Article 41-2Requirements for Payment and Amount of Annual High-Cost Medical Expenses
第四十一条の二（年間の高額療養費の支給要件及び支給額）
High-cost medical expenses are paid to the insured person on the reference date prescribed in item (i) if any of the total sum of the amounts listed in items (i) through (vi) (hereinafter in this paragraph referred to as the "total for the insured person on the reference date"), the total sum of the amounts listed in items (vii) through (xii) (hereinafter in this paragraph referred to as the "total for the dependent on the reference date"), or the total sum of the amounts listed in items (xiii) through (xviii) (hereinafter in this paragraph referred to as the "total for former dependents") exceeds the base amount for calculating high-cost medical expenses, and the amount paid is the total sum of the amount obtained by multiplying the amount obtained by deducting the base amount for calculating high-cost medical expenses from the total for the insured person on the reference date (if that amount is less than zero, zero) by the high-cost medical expenses apportionment rate (meaning the rate obtained by dividing the amount listed in item (i) by the total for the insured person on the reference date), the amount obtained by multiplying the amount obtained by deducting the base amount for calculating high-cost medical expenses from the total for the dependent on the reference date (if that amount is less than zero, zero) by the high-cost medical expenses apportionment rate (meaning the rate obtained by dividing the amount listed in item (vii) by the total for the dependent on the reference date), and the amount obtained by multiplying the amount obtained by deducting the base amount for calculating high-cost medical expenses from the total for former dependents (if that amount is less than zero, zero) by the high-cost medical expenses apportionment rate (meaning the rate obtained by dividing the amount listed in item (xiii) by the total for former dependents); provided, however, that this does not apply if the insured person on the reference date is, on the reference date (meaning the last day of the calculation period (meaning the period from August 1 each year to July 31 of the following year; the same applies hereinafter); the same applies hereinafter), a person to whom the provisions of Article 74, paragraph (1), item (iii) of the Act apply.
高額療養費は、第一号から第六号までに掲げる額を合算した額（以下この項において「基準日被保険者合算額」という。）、第七号から第十二号までに掲げる額を合算した額（以下この項において「基準日被扶養者合算額」という。）又は第十三号から第十八号までに掲げる額を合算した額（以下この項において「元被扶養者合算額」という。）のいずれかが高額療養費算定基準額を超える場合に第一号に規定する基準日被保険者に支給するものとし、その額は、基準日被保険者合算額から高額療養費算定基準額を控除した額（当該額が零を下回る場合には、零とする。）に高額療養費按分率（同号に掲げる額を、基準日被保険者合算額で除して得た率をいう。）を乗じて得た額、基準日被扶養者合算額から高額療養費算定基準額を控除した額（当該額が零を下回る場合には、零とする。）に高額療養費按分率（第七号に掲げる額を、基準日被扶養者合算額で除して得た率をいう。）を乗じて得た額及び元被扶養者合算額から高額療養費算定基準額を控除した額（当該額が零を下回る場合には、零とする。）に高額療養費按分率（第十三号に掲げる額を、元被扶養者合算額で除して得た率をいう。）を乗じて得た額の合算額とする。ただし、当該基準日被保険者が基準日（計算期間（毎年八月一日から翌年七月三十一日までの期間をいう。以下同じ。）の末日をいう。以下同じ。）において法第七十四条第一項第三号の規定が適用される者である場合は、この限りでない。
the total sum of the following amounts relating to outpatient treatment (limited to outpatient treatment on or after the month following the month that includes the day on which the person reaches the age of 70; the same applies hereinafter in this Article) (including outpatient treatment for insurance benefits under Article 98, paragraph (1) of the Act (including as applied mutatis mutandis pursuant to Article 110, paragraph (7) and Article 111, paragraph (3) of the Act) (hereinafter in this Article referred to as "outpatient treatment under continued benefits")) that the insured person on the reference date received, during the calculation period (limited to the period during which a person who is, on the reference date, an insured person of the relevant insurer (excluding specially-insured day laborers, members of mutual aid associations under the National Public Officers Mutual Aid Association Act and the Local Public Officers, etc. Mutual Aid Association Act, and subscribers to the Private School Personnel Mutual Aid System under the Private School Personnel Mutual Aid Association Act; the same applies hereinafter in this Article, Article 43, paragraph (11) and Articles 43-2 through 43-4) (hereinafter referred to as the "insured person on the reference date") was an insured person of the relevant insurer), as an insured person of the relevant insurer (excluding a case where the person is one to whom the provisions of Article 74, paragraph (1), item (iii) of the Act apply) (if high-cost medical expenses are paid pursuant to the provisions of paragraphs (1) through (5) of the preceding Article, the amount obtained by deducting the amount paid to the insured person on the reference date, and if money or goods for reducing the burden relating to the following amounts are provided as other benefits prescribed in Article 53 of the Act, the amount obtained by deducting the amount equivalent to that money or those goods relating to the insured person on the reference date):
計算期間（基準日において当該保険者の被保険者（日雇特例被保険者、国家公務員共済組合法及び地方公務員等共済組合法に基づく共済組合の組合員並びに私立学校教職員共済法の規定による私立学校教職員共済制度の加入者を除く。以下この条、第四十三条第十一項及び第四十三条の二から第四十三条の四までにおいて同じ。）である者（以下「基準日被保険者」という。）が当該保険者の被保険者であった間に限る。）において、当該基準日被保険者が当該保険者の被保険者（法第七十四条第一項第三号の規定が適用される者である場合を除く。）として受けた外来療養（七十歳に達する日の属する月の翌月以後の外来療養に限る。以下この条において同じ。）（法第九十八条第一項（法第百十条第七項及び第百十一条第三項において準用する場合を含む。）の規定による保険給付に係る外来療養（以下この条において「継続給付に係る外来療養」という。）を含む。）に係る次に掲げる額の合算額（前条第一項から第五項までの規定により高額療養費が支給される場合にあっては、当該者に係る支給額を控除した額とし、法第五十三条に規定するその他の給付として次に掲げる額に係る負担を軽減するための金品が支給される場合にあっては、当該者に係る当該金品に相当する額を控除した額とする。）
the total sum of the amounts listed in paragraph (1), item (i), (a) through (f) of the preceding Article relating to the relevant outpatient treatment (excluding treatment subject to specified benefits);
the amount that that person still has to bear for the relevant outpatient treatment (limited to treatment subject to specified benefits);
the total sum prescribed in the preceding item for outpatient treatment (including outpatient treatment under continued benefits) that the insured person on the reference date received, during the calculation period (limited to the period during which the insured person on the reference date was an insured person of the insurer of another health insurance), as an insured person of the insurer of that other health insurance (excluding a case where the person is one to whom the provisions of Article 74, paragraph (1), item (iii) of the Act apply);
計算期間（基準日被保険者が他の健康保険の保険者の被保険者であった間に限る。）において、当該基準日被保険者が当該他の健康保険の保険者の被保険者（法第七十四条第一項第三号の規定が適用される者である場合を除く。）として受けた外来療養（継続給付に係る外来療養を含む。）に係る前号に規定する合算額
the total sum prescribed in item (i) for outpatient treatment (including outpatient treatment under continued benefits) that the insured person on the reference date received, during the calculation period (limited to the period during which the dependent of the insured person on the reference date (limited to a person who is, on the reference date, a dependent of an insured person of the relevant insurer; hereinafter in this Article, Article 43-2, paragraph (1) (including as applied mutatis mutandis pursuant to paragraph (3) of that Article), paragraph (3) and paragraph (5) referred to as the "dependent on the reference date") was an insured person of the relevant insurer and the insured person on the reference date was a dependent of that dependent on the reference date), as a dependent of an insured person of the relevant insurer (excluding a case where the person is one to whom the provisions of Article 110, paragraph (2), item (i), (d) of the Act apply);
計算期間（基準日被保険者の被扶養者（基準日において当該保険者の被保険者の被扶養者である者に限る。以下この条並びに第四十三条の二第一項（同条第三項において準用する場合を含む。）、第三項及び第五項において「基準日被扶養者」という。）が当該保険者の被保険者であり、かつ、当該基準日被保険者が当該基準日被扶養者の被扶養者であった間に限る。）において、当該基準日被保険者が当該保険者の被保険者の被扶養者（法第百十条第二項第一号ニの規定が適用される者である場合を除く。）として受けた外来療養（継続給付に係る外来療養を含む。）に係る第一号に規定する合算額
the total sum prescribed in item (i) for outpatient treatment (including outpatient treatment under continued benefits) that the insured person on the reference date received, during the calculation period (limited to the period during which the dependent on the reference date was an insured person of the insurer of another health insurance and the insured person on the reference date was a dependent of that dependent on the reference date), as a dependent of an insured person of the insurer of that other health insurance (excluding a case where the person is one to whom the provisions of Article 110, paragraph (2), item (i), (d) of the Act apply);
計算期間（基準日被扶養者が他の健康保険の保険者の被保険者であり、かつ、基準日被保険者が当該基準日被扶養者の被扶養者であった間に限る。）において、当該基準日被保険者が当該他の健康保険の保険者の被保険者の被扶養者（法第百十条第二項第一号ニの規定が適用される者である場合を除く。）として受けた外来療養（継続給付に係る外来療養を含む。）に係る第一号に規定する合算額
the amount calculated, as provided by Order of the Ministry of Health, Labour and Welfare, as an amount equivalent to the total sum prescribed in item (i) for outpatient treatment that the insured person on the reference date received, during the calculation period (limited to the period during which the insured person on the reference date was a member, etc. of an insurer body, etc.), as a member, etc. of that insurer body, etc. (excluding a case where the person is equivalent to a person to whom the provisions of Article 74, paragraph (1), item (iii) of the Act apply);
計算期間（基準日被保険者が組合等の組合員等であった間に限る。）において、当該基準日被保険者が当該組合等の組合員等（法第七十四条第一項第三号の規定が適用される者に相当する者である場合を除く。）として受けた外来療養について第一号に規定する合算額に相当する額として厚生労働省令で定めるところにより算定した額
the amount calculated, as provided by Order of the Ministry of Health, Labour and Welfare, as an amount equivalent to the total sum prescribed in item (i) for outpatient treatment that the insured person on the reference date received, during the calculation period (limited to the period during which the dependent on the reference date was a member, etc. (excluding an insured person of the late-stage elderly medical care system) of an insurer body, etc. (excluding an Association of Medical Care Systems for the Elderly Aged 75 and older under the Act on Assurance of Medical Care for Elderly People) and the insured person on the reference date was a dependent, etc. of that dependent on the reference date), as a dependent, etc. of a member, etc. of that insurer body, etc. (excluding a case where the person is equivalent to a person to whom the provisions of Article 110, paragraph (2), item (i), (d) of the Act apply);
計算期間（基準日被扶養者が組合等（高齢者の医療の確保に関する法律に基づく後期高齢者医療広域連合を除く。）の組合員等（後期高齢者医療の被保険者を除く。）であり、かつ、基準日被保険者が当該基準日被扶養者の被扶養者等であった間に限る。）において、当該基準日被保険者が当該組合等の組合員等の被扶養者等（法第百十条第二項第一号ニの規定が適用される者に相当する者である場合を除く。）として受けた外来療養について第一号に規定する合算額に相当する額として厚生労働省令で定めるところにより算定した額
the total sum prescribed in item (i) for outpatient treatment (including outpatient treatment under continued benefits) that the dependent on the reference date received, during the calculation period (limited to the period during which the insured person on the reference date was an insured person of the relevant insurer and the dependent on the reference date was a dependent of that insured person on the reference date), as a dependent of an insured person of the relevant insurer (excluding a case where the person is one to whom the provisions of Article 110, paragraph (2), item (i), (d) of the Act apply);
計算期間（基準日被保険者が当該保険者の被保険者であり、かつ、基準日被扶養者が当該基準日被保険者の被扶養者であった間に限る。）において、当該基準日被扶養者が当該保険者の被保険者の被扶養者（法第百十条第二項第一号ニの規定が適用される者である場合を除く。）として受けた外来療養（継続給付に係る外来療養を含む。）に係る第一号に規定する合算額
the total sum prescribed in item (i) for outpatient treatment (including outpatient treatment under continued benefits) that the dependent on the reference date received, during the calculation period (limited to the period during which the insured person on the reference date was an insured person of the insurer of another health insurance and the dependent on the reference date was a dependent of that insured person on the reference date), as a dependent of an insured person of the insurer of that other health insurance (excluding a case where the person is one to whom the provisions of Article 110, paragraph (2), item (i), (d) of the Act apply);
計算期間（基準日被保険者が他の健康保険の保険者の被保険者であり、かつ、基準日被扶養者が当該基準日被保険者の被扶養者であった間に限る。）において、当該基準日被扶養者が当該他の健康保険の保険者の被保険者の被扶養者（法第百十条第二項第一号ニの規定が適用される者である場合を除く。）として受けた外来療養（継続給付に係る外来療養を含む。）に係る第一号に規定する合算額
the total sum prescribed in item (i) for outpatient treatment (including outpatient treatment under continued benefits) that the dependent on the reference date received, during the calculation period (limited to the period during which the dependent on the reference date was an insured person of the relevant insurer), as an insured person of the relevant insurer (excluding a case where the person is one to whom the provisions of Article 74, paragraph (1), item (iii) of the Act apply);
計算期間（基準日被扶養者が当該保険者の被保険者であった間に限る。）において、当該基準日被扶養者が当該保険者の被保険者（法第七十四条第一項第三号の規定が適用される者である場合を除く。）として受けた外来療養（継続給付に係る外来療養を含む。）に係る第一号に規定する合算額
the total sum prescribed in item (i) for outpatient treatment (including outpatient treatment under continued benefits) that the dependent on the reference date received, during the calculation period (limited to the period during which the dependent on the reference date was an insured person of the insurer of another health insurance), as an insured person of the insurer of that other health insurance (excluding a case where the person is one to whom the provisions of Article 74, paragraph (1), item (iii) of the Act apply);
計算期間（基準日被扶養者が他の健康保険の保険者の被保険者であった間に限る。）において、当該基準日被扶養者が当該他の健康保険の保険者の被保険者（法第七十四条第一項第三号の規定が適用される者である場合を除く。）として受けた外来療養（継続給付に係る外来療養を含む。）に係る第一号に規定する合算額
the amount calculated, as provided by Order of the Ministry of Health, Labour and Welfare, as an amount equivalent to the total sum prescribed in item (i) for outpatient treatment that the dependent on the reference date received, during the calculation period (limited to the period during which the insured person on the reference date was a member, etc. (excluding an insured person of the late-stage elderly medical care system) of an insurer body, etc. (excluding an Association of Medical Care Systems for the Elderly Aged 75 and older under the Act on Assurance of Medical Care for Elderly People) and the dependent on the reference date was a dependent, etc. of that insured person on the reference date), as a dependent, etc. of a member, etc. of that insurer body, etc. (excluding a case where the person is equivalent to a person to whom the provisions of Article 110, paragraph (2), item (i), (d) of the Act apply);
計算期間（基準日被保険者が組合等（高齢者の医療の確保に関する法律に基づく後期高齢者医療広域連合を除く。）の組合員等（後期高齢者医療の被保険者を除く。）であり、かつ、基準日被扶養者が当該基準日被保険者の被扶養者等であった間に限る。）において、当該基準日被扶養者が当該組合等の組合員等の被扶養者等（法第百十条第二項第一号ニの規定が適用される者に相当する者である場合を除く。）として受けた外来療養について第一号に規定する合算額に相当する額として厚生労働省令で定めるところにより算定した額
the amount calculated, as provided by Order of the Ministry of Health, Labour and Welfare, as an amount equivalent to the total sum prescribed in item (i) for outpatient treatment that the dependent on the reference date received, during the calculation period (limited to the period during which the dependent on the reference date was a member, etc. of an insurer body, etc.), as a member, etc. of that insurer body, etc. (excluding a case where the person is equivalent to a person to whom the provisions of Article 74, paragraph (1), item (iii) of the Act apply);
計算期間（基準日被扶養者が組合等の組合員等であった間に限る。）において、当該基準日被扶養者が当該組合等の組合員等（法第七十四条第一項第三号の規定が適用される者に相当する者である場合を除く。）として受けた外来療養について第一号に規定する合算額に相当する額として厚生労働省令で定めるところにより算定した額
the total sum prescribed in item (i) for outpatient treatment (including outpatient treatment under continued benefits) that a person who was a dependent of the insured person on the reference date (excluding the dependent on the reference date) received, during the calculation period (limited to the period during which the insured person on the reference date was an insured person of the relevant insurer and the person who was a dependent of that insured person on the reference date (excluding the dependent on the reference date) was a dependent of that insured person on the reference date), as a dependent of an insured person of the relevant insurer (excluding a case where the person is one to whom the provisions of Article 110, paragraph (2), item (i), (d) of the Act apply);
計算期間（基準日被保険者が当該保険者の被保険者であり、かつ、当該基準日被保険者の被扶養者であった者（基準日被扶養者を除く。）が当該基準日被保険者の被扶養者であった間に限る。）において、当該基準日被保険者の被扶養者であった者（基準日被扶養者を除く。）が当該保険者の被保険者の被扶養者（法第百十条第二項第一号ニの規定が適用される者である場合を除く。）として受けた外来療養（継続給付に係る外来療養を含む。）に係る第一号に規定する合算額
the total sum prescribed in item (i) for outpatient treatment (including outpatient treatment under continued benefits) that a person who was a dependent of the insured person on the reference date (excluding the dependent on the reference date) received, during the calculation period (limited to the period during which the insured person on the reference date was an insured person of the insurer of another health insurance and the person who was a dependent of that insured person on the reference date (excluding the dependent on the reference date) was a dependent of that insured person on the reference date), as a dependent of an insured person of the insurer of that other health insurance (excluding a case where the person is one to whom the provisions of Article 110, paragraph (2), item (i), (d) of the Act apply);
計算期間（基準日被保険者が他の健康保険の保険者の被保険者であり、かつ、当該基準日被保険者の被扶養者であった者（基準日被扶養者を除く。）が当該基準日被保険者の被扶養者であった間に限る。）において、当該基準日被保険者の被扶養者であった者（基準日被扶養者を除く。）が当該他の健康保険の保険者の被保険者の被扶養者（法第百十条第二項第一号ニの規定が適用される者である場合を除く。）として受けた外来療養（継続給付に係る外来療養を含む。）に係る第一号に規定する合算額
the total sum prescribed in item (i) for outpatient treatment (including outpatient treatment under continued benefits) that a person who was a dependent of the dependent on the reference date (excluding the insured person on the reference date) received, during the calculation period (limited to the period during which the dependent on the reference date was an insured person of the relevant insurer and the person who was a dependent of that dependent on the reference date (excluding the insured person on the reference date) was a dependent of that dependent on the reference date), as a dependent of an insured person of the relevant insurer (excluding a case where the person is one to whom the provisions of Article 110, paragraph (2), item (i), (d) of the Act apply);
計算期間（基準日被扶養者が当該保険者の被保険者であり、かつ、当該基準日被扶養者の被扶養者であった者（基準日被保険者を除く。）が当該基準日被扶養者の被扶養者であった間に限る。）において、当該基準日被扶養者の被扶養者であった者（基準日被保険者を除く。）が当該保険者の被保険者の被扶養者（法第百十条第二項第一号ニの規定が適用される者である場合を除く。）として受けた外来療養（継続給付に係る外来療養を含む。）に係る第一号に規定する合算額
the total sum prescribed in item (i) for outpatient treatment (including outpatient treatment under continued benefits) that a person who was a dependent of the dependent on the reference date (excluding the insured person on the reference date) received, during the calculation period (limited to the period during which the dependent on the reference date was an insured person of the insurer of another health insurance and the person who was a dependent of that dependent on the reference date (excluding the insured person on the reference date) was a dependent of that dependent on the reference date), as a dependent of an insured person of the insurer of that other health insurance (excluding a case where the person is one to whom the provisions of Article 110, paragraph (2), item (i), (d) of the Act apply);
計算期間（基準日被扶養者が他の健康保険の保険者の被保険者であり、かつ、当該基準日被扶養者の被扶養者であった者（基準日被保険者を除く。）が当該基準日被扶養者の被扶養者であった間に限る。）において、当該基準日被扶養者の被扶養者であった者（基準日被保険者を除く。）が当該他の健康保険の保険者の被保険者の被扶養者（法第百十条第二項第一号ニの規定が適用される者である場合を除く。）として受けた外来療養（継続給付に係る外来療養を含む。）に係る第一号に規定する合算額
the amount calculated, as provided by Order of the Ministry of Health, Labour and Welfare, as an amount equivalent to the total sum prescribed in item (i) for outpatient treatment that a person who was a dependent, etc. of the insured person on the reference date (excluding the dependent on the reference date) received, during the calculation period (limited to the period during which the insured person on the reference date was a member, etc. (excluding an insured person of the late-stage elderly medical care system) of an insurer body, etc. (excluding an Association of Medical Care Systems for the Elderly Aged 75 and older under the Act on Assurance of Medical Care for Elderly People) and the person who was a dependent, etc. of that insured person on the reference date (excluding the dependent on the reference date) was a dependent, etc. of that insured person on the reference date), as a dependent, etc. of a member, etc. of that insurer body, etc. (excluding a case where the person is equivalent to a person to whom the provisions of Article 110, paragraph (2), item (i), (d) of the Act apply);
計算期間（基準日被保険者が組合等（高齢者の医療の確保に関する法律に基づく後期高齢者医療広域連合を除く。）の組合員等（後期高齢者医療の被保険者を除く。）であり、かつ、当該基準日被保険者の被扶養者等であった者（基準日被扶養者を除く。）が当該基準日被保険者の被扶養者等であった間に限る。）において、当該基準日被保険者の被扶養者等であった者（基準日被扶養者を除く。）が当該組合等の組合員等の被扶養者等（法第百十条第二項第一号ニの規定が適用される者に相当する者である場合を除く。）として受けた外来療養について第一号に規定する合算額に相当する額として厚生労働省令で定めるところにより算定した額
the amount calculated, as provided by Order of the Ministry of Health, Labour and Welfare, as an amount equivalent to the total sum prescribed in item (i) for outpatient treatment that a person who was a dependent, etc. of the dependent on the reference date (excluding the insured person on the reference date) received, during the calculation period (limited to the period during which the dependent on the reference date was a member, etc. (excluding an insured person of the late-stage elderly medical care system) of an insurer body, etc. (excluding an Association of Medical Care Systems for the Elderly Aged 75 and older under the Act on Assurance of Medical Care for Elderly People) and the person who was a dependent, etc. of that dependent on the reference date (excluding the insured person on the reference date) was a dependent, etc. of that dependent on the reference date), as a dependent, etc. of a member, etc. of that insurer body, etc. (excluding a case where the person is equivalent to a person to whom the provisions of Article 110, paragraph (2), item (i), (d) of the Act apply).
計算期間（基準日被扶養者が組合等（高齢者の医療の確保に関する法律に基づく後期高齢者医療広域連合を除く。）の組合員等（後期高齢者医療の被保険者を除く。）であり、かつ、当該基準日被扶養者の被扶養者等であった者（基準日被保険者を除く。）が当該基準日被扶養者の被扶養者等であった間に限る。）において、当該基準日被扶養者の被扶養者等であった者（基準日被保険者を除く。）が当該組合等の組合員等の被扶養者等（法第百十条第二項第一号ニの規定が適用される者に相当する者である場合を除く。）として受けた外来療養について第一号に規定する合算額に相当する額として厚生労働省令で定めるところにより算定した額
The provisions of the preceding paragraph apply mutatis mutandis to the payment of high-cost medical expenses to a person who was an insured person of the relevant insurer during the calculation period (limited to a dependent on the reference date). In this case, the phrase "(meaning the rate obtained by dividing the amount listed in item (i)" in that paragraph is deemed to be replaced with "(meaning the rate obtained by dividing the amount listed in item (iii)", "(meaning the rate obtained by dividing the amount listed in item (vii)" with "(meaning the rate obtained by dividing the amount listed in item (ix)", and "(meaning the rate obtained by dividing the amount listed in item (xiii)" with "(meaning the rate obtained by dividing the amount listed in item (xv)", and the term "Article 74, paragraph (1), item (iii)" in the proviso to that paragraph is deemed to be replaced with "Article 110, paragraph (2), item (i), (d)".
The provisions of paragraph (1) apply mutatis mutandis to the payment of high-cost medical expenses to a person who was an insured person of the relevant insurer during the calculation period (limited to a person who, on the reference date, is an insured person of the insurer of another health insurance). In this case, the terms listed in the middle column of the following table in the provisions listed in the left-hand column of the table are deemed to be replaced with the terms listed in the right-hand column of the table, respectively.
| Paragraph (1) | listed in item (i) | listed in item (ii), limited to the amount that relates to the outpatient treatment prescribed in item (ii) that the person prescribed in paragraph (3) received, during the calculation period (meaning the period from August 1 each year to July 31 of the following year; the same applies hereinafter) (limited to the period during which the person prescribed in paragraph (3) was an insured person of the relevant insurer), as an insured person of the relevant insurer (excluding a case where the person is one to whom the provisions of Article 74, paragraph (1), item (iii) of the Act apply) |
| listed in item (vii) | listed in item (viii), limited to the amount that relates to the outpatient treatment prescribed in item (viii) that the dependent on the reference date received, during the calculation period (limited to the period during which the person prescribed in paragraph (3) was an insured person of the relevant insurer and the dependent on the reference date prescribed in item (iii) was a dependent of that person prescribed in that paragraph), as a dependent of an insured person of the relevant insurer (excluding a case where the person is one to whom the provisions of Article 110, paragraph (2), item (i), (d) of the Act apply) | |
| listed in item (xiii) | listed in item (xiv), limited to the amount that relates to the outpatient treatment prescribed in item (xiv) that a person who was a dependent of the person prescribed in paragraph (3) (excluding that dependent on the reference date) received, during the calculation period (limited to the period during which the person prescribed in paragraph (3) was an insured person of the relevant insurer and the person who was a dependent of the person prescribed in that paragraph (excluding that dependent on the reference date) was a dependent of the person prescribed in that paragraph), as a dependent of an insured person of the relevant insurer (excluding a case where the person is one to whom the provisions of Article 110, paragraph (2), item (i), (d) of the Act apply) | |
| Paragraph (1), proviso | the last day of the calculation period (meaning the period from August 1 each year to July 31 of the following year; the same applies hereinafter) | the last day of the calculation period |
| Paragraph (1), item (i) | on the reference date, an insured person of the relevant insurer | on the reference date, an insured person of the insurer of another health insurance |
| ) was an insured person of the relevant insurer | ) was an insured person of the insurer of that other health insurance (hereinafter referred to as the "insurer on the reference date" in this paragraph) | |
| as an insured person of the relevant insurer (excluding a case | as an insured person of the insurer on the reference date (excluding a case | |
| Paragraph (1), item (ii) | another health insurance | a health insurance other than that of the insurer on the reference date |
| Paragraph (1), item (iii) | on the reference date, a dependent of an insured person of the relevant insurer | on the reference date, a dependent of an insured person of the insurer on the reference date |
| the relevant insurer | that insurer on the reference date | |
| Paragraph (1), item (iv) | another health insurance | a health insurance other than that of the insurer on the reference date |
| Paragraph (1), item (vii) | an insured person of the relevant insurer and | an insured person of the insurer on the reference date and |
| of an insured person of the relevant insurer | of an insured person of the insurer on the reference date | |
| Paragraph (1), item (viii) | another health insurance | a health insurance other than that of the insurer on the reference date |
| Paragraph (1), item (ix) | was an insured person of the relevant insurer | was an insured person of the insurer on the reference date |
| an insured person of the relevant insurer ( | an insured person of the insurer on the reference date ( | |
| Paragraph (1), item (x) | another health insurance | a health insurance other than that of the insurer on the reference date |
| Paragraph (1), item (xiii) | an insured person of the relevant insurer and | an insured person of the insurer on the reference date and |
| of an insured person of the relevant insurer | of an insured person of the insurer on the reference date | |
| Paragraph (1), item (xiv) | another health insurance | a health insurance other than that of the insurer on the reference date |
| Paragraph (1), item (xv) | an insured person of the relevant insurer and | an insured person of the insurer on the reference date and |
| of an insured person of the relevant insurer | of an insured person of the insurer on the reference date | |
| Paragraph (1), item (xvi) | another health insurance | a health insurance other than that of the insurer on the reference date |
第一項の規定は、計算期間において当該保険者の被保険者であった者（基準日において他の健康保険の保険者の被保険者である者に限る。）に対する高額療養費の支給について準用する。この場合において、次の表の上欄に掲げる規定中同表の中欄に掲げる字句は、それぞれ同表の下欄に掲げる字句に読み替えるものとする。
| 第一項 | 同号に掲げる | 第二号に掲げる額のうち、計算期間（毎年八月一日から翌年七月三十一日までの期間をいう。以下同じ。）（第三項に規定する者が当該保険者の被保険者であった間に限る。）において、当該第三項に規定する者が当該保険者の被保険者（法第七十四条第一項第三号の規定が適用される者である場合を除く。）として受けた第二号に規定する外来療養に係る |
| 第七号に掲げる | 第八号に掲げる額のうち、計算期間（第三項に規定する者が当該保険者の被保険者であり、かつ、第三号に規定する基準日被扶養者が当該同項に規定する者の被扶養者であった間に限る。）において、当該基準日被扶養者が当該保険者の被保険者の被扶養者（法第百十条第二項第一号ニの規定が適用される者である場合を除く。）として受けた第八号に規定する外来療養に係る | |
| 第十三号に掲げる | 第十四号に掲げる額のうち、計算期間（第三項に規定する者が当該保険者の被保険者であり、かつ、当該同項に規定する者の被扶養者であった者（当該基準日被扶養者を除く。）が当該同項に規定する者の被扶養者であった間に限る。）において、当該同項に規定する者の被扶養者であった者（当該基準日被扶養者を除く。）が当該保険者の被保険者の被扶養者（法第百十条第二項第一号ニの規定が適用される者である場合を除く。）として受けた第十四号に規定する外来療養に係る | |
| 第一項ただし書 | （毎年八月一日から翌年七月三十一日までの期間をいう。以下同じ。）の末日 | の末日 |
| 第一項第一号 | おいて当該 | おいて他の健康保険の |
| ）が当該保険者 | ）が当該他の健康保険の保険者（以下この項において「基準日保険者」という。） | |
| 保険者の被保険者（法 | 基準日保険者の被保険者（法 | |
| 第一項第二号 | 他の | 基準日保険者以外の |
| 第一項第三号 | おいて当該保険者 | おいて基準日保険者 |
| が当該保険者 | が当該基準日保険者 | |
| 第一項第四号 | 他の | 基準日保険者以外の |
| 第一項第七号 | 当該保険者の被保険者で | 基準日保険者の被保険者で |
| 保険者の被保険者の | 基準日保険者の被保険者の | |
| 第一項第八号 | 他の | 基準日保険者以外の |
| 第一項第九号 | 当該保険者の被保険者で | 基準日保険者の被保険者で |
| 保険者の被保険者（ | 基準日保険者の被保険者（ | |
| 第一項第十号 | 他の | 基準日保険者以外の |
| 第一項第十三号 | 当該保険者の被保険者で | 基準日保険者の被保険者で |
| 保険者の被保険者の | 基準日保険者の被保険者の | |
| 第一項第十四号 | 他の | 基準日保険者以外の |
| 第一項第十五号 | 当該保険者の被保険者で | 基準日保険者の被保険者で |
| 保険者の被保険者の | 基準日保険者の被保険者の | |
| 第一項第十六号 | 他の | 基準日保険者以外の |
The provisions of paragraph (1) apply mutatis mutandis to the payment of high-cost medical expenses to a person who was an insured person of the relevant insurer during the calculation period (limited to a person who, on the reference date, is a dependent of an insured person of the insurer of another health insurance). In this case, the terms listed in the middle column of the following table in the provisions listed in the left-hand column of the table are deemed to be replaced with the terms listed in the right-hand column of the table, respectively.
| Paragraph (1) | listed in item (i) | listed in item (iv), limited to the amount that relates to the outpatient treatment prescribed in item (iv) that the insured person on the reference date prescribed in item (i) received, during the calculation period (meaning the period from August 1 each year to July 31 of the following year; the same applies hereinafter) (limited to the period during which the person prescribed in paragraph (4) was an insured person of the relevant insurer and the insured person on the reference date prescribed in item (i) was a dependent of the person prescribed in that paragraph), as a dependent of an insured person of the relevant insurer (excluding a case where the person is one to whom the provisions of Article 110, paragraph (2), item (i), (d) of the Act apply) |
| listed in item (vii) | listed in item (x), limited to the amount that relates to the outpatient treatment prescribed in item (x) that the person prescribed in paragraph (4) received, during the calculation period (limited to the period during which the person prescribed in paragraph (4) was an insured person of the relevant insurer), as an insured person of the relevant insurer (excluding a case where the person is one to whom the provisions of Article 74, paragraph (1), item (iii) of the Act apply) | |
| listed in item (xiii) | listed in item (xvi), limited to the amount that relates to the outpatient treatment prescribed in item (xvi) that a person who was a dependent of the person prescribed in paragraph (4) (excluding that insured person on the reference date) received, during the calculation period (limited to the period during which the person prescribed in paragraph (4) was an insured person of the relevant insurer and the person who was a dependent of the person prescribed in that paragraph (excluding that insured person on the reference date) was a dependent of the person prescribed in that paragraph), as a dependent of an insured person of the relevant insurer (excluding a case where the person is one to whom the provisions of Article 110, paragraph (2), item (i), (d) of the Act apply) | |
| Paragraph (1), proviso | the last day of the calculation period (meaning the period from August 1 each year to July 31 of the following year; the same applies hereinafter) | the last day of the calculation period |
| Article 74, paragraph (1), item (iii) | Article 110, paragraph (2), item (i), (d) | |
| Paragraph (1), item (i) | on the reference date, an insured person of the relevant insurer | on the reference date, an insured person of the insurer of another health insurance |
| ) was an insured person of the relevant insurer | ) was an insured person of the insurer of that other health insurance (hereinafter referred to as the "insurer on the reference date" in this paragraph) | |
| as an insured person of the relevant insurer (excluding a case | as an insured person of the insurer on the reference date (excluding a case | |
| Paragraph (1), item (ii) | another health insurance | a health insurance other than that of the insurer on the reference date |
| Paragraph (1), item (iii) | on the reference date, a dependent of an insured person of the relevant insurer | on the reference date, a dependent of an insured person of the insurer on the reference date |
| the relevant insurer | that insurer on the reference date | |
| Paragraph (1), item (iv) | another health insurance | a health insurance other than that of the insurer on the reference date |
| Paragraph (1), item (vii) | an insured person of the relevant insurer and | an insured person of the insurer on the reference date and |
| of an insured person of the relevant insurer | of an insured person of the insurer on the reference date | |
| Paragraph (1), item (viii) | another health insurance | a health insurance other than that of the insurer on the reference date |
| Paragraph (1), item (ix) | was an insured person of the relevant insurer | was an insured person of the insurer on the reference date |
| an insured person of the relevant insurer ( | an insured person of the insurer on the reference date ( | |
| Paragraph (1), item (x) | another health insurance | a health insurance other than that of the insurer on the reference date |
| Paragraph (1), item (xiii) | an insured person of the relevant insurer and | an insured person of the insurer on the reference date and |
| of an insured person of the relevant insurer | of an insured person of the insurer on the reference date | |
| Paragraph (1), item (xiv) | another health insurance | a health insurance other than that of the insurer on the reference date |
| Paragraph (1), item (xv) | an insured person of the relevant insurer and | an insured person of the insurer on the reference date and |
| of an insured person of the relevant insurer | of an insured person of the insurer on the reference date | |
| Paragraph (1), item (xvi) | another health insurance | a health insurance other than that of the insurer on the reference date |
第一項の規定は、計算期間において当該保険者の被保険者であった者（基準日において他の健康保険の保険者の被保険者の被扶養者である者に限る。）に対する高額療養費の支給について準用する。この場合において、次の表の上欄に掲げる規定中同表の中欄に掲げる字句は、それぞれ同表の下欄に掲げる字句に読み替えるものとする。
| 第一項 | 同号に掲げる | 第四号に掲げる額のうち、計算期間（毎年八月一日から翌年七月三十一日までの期間をいう。以下同じ。）（第四項に規定する者が当該保険者の被保険者であり、かつ、第一号に規定する基準日被保険者が当該同項に規定する者の被扶養者であった間に限る。）において、当該基準日被保険者が当該保険者の被保険者の被扶養者（法第百十条第二項第一号ニの規定が適用される者である場合を除く。）として受けた第四号に規定する外来療養に係る |
| 第七号に掲げる | 第十号に掲げる額のうち、計算期間（第四項に規定する者が当該保険者の被保険者であった間に限る。）において、当該第四項に規定する者が当該保険者の被保険者（法第七十四条第一項第三号の規定が適用される者である場合を除く。）として受けた第十号に規定する外来療養に係る | |
| 第十三号に掲げる | 第十六号に掲げる額のうち、計算期間（第四項に規定する者が当該保険者の被保険者であり、かつ、当該同項に規定する者の被扶養者であった者（当該基準日被保険者を除く。）が当該同項に規定する者の被扶養者であった間に限る。）において、当該同項に規定する者の被扶養者であった者（当該基準日被保険者を除く。）が当該保険者の被保険者の被扶養者（法第百十条第二項第一号ニの規定が適用される者である場合を除く。）として受けた第十六号に規定する外来療養に係る | |
| 第一項ただし書 | （毎年八月一日から翌年七月三十一日までの期間をいう。以下同じ。）の末日 | の末日 |
| 第七十四条第一項第三号 | 第百十条第二項第一号ニ | |
| 第一項第一号 | おいて当該 | おいて他の健康保険の |
| ）が当該保険者 | ）が当該他の健康保険の保険者（以下この項において「基準日保険者」という。） | |
| 保険者の被保険者（法 | 基準日保険者の被保険者（法 | |
| 第一項第二号 | 他の | 基準日保険者以外の |
| 第一項第三号 | おいて当該保険者 | おいて基準日保険者 |
| が当該保険者 | が当該基準日保険者 | |
| 第一項第四号 | 他の | 基準日保険者以外の |
| 第一項第七号 | 当該保険者の被保険者で | 基準日保険者の被保険者で |
| 保険者の被保険者の | 基準日保険者の被保険者の | |
| 第一項第八号 | 他の | 基準日保険者以外の |
| 第一項第九号 | 当該保険者の被保険者で | 基準日保険者の被保険者で |
| 保険者の被保険者（ | 基準日保険者の被保険者（ | |
| 第一項第十号 | 他の | 基準日保険者以外の |
| 第一項第十三号 | 当該保険者の被保険者で | 基準日保険者の被保険者で |
| 保険者の被保険者の | 基準日保険者の被保険者の | |
| 第一項第十四号 | 他の | 基準日保険者以外の |
| 第一項第十五号 | 当該保険者の被保険者で | 基準日保険者の被保険者で |
| 保険者の被保険者の | 基準日保険者の被保険者の | |
| 第一項第十六号 | 他の | 基準日保険者以外の |
High-cost medical expenses for a person who was an insured person of the relevant insurer during the calculation period (limited to a person who, on the reference date, is a member, etc. (excluding a householder, etc. under National Health Insurance prescribed in paragraph (9) who is an insured person or a dependent thereof, and an insured person of the late-stage elderly medical care system) of an insurer body, etc. (excluding an Association of Medical Care Systems for the Elderly Aged 75 and older under the Act on Assurance of Medical Care for Elderly People); hereinafter in this paragraph referred to as the "member, etc. on the reference date") are to be paid where any of the amounts listed in the left-hand column of the following table exceeds the base amount for calculating high-cost medical expenses, and the amount of those expenses is to be the total sum of the amounts obtained by multiplying the amount listed in the middle column of the table (or zero, if that amount is less than zero) by the rate listed in the right-hand column of the table respectively; provided, however, that this does not apply if the member, etc. on the reference date is, on the reference date, a person equivalent to a person to whom the provisions of Article 74, paragraph (1), item (iii) of the Act apply.
| the amount obtained by totaling the amounts equivalent to the amounts listed in paragraph (1), items (i) through (vi), calculated as provided by Order of the Ministry of Health, Labour and Welfare by deeming the member, etc. on the reference date to be the insured person on the reference date, and the dependent, etc. on the reference date (meaning a person who, on the reference date, is a dependent, etc. of that member, etc. on the reference date; the same applies hereinafter in this table) to be the dependent on the reference date (hereinafter referred to as the "total for the member, etc. on the reference date" in this table) | the amount obtained by deducting the base amount for calculating high-cost medical expenses from the total for the member, etc. on the reference date | the rate obtained by dividing, of the total for the member, etc. on the reference date, the amount equivalent to the amount listed in paragraph (1), item (i), calculated as provided by Order of the Ministry of Health, Labour and Welfare by deeming the member, etc. on the reference date to be the insured person on the reference date, and the dependent, etc. on the reference date to be the dependent on the reference date, by the total for the member, etc. on the reference date |
| the amount obtained by totaling the amounts equivalent to the amounts listed in paragraph (1), items (vii) through (xii), calculated as provided by Order of the Ministry of Health, Labour and Welfare by deeming the member, etc. on the reference date to be the insured person on the reference date, and the dependent, etc. on the reference date to be the dependent on the reference date (hereinafter referred to as the "total for dependents, etc. on the reference date" in this table) | the amount obtained by deducting the base amount for calculating high-cost medical expenses from the total for dependents, etc. on the reference date | the rate obtained by dividing, of the total for dependents, etc. on the reference date, the amount equivalent to the amount listed in paragraph (1), item (vii), calculated as provided by Order of the Ministry of Health, Labour and Welfare by deeming the member, etc. on the reference date to be the insured person on the reference date, and the dependent, etc. on the reference date to be the dependent on the reference date, by the total for dependents, etc. on the reference date |
| the amount obtained by totaling the amounts equivalent to the amounts listed in paragraph (1), items (xiii) through (xviii), calculated as provided by Order of the Ministry of Health, Labour and Welfare by deeming the member, etc. on the reference date to be the insured person on the reference date, and the dependent, etc. on the reference date to be the dependent on the reference date (hereinafter referred to as the "total for former dependents" in this table) | the amount obtained by deducting the base amount for calculating high-cost medical expenses from the total for former dependents | the rate obtained by dividing, of the total for former dependents, the amount equivalent to the amount listed in paragraph (1), item (xiii), calculated as provided by Order of the Ministry of Health, Labour and Welfare by deeming the member, etc. on the reference date to be the insured person on the reference date, and the dependent, etc. on the reference date to be the dependent on the reference date, by the total for former dependents |
計算期間において当該保険者の被保険者であった者（基準日において組合等（高齢者の医療の確保に関する法律に基づく後期高齢者医療広域連合を除く。）の組合員等（第九項に規定する国民健康保険の世帯主等であって被保険者又はその被扶養者である者及び後期高齢者医療の被保険者を除く。）である者に限る。以下この項において「基準日組合員等」という。）に対する高額療養費は、次の表の上欄に掲げる額のいずれかが高額療養費算定基準額を超える場合に支給するものとし、その額は、同表の中欄に掲げる額（当該額が零を下回る場合には、零とする。）にそれぞれ同表の下欄に掲げる率を乗じて得た額の合算額とする。ただし、当該基準日組合員等が基準日において法第七十四条第一項第三号の規定が適用される者に相当する者である場合は、この限りでない。
| 基準日組合員等を基準日被保険者と、基準日被扶養者等（基準日において当該基準日組合員等の被扶養者等である者をいう。以下この表において同じ。）を基準日被扶養者とそれぞれみなして厚生労働省令で定めるところにより算定した第一項第一号から第六号までに掲げる額に相当する額を合算した額（以下この表において「基準日組合員等合算額」という。） | 基準日組合員等合算額から高額療養費算定基準額を控除した額 | 基準日組合員等合算額のうち、基準日組合員等を基準日被保険者と、基準日被扶養者等を基準日被扶養者とそれぞれみなして厚生労働省令で定めるところにより算定した第一項第一号に掲げる額に相当する額を、基準日組合員等合算額で除して得た率 |
| 基準日組合員等を基準日被保険者と、基準日被扶養者等を基準日被扶養者とそれぞれみなして厚生労働省令で定めるところにより算定した第一項第七号から第十二号までに掲げる額に相当する額を合算した額（以下この表において「基準日被扶養者等合算額」という。） | 基準日被扶養者等合算額から高額療養費算定基準額を控除した額 | 基準日被扶養者等合算額のうち、基準日組合員等を基準日被保険者と、基準日被扶養者等を基準日被扶養者とそれぞれみなして厚生労働省令で定めるところにより算定した第一項第七号に掲げる額に相当する額を、基準日被扶養者等合算額で除して得た率 |
| 基準日組合員等を基準日被保険者と、基準日被扶養者等を基準日被扶養者とそれぞれみなして厚生労働省令で定めるところにより算定した第一項第十三号から第十八号までに掲げる額に相当する額を合算した額（以下この表において「元被扶養者合算額」という。） | 元被扶養者合算額から高額療養費算定基準額を控除した額 | 元被扶養者合算額のうち、基準日組合員等を基準日被保険者と、基準日被扶養者等を基準日被扶養者とそれぞれみなして厚生労働省令で定めるところにより算定した第一項第十三号に掲げる額に相当する額を、元被扶養者合算額で除して得た率 |
The provisions of the preceding paragraph apply mutatis mutandis to the payment of high-cost medical expenses to a person who was an insured person of the relevant insurer during the calculation period (limited to a person who, on the reference date, is a dependent, etc. of a member, etc. (excluding an insured person of the late-stage elderly medical care system) of an insurer body, etc. (excluding an Association of Medical Care Systems for the Elderly Aged 75 and older under the Act on Assurance of Medical Care for Elderly People)). In this case, the term "Article 74, paragraph (1), item (iii)" in the proviso to that paragraph is deemed to be replaced with "Article 110, paragraph (2), item (i), (d)", the term "to be the insured person on the reference date, and the dependent, etc. on the reference date (" in the table of that paragraph with "(meaning a person who, on the reference date, is a member, etc. (excluding an insured person of the late-stage elderly medical care system) of an insurer body, etc. (excluding an Association of Medical Care Systems for the Elderly Aged 75 and older under the Act on Assurance of Medical Care for Elderly People); the same applies hereinafter in this table) to be the insured person on the reference date, and the dependent, etc. on the reference date (", "paragraph (1), item (i)" with "paragraph (1), item (iii)", "paragraph (1), item (vii)" with "paragraph (1), item (ix)", and "paragraph (1), item (xiii)" with "paragraph (1), item (xv)".
前項の規定は、計算期間において当該保険者の被保険者であった者（基準日において組合等（高齢者の医療の確保に関する法律に基づく後期高齢者医療広域連合を除く。）の組合員等（後期高齢者医療の被保険者を除く。）の被扶養者等である者に限る。）に対する高額療養費の支給について準用する。この場合において、同項ただし書中「第七十四条第一項第三号」とあるのは「第百十条第二項第一号ニ」と、同項の表中「を基準日被保険者と、基準日被扶養者等（」とあるのは「（基準日において組合等（高齢者の医療の確保に関する法律に基づく後期高齢者医療広域連合を除く。）の組合員等（後期高齢者医療の被保険者を除く。）である者をいう。以下この表において同じ。）を基準日被保険者と、基準日被扶養者等（」と、「第一項第一号に」とあるのは「第一項第三号に」と、「第一項第七号に」とあるのは「第一項第九号に」と、「第一項第十三号に」とあるのは「第一項第十五号に」と読み替えるものとする。
High-cost medical expenses for a person who was an insured person of the relevant insurer during the calculation period (limited to a person who, on the reference date, is an insured person of the late-stage elderly medical care system; hereinafter in this paragraph referred to as the "late-stage elderly insured person on the reference date") are to be paid where any of the amounts listed in the left-hand column of the following table exceeds the base amount for calculating high-cost medical expenses, and the amount of those expenses is to be the total sum of the amounts obtained by multiplying the amount listed in the middle column of the table (or zero, if that amount is less than zero) by the rate listed in the right-hand column of the table respectively; provided, however, that this does not apply if the late-stage elderly insured person on the reference date is, on the reference date, a person equivalent to a person to whom the provisions of Article 74, paragraph (1), item (iii) of the Act apply.
| the amount obtained by totaling the amounts equivalent to the amounts listed in paragraph (1), items (i) through (vi), calculated as provided by Order of the Ministry of Health, Labour and Welfare by deeming the late-stage elderly insured person on the reference date to be the insured person on the reference date, and the other late-stage elderly insured person in the household on the reference date (meaning an insured person of the late-stage elderly medical care system, other than that late-stage elderly insured person on the reference date, who on the reference date belongs to the same household as that late-stage elderly insured person on the reference date; the same applies hereinafter in this table) to be the dependent on the reference date (hereinafter referred to as the "total for the late-stage elderly insured person on the reference date" in this table) | the amount obtained by deducting the base amount for calculating high-cost medical expenses from the total for the late-stage elderly insured person on the reference date | the rate obtained by dividing, of the total for the late-stage elderly insured person on the reference date, the amount equivalent to the amount listed in paragraph (1), item (i), calculated as provided by Order of the Ministry of Health, Labour and Welfare by deeming the late-stage elderly insured person on the reference date to be the insured person on the reference date, and the other late-stage elderly insured person in the household on the reference date to be the dependent on the reference date, by the total for the late-stage elderly insured person on the reference date |
| the amount obtained by totaling the amounts equivalent to the amounts listed in paragraph (1), items (vii) through (xii), calculated as provided by Order of the Ministry of Health, Labour and Welfare by deeming the late-stage elderly insured person on the reference date to be the insured person on the reference date, and the other late-stage elderly insured person in the household on the reference date to be the dependent on the reference date (hereinafter referred to as the "total for other late-stage elderly insured persons in the household on the reference date" in this table) | the amount obtained by deducting the base amount for calculating high-cost medical expenses from the total for other late-stage elderly insured persons in the household on the reference date | the rate obtained by dividing, of the total for other late-stage elderly insured persons in the household on the reference date, the amount equivalent to the amount listed in paragraph (1), item (vii), calculated as provided by Order of the Ministry of Health, Labour and Welfare by deeming the late-stage elderly insured person on the reference date to be the insured person on the reference date, and the other late-stage elderly insured person in the household on the reference date to be the dependent on the reference date, by the total for other late-stage elderly insured persons in the household on the reference date |
| the amount obtained by totaling the amounts equivalent to the amounts listed in paragraph (1), items (xiii) through (xviii), calculated as provided by Order of the Ministry of Health, Labour and Welfare by deeming the late-stage elderly insured person on the reference date to be the insured person on the reference date, and the other late-stage elderly insured person in the household on the reference date to be the dependent on the reference date (hereinafter referred to as the "total for former dependents" in this table) | the amount obtained by deducting the base amount for calculating high-cost medical expenses from the total for former dependents | the rate obtained by dividing, of the total for former dependents, the amount equivalent to the amount listed in paragraph (1), item (xiii), calculated as provided by Order of the Ministry of Health, Labour and Welfare by deeming the late-stage elderly insured person on the reference date to be the insured person on the reference date, and the other late-stage elderly insured person in the household on the reference date to be the dependent on the reference date, by the total for former dependents |
計算期間において当該保険者の被保険者であった者（基準日において後期高齢者医療の被保険者である者に限る。以下この項において「基準日後期高齢者医療被保険者」という。）に対する高額療養費は、次の表の上欄に掲げる額のいずれかが高額療養費算定基準額を超える場合に支給するものとし、その額は、同表の中欄に掲げる額（当該額が零を下回る場合には、零とする。）にそれぞれ同表の下欄に掲げる率を乗じて得た額の合算額とする。ただし、当該基準日後期高齢者医療被保険者が基準日において法第七十四条第一項第三号の規定が適用される者に相当する者である場合は、この限りでない。
| 基準日後期高齢者医療被保険者を基準日被保険者と、基準日後期高齢者医療被保険者以外後期高齢者医療被保険者（基準日において当該基準日後期高齢者医療被保険者と同一の世帯に属する当該基準日後期高齢者医療被保険者以外の後期高齢者医療の被保険者をいう。以下この表において同じ。）を基準日被扶養者とそれぞれみなして厚生労働省令で定めるところにより算定した第一項第一号から第六号までに掲げる額に相当する額を合算した額（以下この表において「基準日後期高齢者医療被保険者合算額」という。） | 基準日後期高齢者医療被保険者合算額から高額療養費算定基準額を控除した額 | 基準日後期高齢者医療被保険者合算額のうち、基準日後期高齢者医療被保険者を基準日被保険者と、基準日後期高齢者医療被保険者以外後期高齢者医療被保険者を基準日被扶養者とそれぞれみなして厚生労働省令で定めるところにより算定した第一項第一号に掲げる額に相当する額を、基準日後期高齢者医療被保険者合算額で除して得た率 |
| 基準日後期高齢者医療被保険者を基準日被保険者と、基準日後期高齢者医療被保険者以外後期高齢者医療被保険者を基準日被扶養者とそれぞれみなして厚生労働省令で定めるところにより算定した第一項第七号から第十二号までに掲げる額に相当する額を合算した額（以下この表において「基準日後期高齢者医療被保険者以外後期高齢者医療被保険者合算額」という。） | 基準日後期高齢者医療被保険者以外後期高齢者医療被保険者合算額から高額療養費算定基準額を控除した額 | 基準日後期高齢者医療被保険者以外後期高齢者医療被保険者合算額のうち、基準日後期高齢者医療被保険者を基準日被保険者と、基準日後期高齢者医療被保険者以外後期高齢者医療被保険者を基準日被扶養者とそれぞれみなして厚生労働省令で定めるところにより算定した第一項第七号に掲げる額に相当する額を、基準日後期高齢者医療被保険者以外後期高齢者医療被保険者合算額で除して得た率 |
| 基準日後期高齢者医療被保険者を基準日被保険者と、基準日後期高齢者医療被保険者以外後期高齢者医療被保険者を基準日被扶養者とそれぞれみなして厚生労働省令で定めるところにより算定した第一項第十三号から第十八号までに掲げる額に相当する額を合算した額（以下この表において「元被扶養者合算額」という。） | 元被扶養者合算額から高額療養費算定基準額を控除した額 | 元被扶養者合算額のうち、基準日後期高齢者医療被保険者を基準日被保険者と、基準日後期高齢者医療被保険者以外後期高齢者医療被保険者を基準日被扶養者とそれぞれみなして厚生労働省令で定めるところにより算定した第一項第十三号に掲げる額に相当する額を、元被扶養者合算額で除して得た率 |
In paragraph (1) (including where applied mutatis mutandis in paragraphs (2) through (4)), paragraph (5) (including where applied mutatis mutandis in paragraph (6)) and paragraph (6), "insurer body, etc." means the Japan Health Insurance Association as an insurer under Article 123, paragraph (1) of the Act, the Japan Health Insurance Association that provides benefits relating to medical care under the provisions of the Mariners Insurance Act, a municipality (including a special ward; the same applies hereinafter), a National Health Insurance Society, a mutual aid association under the National Public Officers Mutual Aid Association Act or the Local Public Officers, etc. Mutual Aid Association Act, the Promotion and Mutual Aid Corporation for Private Schools of Japan, or an Association of Medical Care Systems for the Elderly Aged 75 and older under the Act on Assurance of Medical Care for Elderly People.
第一項（第二項から第四項までにおいて準用する場合を含む。）、第五項（第六項において準用する場合を含む。）及び第六項において「組合等」とは、法第百二十三条第一項の規定による保険者としての全国健康保険協会、船員保険法の規定により医療に関する給付を行う全国健康保険協会、市町村（特別区を含む。以下同じ。）、国民健康保険組合、国家公務員共済組合法若しくは地方公務員等共済組合法に基づく共済組合、日本私立学校振興・共済事業団又は高齢者の医療の確保に関する法律に基づく後期高齢者医療広域連合をいう。
In paragraph (1) (including where applied mutatis mutandis in paragraphs (2) through (4)), paragraph (5) (including where applied mutatis mutandis in paragraph (6)) and paragraph (6), "member, etc." means a specially-insured day laborer (including a person who was a specially-insured day laborer (limited to a person who is within the period until there is no blank space left on the specially-insured day laborer's insurance book issued pursuant to Article 126 of the Act on which to affix a health insurance stamp, and excluding a person who is within a period in which the person does not become a specially-insured day laborer under Article 3, paragraph (2) of the Act owing to approval under the proviso to that paragraph, or a person who has returned that specially-insured day laborer's insurance book pursuant to Article 126, paragraph (3) of the Act); the same applies in the following paragraph, Article 43-3, paragraph (5) and Article 44, paragraphs (2) through (8)), an insured person of Mariners Insurance, a member of a mutual aid association under the National Public Officers Mutual Aid Association Act or the Local Public Officers, etc. Mutual Aid Association Act, a subscriber to the Private School Personnel Mutual Aid System under the provisions of the Private School Personnel Mutual Aid Association Act, the head of a household to which an insured person of National Health Insurance belongs or a member of a National Health Insurance Society (hereinafter referred to as a "householder, etc. under National Health Insurance"), or an insured person of the late-stage elderly medical care system.
第一項（第二項から第四項までにおいて準用する場合を含む。）、第五項（第六項において準用する場合を含む。）及び第六項において「組合員等」とは、日雇特例被保険者（日雇特例被保険者であった者（法第百二十六条の規定により日雇特例被保険者手帳の交付を受け、その手帳に健康保険印紙を貼り付けるべき余白がなくなるに至るまでの間にある者に限り、法第三条第二項ただし書の規定による承認を受けて同項の規定による日雇特例被保険者とならない期間内にある者又は法第百二十六条第三項の規定により当該日雇特例被保険者手帳を返納した者を除く。）を含む。次項、第四十三条の三第五項及び第四十四条第二項から第八項までにおいて同じ。）、船員保険の被保険者、国家公務員共済組合法若しくは地方公務員等共済組合法に基づく共済組合の組合員、私立学校教職員共済法の規定による私立学校教職員共済制度の加入者、国民健康保険の被保険者の属する世帯の世帯主若しくは国民健康保険組合の組合員（以下「国民健康保険の世帯主等」という。）又は後期高齢者医療の被保険者をいう。
In paragraph (1) (including where applied mutatis mutandis in paragraphs (2) through (4)), paragraph (5) (including where applied mutatis mutandis in paragraph (6)) and paragraph (6), "dependent, etc." means a dependent of a specially-insured day laborer, a dependent under the provisions of 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, or an insured person of National Health Insurance who belongs to the same household as a householder, etc. under National Health Insurance, other than that householder, etc. under National Health Insurance.
第一項（第二項から第四項までにおいて準用する場合を含む。）、第五項（第六項において準用する場合を含む。）及び第六項において「被扶養者等」とは、日雇特例被保険者の被扶養者若しくは船員保険法、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。）若しくは地方公務員等共済組合法の規定による被扶養者又は国民健康保険の世帯主等と同一の世帯に属する当該国民健康保険の世帯主等以外の国民健康保険の被保険者をいう。
Read this with the articles around it
treatment subject to specified benefitsmachine translation
「特定給付対象療養」
Treatment for which the general medical expenses for atomic bomb survivors (原爆一般疾病医療費) under the Atomic Bomb Survivors' Assistance Act or another medical benefit a Ministry of Health, Labour and Welfare Order (厚生労働省令) names is to be given, and treatment for a disease needing very costly treatment over a very long period that the Minister of Health, Labour and Welfare designates, received by an insured person or dependent the insurer has certified under Article 41, paragraph (9).
Defined inArticle 41, paragraph (1), item (ii)
insured person of the late-stage elderly medical care systemmachine translation
「後期高齢者医療の被保険者」
An insured person of the late-stage elderly medical care system (後期高齢者医療) under Article 50 of the Act on Assurance of Medical Care for Elderly People.
Short name set inArticle 41, paragraph (4), item (i)
outpatient treatmentmachine translation
「外来療養」
In Article 41, paragraph (5), Article 41-2 and Article 42, paragraphs (6) to (8), the treatment in Article 63, paragraph (1), items (i) to (iv) of the Health Insurance Act — examinations, medicines or materials, procedures, operations or other treatment, and management of treatment at home with the care that goes with it — other than treatment given with admission to a hospital or clinic.
Defined inArticle 41, paragraph (5)· applies only in this provision and in Article 41-2; Article 42, paragraph (6), item (iii); Article 42, paragraph (7), item (iii); and Article 42, paragraph (8), item (iii)
total for former dependentsmachine translation
「元被扶養者合算額」
In Article 41-2, paragraph (1), the total of the amounts in items (xiii) to (xviii): what persons who were dependents (被扶養者) of the insured person on the reference date (基準日被保険者), or of that person's dependent on the reference date (基準日被扶養者), during the calculation period (計算期間, 1 August to the following 31 July), but are no longer such on the reference date, bore for outpatient treatment (外来療養) received from the month after the month they turned 70; where it exceeds the base amount for calculating high-cost medical expenses (高額療養費算定基準額), a share of the excess is paid to the insured person on the reference date as high-cost medical expenses (高額療養費).
Short name set inArticle 41-2, paragraph (1)· applies only in this paragraph
reference datemachine translation
「基準日」
The last day of the calculation period (計算期間), the period from 1 August each year to the following 31 July, on which high-cost medical expenses (高額療養費) and similar amounts for the whole period are worked out.
Defined inArticle 41-2, paragraph (1)
total for the insured person on the reference datemachine translation
「基準日被保険者合算額」
In Article 41-2, paragraph (1), the total of the amounts in items (i) to (vi): what the insured person on the reference date (基準日被保険者) bore during the calculation period (計算期間) for outpatient treatment (外来療養) received from the month after the month they turned 70 — as an insured person or dependent under this or another health insurer, or as a member, etc. of a mutual aid association or similar body or the dependent of one; where it exceeds the base amount for calculating high-cost medical expenses (高額療養費算定基準額), a share of the excess is paid to that person as high-cost medical expenses (高額療養費).
Short name set inArticle 41-2, paragraph (1)· applies only in this paragraph
total for the dependent on the reference datemachine translation
「基準日被扶養者合算額」
In Article 41-2, paragraph (1), the total of the amounts in items (vii) to (xii): what the dependent on the reference date (基準日被扶養者) bore during the calculation period (計算期間) for outpatient treatment (外来療養) received from the month after the month they turned 70 — as a dependent or insured person under this or another health insurer, or as the dependent, etc. or member, etc. of a mutual aid association or similar body; where it exceeds the base amount for calculating high-cost medical expenses (高額療養費算定基準額), a share of the excess is paid to the insured person on the reference date (基準日被保険者) as high-cost medical expenses (高額療養費).
Short name set inArticle 41-2, paragraph (1)· applies only in this paragraph
calculation periodmachine translation
「計算期間」
The period from 1 August each year to the following 31 July, over which annual amounts such as high-cost medical expenses (高額療養費) for outpatient treatment are worked out.
Defined inArticle 41-2, paragraph (1)
insured person on the reference datemachine translation
「基準日被保険者」
A person who, on the reference date (基準日), is an insured person (被保険者) of this insurer, other than a day-labour special insured person (日雇特例被保険者), a member of a mutual aid association (共済組合) under the National Public Officers Mutual Aid Association Act or the Local Public Officers, etc. Mutual Aid Association Act, or a participant in the mutual aid system under the Private School Personnel Mutual Aid Association Act.
Short name set inArticle 41-2, paragraph (1), item (i)
outpatient treatment under continued benefitsmachine translation
「継続給付に係る外来療養」
In Article 41-2, outpatient treatment (外来療養) for which insurance benefits are given under Article 98, paragraph (1) of the Health Insurance Act (including as applied by Article 110, paragraph (7) and Article 111, paragraph (3)): the benefits that continue for treatment under way when a person loses insured status and becomes a day-labour special insured person (日雇特例被保険者) or the dependent of one.
Short name set inArticle 41-2, paragraph (1), item (i)· applies only in this article
insurer on the reference datemachine translation
「基準日保険者」
In Article 41-2, paragraphs (3) and (4) and Article 43-2, paragraph (4), the other health insurer that, on the reference date (基準日), covers a person who was this insurer's insured person during the calculation period (計算期間), as its insured person or as the dependent of one.
Short name set inArticle 41-2, paragraph (3)· applies only in this paragraph
calculation periodmachine translation
「計算期間」
The period from 1 August each year to the following 31 July, over which annual amounts such as high-cost medical expenses (高額療養費) for outpatient treatment are worked out.
Defined inArticle 41-2, paragraph (3)
insurer on the reference datemachine translation
「基準日保険者」
In Article 41-2, paragraphs (3) and (4) and Article 43-2, paragraph (4), the other health insurer that, on the reference date (基準日), covers a person who was this insurer's insured person during the calculation period (計算期間), as its insured person or as the dependent of one.
Short name set inArticle 41-2, paragraph (4)· applies only in this paragraph
calculation periodmachine translation
「計算期間」
The period from 1 August each year to the following 31 July, over which annual amounts such as high-cost medical expenses (高額療養費) for outpatient treatment are worked out.
Defined inArticle 41-2, paragraph (4)
total for former dependentsmachine translation
「元被扶養者合算額」
In the table of Article 41-2, paragraph (5), on high-cost medical expenses (高額療養費) for a person who was this insurer's insured person during the calculation period (計算期間) but on the reference date (基準日) belongs to a mutual aid association or the like (基準日組合員等), the total, worked out as a Ministry of Health, Labour and Welfare Order (厚生労働省令) provides by treating that person as the insured person on the reference date and their dependents on that date as dependents on the reference date, of the amounts corresponding to paragraph (1), items (xiii) to (xviii): what that person's former dependents bore for outpatient treatment (外来療養).
Short name set inArticle 41-2, paragraph (5)
member, etc. on the reference datemachine translation
「基準日組合員等」
In Article 41-2, paragraph (5), a person who was this insurer's insured person during the calculation period (計算期間) and on the reference date (基準日) is a member, etc. (組合員等) of a body other than an Association of Medical Care Systems for the Elderly Aged 75 and older (後期高齢者医療広域連合) — such as a day-labour special insured person, an insured person under Mariners Insurance (船員保険) or a member of a mutual aid association — leaving out a householder, etc. under National Health Insurance (国民健康保険の世帯主等) who is an insured person or dependent here, and an insured person of the late-stage elderly medical care system (後期高齢者医療).
Short name set inArticle 41-2, paragraph (5)· applies only in this paragraph
total for the member, etc. on the reference datemachine translation
「基準日組合員等合算額」
In the table of Article 41-2, paragraph (5), the total, worked out as a Ministry of Health, Labour and Welfare Order (厚生労働省令) provides by treating the member, etc. on the reference date (基準日組合員等) as the insured person on the reference date and that person's dependents, etc. on the reference date (基準日被扶養者等) as dependents on the reference date, of the amounts corresponding to paragraph (1), items (i) to (vi): what that person bore for outpatient treatment (外来療養) during the calculation period (計算期間).
Short name set inArticle 41-2, paragraph (5)
dependent, etc. on the reference datemachine translation
「基準日被扶養者等」
In the table of Article 41-2, paragraph (5), a person who on the reference date (基準日) is a dependent, etc. (被扶養者等) of the member, etc. on the reference date (基準日組合員等): a dependent under Mariners Insurance (船員保険) or a mutual aid association scheme, a dependent of a day-labour special insured person, or a fellow member of a National Health Insurance household.
Defined inArticle 41-2, paragraph (5)· applies only in this provision
total for dependents, etc. on the reference datemachine translation
「基準日被扶養者等合算額」
In the table of Article 41-2, paragraph (5), the total, worked out as a Ministry of Health, Labour and Welfare Order (厚生労働省令) provides by treating the member, etc. on the reference date (基準日組合員等) as the insured person on the reference date and that person's dependents, etc. on the reference date (基準日被扶養者等) as dependents on the reference date, of the amounts corresponding to paragraph (1), items (vii) to (xii): what those dependents bore for outpatient treatment (外来療養) during the calculation period (計算期間).
Short name set inArticle 41-2, paragraph (5)
total for former dependentsmachine translation
「元被扶養者合算額」
In the table of Article 41-2, paragraph (7), on high-cost medical expenses (高額療養費) for a person who was this insurer's insured person during the calculation period (計算期間) but on the reference date (基準日) is an insured person of the late-stage elderly medical care system (後期高齢者医療), the total, worked out as a Ministry of Health, Labour and Welfare Order (厚生労働省令) provides by treating that person as the insured person on the reference date and the other such insured persons in the same household as dependents on the reference date, of the amounts corresponding to paragraph (1), items (xiii) to (xviii): what that person's former dependents bore for outpatient treatment (外来療養).
Short name set inArticle 41-2, paragraph (7)
late-stage elderly insured person on the reference datemachine translation
「基準日後期高齢者医療被保険者」
In Article 41-2, paragraph (7), a person who was this insurer's insured person during the calculation period (計算期間) and on the reference date (基準日) is an insured person of the late-stage elderly medical care system (後期高齢者医療).
Short name set inArticle 41-2, paragraph (7)· applies only in this paragraph
other late-stage elderly insured person in the household on the reference datemachine translation
「基準日後期高齢者医療被保険者以外後期高齢者医療被保険者」
In the table of Article 41-2, paragraph (7), an insured person of the late-stage elderly medical care system (後期高齢者医療), other than the late-stage elderly insured person on the reference date (基準日後期高齢者医療被保険者), who on the reference date (基準日) belongs to that person's household.
Defined inArticle 41-2, paragraph (7)· applies only in this provision
total for other late-stage elderly insured persons in the household on the reference datemachine translation
「基準日後期高齢者医療被保険者以外後期高齢者医療被保険者合算額」
In the table of Article 41-2, paragraph (7), the total, worked out as a Ministry of Health, Labour and Welfare Order (厚生労働省令) provides by treating the late-stage elderly insured person on the reference date (基準日後期高齢者医療被保険者) as the insured person on the reference date and the other late-stage elderly insured persons in the household as dependents on the reference date, of the amounts corresponding to paragraph (1), items (vii) to (xii): what those other household members bore for outpatient treatment (外来療養) during the calculation period (計算期間).
Short name set inArticle 41-2, paragraph (7)
total for the late-stage elderly insured person on the reference datemachine translation
「基準日後期高齢者医療被保険者合算額」
In the table of Article 41-2, paragraph (7), the total, worked out as a Ministry of Health, Labour and Welfare Order (厚生労働省令) provides by treating the late-stage elderly insured person on the reference date (基準日後期高齢者医療被保険者) as the insured person on the reference date and the other late-stage elderly insured persons in the household as dependents on the reference date, of the amounts corresponding to paragraph (1), items (i) to (vi): what that person bore for outpatient treatment (外来療養) during the calculation period (計算期間).
Short name set inArticle 41-2, paragraph (7)
insurer body, etc.machine translation
「組合等」
In Article 41-2, the Japan Health Insurance Association (全国健康保険協会) as the insurer of specially-insured day laborers under Article 123, paragraph (1) of the Health Insurance Act or as giving medical benefits under the Mariners Insurance Act, a municipality (including a special ward of Tokyo), a National Health Insurance society (国民健康保険組合), a mutual aid association (共済組合) under the National Public Officers Mutual Aid Association Act or the Local Public Officers, etc. Mutual Aid Association Act, the Promotion and Mutual Aid Corporation for Private Schools of Japan (日本私立学校振興・共済事業団), or an Association of Medical Care Systems for the Elderly Aged 75 and older (後期高齢者医療広域連合).
Defined inArticle 41-2, paragraph (8)· applies only in this provision
householder, etc. under National Health Insurancemachine translation
「国民健康保険の世帯主等」
The householder of a household that includes an insured person under National Health Insurance (国民健康保険), or a member of a National Health Insurance society (国民健康保険組合).
Short name set inArticle 41-2, paragraph (9)
member, etc.machine translation
「組合員等」
A day-labour special insured person (日雇特例被保険者, including a former one who still holds a handbook with space left for health insurance stamps, with some exceptions), an insured person under Mariners Insurance, a member of a mutual aid association (共済組合) under the National Public Officers Mutual Aid Association Act or the Local Public Officers, etc. Mutual Aid Association Act, a participant in the mutual aid system under the Private School Personnel Mutual Aid Association Act, a householder, etc. under National Health Insurance (国民健康保険の世帯主等), or an insured person of the late-stage elderly medical care system (後期高齢者医療).
Defined inArticle 41-2, paragraph (9)· applies only in this provision
dependent, etc.machine translation
「被扶養者等」
A dependent of a day-labour special insured person (日雇特例被保険者); a dependent under the Mariners Insurance Act, the National Public Officers Mutual Aid Association Act (including as other Acts apply it) or the Local Public Officers, etc. Mutual Aid Association Act; or an insured person under National Health Insurance (国民健康保険) in the same household as a householder, etc. under National Health Insurance (国民健康保険の世帯主等), other than that householder.
Defined inArticle 41-2, paragraph (10)· applies only in this provision
special ward
特別区
A ward (区) of a metropolis (都) (Local Autonomy Act, Article 281, paragraph (1)). Today the only special wards are the 23 wards of Tokyo. A special ward is a basic local government in its own right: it does, in general, the work a city, town or village (市町村) does elsewhere, apart from what the metropolis does across all the wards as one (Article 281-2, paragraph (2)). Where a law or order gives a city (市) work to do, its provisions on that work also apply to a special ward, for the work the ward does (Article 281, paragraph (2), and Article 283, paragraph (2)); a Cabinet Order (政令) can make special rules where they cannot apply as they stand (Article 283, paragraph (3)).
Written by AI using Local Autonomy Act, Arts. 281, 281-2, 283 as a reference.