①When a dependent of an insured person receives medical treatment from a medical institution providing services covered by health insurance that is selected by the dependent, dependent's medical expenses are paid to the insured person for expenses required for the medical treatment.

②The amount of dependent medical expenses is the amount specified in item (i) below (the aggregate of that amount and the amount specified in item (ii) or (iii) if the medical treatment includes dietary treatment or living support, respectively):

③The amount of expenses for medical treatment referred to in item (i) of the preceding paragraph is calculated pursuant to the provisions of Article 76, paragraph (2) when medical treatment (excluding evaluation treatment, patient-requested treatment, and selective treatment) is received from a medical institution providing services covered by health insurance, and the provisions of Article 86, paragraph (2), item (i) when evaluation treatment, patient-requested treatment or selective treatment is received from a medical institution providing services covered by health insurance, the amount of expenses for dietary treatment for inpatients referred to in item (ii) of the preceding paragraph is calculated pursuant to the provisions of Article 85, paragraph (2), and the amount of expenses for living support for inpatients referred to in item (iii) of the preceding paragraph is calculated pursuant to the provisions of Article 85-2, paragraph (2).

④When a dependent receives medical treatment at or from a hospital, clinic or pharmacy listed in Article 63, paragraph (3), item (i) or (ii), the insurer may, on behalf of the relevant insured person, pay to the hospital, clinic or pharmacy expenses incurred for the medical treatment payable by the dependent to the hospital, clinic or pharmacy within the limit of the amount payable to the insured person as expenses for dependent's medical treatment.

⑤When a payment pursuant to the provisions of the preceding paragraph is made, it is deemed that dependent's medical expenses are paid to the insured person.

⑥When a dependent receives medical treatment from a hospital, clinic, or pharmacy listed in Article 63, paragraph (3), item (iii), and the insurer exempts the insured person from payment of an amount equivalent to the amount to be paid as dependent's medical expenses among the expenses required for medical treatment to be paid by the dependent, it is deemed that dependent's medical expenses are paid to the insured person.

⑦The provisions of Article 63, Article 64, Article 70, paragraph (1), Article 72, paragraph (1), Article 73, Article 76, paragraphs (3) through (6), Article 78, Article 84, paragraph (1), Article 85, paragraph (8), Article 87, and Article 98 apply mutatis mutandis to the payment of dependent's medical expenses and to dependent's medical treatment.

⑧The provisions of Article 75 apply mutatis mutandis to payment of the amount calculated by deducting, from the amount of expenses calculated for the relevant medical treatment pursuant to the provisions of paragraph (3) in the case referred to in paragraph (4) (when the amount exceeds the amount of expenses actually incurred in the medical treatment, the amount of expenses actually incurred), the amount payable as dependent's medical expenses with respect to expenses incurred in the medical treatment.

①With 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.

②With 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.

①When 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.

②The 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).

③The 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.

①When 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.

②The provisions of Article 97, paragraphs (2) and Article 98 apply mutatis mutandis to the payment of dependent's transport expenses.

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.

When a dependent of an insured person gives birth, an amount specified by Cabinet Order referred to in Article 101 is paid to the insured person as lump-sum allowance for dependent's childbirth and childcare.

①When 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.

②The 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.

①When 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.

②The 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.

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.

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.

①Insurance 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):

②An 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.

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.

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.

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.

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".