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Order for Enforcement of the Health Insurance Act

Article 42, paragraph (7), item (ii), (a)

第四十二条第七項第二号イ

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

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Underlined: words the amendment adds. A bar: where it removes words.Underlined: words the amendment adds. Struck through: the words it removes.Underlined: words the amendment adds. Struck through: the words it removes.

  1. In force today

    a person listed in paragraph (3), item (i): 61,500 yen (30,750 yen for that relating to medical treatment under the special rule on reaching age 75); provided, however, that in the case of repeated high-cost medical expenses for treatment subject to specified disease benefits, the amount is 44,400 yen (22,200 yen for that relating to medical treatment under the special rule on reaching age 75).

    第三項第一号に掲げる者 六万千五百円(七十五歳到達時特例対象療養に係るものにあっては、三万七百五十円)。ただし、特定疾病給付対象療養高額療養費多数回該当の場合にあっては、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。

  2. Not yet in force Cabinet Order No. 240 of 2026 Reworded

    a person listed in paragraph (3), item (i): 61,500 yen (30,750the total sum of 342,000 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 deducting 1,140,000 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) (or 1,140,000 yen, if that cost is less than 1,140,000 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 of repeated high-cost medical expenses for treatment subject to specified disease benefits, the amount is 44,400 yen (22,200140,100 yen (70,050 yen for that relating to medical treatment under the special rule on reaching age 75).

    第三項第一号に掲げる者 六万千五百三十四万二千円(七十五歳到達時特例対象療養に係るものにあっては、三万七百五十円)。た十七万千円)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、五十七万円。以下このイにおいて同じ。)に満たないときは、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、特定疾病給付対象療養高額療養費多数回該当の場合にあっては、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。

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