Guide to Living in Adachi

National Health Insurance System

Everyone with an address in Japan is required by law to enroll in some form of public health insurance. Public health insurance includes health insurance from one’s place of employment (social insurance) and National Health Insurance (NHI) which is operated by municipalities depending on the area. Those who live in Adachi City, have completed foreign resident registration and are 74 years of age or younger must enroll in the NHI of Adachi City, except those for whom any of the conditions listed below applies. You cannot decide to not enroll or withdraw membership for such reasons as not becoming ill or not wanting to pay insurance premiums. Those who are 75 years of age or older must enroll in the Medical System for Senior Citizens which is a separate program.

1. If you are enrolled in another form of public medical insurance, such as health insurance of your place of employment
2. If your period of stay is less than one year
3. If you receive public financial assistance for everyday living
   

You must complete the designated procedures for enrollment in or withdrawal from NHI. Be sure to complete the applicable procedures within 14 days. If you are late in completing enrollment procedures, you must pay insurance premiums dating back to the date of eligibility. In addition, please note that all medical expenses incurred must be personally borne until you complete the required procedures.

NHI Enrollment Procedures

• If you move into Adachi City (or immigrate to Japan)
• If you withdraw from another form of public health insurance
• If you no longer receive public financial assistance for everyday living
• If a child is born in your family

NHI Withdrawal Procedures

• If you move out of Adachi City (or leave Japan)
• If you enroll in another form of public health insurance
• If you start receiving public financial assistance for everyday living
• If a family member dies

Caution:
If you are an NHI member and your visa has expired, you will be disqualified for NHI and may not use your health insurance card unless you complete visa extension procedures.

National Health Insurance Premiums

○Calculation of Insurance Premiums
Insurance premiums are calculated using the household as a unit, with a per capita levy that is charged equally for each member and a per income levy that is charged according to income. Notification of premiums is sent to the head of the household. The method for calculating premiums varies each fiscal year, and a per income levy is based on Residents’ Tax for the year. In addition, those who are between 40 and 64 years of age are charged premiums for nursing care insurance.
Annual premiums covering April through March of the following year are calculated in June. If there are any changes in the number of members or income due to a member enrolling or withdrawing in the middle of the year, the insurance premiums are recalculated as necessary, and a revision notification and payment slip will be mailed to the head of the household.

Payment of Insurance Premiums

The insurance premiums that are calculated in June are paid in 10 monthly installments from June through March of the following year. Your first five payment slips will be mailed together to the head of the household in mid-June, and the remaining five payment slips will be mailed in mid-November. Insurance premiums can be paid at financial institutions, post offices, convenience stores, Adachi City Office or Residents’ Offices. However, the account transfer service is convenient, and you do not have to worry about forgetting to make your payment.
To apply for the account transfer of insurance premiums, please ask your financial institution or post office (within Adachi), Adachi City Office or Residents’ Offices for more information.

If You Are Unable to Pay Your Insurance Premiums

Since there are special installment programs if you are having financial difficulty meeting your premium payments, please ask for advice as soon as possible. If you are behind in your payments for no particular reason, you will be mailed a reminder, and you may be further reminded with telephone calls and letters, and a collection staff member may visit your home. If you do not respond to the reminders and do not pay, the valid period of your health insurance card may be shortened or you may have to return your health insurance card to the City Office. You may be restricted in terms of the NHI services you can use, or the high medical expense benefit or the lump-sum childbirth allowance you are entitled to may be applied to your balance due.

NHI Services

NHI members can take advantage of the following services. Please inquire in advance for more information on the necessary procedures, requirements and documents.

○When Receiving Medical Treatment
Please be sure to show your national health insurance card when receiving treatment for illnesses or injuries. By doing so, as a rule, Adachi City will bear 70% of the medical expense and the insured (member) pays the remaining 30% of the medical expense. However, in some cases, insurance does not cover injuries, such as those incurred in traffic accidents or during work. Furthermore, the personally borne expense ratio may vary according to the age, income and type of illness of the insured member.

○When a Child is Born
A lump-sum childbirth allowance is provided when an enrolled member gives birth (including stillborn births and miscarriages of pregnancies of 85 days or longer). Furthermore, if you apply before giving birth, you can have the benefit paid from Adachi City Office directly to your medical institution. However, households that are behind in the payment of insurance premiums cannot take advantage of this service.

○When an Enrolled Member Dies
A Funeral Expense Benefit is given to the person who conducts the funeral service.

○High Medical Expense Benefit
If the same person undergoes more than one medical treatment in the same month at the same medical institution and if the medical fee paid exceeds a designated amount (personally borne expense limit), the difference is reimbursed as a high medical expense benefit. Those who are eligible are sent an application for the high medical expense benefit approximately three months after the month in which the medical treatment was given. Please note that the personally borne expense limit varies depending on age and income.

○Limited Medical Expense Applicable Authorization Certificate
If your medical expense for hospitalization or other treatment is particularly expensive, a “gendogaku tekiyo ninteisho” (limited medical expense applicable authorization certificate), which restricts the personally borne expense paid at the medical institution, can be issued. You must apply for this certificate in advance. However, households that are behind in the payment of insurance premiums cannot take advantage of this service.

Inquiries: National Health Insurance Section

Last updated : Thursday, 6-March-2008.

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