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Japan Health Insurance Association
National employee health-insurance association (Kyokai Kenpo).
About
National insurer administering employees' health insurance for small and medium employers under the Japanese NHI and NMPA reimbursement framework, with broad statutory coverage and coverage determination.
Deterministic scores · rules-based, not AIiHow these scores are obtained: each one is computed from this profile's listed attributes — capability checkboxes, certifications, capacity figures and coverage — by a fixed formula, recomputed on every page load. Deterministic and rules-based means the score comes from a fixed, transparent formula over listed attributes — the same inputs always produce the same score. It is not AI: there is no model, no learning, and no hidden weighting. Whether a score is relevant to you depends on your specific project: a capability that raises the number may not matter for your work, and a niche strength your project needs may barely move it. Capability scores are a directional starting point, not a verdict. A lower score does not disqualify a company or consultant, and no decision should rest on the score alone — always contact the company directly to confirm the specifics for your project.
Coverage reach iTiers reported covered lives from 6 points (any) up to 42 points (100 million or more), then adds 4 points per coverage area (capped at 22), 3 per therapeutic focus area (capped at 20), and 5 per geographic region (capped at 16). Levels: 80+ National reach | 60-79 Broad coverage | 40-59 Regional | below 40 Focused. Whether this dimension matters for you depends on your specific project.
33Focused
Formulary strength iCounts the 5 coverage categories (oncology, cell and gene therapy, rare disease, biologics, vaccines) at 9 points each, capped at 45, plus 5 points per formulary tier, capped at 25. Specialty drug coverage adds 16 and a biosimilar policy adds 14. Levels: 80+ Comprehensive | 60-79 Strong | 40-59 Solid | below 40 Basic. Whether this dimension matters for you depends on your specific project.
66Strong
Reimbursement iAdds 7 points per reimbursement code system listed, capped at 35, plus 17 each for medical and pharmacy benefit coverage, 16 for coverage determination, and 15 for appeals management. Levels: 80+ Full-spectrum | 60-79 Broad | 40-59 Established | below 40 Limited. Whether this dimension matters for you depends on your specific project.
79Broad
Value contracting iSums five capability checkboxes: value-based contracting 24 points, outcomes-based contracts 22, risk sharing 20, budget impact modeling 18, and real-world evidence 16. Levels: 80+ Innovative | 60-79 Advanced | 40-59 Emerging | below 40 Traditional. Whether this dimension matters for you depends on your specific project.
18Traditional
Access efficiency iRewards a high approval rate (up to 28 points at 100 percent), fast reviews (20 points at 5 days or less, down to 3 above 20), quick prior-auth turnaround (18 points at 1 day or less, down to 2 above 7), and a low denial rate (20 points at 5 percent or less, 0 above 20); a digital submission portal adds 14. Shows Not reported (score 0) when none of the four metrics is provided. Levels: 80+ Highly efficient | 60-79 Efficient | 40-59 Moderate | below 40 Developing. Whether this dimension matters for you depends on your specific project.
0Not reported
Compliance maturity iAdds 6 points per regulatory framework listed, capped at 45, plus 18 for appeals management and 7 per certification, capped at 22. Recent audit findings add 15 points at zero, 10 at one, 4 at up to three, and nothing above that. Levels: 80+ Exemplary | 60-79 Strong | 40-59 Solid | below 40 Developing. Whether this dimension matters for you depends on your specific project.
36Developing
Coverage & contracting capabilities
Coverage determinationSpecialty drug coverageBiosimilar policyAppeals managementMedical benefitPharmacy benefitBudget impact modeling
Therapeutic focus
OncologyCardiometabolicRare diseasePrimary care
Locations
Tokyo, JapanHQOsaka, JapanRegional office
Live record · illustrative seed data · scores deterministic, rules-based — not AI.