Mitaka City
Municipal Office Information

National Health Insurance (Kokumin Kenko Hoken)

The National Health Insurance Program

 Japan has a public health insurance system, and everyone who lives in Japan must enroll in some form of public health insurance. The National Health Insurance program (Kokumin Kenko Hoken) is one form of public health insurance, and the program is operated at the municipal level. Mitaka City collects insurance premiums from members and pays 70% of the medical costs to medical institutions. The insured member (the enrolled person) pays the remaining 30% at the accounting section of the medical institution where medical treatment is received.

Enrollment, Withdrawal and Changes

Enrollment

 Except for the following cases, everyone who lives in Mitaka City and has completed resident registration must enroll in the National Health Insurance program. You may not enroll in or withdraw from the program voluntarily. Please bring your residence card and special permanent certificate or passport, and complete enrollment procedures.
 Persons not eligible for the National Health Insurance program include:

(1) Those who are enrolled in a health insurance program at the place of employment and family members/dependents of such.

(2) Those who are enrolled in a health insurance union.

(3) Those who are designated as special “temporary” (on a daily basis) health insurance members according to the Health Insurance Law and family members/dependents of such.

(4) Those who are recipients of public assistance.

(5) Those who are tourists and those staying in the country for the short term with a visa of  three months or shorter.

(6) Those who are diplomats.

Withdrawal

(1) When a person who was enrolled in Mitaka City moves to another municipality.

(2) When a person enrolls in another health insurance program, such as one at the place of employment.

(3) When a member dies.

(4) When a person becomes eligible for public assistance.

* If you plan to withdraw from the program, make sure you balance your account of insurance premiums.

* Be sure to return the National Health Insurance certificate when withdrawing.

Change of Status Notification

(1) When the head of the household changes.

(2) When two or more households merge.

(3) When households separate into two or more.

(4) When the head of the household or other member has a change of address or name change.

* Please bring your health insurance certificate and complete the necessary procedures to record the change.For the procedures described above, please complete the appropriate forms at the National Health Insurance Section on the first floor of the Mitaka Municipal Office or at any branch office within 14 days after the change has taken place.

Inquiries: National Health Insurance Admissions Subsection, National Health Insurance and Pension Section, Civil Affairs Department (ext. 2383)

National Health Insurance Benefits

 If you show your health insurance certificate at the reception desk before receiving medical treatment, you will then only need to bear 30% of the medical expenses for the services received. If you file an application in the following cases, you may receive a reimbursement upon review of your application, although you must initially pay the full amount. However, applications for reimbursements are not approved in all cases.

(1) If you paid the medical institution for the entire cost of medical treatment because you were unable to show your health insurance certificate in an emergency or other unexpected situation.

(2) If you have body support equipment made, such as a surgical corset under a doctor’s recommendation, and paid the entire cost.

(3) If you received massage, acupuncture or moxibustion treatments under a doctor’s recommendation.

(4) If you have transportation costs that are recognized as necessary by a doctor.

(5) If you pay for medical treatment for illnesses or injuries incurred while traveling overseas. (A stipulated form to be completed by the doctor oversea is required.) However, this excludes traveling overseas for the purpose of receiving medical treatment.
Applications are handled at the National Health Insurance Section (first floor of Mitaka Municipal Office) or at any branch office.

Other Benefits

High Medical Expense Benefit

 If the personally-borne expenses (varies according to income) for medical treatment at one medical institution exceed a designated amount for one person within the same month (from the 1st to the last day of the month), the excess may be reimbursed as a high medical expense benefit upon application. As a rule, those who are eligible for this benefit are sent an application in the mail within about two months after receiving medical treatment, so please complete the application procedures at the National Health Insurance and Pension Section on the first floor of Mitaka Municipal Office or at any branch office.

Childbirth Lump-sum Benefit

 A benefit of ¥420,000 is offered when a child is born to an insured member.

Funeral Expense

 A benefit of ¥50,000 is offered to the chief mourner when an insured member dies.

Inquiries: National Health Insurance Benefits Subsection, National Health Insurance Section, Civil Affairs Department (ext. 2387)

Reissue of the Health Insurance Certificate

 If your health insurance certificate is lost or badly torn, you can apply to have one reissued. Please complete the necessary procedures at the National Health Insurance Section (first floor of Mitaka Municipal Office) or at any branch office. After the application is received, a new health insurance certificate will be reissued and mailed to your home.

Inquiries: National Health Insurance Admissions Subsection, National Health Insurance Section, Civil Affairs Department (ext. 2383)

Restrictions on the Use of Your health insurance certificate

 While it is natural to be treated at a medical institution for illnesses or injuries, as a rule, health insurance cannot be used in the following cases:

(1) For self-inflicted illnesses or injuries resulting from a suicide attempt or drug addiction.

(2) For illnesses or injuries arising from conspicuously inappropriate behavior, such as drunkenness.
If you use your health insurance certificate for treatment for injuries sustained in a traffic accident caused by a third party, the authority to press charges for casualty compensation is transferred to Mitaka City. Be sure to file the stipulated forms and do not negotiate a compromise with the third party.

Inquiries: National Health Insurance Benefits Subsection, National Health Insurance Section, Civil Affairs Department (ext. 2386)

How to Calculate and Pay Insurance Premiums

How Insurance Premiums are Calculated

 The sum of (A), (B) and (C) is the insurance premium for the National Health Insurance program. (The figures in parentheses apply to FY 2013.)
*Calculated Basic Amount refers to the difference between income for the preceding fiscal year (April to March) you are enrolled in the National Health Insurance program and the basic exemption (¥330,000).

(A) Basic Premium Amount = Portion for Medical Treatment

(1) [ Income Ratio Amount] = Calculated Basic Amount × 4.7%

(2) [ Per Capita Amount ] = Number of household National Health Insurance members × ¥24,400
[ Annual Insurance Premium ] = [ Income Ratio Amount] + [ Per Capita Amount ]
Maximum ceiling: ¥510,000

(B) Levy to Support Elderly People at an Advanced Age = Portion to Support Senior Citizens

(1) [Income Ratio Amount] = Calculated Basic Amount × 1.2%

(2) [Per Capita Amount] = Number of applicable household members × ¥5,500
[Annual Insurance Premium] = [Income Ratio Amount] + [Per Capita Amount]
Maximum ceiling: ¥140,000

(C) Long-term Care Premium Amount = Portion for Long-term Care Insurance

(Levied on National Health Insurance Members who are between 40 and 64 years of age)

(1) [Income Ratio Amount] = Calculated Basic Amount × 1.4%

(2) [Per Capita Amount] = Number of applicable household members × ¥12,500
[Annual Insurance Premium] = [Income Ratio Amount] + [Per Capita Amount]
Maximum ceiling: ¥120,000
*If a member becomes eligible or ineligible during the fiscal year, the annual premium is determined by calculating the eligible months after the payments are divided into 12 monthly units.

Insurance Premium Payment Deadline

 With eight payments made throughout the fiscal year, the deadline for the first payment is the end of July, and the deadline for the eighth, final payment, is the end of February of the following year.

Where to Pay Insurance Premiums

(1) At designated financial institutions;

(2) At convenience stores;

(3) At the Mizuho Bank branch located inside Mitaka Municipal Office;

(4) At the Mitaka Branch of Mizuho Bank;

(5) At any post office in the Kanto area;

(6) At any branch municipal office.
National Health Insurance premiums can also be paid by automatic debit from your financial account. To apply for this service, please complete the designated procedures at your financial institution (excluding JP Bank) or at the Tax Collection Section. Please bring your premiums notification/invoice, seal, and account passbook. Payments will be debited from your account for the portion beginning about one month after you apply.

Inquiries: National Health Insurance Admissions Subsection, National Health Insurance Section, Civil Affairs Department (ext. 2382)

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Mitaka Municipal Office 1-1, Nozaki 1-chome, Mitaka City, 181-8555, Tokyo Tel:0422-45-1151(Main Switchboard) Access Mitaka City Office

Hours:Weekdays, 8:30 a.m. to 5:00 p.m. (Closed:national holidays and during the December29 through January3)