Supplementary Provisions, Article 5
第五条
With regard to the payment of high-cost medical expenses under the provisions of Article 41, paragraph (6) of the New Health Insurance Order for an insured person to whom the provisions of Article 74, paragraph (1), item (ii) of the Health Insurance Act apply, or a dependent to whom the provisions of Article 110, paragraph (2), item (i), (c) of that Act apply, who received treatment subject to specified benefits (meaning treatment subject to specified benefits prescribed in Article 32, paragraph (1) of the Supplementary Provisions of the Cabinet Order Partially Amending the Order for Enforcement of the Health Insurance Act, etc. (Cabinet Order No. 116 of 2008)) during the period from January through March 2009 (hereinafter referred to as an "insured person, etc. under the fiscal 2008 special measure on or after the effective date" in this Article), the term "excluding" in Article 41, paragraph (6) of the New Health Insurance Order is deemed to be replaced with "and excluding treatment for which the benefits specified by the Minister of Health, Labour and Welfare prescribed in Article 32, paragraph (1) of the Supplementary Provisions of the Cabinet Order Partially Amending the Order for Enforcement of the Health Insurance Act, etc. (Cabinet Order No. 116 of 2008) are to be provided", and the provisions of that paragraph are applied.
健康保険法第七十四条第一項第二号の規定が適用される被保険者又は同法第百十条第二項第一号ハの規定が適用される被扶養者のうち、平成二十一年一月から三月までの間に、特定給付対象療養（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）附則第三十二条第一項に規定する特定給付対象療養をいう。）を受けたもの（以下この条において「施行日以後平成二十年度特例措置対象被保険者等」という。）に係る新健保令第四十一条第六項の規定による高額療養費の支給については、同項中「を除く」とあるのは、「及び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）附則第三十二条第一項に規定する厚生労働大臣が定める給付が行われるべき療養を除く」と読み替えて、同項の規定を適用する。
With regard to the base amount for calculating high-cost medical expenses under Article 41, paragraph (3) of the New Health Insurance Order for an insured person, etc. under the fiscal 2008 special measure on or after the effective date, the provisions of Article 42, paragraph (3) of the New Health Insurance Order are applied by deeming the phrase "62,100 yen; provided, however, that in the case of repeated high-cost medical expenses, the amount is 44,400 yen." in item (i) of that paragraph to be replaced with "44,400 yen".
施行日以後平成二十年度特例措置対象被保険者等に係る新健保令第四十一条第三項の高額療養費算定基準額については、新健保令第四十二条第三項第一号中「六万二千百円。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。」とあるのは、「四万四千四百円」と読み替えて、同項の規定を適用する。
With regard to the base amount for calculating high-cost medical expenses under Article 41, paragraph (4) of the New Health Insurance Order for an insured person, etc. under the fiscal 2008 special measure on or after the effective date, the provisions of Article 42, paragraph (4) of the New Health Insurance Order are applied by deeming the phrase "31,050 yen; provided, however, that in the case of repeated high-cost medical expenses, the amount is 22,200 yen." in item (i) of that paragraph to be replaced with "22,200 yen".
施行日以後平成二十年度特例措置対象被保険者等に係る新健保令第四十一条第四項の高額療養費算定基準額については、新健保令第四十二条第四項第一号中「三万千五十円。ただし、高額療養費多数回該当の場合にあっては、二万二千二百円とする。」とあるのは、「二万二千二百円」と読み替えて、同項の規定を適用する。
With regard to the base amount for calculating high-cost medical expenses under Article 41, paragraph (5) of the New Health Insurance Order for an insured person, etc. under the fiscal 2008 special measure on or after the effective date, the provisions of Article 42, paragraph (5) of the New Health Insurance Order are applied by deeming the phrase "24,600 yen" in item (i) of that paragraph to be replaced with "12,000 yen".
施行日以後平成二十年度特例措置対象被保険者等に係る新健保令第四十一条第五項の高額療養費算定基準額については、新健保令第四十二条第五項第一号中「二万四千六百円」とあるのは、「一万二千円」と読み替えて、同項の規定を適用する。
With regard to the limit of the amount that an insurer pays, pursuant to Article 43, paragraph (1) of the New Health Insurance Order, to a medical institution providing services covered by health insurance, etc. prescribed in that paragraph for an insured person, etc. under the fiscal 2008 special measure on or after the effective date, the provisions of that paragraph are applied by deeming the phrase "62,100 yen (31,050 yen for medical treatment under the special rule on reaching age 75); provided, however, that in the case of repeated high-cost medical expenses, the amount is 44,400 yen (22,200 yen for medical treatment under the special rule on reaching age 75)." in item (ii), (a) of that paragraph to be replaced with "44,400 yen (22,200 yen for medical treatment under the special rule on reaching age 75)", and the phrase "24,600 yen" in item (iii), (a) of that paragraph to be replaced with "12,000 yen"; in this case, with regard to the application of the provisions of paragraphs (2) and (3) of Article 43 of the New Health Insurance Order, the phrase "the preceding paragraph" in paragraph (2) of that Article is deemed to be replaced with "the preceding paragraph as replaced pursuant to Article 5, paragraph (5) of the Supplementary Provisions of the Cabinet Order Partially Amending the Order for Enforcement of the Act on Assurance of Medical Care for Elderly People, etc. (Cabinet Order No. 357 of 2008; hereinafter referred to as the "Amending Order" in the following paragraph)", and the phrase "each of those items" in Article 43, paragraph (3) of the New Health Insurance Order is deemed to be replaced with "each of those items (in the case where the provisions of paragraph (1), item (ii) or (iii) are applied as replaced pursuant to Article 5, paragraph (5) of the Supplementary Provisions of the Amending Order, paragraph (1), item (i), and paragraph (1), items (ii) and (iii) as replaced pursuant to paragraph (5) of that Article)".
新健保令第四十三条第一項の規定により施行日以後平成二十年度特例措置対象被保険者等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の限度については、同項第二号イ中「六万二千百円（七十五歳到達時特例対象療養に係るものにあっては、三万千五十円）。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（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。」とあるのは「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、同項第三号イ中「二万四千六百円」とあるのは「一万二千円」と読み替えて、同項の規定を適用する。この場合において、同条第二項及び第三項の規定の適用については、同条第二項中「前項」とあるのは「高齢者の医療の確保に関する法律施行令等の一部を改正する政令（平成二十年政令第三百五十七号。次項において「改正令」という。）附則第五条第五項の規定により読み替えられた前項」と、同条第三項中「当該各号」とあるのは「当該各号（同項第二号又は第三号の規定を改正令附則第五条第五項の規定により読み替えて適用する場合にあっては、第一項第一号並びに同条第五項の規定により読み替えられた第一項第二号及び第三号）」とする。
The provisions of Article 43, paragraphs (4) and (5) of the New Health Insurance Order apply mutatis mutandis to the payment of high-cost medical expenses under Article 41, paragraph (5) of the New Health Insurance Order in the case where, when an insured person, etc. under the fiscal 2008 special measure on or after the effective date has received outpatient treatment (meaning the outpatient treatment prescribed in Article 41, paragraph (5) of the New Health Insurance Order), the amount of co-payment, etc. payable pursuant to the provisions of the Health Insurance Act (meaning the amount of co-payment, etc. prescribed in Article 115, paragraph (1) of that Act) has not been paid; in this case, the phrase "from the expenses required for that medical treatment, an amount equivalent to the amount to be paid to the insured person as high-cost medical expenses under paragraphs (6) through (8) of that Article" in Article 43, paragraph (4) of the New Health Insurance Order is deemed to be replaced with "with respect to high-cost medical expenses under Article 41, paragraph (5), up to the amount obtained by deducting, from the amount of co-payment, etc., the base amount for calculating high-cost medical expenses under Article 5, paragraph (4) of the Supplementary Provisions of the Cabinet Order Partially Amending the Order for Enforcement of the Act on Assurance of Medical Care for Elderly People, etc. (Cabinet Order No. 357 of 2008) (or, where the amount obtained by multiplying the amount of expenses calculated for that outpatient treatment by 10% exceeds that base amount for calculating high-cost medical expenses, the amount so obtained by multiplying)", and the phrase "Article 41, paragraphs (6) through (8)" in Article 43, paragraph (5) of the New Health Insurance Order is deemed to be replaced with "Article 41, paragraph (5)".
新健保令第四十三条第四項及び第五項の規定は、施行日以後平成二十年度特例措置対象被保険者等が外来療養（新健保令第四十一条第五項に規定する外来療養をいう。）を受けた場合において、健康保険法の規定により支払うべき一部負担金等の額（同法第百十五条第一項に規定する一部負担金等の額をいう。）についての支払が行われなかったときの新健保令第四十一条第五項の規定による高額療養費の支給について準用する。この場合において、新健保令第四十三条第四項中「当該療養に要した費用のうち同条第六項から第八項までの規定による高額療養費として被保険者に支給すべき額に相当する額を」とあるのは「同条第五項の規定による高額療養費について、当該一部負担金等の額から高齢者の医療の確保に関する法律施行令等の一部を改正する政令（平成二十年政令第三百五十七号）附則第五条第四項の規定による高額療養費算定基準額（当該外来療養につき算定した費用の額に百分の十を乗じて得た額が当該高額療養費算定基準額を超える場合にあっては、当該乗じて得た額）を控除した額の限度において、」と、同条第五項中「第四十一条第六項から第八項まで」とあるのは「第四十一条第五項」と読み替えるものとする。
The provisions of the preceding paragraphs apply mutatis mutandis to the payment of high-cost medical expenses for a specially-insured day laborer prescribed in Article 37 of the Order for Enforcement of the Health Insurance Act who, where paragraph (1) is applied by deeming that specially-insured day laborer to be an insured person, would come to fall under an insured person, etc. under the fiscal 2008 special measure on or after the effective date.
前各項の規定は、健康保険法施行令第三十七条に規定する日雇特例被保険者であって、当該日雇特例被保険者を被保険者とみなして第一項の規定を適用した場合に施行日以後平成二十年度特例措置対象被保険者等に該当することとなるものに係る高額療養費の支給について準用する。
treatment subject to specified benefitsmachine translation
「特定給付対象療養」
Treatment for which the general medical expenses for atomic bomb survivors (原爆一般疾病医療費) under the Atomic Bomb Survivors' Assistance Act or another medical benefit a Ministry of Health, Labour and Welfare Order (厚生労働省令) names is to be given, and treatment for a disease needing very costly treatment over a very long period that the Minister of Health, Labour and Welfare designates, received by an insured person or dependent the insurer has certified under Article 41, paragraph (9).
Defined inArticle 41, paragraph (1), item (ii)
outpatient treatmentmachine translation
「外来療養」
In Article 41, paragraph (5), Article 41-2 and Article 42, paragraphs (6) to (8), the treatment in Article 63, paragraph (1), items (i) to (iv) of the Health Insurance Act — examinations, medicines or materials, procedures, operations or other treatment, and management of treatment at home with the care that goes with it — other than treatment given with admission to a hospital or clinic.
Defined inArticle 41, paragraph (5)· applies only in this provision and in Article 41-2; Article 42, paragraph (6), item (iii); Article 42, paragraph (7), item (iii); and Article 42, paragraph (8), item (iii)
medical treatment under the special rule on reaching age 75machine translation
「七十五歳到達時特例対象療養」
The medical treatment listed in the items of Article 41, paragraph (4): treatment received, in the month in which they joined the late-stage elderly medical care system (後期高齢者医療) on reaching age 75 on a day other than the first of the month (up to that day), by a person who thereby lost their health insurance coverage as an insured person (被保険者) or as a dependent (被扶養者), and by the former dependents of such an insured person who ceased to be dependents for that reason; for it, the thresholds this Order sets are halved, from 21,000 yen to 10,500 yen.
Short name set inArticle 41-3, paragraph (1), item (i)
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)
New Health Insurance Ordermachine translation
「新健保令」
In the supplementary provisions (附則) of Cabinet Order No. 357 of 2008, the Order for Enforcement of the Health Insurance Act as amended by Article 2 of that Cabinet Order.
Short name set inSupplementary Provisions, Article 4, paragraph (1)· applies only in this provision and in Supplementary Provisions, Articles 5 and 6
insured person, etc. under the fiscal 2008 special measure on or after the effective datemachine translation
「施行日以後平成二十年度特例措置対象被保険者等」
In Article 5 of the supplementary provisions (附則) of Cabinet Order No. 357 of 2008, an insured person to whom Article 74, paragraph (1), item (ii) of the Health Insurance Act applies, or a dependent to whom Article 110, paragraph (2), item (i), (c) of that Act applies, who between January and March 2009 received treatment covered by other public medical benefits (特定給付対象療養) as defined in Article 32, paragraph (1) of the supplementary provisions of Cabinet Order No. 116 of 2008.
Short name set inSupplementary Provisions, Article 5, paragraph (1)· applies only in this article