①When an insurer finds it difficult to pay benefits for medical treatment, expenses for dietary treatment for inpatients, living support expenses for inpatients, or medical expenses combined with treatment outside insurance coverage (hereinafter referred to as "benefits for medical treatment, etc." in this paragraph) or finds it unavoidable in cases where an insured person has received any medical care, medication or treatment at or from a hospital, clinic, pharmacy or any other person other than a medical institution providing services covered by health insurance, it may pay medical expenses in lieu of benefits for medical treatment, etc.

②The amount of medical expenses is determined by the insurer based on: (a) the amount calculated by deducting, from the amount calculated for the medical treatment (excluding dietary treatment and living support), the amount calculated by multiplying the amount by the applicable ratio specified in the items of Article 74, paragraph (1) in accordance with the classifications listed in the items of the same paragraph; and (b) the amount calculated by deducting, from the amount of expenses calculated for the dietary treatment or living support, the amount of standard co-payment for dietary treatment or standard co-payment for living support, respectively.

③The amount of expenses referred to in the preceding paragraph is calculated as the amount referred to in Article 76, paragraph (2) when a benefit for medical treatment is to be received, the amount referred to in Article 85, paragraph (2) when expenses for dietary treatment for inpatients are to be received, the amount referred to in Article 85-2, paragraph (2) when expenses for living support for inpatients are to be received, and the amount referred to in paragraph (2) of the preceding Article when medical expenses combined with treatment outside insurance coverage are to be received; however, the amount must not exceed the amount of expenses actually required for medical treatment.