City News Shinagawa --Partial Changes to the National Health Insurance System and the Health Care System for the Elderly to come into effect on October 1

City News Shinagawa

Partial Changes to the National Health Insurance System and the Health Care System for the Elderly to come into effect on October 1

Pursuant to revisions to the National Health Insurance Law and the Health and Medical Service Law for the Elderly, patient co-payments will be changed as of October 1, 2006.
(The revisions to the National Health Insurance system will be implemented after the plan is passed by the City Council)

1. Co-pay percentage for middle income seniors to change
Starting in October, middle income earners^*(1) who hold an elderly beneficiary certificate (korei jukyusha sho) or a medical care certificate for the elderly (rojin iryo sho) will be subject to a co-pay (the percentage of medical expenses paid by the patient to a medical institution) of 30% instead of than the current 20%. The percentage for lower than middle income earners will remain unchanged at 10%.

Co-pay percentage

20% of medical expenses

30% of medical expenses

^*(1)Middle income earners
Individuals of households with a National Health Insurance member (for individuals with a medical care certificate for the elderly, all members of the household) who is 70 years old or older or is eligible to join the health insurance system for the elderly, and also has a taxable income of ¥1,450,000 or more. However, the co-pay percentage will be 10% if you have made an application in which the total income of those 70 years old or older and those eligible to join the health insurance system for the elderly is less than ¥5,200,000 (for two people or more) or less than ¥3,830,000 (for one person).

2. Co-pay cap for high cost medical expenses to change
In the event of extremely high medical costs, the patient’s co-pay amount will be subject to a cap. Portions over and above that amount will be paid as high cost medical expenses. The co-pay cap will be raised for some individuals.
Co-pay caps (monthly amount)

Individuals under the age of 70	High income earners^*(2)	¥150,000+1% (¥83,400)	If medical expenses exceed ¥500,000, then 1% of the exceeded amount
	General	¥80,100+1% (¥44,400)	If medical expenses exceed ¥267,000, then 1% of the exceeded amount.
	Households not subject to resident tax	¥35,400 (unchanged) (¥24,600)

Amounts shown in parentheses are the limits that apply to payments from the fourth high-cost medical expense paid by those who have had high-cost medical expenses four times or more in the previous 12 months. The 1% amount is not added in this case.
^*(2) High income earners
Individuals in households whose total income after the standard deduction, which is used as the basis for calculating the National Health Insurance premiums, is ¥6,000,000 or more.

Individuals over the age of 70				Outpatient + inpatient (per household)
			Outpatient (per individual)
	Middle income earners		¥44,400	¥80,100 + 1% (¥44,400) If medical expenses exceed ¥267,000, then 1% of the exceeded amount
	General		¥12,000	¥44,400
	Households not subject to resident tax	Low income earners II^*(3)	¥8,000	¥24,600 (unchanged)
		Low income earners I^*(4)	¥8,000	¥15,000 (unchanged)

Amounts shown in parentheses are the limits that apply to payments from the fourth high-cost medical expense paid those who have had high-cost medical expenses four times or more in the previous 12 months. The 1% amount is not added in this case.
^*(3)Low income earners II
When the National Health Insurance subscribers (all members of the household are individuals with a medical care certificate for the elderly [rojin iryo sho]) living in the same household with the head of household are exempt from resident tax.
^*(4) Low income earners I
When the National Health Insurance subscribers (all members of the household are individuals with a medical care certificate for the elderly [rojin iryo sho]) living in the same household with the head of household are exempt from resident tax, and the total household income minus necessary expenses and deductions (the pension income is calculated with a deduction of ¥800,000) is 0.

Interim measures may reduce the limit of co-payments
Interim measures regarding the co-payments of middle and low income earners I and II are being implemented for two years starting in August 2006, in conjunction with revisions to the public pension system and other deductions, the abolition of deductions for the elderly, and the abolition of measures to exempt the elderly from resident tax. Please make inquiries for further details.

3. New meal and occupancy expense coverage during in-patient care at long term treatment facilities
In the past, individuals aged 70 or older who were admitted to a long term treatment facility were only responsible for paying for their meal expenses. To equalize the burden between these individuals and individuals hospitalized under long-term care insurance, however, they will now be required to cover the same meal expenses and occupancy expenses as are covered by long-term care insurance.

Meal and occupancy expenses (amount to be paid per month)

Meal expenses	¥42,000
Occupancy expenses	¥10,000

*Reductions are available for low income earners. Please apply.

Inquiries:
Holders of a National Health Insurance certificate or an elderly beneficiary certificate (korei jukyusha sho): NHI and Pension Section, Tel: 5742-6677
Holders of a medical care certificate for the elderly (rojin iryo sho):
Senior Citizens’ Affairs Section, Tel: 5742-6736.