examination results from Mynaportal.
Please check the Ministry of Health, Labour and Welfare website (https://www.
mhlw.go.jp/english/) for details on how to view this information.
20

To Individuals Who Do Not Receive the Specialized Examination
Please provide us with your medical examination information!
Individuals who periodically receive medical examinations
at a healthcare provider
Among those individuals who are receiving medical treatment for lifestyle related diseases,
many individuals say that they will not receive a medical examination because they are
already receiving treatment. However, the specialized examination also applies to thoseindividuals who are receiving treatment at a healthcare provider.
Providing us with information such as the results of the examination you received at yourhealthcare provider is equivalent to you having received the specialized examination.

[Eligible individuals]
Individuals who are eligible for the specialized examination and who are receiving
treatment at a healthcare provider (a healthcare provider that performs the
specialized examination) for a chronic malady.

[How to provide your information]
Take the specialized examination card and your NHI card to your personal
healthcare provider, and then provide them with your examination information.

Lifestyle improvements are even necessary for
individuals currently receiving medical treatment!
Individuals who receive other medical examinations(medical examinations for entrepreneurs)
For individuals who receive medical examinations for entrepreneurs held by organizations
such as commercial and industrial associations and chambers of commerce and industry
within the prefecture, the individual providing us with the results of this examination isequivalent to the individual having received the specialized examination.

(1) Individuals who receive medical examinations for entrepreneurs held bycommercial and industrial associations and chambers of commerce andindustry within the prefecture[How to provide your information]
When you receive the medical examination for entrepreneurs, take the specialized
examination card that was remitted to you by the NHI member to the medical
examination site and present this card there.

(2) Individuals who receive medical examinations for entrepreneurs underconditions other than (1) and individuals who receive other medical
examinations[How to provide your information]
Present your medical examination results to your medical examination office.

* There is no cost associated with the presentation of information outlined in (1) and (2).
For details, contact the medical examination office of your city or town.

A system is available for assisting with the costs of medical check-ups.
For more information, contact the application counter of your city or town office.
21

Let's Make Use of Generic Medication!
Generic medication (over-the-counter drugs)
refers to inexpensive medication that is produced and sold after its
patent as new medication (leading-edge medication) expires. Generic
medication is recognized as being equivalent to new medication by
the Ministry of Health, Labour and Welfare. Using generic medication
can help you reduce your medication cost.

Are there different types of generic medication?
Generic medication can be used to counteract a variety of diseases and symptoms.
It also comes in a variety of formats, such as capsules, pills, and eye drops.

How expensive is generic medication?
There is a large cost associated with developing leading-edge medication, but
generic medication, which has a much shorter development period, is almost
always less expensive than leading-edge medication.

How do I change to using generic medication?
Tell the doctor who prescribes your medication or the pharmacist who
prepares your medication that "I want to switch to generic medication."* Generic medication is not available for all new medication (leading-edge medication).
Depending on the supply conditions, some items may be out of stock.
* Your doctor may decide to not prescribe you generic medication.

Note
We are carrying out notifications regarding

generic medication twice each year.
What is the notification regarding generic medication?
This is a notification of how you can reduce your medication cost by switchingfrom the new medication that you are taking to generic medication.

Why did you start providing these notifications?
We started providing these notifications to reduce the burden of medication
cost on households as well as to improve the financial affairs of NHI.

Note
Not all individuals will receive the notification regarding generic medication. (For example,
we are providing this notification to individuals who are receiving medical care for lifestyle
related diseases, such as high blood pressure, diabetes, and hyperlipidemia, and arereceiving their medication at pharmacies by prescription.)22

Please Declare Your Intentions Regarding Organ Donation
Declare your intentions regarding organ donation by writing them in the field designed forthem as shown below. Please declare your intentions regarding organ donation.
* The decision of whether to indicate one's intentions regarding organ donation rests with the NHI
member. You are not required to write your intentions in the field designed for them.

How to write your intentions<Example of the back of an NHI card>
備考※以下の欄に記入することにより、臓器提供に関する意思を表示することができます。
記入する場合は、1から3までのいずれかの番号を○で囲んでください。

①③

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。
2 私は、心臓が停止した死後に限り、移植の為に臓器を提供します。
3 私は、臓器を提供しません。
《1又は2を選んだ方で、提供したくない臓器があれば、×をつけてください。》【 心臓・肺・肝臓・腎臓・膵臓・小腸・眼球 】
［特記欄：
］
署名年月日
年
月
日

④ 本人署名（自筆）②

家族署名（自筆）* There is also a space for declaring your organ donor intention on the
Individual Number Card.

Declaring your intentions
Draw a circle around the number that matches your intentions.
• Draw a circle around 1 if you wish to donate your organs after you are declared to bebrain dead, or after your death due to a cardiac arrest.
• Draw a circle around 2 if you do not wish to donate your organs in the event of brain
death but if you do wish to donate your organs in the event that you die from cardiac
arrest. (In this situation, by law, no judgment of whether you have suffered brain
death will be performed.)• Draw a circle around 3 if you do not wish to donate your organs. [To]

Selecting the organs that you do not want to donate
If you drew a circle around 1 or 2, draw an x beside each organ that you do not want todonate.
The organs that can be donated are shown below.
After brain death: heart, lung, liver, kidney, pancreas, small intestine, and eyeballAfter death from cardiac arrest: kidney, pancreas, and eyeball23

Writing information in the special comments field
Donating tissues
If you drew a circle around 1 or 2 and you wish to donate skin, heart valve, bloodvessel, bone, or other tissue, write "All" or the specific tissue such as "Skin," "Heartvalve," "Blood vessel," or "Bone."

Intention to give priority to donations to relatives
If you wish to indicate your intention to give priority to donations to relatives, read thefollowing closely, and then write "Priority to donations to relatives."

Situations in which priority is given to donations to relatives
The following three conditions must be met.
The individual (15 years of age or older) has indicated intent to provide organ donations
and has given written indication of intent to give priority to donations to relatives.
In the event that organs are donated, the relative (spouse,*1 child,*2 or parent*2) has
registered to be a recipient of organ transplants.
Medical conditions (compatibility conditions) have been met.
*1 The other individual in your marriage registration. Common-law marriages are not included.
*2 In addition to genetic parent-child relationships, this includes relationships between adopted
children and adoptive parents.

Points of concern regarding giving priority
to donations to relatives
If, due to medical conditions, a relative towhom the organ transplant applies cannot
be found, the organ shall be donated to anindividual who is not a relative of thedonor.

If you specify by name (in writing) a
relative to whom you wish to give priority
to for organ donation, out of all of yourrelatives, that relative will be given priority
for your organ donations.

If you limit the individuals to whom you wish
to donate organs by specifically naming asingle individual whom you want to receive
your organs, your organs will not be donatedto any other individuals, including relatives.

Priority shall not be given to the donationof organs to relatives when the donor diesof suicide. This is to prevent incidences ofsuicide carried out so that a relative
receives the organs of the dead individual.

Signature and other information
In your own handwriting, write your signature and the date that you did so.
If possible, have your family members also sign this intention declaration card to showthat they are aware that you are carrying this card.
Inquiries regarding organ donations

Japan Organ Transplant Network

Phone: 0120-78-1069 (from 9:00 to 17:30 on weekdays)
Website: https://www.jotnw.or.jp/english/index.html

24