第九十二条
When an insured who is eligible to receive an old-old medical care benefit is delinquent in payment of insurance premiums and, during the period from the due date for payment of those insurance premiums until the period specified by Order of the Ministry of Health, Labour and Welfare has elapsed, still does not pay those insurance premiums even though a municipality has carried out encouragement of insurance premium payment, etc., the Association of Medical Care Systems for the Elderly Aged 75 and older is to temporarily suspend payment of all or part of the old-old medical care benefit, pursuant to the provisions of Order of the Ministry of Health, Labour and Welfare, except where it is found that there are special circumstances specified by Cabinet Order, such as a disaster, regarding the delinquency in payment of those insurance premiums.
後期高齢者医療広域連合は、後期高齢者医療給付を受けることができる被保険者が保険料を滞納しており、かつ、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、市町村が保険料納付の勧奨等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、厚生労働省令で定めるところにより、後期高齢者医療給付の全部又は一部の支払を一時差し止めるものとする。
Even if the period specified by Order of the Ministry of Health, Labour and Welfare as prescribed in the preceding paragraph has not elapsed, if an insured who is eligible to receive an old-old medical care benefit is still in arrears on insurance premiums even though a municipality has carried out encouragement of insurance premium payment, etc., the Association of Medical Care Systems for the Elderly Aged 75 and older may, as specified by Order of the Ministry of Health, Labour and Welfare, temporarily suspend payment of all or part of the old-old medical care benefit, except where it is found that there are special circumstances specified by Cabinet Order, such as a disaster, in respect of the arrears of those insurance premiums.
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しない場合においても、後期高齢者医療給付を受けることができる被保険者が、市町村が保険料納付の勧奨等を行つてもなお保険料を滞納している場合においては、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、厚生労働省令で定めるところにより、後期高齢者医療給付の全部又は一部の支払を一時差し止めることができる。
If an insured to which the provisions of Article 82, paragraph (1) or the main clause of paragraph (2) are applied and for which the payment of the old-old medical care benefit has been temporarily suspended in whole or in part pursuant to the provisions of the preceding two paragraphs still does not pay the delinquent insurance premiums, the Association of Medical Care Systems for the Elderly Aged 75 and older may, pursuant to the provisions of the Order of the Ministry of Health, Labour and Welfare, deduct the amount of the insurance premiums that the insured is delinquent from the amount of the old-old medical care benefit pertaining to the temporary suspension, by giving notice to the insured in advance.
後期高齢者医療広域連合は、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被保険者であつて、前二項の規定による後期高齢者医療給付の全部又は一部の支払の一時差止がなされているものが、なお滞納している保険料を納付しない場合においては、厚生労働省令で定めるところにより、あらかじめ、当該被保険者に通知して、当該一時差止に係る後期高齢者医療給付の額から当該被保険者が滞納している保険料額を控除することができる。
Section 4 Expenses
第四節 費用等
Subsection 1 Bearing of Expenses
第一款 費用の負担
Article 93Expenses Borne by the State
第九十三条(国の負担)
The national government, pursuant to the provisions of Cabinet Order, bears, with respect to the Association of Medical Care Systems for the Elderly Aged 75 and older, an amount equivalent to 3/12 of the sum total (hereinafter referred to as the "total Amount Subject to Sharing") of the amount obtained by deducting the amount of expenses incurred in providing benefits for medical treatment, etc. pertaining to persons falling under the case listed in Article 67, paragraph (1), item (iii) (hereinafter referred to as the "amount of specified expenses") from the sum total (hereinafter referred to as the "amount of expenses incurred in providing benefits for medical treatment, etc.") of the amount obtained by deducting the amount equivalent to the co-payment for the benefits from the amount of expenses required for the benefits for medical treatment pertaining to insured and the amount of expenses required for 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, transport expenses, high-cost medical expenses and sizable medical and nursing expenses (referred to as the "Amount Subject to Sharing" in item (i) of the following paragraph and Article 100, paragraph (1)), and the amount obtained by deducting, from the amount of the contribution for securing medical care in the early phase of an epidemic, the amount obtained by multiplying that amount by the ratio of the amount of specified expenses to the amount of expenses incurred in providing benefits for medical treatment, etc. (referred to as the "amount of specified contribution for securing medical care in the early phase of an epidemic" in Article 100, paragraph (1)) (referred to as the "contribution Amount Subject to Sharing" in Article 100, paragraph (1)).
国は、政令で定めるところにより、後期高齢者医療広域連合に対し、被保険者に係る療養の給付に要する費用の額から当該給付に係る一部負担金に相当する額を控除した額並びに入院時食事療養費、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、移送費、高額療養費及び高額介護合算療養費の支給に要する費用の額の合計額(以下「療養の給付等に要する費用の額」という。)から第六十七条第一項第三号に掲げる場合に該当する者に係る療養の給付等に要する費用の額(以下「特定費用の額」という。)を控除した額(次項第一号及び第百条第一項において「負担対象額」という。)並びに流行初期医療確保拠出金の額から当該流行初期医療確保拠出金の額に療養の給付等に要する費用の額に占める特定費用の額の割合を乗じて得た額(第百条第一項において「特定流行初期医療確保拠出金の額」という。)を控除した額(第百条第一項において「負担対象拠出金額」という。)の合計額(以下「負担対象総額」という。)の十二分の三に相当する額を負担する。
The national government, beyond what is listed in the preceding paragraph, pursuant to the provisions of Cabinet Order, in order to achieve the financial stability of old-old medical care, bears, with respect to the Association of Medical Care Systems for the Elderly Aged 75 and older, an amount equivalent to 1/4 of the amount obtained by multiplying the sum total of the expenses required for benefits related to extremely expensive medical care that are not less than the amount calculated as specified by Cabinet Order as having a significant impact on the finances of old-old medical care due to the occurrence of benefits related to extremely expensive medical care, taking into consideration the ratio of benefits related to extremely expensive medical care to the amount of expenses required for all benefits related to medical care pertaining to insured and other factors, by the sum of the following rates (referred to as the "amount of high-cost medical expenses subject to sharing" in Article 96, paragraph (2)).
国は、前項に掲げるもののほか、政令で定めるところにより、後期高齢者医療広域連合に対し、後期高齢者医療の財政の安定化を図るため、被保険者に係る全ての医療に関する給付に要する費用の額に対する高額な医療に関する給付の割合等を勘案して、高額な医療に関する給付の発生による後期高齢者医療の財政に与える影響が著しいものとして政令で定めるところにより算定する額以上の高額な医療に関する給付に要する費用の合計額に次に掲げる率の合計を乗じて得た額(第九十六条第二項において「高額医療費負担対象額」という。)の四分の一に相当する額を負担する。
the rate obtained by dividing the amount equivalent to one twelfth of the Amount Subject to Sharing by the amount of expenses required for Benefits for Medical Treatment, etc.;
負担対象額の十二分の一に相当する額を療養の給付等に要する費用の額で除して得た率
the contribution rate for the old-old in Article 100, paragraph (1).
第百条第一項の後期高齢者負担率
Beyond what is provided for in the preceding two paragraphs, pursuant to the provisions of Cabinet Order, the national government is to grant two-thirds of the estimated total amount of special burden adjustment, etc. for the relevant fiscal year to the Organization each fiscal year; provided, however, that if the estimated total amount of special burden adjustment, etc. for the fiscal year before the previous fiscal year exceeds the total amount of special burden adjustment, etc. for the same fiscal year, the national government is to grant two-thirds of the amount obtained by subtracting the excess amount from the estimated total amount of special burden adjustment, etc. for the relevant fiscal year, and if the estimated total amount of special burden adjustment, etc. for the fiscal year before the previous fiscal year is less than the total amount of special burden adjustment, etc. for the same fiscal year, the national government is to grant two-thirds of the amount obtained by adding the less amount to the estimated total amount of special burden adjustment, etc. for the relevant fiscal year.
国は、前二項に定めるもののほか、政令で定めるところにより、年度ごとに、機構に対して当該年度の特別負担調整見込額の総額等の三分の二を交付する。ただし、前々年度の特別負担調整見込額の総額等が同年度の特別負担調整額の総額等を超えるときは、当該年度の特別負担調整見込額の総額等からその超える額を控除して得た額の三分の二を交付するものとし、前々年度の特別負担調整見込額の総額等が同年度の特別負担調整額の総額等に満たないときは、当該年度の特別負担調整見込額の総額等にその満たない額を加算して得た額の三分の二を交付するものとする。
Article 94Reduction of Treasury Share
第九十四条(国庫負担金の減額)
If a Association of Medical Care Systems for the Elderly Aged 75 and older unjustly fails to secure the revenue that it should have secured, the national government may reduce the amount to be borne by the Association of Medical Care Systems for the Elderly Aged 75 and older pursuant to the provisions of the preceding Article, pursuant to the provisions of Cabinet Order.
後期高齢者医療広域連合が確保すべき収入を不当に確保しなかつた場合においては、国は、政令で定めるところにより、前条の規定により当該後期高齢者医療広域連合に対して負担すべき額を減額することができる。
The amount to be reduced pursuant to the provisions of the preceding paragraph may not exceed the amount which was unjustly not secured.
前項の規定により減額する額は、不当に確保しなかつた額を超えることができない。
第九十五条(調整交付金)
The national government provides adjustment grants to a Association of Medical Care Systems for the Elderly Aged 75 and older pursuant to the provisions of a Cabinet Order in order to adjust the finances of medical care for the elderly.
国は、後期高齢者医療の財政を調整するため、政令で定めるところにより、後期高齢者医療広域連合に対して調整交付金を交付する。
The total amount of adjustment grants under the provisions of the preceding paragraph is the sum total of the amount equivalent to 1/12 of the total of the estimated amounts of the total amount subject to sharing and the amount equivalent to 1/120 of the estimated amount of the children and child-rearing support levy under the Act on Support for Children and Child-rearing (Act No. 65 of 2012) (hereinafter referred to as the "children and child-rearing support levy").
Article 96Expenses Borne by Prefectures
第九十六条(都道府県の負担)
A prefecture, pursuant to the provisions of Cabinet Order, bears an amount equivalent to one twelfth of the total amount subject to sharing by a Association of Medical Care Systems for the Elderly Aged 75 and older.
都道府県は、政令で定めるところにより、後期高齢者医療広域連合に対し、負担対象総額の十二分の一に相当する額を負担する。
Beyond what is set forth in the preceding paragraph, a prefecture is to bear an amount equivalent to one fourth of the amount subject to high medical care cost contribution to the Association of Medical Care Systems for the Elderly Aged 75 and older, pursuant to the provisions of Cabinet Order.
都道府県は、前項に掲げるもののほか、政令で定めるところにより、後期高齢者医療広域連合に対し、高額医療費負担対象額の四分の一に相当する額を負担する。
Article 97Reduction of Prefecture's Contribution
第九十七条(都道府県の負担金の減額)
If a Association of Medical Care Systems for the Elderly Aged 75 and older unjustly fails to secure the revenue it should have secured and the national government reduces the amount to be borne pursuant to the provisions of Article 94, the prefecture may reduce the amount to be borne by the Association of Medical Care Systems for the Elderly Aged 75 and older pursuant to the provisions of the preceding Article, pursuant to the provisions of Cabinet Order.
後期高齢者医療広域連合が確保すべき収入を不当に確保しなかつた場合において、国が第九十四条の規定により負担すべき額を減額したときは、都道府県は、政令で定めるところにより、前条の規定により当該後期高齢者医療広域連合に対して負担すべき額を減額することができる。
The amount to be reduced pursuant to the provisions of the preceding paragraph may not exceed the amount which was unjustly not secured.
前項の規定により減額する額は、不当に確保しなかつた額を超えることができない。
Article 98Burden on the General Account of a Municipality
第九十八条(市町村の一般会計における負担)
A Municipality, pursuant to the provisions of a Cabinet Order, is to bear an amount equivalent to one twelfth of the Total Amount Subject to Sharing with a Association of Medical Care Systems for the Elderly Aged 75 and older in its general account.
市町村は、政令で定めるところにより、後期高齢者医療広域連合に対し、その一般会計において、負担対象総額の十二分の一に相当する額を負担する。
Article 99Transfer to the Special Account of a Municipality
第九十九条(市町村の特別会計への繰入れ等)
A Municipality, pursuant to the provisions of a Cabinet Order, must transfer from the general account to the special account for medical care for the elderly of the Municipality the amount calculated, pursuant to the provisions of a Cabinet Order, based on the total amount of insurance premiums pertaining to the insured reduced based on the reduced assessment of insurance premiums for persons with small income pursuant to the provisions of the Ordinances of the Association of Medical Care Systems for the Elderly Aged 75 and older, by taking into consideration the financial status of medical care for the elderly and other circumstances.
市町村は、政令で定めるところにより、一般会計から、所得の少ない者について後期高齢者医療広域連合の条例の定めるところにより行う保険料の減額賦課に基づき被保険者に係る保険料につき減額した額の総額を基礎とし、後期高齢者医療の財政の状況その他の事情を勘案して政令で定めるところにより算定した額を市町村の後期高齢者医療に関する特別会計に繰り入れなければならない。
A municipality must, pursuant to the provisions of Cabinet Order, transfer from the general account to the special account of the municipality for old-old medical care, with respect to an insured who was a dependent under the provisions of the Health Insurance Act, the Mariners Insurance Act, the National Public Officers Mutual Aid Association Act (including as applied mutatis mutandis pursuant to other Acts) or the Local Public Officers, etc. Mutual Aid Association Act on the day before the day on which the insured came to fall under any of the items of Article 52, the amount calculated as specified by Cabinet Order, taking into consideration the financial status of old-old medical care and other circumstances, on the basis of the total amount of reduction where, limited to the period from the month containing the day on which the insured came to fall under any of the cases listed in the items of that Article until the month in which two years have elapsed, insurance premiums are reduced pursuant to a reduced assessment of insurance premiums made as provided by Ordinance of the Association.
市町村は、政令で定めるところにより、一般会計から、第五十二条各号のいずれかに該当するに至つた日の前日において健康保険法、船員保険法、国家公務員共済組合法(他の法律において準用する場合を含む。)又は地方公務員等共済組合法の規定による被扶養者であつた被保険者について、同条各号に掲げる場合のいずれかに該当するに至つた日の属する月以後二年を経過する月までの間に限り、条例の定めるところにより行う保険料の減額賦課に基づき保険料を減額した場合における当該減額した額の総額を基礎とし、後期高齢者医療の財政の状況その他の事情を勘案して政令で定めるところにより算定した額を、市町村の後期高齢者医療に関する特別会計に繰り入れなければならない。
A prefecture, pursuant to the provisions of Cabinet Order, bears an amount equivalent to three quarters of the amount to be transferred pursuant to the provisions of the preceding two paragraphs.
都道府県は、政令で定めるところにより、前二項の規定による繰入金の四分の三に相当する額を負担する。
第百条(後期高齢者交付金)
Among the expenses borne in the special account for old-old medical care of the Association of Medical Care Systems for the Elderly Aged 75 and older, the amount obtained by adding, to the sum total of the amount obtained by multiplying the Amount Subject to Sharing by the rate obtained by deducting the contribution rate for the old-old and 50 percent from one and the amount obtained by multiplying the amount of specified expenses by the rate obtained by deducting the contribution rate for the old-old from one (hereinafter referred to as the "amount subject to insurance payment" in this Section), the sum total of the amount obtained by multiplying the contribution Amount Subject to Sharing by the rate obtained by deducting the contribution rate for the old-old and 50 percent from one and the amount obtained by multiplying the amount of specified contribution for securing medical care in the early phase of an epidemic by the rate obtained by deducting the contribution rate for the old-old from one (referred to as the "total amount subject to insurance payment" in Article 121, paragraph (1)) is to be covered by the Old-Old Subsidy granted by the Organization to the Association of Medical Care Systems for the Elderly Aged 75 and older, pursuant to the provisions of Cabinet Order.
後期高齢者医療広域連合の後期高齢者医療に関する特別会計において負担する費用のうち、負担対象額に一から後期高齢者負担率及び百分の五十を控除して得た率を乗じて得た額並びに特定費用の額に一から後期高齢者負担率を控除して得た率を乗じて得た額の合計額(以下この節において「保険納付対象額」という。)に負担対象拠出金額に一から後期高齢者負担率及び百分の五十を控除して得た率を乗じて得た額並びに特定流行初期医療確保拠出金の額に一から後期高齢者負担率を控除して得た率を乗じて得た額の合計額を加えて得た額(第百二十一条第一項において「保険納付対象総額」という。)については、政令で定めるところにより、機構が後期高齢者医療広域連合に対して交付する後期高齢者交付金をもつて充てる。
The contribution rate for the old-old set forth in the preceding paragraph is specified by Cabinet Order every two years based on the rate obtained by multiplying the number set forth in item (i) by the rate set forth in item (ii) and then dividing the product by the number set forth in item (iii):
the number obtained by adding, to one half, a rate equivalent to one half of the ratio of the amount of specified expenses to the amount of expenses required for benefits for medical treatment, etc. in the relevant fiscal year.
二分の一に、当該年度における療養の給付等に要する費用の額に対する特定費用の額の割合の二分の一に相当する率を加えて得た数
The rate obtained by multiplying 11.72 percent by the rate obtained by dividing the prospective total number of insured pertaining to all Association of Medical Care Systems for the Elderly Aged 75 and older in the relevant fiscal year by the total number of insured pertaining to all Association of Medical Care Systems for the Elderly Aged 75 and older in fiscal year 2022.
百分の十一・七二に、当該年度における全ての後期高齢者医療広域連合に係る被保険者の見込総数を令和四年度における全ての後期高齢者医療広域連合に係る被保険者の総数で除して得た率を乗じて得た率
the number arrived at when the rate set forth in the preceding item is added to the rate arrived at when the rate set forth in (a) is multiplied by the rate set forth in (b):
前号に掲げる率に、イに掲げる率にロに掲げる率を乗じて得た率を加えて得た数
the rate obtained by dividing the amount subject to insurance payment in fiscal year 2022 by the amount of expenses required for benefits for medical treatment, etc. in the same fiscal year;
令和四年度における保険納付対象額を同年度における療養の給付等に要する費用の額で除して得た率
the rate arrived at when the prospective total number of participants for all insurers in the relevant fiscal year is divided by the total number of participants for all insurers in fiscal 2022.
The Old-Old Subsidy referred to in paragraph (1) is to be covered by the aid for the old-old collected by the Organization pursuant to the provisions of Article 118, paragraph (1).
Article 101Reduction of Old-Old Subsidy
第百一条(後期高齢者交付金の減額)
If the Association of Medical Care Systems for the Elderly Aged 75 and older unjustly fails to secure the revenue that it should have secured or unjustly incurs expenses that it should not incur, the Minister of Health, Labour and Welfare may, pursuant to the provisions of Cabinet Order, order the Organization to reduce the amount of the Old-Old Subsidy referred to in the same paragraph that is granted to that Association pursuant to the provisions of paragraph (1) of the preceding Article.
厚生労働大臣は、後期高齢者医療広域連合が確保すべき収入を不当に確保しなかつた場合又は後期高齢者医療広域連合が支出すべきでない経費を不当に支出した場合においては、政令で定めるところにより、機構に対し、前条第一項の規定により当該後期高齢者医療広域連合に対して交付する同項の後期高齢者交付金の額を減額することを命ずることができる。
The amount to be reduced pursuant to the provisions of the preceding paragraph may not exceed the amount which has unjustly failed to be secured or the amount which has unjustly been expended.
前項の規定により減額する額は、不当に確保しなかつた額又は不当に支出した額を超えることができない。