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Order for Enforcement of the Health Insurance Act

Article 43, paragraph (1), item (i), (a)

第四十三条第一項第一号イ

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

How the changes are shown

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 who has received certification by the insurer, as provided by Order of the Ministry of Health, Labour and Welfare, as falling under a person listed in paragraph (1), item (i) of the preceding Article: 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 amount of expenses required for that medical treatment, calculated for that medical treatment as provided by Order of the Ministry of Health, Labour and Welfare (or 286,000 yen, if that amount 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 of repeated high-cost medical expenses, the amount is 44,400 yen.

    前条第一項第一号に掲げる者に該当していることにつき厚生労働省令で定めるところにより保険者の認定を受けている者 八万五千八百円と、当該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、高額療養費多数回該当の場合にあっては、四万四千四百円とする。

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

    a person who has received certification by the insurer, as provided by Order of the Ministry of Health, Labour and Welfare, as falling under a person listed in paragraph (1), item (i) of the preceding Article: the total sum of 85,800342,000 yen and the amount obtained by multiplying by 1% the amount obtained by deducting 286,0001,140,000 yen from the amount of expenses required for that medical treatment, calculated for that medical treatment as provided by Order of the Ministry of Health, Labour and Welfare (or 286,0001,140,000 yen, if that amount is less than 286,0001,140,000 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 of repeated high-cost medical expenses, the amount is 44,400140,100 yen.

    前条第一項第一号に掲げる者に該当していることにつき厚生労働省令で定めるところにより保険者の認定を受けている者 八万五千八百三十四万二千円と、当該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、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とする。

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