When a Association of Medical Care Systems for the Elderly Aged 75 and older finds it difficult to pay benefits for medical treatment, or expenses for dietary treatment for inpatients, living support expenses for inpatients, or medical expenses combined with treatment outside insurance coverage (hereinafter referred to as "benefits for medical treatment, etc." in this paragraph and the following paragraph), or when an insured has received any medical care, medication or treatment at or from hospitals, clinics, pharmacies or any other persons other than medical institutions providing services covered by health insurance, etc. and the Association of Medical Care Systems for the Elderly Aged 75 and older finds it unavoidable, it may pay medical expenses in lieu of benefits for medical treatment, etc.;provided, however, that this does not apply during any period for which the provisions of Article 82, paragraph (1) or the main clause of paragraph (2) of the same Article are applied to the insured.
後期高齢者医療広域連合は、療養の給付若しくは入院時食事療養費、入院時生活療養費若しくは保険外併用療養費の支給（以下この項及び次項において「療養の給付等」という。）を行うことが困難であると認めるとき、又は被保険者が保険医療機関等以外の病院、診療所若しくは薬局その他の者について診療、薬剤の支給若しくは手当を受けた場合において、後期高齢者医療広域連合がやむを得ないものと認めるときは、療養の給付等に代えて、療養費を支給することができる。ただし、当該被保険者が第八十二条第一項又は第二項本文の規定の適用を受けている間は、この限りでない。
When an insured has received medical care or medication from a medical institution providing services covered by health insurance, etc. without receiving confirmation of being an insured by electronic eligibility confirmation, etc., and the Association of Medical Care Systems for the Elderly Aged 75 and older finds that the failure to receive that confirmation was due to an emergency or other unavoidable reason, it is to pay medical expenses in lieu of benefits for medical treatment, etc.; provided, however, that this does not apply while the insured is subject to the provisions of Article 82, paragraph (1) or the main clause of paragraph (2).
The amount of medical expenses is determined by the Association of Medical Care Systems for the Elderly Aged 75 and older based on: (a) the amount calculated by deducting, from the amount calculated for the medical treatment (excluding dietary treatment and living support), the amount obtained by multiplying that amount by the applicable ratio specified in the items of Article 67, paragraph (1) in accordance with the categories of cases listed in the items of the same paragraph; and (b) the amount calculated by deducting, from the amount calculated for the dietary treatment or living support, the amount of standard co-payment for dietary treatment or standard co-payment for living support.
With regard to the calculation of the amount of expenses referred to in the preceding paragraph, the provisions of Article 71, paragraph (1) apply mutatis mutandis if benefits for medical treatment are to be received, the provisions of Article 74, paragraph (2) apply mutatis mutandis if dietary treatment expenses for inpatients are to be received, the provisions of Article 75, paragraph (2) apply mutatis mutandis if living support expenses for inpatients are to be received, and the provisions of paragraph (2) of the preceding Article apply mutatis mutandis if medical expenses combined with treatment outside insurance coverage are to be received; provided, however, that the amount may not exceed the amount of expenses actually incurred in the medical treatment.
Read this with the articles around it