Japan Workers’ Medical Benefits Work Injury National health insurance: Medical care and treatment is Regulatory Framework usually provided by clinics, hospitals, and pharmacists under contract with, and paid by, the insurance carrier (some carriers First law: 1911. provide services directly through their own clinics and Current law: 1947 (workmen’s accident compensation hospitals). Benefits include medical treatment, surgery, insurance), with 1980, 1986, 1995, and 2000 amendments. hospitalization, nursing care, dental care, maternity care (only Type of program: Social insurance system. for a difficult childbirth), and medicines. There is no limit to duration. Coverage Cost sharing: The amount depends on the person’s age: under age 3, 20% of the cost; ages 3 to 69, 30% of the cost; aged 70 Employees of all firms in industry and commerce not included or older, 10% of the cost or 20% for those with an income of under voluntary coverage or special schemes. 1,240,000 yen or more. Voluntary coverage for employees in agricultural, forestry, and Inpatients also pay a daily fee toward the cost of food. The fishery establishments with less than five workers. daily fee for food depends on family income and the duration Special systems for seamen and civil servants. of the hospital stay. Employees’ health insurance: Medical benefits are the same Source of Funds as under national health insurance. Cost sharing: The amount depends on the person’s age: under Insured person: None. age 3, 20% of the cost; ages 3 to 69, 30% of the cost; aged 70 Self-employed person: Not applicable. or older, 10% of the cost or 20% for those with an income of Employer: 0.55% to 13.5% of payroll, according to a 3-year 1,240,000 yen or more. accident rate. Inpatients also pay a daily fee toward the cost of food. The Government: Subsidies, set within the limits of the national daily fee for food depends on family income and the duration budget. of the hospital stay. Dependents’ Medical Benefits Qualifying Conditions National health insurance: Same as for the insured person. Work injury benefits: There is no minimum qualifying period. Employees’ health insurance: Same as for the insured Temporary Disability Benefits person. 60% of the insured’s average daily wage in the preceding Administrative Organization 3 months plus a temporary disability supplement equal to 20% of the insured’s average daily wage. The benefit is payable Health Insurance Bureau of the Ministry of Health, Labor, and after a 3-day waiting period until the end of the 18th month (the Welfare (http://www.mhlw.go.jp) supervises both programs. employer pays 60% of the average daily wage for the first National health insurance: Local administration is provided 3 days). mainly by municipal health insurance funds. The National The minimum daily benefit is 4,160 yen. Health Insurance societies provide administration for some The maximum daily benefit is 23,620 yen. insured persons, including the self-employed. National Health Benefit adjustment: Automatic quarterly adjustment for wage Insurance provides medical benefits. changes higher than 10% from the previous quarter. Employees’ health insurance: Social Insurance Agency From the 19th month, less severely disabled persons receive (http://www.sia.go.jp) provides the national administration for the same level of benefit as before until recovery; more the government-managed program. Regional Social Insurance severely disabled persons receive the injury and disease Bureaus and Social Insurance Offices administer the program compensation pension (annual benefit is equal to 100% of the locally. Employees’ Health Insurance provides cash and average daily wage in the preceding 3 months multiplied by medical benefits. For programs managed by Health Insurance between 245 and 313 days until recovery, according to the Societies, insurance divisions of prefecture departments and degree of disability), plus a special supplement based on the 1,756 Health Insurance Societies provide local administration worker’s annual salary bonus. for affiliated workers. Benefits are paid every 2 months. Benefit adjustment: Automatic annual adjustment for wage changes.