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Article 82

第八十二条

If an insured that is delinquent in the payment of insurance premiums (excluding an insured that is eligible to receive payment of general medical expenses for illness under the and other medical care benefits specified by Order of the Ministry of Health, Labour and Welfare (referred to as "payment, etc. of general medical expenses for illness caused by atomic bombs" in paragraph (4)); hereinafter referred to as a "person delinquent in payment of insurance premiums" in this Article) does not pay the insurance premiums during the period from the due date for payment of the insurance premiums until the expiration of the period specified by Order of the Ministry of Health, Labour and Welfare, even though a municipality has made efforts to encourage payment of the insurance premiums, to secure opportunities for consultation pertaining to the payment of the insurance premiums, and to contribute to the payment of the insurance premiums specified by Order of the Ministry of Health, Labour and Welfare (referred to as "encouragement, etc. of payment of insurance premiums" in the following paragraph and Article 92, paragraphs (1) and (2)), and when the person delinquent in payment of insurance premiums has received medical treatment from a medical institution providing services covered by health insurance, etc. or designated home-nursing from a designated home-nursing provider, the Association of Medical Care Systems for the Elderly Aged 75 and older pays to the person delinquent in payment of insurance premiums special medical expenses in lieu of benefits for medical treatment, or payment of dietary treatment expenses for inpatients, living support expenses for inpatients, medical expenses combined with treatment outside insurance coverage, medical expenses, or medical expenses for home-nursing (referred to as "benefits for medical treatment, etc." in the following paragraph, paragraph (4), and paragraph (5)), with regard to expenses required for the medical treatment or designated home-nursing, except when it is found that there are special circumstances specified by Cabinet Order.

後期高齢者医療広域連合は、保険料を滞納している被保険者(による一般疾病医療費の支給その他厚生労働省令で定める医療に関する給付(第四項において「原爆一般疾病医療費の支給等」という。)を受けることができる被保険者を除く。以下この条において「保険料滞納者」という。)が、当該保険料の納期限から厚生労働省令で定める期間が経過するまでの間に、市町村が当該保険料の納付の勧奨及び当該保険料の納付に係る相談の機会の確保その他厚生労働省令で定める保険料の納付に資する取組(次項並びに第九十二条第一項及び第二項において「保険料納付の勧奨等」という。)を行つてもなお当該保険料を納付しない場合においては、当該保険料の滞納につき災害その他の政令で定める特別の事情があると認められる場合を除き、当該保険料滞納者が保険医療機関等から療養を受けたとき、又は指定訪問看護事業者から指定訪問看護を受けたときは、当該保険料滞納者に対し、その療養又は指定訪問看護に要した費用について、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、療養費若しくは訪問看護療養費の支給(次項、第四項及び第五項において「療養の給付等」という。)に代えて、特別療養費を支給する。

Even before the period specified by Order of the Ministry of Health, Labour and Welfare as prescribed in the preceding paragraph has elapsed, if a person delinquent in payment of insurance premiums still does not pay the insurance premiums even though a municipality has carried out encouragement of insurance premium payment, etc., and the person delinquent in payment of insurance premiums has received medical treatment from a medical institution providing services covered by health insurance, etc. or designated home-nursing from a designated home-nursing provider, the Association of Medical Care Systems for the Elderly Aged 75 and older may pay the person delinquent in payment of insurance premiums special medical expenses for the expenses required for the medical treatment or designated home-nursing, in lieu of benefits for medical treatment, etc. However, this does not apply if it is found that there are special circumstances specified by the Cabinet Order referred to in that paragraph.

後期高齢者医療広域連合は、前項に規定する厚生労働省令で定める期間が経過する前においても、市町村が保険料納付の勧奨等を行つてもなお保険料滞納者が当該保険料を納付しない場合においては、当該保険料滞納者が保険医療機関等から療養を受けたとき、又は指定訪問看護事業者から指定訪問看護を受けたときは、当該保険料滞納者に対し、その療養又は指定訪問看護に要した費用について、療養の給付等に代えて、特別療養費を支給することができる。ただし、同項の政令で定める特別の事情があると認められるときは、この限りでない。

When paying special medical expenses pursuant to the provisions of paragraph (1) or the main clause of the preceding paragraph, the Association of Medical Care Systems for the Elderly Aged 75 and older is to notify a person delinquent in insurance premiums to the effect that special medical expenses will be paid if the person delinquent in insurance premiums receives medical treatment at or from a medical institution providing services covered by health insurance, or receives designated home-nursing at or from a designated home-nursing provider, pursuant to the provisions of Order of the Ministry of Health, Labour and Welfare.

後期高齢者医療広域連合は、第一項又は前項本文の規定により特別療養費を支給するときは、あらかじめ、厚生労働省令で定めるところにより、保険料滞納者に対し、当該保険料滞納者が保険医療機関等から療養を受けたとき、又は指定訪問看護事業者から指定訪問看護を受けたときは、特別療養費を支給する旨を通知するものとする。

If a person delinquent in payment of insurance premiums who is subject to the provisions of paragraph (1) or the main clause of paragraph (2) completes payment of the delinquent insurance premiums, or it is found that the amount of delinquent payment pertaining to the person has significantly decreased, or there are special circumstances specified by Cabinet Order, such as disasters, or if the relevant insured has become eligible for the payment, etc. of medical expenses for atomic bomb-related general diseases, and the insured that falls under these cases has received medical treatment from a medical institution providing services covered by health insurance, etc. or designated home-nursing from a designated home-nursing provider, the Association of Medical Care Systems for the Elderly Aged 75 and older provides benefits for medical treatment, etc. to the relevant insured.

後期高齢者医療広域連合は、第一項又は第二項本文の規定の適用を受けている保険料滞納者が滞納している保険料を完納した場合若しくはその者に係る滞納額の著しい減少、災害その他の政令で定める特別の事情があると認められる場合又は当該被保険者が原爆一般疾病医療費の支給等を受けることができる者となつた場合において、これらの場合に該当する被保険者が保険医療機関等から療養を受けたとき、又は指定訪問看護事業者から指定訪問看護を受けたときは、当該被保険者に対し、療養の給付等を行う。

When the Association of Medical Care Systems for the Elderly Aged 75 and older is to provide benefits for medical treatment, etc. pursuant to the provisions of the preceding paragraph, it is to notify in advance, pursuant to the provisions of Order of the Ministry of Health, Labour and Welfare, an insured who falls under the case prescribed in that paragraph that, when the insured receives medical treatment from a medical institution providing services covered by health insurance, etc. or designated home-nursing from a designated home-nursing provider, benefits for medical treatment, etc. will be provided.

後期高齢者医療広域連合は、前項の規定により療養の給付等を行うときは、あらかじめ、厚生労働省令で定めるところにより、同項に規定する場合に該当する被保険者に対し、当該被保険者が保険医療機関等から療養を受けたとき、又は指定訪問看護事業者から指定訪問看護を受けたときは、療養の給付等を行う旨を通知するものとする。

The provisions of Article 64 of the Health Insurance Act and Article 64, paragraph (3), Article 65, Article 66, Article 70, paragraph (2), Article 72, Article 74, paragraph (7) (including as applied mutatis mutandis pursuant to Article 78, paragraph (8)), Article 76, paragraph (2), Article 78, paragraph (3), Article 79, paragraph (2), Article 80, and the preceding Article of this Act apply mutatis mutandis to medical treatment or designated home-nursing pertaining to special medical expenses received at or from a medical institution providing services covered by health insurance, etc. or a designated home-nursing provider, and to the payment of special medical expenses incidental thereto. In this case, any necessary technical replacement of terms is specified by Cabinet Order.

健康保険法第六十四条並びに本法第六十四条第三項、第六十五条、第六十六条、第七十条第二項、第七十二条、第七十四条第七項(第七十八条第八項において準用する場合を含む。)、第七十六条第二項、第七十八条第三項、第七十九条第二項、第八十条及び前条の規定は、保険医療機関等又は指定訪問看護事業者について受けた特別療養費に係る療養又は指定訪問看護及びこれらに伴う特別療養費の支給について準用する。この場合において、必要な技術的読替えは、政令で定める。

If a person delinquent in insurance premiums to whom the provisions of paragraph (1) or the main clause of paragraph (2) are applied would be subject to the provisions of Article 77, paragraph (1) if those provisions were not applied, the Association of Medical Care Systems for the Elderly Aged 75 and older may pay medical expenses to the person.

第一項又は第二項本文の規定の適用を受けている保険料滞納者がこれらの規定の適用を受けていないとすれば第七十七条第一項の規定が適用されることとなるときは、後期高齢者医療広域連合は、療養費を支給することができる。

When a person delinquent in payment of insurance premiums who is subject to the provisions of paragraph (1) or the main clause of paragraph (2) 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, the Association is to pay medical expenses.

第一項又は第二項本文の規定の適用を受けている保険料滞納者が電子資格確認等により被保険者であることの確認を受けないで保険医療機関等について診療又は薬剤の支給を受け、当該確認を受けなかつたことが、緊急その他やむを得ない理由によるものと認めるときは、後期高齢者医療広域連合は、療養費を支給するものとする。

The provisions of Article 77, paragraphs (3) and (4) apply mutatis mutandis to the medical expenses pursuant to the provisions of the preceding two paragraphs. In this case, the term "if the person is to receive" in paragraph (4) of the same Article is deemed to be replaced with "if the person is eligible to receive".

第七十七条第三項及び第四項の規定は、前二項の規定による療養費について準用する。この場合において、同条第四項中「受けるべき場合」とあるのは、「受けることができる場合」と読み替えるものとする。

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