Privacy policy

The IBM Japan Health Insurance Association (“Association” hereinafter) prepares databases containing personal information based on personal information found in various notices, applications, and documents received from insured persons and their family members (“members” hereinafter); personal information found in medical cost details (“rezepts” hereinafter) used by medical care institutions or other facilities to bill the Association for examinations at such facilities; and other personal information, including the numerical results of health examinations. The Association uses this information in health insurance activities and health activities as described below.

Overall, the Association uses personal information pursuant to the Health Insurance Act to provide services that maintain and promote the health of its members and to provide insurance benefits for members in the event of non-occupational illness, injury, death, or childbirth.

Health insurance associations handle large volumes of medical information, including information found on rezepts, health examination data, and other personal information. Additionally, the activities of health insurance associations depend on the implicit trust of association members. For these reasons, the Personal Information Protection Commission and the Ministry of Health, Labour and Welfare recommends, in guidance or other materials it issues, establishing specific restrictions on the use of such information.

Discussed below is how and why the Association uses this personal information.

• The Association uses applications and other materials related to eligibility for insurance coverage in its operations, as outlined below.
  • Master databases, including membership registers, are prepared by entering data chiefly from information found on Notifications of Eligibility as Insured Persons and Dependent (Change) Notices submitted when members join the Association (e.g., health insurance card symbol and number, Individual Number, name, date of birth, gender, address, monthly remuneration). This information is stored on Association administrative processing computers for use across health insurance service operations.
  • Prospective dependents are subject to review and certification when a Dependent (Change) Notice is submitted based on documentation of income and other information, including tax (tax-exempt) certificates and certificates of school attendance.
  • Health insurance cards are issued following a review of information provided in Notifications of Eligibility as Insured Persons and Dependent (Change) Notices.
  • On receiving a Notification of Loss of Eligibility as Insured Person, the Association issues a request for the return of the health insurance card. The cards are reviewed and disposed of after retention for a fixed period of time.
  • In the changes in or additions to data stored in a master database, the revisions will be based on change (correction) notices concerning matters related to eligibility.
  • Through links to benefits data, rezept data, health examination data, and other data, the master databases are used for various purposes. These include reviewing benefits payments, issuing medical care cost information, identifying those eligible for various health activities, and contacting members.
  • Names, addresses, and other contact information in the master databases may be used to contact members even after they lose their eligibility using contact information from notices or other documents.
  • Upon receipt of inquiries from medical care institutions or from other insurers (including municipalities and pension offices) concerning loss of eligibility or other matters related to insured medical consultation and treatment, the Association will respond to indicate whether the individual concerned is covered. This may include providing the health insurance card symbol and number, name, date of birth, gender, date of eligibility, date of loss of eligibility, and other data from master databases. The Association always confirms the identity of the party making the inquiry.
  • In cases in which an examination may have been administered or service provided after loss of eligibility, the Association will check the health insurance card symbol and number, name, date of birth, gender, date of eligibility, date of loss of eligibility, and other data from master databases against data held by other insurers or medical care institutions to prevent duplication of benefits.
  • Data from Notifications of Bases for Calculation, Notifications of Changes in Monthly Amounts, and Notices of Bonus Payments is uploaded to the master databases and used to collect insurance premiums (including regulation insurance premiums and long-term care insurance premiums). In addition, as needed in response to notifications, the Association will ask employers to provide salary/bonus ledgers and other materials for use in this confirmation.
  • Tasks related to the preparation of master databases and the processing of certain inputs thereto, the issuance of health insurance cards, and the preparation of notices of premium payment and other documents are subcontracted to health insurance service system vendors.
  • Data on health insurance card symbol and number, name, date of birth, gender, and address from master databases of applicants for health examinations are provided to contracted examining institutions and their partner examining institutions for use in sending results of health examinations.
  • Data on health insurance card symbol and number and date of birth from master databases of users of contracted recreation facilities are provided to the operators of such facilities for use in processing applications for facility use.
  • Data on health insurance card symbol and number, name, and address from master databases are used to send Association bulletins to members.
• The Association uses claims for cash benefits and other benefits in its operations, as outlined below.
  • Data is entered into Association administrative processing computers to confirm the information provided in claims and to make suitable benefit decisions.
  • Data on benefit records is input and stored for later use in confirming or reviewing claims.
  • The Association reviews data from master databases for members claiming the Childbirth and Childcare Lump-Sum Grant or Dependents' Childbirth and Childcare Lump-Sum Grant, including the health insurance card symbol and number, name, and date of birth and check this data with other insurers to make appropriate benefit decisions and make adjustments related to duplication of benefits with other insurers.
  • The Association will respond to inquiries from other insurers to indicate whether or not a claim has been filed and/or payment of benefits has been made for the Childbirth and Childcare Lump-Sum Grant, Dependents' Childbirth and Childcare Lump-Sum Grant, or Injury and Sickness Allowance. The Association always confirms the identity of the party making the inquiry.
  • The Association uses rezept data for those claiming the Injury and Sickness Allowance to check claims. In certain cases, the Association will confirm treatment status or other information with the physician responsible or visit a health or medical facility to ensure appropriate decision-making regarding benefits.
• Rezept data is stored on Association administrative processing computers for use across health insurance service operations. The format is either: for claims submitted in CSV format by Health Insurance Claims Review & Reimbursement Services (HICRRS), the original format or images thereof; for paper rezepts, a database of digital versions thereof compiled by HICRRS.
  • Rezept data is checked by rezept inspection vendors. In the event of any questions concerning the information provided in the claims, the Association may ask HICRRS to complete a follow-up review.
  • If a follow-up review leads to suspicions that an examination occurred after loss of eligibility, the Association may forward data, including the Association name, health insurance card symbol and number, name, date of birth, date of loss of eligibility, and date of examination, to the medical care institution.
  • Similarly, the Association may forward data, including the Association name, health insurance card symbol and number, name, and date of birth to medical care institutions to determine whether patients expected to receive payment of High-Cost Medical Care Benefits will also receive assistance from public funds or from their local governments.
  • Rezept data is used to analyze medical care costs and to manage the Association’s medical care costs. This data is also used to identify those eligible for follow-up guidance and education on preventing lifestyle-related conditions following health examinations.
  • Members examined by multiple medical care institutions in a single month will be identified and provided guidance based on rezept data.
  • Decisions on payment of High-Cost Medical Care Benefits and additional benefits are made based on rezept data. These benefits include Patient Cost-Sharing Reimbursements and Additional Benefits, Total High-Cost Medical Care Additional Sum, and medical care additional sum for dependents
  • The Association makes decisions regarding the payment of Injury and Sickness Allowance by referring to rezept data.
  • The Association makes decisions regarding the payment of medical care expenses and Secondary Dependent Medical Costs, including those for judotherapy, by referring to rezept data.
  • In response to requests for disclosure, rezept data is printed and delivered. Requests for disclosure from parties other than the individual concerned will be handled in accordance with established procedures and fulfilled only in response to parties authorized by such procedures.
  • A subcontracted health insurance service system vendor will provide medical care cost information and notices of price differences for generic drugs to members based on rezept data.
  • With the consent of the member in question, the Association may share rezept data with medical care institutions and dispensing pharmacies for the purpose of improving the safety and quality of medical care, improving the efficiency of medical care benefits, and rationalizing medical care expenses.
  • If a member receives medical consultation and treatment for injuries attributable to the actions of a third party in traffic accidents or under similar circumstances, the Association will provide a copy of the patient’s rezept to the casualty insurer as proof of medical care costs.
  • The Association will provide details of medical care costs and other data concerning members receiving medical care overseas to a subcontracted translation vendor for translation into Japanese.
  • The Association will send copies of rezepts and application forms containing certain information found in rezepts to the High-Cost Medical Care Group of the National Federation of Health Insurance Societies (NFHIS) to apply for the joint undertaking conducted by NFHIS, under which NFHIS pays a part of high-cost medical care, and receive assistance for medical care costs.
  • After removal of personal identity information, rezepts may be used as teaching materials as case studies in rezept inspection training programs organized by multiple health insurance associations.
• Health examinations are provided by subcontracted health examination service providers.
  • Data on the numerical results of health examinations are obtained from the health examination service provider and provided to the examinees. This data is also stored on Association administrative processing computers for use in identifying those eligible for follow-up guidance and to provide information on preventing lifestyle-related conditions.
  • The Association provides health examinations jointly with employers. In principle, the employer is also notified of the results of health examinations of insured persons. This data is shared by the employer and the Association to facilitate management of the health of insured persons (employees).
  • Health examination results are stored in master databases for comparison to future data and for use as reference information in providing health management services and health guidance.
• Other health activities
  • Specific Health Guidance is provided by a subcontracted health guidance service provider.
  • Information and communication technology (ICT) is used to provide members with personalized information based on treatment data.
  • For reference in data analysis and evaluations based on Data Health Plans (plans for implementing health activities effectively and efficiently based on data analysis, including medical care information and health examination results, as part of Japan's National Growth Strategy)*
  • Health examination results and medical data may be used by various federations and research associations of which the Association is a member as materials for effectively implementing health promotion and illness prevention measures.*
  • For use in surveys conducted to study the Association’s health activity programs.
  • For use in dissemination of various health information to maintain and promote health of Association members.

  (*) Before such use, data will be anonymized by removing names, dates of birth, addresses, and other identifying information. In cases in which anonymization is difficult, the Association will obtain the consent of the individual concerned.

• HR data on Association management and employees, lists of Association Committee members, and lists of personnel responsible at employers
  • Documents related to the appointment and hiring of Association management and employees will be stored under strict security.
  • Documents related to compensation of management and employees will be stored under strict security and used to process withholding taxes and for other purposes.
  • Documents related to performance evaluations and other HR matters will be stored under strict security and used in personnel transfers and other activities.
  • Lists of Association Committee members and directors are used to communicate dates and times of Association Committee and Board of Directors meetings and other information.
  • Lists of personnel responsible at employers will be used for various purposes, including communicating information on briefings for personnel responsible at employers, health management promotion committee meetings, and other purposes.
• Specific Personal Information
  • Specific Personal Information refers to personal information that includes Individual Numbers (Social Security and Tax Numbers) (including numbers, codes, or other symbols corresponding to and used in place of Individual Numbers other than certificates of residence codes).
  • The Act on the Use of Numbers to Identify a Specific Individual in the Administrative Procedures (“Act” hereinafter) specifies the scope of use of Specific Personal Information, including the coordination of such information between parties involved in administrative operations, such as administrative agencies (e.g., obtaining information on taxation or non-taxation status from municipal governments for use in dependent certification by a health insurance association). This information is not used beyond the scope specified in the Act.
  • In certain cases, the notices described under 1 and 2 above may qualify as Specific Personal Information because they include Individual Numbers. Since use of such data in accordance with the purposes and methods of use specified under 1 and 2 above falls outside the scope of use specified in the Act, appropriate measures will be taken, including masking or removal of Individual Numbers.
• The Association handles tasks such as retention, administration, disposal, and deletion of personal information, as outlined below.
  • For personal information indicated on various paper notices, applications, rezepts, or other documents, upon completing input processing, the Association or a subcontractor will retain such documents in storage for the mandatory retention period (in years) specified in Association document control regulations. The documents will not be removed from storage except when needed for confirmation or similar purposes.
  • Personal information on media other than paper will be retained and administered appropriately in accordance with management and administration rules on retention in media other than paper format.
  • Paper documents containing personal data for which the mandatory retention period (in years) has expired or personal data is no longer needed as processing is complete will be shredded so as to render the documents illegible. Large volumes of documents containing personal data are handled by dissolving by a specialized subcontractor.
  • Before disposing of personal computers or magnetic media or returning them at the end of a lease period, all data stored on such devices or media is rendered unrecoverable by data destruction software.
  • Personal information held by the Association is used for no purpose other than the above activities.

• Purposes of use necessary for payment of insurance benefits to insured persons, etc.
  [Examples of such use within the Association]
  • Confirmation of the eligibility of insured persons, certification of dependents, and issuance and management of health insurance cards
  • Payment of insurance benefits and additional benefits
  • Administration of use as stipulated by the Act on the Use of Numbers to Identify a Specific Individual in Administrative Procedures
  [Examples of provision of information to other operators, etc.]
  • Payment to salary accounts (employers) for automatic payment of High-Cost Medical Care Benefits, Patient Cost-Sharing Reimbursements, etc.
  • Outsourcing of translations related to overseas medical care expenses
  • Filing claims with casualty insurers, etc. related to third party actions
  • Joint operations involving high-cost medical care benefits with the National Federation of Health Insurance Societies
  • Coordination of information as stipulated by the Act on the Use of Numbers to Identify a Specific Individual in Administrative Procedures
  • Outsourcing of data processing related to the eligibility of insured persons, etc.
• Purposes of use necessary for collection of insurance premiums, etc.
  [Examples of such use within the Association]
  • Ascertaining of standard monthly remuneration and standard bonus amounts
  • Collection of health insurance premiums, long-term care insurance premiums, and regulation insurance premiums
• Purposes of use necessary for health activities
  [Examples of such use within the Association]
  • Health examinations for purposes of health maintenance and promotion; health guidance and health consultations
  • Implementation of specific health checkups and health guidance
  • Transmission of health information etc. for purposes of health maintenance and promotion
  [Examples of provision of information to other operators, etc.]
  • Management of implementation status of specific health checkups and health guidance, and reporting such to the national government
  • Entrustment of health guidance and health consultations to industrial physicians
  • Entrustment of health examinations to medical care institutions
  • Provision of health examination results to employers as part of joint health activities
  • Provision of medical care cost information to insured persons, etc.
• Purposes of use necessary for review and payment of medical fees
  [Examples of such use within the Association]
  • Inspection and review of the contents of medical cost details (rezepts), etc.
  [Examples of provision of information to other operators, etc.]
  • Entrustment of inspection and review of the contents of rezept data
  • Entrustment of data entry by punching input and image scanning for computer processing of rezept data
  [Examples of provision of information to the healthcare bill check and payment organization]
  • Provision of member information for rezept transfers via the system for online confirmation of eligibility, etc.
  • Inquiries and provision of member information related to requests for re-examination for rezept transfers via the system for online confirmation of eligibility, etc.
• Purposes of use necessary to support Association operations
  [Examples of such use within the Association]
  • Medical care cost analysis; disease analysis
  [Examples of provision of information to other operators, etc.]
  • Outsourcing of data processing related to medical care cost analysis and medical care cost information
  • Participation in the medical care cost analysis project at the headquarters of the National Federation of Health Insurance Societies
• Other purposes
  [Examples of such use within the Association]
  • Basic data to maintain and improve administrative operations of the Association
  [Examples of provision of information to other operators, etc.]
  • Consultations with or notifications to insurers, medical care institutions, etc. in administration of claims for compensation from third parties
• Specific Personal Information
  Purposes of use in coordinating information with other medical insurers or administrative agencies (“other institutions” hereinafter) as stipulated in Article 19, Item 7 of the Act on the Use of Numbers to Identify a Specific Individual in Administrative Procedures
  [Receiving information from other institutions for administrative processing by the Association]
  • Benefit information related to the review process for insurance benefits such as injury and sickness allowance and high-cost medical care benefits
  • Information on taxation/tax exemption related to matters such as determination of copayment categories of elderly recipients
  • Information on eligibility with other institutions related to the process of obtaining the eligibility of insured persons
  • Information on taxation/tax exemption, certificate of residence information, etc. related to the dependent certification process
  [Provision of information by the Association for administrative processing by other institutions]
  • Information on insurance benefits from the Association related to the benefit payment process of other institutions for benefits such as high-cost medical care benefits and childbirth- and funeral-related benefits
  • Information on eligibility and dependent certification with the Association for the process of confirmation of eligibility by other institutions for purposes such as obtaining the eligibility of insured persons and dependent certification
• Purposes of use pertaining to the use of the online eligibility verification system
  [Provision of information by the Association for administrative processing by other institutions]
  • Eligibility-related information on insured persons, etc. and registration of specific health checkup data
  [Receiving information from other institutions for administrative processing by the Association]
  • Specific health checkup data