A Health Insurance System for Those 75 Years of Age or Older

Section in charge: Elderly Health Section, Elderly Health Division

Those who are currently enrolled in National Health Insurance or employee’s health insurance will automatically be withdrawn from that insurance and enroll in the Medical Care System for the Older Senior Citizen when they turn 75 years of age.

●Those Who Are Eligible
Everyone 75 years of age or older who is registered as a resident in Shinjuku City must enroll in the Medical Care System for the Older Senior Citizen. In addition, those who are between 65 and 74 years of age with a designated level of disability can enroll in the Medical Care System for the Older Senior Citizen on a voluntary basis through an accelerated program. However, enrollment is not permitted for some individuals, such as those listed below:

1. If your status of residence is “Diplomat” or for medical purposes or tourism/vacation within “Designated Activities.”
2. Those who stay in Japan beyond the designated period of stay or those whose period of stay stated on the visa (e.g., short-term visa) is three months or less (The latter exclude those who have some form of documentation that verifies their actual period of stay will be longer than three months.)
3. Those who are receiving public financial assistance for everyday living

Please call for more information on enrollment requirements.

●Acquisition/Loss of Eligibility and Necessary Procedures
Eligibility for insurance does not start from the date of application, but instead dates back to the date by which enrollment should have been completed.

1. If you reach 75 years of age (from your 75th birthday)
2. If you are 75 years of age or older and move into Tokyo (enter Japan) from another area (A notification form must be filed.)
3. If you are 65 years of age or older and are confirmed by the Tokyo Metropolitan Association of Medical Care Services for Older Senior Citizens as having a designated level of disability (An application form must be filed.)
4. If other conditions, such as the termination of public financial assistance for everyday living, apply (A notification form must be filed.)

If you lose your eligibility for membership, you must return your health insurance card.

1. If you move out of Tokyo (leave Japan) or return to your home country (A notification form must be filed.)
2. If a member dies
3. If you are between 65 and 74 years of age and no longer have a designated level of disability or if you request to withdraw your application to have your disability confirmed. (Note: You must submit a withdrawal application form.)
4. If other conditions, such as you start receiving public financial assistance for everyday living, apply (A notification form must be filed.)

●Health Insurance Card
Each qualifying member of the Medical Care System for the Older Senior Citizen will be issued a health insurance card.
A new health insurance card will be mailed to those who reach 75 years of age. You will not need to complete designated procedures.

●Health Insurance Premiums
Annual insurance premiums are calculated for each and every member and consist of a per capita amount, which everyone bears equally, and an income-based amount, which is borne according to income.
Insurance premium rates (uniform in Tokyo as a rule) and insurance premium ceilings are established by the Tokyo Metropolitan Association of Medical Care Services for Older Senior Citizens and considered for adjustment every two years.
Note: For those with a low income, there are reduction programs using designated standards.

● How to Pay the Insurance Premium
Because insurance premiums are an indispensable resource for the smooth operation of the Medical Care System for the Older Senior Citizen, please do not forget to pay your premiums.

1. Pension deduction: If you receive a designated amount or more in public pension and if the total sum of your premiums for Long-Term Care Insurance and Medical Care Insurance for Older Senior Citizens is within 1/2 of that pension amount, premiums are deducted directly from your pension. However, if you submit an application form for a change in payment method and a request form for the direct debit (automatic payment) service, then premiums are paid by direct debit from your financial account.
2. Other than pension deduction: If the requirements for pension deduction do not apply to you, please pay your premiums by the designated deadline at the service counters of financial institutions or convenience stores. Premiums can also be paid at the City Office or your local Branch Office. Paying by bank account debit (direct debit method) is convenient and recommended. Ordinarily, premiums are automatically deducted from your financial account at the end of each month. If you would like to take advantage of this service, please complete the request form for the direct debit (automatic payment) service enclosed with your premium invoice.

Membership Benefits of the Medical Care System for the Older Senior Citizen

Section in charge: Elderly Health Section, Elderly Health Division

The Medical Care System for the Older Senior Citizen is a medical health insurance system in which members who are 75 years of age or older pay insurance premiums according to their income to cover medical expenses. If you receive treatment for an illness or injury and show your Older Senior Citizen’s Medical Care Insurance card at the hospital reception counter, then you only need to pay a portion of the medical expense. The Medical Care System for the Older Senior Citizen will cover the remaining portion.

●Personally Borne Expense Paid at the Counter
The personally borne expense paid at hospitals and other medical institutions is from 10 to 30% of the total medical expense covered by health insurance. (Your income and other factors determine the percentage of medical expenses you pay.) Please call for more information.

●High Medical Expenses
If the medical fees you paid between the first and last days of the month exceed the designated ceiling for personally borne medical expenses, the excess amount can be reimbursed.
Because a notification from the Tokyo Metropolitan Association of Medical Care Services for Older Senior Citizens is mailed to those who can receive this benefit after a designated period, please complete the form after you receive the notification and apply for it.

●Financial Assistance for Hospitalization Expenses
If a member of the Medical Care System for the Older Senior Citizen is hospitalized for a total of seven days or longer during the fiscal year, a benefit of ¥10,000 to ¥30,000 is provided according to the length of hospitalization.
To receive this benefit, you must complete designated application procedures. Please call for more information concerning the required documents to complete this process.

●Funeral Expense Benefit
If a member of the Medical Care System for the Older Senior Citizen dies, a benefit of ¥70,000 is paid to the person who arranged the funeral.
To receive this benefit, an application form must be filed. Please call for more information concerning the required documents.

●Recreation Programs
Various recreation programs are provided to help members of the Medical Care System for the Older Senior Citizen maintain their health. Please inquire for details.

●Health Checkups
Health checkups are conducted for members of the Medical Care System for the Older Senior Citizen at local medical institutions. To apply for a health checkup, please read the section for health checkups on page 9.

April 1, 2023