The long-term care insurance program
Long-term care insurance is a public social insurance program operated by municipal governments to provide long-term care services. Membership is mandatory for those 40 years of age or older. Under the long-term care insurance system, Health Insurance Associations collect long-term care insurance premiums on behalf of the long-term care insurance program from category 2 insured persons who are members of the Society.
- Description
- Procedures
- FAQ
- Who is eligible for long-term care insurance?
- Long-term care insurance premiums
- Details of long-term care insurance services
Who is eligible for long-term care insurance?
Insured persons aged 40 or older are eligible for long-term care insurance. These individuals are categorized as shown below by age, etc. In contrast to health insurance, this program lacks the category of “dependents”. All members are considered insured persons.
- **In some cases, persons aged 40 or older are exempt from long-term care insurance. See “Exempt persons” below.
| Category 1 insured persons | Persons aged 65 and above |
|---|---|
| Category 2 insured persons | Persons aged 40 through 64 who are insured under medical insurance (insured persons, dependents) |
| Exempt persons | Even persons eligible as category 1 or category 2 insured persons under long-term care insurance are exempt, and are therefore not covered as insured persons under long-term care insurance, if they meet the following requirements:
For overseas residents under case 1 above who reside overseas due to assignment by employers, the employers will submit notifications of exemption. For dependents (family members) who are overseas residents because they are accompanying employees posted overseas, employers will submit notifications of exemption by undertaking the employers’ procedures for registering family members accompanying employees on overseas postings. Note that accompanying family members must be registered in this way. In other cases, notification must be submitted to the Suntory Health Insurance Association. Contact the Health Insurance Association for more information. |
The long-term care insurance system
Copayments for long-term care services will be 10% (20% or 30% for high-income earners) of the cost of the services, depending on the user's ability to pay. You can check your copayment on the Long-term Care Insurance Copayment Certificate issued to persons needing support or long-term care.
【Category 1 insured persons with copayments of 20% or 30%】
| Copayment | Income standard |
|---|---|
| 20% |
|
| 30% |
|
* Notwithstanding the above, copayments are 10% for Category 2 insured persons, those exempt from paying municipal tax, and those receiving public assistance.
* If your copayment for long-term care exceeds 44,400 yen in a month (measures are available to reduce this amount for low-income earners and other eligible persons), then the amount in excess of this amount will be refunded as high long-term care service costs.
Long-term care insurance premiums
As outlined below, the amount of long-term care insurance premiums and how to collect it collected vary by category of insured person.
Long-term care insurance premiums for a category 1 insured person
| Collection method | Collected by municipalities. Collected directly from pension if pension benefits total 15,000 yen or more per month. Collected individually if pension benefits total less than 15,000 yen per month. |
|---|---|
| Calculation method | Insurance premiums are determined by multiplying the base amount established by the ordinance of each municipality by an income-dependent insurance premium rate. |
Long-term care insurance premiums for category 2 insured person
| Collection method |
|
|---|---|
| Calculation method | Value obtained by multiplying the standard monthly remuneration and the standard bonus by the long-term care insurance premium rate (varies by Health Insurance Association) |
The specified insured person system under long-term care insurance
As authorized by the Minister of Health, Labour and Welfare, since April 1, 2022 the Suntory Health Insurance Association has applied the specified insured person system under long-term care insurance to ensure equitable sharing of insurance premium burdens among the insured. Under this system, if an insured person’s dependents (family members) include a category 2 insured person, long-term care insurance premiums are paid to the Health Insurance Association, even if the insured person (employee) is not a category 2 insured person. The following table indicates which dependents of insured persons are subject to the collection of long-term care insurance premiums by the Suntory Health Insurance Association:
■Long-term care insurance premium collection status in the Suntory Health Insurance Association
| Dependent (dependent family member) | ||||||||
|---|---|---|---|---|---|---|---|---|
| No dependents | Under 40 years of age | 40-64 years of age | Aged 65 or older | |||||
| Residing in Japan or accompanying the insured on overseas posting (notification of accompaniment to employer required) | Residing in Japan | Accompanying the insured on overseas posting (notification of accompaniment to employer required) | Residing in Japan | Accompanying the insured on overseas posting (notification of accompaniment to employer required) | ||||
| Insured person (employee) | Working in Japan | Under 40 years of age | No premiums collected | No premiums collected | Premiums collected (dependent subject to premiums) | - | No premiums collected (dependent premiums paid to municipality) | - |
| 40-64 years of age | Premiums collected (insured person subject to premiums) | Premiums collected (insured person subject to premiums) *1 |
Premiums collected (both insured person and dependent subject to premiums) *2 | - | No premiums collected (dependent premiums paid to municipality) | - | ||
| Aged 65 or older | No premiums collected (insured person premiums paid to municipality) | No premiums collected (insured person premiums paid to municipality) |
No premiums collected (insured person premiums paid to municipality, no dependent premiums collected) *4 | - | No premiums collected (both insured person and dependent premiums paid to municipality) | - | ||
| Overseas posting | Under 40 years of age | No premiums collected | No premiums collected | Premiums collected (dependent subject to premiums) | No premiums collected (dependent exempt) *3 | No premiums collected (dependent premiums paid to municipality) | No premiums collected (exempt) | |
| 40-64 years of age | No premiums collected (insured person exempt) | No premiums collected (insured person exempt) |
Premiums collected (dependent subject to premiums) | No premiums collected (both insured person and dependent exempt) *3 |
No premiums collected (dependent premiums paid to municipality) | No premiums collected (exempt) | ||
| Aged 65 or older | No premiums collected (exempt) | No premiums collected (exempt) | No premiums collected (exempt) | No premiums collected (exempt) | No premiums collected (dependent premiums paid to municipality) | No premiums collected (exempt) | ||
- *1 Only the insured person is subject to collection of premiums. The family member is not subject to collection of premiums.
- *2 While both the insured person and dependent are subject to collection of premiums, premiums are collected for the insured person only.
- *3 While the dependent accompanying the insured person (on overseas posting) is exempt, the employer’s procedures for the registration of family members accompanying employees on overseas posting must be completed.
- *4 If the insured person is 65 or older, premiums are directly paid to the municipality. The Health Insurance Association will not collect premiums for dependents aged 40-64 years.
Details of long-term care insurance services
As shown below, long-term care insurance services include “services provided at home”, “services provided at care facilities”, and “locality-oriented services”.
Services provided at home
- Services provided on visits to the patient at home or elsewhere Long-term care on a visitation basis, nursing on a visitation basis, bathing service on a visitation basis, rehabilitation on a visitation basis, instructions for medical care at home
- Services provided at care facilities
Long-term care at care facilities, rehabilitation at care facilities, short-term stay for livelihood care, short-term stay for medical and long-term care, therapy for persons staying at specified facilities - Services providing a care environment
Lending of welfare appliances, aid for purchases of welfare appliances, allowances for modifying homes
Services provided at care facilities
These services are available only for those judged as needing long-term care.
- Note: As a general rule, new patients accepted for inpatient care at special nursing homes for the elderly will be restricted to those in the category of persons needing long-term care 3 and above.
- Welfare facilities for the elderly requiring long-term care (special nursing homes for the elderly)
- Health facilities for the elderly in need of long-term care (health services facility for the aged)
- Integrated facilities for medical and long-term care (medical treatment beds for long-term inpatients)
Locality-oriented services
This is a framework for providing a wide range of flexible services to enable those who need long-term care to continue living in their familiar home communities. These services are operated by individual municipal governments. In principle, they are available for use only by residents of the municipality.
- Small-scale multifunctional long-term care at home
- Group homes for elderly persons with acknowledge Syndrome
- Daytime services available for dementia patients
- Nighttime long-term care on visitation basis
- Daily Life Long-Term Care for a Person Admitted to a Community-Based Specified Facility
- Admission to a Community-Based Facility for Preventive Daily Long-Term Care of the Elderly Covered by Public Aid
- Nursing on a visitation basis of regular rounds and on-demand response
- Nursing and small-scale multifunctional domiciliary care services (combination services)
For what types of long-term care services is a category 2 insured person eligible?
Category 2 insured persons aged 40-64 are eligible to receive long-term care services under long-term care insurance only if they suffer from one of the following specified diseases and disorders. Category 1 insured persons aged 65 or older are eligible to receive the services whatever the condition or disorder.
- Pre-acknowledge syndrome
- Cerebrovascular disease
- Amyotrophic lateral sclerosis (ALS, or Lou Gehrig's Disease)
- Parkinson's disease-related conditions
- Spinocerebellar degeneration
- Multiple system atrophy
- Diabetic nephropathy, diabetic retinopathy, diabetic neuropathy
- Arteriosclerosis obliterans
- Chronic obstructive pulmonary disease
- Degenerative joint disease with pronounced deformation of both knee or hip joints
- Rheumatoid arthritis
- Ossification of posterior longitudinal ligament
- Stenochoria of the spinal canal
- Osteoporosis involving bone fractures
- Progeria
- Terminal cancer
ColumnRegional assistance services and comprehensive regional assistance centers
Regional assistance services are services provided by municipal governments for those who may require assistance or long-term care. “Comprehensive regional assistance centers” play an important role in providing these services.
Comprehensive regional assistance centers are the central facilities that provide the assistance and support needed to maintain the daily life of elderly people in the community; to improve their health, welfare, and medical care; and to ensure a stable quality of life. These centers provide a consistent range of services - from consultations to service coordination.
In addition, long-term care on a visitation basis and long-term care at care facilities for persons needing assistance will be migrated to regional assistance services by fiscal 2017.
There is no frequently asked questions and answers that have been registered.