Chapter III Insured Persons
第三章 被保険者
Section 1 Eligibility
第一節 資格
Article 31Applicable Places of Business
第三十一条(適用事業所)
An employer of a non-applicable place of business may operate the place of business as an applicable place of business with authorization from the Minister of Health, Labour and Welfare.
When intending to obtain the authorization referred to in the preceding paragraph, the employer of a place of business must, with the consent of half or more of the workers employed at the place of business (limited to those to be insured persons), apply to the Minister of Health, Labour and Welfare for the authorization.
第三十二条
If an applicable place of business no longer falls under the items of Article 3, paragraph (3), it is deemed to be authorized under paragraph (1) of the preceding Article.
第三十三条
An employer of a place of business under Article 31, paragraph (1) may make the place of business a non-applicable place of business with authorization from the Minister of Health, Labour and Welfare.
When intending to obtain the authorization referred to in the preceding paragraph, the employer of the place of business must, with the consent of three-quarters or more of the workers employed at the place of business (limited to insured persons), apply to the Minister of Health, Labour and Welfare for the authorization.
第三十四条
When the employer of two or more applicable places of business is the same, the employer may merge the two or more places of business into one applicable place of business with approval from the Minister of Health, Labour and Welfare.
When the approval referred to in the preceding paragraph is obtained, the relevant two or more places for business are no longer deemed to be applicable places for business.
Article 35Time of Acquisition of Eligibility
第三十五条(資格取得の時期)
An insured person (excluding insured persons with optional and continued coverage; the same applies hereinafter from this Article through Article 38) obtains eligibility as an insured person from the day on which the person has become an employee of an applicable place of business, the day on which the place of business employing the person has become an applicable place of business, or the day on which the provisions of the proviso to Article 3, paragraph (1) are no longer applicable.
Article 36Time of Loss of Eligibility
第三十六条(資格喪失の時期)
An insured person loses eligibility as an insured person from the day immediately after the day on which the person falls under any of the following items (or the day on which the respective fact arises if the person also falls under the preceding Article):
the person dies;
死亡したとき。
the person is no longer employed at the place of business;
その事業所に使用されなくなったとき。
the person falls under the proviso to Article 3, paragraph (1); or
第三条第一項ただし書の規定に該当するに至ったとき。
authorization under Article 33, paragraph (1) is obtained.
第三十三条第一項の認可があったとき。
A request referred to in Article 3, paragraph (4) must be made within 20 days after the date on which eligibility as an insured person is lost; however, when finding a justifiable reason, the insurer may accept a request even after the day on which that period expires.
If the person who made a request referred to in Article 3, paragraph (4) fails to pay the first insurance premium by the due date, the person is deemed to not have become an insured person with optional and continued coverage, notwithstanding the provisions of the same paragraph; however, this does not apply if the insurer finds a justifiable reason for the delay in payment.
An insured person with optional and continued payment loses eligibility from the day immediately after the day on which the person fell under any of the following items (in the case any of the items (iv) through (vi) from the day on which the person fell under the item):
任意継続被保険者は、次の各号のいずれかに該当するに至った日の翌日(第四号から第六号までのいずれかに該当するに至ったときは、その日)から、その資格を喪失する。
two years have elapsed since the day on which the person became an insured person with optional and continued coverage;
任意継続被保険者となった日から起算して二年を経過したとき。
the person dies;
死亡したとき。
insurance premiums (excluding the first insurance premium) are not paid by the due date (excluding when the insurer finds a justifiable reason for the delay in payment);
保険料(初めて納付すべき保険料を除く。)を納付期日までに納付しなかったとき(納付の遅延について正当な理由があると保険者が認めたときを除く。)。
the person becomes an insured person;
被保険者となったとき。
the person becomes an insured person covered by Seamen's Insurance; or
船員保険の被保険者となったとき。
the person becomes a person with late-stage elderly medical care insurance.
後期高齢者医療の被保険者等となったとき。
the person has notified the insurer, pursuant to Order of the Ministry of Health, Labour and Welfare, of the person's wish to cease to be an insured person with optional and continued coverage, and the last day of the month that includes the day on which that notification was accepted arrives.
任意継続被保険者でなくなることを希望する旨を、厚生労働省令で定めるところにより、保険者に申し出た場合において、その申出が受理された日の属する月の末日が到来したとき。
Article 39Confirmation of Acquisition or Loss of Eligibility
第三十九条(資格の得喪の確認)
The acquisition or loss of eligibility as an insured person takes effect through confirmation by an insurer (meaning the Minister of Health, Labour and Welfare if the person is an insured person with optional and continued coverage under the health insurance program administered by JHIA; a health insurance society if the insured person is under the health insurance program administered by the health insurance society; or otherwise, the Minister of Health, Labour and Welfare; the same applies hereinafter excluding in Article 164, paragraphs (2) and (3), Article 180, paragraph (1), paragraph (2) and paragraph (4), and Article 181, paragraph (1)); however, this does not apply to the loss of eligibility as an insured person due to falling under Article 36, item (iv) or the acquisition or loss of eligibility as an insured person with optional continued coverage.
The confirmation referred to in the preceding paragraph is to be made by a notification pursuant to the provisions of Article 48, a request pursuant to the provisions of Article 51, paragraph (1), or sua sponte.
With regard to the confirmation referred to in paragraph (1), the provisions of Chapter III (excluding Articles 12 and 14) of the Administrative Procedure Act (Act No. 88 of 1993) do not apply.
第一項の確認については、行政手続法(平成五年法律第八十八号)第三章(第十二条及び第十四条を除く。)の規定は、適用しない。
Section 2 Standard Monthly Remuneration Amount and Standard Bonus
第二節 標準報酬月額及び標準賞与額
Article 40Standard Monthly Remuneration Amount
第四十条(標準報酬月額)
The standard monthly remuneration amount is determined based on the insured person's monthly remuneration amount according to the following grading (if the grading has been revised pursuant to the provisions of the following paragraph, the revised grading).
| Standard Monthly Remuneration Amount Grade | Standard monthly remuneration amount | Monthly remuneration amount |
| Level 1 | 58,000 yen | Less than 63,000 yen |
| Level 2 | 68,000 yen | 63,000 yen or more but less than 73,000 yen |
| Level 3 | 78,000 yen | 73,000 yen or more but less than 83,000 yen |
| Level 4 | 88,000 yen | 83,000 yen or more but less than 93,000 yen |
| Level 5 | 98,000 yen | 93,000 yen or more but less than 101,000 yen |
| Level 6 | 104,000 yen | 101,000 yen or more but less than 107,000 yen |
| Level 7 | 110,000 yen | 107,000 yen or more but less than 114,000 yen |
| Level 8 | 118,000 yen | 114,000 yen or more but less than 122,000 yen |
| Level 9 | 126,000 yen | 122,000 yen or more but less than 130,000 yen |
| Level 10 | 134,000 yen | 130,000 yen or more but less than 138,000 yen |
| Level 11 | 142,000 yen | 138,000 yen or more but less than 146,000 yen |
| Level 12 | 150,000 yen | 146,000 yen or more but less than 155,000 yen |
| Level 13 | 160,000 yen | 155,000 yen or more but less than 165,000 yen |
| Level 14 | 170,000 yen | 165,000 yen or more but less than 175,000 yen |
| Level 15 | 180,000 yen | 175,000 yen or more but less than 185,000 yen |
| Level 16 | 190,000 yen | 185,000 yen or more but less than 195,000 yen |
| Level 17 | 200,000 yen | 195,000 yen or more but less than 210,000 yen |
| Level 18 | 220,000 yen | 210,000 yen or more but less than 230,000 yen |
| Level 19 | 240,000 yen | 230,000 yen or more but less than 250,000 yen |
| Level 20 | 260,000 yen | 250,000 yen or more but less than 270,000 yen |
| Level 21 | 280,000 yen | 270,000 yen or more but less than 290,000 yen |
| Level 22 | 300,000 yen | 290,000 yen or more but less than 310,000 yen |
| Level 23 | 320,000 yen | 310,000 yen or more but less than 330,000 yen |
| Level 24 | 340,000 yen | 330,000 yen or more but less than 350,000 yen |
| Level 25 | 360,000 yen | 350,000 yen or more but less than 370,000 yen |
| Level 26 | 380,000 yen | 370,000 yen or more but less than 395,000 yen |
| Level 27 | 410,000 yen | 395,000 yen or more but less than 425,000 yen |
| Level 28 | 440,000 yen | 425,000 yen or more but less than 455,000 yen |
| Level 29 | 470,000 yen | 455,000 yen or more but less than 485,000 yen |
| Level 30 | 500,000 yen | 485,000 yen or more but less than 515,000 yen |
| Level 31 | 530,000 yen | 515,000 yen or more but less than 545,000 yen |
| Level 32 | 560,000 yen | 545,000 yen or more but less than 575,000 yen |
| Level 33 | 590,000 yen | 575,000 yen or more but less than 605,000 yen |
| Level 34 | 620,000 yen | 605,000 yen or more but less than 635,000 yen |
| Level 35 | 650,000 yen | 635,000 yen or more but less than 665,000 yen |
| Level 36 | 680,000 yen | 665,000 yen or more but less than 695,000 yen |
| Level 37 | 710,000 yen | 695,000 yen or more but less than 730,000 yen |
| Level 38 | 750,000 yen | 730,000 yen or more but less than 770,000 yen |
| Level 39 | 790,000 yen | 770,000 yen or more but less than 810,000 yen |
| Level 40 | 830,000 yen | 810,000 yen or more but less than 855,000 yen |
| Level 41 | 880,000 yen | 855,000 yen or more but less than 905,000 yen |
| Level 42 | 930,000 yen | 905,000 yen or more but less than 955,000 yen |
| Level 43 | 980,000 yen | 955,000 yen or more but less than 1,005,000 yen |
| Level 44 | 1,030,000 yen | 1,005,000 yen or more but less than 1,055,000 yen |
| Level 45 | 1,090,000 yen | 1,055,000 yen or more but less than 1,115,000 yen |
| Level 46 | 1,150,000 yen | 1,115,000 yen or more but less than 1,175,000 yen |
| Level 47 | 1,210,000 yen | 1,175,000 yen or more but less than 1,235,000 yen |
| Level 48 | 1,270,000 yen | 1,235,000 yen or more but less than 1,295,000 yen |
| Level 49 | 1,330,000 yen | 1,295,000 yen or more but less than 1,355,000 yen |
| Level 50 | 1,390,000 yen | 1,355,000 yen or more |
標準報酬月額は、被保険者の報酬月額に基づき、次の等級区分(次項の規定により等級区分の改定が行われたときは、改定後の等級区分)によって定める。
| 標準報酬月額等級 | 標準報酬月額 | 報酬月額 |
| 第一級 | 五八、〇〇〇円 | 六三、〇〇〇円未満 |
| 第二級 | 六八、〇〇〇円 | 六三、〇〇〇円以上七三、〇〇〇円未満 |
| 第三級 | 七八、〇〇〇円 | 七三、〇〇〇円以上八三、〇〇〇円未満 |
| 第四級 | 八八、〇〇〇円 | 八三、〇〇〇円以上九三、〇〇〇円未満 |
| 第五級 | 九八、〇〇〇円 | 九三、〇〇〇円以上一〇一、〇〇〇円未満 |
| 第六級 | 一〇四、〇〇〇円 | 一〇一、〇〇〇円以上一〇七、〇〇〇円未満 |
| 第七級 | 一一〇、〇〇〇円 | 一〇七、〇〇〇円以上一一四、〇〇〇円未満 |
| 第八級 | 一一八、〇〇〇円 | 一一四、〇〇〇円以上一二二、〇〇〇円未満 |
| 第九級 | 一二六、〇〇〇円 | 一二二、〇〇〇円以上一三〇、〇〇〇円未満 |
| 第一〇級 | 一三四、〇〇〇円 | 一三〇、〇〇〇円以上一三八、〇〇〇円未満 |
| 第一一級 | 一四二、〇〇〇円 | 一三八、〇〇〇円以上一四六、〇〇〇円未満 |
| 第一二級 | 一五〇、〇〇〇円 | 一四六、〇〇〇円以上一五五、〇〇〇円未満 |
| 第一三級 | 一六〇、〇〇〇円 | 一五五、〇〇〇円以上一六五、〇〇〇円未満 |
| 第一四級 | 一七〇、〇〇〇円 | 一六五、〇〇〇円以上一七五、〇〇〇円未満 |
| 第一五級 | 一八〇、〇〇〇円 | 一七五、〇〇〇円以上一八五、〇〇〇円未満 |
| 第一六級 | 一九〇、〇〇〇円 | 一八五、〇〇〇円以上一九五、〇〇〇円未満 |
| 第一七級 | 二〇〇、〇〇〇円 | 一九五、〇〇〇円以上二一〇、〇〇〇円未満 |
| 第一八級 | 二二〇、〇〇〇円 | 二一〇、〇〇〇円以上二三〇、〇〇〇円未満 |
| 第一九級 | 二四〇、〇〇〇円 | 二三〇、〇〇〇円以上二五〇、〇〇〇円未満 |
| 第二〇級 | 二六〇、〇〇〇円 | 二五〇、〇〇〇円以上二七〇、〇〇〇円未満 |
| 第二一級 | 二八〇、〇〇〇円 | 二七〇、〇〇〇円以上二九〇、〇〇〇円未満 |
| 第二二級 | 三〇〇、〇〇〇円 | 二九〇、〇〇〇円以上三一〇、〇〇〇円未満 |
| 第二三級 | 三二〇、〇〇〇円 | 三一〇、〇〇〇円以上三三〇、〇〇〇円未満 |
| 第二四級 | 三四〇、〇〇〇円 | 三三〇、〇〇〇円以上三五〇、〇〇〇円未満 |
| 第二五級 | 三六〇、〇〇〇円 | 三五〇、〇〇〇円以上三七〇、〇〇〇円未満 |
| 第二六級 | 三八〇、〇〇〇円 | 三七〇、〇〇〇円以上三九五、〇〇〇円未満 |
| 第二七級 | 四一〇、〇〇〇円 | 三九五、〇〇〇円以上四二五、〇〇〇円未満 |
| 第二八級 | 四四〇、〇〇〇円 | 四二五、〇〇〇円以上四五五、〇〇〇円未満 |
| 第二九級 | 四七〇、〇〇〇円 | 四五五、〇〇〇円以上四八五、〇〇〇円未満 |
| 第三〇級 | 五〇〇、〇〇〇円 | 四八五、〇〇〇円以上五一五、〇〇〇円未満 |
| 第三一級 | 五三〇、〇〇〇円 | 五一五、〇〇〇円以上五四五、〇〇〇円未満 |
| 第三二級 | 五六〇、〇〇〇円 | 五四五、〇〇〇円以上五七五、〇〇〇円未満 |
| 第三三級 | 五九〇、〇〇〇円 | 五七五、〇〇〇円以上六〇五、〇〇〇円未満 |
| 第三四級 | 六二〇、〇〇〇円 | 六〇五、〇〇〇円以上六三五、〇〇〇円未満 |
| 第三五級 | 六五〇、〇〇〇円 | 六三五、〇〇〇円以上六六五、〇〇〇円未満 |
| 第三六級 | 六八〇、〇〇〇円 | 六六五、〇〇〇円以上六九五、〇〇〇円未満 |
| 第三七級 | 七一〇、〇〇〇円 | 六九五、〇〇〇円以上七三〇、〇〇〇円未満 |
| 第三八級 | 七五〇、〇〇〇円 | 七三〇、〇〇〇円以上七七〇、〇〇〇円未満 |
| 第三九級 | 七九〇、〇〇〇円 | 七七〇、〇〇〇円以上八一〇、〇〇〇円未満 |
| 第四〇級 | 八三〇、〇〇〇円 | 八一〇、〇〇〇円以上八五五、〇〇〇円未満 |
| 第四一級 | 八八〇、〇〇〇円 | 八五五、〇〇〇円以上九〇五、〇〇〇円未満 |
| 第四二級 | 九三〇、〇〇〇円 | 九〇五、〇〇〇円以上九五五、〇〇〇円未満 |
| 第四三級 | 九八〇、〇〇〇円 | 九五五、〇〇〇円以上一、〇〇五、〇〇〇円未満 |
| 第四四級 | 一、〇三〇、〇〇〇円 | 一、〇〇五、〇〇〇円以上一、〇五五、〇〇〇円未満 |
| 第四五級 | 一、〇九〇、〇〇〇円 | 一、〇五五、〇〇〇円以上一、一一五、〇〇〇円未満 |
| 第四六級 | 一、一五〇、〇〇〇円 | 一、一一五、〇〇〇円以上一、一七五、〇〇〇円未満 |
| 第四七級 | 一、二一〇、〇〇〇円 | 一、一七五、〇〇〇円以上一、二三五、〇〇〇円未満 |
| 第四八級 | 一、二七〇、〇〇〇円 | 一、二三五、〇〇〇円以上一、二九五、〇〇〇円未満 |
| 第四九級 | 一、三三〇、〇〇〇円 | 一、二九五、〇〇〇円以上一、三五五、〇〇〇円未満 |
| 第五〇級 | 一、三九〇、〇〇〇円 | 一、三五五、〇〇〇円以上 |
If the ratio of the number of insured persons with the highest grade of standard monthly remuneration amount to the total number of insured persons on March 31 in a year exceeds 0.015 and that status is found to continue, the grading of the standard monthly remuneration amount may be revised by adding another grade to that highest grade by Cabinet Order from September 1 in the same year; provided, however, that the ratio of the number of insured persons with the highest grade of the revised standard monthly remuneration amount to the total number of insured persons must not be less than 0.005 on March 31 in the same year.
毎年三月三十一日における標準報酬月額等級の最高等級に該当する被保険者数の被保険者総数に占める割合が百分の一・五を超える場合において、その状態が継続すると認められるときは、その年の九月一日から、政令で、当該最高等級の上に更に等級を加える標準報酬月額の等級区分の改定を行うことができる。ただし、その年の三月三十一日において、改定後の標準報酬月額等級の最高等級に該当する被保険者数の同日における被保険者総数に占める割合が百分の〇・五を下回ってはならない。
When planning the establishment or amendment of Cabinet Order referred to in the preceding paragraph, the Minister of Health, Labour and Welfare is to hear the opinions of the Social Security Council.
厚生労働大臣は、前項の政令の制定又は改正について立案を行う場合には、社会保障審議会の意見を聴くものとする。
第四十一条(定時決定)
An insurer determines the standard monthly remuneration amount based on the monthly remuneration amount which is obtained by dividing the total amount of remuneration received by the insured person at the place of business at which the person is employed as of July 1 each year for the preceding three-month period (limited to a period of consecutive employment at the place of business, and excluding any month in which the number of days based on which remuneration is paid is less than 17 days (11 days for persons specified by Order of the Ministry of Health, Labour and Welfare; the same applies in Article 43, paragraph (1), Article 43-2, paragraph (1) and Article 43-3, paragraph (1))) by the number of months in that period.
保険者等は、被保険者が毎年七月一日現に使用される事業所において同日前三月間(その事業所で継続して使用された期間に限るものとし、かつ、報酬支払の基礎となった日数が十七日(厚生労働省令で定める者にあっては、十一日。第四十三条第一項、第四十三条の二第一項及び第四十三条の三第一項において同じ。)未満である月があるときは、その月を除く。)に受けた報酬の総額をその期間の月数で除して得た額を報酬月額として、標準報酬月額を決定する。
A standard monthly remuneration amount determined pursuant to the provisions of the preceding paragraph is the standard monthly remuneration amount of each month from September in the relevant year until August in the following year.
前項の規定によって決定された標準報酬月額は、その年の九月から翌年の八月までの各月の標準報酬月額とする。
Regarding persons who obtained eligibility as an insured person during the period between June 1 and July 1 or insured persons whose standard monthly remuneration amount has been or is to be revised in any month from July through September pursuant to the provisions of Articles 43, 43-2 or 43-3, the provisions of paragraph (1) do not apply during that year.
Article 42Determination upon Acquisition of Eligibility as an Insured Person
第四十二条(被保険者の資格を取得した際の決定)
When a person who obtains eligibility as an insured person, the insurer determines the standard monthly remuneration amount with the amounts listed below as the monthly remuneration amount:
if the wages are determined on the basis of a monthly, weekly or other fixed period, the amount equivalent to thirty times the amount obtained by dividing the amount of the remuneration as of the day on which eligibility as an insured person is obtained by the total number of days in that period;
if the remuneration is determined on the basis of working days or hours, or in accordance with a piece rate or other contract price, the average of the amounts of remuneration received by persons engaged in similar work at the place of business for one month preceding the month in which eligibility as an insured person is obtained and who receive similar remuneration;
if it is difficult to calculate pursuant to the provisions of the preceding two items, the amount of remuneration received by a person engaged in similar work in the region for one month preceding the month in which eligibility as an insured person is obtained and who receives similar remuneration; or
in the case of receiving remuneration corresponding to two or more of the preceding three items, the total sum of the amounts calculated for each pursuant to the provisions of the preceding three items.
A standard monthly remuneration amount determined pursuant to the provisions of the preceding paragraph is the standard monthly remuneration amount of each month since the day on which the person obtained eligibility as an insured person until August in that year (August in the following year if the person obtained eligibility as an insured person between July 1 to December 31).
第四十三条(改定)
If the amount obtained by dividing the total amount of remuneration received for three consecutive months at the place of business employing an insured person (in each month, the number of days based on which remuneration is paid must be no less than 17 days) by three is significantly higher or lower than the person's monthly remuneration that is the basis of the standard monthly remuneration amount and the insurer finds it necessary, the insurer may revise the standard monthly remuneration amount by setting the first-mentioned amount as the monthly remuneration amount starting from the month following the months in which the monthly remuneration amount was significantly high or low.
A standard monthly remuneration amount revised pursuant to the provisions of the preceding paragraph is the standard monthly remuneration amount for each month until August in that year (until August in the following year for a revision in any month from July to December).
前項の規定によって改定された標準報酬月額は、その年の八月(七月から十二月までのいずれかの月から改定されたものについては、翌年の八月)までの各月の標準報酬月額とする。
Article 43-2Amount Revised When Childcare Leave Ends
第四十三条の二(育児休業等を終了した際の改定)
If childcare leave prescribed in Article 2, item (i) of the Act on the Welfare of Workers Taking Child Care or Family Care Leave to Care for Children or Other Family Members (Act No. 76 of 1991), leave through a measure equivalent to the system for childcare leave prescribed in Article 23, paragraph (2) of the same Act or a measure taken in the same manner as the system for childcare leave prescribed in item (ii) of the same paragraph pursuant to the provisions of Article 24, paragraph (1) of the same Act, or childcare leave based on laws and regulations specified by Cabinet Order (hereinafter referred to as "childcare leave") taken by an insured person ends and the person is taking care of a child less than three years of age to which the childcare leave pertains on the last day of the childcare leave (referred to as "last day of childcare leave" hereinafter in this Article) after submitting a request to the insurer via the employer of the place of business employing the person as specified by Order of the Ministry of Health, Labour and Welfare, the standard monthly remuneration amount is revised by setting the amount obtained by dividing the total amount of remuneration received for the three months beginning with the month which includes the day following the last day of childcare leave (limited to a period of consecutive employment at the place of business employing the person on the day following the last day of childcare leave; and excluding any month in which the number of days based on which remuneration is paid is less than 17 days) by the number of months in that period as the monthly remuneration amount, notwithstanding the provisions of Article 41; provided, however, that this does not apply to an insured person who commences the maternity leave prescribed in paragraph (1) of the following Article on the day following the last day of childcare leave.
保険者等は、育児休業、介護休業等育児又は家族介護を行う労働者の福祉に関する法律(平成三年法律第七十六号)第二条第一号に規定する育児休業、同法第二十三条第二項の育児休業に関する制度に準ずる措置若しくは同法第二十四条第一項(第二号に係る部分に限る。)の規定により同項第二号に規定する育児休業に関する制度に準じて講ずる措置による休業又は政令で定める法令に基づく育児休業(以下「育児休業等」という。)を終了した被保険者が、当該育児休業等を終了した日(以下この条において「育児休業等終了日」という。)において当該育児休業等に係る三歳に満たない子を養育する場合において、その使用される事業所の事業主を経由して厚生労働省令で定めるところにより保険者等に申出をしたときは、第四十一条の規定にかかわらず、育児休業等終了日の翌日が属する月以後三月間(育児休業等終了日の翌日において使用される事業所で継続して使用された期間に限るものとし、かつ、報酬支払の基礎となった日数が十七日未満である月があるときは、その月を除く。)に受けた報酬の総額をその期間の月数で除して得た額を報酬月額として、標準報酬月額を改定する。ただし、育児休業等終了日の翌日に次条第一項に規定する産前産後休業を開始している被保険者は、この限りでない。
A standard monthly remuneration amount revised pursuant to the provisions of the preceding paragraph is the standard monthly remuneration amount for each month since the month following the month which includes the day on which two years have elapsed since the day following the last day of childcare leave until August in that year (August in the following year if that following month is any of September to December).
Article 43-3Amount Revised after End of Maternity Leave
第四十三条の三(産前産後休業を終了した際の改定)
If maternity leave (meaning not engaging in labor for the period from 42 days (98 days in the case of multiple fetuses) before the day of childbirth (the due date of childbirth if the day of childbirth is after the due date of childbirth) to 56 days after the day of childbirth (limited to not engaging in labor for reasons relating to pregnancy or childbirth); hereinafter the same applies) taken by an insured person ends and the person is taking care of a child to which the maternity leave pertains on the last day of the maternity leave (referred to as "last day of maternity leave" hereinafter in this Article) after submitting a request to the insurer via the employer of the place of business employing the person as specified by Order of the Ministry of Health, Labour and Welfare, the standard monthly remuneration amount is revised by setting the amount obtained by dividing the total amount of remuneration received for the three months beginning with the month which includes the day following the last day of maternity leave (limited to a period of consecutive employment at the place of business employing the person on the day following the last day of maternity leave; and excluding any month in which the number of days based on which remuneration is paid is less than 17 days) by the number of months in that period as the monthly remuneration amount, notwithstanding the provisions of Article 41; provided, however, that this does not apply to an insured person who commences childcare leave on the day following the last day of maternity leave.
保険者等は、産前産後休業(出産の日(出産の日が出産の予定日後であるときは、出産の予定日)以前四十二日(多胎妊娠の場合においては、九十八日)から出産の日後五十六日までの間において労務に服さないこと(妊娠又は出産に関する事由を理由として労務に服さない場合に限る。)をいう。以下同じ。)を終了した被保険者が、当該産前産後休業を終了した日(以下この条において「産前産後休業終了日」という。)において当該産前産後休業に係る子を養育する場合において、その使用される事業所の事業主を経由して厚生労働省令で定めるところにより保険者等に申出をしたときは、第四十一条の規定にかかわらず、産前産後休業終了日の翌日が属する月以後三月間(産前産後休業終了日の翌日において使用される事業所で継続して使用された期間に限るものとし、かつ、報酬支払の基礎となった日数が十七日未満である月があるときは、その月を除く。)に受けた報酬の総額をその期間の月数で除して得た額を報酬月額として、標準報酬月額を改定する。ただし、産前産後休業終了日の翌日に育児休業等を開始している被保険者は、この限りでない。
A standard monthly remuneration amount revised pursuant to the provisions of the preceding paragraph is the standard monthly remuneration amount for each month since the month following the month which includes the day on which two years have elapsed since the day following the last day of maternity leave until August in that year (August in the following year if that following month is any of September to December).
Article 44Special Provisions for Calculation of Monthly Remuneration
第四十四条(報酬月額の算定の特例)
If it is difficult to calculate an insured person's monthly remuneration amount pursuant to the provisions of Article 41, paragraph (1), Article 42, paragraph (1), Article 43-2, paragraph (1) or paragraph (1) of the preceding Article, or if the amount calculated pursuant to the provisions of Article 41, paragraph (1), Article 42, paragraph (1), Article 43, paragraph (1), Article 43-2, paragraph (1) or paragraph (1) of the preceding Article is found to be significantly unjustifiable, notwithstanding these provisions, the insured person's monthly remuneration amount is an amount determined by the insurer.
In the case of the preceding paragraph, if the insurer is a health insurance society, the calculation method in the same paragraph must be specified by the constitution.
In calculating the monthly remuneration amount for an insured person who receives remuneration at two or more places of business at the same time, the total sum of the amounts calculated pursuant to the provisions of Article 41, paragraph (1), Article 42, paragraph (1), Article 43, paragraph (1), Article 43-2, paragraph (1), or paragraph (1) of the preceding Article or paragraph (1) is the person's monthly remuneration amount.
Article 45Determination of the Amount of Standard Bonus
第四十五条(標準賞与額の決定)
An insurer determines the standard bonus amount in a month based on the amount of bonus received by the insured in the month in which the person received the bonus by rounding the amount down to the nearest 1,000 yen; provided, however, that if the cumulative amount of standard bonus during that fiscal year (from April 1 to the following March 31; the same applies hereinafter) exceeds 5,730,000 yen (an amount specified by Cabinet Order if the standard monthly remuneration amount grading has been revised pursuant to the provisions of Article 40, paragraph (2); the same applies in this paragraph) due to the bonus received by the insured person in that month, the standard bonus amount for the month is determined so that the cumulative amount is 5,730,000 yen and the standard amount of bonus received after the following month in the fiscal year is zero.
保険者等は、被保険者が賞与を受けた月において、その月に当該被保険者が受けた賞与額に基づき、これに千円未満の端数を生じたときは、これを切り捨てて、その月における標準賞与額を決定する。ただし、その月に当該被保険者が受けた賞与によりその年度(毎年四月一日から翌年三月三十一日までをいう。以下同じ。)における標準賞与額の累計額が五百七十三万円(第四十条第二項の規定による標準報酬月額の等級区分の改定が行われたときは、政令で定める額。以下この項において同じ。)を超えることとなる場合には、当該累計額が五百七十三万円となるようその月の標準賞与額を決定し、その年度においてその月の翌月以降に受ける賞与の標準賞与額は零とする。
The provisions of Article 40, paragraph (3) apply mutatis mutandis to the establishment or amendment of Cabinet Order referred to in the preceding paragraph and the provisions of the preceding Article apply mutatis mutandis to the calculation of the amount of standard bonus.
Article 46Value of Allowance in Kind
第四十六条(現物給与の価額)
When all or part of remuneration or bonus should be paid other than in currency, the amount is specified by the Minister of Health, Labour and Welfare based on the local market price.
A health insurance society may establish different standards in its constitution notwithstanding the provisions of the preceding paragraph.
健康保険組合は、前項の規定にかかわらず、規約で別段の定めをすることができる。
第四十七条(任意継続被保険者の標準報酬月額)
Notwithstanding the provisions of Articles 41 through 44, with respect to the standard monthly remuneration amount of an insured person with optional and continued coverage, the smaller amount between the amounts listed in the following items is the person's standard monthly remuneration amount:
任意継続被保険者の標準報酬月額については、第四十一条から第四十四条までの規定にかかわらず、次の各号に掲げる額のうちいずれか少ない額をもって、その者の標準報酬月額とする。
the standard monthly remuneration amount to be paid when the insured person with optional and continued coverage has lost eligibility as an insured person; or
the standard monthly remuneration amount calculated when the average standard monthly remuneration amount of all insured persons administered by the insurer (if the health insurance association has any amount specified in its constitution within the range of the average amount, that amount) that provided insurance to the insured person with optional and continued coverage on September 30 in the preceding year (for the standard monthly remuneration amount from January to March, the year prior to the preceding year) is deemed to be the monthly remuneration amount that is the basis of the standard monthly remuneration amount.
In the case where the insurer is a health insurance society, notwithstanding the provisions of the preceding paragraph, with respect to an insured person with optional and continued coverage for whom the amount listed in item (i) of that paragraph exceeds the amount listed in item (ii) of that paragraph, the health insurance society may, as provided in its constitution, make the amount listed in item (i) of that paragraph (if the health insurance society has an amount that its constitution specifies within the range exceeding the amount listed in item (ii) of that paragraph and less than the amount listed in item (i) of that paragraph, the standard monthly remuneration amount calculated when the amount so specified in its constitution is deemed to be the monthly remuneration amount that is the basis of the standard monthly remuneration amount) the person's standard monthly remuneration amount.
Section 3 Notification
第三節 届出等
第四十八条(届出)
The employer of an applicable place of business must notify the insurer of particulars relating to the acquisition and loss of eligibility as an insured person as well as the monthly remuneration amount and bonus amount pursuant to Order of the Ministry of Health, Labour and Welfare.
第四十九条(通知)
When the Minister of Health, Labour and Welfare gives authorization pursuant to the provisions of Article 33, paragraph (1), the Minister must notify the employer to that effect, and the insurer, upon performing confirmation pursuant to Article 39, paragraph (1), or determining or revising the standard remuneration amount (meaning the standard monthly remuneration amount and standard monthly bonus amount; the same applies hereinafter), must notify the employer to that effect.
When a notice referred to in the preceding paragraph is given, the employer must promptly notify the person who is or was insured.
When an insured person loses eligibility as an insured person and a notice referred to in the preceding paragraph cannot be given since the whereabouts of the person are unknown, the employer must notify the Minister of Health, Labour and Welfare and the insurer to that effect.
When the notification referred to in the preceding paragraph is given, the Minister of Health, Labour and Welfare and the insurer must give public notice of the matters stated in the notification given to the employer pursuant to the provisions of paragraph (1) about the person whose whereabouts are unknown.
If the Minister of Health, Labour and Welfare and the insurer fail to give a notice referred to in paragraph (1) due to abolishment of the place of business or other unavoidable circumstances, they must make a public notice of the matters to be notified in lieu of the notice referred to in paragraph (1).
第五十条
When a notification is given pursuant to the provisions of Article 48, if no fact pertaining the notice is found, the insurer must give notify to that effect the employer who gave the notification.
The provisions of paragraphs (2) through (5) of the preceding Article apply mutatis mutandis to the notice referred to the preceding paragraph.
前条第二項から第五項までの規定は、前項の通知について準用する。
Article 51Request for Confirmation
第五十一条(確認の請求)
A person who is or was an insured person may at any time demand confirmation pursuant to the provisions of Article 39, paragraph (1).
When an insurer receives a request referred to in the provisions of the preceding paragraph, the insurer must dismiss the request if no fact pertaining to it is found.
Article 51-2Provision of Information
第五十一条の二(情報の提供等)
The Minister of Health, Labour and Welfare provides information to JHIA on matters concerning the eligibility of insured persons and standard remuneration, and necessary information concerning the provision of JHIA's services, pursuant to Order of the Ministry of Health, Labour and Welfare.
Article 51-3Delivery, etc. of Documents Necessary for Confirming Eligibility as an Insured Person
第五十一条の三(被保険者の資格の確認に必要な書面の交付等)
When an insured person or the insured person's dependent is in a situation where the insured person or dependent cannot undergo electronic eligibility confirmation, the insured person may, pursuant to Order of the Ministry of Health, Labour and Welfare, request the insurer to deliver a document stating the matters specified by Order of the Ministry of Health, Labour and Welfare as information relating to the eligibility of the insured person or the insured person's dependent who is in that situation, or to provide those matters by electronic or magnetic means (meaning a method using an electronic data processing system or another method using information and communications technology that is specified by Order of the Ministry of Health, Labour and Welfare; the same applies hereinafter in this Article). In this case, the insurer is, pursuant to Order of the Ministry of Health, Labour and Welfare, to promptly deliver the document to the insured person who has made the request for delivery of the document, and to provide the matters by electronic or magnetic means to the insured person who has made the request for provision by electronic or magnetic means.
被保険者又はその被扶養者が電子資格確認を受けることができない状況にあるときは、当該被保険者は、厚生労働省令で定めるところにより、保険者に対し、当該状況にある被保険者若しくはその被扶養者の資格に係る情報として厚生労働省令で定める事項を記載した書面の交付又は当該事項の電磁的方法(電子情報処理組織を使用する方法その他の情報通信の技術を利用する方法であって厚生労働省令で定めるものをいう。以下この条において同じ。)による提供を求めることができる。この場合において、当該保険者は、厚生労働省令で定めるところにより、速やかに、当該書面の交付の求めを行った被保険者に対しては当該書面を交付するものとし、当該電磁的方法による提供の求めを行った被保険者に対しては当該事項を電磁的方法により提供するものとする。
An insured person or the insured person's dependent who has received the document referred to in the preceding paragraph pursuant to the provisions of that paragraph, or who has been provided by electronic or magnetic means with the matters specified by Order of the Ministry of Health, Labour and Welfare referred to in that paragraph, may receive the confirmation referred to in Article 63, paragraph (3) (including as applied mutatis mutandis pursuant to Article 110, paragraph (7)), Article 85, paragraph (1), Article 85-2, paragraph (1), Article 86, paragraph (1), or Article 88, paragraph (3) (including as applied mutatis mutandis pursuant to Article 111, paragraph (3)) by presenting the document, or a display of those matters made by a method specified by Order of the Ministry of Health, Labour and Welfare.