Japan makes the benefit period of the Injury and Sickness Allowance (傷病手当金) cumulative — changed to 「1 year and 6 months in total from the day payment starts」 (for insured persons themselves under the 健康保険法 and the 船員保険法; in force January 1, 2022)
Source material is a Japanese government announcement (in Japanese); this page is a summary.
This amendment concerns the 傷病手当金 under the 健康保険法 and the 船員保険法, and applies to insured persons themselves. From January 1, 2022 Japan's 傷病手当金 is paid for 「1 year and 6 months in total from the day payment starts」, so that the benefit period is not reduced by the number of days in any period in between for which no 傷病手当金 was paid; the benefit period is reduced, however, for a period in which part of the allowance was paid because the amount of remuneration, a disability pension, a maternity allowance or the like was less than the amount of the 傷病手当金.
Key facts
| Effective date | January 1, 2022 (令和4年1月1日). 問12 of the Q&A states 「令和4年1月1日から施行される」. The 「施行期日」 item in the PDF outline of the amending Act likewise sets the main rule at 「令和４年１月１日」, but lists exceptions in brackets — 1(1) (the counter charge for the latter-stage elderly) on a day to be fixed by cabinet order between October 1 of 令和4年 and March 1 of 令和5年; 2(1) (exemption from insurance premiums during childcare leave) on October 1 of 令和4年; 2(2) and 4(1) on April 1 of 令和4年; 4(2) on April 1 of 令和6年; and 4(3), apart from some parts, on a day to be fixed by cabinet order within a period not exceeding 3 years counted from the date of promulgation. Making the 傷病手当金 benefit period cumulative is item 1(2) of the outline, and it is not included in this list of bracketed exceptions. |
|---|---|
| How the benefit period is calculated | The benefit period under Article 99, paragraph 4 of the 健康保険法 is 「その支給を始めた日から通算して1年6月間」. It is fixed by counting 1 year and 6 months on the calendar from the 4th day, on which payment begins after the 3-day waiting period following the first claim (問1). In the example in 問2, payment begins on March 4 after the 3-day waiting period of March 1–3 of 令和4年, and the benefit period runs to September 3 of 令和5年 — 549 days. The benefit period and the daily amount payable are determined on the day payment starts (問3). |
| When the benefit period is not reduced / when it is reduced | Not reduced — by the number of days in a 無支給期間 (問1); for a period in which the 傷病手当金 was not paid because of adjustment against remuneration, a disability pension, a maternity allowance or the like (問5); where, for a period with no payment, only a 傷病手当金付加金 (supplementary allowance) was paid under the rules of a health insurance society (問8); and where the 傷病手当金 was not paid because of the expiry of the limitation period (問10). Reduced — where the amount of remuneration, a disability pension, a maternity allowance or the like is less than the amount of the 傷病手当金 so that part of the 傷病手当金 is paid (問5); where a 傷病手当金 has been paid in a case in which a maternity allowance should have been paid and is treated as an advance payment of that maternity allowance (問5); and, where a 傷病手当金 is paid for the same period in respect of more than one illness or injury, by the number of days paid, for the benefit period relating to each of them (問6). |
| Example of remaining benefit days and the day the benefit period ends (問2) | From a benefit period of 549 days: ① after 38 days paid, 511 days remain; ② after 10 days paid, 501 days; ③ after 31 days paid, 470 days. The day on which the remaining benefit days reach 0 is the day the benefit period ends. If the person is unable to work for 470 consecutive days from the day after the end of period ③ (June 11 of 令和4年), the benefit period ends on September 23 of 令和5年; if the person worked for a total of 40 days during the benefit period, it ends on November 2 of 令和5年. |
| Transitional measure (for allowances that started before the effective date) | Article 3, paragraph 2 of the Supplementary Provisions of the amending Act — the provisions after the amendment apply to a 傷病手当金 for which 1 year and 6 months counted from 「the day payment started」 had not elapsed as at the day before the effective date, while a 傷病手当金 whose benefit period under the provisions before the amendment expired before the effective date remains under the former rules. Accordingly, a 傷病手当金 whose payment started on or after July 2 of 令和2年 had not passed 1 year and 6 months as at the day before the effective date (December 31 of 令和3年), so the provisions after the amendment apply. 【例1】 If the day payment started is July 1 of 令和2年, the benefit period expires on December 31 of 令和3年, so the provisions before the amendment apply. 【例2】 Where payment started on July 2 of 令和2年 and July 2–31 (30 days) was paid, the number of benefit days from July 2 of 令和2年 to January 1 of 令和4年 is 549, and the remaining benefit days as at January 1 of 令和4年 are 519. |
| Calculating the amount payable, and continued benefits after loss of insured status | This amendment makes no change to the way the amount of the 傷病手当金 is calculated; as before, the amount calculated when payment starts is paid (問15). As for continued 傷病手当金 after loss of insured status, Article 104 of the 健康保険法 provides that it is received 「継続して」 (continuously), so, as before, the benefit can continue to be received from the same insurer for the period during which it could have been received as an insured person. Where the person has temporarily become able to work, however, the 傷病手当金 is not paid even if they again become unable to work because of the same illness or injury, whether or not it has been cured (問14). |
Last checked:
This amendment concerns the 傷病手当金 (Injury and Sickness Allowance) under the 健康保険法 (Health Insurance Act) and the 船員保険法 (Mariners Insurance Act), and applies to insured persons themselves. Japan amended the 健康保険法 and the 船員保険法 by the 「全世代対応型の社会保障制度を構築するための健康保険法等の一部を改正する法律」 (令和3年法律第66号) and, from January 1, 2022, made the benefit period of the 傷病手当金 cumulative. The outline of the amending Act describes this item as 「傷病手当金について、出勤に伴い不支給となった期間がある場合、その分の期間を延長して支給を受けられるよう、支給期間の通算化を行う」. The benefit period is 「その支給を始めた日から通算して1年6月間」 under Article 99, paragraph 4 of the 健康保険法, and is fixed by counting 1 year and 6 months on the calendar from the 4th day, on which payment begins after the 3-day 待期期間 (waiting period) following the first claim (Q&A 問1). The benefit period is reduced by the units in which the 傷病手当金 is paid, and as a rule it is not reduced by the number of days in any 無支給期間 (period with no payment) in between (問1 and 問5). It is reduced, however, where the amount of remuneration, a disability pension, a maternity allowance or the like is less than the amount of the 傷病手当金 so that part of the 傷病手当金 is paid, and where a 傷病手当金 has been paid in a case in which a maternity allowance should have been paid and is treated as an advance payment (内払) of that maternity allowance (問5). As a transitional measure, the provisions after the amendment apply to a 傷病手当金 for which 1 year and 6 months counted from 「the day payment started」 had not elapsed as at the day before the effective date, while a 傷病手当金 whose benefit period under the provisions before the amendment expired before the effective date remains under the former rules (Article 3, paragraph 2 of the Supplementary Provisions of the amending Act, and 問13).
Summaries below are factual notes based on government announcements and primary sources — not evaluations or opinions.
Summaries reflect national-level programs. Municipal (city/ward/town) programs may differ — confirm with the official desk before applying.
FAQ
If I go back to work for some days in between, can I receive the 傷病手当金 for that much longer later on?
The benefit period is reduced by the units in which the 傷病手当金 is paid, and where there is a 無支給期間 (period with no payment) in between, the benefit period is not reduced by the number of days in it (問1). The outline of the amending Act likewise describes the amendment as making the benefit period cumulative 「出勤に伴い不支給となった期間がある場合、その分の期間を延長して支給を受けられるよう」. There are exceptions, however. Where the amount of remuneration, a disability pension, a maternity allowance or the like is less than the amount of the 傷病手当金 so that part of the 傷病手当金 is paid, the benefit period is reduced; and where a 傷病手当金 has been paid in a case in which a maternity allowance should have been paid and is treated as an advance payment of that maternity allowance, the benefit period is also reduced (問5).
What happens to continued benefits after loss of insured status (on leaving a job, for example)?
On continued 傷病手当金 after loss of insured status, 問14 states that, because Article 104 of the 健康保険法 provides that it is received 「継続して」 (continuously), the benefit can, as before, continue to be received from the same insurer for the period during which it could have been received as an insured person. It states, however, that where the person has temporarily become able to work, the 傷病手当金 is not paid even if they again become unable to work because of the same illness or injury, whether or not it has been cured (問14). This is a statement about continued benefits after loss of insured status, and is a separate item from the cumulative benefit period described above (under which the benefit period is not reduced by the number of days in a period with no payment).
Does the cumulative rule also apply to a 傷病手当金 I had been receiving before January 1, 2022?
Under Article 3, paragraph 2 of the Supplementary Provisions of the amending Act, the provisions after the amendment apply to a 傷病手当金 for which 1 year and 6 months counted from 「the day payment started」 had not elapsed as at the day before the effective date. Accordingly, a 傷病手当金 whose payment started on or after July 2 of 令和2年 (2020) had not passed 1 year and 6 months as at December 31 of 令和3年, the day before the effective date, so the provisions after the amendment apply and the benefit period is counted cumulatively. 【例2】 in the document states that, where payment started on July 2 of 令和2年 and July 2–31 (30 days) was paid, the number of benefit days from July 2 of 令和2年 to January 1 of 令和4年 is 549, and the remaining benefit days as at January 1 of 令和4年 are 519. Conversely, a 傷病手当金 whose benefit period under the provisions before the amendment expired before the effective date remains under the former rules — in 【例1】, where the day payment started is July 1 of 令和2年, the benefit period expires on December 31 of 令和3年, so the provisions before the amendment apply (問13).
What happens to the benefit period and the amount if I make a claim retroactively later?
Where a claim is made retroactively after the event for a period on or after the day payment started (the reckoning day), the day payment started does not change and neither the benefit period nor the amount changes, so there is no need to cancel the decision to pay the 傷病手当金 made on the basis of that starting day (問3). Conversely, where a claim is made for a period before the day payment started, the day payment started changes and so do the benefit period and the amount, so the decision to pay the 傷病手当金 made on the basis of the 「old」 starting day is cancelled and a payment decision is made again on the basis of the 「new」 starting day (問3 and 問4). The way the amount itself is calculated is not changed by this amendment; as before, the amount calculated when payment starts is paid (問15). In addition, this document is an administrative communication addressed to the 全国健康保険協会, 健康保険組合, 健康保険組合連合会 and 地方厚生(支)局, and it does not state where an individual should make enquiries.