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A Brief Introduction to Labor Insurance
  1. Insured unit and insured persons:
    Labor insurance is a group insurance. All units eligible for coverage shall join the program with their employees insured. Labor insurance is both compulsory and voluntary. Under the compulsory category, all workers, aged above 15 and below 60, working in an establishment with 5 or more employees such as factories, mines, companies, business firms, journalistic, cultural and non-profit cooperative enterprises, and employees of government agencies or public and private schools who are not eligible for civil servants・ insurance program or the insurance program of teachers and employees of private schools, persons employed in the fishing industry, persons receiving vocational training in vocational training institutes registered with the government, freelance workers without regular employer or self-employed workers as well as fishermen who belong to Class A of Fishermen・s Association are required to join the labor insurance program. Candidates participating on a voluntary basis include all workers belonging to industries other than those which are legally and compulsory required to join the program; employers who are also working; workers working for an employer with less than four employees; those insured who have withdrawn from the program due to separation from employment but have not filed for old-age benefits and have resumed working after reaching the age of 60; retirees who have claimed old-age benefits from social insurance schemes and resumed working; and persons who have, in accordance with law, applied for leave without pay for nursing at home.
  2. Premium rates and insurance salary:
    The premium rates are of two types: ordinary risk and occupational accident. The former is currently prescribed at a rate of 5.5% of the insured person・s monthly insurance salary. The ratio of the premium payment is 70% paid by the employer, if the insured has a regular employer, 20% by the insured and 10% by the government. For occupational accident, the full premium is for the account of the employer. In case of no regular employer or being self-employed, the insured affiliated with an occupational union shall bear 60% of the premium for both the ordinary risk and occupational accident insurance, and the remaining 40% shall be paid by the government. Being Class A member of Fishermen・s Association without a regular employer or self-employed, the insured shall bear 20% of the premium for both the ordinary risk and occupational accident insurance, and the remaining 80% shall be paid by the government. As to the insurance premium rate for occupational accident, it varies according to the Table of Categories of Occupations and Premium Rates Applicable for Occupational Accident Insurance. Since the Merit Rating System of Occupational Accident Insurance was implemented in 1996, an insured unit with over one hundred employees shall pay the premium at a rate which is readjusted every year pursuant to the increase or decrease of occupational injury benefits claimed by the insured unit. Application of the measure has been further expanded to cover units with 70 employees since 2003. In addition, the insurance salary for labor insurance has been based on the actual salary total of the insured filed in accordance with the Table of Grades of Insurance Salary.
  3. Benefits:
    The labor insurance program provides five kinds of benefits payable in cash, viz. maternity benefits, injury or sickness benefits, disability benefits, old-age benefits, and death benefits under the ordinary risk category. For occupational accident, there are injury or sickness benefits, disability benefits, death benefits and medical care benefits.
    • Maternity benefits:
      If an insured person has childbirth occurring more than 280 or more days after joining the program or has premature labor occurring 181 days after joining, she is entitled to claim a lump sum of maternity benefits equivalent to one month of her average monthly insurance salary.
    • Injury or sickness benefits:
      In case an insured person is not receiving salary payment on account of an injury or sickness for which he or she receives medical treatment, he or she is entitled to claim injury or sickness benefits beginning from the fourth day on which he or she is incapacitated for work.

      The inpatient hospitalization benefits of ordinary injury or sickness shall be payable at the rate of fifty percent of the average monthly insurance salary of an insured person for the maximum period of six months. In case the insured person has at lease one full year of insurance coverage prior to the occurrence of the injury or sickness, such benefits shall be payable for an additional six months.

      The inpatient hospitalization benefits and outpatient medical care benefits of occupational injury or sickness shall be payable at the rate of seventy percent of the average monthly insurance salary. In case the injured person has not recovered from the injury or sickness after one full year, the benefits are reduced to fifty percent of the average monthly insurance salary for the maximum period of one year.
    • Disability benefits:
      In case an insured person who, in the wake of a medical treatment of injury or sickness, on the expiration of the period when he or she receives ordinary injury or sickness benefits, or at least one year after receiving medical treatment, has not recovered or suffers from any physical handicap which conforms to the provisions of the Disability Benefits Payment Schedule, and the diagnosis by a hospital specially contracted by the Bureau of National Health Insurance confirms that the insured person will be disabled for the rest of his or her life or his or her injury or sickness is incurable, he or she may claim the payment of disability benefits according to the degree of disability. The minimum payment of disability benefits is equivalent to thirty day・s salary computed on the basis of the average monthly insurance salary of the insured person; the maximum payment, 1,200 days. An insured person shall be paid an additional fifty percent of disability benefits if he can not continue to work on account of disability caused by occupational injury or sickness. If an insured person is unable to continue his original work after receiving disability benefits, the effect of his or her insurance shall be terminated immediately.
    • Old-age benefits:
      An insured person who has any of the following conditions is entitled to claim old-age benefits:
      • An insured person at least sixty years of age or a female insured person at least fifty-five years of age who has been insured for at least one year and retires;
      • An insured person whose insurance coverage reached over fifteen years, who is at least fifty-five years of age and retires;
      • An insured person who has been insured in the same insured unit for over twenty-five years and retires;
      • An insured person whose insurance coverage reached over twenty-five years, who is at least fifty years of age and retires;
      • An insured person who has been employed for more than five years in physical hard labor, work of special character, certified by the competent central authority as dangerous, who is at least fifty-five years of age and retires; or
      • Those retirees who are transferred to the military and civil servants・ insurance program and have met the requirements as specified in Article 76 of the Labor Insurance Act.

        An insured person who claims old-age benefits payment shall receive one-month・s old-age benefits for each one of his or her coverage years computed on the basis of his or her average monthly insurance salary. In case his or her coverage exceeds fifteen years, he or she is entitled to received two-months・ old-age benefits for each one of the excess years, provided that the maximum amount of old-age benefits payment shall not exceed forty-five months of insurance salary for his or her insurance coverage below sixty years of age. Where it has exceeded half a year, it shall be counted as one year. In case an insured person continues to work after attaining sixty years of age only additional five years are payable. The maximum payment including the old-age benefits receivable before he or she attains sixty years of age shall not exceed fifty months・ insurance salary.
    • Death benefits:
      • Death of family member:
        Three months・ salaries on the basis of his or her average monthly insurance salary in the event of the death of his or her father, mother or spouse; Two and a half months・ salaries on the basis of his or her average monthly insurance salary in the event of the death of his or her child at least twelve years of age; or One and a half months・ salaries on the basis of his or her average monthly insurance salary in the event of the death of his or her child less than twelve years of age.
      • Death of the insured:
        In the event of the death of an insured person, five months・ average monthly insurance salary for burial subsidy is payable in addition to survivors・ benefits paid according to the following provisions:
        l Ten-month survivors・ benefits shall be payable in one lump sum on the basis of his or her average monthly insurance salary in case his or her insurance coverage is less than one full year; l Twenty-month survivors・ benefits shall be payable in one lump sum on the basis of his or her average monthly insurance salary in case his or her insurance coverage is more than one full year but less than two full years; or l Thirty-month survivors・ benefits shall be payable in one lump sum on the basis of his or her average monthly insurance salary in case his or her insurance coverage is more than two full years.
      • Death of the insured caused by occupational injury or sickness:
        In case an insured person dies from an occupational injury or sickness, not only shall a five-month burial subsidy be payable on the basis of his or her average monthly insurance salary, but forty-month survivors・ benefits shall also be payable to his survivors.
    • Medical care benefits for occupational injury:
      Medical care benefits for ordinary injury or sickness are covered by the national health insurance program while medical costs from occupational injury are paid by the labor insurance program. Such being the case, the insured who has contracted occupational injury or sickness should apply for medical service with the medical service institute under the national health insurance program, in which case, cost-sharing shall be exempt and half of the expenses for ordinary and therapeutic diet shall be paid for the maximum period of 30 days. In addition, to protect the health of the insured, the Bureau of Labor Insurance also offers free medical check-ups to workers to prevent and treat occupational disease in the early stages.
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