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Article 84High-Cost Medical Expenses

第八十四条(高額療養費)

When the amount of co-payment prescribed in Article 67 with respect to benefits for medical treatment or the amount calculated by deducting, from the amount of expenses incurred in medical treatment (excluding dietary treatment and living support; hereinafter the same applies in this Article), the amount paid as medical expenses combined with treatment outside insurance coverage, medical expenses, medical expenses for home-nursing, or special medical expenses with respect to the expenses incurred in the medical treatment, or the amount equivalent to the difference paid pursuant to the provisions of Article 57, paragraph (2) (referred to as the "amount of co-payment, etc." in paragraph (1) of the following Article) is extremely large, the Association of Medical Care Systems for the Elderly Aged 75 and older pays high-cost medical expenses to the insured that received the benefits for medical treatment, or the payment of the medical expenses combined with treatment outside insurance coverage, medical expenses, medical expenses for home-nursing, or special medical expenses.

後期高齢者医療広域連合は、療養の給付につき支払われた第六十七条に規定する一部負担金の額又は療養(食事療養及び生活療養を除く。以下この条において同じ。)に要した費用の額からその療養に要した費用につき保険外併用療養費、療養費、訪問看護療養費若しくは特別療養費として支給される額若しくは第五十七条第二項の規定により支給される差額に相当する額を控除した額(次条第一項において「一部負担金等の額」という。)が著しく高額であるときは、その療養の給付又はその保険外併用療養費、療養費、訪問看護療養費若しくは特別療養費の支給を受けた被保険者に対し、高額療養費を支給する。

The requirements for payment and the amount of high-cost medical expenses and other necessary matters concerning the payment of high-cost medical expenses shall be prescribed by Cabinet Order by taking into consideration the impact of the burden of the expenses incurred in the relevant medical treatment on household finances, in particular the household finances of persons who continuously receive medical treatment over a long period, and the amount of expenses incurred in the medical treatment.

高額療養費の支給要件、支給額その他高額療養費の支給に関して必要な事項は、療養に必要な費用の負担の家計、とりわけ長期にわたつて継続的に療養を受ける者の家計に与える影響及び療養に要した費用の額を考慮して、政令で定める。

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