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Read the text in force →健康保険法
Chapter IV Insurance Benefits (Articles 110-2 to 122)
The law as Act Partially Amending the Health Insurance Act, etc. (Act No. 31 of 2026) leaves it, with the words it changes marked.
The main text is read a page at a time: a chapter to a page, and a long chapter in runs of articles. The whole main text, and the supplementary provisions and appended tables this amendment changes. Those it leaves untouched are on the page for the text in force.
With regard to the payment of dependent's medical expenses pertaining to a dependent of an insured person as prescribed in Article 75-2, paragraph (1), an insurer my take measures consisting of setting rates exceeding those specified in paragraph (2), item (i), sub-items (a) through (d) of the preceding Article but less than 100/100.
保険者は、第七十五条の二第一項に規定する被保険者の被扶養者に係る家族療養費の支給について、前条第二項第一号イからニまでに定める割合を、それぞれの割合を超え百分の百以下の範囲内において保険者が定めた割合とする措置を採ることができる。
With regard to the application of the provisions of paragraph (4) of the preceding Article pertaining to the dependent prescribed in the preceding paragraph, the phrase "the amount payable to the insured person as expenses for dependent's medical treatment" in paragraph (4) is replaced with "the amount of expenses calculated for the medical treatment (if the amount exceeds the amount of expenses actually incurred in the medical treatment, the amount of expenses actually incurred). In this case, the insurer may to decide to collect an amount obtained by deducting the amount to be paid to the insured person as expenses for dependent's medical treatment from the amount that was paid directly from the insured person pertaining to the dependent or to postpone the collection.
前項に規定する被扶養者に係る前条第四項の規定の適用については、同項中「家族療養費として被保険者に対し支給すべき額」とあるのは、「当該療養につき算定した費用の額（その額が現に当該療養に要した費用の額を超えるときは、当該現に療養に要した費用の額）」とする。この場合において、保険者は、当該支払をした額から家族療養費として被保険者に対し支給すべき額を控除した額をその被扶養者に係る被保険者から直接に徴収することとし、その徴収を猶予することができる。
When a dependent of an insured person has received designated home-nursing from a designated home-nursing provider, with regard to expenses incurred in the designated home-nursing, dependent's medical expenses for home-nursing are paid to the insured person.
被保険者の被扶養者が指定訪問看護事業者から指定訪問看護を受けたときは、被保険者に対し、その指定訪問看護に要した費用について、家族訪問看護療養費を支給する。
The amount of dependent's medical expenses for home-nursing is obtained by multiplying the amount of expenses calculated pursuant to the provisions specified by the Minister of Health, Labor and Welfare referred to in Article 88, paragraph (4) pertaining to the designated home-nursing by the ratio specified in Article 110, paragraph (2), item (i), sub-items (a) through (d) in accordance with the classifications listed in the same items (if the provisions of paragraph (1) or (2) of the preceding Article are to be applied, the amount when the provisions are deemed to have been applied).
家族訪問看護療養費の額は、当該指定訪問看護につき第八十八条第四項の厚生労働大臣の定めの例により算定した費用の額に第百十条第二項第一号イからニまでに掲げる場合の区分に応じ、同号イからニまでに定める割合を乗じて得た額（家族療養費の支給について前条第一項又は第二項の規定が適用されるべきときは、当該規定が適用されたものとした場合の額）とする。
The provisions of Article 88, paragraphs (2), (3), (6) through (11), and (13), Article 90, paragraph (1), Article 91, Article 92, paragraphs (2) and (3), Article 94, and Article 98 apply mutatis mutandis to payment of dependent's medical expenses for home-nursing and to designated home-nursing for dependents.
第八十八条第二項、第三項、第六項から第十一項まで及び第十三項、第九十条第一項、第九十一条、第九十二条第二項及び第三項、第九十四条並びに第九十八条の規定は、家族訪問看護療養費の支給及び被扶養者の指定訪問看護について準用する。
When a dependent of an insured person is transported to a hospital or clinic in order to receive medical treatment, the insurer pays, as dependent's transport expenses, an amount calculated pursuant to Order of the Ministry of Health, Labour and Welfare referred to in Article 97, paragraph (1) to the insured person.
被保険者の被扶養者が家族療養費に係る療養を受けるため、病院又は診療所に移送されたときは、家族移送費として、被保険者に対し、第九十七条第一項の厚生労働省令で定めるところにより算定した金額を支給する。
The provisions of Article 97, paragraphs (2) and Article 98 apply mutatis mutandis to the payment of dependent's transport expenses.
第九十七条第二項及び第九十八条の規定は、家族移送費の支給について準用する。
When a dependent of an insured person, pursuant to Order of the Ministry of Health, Labour and Welfare, receives confirmation that the person is a dependent by electronic eligibility confirmation, etc. from a delivery-handling medical institution providing services covered by health insurance, etc. or designated birthing center, etc. that is selected by the dependent, and receives delivery care, dependent's delivery expenses are paid to the insured person for the expenses required for the delivery care.
被保険者の被扶養者が、厚生労働省令で定めるところにより、分娩取扱保険医療機関等又は指定助産所等のうち自己の選定するものから、電子資格確認等により、被扶養者であることの確認を受け、分娩の手当を受けたときは、被保険者に対し、その分娩の手当に要した費用について、家族分娩費を支給する。
The amount of dependent's delivery expenses is the amount of expenses calculated for the relevant delivery care in accordance with the determination under Article 98-2, paragraph (2).
家族分娩費の額は、当該分娩の手当につき第九十八条の二第二項の定めの例により算定した費用の額とする。
The provisions of Article 98-2, paragraphs (3) to (9) apply mutatis mutandis to the payment of dependent's delivery expenses, the provisions of paragraph (10) of that Article apply mutatis mutandis to the payment of an amount equivalent to the expenses required for delivery care pertaining to a dependent, and the provisions of Article 98-3, Article 98-4, Article 98-10, paragraph (1), Article 98-13 and Articles 98-19 through 98-23, and the provisions of Article 70, paragraph (1) and Article 72, paragraph (1) as applied mutatis mutandis pursuant to Article 98-5, apply mutatis mutandis to delivery care pertaining to dependent's delivery expenses, respectively.
第九十八条の二第三項から第九項までの規定は家族分娩費の支給について、同条第十項の規定は被扶養者に係る分娩の手当に要した費用に相当する金額の支給について、第九十八条の三、第九十八条の四、第九十八条の十第一項、第九十八条の十三及び第九十八条の十九から第九十八条の二十三までの規定並びに第九十八条の五において準用する第七十条第一項及び第七十二条第一項の規定は家族分娩費に係る分娩の手当について、それぞれ準用する。
When a dependent of an insured person dies, the amount specified by Cabinet Order referred to in Article 100, paragraph (1) is paid to the insured person as dependent's burial charges.
被保険者の被扶養者が死亡したときは、家族埋葬料として、被保険者に対し、第百条第一項の政令で定める金額を支給する。
Lump-SumLump-sum Allowance forat Dependent's Childbirth and Childcare
家族出産育児時一時金
When a dependent of an insured person receives delivery care under health insurance from a delivery-handling medical institution providing services covered by health insurance, etc. or designated birthing center, etc. and gives birth, an amount specified by Cabinet Order referred to in Article 101 , paragraph (1) is paid to the insured person as lump-sum allowance forat dependent's childbirth and childcare.
被保険者の被扶養者が分娩取扱保険医療機関等又は指定助産所等から健康保険の分娩の手当を受け、出産したときは、家族出産育児時一時金として、被保険者に対し、第百一条第一項の政令で定める金額を支給する。
The provisions of Article 98-22 and Article 98-23 apply mutatis mutandis to delivery care pertaining to the lump-sum allowance at dependent's childbirth, and the provisions of Article 101, paragraphs (2) to (7) apply mutatis mutandis to the payment of the lump-sum allowance at dependent's childbirth, respectively.
第九十八条の二十二及び第九十八条の二十三の規定は家族出産時一時金に係る分娩の手当について、第百一条第二項から第七項までの規定は家族出産時一時金の支給について、それぞれ準用する。
When the amount of co-payment made in relation to benefits for medical treatment or the amount calculated by deducting, from the amount of expenses incurred in medical treatment (excluding dietary treatment and living support; the same applies hereinafter in the following paragraph), an amount equivalent to the amount paid as medical expenses combined with treatment outside insurance coverage, medical expenses, medical expenses for home-nursing, dependent's medical expenses, or dependent's medical expenses for home-nursing in relation to the medical treatment (referred to as the "amount of co-payment, etc." in paragraph (1) of the following Article) is extremely large, the insurer pays high-cost medical expenses to the person who received payment of the benefits for medical treatment, or medical expenses combined with treatment outside insurance coverage, medical expenses, medical expenses for home-nursing expenses, dependent's medical expenses, or dependent's medical expenses for home-nursing.
療養の給付について支払われた一部負担金の額又は療養（食事療養及び生活療養を除く。次項において同じ。）に要した費用の額からその療養に要した費用につき保険外併用療養費、療養費、訪問看護療養費、家族療養費若しくは家族訪問看護療養費として支給される額に相当する額を控除した額（次条第一項において「一部負担金等の額」という。）が著しく高額であるときは、その療養の給付又はその保険外併用療養費、療養費、訪問看護療養費、家族療養費若しくは家族訪問看護療養費の支給を受けた者に対し、高額療養費を支給する。
The requirements for payment of high-cost medical expenses, the amount thereof, and other necessary matters concerning the payment of high-cost medical expenses are specified by Cabinet Order by taking into consideration the impact of sharing of costs necessary for the relevant medical treatment on household finances, in particular the household finances of persons who receive medical treatment continuously over a long period, and the amount of expenses incurred in the medical treatment.
高額療養費の支給要件、支給額その他高額療養費の支給に関して必要な事項は、療養に必要な費用の負担の家計、とりわけ長期にわたって継続的に療養を受ける者の家計に与える影響及び療養に要した費用の額を考慮して、政令で定める。
When the amount of co-payment, etc. (if high-cost medical expenses referred to in paragraph (1) of the preceding Article is to be paid, the amount obtained by deducting the amount so paid from the amount of co-payment, etc.), or the sum of the amount to be borne by a user of long-term care service prescribed in Article 51, paragraph (1) of the Long-Term Care Insurance Act (if expenses for high-cost long-term care service referred to in the same paragraph are paid, the amount obtained by deducting the amount so paid from the amount to be borne by the user of long-term care service), and the amount to be borne by a user of a service to prevent long-term care prescribed in Article 61, paragraph (1) of the same Act (if expenses for high-cost service to prevent long-term care referred to in the same paragraph are to be paid, the amount obtained by deducting the amount so paid from the amount to be borne by the user of the service to prevent long-term care) is extremely large, expenses for high-cost medical treatment combined with long-term care are paid to the person who received benefits for medical treatment to which the amount of the co-payment pertained, or payment of medical expenses combined with treatment outside insurance coverage, medical expenses, medical expenses for home-nursing, dependent's medical expenses, or dependent's medical expenses for home-nursing.
一部負担金等の額（前条第一項の高額療養費が支給される場合にあっては、当該支給額に相当する額を控除して得た額）並びに介護保険法第五十一条第一項に規定する介護サービス利用者負担額（同項の高額介護サービス費が支給される場合にあっては、当該支給額を控除して得た額）及び同法第六十一条第一項に規定する介護予防サービス利用者負担額（同項の高額介護予防サービス費が支給される場合にあっては、当該支給額を控除して得た額）の合計額が著しく高額であるときは、当該一部負担金等の額に係る療養の給付又は保険外併用療養費、療養費、訪問看護療養費、家族療養費若しくは家族訪問看護療養費の支給を受けた者に対し、高額介護合算療養費を支給する。
The provisions of paragraph (2) of the preceding Article apply mutatis mutandis to the payment of expenses for high-cost medical treatment combined with long-term care.
前条第二項の規定は、高額介護合算療養費の支給について準用する。
When the grounds for a benefit claim are caused by intentional criminal conduct committed by a person who is or was an insured person, or were intentionally caused thereby, no insurance benefits are paid based on those grounds.
被保険者又は被保険者であった者が、自己の故意の犯罪行為により、又は故意に給付事由を生じさせたときは、当該給付事由に係る保険給付は、行わない。
When the grounds for a benefit claim are caused by a conflict, state of drunkenness or significant misconduct by the insured person, the insurer may refrain from paying, in whole or in part, insurance benefits based on those grounds.
被保険者が闘争、泥酔又は著しい不行跡によって給付事由を生じさせたときは、当該給付事由に係る保険給付は、その全部又は一部を行わないことができる。
Insurance benefits are not provided for sickness, injury or childbirth for a period in which the relevant person who is or was an insured person falls under any of the following items (limited to cases specified by Order of the Ministry of Health, Labour and Welfare for payment of injury and sickness allowance or childbirth allowance):
被保険者又は被保険者であった者が、次の各号のいずれかに該当する場合には、疾病、負傷又は出産につき、その期間に係る保険給付（傷病手当金及び出産手当金の支給にあっては、厚生労働省令で定める場合に限る。）は、行わない。
the person is committed to a juvenile training school or any other institution equivalent thereto; or
少年院その他これに準ずる施設に収容されたとき。
the person is confined to a penal institution, work facility, or any other facility equivalent thereto.
刑事施設、労役場その他これらに準ずる施設に拘禁されたとき。
An insurer may not prevent insurance benefits pertaining to a dependent of an insured person from being paid even if the person who is or was an insured person falls under any of the items of the preceding paragraph.
保険者は、被保険者又は被保険者であった者が前項各号のいずれかに該当する場合であっても、被扶養者に係る保険給付を行うことを妨げない。
When a person who is or was an insured person fails to follow instructions concerning medical treatment without a justifiable reason, the insurer may refrain from providing part of the applicable insurance benefits.
保険者は、被保険者又は被保険者であった者が、正当な理由なしに療養に関する指示に従わないときは、保険給付の一部を行わないことができる。
An insurer may determine not to pay all or some of the injury and sickness allowance or childbirth allowance to a person who received or intended to receive insurance benefits by means of deception or other wrongful conduct for a specified period no longer than six months; however, this does not apply when one year or more has elapsed after the day of the deception or wrongful conduct.
保険者は、偽りその他不正の行為により保険給付を受け、又は受けようとした者に対して、六月以内の期間を定め、その者に支給すべき傷病手当金又は出産手当金の全部又は一部を支給しない旨の決定をすることができる。ただし、偽りその他不正の行為があった日から一年を経過したときは、この限りでない。
When a person who is to receive insurance benefits fails to comply with an order issued pursuant to the provisions of Article 59 or refuses to answer questions or to undergo a medical examination without a justifiable reason, the insurer may refrain from providing all or part of the applicable insurance benefits.
保険者は、保険給付を受ける者が、正当な理由なしに、第五十九条の規定による命令に従わず、又は答弁若しくは受診を拒んだときは、保険給付の全部又は一部を行わないことができる。
The provisions of Article 116, Article 117, Article 118, paragraph (1) and Article 119 apply mutatis mutandis to dependents of an insured person. In this case, the phrase "insurance benefits" in those provisions is deemed to be replaced with "insurance benefits pertaining to the dependent".
第百十六条、第百十七条、第百十八条第一項及び第百十九条の規定は、被保険者の被扶養者について準用する。この場合において、これらの規定中「保険給付」とあるのは、「当該被扶養者に係る保険給付」と読み替えるものとする。