Order for Enforcement of the Health Insurance Act

• Under this Order, which carries out the Health Insurance Act (健康保険法, Act No. 70 of 1922), the monthly ceiling on co-payments (一部負担金) and similar amounts, counted as before, turns on the standard monthly remuneration (標準報酬月額) of the month of treatment in twelve bands: 342,000 yen plus 1% of the medical cost above 1,140,000 yen at 1,270,000 yen or more; 303,000 yen plus 1% above 1,010,000 yen at 1,030,000 to under 1,270,000 yen; 270,300 yen plus 1% above 901,000 yen at 830,000 to under 1,030,000 yen; 209,400 yen plus 1% above 698,000 yen at 710,000 to under 830,000 yen; 194,400 yen plus 1% above 648,000 yen at 620,000 to under 710,000 yen; 179,100 yen plus 1% above 597,000 yen at 530,000 to under 620,000 yen; 110,400 yen plus 1% above 368,000 yen at 440,000 to under 530,000 yen; 98,100 yen plus 1% above 327,000 yen at 360,000 to under 440,000 yen; 85,800 yen plus 1% above 286,000 yen at 280,000 to under 360,000 yen; 69,600 yen at 200,000 to under 280,000 yen; 65,400 yen at 160,000 to under 200,000 yen; and 61,500 yen below 160,000 yen — with 36,900 yen, below 530,000 yen, for someone not liable to municipal inhabitant tax (市町村民税) or in need of public assistance (要保護者) as a Ministry of Health, Labour and Welfare Order (厚生労働省令) defines. Where the high-cost medical expense benefit (高額療養費) has already been paid in three or more of the 12 months up to the month of treatment, the ceiling is 140,100 yen at 830,000 yen or more, 93,000 yen at 530,000 to under 830,000 yen, 44,400 yen at 160,000 to under 530,000 yen, 34,500 yen below 160,000 yen and 24,600 yen for those not liable to that tax or in need of assistance. Treatment received before these ceilings took effect keeps the earlier ones.This is the rule from 1 August 2027.(Art. 41(1), Art. 42(1), Art. 42(1)(i), Art. 42(1)(ii), Art. 42(1)(iii), Art. 42(1)(iv), Art. 42(1)(v), Art. 42(1)(vi), Art. 42(1)(vii), Art. 42(1)(viii), Art. 42(1)(ix), Art. 42(1)(x), Art. 42(1)(xi), Art. 42(1)(xii), Art. 42(1)(xiii), Suppl. Prov. Art. 1(1)(ii), Suppl. Prov. Art. 18(2)) (the provisions it rests on)
• For treatment from the month after the one in which a person turns 70, the household's own monthly ceiling, counted without the 21,000-yen threshold, is 61,500 yen, or 44,400 yen where the benefit has already been paid in three or more of the 12 months up to the month of treatment. For those who pay 30% it is 270,300 yen plus 1% of the medical cost above 901,000 yen at a standard monthly remuneration (標準報酬月額) of 830,000 yen or more, 179,100 yen plus 1% above 597,000 yen at 530,000 to under 830,000 yen, and 85,800 yen plus 1% above 286,000 yen below 530,000 yen (140,100, 93,000 and 44,400 yen in that repeated case), while it is 25,700 yen (24,600 yen in that repeated case) for those not liable to municipal inhabitant tax (市町村民税) or in need of public assistance (要保護者) as a Ministry of Health, Labour and Welfare Order (厚生労働省令) defines, and 15,700 yen where the insured person and every dependent have no income as that tax counts it. For outpatient care alone, each person who does not pay 30% has a ceiling of 22,000 yen, 11,000 yen if not liable to that tax or in need of public assistance, and 8,000 yen with no such income.This is the rule until 31 July 2027.(Art. 41(3), Art. 41(5), Art. 42(3), Art. 42(3)(i), Art. 42(3)(ii), Art. 42(3)(iii), Art. 42(3)(iv), Art. 42(3)(v), Art. 42(3)(vi), Art. 42(5), Art. 42(5)(i), Art. 42(5)(ii), Art. 42(5)(iii)) (the provisions it rests on)
• For treatment from the month after the one in which a person turns 70, the household's own monthly ceiling, counted without the 21,000-yen threshold, follows for those who pay 30% the nine top bands of the general monthly ceiling, from 342,000 yen plus 1% of the medical cost above 1,140,000 yen at a standard monthly remuneration (標準報酬月額) of 1,270,000 yen or more down to 85,800 yen plus 1% above 286,000 yen below 360,000 yen. For others it is 69,600 yen at 200,000 yen or more, 65,400 yen at 160,000 to under 200,000 yen and 61,500 yen below 160,000 yen (44,400, 44,400 and 34,500 yen where the benefit has already been paid in three or more of the 12 months up to the month of treatment), 25,700 yen (24,600 yen in that repeated case) for those not liable to municipal inhabitant tax (市町村民税) or in need of public assistance (要保護者) as a Ministry of Health, Labour and Welfare Order (厚生労働省令) defines, and 15,700 yen where the insured person and every dependent have no income as that tax counts it. For outpatient care alone, each person who does not pay 30% has a ceiling of 28,000 yen at 160,000 yen or more, 22,000 yen below it, 13,000 yen if not liable to that tax or in need of public assistance and 8,000 yen with no such income; treatment received before these ceilings took effect keeps the earlier ones.This is the rule from 1 August 2027.(Art. 41(3), Art. 41(5), Art. 42(3), Art. 42(3)(i), Art. 42(3)(ii), Art. 42(3)(iii), Art. 42(3)(iv), Art. 42(3)(v), Art. 42(3)(vi), Art. 42(3)(vii), Art. 42(3)(viii), Art. 42(3)(ix), Art. 42(3)(x), Art. 42(3)(xi), Art. 42(3)(xii), Art. 42(3)(xiii), Art. 42(3)(xiv), Art. 42(5), Art. 42(5)(i), Art. 42(5)(ii), Art. 42(5)(iii), Art. 42(5)(iv), Suppl. Prov. Art. 1(1)(ii), Suppl. Prov. Art. 18(2)) (the provisions it rests on)
• There is also a yearly ceiling: over each calculation period from 1 August to 31 July, where the co-payments and similar amounts of an insured person and their dependents for treatment received while insured with this insurer (for treatment up to the month in which a person turns 70, only those of 21,000 yen or more from one provider in a month), less what the monthly benefit and the yearly benefit for those 70 or over have paid back, exceed the yearly ceiling that applies, the person insured on 31 July — or, for someone whose insured status ended during the period, on the day before it ended — is paid the excess as high-cost medical expenses (高額療養費). The ceiling is 530,000 yen as a rule; it is 1,680,000 yen if their standard monthly remuneration (標準報酬月額) for that month is 830,000 yen or more, 1,110,000 yen at 530,000 to under 830,000 yen, and 290,000 yen, below 530,000 yen, for someone not liable to municipal inhabitant tax (市町村民税) or in need of public assistance (要保護者) as a Ministry of Health, Labour and Welfare Order (厚生労働省令) defines. Under a transitional provision of Cabinet Order No. 240 of 2026 (令和8年政令第240号), someone the insurer has confirmed, on their application or on its own initiative, as having a standard monthly remuneration for that month under 160,000 yen, and who is not in that tax-exempt group, is held instead to the ceiling that Cabinet Order's later stage sets for that band.This is the rule until 31 July 2027.(Art. 41-2(1), Art. 41-3(1), Art. 41-3(1)(i), Art. 42(11), Art. 42(11)(i), Art. 42(11)(ii), Art. 42(11)(iii), Art. 42(11)(iv), Art. 43(12), Suppl. Prov. Art. 19(1), Suppl. Prov. Art. 19(3), Suppl. Prov. Art. 1(1)(ii)) (the provisions it rests on)
• There is also a yearly ceiling: over each calculation period from 1 August to 31 July, where the co-payments and similar amounts of an insured person and their dependents for treatment received while insured with this insurer, counted as for the monthly benefit and less what the monthly benefit and the yearly benefit for those 70 or over have paid back, exceed the yearly ceiling that applies, the person insured on 31 July — or, for someone whose insured status ended during the period, on the day before it ended — is paid the excess as high-cost medical expenses (高額療養費). The ceiling is 530,000 yen as a rule; it is 1,680,000 yen if their standard monthly remuneration (標準報酬月額) for that month is 830,000 yen or more, 1,110,000 yen at 530,000 to under 830,000 yen, 410,000 yen below 160,000 yen, and 290,000 yen, below 530,000 yen, for someone not liable to municipal inhabitant tax (市町村民税) or in need of public assistance (要保護者) as a Ministry of Health, Labour and Welfare Order (厚生労働省令) defines. Treatment received before these ceilings took effect keeps the earlier rule.This is the rule from 1 August 2027.(Art. 41-2(1), Art. 41-3(1), Art. 41-3(1)(i), Art. 42(11), Art. 42(11)(i), Art. 42(11)(ii), Art. 42(11)(iii), Art. 42(11)(iv), Art. 42(11)(v), Art. 43(12), Suppl. Prov. Art. 1(1)(ii), Suppl. Prov. Art. 18(2)) (the provisions it rests on)
• Under the Act, a person aged 70 or over (from the month after the one in which they turn 70) pays a co-payment (一部負担金) of 20% for medical treatment, but 30% where their remuneration reaches the level this Order sets: a standard monthly remuneration (標準報酬月額) of 280,000 yen or more in the month of treatment. The 30% does not apply where the income of the insured person and their dependents aged 70 or over, worked out as a Ministry of Health, Labour and Welfare Order (厚生労働省令) sets, is under 5,200,000 yen (3,830,000 yen with no such dependent), nor where an insured person with no such dependent and a former dependent who left their cover within the last five years on joining late-stage elderly medical care (後期高齢者医療) have a combined income under 5,200,000 yen.(Art. 34(1), Art. 34(2), Art. 34(2)(i), Art. 34(2)(ii), Health Insurance Act Art. 74(1)(ii), Health Insurance Act Art. 74(1)(iii)) (the provisions it rests on)
• The burial charges (埋葬料) paid when an insured person dies, to the person who depended on them and arranged the burial, are 50,000 yen; where there is no such person, whoever arranged the burial is paid its cost, up to that amount, under the Act. The lump-sum allowance for childbirth and childcare (出産育児一時金) is 488,000 yen. Where the insurer finds that the birth took place under the medical care of a hospital, clinic, midwifery home or other provider that holds insurance, meeting a Ministry of Health, Labour and Welfare Order's (厚生労働省令) requirements, to pay compensation when a child is left with cerebral palsy by a birth accident, and that takes that Order's measures to collect, analyse and share information on such accidents, the insurer adds an amount it sets, up to 30,000 yen, based on the extra cost of that insurance to the insured person.(Art. 35(1), Art. 36(1), Art. 36(1)(i), Art. 36(1)(ii), Health Insurance Act Art. 100(1), Health Insurance Act Art. 100(2)) (the provisions it rests on)
• When an insured person (other than a specially-insured day laborer, 日雇特例被保険者) works at two or more places of business at the same time, each employer bears, of the premium on the standard monthly remuneration (標準報酬月額), half the person's premium (or the employer's larger share where a health insurance society has raised it under Article 162 of the Act) times the share of the person's monthly remuneration (報酬月額) that is worked out for its place of business. Of the premium on the standard bonus amount (標準賞与額), each bears that half times its share of the bonuses the person received that month. Each employer pays both its own share and the matching share of the insured person.(Art. 47(1), Art. 47(1)(i), Art. 47(1)(ii), Art. 47(2), Art. 47(3), Health Insurance Act Art. 161(4), Health Insurance Act Art. 162(1)) (the provisions it rests on)

• 1 October 2026

  The text on this site

  Cabinet Order on the Arrangement of Related Cabinet Orders upon the Partial Enforcement of the Act Partially Amending the National Pension Act, etc., and Other Matters, to Strengthen the Functions of the Pension System in Light of Socioeconomic Changes

  社会経済の変化を踏まえた年金制度の機能強化のための国民年金法等の一部を改正する等の法律の一部の施行に伴う関係政令の整備に関する政令

  Cabinet Order No. 276 of 2026The text after this amendment, on e-Gov

• 1 October 2026

  Cabinet Order on the Arrangement of Related Cabinet Orders and on Transitional Measures upon the Partial Enforcement of the Act Partially Amending the Medical Care Act, etc.

  医療法等の一部を改正する法律の一部の施行に伴う関係政令の整備及び経過措置に関する政令

  Cabinet Order No. 274 of 2026The text after this amendment, on e-Gov

• 1 August 2026

  Cabinet Order Partially Amending the Order for Enforcement of the Health Insurance Act, etc.

  健康保険法施行令等の一部を改正する政令

  Cabinet Order No. 240 of 2026The text after this amendment, on e-Gov

• 1 August 2026

  Cabinet Order Partially Amending the Order for Enforcement of the Health Insurance Act, etc.

  健康保険法施行令等の一部を改正する政令

  Cabinet Order No. 219 of 2026The text after this amendment, on e-Gov

• 29 July 2026

  Cabinet Order Partially Amending the Order for Enforcement of the Health Insurance Act, etc.

  健康保険法施行令等の一部を改正する政令

  Cabinet Order No. 240 of 2026The text after this amendment, on e-Gov

• 25 June 2026

  Cabinet Order Partially Amending the Order for Enforcement of the Health Insurance Act, etc.

  健康保険法施行令等の一部を改正する政令

  Cabinet Order No. 219 of 2026The text after this amendment, on e-Gov

• 8 April 2026

  Cabinet Order Partially Amending the Cabinet Order on the Calculation, etc. of Grants for Early-Stage Elderly People and National Treasury Contributions for Latter-Stage Elderly Medical Care

  前期高齢者交付金及び後期高齢者医療の国庫負担金の算定等に関する政令の一部を改正する政令

  Cabinet Order No. 133 of 2026The text after this amendment, on e-Gov

• 1 April 2026

  Cabinet Order Partially Amending the Order for Enforcement of the Medical Care Act, etc.

  医療法施行令等の一部を改正する政令

  Cabinet Order No. 66 of 2026The text after this amendment, on e-Gov

• 1 April 2026

  Cabinet Order on the Arrangement of Related Cabinet Orders upon the Partial Enforcement of the Act Partially Amending the Act on Support for Children and Child-rearing, etc.

  子ども・子育て支援法等の一部を改正する法律の一部の施行に伴う関係政令の整備に関する政令

  Cabinet Order No. 11 of 2026The text after this amendment, on e-Gov

• 1 April 2026

  Cabinet Order Partially Amending the Order for Enforcement of the Health Insurance Act and the Order for Enforcement of the Mariners Insurance Act

  健康保険法施行令及び船員保険法施行令の一部を改正する政令

  Cabinet Order No. 421 of 2025The text after this amendment, on e-Gov

All 34 amendments already in force

• For treatment of a disease the Minister of Health, Labour and Welfare designates as needing a very costly treatment that must go on for a very long time, a person the insurer has recognized, as a Ministry of Health, Labour and Welfare Order (厚生労働省令) sets, pays at most 10,000 yen a month to each hospital or pharmacy, the rest being paid as high-cost medical expenses (高額療養費). The ceiling is 20,000 yen for treatment, up to the month in which they turn 70, of someone (or a dependent of someone) with a standard monthly remuneration (標準報酬月額) of 530,000 yen or more, unless the disease is one whose treatment cost the State bears that the Minister names.(Art. 41(9), Art. 41(9)(i), Art. 41(9)(ii), Art. 42(9), Art. 42(9)(i), Art. 42(9)(ii)) (the provisions it rests on)
• A person receiving public assistance (被保護者) under the Public Assistance Act (生活保護法) has a ceiling of 36,900 yen a month for treatment from each provider, or, from the month after the one in which they turn 70, 15,700 yen for a hospital stay and 8,000 yen for outpatient care. A person the insurer has recognized as receiving treatment for a long-lasting disease covered by a public medical benefit the Minister of Health, Labour and Welfare designates has the monthly ceilings applied to each provider separately, with its own count of repeated months for hospital stays at the same hospital or clinic.(Art. 41(7), Art. 41(8), Art. 42(7), Art. 42(7)(i), Art. 42(7)(ii), Art. 42(7)(iii), Art. 42(8), Art. 42(8)(i), Art. 42(8)(ii), Art. 42(8)(iii)) (the provisions it rests on)
• Someone who keeps receiving the injury and sickness allowance (傷病手当金) after their insured status ends, as the Act allows a person insured for a year or more, is not paid it while they can receive an old-age or retirement pension this Order lists — such as an old-age basic pension (老齢基礎年金), an old-age employees' pension (老齢厚生年金) or a retirement pension of the mutual aid schemes from before their unification — unless that pension is wholly stopped. Where the pension, worked out as a Ministry of Health, Labour and Welfare Order (厚生労働省令) sets, is less than the allowance, the difference is paid. None of this applies to someone who can receive the allowance as a specially-insured day laborer (日雇特例被保険者) under Article 135 of the Act.(Art. 37(1), Art. 38(1), Art. 38(1)(i), Art. 38(1)(ii), Art. 38(1)(iv-2), Health Insurance Act Art. 108(5), Health Insurance Act Art. 104(1)) (the provisions it rests on)
• Under the Act, where someone due to receive the injury and sickness allowance (傷病手当金) can receive a disability allowance (障害手当金) under the Employees' Pension Insurance Act (厚生年金保険法) for the same illness or injury, the allowance is not paid until its running total reaches the disability allowance. This Order sets what is paid on the day the total gets there: the amount by which it passes the disability allowance, or, where the person can receive remuneration or a maternity allowance (出産手当金), the smaller of that amount and the gap between the daily allowance and the remuneration or maternity allowance.(Art. 36-2(1), Art. 36-2(1)(i), Art. 36-2(1)(ii), Art. 36-2(1)(iii), Art. 36-2(1)(iv), Health Insurance Act Art. 108(4)) (the provisions it rests on)

• This Order sets no penalty of its own. Under the Act, an employer who without good reason fails to notify the insurer of an employee's gaining or losing insured status or of their remuneration and bonuses, makes a false notification, does not pay premiums by the deadline in a demand notice, or refuses to show documents, answer an official's questions or allow an inspection, among the other breaches the Act lists, is punished by imprisonment (拘禁刑) for up to six months or a fine (罰金) of up to 500,000 yen.(Health Insurance Act Art. 48(1), Health Insurance Act Art. 161(2), Health Insurance Act Art. 208(1), Health Insurance Act Art. 208(1)(i), Health Insurance Act Art. 208(1)(iii), Health Insurance Act Art. 208(1)(v)) (the provisions it rests on)
• A health insurance society must notify its budget to the Minister of Health, Labour and Welfare (厚生労働大臣) before each fiscal year, needs the Minister's approval to issue society bonds or dispose of important property, and must submit a report on its business and accounts within six months after each year ends. Its members and former members may inspect the minutes of its society meeting (組合会) and that report, and the society may refuse only with good reason.(Art. 16(1), Art. 22(1), Art. 23(1), Art. 24(1), Art. 24(3), Art. 13(4)) (the provisions it rests on)
• The Minister may designate a health insurance society whose regular spending keeps exceeding its regular income, whose benefit and contribution costs keep exceeding 9.5% of its members' total standard monthly remuneration and standard bonus amounts, and whose reserves have fallen below a level this Order sets; under the Act such a designated health insurance society (指定健康保険組合) must have a three-year plan to improve its soundness (健全化計画) approved by the Minister. Where a designated society has not applied for approval of its plan by the date the Minister sets, or cannot obtain it, the Minister may order it dissolved if its business or finances make it hard to carry on.(Art. 29(1), Art. 30(1), Art. 31(1), Art. 31(1)(i), Art. 31(1)(ii), Health Insurance Act Art. 28(1), Health Insurance Act Art. 29(2)) (the provisions it rests on)
• Where a person liable to pay is behind with premiums for at least the number of months a Ministry of Health, Labour and Welfare Order (厚生労働省令) sets, may be hiding property to escape a disposition of delinquency (滞納処分), owes at least an amount that Order sets (counting arrears of employees' pension premiums and the like) and shows no sincere intention to pay despite dispositions, the Minister may, where it is needed for effective collection, hand the dispositions over to the Minister of Finance (財務大臣) — all of them except notices, stays of execution, extensions, exemptions and the other powers this Order keeps back. The Commissioner of the National Tax Agency (国税庁長官), to whom they pass, hands them all to the Director-General of the regional taxation bureau (国税局長) for the place of business, who may pass them on to the head of the district tax office (税務署長).(Art. 63(1), Art. 63(1)(i), Art. 63(1)(ii), Art. 63(1)(iii), Art. 63(1)(iv), Art. 64(1), Art. 64-3(1), Art. 64-3(2), Health Insurance Act Art. 204-2(1)) (the provisions it rests on)
• Once the Minister of Health, Labour and Welfare (厚生労働大臣) has given public notice that the Japan Pension Service (日本年金機構) is to collect premiums, it collects them where a person who has received a demand, or a notice bringing the payment date forward, asks to pay at a pension office (年金事務所); where its collection staff visit and the person asks to pay them; where its staff obtain money by a disposition following the national tax rules; and in other cases a Ministry of Health, Labour and Welfare Order (厚生労働省令) sets. It must give the payer a receipt.(Art. 64-4(1), Art. 64-4(1)(i), Art. 64-4(1)(ii), Art. 64-4(1)(iii), Art. 64-4(1)(iv), Art. 64-4(1)(v), Art. 64-5(1), Art. 64-8(1), Health Insurance Act Art. 204-6(1)) (the provisions it rests on)
• For specially-insured day laborers (日雇特例被保険者) living in an area the Minister of Health, Labour and Welfare designates, the mayor of the municipality (市町村長) issues and takes back their insurance notebook (日雇特例被保険者手帳) and keeps track of which of them are category 2 insured persons of long-term care insurance (介護保険第二号被保険者), as statutory entrusted work of the first kind (第一号法定受託事務) under the Local Autonomy Act (地方自治法), a separate Act. The Japan Health Insurance Association entrusts the municipality with their eligibility certificates (受給資格者票) and special medical expense cards (特別療養費受給票), and with checking their premium payments and dependents for benefits other than burial charges.(Art. 61(1), Art. 61(1)(i), Art. 61(1)(ii), Art. 61(2), Art. 61(2)(i), Art. 61(2)(ii), Art. 61(2)(iii), Art. 62(1), Health Insurance Act Art. 203(1)) (the provisions it rests on)
• The powers this Order gives the Minister of Health, Labour and Welfare over health insurance societies may in part be delegated, as a Ministry of Health, Labour and Welfare Order (厚生労働省令) sets, to the Director-General of the Regional Bureau of Health and Welfare (地方厚生局長), and from there to the head of the branch bureau (地方厚生支局長).(Art. 32(1), Art. 32(2)) (the provisions it rests on)
• Under the Act, an employer who without good reason fails to report, reports falsely or fails to show documents as the Act requires, or neglects the work needed to carry out the Act, is liable to a non-criminal fine (過料) of up to 100,000 yen. So is an insured person, or someone due to receive a benefit, who without good reason fails to make, or falsely makes, a request or notification the Act requires, or fails to submit documents.(Health Insurance Act Art. 216(1), Health Insurance Act Art. 217(1)) (the provisions it rests on)