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Article 108第百八条
Coordination of Injury and Sickness Allowance or Childbirth Allowance With Remuneration（傷病手当金又は出産手当金と報酬等との調整）
Article 108, paragraph (1)
Injury and sickness allowance is not paid to a person who may receive all or part of the person's remuneration in case of sickness or injury during the period in which the person may receive the remuneration; provided, however, that if the amount of the remuneration to be received is less than the amount calculated pursuant to the provisions of Article 99, paragraph (2) (excluding the cases falling under Article 103, paragraph (1) or , paragraph (3) or (4)), the difference between those amounts is paid.
Childbirth allowance is not paid to a person who may receive all or part of the person's remuneration in case of childbirth during the period in which the person may receive the remuneration; provided, however, that if the amount of the remuneration to be received is less than the amount of childbirth allowance, the difference between those amounts is paid.
Injury and sickness allowance is not paid when the person to receive injury and sickness allowance is eligible for a disability welfare pension pursuant to the Employee's Pension Insurance Act due to the same sickness and injury, and diseases caused thereby; provided, however, that if the amount of the disability welfare pension to be received (when it is possible to receive the disability basic pension pursuant to the National Pension Act based on the same payment reason as that for the disability welfare pension, the total sum of the amount of the disability welfare pension and the amount of the disability basic pension) calculated pursuant to Order of the Ministry of Health, Labour and Welfare (hereinafter referred to as the "amount of disability pension" in this paragraph) is less than the amount calculated pursuant to the provisions of Article 99, paragraph (2), the difference between the calculated amount and an amount specified in accordance with the classification of each of the following items is paid:
if the person is ineligible for remuneration and eligible for childbirth allowance:the amount of childbirth allowance (that amount if it exceeds the amount calculated pursuant to the provisions of Article 99, paragraph (2)) or the amount of disability pension, whichever is larger;
if the person is entitled to all or part of the person's remuneration and not eligible for childbirth allowance:all or part of the remuneration (that amount if it exceeds the amount calculated pursuant to the provisions of Article 99, paragraph (2)) or the amount of disability pension, whichever is larger; or
if the person is entitled to all or part of remuneration and eligible for childbirth allowance:the total sum of all or part of the remuneration and the amount of childbirth allowance calculated pursuant to the provision of the proviso to the preceding paragraph (that amount if it amount exceeds the amount calculated pursuant to the provisions of Article 99, paragraph (2)), or the amount of disability pension, whichever is larger.
When a person who is to receive injury and sickness allowance is eligible for disability allowance pursuant to the Employee's Pension Insurance Act due to the same sickness and injury, and diseases caused thereby, injury and sickness allowance is not paid during the period from day on which the person starts receiving the disability allowance until the day on which the total sum of the amounts calculated pursuant to the provisions of Article 99, paragraph (2) in the case where the person is to receive payment of injury and sickness allowance after that day reaches the amount of the disability allowance; provided, however, this does not apply to the difference between that total amount and the disability allowance or another difference specified by Cabinet Order if the person is entitled to all or some of remuneration or eligible for childbirth allowance, or in other cases specified by Cabinet Order on the day when the total amount reaches or exceeds the amount of the disability allowance.
When a person who is to receive injury and sickness allowance (limited to a person who is to receive it pursuant to the provisions of Article 104 and who meets the requirements specified by Cabinet Order) is eligible for payment of pension benefits specified by Cabinet Order pursuant to the National Pension Act or the Employee's Pension Insurance Act with aging or retirement as the grounds for payment (hereinafter referred to as "superannuation benefits" in this paragraph and the following paragraph), injury and sickness allowance is not paid; provided, however, that if the amount of the superannuation benefits (if there are two or more superannuation benefits, the total sum of the benefits) calculated pursuant to Order of the Ministry of Health, Labour and Welfare is less than the amount of injury and sickness allowance, the difference between those amounts is paid.
When finding it necessary for the payment of injury and sickness allowance pursuant to the provisions of the preceding three paragraphs, an insurer may request those who pay superannuation benefits (referred to as "pension insurers" in the next paragraph) to provide necessary materials about the status of payment of disability welfare pension or disability basic pension referred to in paragraph (2), disability allowance referred to in paragraph (3), or superannuation benefits referred to in the preceding paragraph.
Pension insurers (except for the Minister of Health, Labour and Welfare), with the consent of the Minister of Health, Labour and Welfare, may delegate affairs related to the provision of documents pursuant to the provisions of the preceding paragraph to the Minister of Health, Labour and Welfare.
When a person prescribed in any of paragraphs (1) through (4) of the preceding Article becomes sick or injured, or gives birth, with respect to all of part of the remuneration to which the person is entitled, the entire amount of injury and sickness allowance or childbirth allowance is paid if the person is unable to receive all of the remuneration, and the difference between the amount of remuneration received and the amount of injury and sickness allowance or childbirth allowance is paid if the person is unable to receive part of the remuneration and the received amount is less than the amount of injury and sickness allowance or childbirth allowance; provided, however, that if a part of injury and sickness allowance or childbirth allowance is received pursuant to the provisions of the proviso to paragraph (1), paragraph (2), paragraph (3) or paragraph (4) of the preceding article, an amount equivalent to the allowance is deducted from the amount to be paid.
When a dependent of an insured person receives medical treatment from a medical institution providing services covered by health insurance that is selected by the dependent, dependent's medical expenses are paid to the insured person for expenses required for the medical treatment.
The amount of dependent medical expenses is the amount specified in item (i) below (the aggregate of that amount and the amount specified in item (ii) or (iii) if the medical treatment includes dietary treatment or living support, respectively):
the amount obtained by multiplying the amount of expenses calculated for the medical treatment (excluding dietary treatment and living support) (if the amount exceeds the amount of expenses actually incurred in the medical treatment, the amount of expenses actually incurred; the same applies hereinafter in this item) (in the case where partially uninsured treatment is received from a medical institution providing services covered by health insurance, etc. (including the case where evaluation treatment, patient-requested treatment or selective treatment is received together with that partially uninsured treatment), the amount obtained by deducting from that amount of expenses the amount calculated in accordance with the example of the determination by the Minister of Health, Labour and Welfare pursuant to the provisions of Article 86, paragraph (3), item (i), (b)) by the ratio prescribed in (a) through (d) listed below in accordance with the classifications in (a) through (d):
if the month which contains the 70th birthday of the dependent of an insured person listed in Article 74, paragraph (1), item (iii) or another insured person specified by Cabinet Order has elapsed:0.70;
the amount calculated by deducting, from the amount calculated for the dietary treatment (when that amount exceeds the amount of expenses actually incurred in the dietary treatment, the amount of expenses actually incurred), the amount of standard co-payment for dietary treatment; or
the amount calculated by deducting, from the amount calculated for the living support (when the amount exceeds the amount of expenses actually incurred in the living support, the amount of expenses actually incurred), the amount of standard co-payment for living support.
The amount of expenses for medical treatment referred to in item (i) of the preceding paragraph is calculated pursuant to the provisions of Article 76, paragraph (2) when medical treatment (excluding evaluation treatment, patient-requested treatment, selective treatment, and partially uninsured treatment) is received from a medical institution providing services covered by health insurance, etc., the provisions of Article 86, paragraph (2), item (i) when evaluation treatment, patient-requested treatment or selective treatment is received from a medical institution providing services covered by health insurance, etc. (excluding when partially uninsured treatment is received together with that evaluation treatment, patient-requested treatment or selective treatment), and the provisions of paragraph (3), item (i) of the same Article when partially uninsured treatment is received from a medical institution providing services covered by health insurance, etc. (including when evaluation treatment, patient-requested treatment or selective treatment is received together with that partially uninsured treatment), the amount of expenses for dietary treatment for inpatients referred to in item (ii) of the preceding paragraph is calculated pursuant to the provisions of Article 85, paragraph (2), and the amount of expenses for living support for inpatients referred to in item (iii) of the preceding paragraph is calculated pursuant to the provisions of Article 85-2, paragraph (2).
When a dependent receives medical treatment at or from a hospital, clinic or pharmacy listed in Article 63, paragraph (3), item (i) or (ii), the insurer may, on behalf of the relevant insured person, pay to the hospital, clinic or pharmacy expenses incurred for the medical treatment payable by the dependent to the hospital, clinic or pharmacy within the limit of the amount payable to the insured person as expenses for dependent's medical treatment.
When a payment pursuant to the provisions of the preceding paragraph is made, it is deemed that dependent's medical expenses are paid to the insured person.
前項の規定による支払があったときは、被保険者に対し家族療養費の支給があったものとみなす。
Article 110, paragraph (6)
When a dependent receives medical treatment from a hospital, clinic, or pharmacy listed in Article 63, paragraph (3), item (iii), and the insurer exempts the insured person from payment of an amount equivalent to the amount to be paid as dependent's medical expenses among the expenses required for medical treatment to be paid by the dependent, it is deemed that dependent's medical expenses are paid to the insured person.
The provisions of Article 63, Article 64, Article 70, paragraph (1), Article 72, paragraph (1), Article 73, Article 76, paragraphs (3) through (6), Article 78, Article 84, paragraph (1), Article 85, paragraph (8), Article 87, and Article 98 apply mutatis mutandis to the payment of dependent's medical expenses and to dependent's medical treatment.
The provisions of Article 75 apply mutatis mutandis to payment of the amount calculated by deducting, from the amount of expenses calculated for the relevant medical treatment pursuant to the provisions of paragraph (3) in the case referred to in paragraph (4) (when the amount exceeds the amount of expenses actually incurred in the medical treatment, the amount of expenses actually incurred), the amount payable as dependent's medical expenses with respect to expenses incurred in the medical treatment.