Supplementary Provisions

This Cabinet Order comes into effect on August 1, 2026; provided, however, that the provisions listed in the following items come into effect on the days specified in those items respectively:

The certification by an insurer under the provisions of Article 43, paragraph (1), item (iv), (b) and (c) of the Order for Enforcement of the Health Insurance Act as amended by the provisions of Article 1 (hereinafter referred to as the "New Order for Enforcement of the Health Insurance Act" in this Article and Articles 17 and 19 of the Supplementary Provisions) (including where these provisions are applied mutatis mutandis pursuant to Article 44, paragraph (1) of the New Order for Enforcement of the Health Insurance Act; the same applies hereinafter in this Article) may be made, even before the date of enforcement of this Cabinet Order (hereinafter referred to as the "Effective Date"), in accordance with the provisions of (b) and (c) of that item.

The certification by an insurer under the provisions of Article 43, paragraph (1), item (i), (a) through (m), item (ii), (b) through (i) and (k) through (n), item (iii), (b) through (i) and (k) through (n), and item (iv), (b) through (d) of the Order for Enforcement of the Health Insurance Act as amended by the provisions of Article 2 (hereinafter referred to as the "item (ii) New Order for Enforcement of the Health Insurance Act" in this Article and Article 19, paragraphs (1) and (2) of the Supplementary Provisions) (including where these provisions (excluding the parts relating to Article 43, paragraph (1), item (i), (a) through (h) and (j) through (l), item (ii), (b) through (i) and (k), and item (iii), (b) through (i) and (k)) are applied mutatis mutandis pursuant to Article 44, paragraph (1) of the item (ii) New Order for Enforcement of the Health Insurance Act; the same applies hereinafter in this Article) may be made, even before the date of enforcement of the provisions listed in Article 1, item (ii) of the Supplementary Provisions (hereinafter referred to as the "item (ii) Effective Date"), in accordance with the provisions of Article 43, paragraph (1), item (i), (a) through (m), item (ii), (b) through (i) and (k) through (n), item (iii), (b) through (i) and (k) through (n), and item (iv), (b) through (d) of the item (ii) New Order for Enforcement of the Health Insurance Act.

①In the application of Article 43, paragraph (12) of the New Order for Enforcement of the Health Insurance Act in the case where the day on which the eligibility prescribed in that paragraph was lost is August 1, 2026, the phrase "the day before the day on which that eligibility was lost (or, where there are multiple days in the calculation period on which that eligibility was lost, the latest of those days)" in that paragraph is deemed to be replaced with "the day on which that eligibility was lost".

②In the application of Article 44, paragraph (5) of the New Order for Enforcement of the Health Insurance Act in the case where the day on which the approval prescribed in that paragraph was received, or the day on which a specially-insured day laborer's insurance book was returned, is August 1, 2026, the phrase "the day before the day on which that approval was received or the day on which that specially-insured day laborer's insurance book was returned (or, where there are multiple days in the calculation period on which that approval was received or that specially-insured day laborer's insurance book was returned, the latest of those days)" in that paragraph is deemed to be replaced with "the day on which that approval was received or the day on which that specially-insured day laborer's insurance book was returned".

With regard to the payment of high-cost medical expenses under the provisions of the Health Insurance Act for medical treatment provided before the Effective Date, the provisions then in force continue to govern.

①Where an insurer pays high-cost medical expenses to an insured person pursuant to the provisions of Article 41-3, paragraph (1) of the New Order for Enforcement of the Health Insurance Act, for a person who has received confirmation by the insurer that the person falls under an insured person whose standard monthly remuneration for the month that includes the reference date prescribed in the proviso to Article 41-2, paragraph (1) of the New Order for Enforcement of the Health Insurance Act (including the day deemed to be the reference date pursuant to Article 43, paragraph (12) of the New Order for Enforcement of the Health Insurance Act; hereinafter referred to as the "reference date" in the following paragraph) is less than 160,000 yen (excluding persons listed in Article 42, paragraph (11), item (iv) of the New Order for Enforcement of the Health Insurance Act), the insurer is to calculate those high-cost medical expenses using the base amount for calculating high-cost medical expenses in accordance with the provisions of Article 42, paragraph (11) (limited to the part relating to item (iv)) of the item (ii) New Order for Enforcement of the Health Insurance Act.

②Where an insurer pays high-cost medical expenses to an insured person pursuant to the provisions of Article 41-3, paragraph (2) of the New Order for Enforcement of the Health Insurance Act, for a person who has received confirmation by the insurer that the person falls under an insured person whose standard monthly remuneration for the month that includes the reference date is less than 160,000 yen (excluding persons listed in Article 42, paragraph (12), item (iv) or (v) of the New Order for Enforcement of the Health Insurance Act), the insurer is to calculate those high-cost medical expenses using the annual base amount for calculating high-cost medical expenses for persons aged 70 or over in accordance with the provisions of Article 42, paragraph (12) (limited to the part relating to item (iv)) of the item (ii) New Order for Enforcement of the Health Insurance Act.

③The confirmation under the preceding two paragraphs is to be made by the insurer, as provided by Order of the Ministry of Health, Labour and Welfare, upon the application of the person who receives payment of high-cost medical expenses under the provisions of Article 41-3 of the New Order for Enforcement of the Health Insurance Act, or by its own authority.