When workers covered by health insurance takes leave without pay due to non-work-related injuries or illnesses, they can receive benefits. Currently, the benefits are paid for up to a continuous period of one year and six months. From January 2022, the maximum period will be changed to a total of one year and six months. Following are major points of the change, according to Q&A provided by the Health and Labor Ministry regarding the revision to the rules of accident and sickness benefits.
[1] The duration and expiration of benefit payment period
The maximum period of the payment of accident and sickness benefit will be a total of one year and six months. Excluding the first three days of the moratorium period, the calculation is started from the fourth day from the claim is made, according to the calendar.
Let’s check the calculation method using an example.
[Case] A worker became unable to work from March 1, 2022, and has claimed benefits for multiple periods.
1. March 1, 2022 – April 10, 2022 Benefits are paid for 38 days (excluding the moratorium)
2. April 11, 2022 – April 20, 2022 Benefits are paid for 10 days
3. May 11, 2022 – June 10, 2022 Benefits are paid for 31 days
In this case, the three days from March 1, 2022, are considered as the moratorium period and the calculation of the benefit payment period starts from March 4. According to the calendar, the last day of the one-year-and-six-month period is September 3, 2023, and the total number of days is 549.
After the first round of benefit payment (above 1), the number of remaining days will be 511 (549-38), and after the second round of payment (above 2), the number of remaining days will be 501 (511-10). Once the third round of payment ends (above 3), 470 days (401-31) will remain as the period for which benefit can be claimed if necessary.
[2] In the case a worker is receiving benefits as of January 2022
If a worker was receiving benefits before December 31, 2021, the total period of benefit payment will be determined according to whether one year and six months have passed from the initial day of the payment as of December 31, 2021. If the start of the benefit payment was on July 1, 2020, or before, one year and six months will elapse as of December 31, 2021. Even if the worker becomes unable to work due to the same injury or illness after January 1, 2022, benefit cannot be claimed. If the worker started receiving benefit on July 2, 2020, or after, the period of one year and six months will not expire as of December 31, 2021, therefore, the worker can claim benefits after January 1, 2022.
For example, if benefits were paid for 30 days from July 2 to July 31 of 2020, the benefit payment period will be from July 2, 2020, to January 1, 2022, and the total number of days is 549. Since benefits have already been paid for 30 days, the remainder of the period will be 519 days as of January 1, 2022.
Normally, companies provide explanation to employees about the system of non-work-related injury or sickness benefits when the need arises. Even if there were such cases in the past, companies should understand the latest change and provide accurate explanation to their employees.
[Reference]
Ministry of Health, Labour and Welfare (Japanese only)
Changes in the calculation of the payment period of accident and sickness benefits by Health Insurance Associations
https://www.mhlw.go.jp/stf/newpage_22308.html
Japanese law database service “Notice regarding changes in the Health Insurance Act pursuant to law amendments to establish a social security system that covers all generations”
https://www.mhlw.go.jp/hourei/doc/tsuchi/T211115S0010.pdf
*This article was written based on the laws as of December 7, 2021.
