Social Welfare
- Health Care System for the Aged -
Health Care System for the Aged
The Health Care System for the Aged will start in April 2008, replacing the
current Elderly Health Care System.
People who are 75 years old and over (and people having certain grades of disability
who are 65 years and over) are currently provided with medical benefits under
the Elderly Health Care System, while being on the National Health Insurance
lists or other public health insurance lists. However, they will be provided
with medical benefits under the newly established Health Care System for the
Aged, starting from April 2008.
Under the new health care system, the Extended Association for Medical Care
for the Aged , which is established by each prefecture and joined by all municipalities
of its prefecture, will take care of paperwork as an insurer.
Under the new health care system, each prefecture will establish an Extended
Association for Medical Care for the Aged, which consists of all municipalities
of its prefecture, and the association will take care of paperwork of the medical
system as an insurer. In Osaka Prefecture, the Osaka Prefecture Extended Association
for Medical Care for the Aged will take care of this paperwork.
[Persons to be Insured]
- People aged 75 or over living in Osaka Prefecture
- People aged 65 to 74 living in Osaka Prefecture who are judged to have certain
grades of disability by the Osaka Prefecture Extended Association for Medical
Care for the Aged
<Regarding People who are Provided with Medical Benefits under the Current
Elderly Health Care System>
When the Health Care System for the Aged starts on April 1, 2008, they will
automatically become eligible for the new system. After the new system starts,
people will automatically become eligible when they become 75 (on their birthday).
People who are judged to have certain grades of disability under the current
system are also considered to have been judged to have certain grades of disability
by the Osaka Prefecture Extended Association for Medical Care for the Aged.
<Regarding the Current Public Health Insurance>
When people become eligible for the new system, they automatically become insured
under the new system, withdrawing from the current public health insurances.
Therefore, the health insurance cards of the current health insurances will
become unusable.
- People eligible for the new system in other prefectures who move into Osaka
Prefecture (except the special case for residence)
<Regarding the Special Care for Residence>
When a person eligible for the new system moves into another prefecture, he/she,
in principle, becomes an insured person of the Extended Association for Medical
Care for the Aged of the prefecture that he/she moves into. However, when a
person moves into another prefecture for the reason of admission to a welfare
facility or long-term hospitalization, he/she remains insured by the prefecture
that he/she originally lived in.
<Regarding Exempted People>
People on welfare will not be eligible for the new system because they receive
medical assistance under the Public Assistance Law.
[Issue of Health Insurance Card]
The Osaka Prefecture Extended Association for Medical Care for the Aged issues
a health insurance card for the Health Care System for the Aged to each insured
person.
When an insured person sees a doctor after April 1, 2008, he/she will need this
health insurance card. The cards will be sent to all insured persons in March,
2008. After the new system starts, a card will be newly issued when the current
card expires or when a person becomes eligible for the new system.
[Insurance Premium]
On withdrawal from the current public health insurances, the insured persons must
pay an insurance premium in order to cover part of the expenses of the Health
Care System for the Aged.
The insurance rate has been made uniform in the areas administered by the Osaka
Prefecture Extended Association for Medical Care for the Aged (throughout the
municipalities in Osaka Prefecture).
The amount of insurance premium is individually decided and imposed on each insured
person as with the Nursing Care Insurance. The insurance rate and maximum insurance
premium are decided under the regulations of the Osaka Prefecture Extended Association
for Medical Care for the Aged, based on the standard of premium calculated by
the government.
The insurance premium basically consists of one on a per capita basis and one
on an income basis. The amount deducting the basic exemption (330,000 yen) from
the total income is used when the insurance premium on an income basis is decided.
<Calculation of Insurance Premium>
The insurance premium is decided based on the expenses necessary to provide medical
benefits.
The amount of the insurance premium for each insured person is the total of the
one on a per capita basis, which is paid equally by all the insured persons, and
the one on an income basis, which is paid by the insured persons according to
their income.
The amount deducting the basic exemption (330,000 yen) from the total income (the
amount after the basic exemption) is used when the insurance premium is decided
on an income basis.
The amount of insurance premium on an income basis is the total of the amount
after the basic exemption multiplied by the income basis rate, which is common
to all insured persons.
• Insurance Premium = Insurance Premium on a Per Capita Basis + Insurance
Premium on an Income Basis
<How to Pay Insurance Premium>
- Special Collection: The insurance premium is withheld from the annual pension
if the total amount of the pension is 180,000 yen or more per annum. However,
if the total of nursing-care insurance premium and the health care insurance
premium is more than half of the annual pension, Normal Collection is applied.
- Normal Collection: Insured persons who are not applicable for Special Collection
or who are applicable for Special Collection but whose insurance premium is
not collected by the way of Special Collection for any reason shall pay the
insurance premium by account transfer, bank transfer or other method for every
payment term.
<Exemption System of Insurance Premium>
Low-income earners are partly exempted from the payment of the insurance premium
on a per capita basis according to the income level of their household.
|
Total Amount of Income of the Household
|
Exemption Rate
|
| Under the amount of basic exemption
(¥330,000) |
70%
|
| Under the total of the amount
of basic exemption (¥330,000) + ¥245,000 x (the number of family
members in the household -1) |
50%
|
| Under the total of the amount
of basic exemption (¥330,000) + ¥350,000 x the number of family
members in the household |
20%
|
* The figures for exemption amount and exemption rate may be subject to
change according to the next systemic revisions.
To avoid radical changes, people who currently do not have to pay the insurance
premium as nonworking dependents of employee's health insurances will be exempted
from 50 percent of the insurance premium on a per capita basis for two years
after becoming eligible for the Health Care System for the Aged. (The insurance
premium on an income basis will not be imposed.)
<When Insurance Premium Falls into Arrears>
When an insured person misses the payment deadline, he/she is reminded and urged
to pay.
If an insured person does not pay the insurance premium for more than one year,
a health insurance certificate is issued instead of the health insurance card,
unless otherwise he/she is judged to have specific reasons to be unable to pay,
due to suffering from a disaster, for example. When the certificate is issued,
the insured person must pay the entire amount of their medical expenses at the
medical institution, and later the amount excluding the copayment (the equivalent
of medical benefits) will be reimbursed by the Osaka Prefecture Extended Association
for Medical Care for the Aged.
[Regarding Medical Benefits]
° When an insured person has medical treatment for injuries or illness,
he/she must bear a part of the medical expenses at the medical institutions
as with the current Elderly Health Care System.
- The copayment rate: 10 percent (30 percent for those who have equivalent
level of income to generations still working)
- The health insurance card must be presented in order for the insured persons
to be provided with medical treatment benefits.
° The contents of the medical benefits that the extended associations provide
are basically the same as those provided under the current system, except for
the medical benefits for high-cost medical treatment combined with nursing care
expenses, which will be newly introduced.
- Medical Treatment Benefits: Provided when an insured person has medical treatment for injuries or illness.
- Benefits for Food Costs in the Hospital: A part of food costs are provided while an insured person is in hospital.
- Benefits for Everyday Life Costs in Hospital: A part of food costs and hospital expenses are provided while an insured person is in the nursing ward of hospital.
- Benefits for Medical Treatment Covered by the Insurance Combined with not Covered: Provided when an insured person wishes for special medical cares or medical environments, including an amenity bed.
- Reimbursement of Medical Treatment Costs: Made when an insured person has paid the entire expenses of medical treatment under unavoidable circumstances.
- Medical Treatment Benefits for Visiting Nursing Care: Provided when an insured person receives visiting nursing care service.
- Special Medical Treatment Benefits: Provided when an insured person needs to be transferred due to emergency hospitalization or hospital change.
- Reimbursement of High Medical Expenses: Made when the copayment per month exceeds the predetermined amount.
- Reimbursement of High Medical Expenses Judged by the Total Amount of Medical and Nursing Care Expenses: Provided when the total of the copayment of both the medical insurance and nursing care insurance per year exceeds the predetermined amount.
[Management of Finance]
Under the Medical Care System for the Aged, of the expenses excluding the copayment that is paid by insured persons at medical institutions, approximately 50 percent is covered by public funds (the government, prefectures and municipalities), approximately 40 percent is covered by the funds supported by the generations still working (the insurance premium paid by them), and approximately 10 percent is covered by the insurance premium paid by the insured persons.
[Contact Information regarding Procedures and the System]
Under the Medical Care System for the Aged, the extended association of each prefecture and the municipalities are working in collaboration together to take care of paperwork.
Functions of each are basically as follows:
<Main Functions of the Extended Associations>
- Certification of the eligibility of the insured persons and administration of
the insured persons
- Decision of the amount of the insurance premium and imposition of the insurance premium
- Providing medical benefits
- Implementation of health care projects (health examinations etc.)
<Main Functions of the Municipalities>
- Collection of the insurance premium
- Giving the health insurance card or the health insurance certificate to
an insured person
- Work as liaison such as receiving various kinds of notices and applications
Please ask for
Health Care System for the Aged Group (Koki Koreisha Iryo Tanto) of the Insurance
Affairs Office (Hokenjigyo-shitsu) (TEL: 072-824-1181)
The Osaka Prefecture Extended Association for Medical Care for the Aged (TEL:
06-4790-2028)
