Financial Planning Skills Test, Grade 3 | Practical Social Insurance and Public Pension Cases

High-Cost Medical Expense Benefits are assessed using insured-treatment cost sharing paid within the same calendar month. January 31 and February 1 are in different months despite being consecutive dates, so each month is compared separately with its ceiling. This differs from the medical expense deduction for income tax, including in its aggregation period and purpose.

When high insured-treatment costs are known in advance, the patient can consent to ceiling information being provided through a My Number health insurance card, or present a Certificate of Eligibility for Ceiling-Amount Application, to limit the eligible counter payment. The medical expense deduction is an income-tax measure, not a procedure that directly limits payment at the time of treatment.

The allowance requires three consecutive days during which the employee cannot work because of treatment. Working on Wednesday breaks continuity with Monday and Tuesday, so the count restarts on Thursday. Thursday, Friday, and Saturday complete the waiting period, and Sunday may be payable as day four if the other requirements are met.

Paid leave and company holidays such as Saturday and Sunday may count toward the three-day waiting period when the employee cannot work because of treatment; remuneration during the waiting period does not control whether a day counts. Friday through Sunday are therefore three consecutive days, and Monday may be payable if the remaining conditions are met.

The maximum for the same illness is 18 months in cumulative payable periods from the initial payment date. The eight paid months have been used, but the four months worked and not paid do not consume the cumulative maximum. Returning to work neither removes the remaining period nor creates a fresh 18-month maximum for the same illness.

Continued benefit after loss of insured status requires not only at least one continuous year of insured status before retirement, but also receipt of the allowance or satisfaction of its conditions when insured status is lost. Working on the retirement date defeats that condition, so two years of insured status alone is insufficient.

If delivery occurs after the expected date, the overdue period from the expected date through actual delivery is also covered by Maternity Allowance. The delivery date belongs to the prenatal side, and the 56 postnatal days begin on the day after actual delivery. The original 42 prenatal days are not reduced by the number of overdue days.

Maternity Allowance is paid when the eligible periods overlap, but if the daily Injury and Sickness Allowance is higher, the insured person may claim the difference as Injury and Sickness Allowance. The two benefits are not paid in full simultaneously; here they are coordinated to a total of JPY 6,800 per day.

The Old-Age Basic Pension and Old-Age Employees' Pension may be deferred separately. The ordinary increase is 0.7% per month, so 24 months produces 16.8%, and the increased rate continues for life. It is the Special Old-Age Employees' Pension that cannot be deferred, not the ordinary Old-Age Basic Pension.

For contribution deferment between ages 20 and 49, the prior-year incomes of the applicant and spouse are assessed, but the household head's income is not. An approved period counts toward the qualifying period for the Old-Age Basic Pension, but does not increase its amount unless contributions are paid later. Later payment is possible within ten years, distinguishing approved deferment from both simple nonpayment and full payment.