With regard to sickness and injury of insured persons, benefits for medical treatment are paid as listed below:
被保険者の疾病又は負傷に関しては、次に掲げる療養の給付を行う。
medical examinations;
診察
provision of medication or materials for medical treatment;
薬剤又は治療材料の支給
treatment, operations or any other medical treatment;
処置、手術その他の治療
in-home medical care management as well as care and any other nursing involved in in-home medical care; and
居宅における療養上の管理及びその療養に伴う世話その他の看護
hospitalization or visiting a clinic, and care and other nursing involved in medical treatment provided there.
病院又は診療所への入院及びその療養に伴う世話その他の看護
Benefits for the following types of medical treatment are not included in the benefits referred to in the preceding paragraph:
次に掲げる療養に係る給付は、前項の給付に含まれないものとする。
medical treatment consisting of the provision of meals and given in combination with the type of medical treatment listed in item (v) of the preceding paragraph (excluding hospitalization in a sanatorium ward (hereinafter referred to as "sanatorium ward") as prescribed in Article 7, paragraph (2), item (iv) of the Medical Care Act (Act No. 205 of 1948), and care and other nursing involved in the medical treatment there which is provided to an insured person whose 65th birthday is in any month before the month in which the person receives the relevant medical treatment (hereinafter referred to as "insured person undergoing special long-term hospitalization"); hereinafter referred to as "dietary treatment");
食事の提供である療養であって前項第五号に掲げる療養と併せて行うもの（医療法（昭和二十三年法律第二百五号）第七条第二項第四号に規定する療養病床（以下「療養病床」という。）への入院及びその療養に伴う世話その他の看護であって、当該療養を受ける際、六十五歳に達する日の属する月の翌月以後である被保険者（以下「特定長期入院被保険者」という。）に係るものを除く。以下「食事療養」という。）
the following types of medical treatment given in combination with the type of medical treatment listed in item (v) of the preceding paragraph (limited to medical treatment provided to an insured person undergoing special long-term hospitalization; hereinafter referred to as "living support"):
次に掲げる療養であって前項第五号に掲げる療養と併せて行うもの（特定長期入院被保険者に係るものに限る。以下「生活療養」という。）
medical treatment consisting of the provision of meals;
食事の提供である療養
medical treatment consisting of the creation of an appropriate environment for medical treatment in terms of temperature, lighting and water supply;
温度、照明及び給水に関する適切な療養環境の形成である療養
medical treatment using advanced medical care techniques specified by the Minister of Health, Labour and Welfare and other medical treatment which are specified by the Minister of Health, Labour and Welfare as treatment that requires evaluation to determine whether it should be subject to benefits referred to in the preceding paragraph from the viewpoint of efficiently providing appropriate medical care (excluding patient-requested treatment in the following item; hereinafter referred to as "evaluation treatment");
medical treatment using advanced medical care techniques and specified by the Minister of Health, Labour and Welfare as treatment that requires evaluation to determine whether it should be subject to benefits referred to in the preceding paragraph, based on a request by the person who intends to receive the medical treatment, from the viewpoint of efficiently providing appropriate medical care (hereinafter referred to as "patient-requested treatment"); and
高度の医療技術を用いた療養であって、当該療養を受けようとする者の申出に基づき、前項の給付の対象とすべきものであるか否かについて、適正な医療の効率的な提供を図る観点から評価を行うことが必要な療養として厚生労働大臣が定めるもの（以下「患者申出療養」という。）
the provision of a special ward pertaining to the selection of insured persons and other medical treatment prescribed by the Minister of Health, Labour and Welfare (hereinafter referred to as "selective treatment").
被保険者の選定に係る特別の病室の提供その他の厚生労働大臣が定める療養（以下「選定療養」という。）
A person who intends to receive benefits under paragraph (1) is, pursuant to Order of the Ministry of Health, Labour and Welfare, to receive confirmation that the person is an insured person from a hospital, clinic, or pharmacy that the person selects from those listed below, by electronic eligibility confirmation or another method specified by Order of the Ministry of Health, Labour and Welfare (hereinafter referred to as "electronic eligibility confirmation, etc."), and to receive the benefits under that paragraph:
a hospital or clinic designated by the Minister of Health, Labour and Welfare (if the hospital or clinic has received a designation excluding all or some of its beds pursuant to the provisions of Article 65, excluding those beds; hereinafter referred to as "medical institution providing services covered by health insurance") or a pharmacy designated by the Minister of Health, Labour and Welfare (hereinafter referred to as "pharmacy providing services covered by health insurance");
厚生労働大臣の指定を受けた病院若しくは診療所（第六十五条の規定により病床の全部又は一部を除いて指定を受けたときは、その除外された病床を除く。以下「保険医療機関」という。）又は薬局（以下「保険薬局」という。）
a hospital, clinic, or pharmacy which provides medical care or prescriptions to an insured person administered by a specific insurer and which is specified by the insurer; and
特定の保険者が管掌する被保険者に対して診療又は調剤を行う病院若しくは診療所又は薬局であって、当該保険者が指定したもの
a hospital, clinic, or pharmacy established by an insurer which is a health insurance society.
健康保険組合である保険者が開設する病院若しくは診療所又は薬局
A request referred to in paragraph (2), item (iv), as prescribed by the Minister of Health, Labour and Welfare, is to be made to the Minister of Health, Labour and Welfare and accompanied by statements by the establisher of the core clinical research hospital provided for by Article 4-3 of the Medical Care Act (limited to a medical institution providing services covered by health insurance) which provides the medical treatment to which the request pertains and other necessary documents.
When the Minister of Health, Labour and Welfare receives a request under paragraph (2), item (iv), the Minister of Health, Labour and Welfare is to promptly examine the request and specify the medical treatment pertaining to the request as patient-requested treatment if it is found to require the evaluation provided for in that item.
If Minister of Health, Labour and Welfare determines that the medical treatment to which the application referred to in paragraph (2), item (iv) pertains pursuant to the provisions of the preceding paragraph is patient-requested treatment, the Minister is to promptly notify the applicant to that effect.
If the Minister of Health, Labour and Welfare examines the application referred to in paragraph (2), item (iv) pursuant to the provisions of paragraph (5) and determines that the medical treatment pertaining to the application is not to be specified as patient-requested treatment, the Minister is to promptly notify the applicant to that effect and the reason therefor.
Read this with the articles around it
(Benefits for Medical Treatment)
With regard to sickness and injury of insured persons, benefits for medical treatment are paid as listed below:
被保険者の疾病又は負傷に関しては、次に掲げる療養の給付を行う。
Open this provision(Benefits for Medical Treatment)
hospitalization or visiting a clinic, and care and other nursing involved in medical treatment provided there.
病院又は診療所への入院及びその療養に伴う世話その他の看護
Open this provision(Benefits for Medical Treatment)
medical treatment using advanced medical care techniques and specified by the Minister of Health, Labour and Welfare as treatment that requires evaluation to determine whether it should be subject to…
高度の医療技術を用いた療養であって、当該療養を受けようとする者の申出に基づき、前項の給付の対象とすべきものであるか否かについて、適正な医療の効率的な提供を図る観点から評価を行うことが必要な療養として厚生労働大臣が定めるもの（以下「患者申出療養」という。）
Open this provision(Benefits for Medical Treatment)
When the Minister of Health, Labour and Welfare receives a request under paragraph (2), item (iv), the Minister of Health, Labour and Welfare is to promptly examine the request and specify the…
厚生労働大臣は、第二項第四号の申出を受けた場合は、当該申出について速やかに検討を加え、当該申出に係る療養が同号の評価を行うことが必要な療養と認められる場合には、当該療養を患者申出療養として定めるものとする。
Open this provision(Designation of Medical Institutions and Pharmacies Providing Services Covered by Health Insurance)
A designation referred to in Article 63, paragraph (3), item (i) is provided upon an application by the establisher who opened a hospital, clinic, or pharmacy, as specified by Cabinet Order.
第六十三条第三項第一号の指定は、政令で定めるところにより、病院若しくは診療所又は薬局の開設者の申請により行う。
Open this provisionA hospital that meets the following requirements for playing a central role in the implementation of clinical research may bear the name "core hospital for clinical research"…
病院であつて、臨床研究の実施の中核的な役割を担うことに関する次に掲げる要件に該当するものは、厚生労働大臣の承認を得て臨床研究中核病院と称することができる。
Open this provisionlong-term care beds (meaning hospital or clinic beds other than those described in the above three items that are primarily for the hospitalization of patients requiring long-term recuperation; the…
療養病床（病院又は診療所の病床のうち、前三号に掲げる病床以外の病床であつて、主として長期にわたり療養を必要とする患者を入院させるためのものをいう。以下同じ。）
Open this provisioninsured person
「被保険者」
A person employed at an applicable place of business (適用事業所), or an insured person with optional and continued coverage (任意継続被保険者); the persons listed in the items of Article 3, paragraph (1) — among them some temporary, seasonal and short-time workers and persons insured under late-stage elderly medical care (後期高齢者医療) — cannot be insured persons, except as specially-insured day laborers (日雇特例被保険者).
Defined inArticle 3, paragraph (1)· applies throughout the law
electronic eligibility confirmationmachine translation
「電子資格確認」
The way a person seeking treatment from a medical institution or pharmacy covered by health insurance (保険医療機関等), or designated home nursing (指定訪問看護) from a designated home-nursing provider (指定訪問看護事業者), is confirmed as an insured person or dependent: they ask the insurer about their eligibility by sending the electronic certificate for user verification (利用者証明用電子証明書) recorded on their Individual Number Card (個人番号カード), or by another method a Ministry of Health, Labour and Welfare Order (厚生労働省令) sets, receive the insurer's answer online, and pass it to the institution or provider, which then confirms their status.
Defined inArticle 3, paragraph (13)· applies throughout the law
insured person undergoing special long-term hospitalization
「特定長期入院被保険者」
An insured person who, when receiving inpatient care in a long-term care bed (療養病床) with the care and nursing that go with it, is in or past the month after the month in which they reach 65.
Short name set inArticle 63, paragraph (2), item (i)
sanatorium ward
「療養病床」
A long-term care bed (療養病床) as defined in Article 7, paragraph (2), item (iv) of the Medical Care Act: a hospital or clinic bed, other than a psychiatric, infectious disease or tuberculosis bed, mainly for patients who need medical care over a long period.
Short name set inArticle 63, paragraph (2), item (i)
dietary treatment
「食事療養」
Meals provided as treatment together with inpatient care in a hospital or clinic (the treatment in Article 63, paragraph (1), item (v)), other than those given with a stay in a sanatorium ward (療養病床) to an insured person who is, at the time, past the month in which they reach the age of 65 (an insured person undergoing special long-term hospitalization, 特定長期入院被保険者).
Short name set inArticle 63, paragraph (2), item (i)
living support
「生活療養」
Meals, and a suitable care environment as to temperature, lighting and water supply, provided together with inpatient care (Article 63, paragraph (1), item (v)) to an insured person undergoing special long-term hospitalization (特定長期入院被保険者).
Short name set inArticle 63, paragraph (2), item (ii)
evaluation treatment
「評価療養」
Treatment using advanced medical technology that the Minister of Health, Labour and Welfare specifies, and other treatment the Minister specifies as needing to be evaluated, with a view to providing appropriate medical care efficiently, for whether it should be covered by medical treatment benefits (療養の給付) — other than patient-requested treatment (患者申出療養).
Short name set inArticle 63, paragraph (2), item (iii)
patient-requested treatment
「患者申出療養」
Medical treatment using advanced medical technology that the Minister of Health, Labour and Welfare designates as needing evaluation, at the request of the person who wishes to receive it, of whether it should be covered by the benefits for medical treatment (療養の給付), with a view to providing appropriate medical care efficiently.
Short name set inArticle 63, paragraph (2), item (iv)
selective treatment
「選定療養」
A special hospital room the insured person chooses, and other treatment of kinds the Minister of Health, Labour and Welfare specifies — one of the kinds of treatment Article 63, paragraph (2) leaves out of medical treatment benefits (療養の給付).
Short name set inArticle 63, paragraph (2), item (v)
electronic eligibility confirmation, etc.machine translation
「電子資格確認等」
Electronic eligibility confirmation (電子資格確認) or another method a Ministry of Health, Labour and Welfare Order (厚生労働省令) sets, by which a person seeking medical treatment benefits (療養の給付) is confirmed as an insured person by the hospital, clinic or pharmacy of their choice among those listed in Article 63, paragraph (3).
Short name set inArticle 63, paragraph (3)
medical institution providing services covered by health insurancemachine translation
「保険医療機関」
A hospital or clinic designated by the Minister of Health, Labour and Welfare under Article 63, paragraph (3), item (i), at which insured persons can receive the benefits for medical treatment (療養の給付) of health insurance, not counting any beds left out of its designation under Article 65.
Short name set inArticle 63, paragraph (3), item (i)
pharmacy providing services covered by health insurancemachine translation
「保険薬局」
A pharmacy designated by the Minister of Health, Labour and Welfare, from which insured persons can receive the benefits for medical treatment (療養の給付) of health insurance.
Short name set inArticle 63, paragraph (3), item (i)
health insurance society
健康保険組合
A corporation that runs the health insurance of the insured persons who are its members; it and the Japan Health Insurance Association (全国健康保険協会) are the two insurers of health insurance (Health Insurance Act, Articles 4, 6 and 9). It is made up of the employers of the workplaces it covers, the insured persons they employ and its insured persons with optional and continued coverage (Article 8). An employer that regularly employs at least the number of insured persons a Cabinet Order (政令) sets, or employers that reach that number together, may set one up: they draw up its constitution (規約) with the consent of at least half of the insured persons at each workplace concerned, and obtain the authorization of the Minister of Health, Labour and Welfare (Articles 11 and 12).
Written by AI using Health Insurance Act, Arts. 4, 6, 8, 9, 11, 12 as a reference.