Article 57Coordination with Benefits Related to Medical Services Provided by Other Laws and Regulations
第五十七条（他の法令による医療に関する給付との調整）
The provision of benefits for medical treatment, or the payment of dietary treatment expenses for inpatients, living support expenses for inpatients, medical expenses combined with treatment outside insurance coverage, medical expenses, medical expenses for home-nursing, special medical expenses or transport expenses, is not made in the case where the insured is able to receive, for the relevant illness or injury, benefits related to medical care based on laws and regulations such as medical compensation benefits, medical benefits for multiple-business workers or medical benefits under the provisions of the Industrial Accident Compensation Insurance Act (Act No. 50 of 1947), medical compensation under the provisions of the National Public Officers' Accident Compensation Act (Act No. 191 of 1951; including as applied mutatis mutandis pursuant to other Acts), medical compensation under the provisions of the Local Public Officers Accident Compensation Act (Act No. 121 of 1967) or a Prefectural or Municipal Ordinance based on that Act, or other laws and regulations specified by Cabinet Order, in the case where the insured is able to receive benefits equivalent to the respective benefits pursuant to the provisions of the Long-Term Care Insurance Act, or in the case where benefits related to medical care have been provided at the expense of the national government or a local government under laws and regulations other than these.
療養の給付又は入院時食事療養費、入院時生活療養費、保険外併用療養費、療養費、訪問看護療養費、特別療養費若しくは移送費の支給は、被保険者の当該疾病又は負傷につき、労働者災害補償保険法（昭和二十二年法律第五十号）の規定による療養補償給付、複数事業労働者療養給付若しくは療養給付、国家公務員災害補償法（昭和二十六年法律第百九十一号。他の法律において準用する場合を含む。）の規定による療養補償、地方公務員災害補償法（昭和四十二年法律第百二十一号）若しくは同法に基づく条例の規定による療養補償その他政令で定める法令に基づく医療に関する給付を受けることができる場合、介護保険法の規定によつて、それぞれの給付に相当する給付を受けることができる場合又はこれらの法令以外の法令により国若しくは地方公共団体の負担において医療に関する給付が行われた場合には、行わない。
If benefits under a law or regulation as prescribed in the preceding paragraph are benefits in kind related to medical care, and co-payment or collection of actual costs has been made for the benefits and the amount of co-payment or collection of actual costs exceeds the amount of co-payment under this Act if the benefits are considered to have been provided as benefits for medical treatment under this Act, or if benefits under a law or regulation as prescribed in the same paragraph (excluding the Long-Term Care Insurance Act) are payment of medical expenses and the amount paid is less than the amount of dietary treatment expenses for inpatients, living support expenses for inpatients, medical expenses combined with treatment outside insurance coverage, medical expenses, medical expenses for home-nursing, special medical expenses, or transport expenses if dietary treatment expenses for inpatients, living support expenses for inpatients, medical expenses combined with treatment outside insurance coverage, medical expenses, medical expenses for home-nursing, special medical expenses, or transport expenses are to be paid for the medical treatment under this Act, the Association of Medical Care Systems for the Elderly Aged 75 and older must pay the difference between those amounts to the insured.
後期高齢者医療広域連合は、前項に規定する法令による給付が医療に関する現物給付である場合において、その給付に関し一部負担金の支払若しくは実費徴収が行われ、かつ、その一部負担金若しくは実費徴収の額が、その給付がこの法律による療養の給付として行われたものとした場合におけるこの法律による一部負担金の額を超えるとき、又は同項に規定する法令（介護保険法を除く。）による給付が医療費の支給である場合において、その支給額が、当該療養につきこの法律による入院時食事療養費、入院時生活療養費、保険外併用療養費、療養費、訪問看護療養費、特別療養費又は移送費の支給をすべきものとした場合における入院時食事療養費、入院時生活療養費、保険外併用療養費、療養費、訪問看護療養費、特別療養費又は移送費の額に満たないときは、それぞれその差額を当該被保険者に支給しなければならない。
In the case referred to in the preceding paragraph, when an insured receives the medical treatment at a medical institution providing services covered by health insurance, etc. (meaning a medical institution providing services covered by health insurance prescribed in Article 63, paragraph (3), item (i) of the Health Insurance Act (hereinafter referred to as a "medical institution providing services covered by health insurance") or pharmacies providing services covered by health insurance; the same applies hereinafter), the Association of Medical Care Systems for the Elderly Aged 75 and older may, on behalf of the insured, pay to the medical institution providing services covered by health insurance, etc. the expenses required for the medical treatment payable by the insured to the medical institution providing services covered by health insurance, etc., within the limit of the amount payable to the insured pursuant to the provisions of the preceding paragraph.
前項の場合において、被保険者が保険医療機関等（健康保険法第六十三条第三項第一号に規定する保険医療機関（以下「保険医療機関」という。）又は保険薬局をいう。以下同じ。）について当該療養を受けたときは、後期高齢者医療広域連合は、前項の規定により被保険者に支給すべき額の限度において、当該被保険者が保険医療機関等に支払うべき当該療養に要した費用を、当該被保険者に代わつて保険医療機関等に支払うことができる。
When expenses have been paid to a medical institution providing services covered by health insurance, etc. pursuant to the provisions of the preceding paragraph, the payment under paragraph (2) is deemed to have been made to insured to the extent of the payment.
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