IBM Japan Health Insurance Association

IBM Japan Health Insurance Association

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The long-term care insurance program

Long-term care insurance is a public social insurance program run 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 Societies 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.

Who is eligible for long-term care insurance?

Insured persons aged 40 and 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.

Persons aged 65 and above Category 1 insured persons
Members of medical care insurance aged 40 through 64
(Insured persons, dependents)
Category 2 insured persons

The long-term care insurance system

  • ** The copayment for a category 1 insured person with total income of 1.6 million yen (2.8 million yen if the sole source of income is pension benefits) or more will be 20%.
    However, the copayment will be 10% if the total of pension income and other total income for category 1 insured person(s) in the same household is less than 2.8 million yen for a single person or less than 3.46 million yen for two or more persons.
  • ** Every year, persons identified as needing assistance or needing long-term care are issued a Long-term Care Insurance Copayment Certificate indicating applicable copayment rates.

Long-term care insurance premiums

As outlined below, the amount of long-term care insurance premiums and how they are collected varies 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
  • Health Insurance Association insured persons: Collected by the Health Insurance Association from monthly salary and bonuses in the same way as health insurance premiums
  • Health Insurance Association dependents: No premiums collected directly (included in amount collected from insured person)
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)

Click here for Monthly Long-term care insurance premium table (After April, 2016)

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.

  • 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)
  • Long-term care medical treatment facility (medical treatment beds for long-term inpatients)
  • 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.

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(beginning April 2012)
  • 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 above 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

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