IBM Japan Health Insurance Association

IBM Japan Health Insurance Association

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The Medical Care System for the Advanced Elderly

Launched in April 2008, this system is a medical care insurance system for persons aged 75 or older or those aged 65 or older with certain disabilities. When you reach the age of 75 (or age 65 if you have certain disabilities), your medical care insurance system will switch from health insurance to the Medical Care System for the Advanced Elderly.

Run by “regional alliances”

The Medical Care System for the Advanced Elderly is run by “a regional alliance for the medical care of the advanced elderly”. Each regional alliance is established for an individual prefecture. All municipalities in a prefecture belong to one regional alliance. While the regional alliances make decisions on insurance premiums and payments for medical care costs, municipal offices handle tasks such as collecting insurance premiums.

Insurance premiums determined by each prefecture

The amount of insurance premiums is determined by ordinances of each prefecture. The cost to each member is determined based on the number of people in the household (benefits portion) and income (ability portion). Lower-income members have various ways to reduce their premiums.

All members are considered insured persons

All members of the Medical Care System for the Advanced Elderly are considered insured persons and pay insurance premiums. There is no system corresponding to the system for “dependents” under the health insurance system.

Same insurance benefits as under the health insurance system

While the Medical Care System for the Advanced Elderly provides the same insurance benefits as other medical care insurance systems (e.g., health insurance), the copayment is only 10% (although the copayment remains 30% for persons earning income at the same levels as active workers).

Approaching “age 75”

About half a month prior to an insured person's or dependent's “75th” birthday, the Health Insurance Association will send information about joining the Medical Care System for the Advanced Elderly. Apply to join the system as described in these documents.

When you join the Medical Care System for the Advanced Elderly, you will lose your eligibility as an insured person (or dependent) under the health insurance system.

Since the Medical Care System for the Advanced Elderly is completely independent of other medical care insurance systems, you will lose your eligibility as an insured person or dependent under your previous health insurance program after you join.

Note that when an insured person under the health insurance system switches to the Medical Care System for the Advanced Elderly after reaching the age of 75, his or her dependents will also lose their status as dependents. (See the table below.)

Eligibility status before and after joining the Medical Care System for the Advanced Elderly

■▲ Both insured person and dependent reach the age of 75 ■▲ Both insured person and dependent join the Medical Care System for the Advanced Elderly
■ Insured person reaches the age of 75
▲ Dependent less than 75 years of age
■ Insured person: joins Medical Care System for the Advanced Elderly
▲ Dependent: Loses eligibility as a dependent under the health insurance system → Joins another medical care insurance system such as National Health Insurance or becomes a dependent of another family member
■ Insured person less than 75 years of age
▲ Dependent reaches the age of 75
■ Insured person: Remains eligible as an insured person under the health insurance system.
▲ Dependent: Loses eligibility as a dependent under the health insurance system → Joins Medical Care System for the Advanced Elderly

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