Supplementary Provisions, Article 31
第三十一条
Among the persons listed in Article 42, paragraph (2), item (ii) of the Order for Enforcement of the Health Insurance Act, 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 is, notwithstanding Article 42, paragraph (2) of the Order for Enforcement of the Health Insurance Act, the amount specified in Article 42, paragraph (2), item (i) of the Order for Enforcement of the Health Insurance Act before the amendment by the provisions of Article 1 (hereinafter referred to in this Article as the "Former Health Insurance Order").
健康保険法施行令第四十二条第二項第二号に掲げる者のうち、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。）に係る同令第四十一条第二項の高額療養費算定基準額は、同令第四十二条第二項の規定にかかわらず、第一条の規定による改正前の健康保険法施行令（以下この条において「旧健保令」という。）第四十二条第二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) of the Order for Enforcement of the Health Insurance Act as applied by deeming the terms to be replaced pursuant to Article 28, paragraph (2) of the Supplementary Provisions, in the case where the month in which benefits for medical treatment or the medical care of the person's dependent (meaning a dependent prescribed in Article 34, paragraph (2) of the Order for Enforcement of the Health Insurance Act; the same applies hereinafter in this item) is received is from April through August 2008, is less than 6,210,000 yen (in the case of a person who has neither a dependent nor a person who was a dependent prescribed in Article 34, paragraph (2) of the Order for Enforcement of the Health Insurance Act as applied by deeming the terms to be replaced pursuant to Article 28, paragraph (2) of the Supplementary Provisions, 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（健康保険法施行令第三十四条第二項に規定する被扶養者をいう。以下この号において同じ。）の療養を受ける月が平成二十年四月から八月までの場合における附則第二十八条第二項の規定により読み替えて適用する健康保険法施行令第三十四条第二項の収入の額が六百二十一万円未満である者（被扶養者及び附則第二十八条第二項の規定により読み替えて適用する健康保険法施行令第三十四条第二項に規定する被扶養者であった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 who falls under both of the following:
次のイ及びロのいずれにも該当する者
an insured person who has no dependent prescribed in Article 34, paragraph (2) of the Order for Enforcement of the Health Insurance Act and who has a person who was a dependent (meaning a person who has ceased to be a dependent by coming to fall under the proviso to Article 3, paragraph (7) of the Health Insurance Act; the same applies hereinafter in this item and Article 33, paragraph (4), item (ii) of the Supplementary Provisions);
健康保険法施行令第三十四条第二項に規定する被扶養者がいない被保険者であって、被扶養者であった者（健康保険法第三条第七項ただし書に該当するに至ったため被扶養者でなくなった者をいう。以下この号及び附則第三十三条第四項第二号において同じ。）がいるもの
a person for whom, in the case where the month in which benefits for medical treatment are received is from September through December 2008, the amount of income under Article 34, paragraph (2) of the Order for Enforcement of the Health Insurance Act that results if the person who was a dependent of the person is deemed to be a dependent prescribed in that paragraph and that paragraph is applied is less than 5,200,000 yen.
療養の給付を受ける月が平成二十年九月から十二月までの場合において、その被扶養者であった者について、健康保険法施行令第三十四条第二項に規定する被扶養者とみなして同項の規定を適用した場合の同項の収入の額が五百二十万円未満である者
The base amount for calculating high-cost medical expenses under Article 41, paragraph (3) of the Order for Enforcement of the Health Insurance Act for an insured person with specified income is, notwithstanding Article 42, paragraph (3) of the Order for Enforcement of the Health Insurance Act, the amount specified in Article 42, paragraph (3), item (i) of the Former Health Insurance Order.
特定収入被保険者に係る健康保険法施行令第四十一条第三項の高額療養費算定基準額は、同令第四十二条第三項の規定にかかわらず、旧健保令第四十二条第三項第一号に定める額とする。
Where an insured person with specified income has received medical care listed in the following items, and the co-payment payable under the provisions of the Health Insurance Act has not been paid, the limit of the amount that the insurer pays, pursuant to Article 43, paragraph (1) of the Order for Enforcement of the Health Insurance Act, to the medical institution providing services covered by health insurance, etc. prescribed in that paragraph in respect of the insured person with specified income is, notwithstanding the items of that paragraph, the amount obtained by deducting, from the amount of the co-payment concerned, the amount specified in each of the following items in accordance with the category of medical care listed in that item.
medical care listed in Article 43, paragraph (1), item (ii) of the Order for Enforcement of the Health Insurance Act: the amount specified in Article 43, paragraph (1), item (ii), (a) of the Former Health Insurance Order;
健康保険法施行令第四十三条第一項第二号に掲げる療養 旧健保令第四十三条第一項第二号イに定める額
medical care listed in Article 43, paragraph (1), item (iii) of the Order for Enforcement of the Health Insurance Act: the amount specified in Article 43, paragraph (1), item (iii), (a) of the Former Health Insurance Order.
健康保険法施行令第四十三条第一項第三号に掲げる療養 旧健保令第四十三条第一項第三号イに定める額
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 (limited to those relating to a person who falls under paragraph (1), item (i)) for an insured person with specified income, Article 43, paragraph (3) of the Order for Enforcement of the Health Insurance Act is applied by deeming the phrase "the amount specified in each of those items" in that paragraph to be replaced with "the amount specified in sub-item (a) of each of those items before the amendment by the provisions of Article 1 of the Cabinet Order Partially Amending the Order for Enforcement of the Health Insurance Act, etc. (Cabinet Order No. 116 of 2008)".
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（第一項第一号に該当する者に係るものに限る。）に係る高額療養費の支給については、健康保険法施行令第四十三条第三項中「当該各号に定める額」とあるのは、「健康保険法施行令等の一部を改正する政令（平成二十年政令第百十六号）第一条の規定による改正前の当該各号イに定める額」と読み替えて、同項の規定を適用する。
medical institution providing services covered by health insurance, etc.machine translation
「保険医療機関等」
In Article 43, paragraphs (1) and (5), the hospitals, clinics and pharmacies designated by the Minister of Health, Labour and Welfare (保険医療機関 and 保険薬局) and those listed in Article 63, paragraph (3), item (ii) of the Health Insurance Act — the hospitals, clinics and pharmacies an insurer designates to treat or dispense to the persons it insures — to which the insurer pays high-cost medical expenses (高額療養費) directly where the co-payment or other cost has not been paid.
Short name set inArticle 43, paragraph (1)· applies only in this paragraph and in Article 43, paragraph (5)
Former Health Insurance Ordermachine translation
「旧健保令」
In Article 31 of the supplementary provisions (附則) of Cabinet Order No. 116 of 2008, the Order for Enforcement of the Health Insurance Act as it stood before its amendment by Article 1 of that Cabinet Order.
Short name set inSupplementary Provisions, Article 31, paragraph (1)· applies only in this article
insured person with specified incomemachine translation
「特定収入被保険者」
In Article 31 of the supplementary provisions (附則) of Cabinet Order No. 116 of 2008, a person listed in Article 42, paragraph (2), item (ii) of the Order for Enforcement of the Health Insurance Act whose income, for treatment from April to August 2008, is under 6.21 million yen (4.84 million yen for one with no dependents or former dependents), or who has no dependents but a former dependent and, for treatment from September to December 2008, would have income under 5.2 million yen counting that person as a dependent; for them the base amount for calculating high-cost medical expenses (高額療養費算定基準額) is the amount in Article 42, paragraph (2), item (i) of that Order as it stood before that Cabinet Order amended it.
Short name set inSupplementary Provisions, Article 31, paragraph (1)· applies only in this article
dependentmachine translation
「被扶養者」
In Article 31, paragraph (1), item (i) of the supplementary provisions (附則) of Cabinet Order No. 116 of 2008, a dependent as provided in Article 34, paragraph (2) of the Order for Enforcement of the Health Insurance Act.
Defined inSupplementary Provisions, Article 31, paragraph (1), item (i)· applies only in this item