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Updated: July 2025, 2

Criteria for being designated as an insurance medical institution

Designation as an insurance medical institution is a system required for medical institutions to provide medical treatment covered by public health insurance under the Health Insurance Act.

To receive the designation, the following criteria must be met:

(1) Compliance with facility standards

Hospitals are required to have the necessary facilities and personnel to provide appropriate insured medical care.
This includes ensuring that each medical department has the necessary medical equipment and facility conditions.

(2) Qualification requirements for medical personnel

Doctors, dentists, and pharmacists providing insured medical treatment must have the appropriate qualifications and have received the necessary training.

(3) Proper operation and management

Proper recording and storage of medical records, management of medical fee claims, and appropriate patient care are required.

⑷ Validity period and renewal of designation

The designation of an insurance medical institution is usually valid for six years, and renewal procedures must be completed in order to continue receiving the designation.
If you fail to renew your insurance, your medical treatment will no longer be covered, so you are required to submit the appropriate application within the specified period.

Benefits of being designated as an insurance medical institution

Being designated as an insurance medical institution has the following benefits:

(1) It becomes possible to provide medical treatment covered by health insurance

By receiving this designation, patients can receive medical treatment using public health insurance, and medical institutions can charge medical fees.

(2) Response as a designated medical institution for workers' accident compensation and public assistance

By being designated as an insurance medical institution, we will be able to apply for designation as a medical institution for workers' compensation insurance and welfare assistance, enabling us to treat a wider range of patients.

⑶ Contribution to local medical care

By providing medical treatment covered by public health insurance, we can contribute to improving access to medical care in the region and expect to see a stable number of patients.

Details of the designation application procedure

The procedures for applying for designation as an insurance medical institution vary depending on the situation, such as opening a new clinic or relocating.
Each case will be explained below.

(1) Application for designation as a health insurance medical institution in relation to the opening of a new clinic or branch office

Clinics that only provide free treatment do not need to be designated as an insurance medical institution, but all clinics that provide insurance treatment must be designated as an insurance medical institution.

For designation as an insurance medical institution, applications must be submitted by the deadline set by the Health and Welfare Bureau after the opening of the clinic, and the designation will, in principle, be made on the 1st of the following month. By receiving this designation, you will be able to begin medical treatment at the clinic.

A medical institution code, which is required for receipts, etc., will also be assigned at the time of this designation.

When opening a new clinic or a branch clinic, the following procedures must be completed in order to be designated as an insured medical institution.

Submitting a designation application

Prepare the necessary documents and submit an application for designation to the local health and welfare bureau in your area. The application should include an overview of the facility, medical specialties, and the qualifications of medical staff.

Check the example of the designated application form

To avoid any errors in your application, it is important to fill out the form while referring to the sample provided by the Ministry of Health, Labour and Welfare.

Inspection and on-site inspection

Once submitted, a review will be conducted and, if necessary, an on-site inspection will be carried out - an important process to ensure that facilities and staffing standards are met.

Issuance of designation notice

If the screening is passed, you will be issued a notice of designation as an insurance medical institution, and your designation will be officially completed.

(2) Application for designation as a health insurance medical institution following relocation of a clinic (retroactive application)

When relocating a clinic, the public health center must obtain permission to open the new clinic and close down the original clinic at the same time, effectively relocating the clinic.

After opening a clinic at the new location, you will apply for designation as an insurance medical institution.You will receive the designation the following month, so you will need to apply retroactively to avoid a blank period for designation as an insurance medical institution.　

A retroactive application is a procedure in which the effectiveness of the designation is retroactively recognized in order to continue medical treatment after the relocation.
Retroactive applications are possible when an insured medical institution etc. relocates to a nearby location (within 2 km in principle) and the old and new medical institutions etc. are opened and closed on the same day, and patients continue to receive treatment.　

As a general rule, you must apply for designation at your new location before relocating so that you can continue to provide insured medical care.

(3) Notification of designation of other insurance medical institutions

Appropriate designation applications or notifications are required in the following cases:

Designated medical institution

Pharmacy Application If you wish to dispense medicines under health insurance as an insurance pharmacy, you will need to apply to become a designated medical institution pharmacy.

Registration in the list of insurance medical institutions

Designated medical institutions will be listed in the Health Bureau's "List of Insurance Medical Institutions," which will serve as a reference for local patients when choosing a medical institution.

Renewal of insurance medical institution designation notice

You will need to renew your designation notice every six years when the designation expires.
Please be aware that if you delay your renewal application, you may be temporarily unable to provide insured medical treatment.

Various change notifications

In addition, if there are any changes to the following items regarding the designated information of the insured medical institution, you must submit a change notification each time.
　

For medical corporation applications, please contact Support Administrative Scrivener Corporation

At Support Administrative Scrivener Corporation, we provide application support and consulting regarding branching, relocation, etc. of clinics and hospitals for those who are establishing a new medical corporation.

Applications related to medical corporations and clinics are highly specialized and can be said to be one of the fields in which there are few administrative scriveners who can handle them.

Our staff has a track record of applying in all prefectures across the country. Please contact us by all means.
　

*We will handle some of the work related to opening a clinic in collaboration with a social insurance and labor consultant.

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