The long-term care insurance program

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.

• *In some cases, persons aged 40 or above are exempt from long-term care insurance.

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

Copayments for long-term care services

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%	Total income of the person: 1.6 million yen or more, Pension income + other total income of Category 1 insured persons in the same household: 2.8 million yen or more for a single-person household, 3.46 million yen or more for a household of two or more persons
30%	Total income of the person: 2.2 million yen or more, Pension income + other total income of Category 1 insured persons in the same household: 3.4 million yen or more for a single-person household, 4.63 million yen or more for a household of two or more persons

• * 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 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 Society insured persons: Collected by the Health Insurance Society from monthly salary and bonuses in the same way as health insurance premiums Health Insurance Society 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 Society)

Specified Insured Persons program for long-term care insurance

Health Insurance Societies introduce "specified insured persons program" for long-term care insurance" based on approval of Minister of Health and Welfare to fairly collecting the insurance premiums from the insured. Under the program, the insured person, who is not a Category 2 insured person, is required to pay the long-term care insurance premiums if any of his/her family members is a Category 2 insured person. Payment of the long-term care insurance premiums for Mitsui O.S.K. Health Insurance Society members are explained below.

Age of the insured and the family	Premiums to be paid or not by types of the insured, Premiums to be paid to
The insured: 39 or under The family: 39 or under	The insured: unnecessary to pay The family: unnecessary to pay
The insured: 39 or under The family: 40 - 64	The insured: unnecessary to pay The family: pay to Mitsui O.S.K. Health Insurance Society via the insured as Category 2 insured person ("Specified Insured Persons program" is applied.)
The insured: 39 or under The family: 65 or over	The insured: unnecessary to pay The family: pay to their local municipal government as Category 1 insured person
The insured: 40 - 64 The family: 39 or under	The insured: pay to Mitsui O.S.K. Health Insurance Society as Category 2 insured person The family: unnecessary to pay
The insured: 40 - 64 The family: 40 - 64	The insured and the family: pay to Mitsui O.S.K. Health Insurance Society as Category 2 insured person
The insured: 40 - 64 The family: 65 or over	The insured: pay to Mitsui O.S.K. Health Insurance Society as Category 2 insured person The family: pay to their local municipal government as Category 1 insured person
The insured: 65 or over The family: 39 or under	The insured: pay to their local municipal government as Category 1 insured person The family: unnecessary to pay
The insured: 65 or over The family: 40 - 64	The insured: pay to their local municipal government as Category 1 insured person The family: pay to Mitsui O.S.K. Health Insurance Society via the insured as Category 2 insured person ("Specified Insured Persons program" is applied.)
The insured: 65 or over The family: 65 or over	The insured and the family: pay to their local municipal government as Category 1 insured person

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)
• Integrated facilities for medical and 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.

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