If a specially-insured day laborer falls under any of the following items, and three months (two months if the day on which the laborer fell under the item is the first day of the month; the same applies in paragraph (5)) have not elapsed since the first day of the month including the day on which the laborer fell under the item, or the laborer's dependent submitted a special medical expense card for a hospital, clinic or pharmacy that the dependent selected from those listed in Article 63, paragraph (3), item (i) or (ii) and received medical treatment therefrom, or submitted the special medical expense card to a designated home-nursing provider that the dependent selected and received designated home-nursing, special medical expenses required for the medical treatment or designated home-nursing are paid to the specially-insured day laborer; provided, however, that this does not apply if, with respect to the relevant sickness or injury, the specially-insured day laborer is eligible for benefits for medical treatment, for payment of expenses for dietary treatment for inpatients, expenses for living support for inpatients, 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, or is eligible for payment of expenses for in-home long-term care services, expenses for special in-home long-term care services, expenses for community-based long-term care services, expenses for special community-based long-term care services, expenses for long-term care facility services, allowance for special long-term care facility service expenses, expenses for services to prevent long-term care, or expenses for special services to prevent long-term care pursuant to the provisions of the Long-Term Care Insurance Act:
次の各号のいずれかに該当する日雇特例被保険者でその該当するに至った日の属する月の初日から起算して三月（月の初日に該当するに至った者については、二月。第五項において同じ。）を経過しないもの又はその被扶養者が、特別療養費受給票を第六十三条第三項第一号若しくは第二号に掲げる病院若しくは診療所若しくは薬局のうち自己の選定するものに提出して、そのものから療養を受けたとき、又は特別療養費受給票を指定訪問看護事業者のうち自己の選定するものに提出して、そのものから指定訪問看護を受けたときは、日雇特例被保険者に対し、その療養又は指定訪問看護に要した費用について、特別療養費を支給する。ただし、当該疾病又は負傷につき、療養の給付若しくは入院時食事療養費、入院時生活療養費、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又は介護保険法の規定による居宅介護サービス費の支給、特例居宅介護サービス費の支給、地域密着型介護サービス費の支給、特例地域密着型介護サービス費の支給、施設介護サービス費の支給、特例施設介護サービス費の支給、介護予防サービス費の支給若しくは特例介護予防サービス費の支給を受けることができるときは、この限りでない。
the specially-insured day laborer receives a specially-insured day laborer's insurance book for the first time;
初めて日雇特例被保険者手帳の交付を受けた者
the relevant specially insured day laborer's insurance book no longer contains blank space for stamps for proof of health insurance in the month in which insurance premiums for 26 days or more have been paid in total in the previous one month or two consecutive months or insurance premiums for 78 days or more have been paid in total in the previous three to six consecutive months, or was returned within the following month pursuant to the provisions of Article 126, paragraph (3), and the specially-insured day laborer then received a new specially-insured day laborer's insurance book; or
一月間若しくは継続する二月間に通算して二十六日分以上又は継続する三月ないし六月間に通算して七十八日分以上の保険料が納付されるに至った月において日雇特例被保険者手帳に健康保険印紙をはり付けるべき余白がなくなり、又はその月の翌月中に第百二十六条第三項の規定により日雇特例被保険者手帳を返納した後、初めて日雇特例被保険者手帳の交付を受けた者
the specially-insured day laborer receives a specially-insured day laborer's insurance book after one year or more has elapsed since the day on which the laborer's previous insurance book ceased to contain blank space for stamps for proof of health insurance or the day on which the laborer's previous insurance book was returned pursuant to the provisions of Article 126, paragraph (3) (the most recent specially-insured day laborer's insurance book if two or more insurance books have been issued).
前に交付を受けた日雇特例被保険者手帳（前に二回以上にわたり日雇特例被保険者手帳の交付を受けたことがある場合においては、最後に交付を受けた日雇特例被保険者手帳）に健康保険印紙をはり付けるべき余白がなくなった日又は第百二十六条第三項の規定によりその日雇特例被保険者手帳を返納した日から起算して一年以上を経過した後に日雇特例被保険者手帳の交付を受けた者
The amount of special medical expenses is the amount stated in item (i) below for medical treatment provided by a hospital, clinic, or pharmacy listed in Article 63, paragraph (3), item (i) or (ii) (if dietary treatment is included in the treatment, the sum of the amount stated in item (i) below and the amount stated in item (ii); if living support is included in the treatment, the sum of the amount stated in item (i) below and the amount stated in item (iii)), or the amount listed in item (iv) for designated home-nursing provided by a designated home-nursing provider:
an amount equivalent to 0.70 of 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 amount calculated by deducting the amount of standard co-payment for dietary treatment from the amount calculated for the dietary treatment (when the amount exceeds the amount of expenses actually incurred in the dietary treatment, the amount of expenses actually incurred);
the amount calculated by deducting the amount of standard co-payment for living support 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); and
an amount equivalent to 0.70 of the amount of expenses calculated for designated home-nursing.
当該指定訪問看護につき算定された費用の額の百分の七十に相当する額
When applying the provisions of the preceding paragraph to a person who receives medical treatment or designated home-nursing referred to in paragraph (1) before the first March 31 after the person's 6th birthday, "0.70" in items (i) and (iv) of the same paragraph is replaced with "0.80".
When applying the provisions of paragraph (2) to a person who receives medical treatment or designated home-nursing referred to in paragraph (1) (excluding insured persons who fall under the cases listed in Article 74, paragraph (1), item (iii) as applied mutatis mutandis to Article 149 and their dependents, and the dependents of insured persons specified by Cabinet Order) after the month following the month which included the person's 70th birthday, "0.70" in paragraph (2), items (i) and (iv) are replaced with "0.80".
An insurer issued a special medical expense card upon application by a specially-insured day laborer who falls under any of the items of paragraph (1) if three months have not elapsed since the first day of the month in which the laborer acquired the eligibility.
The provisions of Article 132 apply mutatis mutandis to the payment of special medical expenses. In this case, the phrases "confirmation prescribed in Article 129, paragraph (3)" and "lack of confirmation" in Article 132, paragraph (2) are deemed to be replaced with "issuance of a special medical expense card" and "lack of issuance".
The provisions of Article 87, paragraphs (2) and (3) apply mutatis mutandis to the calculation of the amount of medical expenses paid pursuant to the provisions of Article 132, paragraph (1) and (2) as applied mutatis mutandis pursuant to the preceding paragraph.
The form and issuance of special medical expense cards and other necessary matters concerning them are specified by Order of the Ministry of Health, Labour and Welfare.
特別療養費受給票の様式及び交付その他特別療養費受給票に関して必要な事項は、厚生労働省令で定める。