[4] The system originated from labor unions representing workers in dangerous industries, and over time was gradually extended so that currently all Japanese citizens and residents should be covered.
The information in this article relates to Minato Ward in Tokyo, and NHI conditions in other municipalities may differ.
[6] When the insured person uses a medical facility that accepts NHI, they will only need to pay part of the cost.
The rate at which the premiums are calculated is based on the Resident's tax (住民税, juuminzei) amount charged by the local municipal government.
In 2010 the premiums were:[10] Calculated by multiplying the total residents tax paid by all NHI members in the household by 0.80.
Calculated by multiplying the total residents tax paid by all NHI members in the household by 0.23.
Calculated by multiplying the total residents tax paid by all category 2 NHI members in the household by 0.11.
If payments are not made, the municipality may have the members property (savings, salaries, telephone lines, etc.)
[13] When the insured person uses a medical facility that accepts NHI, they will only need to pay part of the cost.
As of 2011 this copayment will be either 10% or 30% depending on the income of the insured person, and in April 2011 the lowest rate will rise to 20%.
For members who are exempt from residents tax, a Ceiling Applied/Standard Personally Borne Amount Reduction Certificate is required.
[16] For those over 70 years of age: If NHI members over 70 years old who pay Resident's tax show their NHI card and an Old Age Medical Insurance card they only have to pay the amount specified as their personally borne expense ceiling.
[16] NHI members can go to their city office to apply for cash reimbursements for when they pay the full amount for medical services.
NHI members over 70 and under 75 years of age are responsible for paying up to their expense ceiling as usual.
But members from households who are exempt from resident's tax will be categorized as Low Income Earner 1 or 2.
Members who have one of these certificates will only need to pay the maximum ceiling amount for the examination/treatment, and therefore have no need to apply for a High Medical Expense Subsidy.
(i) Hospitalized up to 90 days in the last 12 months (ii) Hospitalized over 90 days in the last 12 months (iii) Recipient of the Elderly Recipient Certificate whose household is exempt from resident's ta and the total income of the household is ¥0 (Pension income is calculated with deduction amount as ¥800,000.
This allowance is also paid in cases of miscarriage or stillbirth if this occurs after 85 days (4 months) of pregnancy.
Also, if the death was due to the act of a third party (such as a traffic accident) and their compensation is available, NHI will not provide the funeral allowance.
However, if their livelihood has been effected by a natural disaster, unemployment, or other difficulties, then reductions of or exemptions from paying their copayment are possible for a period of up to three months.
[24] NHI cannot be used in the following cases: If it receives a request, after about one month the city will disclose medical fee receipts and other documents to: When NHI members reach 75 years old (or 65 for those with a certain degree of disability) they can receive medical care under the Long Life Health Insurance System.