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An Overview of the Medical Care System
for Older Senior Citizens
For those 75 years of age and older and those between 65
and 74 years of age recognized by the Association as
having a designated level of disability
June 2021
Tokyo Metropolitan Association of Medical Care Services
for Older Senior Citizens (Tokyoto Koki Koreisha Iryo
Koiki Rengo)
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―― Table of Contents ――
Contact Us If You Have Any Questions About the Medical Care System for Older
Senior Citizens ......................................................................................................... 3
1. What Is the Medical Care System for Older Senior Citizens? .............................. 4
2. Health Insurance Card .......................................................................................... 6
3. Percentage of Personally Borne Expenses for Receiving Treatment at Medical
Institutions .............................................................................................................. 7
4. Ceiling of Personally Borne Expenses ................................................................ 8
5. Reimbursement for Medical Expenses .............................................................. 16
6. Proper Way of Receiving Therapy from Judo Therapists .................................. 18
7. When Receiving Acupuncture, Moxibustion, Massage, Acupressure or Similar
Treatments ............................................................................................................. 20
8. When Transported under a Physician’s Orders in an Emergency or Other
Unavoidable Circumstances (Transportation Benefit) ........................................... 21
9. When an Enrolled Member Dies (Funeral Benefit) ............................................ 22
10. When You Are Involved in a Traffic Accident ................................................ 23
11. Notice About Health Checkups ....................................................................... 24
12. Insurance Premiums ........................................................................................ 25
13. Current Medical Expenses .............................................................................. 30
14. Operation of the Medical Care System for Older Senior Citizens .................... 31
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Contact Us If You Have Any Questions About the
Medical Care System for Older Senior Citizens
Association Call Center
Telephone number: 0570-086-519
Weekdays from 9 a.m. to 5 p.m.
Notes:
1. To accurately understand your questions and requests while improving and maintaining service
quality, we record all incoming calls.
2. When contacting us from a PHS or IP phone, please use:
Telephone number: 03-3222-4496
Fax number: 0570-086-075
Email address: [email protected]
3. We accept faxes and emails on a 24-hour basis.
4. If you have inquiries related to specific personal information—such as the amount of your
insurance premiums—please contact the service counter in charge of the Medical Care System
for Older Senior Citizens at your local municipal office.
You can also access the Association’s website. To find the website, search for “Tokyo-ikiiki.net.”
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1. What Is the Medical Care System for Older
Senior Citizens?
The Medical Care System for Older Senior Citizens is for residents 75 years of age and older and
those between 65 and 74 years of age with a designated level of disability.
Residents of Tokyo are automatically switched from their prior medical health insurance plan
(National Health Insurance, employee health insurance, mutual aid association, etc.) to the Medical Care
System for Older Senior Citizens on their 75th birthday. There is no need to complete any enrollment
procedures.
Residents between 65 and 74 years of age with a designated level of disability who complete
application procedures are enrolled in the system from the day they receive approval from the
Association.
If you would like to enroll, please present your physical disability certificate, Ai-no-Techo
(intellectual disability certificate), mental disability certificate, or National Pension enrollment
certificate—as well as a My Number Card or other document showing your individual number (My
Number)—and complete the application procedures at the appropriate service counter of your local
municipal office. (Please note that applications cannot be backdated.) Once you are approved for
enrollment in this insurance plan, please immediately withdraw from your existing medical insurance
plan. You can renounce your authorized disability before 74 years of age, but the renouncement cannot be
backdated.
Frequently Asked Questions
Q: A husband turns 75 years of age and switches from social insurance to the Medical Care System for
Older Senior Citizens. What happens to his wife (74 years of age), who is a dependent?
A: Since he will be enrolled in the Medical Care System for Older Senior Citizens, he must withdraw
from his current insurance. His wife, who is a dependent covered by that insurance, must also
withdraw and enroll in another insurance plan, such as National Health Insurance.
Q: Please tell me more about the “designated level of disability.”
A: “Designated level of disability” refers to the following:
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1. Physical disability certificate levels 1 to 3, and some of level 4*
2. Tokyo intellectual disability certificate levels 1 and 2
3. Mental disability certificate levels 1 and 2
4. National Pension enrollment certificate (disability pension levels 1 and 2)
* “Some of level 4” refers to lower limb disability level 4-1 (lacking all toes on both feet), lower
limb disability level 4-3 (lacking more than half a lower leg), lower limb disability level 4-4
(significant functional disability of one limb), and vocal/language dysfunction.
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2. Health Insurance Card
Each enrolled member receives a health insurance card. Please present your card when receiving
medical treatment at a hospital or other medical institution.
The card is sent before your 75th birthday via simple registered mail from the local municipal office.
If you will be away from home for a long period of time around your 75th birthday or wish to have it sent
somewhere other than your home address, please contact the appropriate service counter at your local
municipal office in advance.
If you lose or damage your card, apply for a reissue at appropriate service counter of your
municipality.
Although health insurance cards are updated every two years, you will be sent a new card while your
current one is still valid if your personally borne expense percentage changes, for example, due to the
annual assessment in August, a change in household composition, or a correction in income of the
previous year. When you receive your new card, please be sure to turn in the old one to the appropriate
service counter of your local municipal office. (You can turn it in by mail as well.)
Please note that if you use your old health insurance card after your personally borne expense
percentage rate changes or you lose eligibility because you move out of Tokyo, you must complete the
necessary procedures to arrange payment of the difference or make reimbursement.
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3. Percentage of Personally Borne Expenses for
Receiving Treatment at Medical Institutions
The personally borne expense percentage you pay when receiving medical treatment is 30 percent if
you have other insured members in your household with a taxable income (for residents tax) of
¥1,450,000 or more, and 10 percent if you do not.
If you were born on or after January 2, 1945, and the total income of your household members
enrolled in the Medical Care System for Older Senior Citizens is ¥2,100,000 or less—which serves as the
basis for your insurance premium assessment—your personally borne expense will be 10 percent.
Even if your taxable income (for residents tax) is ¥1,450,000 or more, you can apply at the
appropriate service counter of your local municipal office to have the standard income used if you fulfill
any of the income conditions noted below. If approved, your personally borne expense percentage will
change to 10 percent from the month following the date you apply.
(1) Only one member of your household is enrolled in the Medical Care System for Older Senior Citizens,
and revenue (income before expenses and deductions) for the previous year is below ¥3,830,000.
Even when total revenue is ¥3,830,000 or more, your personally borne percentage will be 10 percent
if your household includes a person between 70 and 74 years of age and the total revenue of the person
and the enrolled member is below ¥5,200,000.
(2) Two or more members in your household are enrolled in the Medical Care System for Older Senior
Citizens, and the total revenue of the enrolled members for the previous year is below ¥5,200,000.
You need to apply to have standard income used every year. When completing the application
procedures, you must present an official form of valid ID, such as a passport or physical disability
certificate, as well as a My Number Card or other document showing your individual number (My
Number).
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4. Ceiling of Personally Borne Expenses
For High Medical Expenses
When monthly medical expenses (from the first to the end of the month) are high, you will be
reimbursed the amount that exceeds the designated ceiling amount (see “Limits on Personally Borne
Expenses for Monthly Medical Treatment” on page 8). If you are entitled to this payment, the Association
will automatically send you an application (no need to apply) around four months after the month in
which your medical expenses exceeded the limit. After you receive this application, submit it to the
service counter in charge of insurance at your local municipal office.
You must present an official form of valid ID at this time, as well as a My Number Card or document
showing your individual number (My Number). For second and subsequent times, the payment will be
sent to the account designated at the time of the initial application, so there is no need to apply again.
┌───────────────────────────┐
Limits on Personally Borne Expenses for Monthly
Medical Treatment
Below are the income categories, their respective limits for outpatient care (for one individual), and limits
for outpatient care + hospitalization (for the whole household), in order:
General (personally borne rate: 10 percent): Up to ¥18,000 (annual limit of ¥144,000); up to ¥57,600
Note: If a member has been issued a payment for high medical expenses three times in the past
twelve months, he/she will become a “multiple-use patient” from the fourth time onward. The
limit drops to ¥44,400. Please note that outpatient treatment (for one individual) is not counted in
the number of times required to become a multiple-use patient.
Category II (personally borne rate: 10 percent): up to ¥8,000; up to ¥24,600
Category I (personally borne rate: 10 percent): up to ¥8,000; up to ¥15,000
“Category II” refers to members whose entire household is not subject to residents tax and who do not fall
under Category I.
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“Category I” refers to those from households exempt from inhabitant tax whose income is zero yen for all
household members (800,000 yen is deducted for public pension income, and another 100,000 yen is
deducted for salary income after deducting salary income), or those who receive an old-age welfare
pension.
If your total personally borne expense (if you are receiving subsidies for monthly high medical expenses,
this is the amount after the subsidy is subtracted) for months you had an income category of “General,”
“Category 1,” or “Category 2” (as of the last day of the calculation term) exceeds ¥144,000 during the
term for the annual limit for outpatient treatment (August 1 to July 31 of the next year), the excess
amount (total monthly amount for outpatient treatment) will be reimbursed as high medical expense
payment.
Only the limits for both outpatient treatment and hospitalization (by household) apply to those in the
“actively working category” (personally borne expense rate of 30 percent).
The new limits for each category are as follows:
Income at “actively working level 3” (personally borne rate: 30 percent; taxable income: ¥6,900,000
or more): up to ¥252,600. (If total medical expenses are over ¥842,000, one percent of the excess
amount plus ¥252,600.)
Note: If a member has been issued a payment for high medical expenses three times in the
past twelve months, he/she will become a “multiple-use patient” from the fourth time onward,
and the limit will drop to ¥140,100.
Income at “actively working level 2” (personally borne rate: 30 percent; taxable income: ¥3,800,000
or more): up to ¥167,400 (If total medical expenses are over ¥558,000, one percent of the excess
amount plus ¥167,400)
Note: If a member has been issued a payment for high medical expenses three times in the past
twelve months, he/she will become a “multiple-use patient” from the fourth time onward, and the
limit will drop to ¥93,000.
Income at the “actively working level” 1 (personally borne rate: 30 percent; taxable income:
¥1,450,000 or more): up to ¥80,100. (If total medical expenses are over ¥267,000, one percent of the
excess amount plus ¥80,100.)
Note: If a member has been issued a payment for high medical expenses three times in the past
twelve months, he/she will become a “multiple-use patient” from the fourth time onward, and the
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limit will drop to ¥44,400.
└───────────────────────────┘ Please note that reimbursement for high medical expenses does not apply to meal expenses during
hospitalization or to additional fees for special beds that insurance does not cover.
If you turn seventy-five years old during the month, the personally borne expense limit for your prior
medical health insurance and for the Medical Care System for Older Senior Citizens will be halved for
that month (unless your birthday is the first of the month).
Joint Personally Borne Expense Limit for Medical Health
Insurance and Nursing Care Insurance (High Medical and
Nursing Care Joint Expenses)
If the sum of the personally borne expenses for the Medical Care System for Older Senior Citizens
and for Nursing Care Insurance in one household for a year (from August 1 through July 31 of the
following year) exceeds the designated limit on personally borne expenses for your household (only for
expenses above ¥500), you can apply to have the excess amount from each insurance plan reimbursed.
When completing such procedures, you must present an official form of valid ID, such as a passport
or physical disability certificate, as well as a My Number Card or other document showing your
individual number (My Number).
┌───────────────────────────┐
Annual Joint Personally Borne Expense Limit for Medical
Health Insurance and Nursing Care Insurance
Here are the income categories and their respective ceilings:
Income at the actively working level III: ¥2,120,000
Income at the actively working level II: ¥1,410,000
Income at the actively working level I: ¥670,000
General: ¥560,000
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Category II: ¥310,000
Category I: ¥190,000
└───────────────────────────┘
Cost of Meals For Standard Hospitalization (Non-Long-
Term Care Hospitalization)
If you are hospitalized as an ordinary patient (non-long-term care), the standard limits for personally
borne expense per meal are as follows:
┌───────────────────────────┐
Standard Personally Borne Expenses Per Meal (Standard
Hospitalization)
The following lists the income categories and their respective cost per meal:
Income at the actively working level and general: ¥460
Category II, when hospitalized in the past 12 months for 90 days or fewer: ¥210
Category II, when hospitalized in the past 12 months for over 90 days (long-term hospitalization):
¥160
Category I: ¥100
└───────────────────────────┘
The personally borne expense per meal for patients with income at the “actively working level” and in
general categories with designated intractable diseases remains at ¥260. The personally borne expense per
meal for patients who remain hospitalized in psychiatric wards from April 1, 2015 or before also remains
at ¥260.
If you fall under Category II and were hospitalized in the past 12 months for over 90 days, please
bring your hospital invoice or receipt documenting the number of days of hospitalization and complete
the application procedures at the appropriate service counter of your local municipal office. (If you have
received a payment reduction, you may add up hospitalization periods covered by other health insurance
for the days of hospitalization during the time you had certification equivalent to Category II.) If the date
listed on your certificate of payment reduction pertains to long-term hospitalization, however, you do not
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have to apply again.
Long-term hospitalization will apply from the first of the following month after the date you apply.
The difference will be paid for the period between the application date and the end of the application
month.
The Cost of Meals, Living, etc. during Long-Term Care
Hospitalization
If you are hospitalized for long-term care, the standard ceilings for the personally borne expense for
meals and living are as outlined below:
The personally borne cost for meals for those with a designated intractable disease will be the same
as for a patient in standard hospitalization mentioned above, and will be exempt from living cost
payment.
┌───────────────────────────┐
Standard Personally Borne Expenses for Meals and Living
for Those with Low Need for Hospital Treatment (Long-
Term Care Patient)
The following lists income categories and their respective costs per meal and living expenses per day, in
order:
Income at the actively working level and general: ¥460; ¥370
Category II: ¥210; ¥370
Category I: ¥130; ¥370
Old-age welfare pension recipient: ¥100; ¥0
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Standard Personally Borne Expenses for Meals and Living
for Those with High Need for Hospital Treatment (Long-
Term Care Patient)
The following lists income categories and their respective costs per meal and living expenses per day, in
order:
Income at the actively working level and general: ¥460; ¥370
Category II when hospitalized in the past 12 months for 90 days or less: ¥210; ¥370
Category II when hospitalized in the past 12 months for over 90 days (long-term hospitalization):
¥160; ¥370
Category I: ¥100; ¥370
Old-age welfare pension recipient: ¥100; ¥0
└───────────────────────────┘
Please note that regardless of the level of need for hospital treatment, in some cases the expense for
meals for members with an income at the actively working level and those in the general category may be
¥420, depending on the standards of the medical institution.
Additionally, if you have a high need for hospital treatment, fall under Category II and were
hospitalized in the past 12 months for over 90 days, please bring your hospital invoice or receipt
documenting the number of days of hospitalization and complete the application procedures at the
appropriate service counter of your local municipal office. (You may add up hospitalization periods
covered by other health insurance for the days of hospitalization during the time you had certification
equivalent to Category II.) If the date listed on your certificate of payment reduction pertains to long-term
hospitalization, however, you do not have to apply again.
Long-term hospitalization will apply from the first of the following month after the application date.
The difference will be paid for the period between the application date and the end of the application
month.
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Certificate of Personally Borne Expense Ceiling and
Payment Reduction, and Certificate of Personally Borne
Expense Ceiling
If your personally borne expense rate is 10 percent and everyone in your household is exempt from
residents tax, present the certificate of personally borne expense ceiling and payment reduction at the
service counter of a medical institution to get your personally borne expense for hospital meals reduced.
Apply at the appropriate service counter of your local municipal office to receive this certificate.
If your personally borne expense rate is 30 percent and the income subject to residents tax for all
household members that are members of the Medical Care System for Older Senior Citizens is less than
¥6,900,000, present the certificate of personally borne expense ceiling at the service counter of a medical
institution to apply the personally borne expense ceiling to health insurance-applicable medical
treatments. Apply at the appropriate service counter of your local municipal office to receive this
certificate.
Even if you have a certificate of personally borne expense ceiling and payment reduction or certificate
of personally borne expense ceiling from a prior health insurance plan, you must apply again if you wish
to have it issued when enrolling in the Tokyo Medical Care System for Older Senior Citizens. When
completing the application procedures, you must present an official form of valid ID—such as a passport
or physical disability certificate—as well as a My Number Card or other document showing your
individual number (My Number).
Treatment Certificate for Those with Special Illnesses
If you have a special illness and need expensive, long-term medical treatment, apply at your local
municipal office. If you qualify, you will receive a treatment certificate for people with special illnesses.
If you present this certificate at the service counter of a medical institution, your personally borne
expenses will be limited to ¥10,000 per month at each medical institution.
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Special illnesses refer to the following:
(1) Some congenital blood coagulation factor disorders (e.g., hemophilia)
(2) Chronic kidney disorders requiring artificial dialysis
(3) HIV (human immunodeficiency virus) infections caused by the injection of blood coagulants
(blood derivatives)
Even if you have an equivalent certificate from your prior health insurance plan, you must complete
the application procedure again when enrolling in the Tokyo Medical Care System for Older Senior
Citizens.
When completing such procedures, you must present an official form of valid ID, such as a passport
or physical disability certificate, as well as a notification card or other document showing your individual
number (My Number).
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5. Reimbursement for Medical Expenses
If you pay for all medical costs in the following cases, you can apply at a later date at your local
municipal office for reimbursement for the amount that the insurer should pay.
┌───────────────────────────┐
Items Required for All Cases
Your health insurance card, and documentation to confirm your bank account
When completing such procedures, you must also present an official form of valid ID, such as a
passport or physical disability certificate, as well as a My Number Card or other document showing your
individual number (My Number).
└───────────────────────────┘
(1) When you have received medical treatment without showing your health insurance card, or at a
medical institution where the treatment is not covered by insurance. Please note that this is
restricted to situations that the Association recognizes as being unavoidable.
You will need a document equivalent to a statement of medical expenses and a receipt, as well as
the items required for all cases mentioned above.
(2) When you have received treatment from a judo therapist for injuries such as a broken/fractured bone
or dislocated joint. Please note that a physician’s consent is required for these types of treatments
unless the situation is an emergency. This only applies to treatment within the range insurance
designates. Reimbursement is not offered for treatment received during hospitalization.
You will need a receipt for the treatment fee, as well as the items required for all cases mentioned
above.
(3) When you have received a massage, acupuncture, moxibustion or similar treatments that a physician
has deemed necessary (consent and approval by the physician is required). This excludes those
treatments received while hospitalized. You will need a receipt for the treatment fee and a letter of
consent from the physician, as well as the items required for all cases mentioned above.
(4) When you have purchased therapeutic items such as a corset prepared by a prosthetist and orthotist, or
paid for a blood transfusion, that the physician recognizes as necessary. This also applies to some
ready-made therapeutic items.
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You will need a written statement (medical certificate) stating the need for the adaptive
equipment, a receipt, and in the case of shoe-type equipment a photo that can confirm the full
view (including attachments) as well as the items required for all cases mentioned above. For
blood transfusions you will also need a certificate from the physician and a receipt.
(5) When you have received treatment overseas under unavoidable circumstances. Please note that this
does not apply to overseas travel for treatment purposes. Only treatments within the range
designated by insurance in Japan are covered.
You will need a statement of medical treatment, an itemized receipt, translation of these
documents, passport or other document that provides proof of your travel, a consent form for the
investigation of medical treatment details, as well as the items required for all cases mentioned
above.
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6. Proper Way of Receiving Therapy from
Judo Therapists
Please note that insurance covers treatment by judo therapists only when a physician or licensed judo
therapist diagnoses or determines that certain conditions are satisfied.
Cases covered by insurance:
Acute bruises, sprains, muscle strains, broken/fractured bones and dislocated joints. For broken/fractured
bones and dislocated joints, the consent of a physician is required, except in emergencies.
Examples of cases not covered by insurance:
(1) Simple stiff shoulder and muscle wasting
(2) Chronic disease such as the aftereffects of cerebropathy
(3) Long-term treatment that does not lessen symptoms
(4) When the same injury is being treated at a different hospital, clinic or other medical institution
Points to Note when Receiving Treatment
(1) Medical health insurance only covers treatment for therapeutic purposes. You must accurately explain
the cause of your injury (when, where and how you became injured, and your symptoms).
(2) Judo therapists are allowed to accept two payment methods: “reimbursement,” meaning the patient
pays all medical costs and later claims reimbursement at the appropriate service counter of his/her local
municipal office; and “receipt delegation,” meaning the patient pays his/her personally borne expense to
the judo therapist, who claims the remaining amount from the insurer. When a judo therapist makes a
patient-related insurance claim, he/she must check the details of the application for medical expense
payment (cause of the injury, name of the injury, days of treatment, cost) and have the patient complete
the representative recipient field (address, name, delegation date).
If the patient cannot write due to a wrist injury or other reason, the judo therapist may write in the
patient’s stead, provided that the patient affixes his/her personal seal.
(3) When you receive treatment for a long period of time, your injury may be aggravated by medical
19
factors. Consult with the judo therapist and receive an examination at a hospital or clinic.
(4) Please keep the receipts that your judo therapist issues (free of charge) in a safe place.
(5) The Association may contact you to check the dates and details of treatment or other information.
Thank you for your cooperation.
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7. When Receiving Acupuncture, Moxibustion,
Massage, Acupressure or Similar Treatments
Medical insurance will cover the procedure only if certain conditions are met and a written consent is
issued by the physician, so please consult your physician in advance.
21
8. When Transported under a Physician’s Orders in
an Emergency or Other Unavoidable Circumstances
(Transportation Benefit)
Insurance may cover the cost of transportation if the patient is seriously ill with limited mobility, must
change hospitals under the orders of a physician, and the transfer is urgent and unavoidable. You can
apply at the appropriate service counter of your local municipal office for this transfer benefit, which is
subject to approval.
Insurance does not cover the cost of transportation for examination purposes, location changes due to
the patient’s desire or for the convenience of the family, daily transportation from home to the hospital or
at the time of discharge from hospitalization, or other non-emergencies.
The transportation benefit provided is calculated based on the transportation cost of the most ordinary
and economical route and means.
Items required for application: You will need a written statement from your physician concerning the
need for transportation, a receipt (that shows the route details), your health insurance card, and
documentation to confirm your bank account.
When completing procedures, you must present an official form of valid ID, such as a passport or
physical disability certificate, as well as a My Number Card or other document showing your individual
number (My Number).
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9. When an Enrolled Member Dies (Funeral Benefit)
A funeral expense of 50,000 yen will be paid to the person who conducted the funeral service if they
apply at the appropriate section of their local municipality. The amount of the benefits and items required
for application may differ between municipalities. For details, please contact the appropriate service
counter at the enrolled member’s local municipal office.
Items Required for Application
A receipt for the funeral expenses (must confirm that the applicant hosted the funeral); documentation to
confirm the applicant’s financial institution, and account number and name on the account
23
10. When You Are Involved in a Traffic
Accident/Other Incident
If you are injured by a third party in a traffic accident or other incident, please tell the hospital that
your injury was the result of an accident/incident when receiving treatment. Also be sure to file a report
with the police, and notify the appropriate service counter at your local municipal office as soon as
possible. You may use your health insurance card for treatment once you file these notifications.
The staff in charge at your local municipal office will tell you which documents are required for
application. Please file the notification within thirty days of the accident/incident as a rule.
The Association will cover the medical expense temporarily, and later bill the person who caused the
accident. Please be careful when settling the case out of court, because an unfavorable settlement may
make it difficult to bill the person who caused the accident.
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11. Notice About Health Checkups
● Remember to receive a health checkup once a year
Even if you are currently visiting a hospital regularly or feel healthy, please get a health checkup once
a year for the early detection and early treatment of illness to prolong your life and safeguard your health.
For details, please contact the appropriate service counter of your local municipal office.
The personally borne expense for the checkup is ¥500. Some municipalities offer health checkups free
of charge. Note that those who are institutionalized may be ineligible for health checkups.
25
12. Insurance Premiums
Enrolled members pay insurance premiums—calculated as a percentage of the total medical
expenses—so that the Association can allocate funds to pay for treatment that members receive for illness
or injury. Insurance premiums are an important financial resource for supporting the Medical Care
System for Older Senior Citizens.
Insurance premium rates are reviewed/revised every two years, and the rates are the same throughout
Tokyo.
Notices about insurance premiums are sent to enrolled members from their local municipal offices.
How Insurance Premiums Are Calculated
Every enrolled member pays an insurance premium. This premium is the sum of the per capita amount
of ¥44,100 per member, plus the income ratio amount determined by the income the member earned
during the previous year (income that serves as the basis for assessment × income ratio of 8.72 percent).
The per capita amount of ¥44,100 and the income ratio of 8.72 percent are applicable for two years from
fiscal 2020 through fiscal 2021.
The ceiling for annual insurance premiums is ¥640,000, and fractions smaller than ¥100 are omitted in
the final insurance premium figures.
If you turn 75 years old in the middle of the fiscal year or move from another prefecture, your
insurance premiums will be calculated on a monthly basis from that month.
Income as the basis for insurance premium assessment refers to the basic deduction designated in the
Local Tax Act (¥430,000 for those whose total income is 24 million or less) subtracted from the total of
gross income earned during the previous year, forestry income, and income from the transfer of stocks or
long- and short-term assets. (Carried-forward miscellaneous losses cannot be deducted.)
How to Pay Your Insurance Premiums
You pay your insurance premiums to your local municipal office, and can either make these payments
through special collection or regular collection, as outlined below.
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Special Collection (deducted from your public pension/pension from which Nursing Care insurance premiums are deducted)
Members whose annual public pension is ¥180,000 or greater and the sum of the Nursing Care
Insurance premiums and Medical Care System for Older Senior Citizens premiums is 50 percent or less
of the amount of one payment of the public pension are eligible.
Special collection is separated into tentative collection and finalized collection. Until your income in
the previous year is finalized, insurance premiums for tentative collection in April, July and August are
calculated based on your insurance premiums in the previous year. The total insurance premiums for
finalized collection are the finalized yearly insurance premium based on your finalized income in the
previous year, minus the amount already collected for special collection. That amount is separately
collected over three terms (October, December and February). Regular Collection (payment by invoice or bank transfer)
If you are ineligible for special collection, you pay premiums by invoice or bank transfer. The number
of terms for payment differs between municipalities. For details, please contact the appropriate service
counter at your local municipal office.
Note: Those who just became eligible for the Medical Care System for Older Senior Citizens or have just
moved from another municipality must pay for premiums through regular collection for a period of time.
You Can Pay by the Convenient Bank Transfer
If you are paying by invoice, you may also apply to pay by bank transfer. The account you designate
does not have to be your own; you may also use the account of the head of your household, your spouse
or another account. Information of the bank account you used to pay your National Health Insurance
premiums (tax) will not be transferred, so you will have to complete new procedures to pay by bank
transfer. If You Fall Behind in Your Premium Payments
If you fall behind in your insurance premium payments, we will send you a reminder. You may also
receive a formal demand by phone or in writing. If you still do no pay, you may be sent a health insurance
card with a shorter validity period (short-term health insurance card), or your property may be seized.
If you have difficulty paying your insurance premiums for certain reasons, please consult the
27
appropriate service counter of your local municipal office as soon as possible.
Insurance Premium Reduction or Exemption
If you have difficulty paying your insurance premiums due to exceptional circumstances such as
suffering serious damage in a disaster or the suspension/abandonment of a business, you may apply for a
reduction or exemption of your insurance premiums. Please consult the appropriate service counter of
your local municipal office as soon as possible.
Reduction of Insurance Premiums
If your income is low, you may be able to have your insurance premiums reduced. You may have to
declare your income when you apply for such a reduction. Reduction of the Per Capita Amount
Your per capita amount of insurance premiums can be reduced depending on the total income of all
members enrolled in the Medical Care System for Older Senior Citizens in your household and the head
of the household.
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The percentage of the reduction in the per capita amount for fiscal 2021 can be 70 percent, 50 percent, or
20 percent.
The following lists the income categories and their respective percentages:
(1) A household with a total income at or less than ¥430,000 + (total number of persons with salary
income or public pension income -1) × ¥100,000: 70 percent reduction
(2) A household with a total income at or less than ¥430,000 + (total number of persons with salary
income or public pension income -1) × ¥100,000 + (¥285,000 × number of members): 50 percent
reduction
(3) A household with a total income at or less than ¥430,000 + (total number of persons with salary
income or public pension income -1) × ¥100,000 + (¥520,000 × number of members): 20 percent
reduction
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Notes:
1. For the public pension income of members 65 years of age or older (as of January 1, 2021), the
reduction assessment is made based on the income minus ¥150,000 (special deduction for senior
citizens).
2. Even when the head of the household is not an enrolled member, his/her income is taken into
consideration in the reduction assessment. Reduction assessment is based on their composition
as of April 1 of the fiscal year (if you became a member in Tokyo during the fiscal year, the day
you became a member). 3. The "total number of persons with salary income or public pension income" is the total number
of insured persons and heads of households in the same household who have "salary income
exceeding 550,000 yen" or "public pension income exceeding 600,000 yen for persons under 65
years old and 1,250,000 yen for persons 65 years old and over.” This applies when the total
number of persons is two or more. Reduction of the Income Ratio Amount
The income ratio amount of insurance premiums can be reduced depending on the enrolled members’
income (the amount after subtracting the basic deduction as designated in the Local Tax Act [¥430,000
for those with total income of ¥24 million] from total income), which serves as the basis for insurance
premium assessment.
If the income amount assessed is ¥200,000 or less, the enrolled member is eligible for a reduction in
insurance premiums. This is a special reduction measure of the Association.
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The percentage of reduction in the income ratio amount can be 50 percent or 25 percent.
The following lists the income categories and their respective reduction percentages:
1) If the income amount assessed is ¥150,000 or less: Reduced by 50 percent (50 percent imposed)
(2) If the income amount assessed is ¥200,000 or less: Reduced by 25 percent (75 percent imposed)
└───────────────────────────┘ Reduction for Former Dependents
If you were enrolled in an employee insurance program—excluding the National Health Insurance and
National Health Insurance Union systems—the per capita reduction rate for your former dependents until
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the day before you enroll in the Medical Care System for Older Senior Citizens will be 50 percent for two
years (i.e., until the month after two years have passed since you enrolled). The income ratio amount will
not be charged for the time being.
If you are eligible for a reduction in the per capita amount due to low income, the higher reduction
rate will be prioritized.
Calculation Example for Annual Insurance Premiums
Case: A single-person household with an enrolled member whose annual income is only ¥1,700,000 from
a public pension
Calculation of per capita amount: The member’s eligibility for a reduction in the per capita amount will
be assessed.
Pension income of ¥1,700,000 – pension deduction of ¥1,100,000 – special deduction for senior
citizens of ¥150,000 = ¥450,000
The ¥450,000 amount falls under the 50 percent reduction category, so the per capita amount will be:
¥44,100 – (¥44,100 × 50 percent) = ¥22,050
Calculation of income ratio amount: The member’s eligibility for a reduction in the income ratio amount
will be assessed.
Pension income of ¥1,700,000 – pension deduction of ¥1,100,000 – basic deduction of ¥430,000 =
¥170,000
The amount of ¥170,000 falls under the 25 percent reduction category, so the income ratio amount is:
(¥170,000 × income ratio of 8.72 percent) – [(¥170,000 × income ratio of 8.72 percent) × 25 percent]
= ¥11,118.
The resulting annual insurance premium is ¥33,100, as the sum of the per capita amount of ¥22,050
and the income ratio amount of ¥11,118, with the fraction below ¥100 being omitted.
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13. Current Medical Expenses
“Medical expenses” refers to the total personally borne expenses you paid at medical institutions and
the medical subsidies the Association of Medical Care Services for Older Senior Citizens issued. This is
increasing year by year due to the rising number of members. Medical expenses the Association paid rose
from 1,224.7 billion yen in fiscal 2014 to 1,489.3 billion yen in fiscal 2019. Per capita medical expenses
also increased from ¥919,000 in fiscal 2014 to ¥950,000 in fiscal 2019.
Any increase in medical expenses also increases the insurance premiums that enrolled members pay,
as well as the costs working people must pay.
With that in mind, we encourage you to help lower medical expenses by improving your lifestyle
habits and receiving proper checkups.
Use Generic Medicines
Generic medicines are certified as having the quality, beneficial effects and safety equivalent to those
of the original name-brand products, and are generally offered at a lower price. That helps reduce the
medication expenses patients pay and reduce overall medical expenses.
Since there are programs to test out generic medicines as well, please consult your physician or
pharmacist if you prefer generic medicine.
However, not all brand-name medicines have generic substitutes. Please note that you may not be able
to use generic medicine depending on the treatment you receive.
The Association sends a notification of the difference in cost of generic medicine to members who
should have a lower personally borne expense if they switch from the brand-name medicine they are
using to generic medicine. The notification will be sent in late- June and mid-December for fiscal 2021.
A sticker to indicate your intention to use generic medicines is enclosed with the health insurance card
sent to you. If you are willing to use generic medicines, place the sticker on your insurance card, or in
your prescription record book to clearly indicate your intention to the medical institution or pharmacy.
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14. Operation of the Medical Care System for
Older Senior Citizens
The Tokyo Metropolitan Association of Medical Care Services for Older Senior Citizens—which
comprises all municipalities in Tokyo—operates the Medical Care System for Older Senior Citizens.
The Association runs the insurance program system, handling aspects such as the authorization of
enrolled members, determination of insurance premium rates, billing of insurance premiums, provision of
medical benefits, and planning of health checkups.
Municipal offices serve as the reception counters for enrollment, and handle notifications of loss of
eligibility and changes of address as well as applications for benefits. In addition, they act as service
counters that distribute health insurance cards, collect insurance premiums, and offer advice concerning
payment.
Medical expenses, excluding expenses borne by patients, are financed by insurance premiums that
enrolled members pay (which finances about 10 percent), public funds from the government of Japan, the
Tokyo Metropolitan Government and municipal offices in Tokyo (about 50 percent), and contributions
from other medical health insurance systems (from actively working generations; about 40 percent).
You may be required to provide your individual number (My Number) when completing various
procedures. You must present an official form of valid ID, such as a passport or physical disability
certificate, as well as a My Number Card or other document showing your individual number (My
Number). For details of the procedures, please contact the Association or the appropriate service counter
at your local municipal office.
Please beware of expense reimbursement fraud
Employees of the Association or municipalities will never ask you to operate an ATM (automated
teller machine).
Please beware of suspicious visits by anyone claiming to be a government official who tries to obtain
your cash card or insurance card information by saying it is necessary for reimbursement procedures.
If you receive a suspicious phone call, please consult the nearest police station, the Association, or the
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appropriate service counter at your local municipal office.
――――――――――
This pamphlet is based on laws and reference materials produced by the Ministry of Health, Labour
and Welfare. Please note that this information is subject to change, depending on revisions in the system
and other factors.
