Order for Enforcement of the Health Insurance Act
Article 42, paragraph (1), item (i)
第四十二条第一項第一号
Each amendment that changed this provision, and each that will, oldest first. Each is shown against the wording just before it; where an amendment gives the provision another number, it is followed under the new one. Read it as it stands today
In force today
a person other than those listed in the following item through item (v): the total sum of 85,800 yen and the amount obtained by multiplying by 1% the amount obtained by deducting 286,000 yen from the cost of the medical treatment, calculated as provided by Order of the Ministry of Health, Labour and Welfare, relating to the total sum of the amounts listed in the items of Article 41, paragraph (1) (or 286,000 yen, if that cost is less than 286,000 yen) (where that amount includes a fractional amount of less than 1 yen, the amount obtained by rounding down that fractional amount if it is less than 50 sen, or by rounding it up to 1 yen if it is 50 sen or more); provided, however, that in the case where the number of months in which high-cost medical expenses (limited to those under paragraphs (1) through (4) of that Article) have already been paid within 12 months on or before the month in which that medical treatment was received is three or more (hereinafter referred to as a "case of repeated high-cost medical expenses" in this Article and paragraph (1) of the following Article), the amount is 44,400 yen.
次号から第五号までに掲げる者以外の者 八万五千八百円と、第四十一条第一項各号に掲げる額を合算した額に係る療養につき厚生労働省令で定めるところにより算定した当該療養に要した費用の額（その額が二十八万六千円に満たないときは、二十八万六千円）から二十八万六千円を控除した額に百分の一を乗じて得た額（この額に一円未満の端数がある場合において、その端数金額が五十銭未満であるときは、これを切り捨て、その端数金額が五十銭以上であるときは、これを一円に切り上げた額）との合算額。ただし、当該療養のあった月以前の十二月以内に既に高額療養費（同条第一項から第四項までの規定によるものに限る。）が支給されている月数が三月以上ある場合（以下この条及び次条第一項において「高額療養費多数回該当の場合」という。）にあっては、四万四千四百円とする。
a person other than those listed in the following item through item (v)an insured person whose standard monthly remuneration for the month in which the medical treatment was received is 1,270,000 yen or more, or a dependent of such a person: the total sum of85,800342,000 yen and the amount obtained by multiplying by 1% the amount obtained by deducting286,0001,140,000 yen from the cost of the medical treatment, calculated as provided by Order of the Ministry of Health, Labour and Welfare, relating to the total sum of the amounts listed in the items of Article 41, paragraph (1) (or286,0001,140,000 yen, if that cost is less than286,0001,140,000 yen) (where that amount includes a fractional amount of less than 1 yen, the amount obtained by rounding down that fractional amount if it is less than 50 sen, or by rounding it up to 1 yen if it is 50 sen or more); provided, however, that in the case where the number of months in which high-cost medical expenses (limited to those under paragraphs (1) through (4) of that Article) have already been paid within 12 months on or before the month in which that medical treatment was received is three or more (hereinafter referred to as a "case of repeated high-cost medical expenses" in this Article and paragraph (1) of the following Article), the amount is44,400140,100 yen.次号から第五号までに掲げる者以外の者 八万五千八百療養のあった月の標準報酬月額が百二十七万円以上の被保険者又はその被扶養者 三十四万二千円と、第四十一条第一項各号に掲げる額を合算した額に係る療養につき厚生労働省令で定めるところにより算定した当該療養に要した費用の額（その額が二十八万六千百十四万円に満たないときは、二十八万六千円）から二十八万六千百十四万円）から百十四万円を控除した額に百分の一を乗じて得た額（この額に一円未満の端数がある場合において、その端数金額が五十銭未満であるときは、これを切り捨て、その端数金額が五十銭以上であるときは、これを一円に切り上げた額）との合算額。ただし、当該療養のあった月以前の十二月以内に既に高額療養費（同条第一項から第四項までの規定によるものに限る。）が支給されている月数が三月以上ある場合（以下この条及び次条第一項において「高額療養費多数回該当の場合」という。）にあっては、四万四千四百十四万百円とする。