Order for Enforcement of the Health Insurance Act
Article 42, paragraph (7), item (i), (a)
第四十二条第七項第一号イ
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 listed in paragraph (1), item (i): the total sum of 85,800 yen (42,900 yen for that relating to medical treatment under the special rule on reaching age 75) and the amount obtained by multiplying by 1% the amount obtained by deducting 286,000 yen from the cost of the treatment subject to specified disease benefits, calculated as provided by Order of the Ministry of Health, Labour and Welfare, relating to the amounts listed in Article 41, paragraph (1), item (i), (a) through (f) (or 286,000 yen, if that cost is less than 286,000 yen (143,000 yen for that relating to medical treatment under the special rule on reaching age 75; the same applies hereinafter in this (a))) (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 paid pursuant to paragraph (7) of that Article for inpatient treatment received from the same hospital or clinic by the insured person or dependent who received the treatment subject to specified disease benefits (limited to inpatient treatment)) have already been paid within 12 months on or before the month in which that treatment subject to specified disease benefits (limited to inpatient treatment) was received is three or more (hereinafter referred to as a "case of repeated high-cost medical expenses for treatment subject to specified disease benefits" in this paragraph), the amount is 44,400 yen (22,200 yen for that relating to medical treatment under the special rule on reaching age 75).
第一項第一号に掲げる者 八万五千八百円（七十五歳到達時特例対象療養に係るものにあっては、四万二千九百円）と、第四十一条第一項第一号イからヘまでに掲げる額に係る特定疾病給付対象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特定疾病給付対象療養に要した費用の額（その額が二十八万六千円（七十五歳到達時特例対象療養に係るものにあっては、十四万三千円。以下このイにおいて同じ。）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、当該特定疾病給付対象療養（入院療養に限る。）のあった月以前の十二月以内に既に高額療養費（当該特定疾病給付対象療養（入院療養に限る。）を受けた被保険者又はその被扶養者がそれぞれ同一の病院又は診療所から受けた入院療養に係るものであって、同条第七項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（以下この項において「特定疾病給付対象療養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（七十五歳到達時特例対象療養に係るものにあっては、二万二千二百円）とする。
a person listed in paragraph (1), item (i): the total sum of
85,800 yen (42,900342,000 yen (171,000 yen for that relating to medical treatment under the special rule on reaching age 75) and the amount obtained by multiplying by 1% the amount obtained by deducting286,0001,140,000 yen from the cost of the treatment subject to specified disease benefits, calculated as provided by Order of the Ministry of Health, Labour and Welfare, relating to the amounts listed in Article 41, paragraph (1), item (i), (a) through (f) (or286,0001,140,000 yen, if that cost is less than286,000 yen (143,0001,140,000 yen (570,000 yen for that relating to medical treatment under the special rule on reaching age 75; the same applies hereinafter in this (a))) (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 paid pursuant to paragraph (7) of that Article for inpatient treatment received from the same hospital or clinic by the insured person or dependent who received the treatment subject to specified disease benefits (limited to inpatient treatment)) have already been paid within 12 months on or before the month in which that treatment subject to specified disease benefits (limited to inpatient treatment) was received is three or more (hereinafter referred to as a "case of repeated high-cost medical expenses for treatment subject to specified disease benefits" in this paragraph), the amount is44,400 yen (22,200140,100 yen (70,050 yen for that relating to medical treatment under the special rule on reaching age 75).第一項第一号に掲げる者
八万五千八百三十四万二千円（七十五歳到達時特例対象療養に係るものにあっては、四万二千九百十七万千円）と、第四十一条第一項第一号イからヘまでに掲げる額に係る特定疾病給付対象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特定疾病給付対象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（七十五歳到達時特例対象療養に係るものにあっては、十四万三千五十七万円。以下このイにおいて同じ。）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、当該特定疾病給付対象療養（入院療養に限る。）のあった月以前の十二月以内に既に高額療養費（当該特定疾病給付対象療養（入院療養に限る。）を受けた被保険者又はその被扶養者がそれぞれ同一の病院又は診療所から受けた入院療養に係るものであって、同条第七項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（以下この項において「特定疾病給付対象療養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（七十五歳到達時特例対象療養に係るものにあっては、二万二千二百七万五十円）とする。