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Long-term care insurance system

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Long-term care insurance is a public system administered by municipalities, and people over the age of 40 are mandated to be members to enable the system to provide services to eligible people. The Coca-Cola Bottlers Japan Health Insurance Association deputizes the collection of long-term care insurance premiums for long-term care insurance for secondary insured persons to the members of the Health Insurance Association.

People covered by long-term care insurance

People over the age of 40 become insured by long-term care insurance, and are divided by age, etc., as below. There are no schemes that correspond to “dependent” in health insurance, and all members become insured.

* There may be cases where those who are aged over 40 are exempted from long-term care insurance.

Person aged 65 or over Primary insured person
Medical insurance scheme member aged 40 to 64
(insured person, dependent)
Secondary insured person

Long-term care insurance Schemes

Long-term care insurance Schemes

When you use a long-term care service, you will have to copay 10% (20% or 30% for those with high income) of the cost involved according to the co-payment ability of the person who receives the service. Your co-payment percentage is stated on the “long-term care insurance co-payment percentage certificate” issued to the certified person who requires assistance or nursing care.

【Primary insured person whose co-payment percentage is 20% or 30%】
Co-payment percentage Income level
20% ①Total income amount of the insured person is over 1.6 million yen, and
②The “pension income + other total income amount” of the primary insured person belonging to the same household is over 2.8 million yen for a single-person household and over 3.46 million yen for a household with more than two people.
30%
(From August 2018)
①Total income amount of the insured person is over 2.2 million yen, and
②The “pension income + other total income amount” of the primary insured person belonging to the same household is over 3.4 million yen for a single-person household and over 4.63 million yen for a household with more than two people.
  • *The co-payment percentage for a secondary insured person, a person exempted from municipal inhabitant tax, and a recipient of welfare benefits is 10%, regardless of the above.
  • *If the long-term care insurance co-payment amount exceeds 44,400 yen for a month (there are relief measures for people with low income ), the excess amount will be refunded as high-cost long-term care service costs.

Insurance premiums for long-term care insurance

Amount and collection method of long-term care insurance are decided by the category of insured person as below.

Insurance premiums of primary insured person

Collection method Collected by municipalities. Collected directly from pensions of people receiving pension of more than 15,000 yen per month. Collected individually from people receiving less than 15,000 yen per month.
Calculation method The insurance premiums will be calculated by multiplying the standard amount established by the municipality ordinances by the graded insurance premium rate in accordance with income.

Insurance premiums of secondary insured person

Collection method
  • Health insurance association insured person: as with the health insurance premiums, the health insurance association collects premiums from monthly wages and bonuses.
  • Health insurance association dependent: no premium is directly collected since it is incorporated in premiums collected from the relevant insured person.
Calculation method Calculated by multiplying Standard monthly remuneration amount and standard bonus amount by long-term care insurance premium rate (varies by health insurance association).

Business service contents of long-term care insurance

In long-term care insurance business services, there are “home-care services,” “in-facility services,” and “community-based services”, as below.

Home-care services

  • Service received by being visited at home, etc.
    Home-visit care, home nursing care, home-visit bathing assistance, home-visit rehabilitation, at-home health care management and guidance
  • Facility usage services
    Preventive day care, day-care rehabilitation, short stay living care, short stay medical care, specific facility resident living care
  • Services supporting the provision of nursing care
    Lending of welfare equipment, provision of welfare equipment purchase fees, provision of house adaptation fees

In-facility services

Only people judged as being in need of such care can use these services.

* Residents newly admitted to a home for elderly persons requiring special care are limited in principle to the elderly persons requiring nursing care level 3 or more.

  • Welfare facility for elderly persons requiring long-term care (e.g. home for elderly persons requiring special care)
  • Health facility for elderly persons requiring long-term care (e.g. health facility for elderly persons)
  • Long-term care medical treatment type medical facility (e.g. long term care bed)

Community-based services

This is a framework to provide diverse and flexible services in order for people requiring nursing care to continue their lives in a familiar environment. These business services are administered by municipalities, and residents can in principle receive these services in their municipality.

  • Small-scale multifunctional home-care support
  • Group home care for elderly persons dementia sufferers
  • Day service for dementia sufferers
  • Home-visit care available at night
  • Resident nursing care in community-based welfare facility for elderly persons requiring nursing care
  • Resident long-term care in community-based special facility
  • Regular home visitation and as-needed visitation home-visit nursing care
  • Nursing care with small-scale multifunctional home-care support (combination services)

When a secondary insured person is eligible to receive long-term care service

Secondary insured persons aged 40 to 64 are able to receive long-term care service under long-term care insurance only if they fall into a “special disease” category listed below. Primary insured persons of age 65 or over are not asked whether they suffer from a “special disease” or not.

  1. Presenile dementia
  2. Cerebrovascular disease
  3. Amyotrophic lateral sclerosis (ALS)
  4. Parkinsonism related disease
  5. Spinocerebellar degeneration
  6. Multiple system atrophy
  7. Diabetic nephropathy, diabetic retinopathy, diabetic neuropathy
  8. Arteriosclerosis obliterans
  9. Chronic obstructive pulmonary disease
  10. Osteoarthritis of knee or hip joint associated with marked deformities
  11. Articular rheumatism
  12. Ossification of the posterior longitudinal ligament
  13. Spinal canal stenosis
  14. Osteoporosis accompanying bone fracture
  15. Progeria
  16. Terminal cancer

Column

Community support business services and Community General Support Center

Community support business services are provided by municipalities to people that may require support or long-term care, and the “Community General Support Center” plays a large role in providing these services.
The Community General Support Center is a core institution that focuses on maintaining life functions of the elderly persons in the community, improving health, welfare and medical care, and providing aid and support necessary for the stability of life, and it provides consultation on the consistent adjustment of services.
Home-visit care and preventive day-care of elderly persons requiring support are going to be transferred to community support business service within fiscal year 2017.

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