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Supplementary Provisions, Article 5

第五条

Among the insured persons to whom Article 74, paragraph (1), item (iii) or Article 110, paragraph (2), item (i)(d) of the Health Insurance Act applies, for those who fall under any of the following items (hereinafter referred to in this Article as "insured persons with specified income"), the base amount for calculating high-cost medical expenses under Article 41, paragraph (2) of the Order for Enforcement of the Health Insurance Act (hereinafter referred to in this Article as the "Order") is, notwithstanding Article 42, paragraph (2) of the Order, the amount specified in item (i) of that paragraph.

健康保険法第七十四条第一項第三号又は第百十条第二項第一号ニの規定が適用される被保険者のうち、次の各号のいずれかに該当するもの(以下この条において「特定収入被保険者」という。)に係る健康保険法施行令(以下この条において「令」という。)第四十一条第二項の高額療養費算定基準額は、令第四十二条第二項の規定にかかわらず、同項第一号に定める額とする。

a person for whom the amount of income under Article 34, paragraph (2) or Article 39, paragraph (2) of the Order, in the case where the month in which benefits for medical treatment or the medical care of the person's dependent is received is from September 2006 through August 2007, is less than 6,210,000 yen (in the case of a person with no dependent, a person for whom it is less than 4,840,000 yen);

療養の給付又はその被扶養者の療養を受ける月が平成十八年九月から平成十九年八月までの場合における令第三十四条第二項又はの収入の額が六百二十一万円未満である者(被扶養者がいない者にあっては、四百八十四万円未満である者)

a person for whom the amount of income under Article 34, paragraph (2) or Article 39, paragraph (2) of the Order, in the case where the month in which benefits for medical treatment or the medical care of the person's dependent is received is from September 2007 through March 2008, is less than 6,210,000 yen (in the case of a person with no dependent, a person for whom it is less than 4,840,000 yen).

療養の給付又はその被扶養者の療養を受ける月が平成十九年九月から平成二十年三月までの場合における令第三十四条第二項又はの収入の額が六百二十一万円未満である者(被扶養者がいない者にあっては、四百八十四万円未満である者)

For an insured person with specified income, the base amount for calculating high-cost medical expenses under Article 41, paragraph (3) of the Order is, notwithstanding Article 42, paragraph (3) of the Order, the amount specified in item (i) of that paragraph.

特定収入被保険者に係る令第四十一条第三項の高額療養費算定基準額は、令第四十二条第三項の規定にかかわらず、同項第一号に定める額とする。

With regard to the high-cost medical expenses to be paid to an insured person with specified income pursuant to Article 43, paragraph (1) of the Order, the amount that the insurer pays to the medical institution providing services covered by health insurance, etc. prescribed in that paragraph is, notwithstanding that paragraph, limited to the amount obtained by deducting, from the amount of the co-payment concerned prescribed in that paragraph, the amount specified in each of the following items in accordance with the category of medical care listed in .

令第四十三条第一項の規定により特定収入被保険者に対し支給すべき高額療養費について保険者が同項に規定する保険医療機関等に支払う額は、同項の規定にかかわらず、同項に規定する当該一部負担金の額から次の各号に掲げる療養の区分に応じ、当該各号に定める額を控除した額を限度とする。

medical care listed in Article 43, paragraph (1), item (ii) of the Order: the amount specified in sub-item (a) of that item;

令第四十三条第一項第二号に掲げる療養 同号イに定める額

medical care listed in Article 43, paragraph (1), item (iii) of the Order: the amount specified in sub-item (a) of that item.

令第四十三条第一項第三号に掲げる療養 同号イに定める額

With regard to the payment of high-cost medical expenses relating to medical expenses combined with treatment outside insurance coverage or dependent's medical expenses for an insured person with specified income, Article 43, paragraph (3) of the Order is applied by deeming the phrase "each of those items" in that paragraph to be replaced with "sub-item (a) of each of those items".

特定収入被保険者に対する保険外併用療養費又は家族療養費に係る高額療養費の支給については、令第四十三条第三項中「当該各号」とあるのは「当該各号イ」と読み替えて、同項の規定を適用する。

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