Chapter V Special Provisions Concerning Specially-Insured Day Laborers
第五章 日雇特例被保険者に関する特例
Section 1 Insurer Providing Insurance for Specially-Insured Day Laborers
第一節 日雇特例被保険者の保険の保険者
第百二十三条
The insurer providing insurance for specially-insured day laborers is JHIA.
Of the services imposed on insurers providing insurance for specially-insured day laborers, the issuance of an insurance book for a specifically insured day laborer, collection of insurance premiums pertaining to a specially-insured day laborer and collection of day laborer contributions, as well as services incidental to these are covered by the Minister of Health, Labour and Welfare.
日雇特例被保険者の保険の保険者の業務のうち、日雇特例被保険者手帳の交付、日雇特例被保険者に係る保険料の徴収及び日雇拠出金の徴収並びにこれらに附帯する業務は、厚生労働大臣が行う。
Section 2 Standard Daily Wages
第二節 標準賃金日額等
Article 124Daily Amount of Standard Wages
第百二十四条(標準賃金日額)
The standard daily wage amount is based on the relevant insured person's daily wage amount according to the following grading (if the grading has been revised pursuant to the provisions of the following paragraph, the revised grading).
| Standard Daily Wage Grade | Standard daily wages | Daily Amount of Wages |
| Level 1 | 3,000 yen | Less than 3,500 yen |
| Level 2 | 4,400 yen | Not less than 3,500 yen but less than 5,000 yen |
| Level 3 | 5,750 yen | Not less than 5,000 yen but less than 6,500 yen |
| Level 4 | 7,250 yen | Not less than 6,500 yen but less than 8,000 yen |
| Level 5 | 8,750 yen | Not less than 8,000 yen but less than 9,500 yen |
| Level 6 | 10,750 yen | Not less than 9,500 yen but less than 12,000 yen |
| Level 7 | 13,250 yen | Not less than 12,000 yen but less than 14,500 yen |
| Level 8 | 15,750 yen | Not less than 14,500 yen but less than 17,000 yen |
| Level 9 | 18,250 yen | Not less than 17,000 yen but less than 19,500 yen |
| Level 10 | 21,250 yen | Not less than 19,500 yen but less than 23,000 yen |
| Level 11 | 24,750 yen | Not less than 23,000 yen |
標準賃金日額は、日雇特例被保険者の賃金日額に基づき、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)による。
| 標準賃金日額等級 | 標準賃金日額 | 賃金日額 |
| 第一級 | 三、〇〇〇円 | 三、五〇〇円未満 |
| 第二級 | 四、四〇〇円 | 三、五〇〇円以上五、〇〇〇円未満 |
| 第三級 | 五、七五〇円 | 五、〇〇〇円以上六、五〇〇円未満 |
| 第四級 | 七、二五〇円 | 六、五〇〇円以上八、〇〇〇円未満 |
| 第五級 | 八、七五〇円 | 八、〇〇〇円以上九、五〇〇円未満 |
| 第六級 | 一〇、七五〇円 | 九、五〇〇円以上一二、〇〇〇円未満 |
| 第七級 | 一三、二五〇円 | 一二、〇〇〇円以上一四、五〇〇円未満 |
| 第八級 | 一五、七五〇円 | 一四、五〇〇円以上一七、〇〇〇円未満 |
| 第九級 | 一八、二五〇円 | 一七、〇〇〇円以上一九、五〇〇円未満 |
| 第一〇級 | 二一、二五〇円 | 一九、五〇〇円以上二三、〇〇〇円未満 |
| 第一一級 | 二四、七五〇円 | 二三、〇〇〇円以上 |
If the ratio of the total number of days of payment of insurance premiums pertaining to the standard daily wage amount corresponding to the highest grade of standard daily wage amount to the total number of days of payment of insurance premiums pertaining to specially-insured day laborers in one fiscal year exceeds 0.03, and it is found that the status will continue, the grading of standard daily wage amount may be revised by adding another grade above the highest grade from September 1 in the following fiscal year by Cabinet Order; however, the ratio of the total number of days of payment of insurance premiums pertaining to the standard daily wage amount corresponding to the highest grade of standard daily wage amount to the total number of days of payment of insurance premiums pertaining to specially-insured day laborers in that fiscal year must not fall below 0.01.
一の年度における標準賃金日額等級の最高等級に対応する標準賃金日額に係る保険料の延べ納付日数の当該年度における日雇特例被保険者に関する保険料の総延べ納付日数に占める割合が百分の三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、翌年度の九月一日から、政令で、当該最高等級の上に更に等級を加える標準賃金日額の等級区分の改定を行うことができる。ただし、当該一の年度において、改定後の標準賃金日額等級の最高等級に対応する標準賃金日額に係る保険料の延べ納付日数の日雇特例被保険者に関する保険料の総延べ納付日数に占める割合が百分の一を下回ってはならない。
The provisions of Article 40, paragraph (3) apply mutatis mutandis to the establishment or amendment of Cabinet Order referred to in the preceding paragraph.
Article 125Daily Amount of Wages
第百二十五条(賃金日額)
The daily amount of wages is calculated pursuant to the following items:
賃金日額は、次の各号によって算定する。
if the wages are determined on the basis of working days or hours, or daily output, or it is otherwise possible to calculate the daily wages for a specially-insured day laborer, the determined or calculated amount;
if the wages are determined in accordance with total output over a period of two days or more, or it is otherwise not possible to calculate the daily wages for a specially-insured day laborer (excluding cases that fall under the following item), the average amount of daily wages received on the preceding day (if no person received a similar wage for engaging in similar work on the preceding day, the most recent day on which any person does so) by persons who engaged in similar work at the same place of business and receive similar wages;
if the amount of wages is based on a period of two days or more, the amount obtained by dividing that amount by the number of days in the period concerned (30 days if the period is one month);
賃金が二日以上の期間によって定められる場合には、その額をその期間の総日数(月の場合は、一月を三十日として計算する。)で除して得た額
if it is not possible to calculate pursuant to the provisions of the preceding three items, the amount of a wages received by persons who engaged in similar work and receive similar wages in a day in that region;
if the relevant person receives wages corresponding to two or more of each of the preceding items, the total sum of the amounts calculated for each of the wages in accordance with the preceding items; and
if the person is employed at two or more places of business in a day, the amount calculated pursuant to the preceding items for wages paid from the first place of business employing the person.
In the case of the preceding paragraph, with regard to a wage to be paid other than in currency, the amount is specified by the Minister of Health, Labour and Welfare based on the local market price.
Article 126Specially-Insured Day Laborer's Insurance Book
第百二十六条(日雇特例被保険者手帳)
A day worker who becomes a specially-insured day laborer must request the Minister of Health, Labour and Welfare to issue a specially-insured day laborer's insurance book within five days since the day on which the person becomes a specially-insured day laborer; however, this does not apply if the person already has a specially-insured day laborer's insurance book issued that contains a blank space for stamps for proof of health insurance.
When the Minister of Health, Labour, and Welfare receives a request referred to in the preceding paragraph, the Minister must issue a specially-insured day laborer's insurance book.
厚生労働大臣は、前項の申請があったときは、日雇特例被保険者手帳を交付しなければならない。
A person who has received a specially-insured day laborer's insurance book must return it to the Minister of Health, Labour and Welfare if it has become obvious that the person is unlikely to become a specially-insured day laborer within the period during which a blank space for stamps for proof of health insurance remains in the insurance book, or receives approved pursuant to the proviso to Article 3, paragraph (2).
The form, issuance and return of and other necessary matters concerning an specifically insured day laborer's insurance book are specified by Order of the Ministry of Health, Labour and Welfare.
日雇特例被保険者手帳の様式、交付及び返納その他日雇特例被保険者手帳に関して必要な事項は、厚生労働省令で定める。
Section 3 Insurance Benefits Pertaining to Specially-Insured Day Laborers
第三節 日雇特例被保険者に係る保険給付
Article 127Types of Insurance Benefits
第百二十七条(保険給付の種類)
Insurance benefits pursuant to this Act pertaining to specially-insured day laborers (including former specially-insured day laborers; the same applies hereinafter in this Section) are as follows:
日雇特例被保険者(日雇特例被保険者であった者を含む。以下この節において同じ。)に係るこの法律による保険給付は、次のとおりとする。
benefits for medical treatment, as well as payment of dietary treatment expenses for inpatients, living support expenses for inpatients, medical expenses combined with treatment outside insurance coverage, medical expenses, medical expenses for home-nursing, and transport expenses;
療養の給付並びに入院時食事療養費、入院時生活療養費、保険外併用療養費、療養費、訪問看護療養費及び移送費の支給
payment of injury and sickness allowance;
傷病手当金の支給
payment of burial charges;
埋葬料の支給
payment of lump-sum allowance for childbirth and childcare;
出産育児一時金の支給
payment of childbirth allowance;
出産手当金の支給
payment of dependent's medical expenses, dependent's medical expenses for home-nursing, and dependent's transport expenses;
家族療養費、家族訪問看護療養費及び家族移送費の支給
payment of dependent's burial charges;
家族埋葬料の支給
lump-sum allowance for dependent's childbirth and childcare;
家族出産育児一時金の支給
payment of special medical expenses; and
特別療養費の支給
payment of high-cost medical expenses and expenses for high-cost medical treatment combined with long-term care.
高額療養費及び高額介護合算療養費の支給
Article 128Coordination with Benefits by Medical Insurance
第百二十八条(他の医療保険による給付等との調整)
Benefits for medical treatment, or dietary treatment expenses for inpatients, living support expenses for inpatients, medical expenses combined with treatment outside insurance coverage, medical expenses, medical expenses for home-nursing, transport expenses, injury and sickness allowance, burial charges, lump-sum allowance for childbirth and childcare, or childbirth allowance, pertaining to a specially-insured day laborer, are not paid if the specially-insured day laborer may receive payment equivalent to these for the same sickness, injury, death or childbirth pursuant to the provisions of the preceding Chapter, medical insurance laws other than this Act (excluding the National Health Insurance Act; the same applies hereinafter in this Article), the laws and regulations prescribed in Article 55, paragraph (1), or the Long-Term Care Insurance Act.
When the JHIA finds it necessary for the payment of injury and sickness allowance pertaining to specially-insured day laborers, it may request persons who provide benefits pursuant to the provisions of the Industrial Accident Compensation Insurance Act, the National Public Officers' Accident Compensation Act, or the Local Public Officers Accident Compensation Act or a Prefectural or Municipal Ordinance based on that Act to provide necessary materials about the status of payment of those benefits.
協会は、日雇特例被保険者に係る傷病手当金の支給を行うにつき必要があると認めるときは、労働者災害補償保険法、国家公務員災害補償法又は地方公務員災害補償法若しくは同法に基づく条例の規定により給付を行う者に対し、当該給付の支給状況につき、必要な資料の提供を求めることができる。
Benefits for medical treatment, or 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, transport expenses, burial charges, or lump-sum allowance for childbirth and childcare, pertaining to a specially-insured day laborer, are not paid, to that extent, if the relevant person has received a benefit equivalent to payment of dependent's medical expenses (including medical expenses paid pursuant to the provisions of Article 132 as applied mutatis mutandis to Article 140, paragraph (2)), dependent's medical expenses for home-nursing, dependent's transport expenses, dependent's burial charges, or lump-sum allowance for dependent's childbirth and childcare for the same sickness, injury, death or childbirth pursuant to the provisions of the preceding Chapter or the provisions of medical insurance laws other than this Act.
Dependent's medical expenses, dependent's medical expenses for home-nursing, dependent's transport expenses, dependent's burial charges, or dependent's lump-sum allowance for childbirth and childcare, pertaining to a specially-insured day laborer, are not paid if the relevant person may receive a benefit equivalent to payment of those expenses or allowances, or benefits for medical treatment, dietary treatment expenses for inpatients, living support expenses for inpatients, medical expenses combined with treatment outside insurance coverage, medical expenses, medical expenses for home-nursing, transport expenses, burial charges, or lump-sum allowance for childbirth and childcare under this Chapter for the same sickness, injury, death or childbirth pursuant to the provisions of the preceding Chapter, medical insurance laws other than this act, or the Long-Term Care Insurance Act.
日雇特例被保険者に係る家族療養費、家族訪問看護療養費、家族移送費、家族埋葬料又は家族出産育児一時金の支給は、同一の疾病、負傷、死亡又は出産について、前章の規定若しくはこの法律以外の医療保険各法の規定又は介護保険法の規定によりこれらに相当する給付又はこの章の規定による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、移送費、埋葬料若しくは出産育児一時金の支給に相当する給付を受けることができる場合には、行わない。
Special medical expenses (including medical expenses paid pursuant to the provisions of Article 132 as applied mutatis mutandis to Article 145, paragraph (6)) are not paid if the relevant person may receive benefits equivalent to benefits for medical treatment, dietary treatment expenses for inpatients, living support expenses 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 under this Chapter for the same sickness or injury pursuant to the provisions of the preceding Chapter, the provisions of medical insurance laws other than this Act, the laws and regulations prescribed in Article 55, paragraph (1), or the Long-Term Care Insurance Act.
Benefits for medical treatment, or 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, transport expenses, dependent's medical expenses, dependent's medical expenses for home-nursing, dependent's transport expenses, or special medical expenses, pertaining to a specially-insured day laborer, are not made to that extent if the specially-insured day laborer received medical treatment or medical expenses for the same sickness or injury borne by the national government or a local government pursuant to the provisions of other Acts.
日雇特例被保険者に係る療養の給付又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、移送費、家族療養費、家族訪問看護療養費、家族移送費若しくは特別療養費の支給は、同一の疾病又は負傷について、他の法令の規定により国又は地方公共団体の負担で療養又は療養費の支給を受けたときは、その限度において、行わない。
Article 129Benefits for Medical Treatment
第百二十九条(療養の給付)
With regard to sickness and injury of a specially-insured day laborer, benefits for medical treatment listed in each item of Article 63, paragraph (1) are paid.
To receive benefits for medical treatment, a specially-insured day laborer must fall under any of the following items on the day on which the benefits are received; provided, however, that in the case of item (ii), benefits for medical treatment are not provided for sickness or injury for which a benefit for medical treatment was provided under item (i) or any sickness or injury caused thereby:
insurance premiums have been paid for the specially-insured day laborer for 26 days or more in total in the two months preceding the month including the day on which the benefits are received or for 78 days or more in total in the six months preceding the month including that day; or
当該日の属する月の前二月間に通算して二十六日分以上又は当該日の属する月の前六月間に通算して七十八日分以上の保険料が、その日雇特例被保険者について、納付されていること。
one year (five years with regard to the sicknesses designated by the Minister of Health, Labour and Welfare) has not passed since the date of commencement of the benefit for medical treatment received for the relevant sickness or injury (including those that caused the sickness or injury; the same applies hereinafter in this paragraph) pursuant to the preceding item (if special medical expenses (including medical expenses paid pursuant to the provisions of Article 132 applied mutatis mutandis to Article 145, paragraph (6); the same applies hereinafter in this item), expenses for in-home long-term care services pursuant to the provisions of the Long-Term Care Insurance Act (limited to expenses for services equivalent to designated in-home services; the same applies hereinafter in this item, Article 135, paragraph (4), and Article 145, paragraph (1)), expenses for special in-home long-term care services (limited to expenses for services equivalent to in-home services or services equivalent thereto; the same applies hereinafter in Article 135, paragraph (4), and Article 145, paragraph (1)), expenses for community-based long-term care services (limited to expenses for services equivalent to designated community-based services; the same applies hereinafter in this Article, Article 135, paragraph (4), and Article 145, paragraph (1)), expenses for special community-based long-term care services (limited to the payment pertaining to services equivalent to community-based services or pertaining to services equivalent thereto; the same applies hereinafter in this item, Article 135, paragraph (4), and Article 145, paragraph (1)), expenses for long-term care facility services (limited to expenses for services equivalent to designated facility services; the same applies hereinafter in this item, Article 135, paragraph (4), and Article 145, paragraph (1)), expenses for special long-term care facility services (limited to expenses for services equivalent to facility services; the same applies hereinafter in this item, Article 135, paragraph (4), and Article 145, paragraph (1)), expenses for services to prevent long-term care (limited to expenses for services equivalent to designated services to prevent long-term care; the same applies hereinafter in this item, Article 135, paragraph (4), and Article 145, paragraph (1)), or expenses for special services to prevent long-term care (limited to expenses for services equivalent to services to prevent long-term care or services equivalent thereto; the same applies in this paragraph, Article 135, paragraph (4), and Article 145, paragraph (1)) were paid for the relevant sickness or injury before that date of commencement, the date of commencement of payment of special medical expenses, or 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, expenses for special long-term care facility services, 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) (excluding cases that fall under the preceding item);
前号に該当することにより当該疾病(その原因となった疾病又は負傷を含む。以下この項において同じ。)又は負傷につき受けた療養の給付の開始の日(その開始の日前に当該疾病又は負傷につき特別療養費(第百四十五条第六項において準用する第百三十二条の規定により支給される療養費を含む。以下この号において同じ。)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(その支給のうち療養に相当する指定居宅サービスに係るものに限る。以下この号、第百三十五条第四項及び第百四十五条第一項において同じ。)、特例居宅介護サービス費の支給(その支給のうち療養に相当する居宅サービス又はこれに相当するサービスに係るものに限る。以下この号、第百三十五条第四項及び第百四十五条第一項において同じ。)、地域密着型介護サービス費の支給(その支給のうち療養に相当する指定地域密着型サービスに係るものに限る。以下この号、第百三十五条第四項及び第百四十五条第一項において同じ。)、特例地域密着型介護サービス費の支給(その支給のうち療養に相当する地域密着型サービス又はこれに相当するサービスに係るものに限る。以下この号、第百三十五条第四項及び第百四十五条第一項において同じ。)、施設介護サービス費の支給(その支給のうち療養に相当する指定施設サービス等に係るものに限る。以下この号、第百三十五条第四項及び第百四十五条第一項において同じ。)、特例施設介護サービス費の支給(その支給のうち療養に相当する施設サービスに係るものに限る。以下この号、第百三十五条第四項及び第百四十五条第一項において同じ。)、介護予防サービス費の支給(その支給のうち療養に相当する指定介護予防サービスに係るものに限る。以下この号、第百三十五条第四項及び第百四十五条第一項において同じ。)若しくは特例介護予防サービス費の支給(その支給のうち療養に相当する介護予防サービス又はこれに相当するサービスに係るものに限る。以下この号、第百三十五条第四項及び第百四十五条第一項において同じ。)が行われたときは、特別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の開始の日)から一年(厚生労働大臣が指定する疾病に関しては、五年)を経過していないこと(前号に該当する場合を除く。)。
When a specially-insured day laborer proves that the laborer falls under item (i) of the preceding Article with a specially-insured day laborer's insurance book and applies, the insurer must issue a qualified recipient card which shows confirmation of the proof or add the confirmation to a qualified recipient card which has already been issued.
When intending to receive benefits for medical treatment listed in each item of Article 63, paragraph (1), a specially-insured day laborer is to select a hospital, clinic, or pharmacy from those listed in paragraph (3), item (i) or (ii) of the same Article, submit the laborer's qualified recipient card thereto, and receive the benefits therefrom.
The qualified recipient card referred to in the preceding paragraph must have been confirmed pursuant to the provisions of paragraph (3) and thereby prove that the recipient requirements for sickness and injury prescribed in paragraph (2) are met.
The form of a qualified recipient card, the confirmation pursuant to the provisions of paragraph (3), and other necessary matters concerning a qualified recipient card are specified by Order of the Ministry of Health, Labour and Welfare.
受給資格者票の様式、第三項の規定による確認その他受給資格者票に関して必要な事項は、厚生労働省令で定める。
Article 130Dietary Treatment Expenses for Inpatients
第百三十条(入院時食事療養費)
When a specially-insured day laborer (excluding a person who receives medical treatment consisting of hospitalization in a sanatorium ward and care and other nursing incidental to that medical treatment after the month which contains the person's 65th birthday (hereinafter referred to as a "specially-insured day laborer receiving specified long-term hospitalization")) submits the laborer's qualified recipient card to a hospital or clinic which the laborer selected from those listed in Article 63, paragraph (3), item (i) or (ii) and receives dietary treatment along with benefits for medical treatment listed in paragraph (1), item (v) of the same Article from the hospital or clinic, dietary treatment expenses for inpatients pertaining to the dietary treatment are paid.
Article 130-2Living Support Expenses for Inpatients
第百三十条の二(入院時生活療養費)
When a specially-insured day laborer receiving specified long-term and hospitalization submits the laborer's qualified recipient card to a hospital or clinic which the laborer selected from those listed in Article 63, paragraph (3), item (i) or (ii) and receives living support along with benefits for medical treatment listed in paragraph (1), item (v) of the same Article from the hospital or clinic, living support expenses for inpatients pertaining to the living support are paid.
特定長期入院日雇特例被保険者が第六十三条第三項第一号又は第二号に掲げる病院又は診療所のうち自己の選定するものに受給資格者票を提出して、そのものから同条第一項第五号に掲げる療養の給付と併せて受けた生活療養に要した費用について、入院時生活療養費を支給する。
When a specially insured day laborer submits the laborer's qualified recipient card and receives evaluation treatment, patient-requested treatment, or selective treatment from a hospital, clinic, or pharmacy that the laborer selected from those listed in Article 63, paragraph (3), item (i) or (ii), medical expenses combined with treatment outside insurance coverage are paid for expenses required for that treatment.
第百三十二条(療養費)
When an insurer finds it difficult to pay benefits for medical treatment or expenses for dietary treatment for inpatients, living support expenses for inpatients, or medical expenses combined with treatment outside insurance coverage (hereinafter referred to as a "benefits for medical treatment, etc." in this paragraph) or finds it unavoidable in cases where a specially-insured day laborer has received any medical care, medication or treatment from a hospital, clinic, pharmacy or other person not listed in Article 63, paragraph (3), items (i) and (ii), it may pay medical expenses in lieu of benefits for medical treatment, etc.
保険者は、療養の給付若しくは入院時食事療養費、入院時生活療養費若しくは保険外併用療養費の支給(以下この項において「療養の給付等」という。)を行うことが困難であると認めるとき、又は日雇特例被保険者が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以外の病院、診療所、薬局その他の者から診療、薬剤の支給若しくは手当を受けた場合において、保険者がやむを得ないものと認めるときは、療養の給付等に代えて、療養費を支給することができる。
The provisions of the preceding paragraph apply when a specially-insured day laborer receives medical care or medication from a hospital, clinic or pharmacy listed in Article 63, paragraph (3), item (i) or (ii) without the confirmation prescribed in Article 129, paragraph (3) and the insurer finds that the lack of confirmation was due to urgent and unavoidable reasons.
日雇特例被保険者が、第百二十九条第三項に規定する確認を受けないで、第六十三条第三項第一号又は第二号に掲げる病院若しくは診療所又は薬局から診療又は薬剤の支給を受けた場合において、保険者が、その確認を受けなかったことを緊急やむを得ない理由によるものと認めるときも、前項と同様とする。
Article 133Medical Expenses for Home-Nursing
第百三十三条(訪問看護療養費)
When a specially-insured day laborer submits the laborer's qualified recipient card to a designated home-nursing provider selected by the laborer, and receives designated home-nursing from the provider, with regard to expenses incurred in the designated home-nursing, medical expenses for home-nursing are paid.
The provisions of Article 129, paragraphs (2) and (5) apply mutatis mutandis to the payment of medical expenses for home-nursing.
第百三十四条(移送費)
When a specially-insured day laborer has been transported to a hospital or clinic in order to receive medical treatment (including medical treatment covered by medical expenses combined with treatment outside insurance coverage or by special medical expenses), an amount calculated pursuant to Order of the Ministry of Health, Labour and Welfare referred to in Article 97, paragraph (1) as transport expenses.
Article 135Injury and Sickness Allowance
第百三十五条(傷病手当金)
When a specially-insured day laborer receives benefits for medical treatment (including benefits in the form of medical expenses combined with treatment outside insurance coverage, medical expenses, and medical expenses for home nursing, as well as in-home long-term care service expenses, special in-home long-term care service expenses, community-based long-term care service expenses, special community-based long-term care service expenses, long-term care facility service expenses, exceptional allowance for long-term care facility services, expenses for services to prevent long-term care, and exceptional allowance for services to prevent long-term care, pursuant to the provisions of the Long-Term Care Insurance Act (limited to those equivalent to medical treatment pertaining to in-home services or equivalent services, community-based services or equivalent services, facility services, or services to prevent long-term care or equivalent services), paid to persons who have a qualified recipient card referred to in Article 129, paragraph (3) (limited to cards falling under the provisions of paragraph (5) of the same Article); the same applies in the following paragraph and following Article) and is unable to engage in labor due to the medical treatment (including in-home services and services equivalent thereto, facility services, and long-term care preventive services equivalent to medical care, and services equivalent thereto), the injury and sickness allowance is paid for the period during which the specially-insured day laborer is unable to engage in work, starting from the day on which three days elapsed after the day on which the laborer became unable to engage in work.
日雇特例被保険者が療養の給付(保険外併用療養費、療養費及び訪問看護療養費の支給並びに介護保険法の規定による居宅介護サービス費、特例居宅介護サービス費、地域密着型介護サービス費、特例地域密着型介護サービス費、施設介護サービス費、特例施設介護サービス費、介護予防サービス費及び特例介護予防サービス費の支給(これらの支給のうち療養に相当する居宅サービス若しくはこれに相当するサービス、地域密着型サービス若しくはこれに相当するサービス、施設サービス又は介護予防サービス若しくはこれに相当するサービスに係るものに限る。)であって、第百二十九条第三項の受給資格者票(同条第五項の規定に該当するものに限る。)を有する者に対して行われるものを含む。次項及び次条において同じ。)を受けている場合において、その療養(居宅サービス及びこれに相当するサービス並びに施設サービス並びに介護予防サービス及びこれに相当するサービスのうち、療養に相当するものを含む。)のため労務に服することができないときは、その労務に服することができなくなった日から起算して三日を経過した日から労務に服することができない期間、傷病手当金を支給する。
The amount of sickness and injury allowance per day is an amount prescribed in the following items, in accordance with the classifications in the following items; provided, however, that if both items are applicable, the larger of the amounts is paid:
傷病手当金の額は、次の各号に掲げる場合の区分に応じ、一日につき、当該各号に定める金額とする。ただし、次の各号のいずれにも該当するときは、いずれか高い金額とする。
with respect to the relevant specially-insured day laborer, insurance premiums had been paid for 26 days or more in the two months before the month including the day on which the laborer received the relevant benefit for medical treatment for the first time:an amount equivalent to 1/45th of the largest of the monthly total of the laborer's standard daily wages pertaining the days for which insurance premiums were paid in the period; or
当該日雇特例被保険者について、その者が初めて当該療養の給付を受けた日の属する月の前二月間に通算して二十六日分以上の保険料が納付されている場合 当該期間において保険料が納付された日に係るその者の標準賃金日額の各月ごとの合算額のうち最大のものの四十五分の一に相当する金額
with respect to the specially-insured day laborer, insurance premiums had been paid for 78 days or more in the six months before the month including the day on which the laborer received the benefit for medical treatment for the first time:an amount equivalent to 1/45th of the largest of the monthly total of the laborer's standard daily wages pertaining to the days for which insurance premiums were paid in the period.
当該日雇特例被保険者について、その者が初めて当該療養の給付を受けた日の属する月の前六月間に通算して七十八日分以上の保険料が納付されている場合 当該期間において保険料が納付された日に係るその者の標準賃金日額の各月ごとの合算額のうち最大のものの四十五分の一に相当する金額
The payment period for injury and sickness allowance pertaining to a specially-insured day laborer is not to exceed six months (one year and six months for sickness and injury designated by the Minister of Health, Labour and Welfare) from the day on which the payment started, with regard to the same sickness and injury as well as any sickness and injury caused thereby.
日雇特例被保険者に係る傷病手当金の支給期間は、同一の疾病又は負傷及びこれにより発した疾病に関しては、その支給を始めた日から起算して六月(厚生労働大臣が指定する疾病に関しては、一年六月)を超えないものとする。
If a specially-insured day laborer is, with regard to sickness or injury, unable to receive all of the benefits for medical treatment or all of the payment of medical expenses combined with treatment outside insurance coverage, medical expenses, or medical expenses for home nursing pursuant to the provisions of Article 128, or unable to receive all of the payment, pursuant to Article 20 of the Long-Term Care Insurance Act, 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 facility care services, expenses for special long-term care facility services, expenses for services to prevent long-term care, or expenses for special services to prevent long-term care pursuant to the provisions of that Act (limited to payment made to those who have a qualified recipient card under Article 129, paragraph (3) (limited to cards falling under paragraph (5) of the same Article); the same applies hereinafter in this paragraph), then benefits for medical treatment or payment for medical expenses combined with treatment outside insurance coverage, medical expenses, or medical expenses for home nursing, and relevant benefits equivalent to payment of expenses for in-home long-term care services, payment of expenses for special in-home long-term care services, payment of community-based long-term care services, payment of expenses for special community-based long-term care services, payment of long-term care facility service expenses, payment of expenses for special long-term care facility services, payment of expenses for services to prevent long-term care, or payment of expenses for special services to prevent long-term care, pursuant to the provisions of the Long-Term Care Insurance Act, as well as payment of expenses for the relevant medical treatment and other medical treatment are deemed to be benefits for medical treatment or payment of medical expenses combined with treatment outside insurance coverage, medical expenses, or medical expenses for home nursing pursuant to the provisions of this Chapter, or payment of expenses for in-home long-term care services, payment of expenses for special in-home long-term care services, payment of expenses for community-based long-term care services, payment of expenses for special community-based long-term care services, payment of expenses for long-term care services, payment of expenses for special long-term care facility services, payment of expenses for services to prevent long-term care, or payment of expenses for special services to prevent long-term care, pursuant to the provisions of the Long-Term Care Insurance Act, and the provisions of paragraphs (1) and (2) apply.
日雇特例被保険者が、その疾病又は負傷について、第百二十八条の規定により療養の給付若しくは保険外併用療養費、療養費若しくは訪問看護療養費の支給の全部を受けることができない場合又は介護保険法第二十条の規定により同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(これらの給付のうち第百二十九条第三項の受給資格者票(同条第五項の規定に該当するものに限る。)を有する者に対して行われるものに限る。以下この項において同じ。)の全部を受けることができない場合においては、療養の給付若しくは保険外併用療養費、療養費若しくは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に相当する当該給付又は当該療養若しくは療養費の支給をこの章の規定による療養の給付若しくは保険外併用療養費、療養費若しくは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とみなして、第一項及び第二項の規定を適用する。
第百三十六条(埋葬料)
When a specially-insured day laborer dies, insurance premiums had been paid for the laborer for 26 days or more in total in the two months preceding the month including the day of death or for 78 days or more in total in the six months preceding that month, and the laborer received benefits for medical treatment, or payment of medical expenses combined with treatment outside insurance coverage, medical expenses, or medical expenses for home nursing at the time of death, or the death was within three days since the day of loss of benefits for medical treatment, or payment of medical expenses combined with treatment outside insurance coverage, medical expenses, or medical expenses for home nursing, the amount of burial charges specified by Cabinet Order referred to in Article 100, paragraph (1) is paid to the person whose livelihood depends on the income of the laborer and who arranged the burial.
If there is no one to receive burial charges pursuant to the provisions of the preceding paragraph, an amount equivalent to the expenses required for the burial within the range of amount of burial charges referred to in the preceding paragraph is paid to the person who arranged the burial.
Article 137Lump-sum Allowance for Childbirth and Childcare
第百三十七条(出産育児一時金)
When a specially-insured day laborer gives birth and insurance premiums have been paid for the laborer for 26 days or more in total during the two months preceding the month including the day of childbirth, an amount specified by Cabinet Order referred to in Article 101 is paid as a lump-sum allowance for childbirth and childcare.
Article 138Childbirth Allowance
第百三十八条(出産手当金)
Childbirth allowance is paid to a specially-insured day laborer eligible for payment of lump-sum allowance for childbirth and childcare in the period during which the laborer does not engage in labor, starting 42 days (98 days in the case of multiple fetuses) preceding the day of childbirth (the scheduled date of childbirth if the day of childbirth is after the scheduled date of childbirth) and ending 56 days following the day of childbirth.
出産育児一時金の支給を受けることができる日雇特例被保険者には、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かった期間、出産手当金を支給する。
The amount of childbirth allowance per day is an amount equivalent to 1/45th of the largest of the monthly total of the specially-insured laborer's standard daily wages pertaining to the days for which insurance premiums were paid in the four months preceding the month including the day of childbirth.
出産手当金の額は、一日につき、出産の日の属する月の前四月間の保険料が納付された日に係る当該日雇特例被保険者の標準賃金日額の各月ごとの合算額のうち最大のものの四十五分の一に相当する金額とする。
Article 139Coordination of Childbirth Allowance with Injury and Sickness Allowance
第百三十九条(出産手当金と傷病手当金との調整)
Injury and sickness allowance is not paid to a specially-insured day laborer during the period in which the laborer receives childbirth allowance; provided, however, that if the amount of injury and sickness allowance exceeds the amount of childbirth allowance, this does not apply to the amount in excess.
日雇特例被保険者に対し出産手当金を支給する場合においては、その期間、その者に対し、傷病手当金は、支給しない。ただし、傷病手当金の額が出産手当金の額を超えるときは、その超える部分については、この限りでない。
Article 140Dependent's Medical Expenses
第百四十条(家族療養費)
When a dependent of an insured person submits the dependent's qualified recipient card to a hospital, clinic, or pharmacy that the dependent selected from those listed in Article 63, paragraph (3), item (i) or (ii) and receives evaluation treatment, patient-requested treatment, or selective treatment from that hospital, clinic, or pharmacy, dependent's medical expenses are paid to the specially-insured day laborer for the expenses required for the treatment.
日雇特例被保険者の被扶養者が受給資格者票を第六十三条第三項第一号又は第二号に掲げる病院若しくは診療所又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は、日雇特例被保険者に対し、その療養に要した費用について、家族療養費を支給する。
The provisions of Article 129, paragraphs (2), (4) and (5) as well as Article 132 apply mutatis mutandis to the payment of dependent's medical expenses.
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) or (2) as applied mutatis mutandis pursuant to the preceding paragraph.
Article 141Dependent Medical's Expenses for Home-Nursing
第百四十一条(家族訪問看護療養費)
When a dependent of a specially-insured day laborer submits the dependent's qualified recipient card to a designated home-nursing provider selected by the dependent, and receives designated home-nursing from the provider, with regard to expenses incurred in the designated home-nursing, dependent's medical expenses for home-nursing are paid to the specially-insured day laborer.
The provisions of Article 129, paragraphs (2) and (5) apply mutatis mutandis to the payment of dependent's medical expenses for home-nursing.
Article 142Dependent's Transport Expenses
第百四十二条(家族移送費)
When a dependent of a specially-insured day laborer is transported to a hospital or clinic in order to receive medical treatment to which expenses for dependent's medical treatment pertain (including medical treatment covered by special medical expenses), an amount calculated pursuant to Order of the Ministry of Health, Labour and Welfare referred to in Article 97, paragraph (1) is paid, as dependent's transport expenses, to the specially-insured day laborer.
Article 143Dependent's Burial Charges
第百四十三条(家族埋葬料)
When a dependent of a specially-insured day laborer dies, dependent's burial charges are paid to the specially-insured day laborer.
In order for a specially-insured day laborer to receive dependent's burial charges, insurance premiums must have been paid for the specially-insured day laborer for 26 days or more in total during the two months preceding the month including the day of death or for 78 days or more in total during the six months preceding that month.
日雇特例被保険者が家族埋葬料の支給を受けるには、死亡の日の属する月の前二月間に通算して二十六日分以上又は当該月の前六月間に通算して七十八日分以上の保険料が、その日雇特例被保険者について、納付されていなければならない。
The amount of dependent's burial charges is an amount specified by Cabinet Order referred to in Article 113.
家族埋葬料の額は、第百十三条の政令で定める金額とする。
When a dependent of a specially-insured day laborer gives birth to a child, lump-sum allowance for dependent's childbirth and childcare is paid to the specially-insured day laborer.
In order for a specially-insured day laborer to receive lump-sum allowance for dependent's childbirth and childcare, insurance premiums must have been paid for the specially-insured day laborer for 26 days or more in total in the two months preceding the month including the day of childbirth or for 78 days or more in total in the six months preceding that month.
日雇特例被保険者が家族出産育児一時金の支給を受けるには、出産の日の属する月の前二月間に通算して二十六日分以上又は当該月の前六月間に通算して七十八日分以上の保険料が、その日雇特例被保険者について、納付されていなければならない。
The amount of lump-sum allowance for dependent's childbirth and childcare is the amount specified by Cabinet Order referred to in Article 101.
家族出産育児一時金の額は、第百一条の政令で定める金額とする。
Article 145Special Medical Expenses
第百四十五条(特別療養費)
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。
第百四十六条
Special medical expenses for a specially-insured day laborer who received approval pursuant to the proviso to Article 3, paragraph (2) are not paid from the day on which the laborer becomes no longer a specially-insured day laborer, and special medical expenses for a specially-insured day laborer who returns the relevant specially-insured day laborer's insurance book pursuant to the provisions of Article 126, paragraph (3) are not paid from the day following the day on which that insurance book was returned.
Article 147High-Cost Medical Expenses
第百四十七条(高額療養費)
When the amount of co-payment made in relation to the payment of 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), 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, dependent's medical expenses for home-nursing, or special medical expenses (in the following Article referred to as the "amount of co-payment pertaining to specially-insured day laborer") pertaining to a specially-insured day laborer is extremely large, high-cost medical expenses are paid to the specially-insured day laborer who received benefits for that medical treatment, or the payment of the 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, or special medical expenses.
When the amount of co-payment, etc. pertaining to a specially-insured day laborer (when high-cost medical expenses referred to in the preceding Article are paid, the amount obtained by deducting an amount equivalent to the amount so paid from the amount of co-payment, etc.) or the sum of the amount to be borne by a user of a long-term care service pursuant to the provisions of Article 51, paragraph (1) of the Long-Term Care Insurance Act (when 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 pursuant to the provisions of Article 61, paragraph (1) of the same Act (when expenses for high-cost preventive 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 preventive long-term care service) is extremely large, expenses for high-cost medical treatment combined with long-term care are paid to the specially-insured day laborer who received benefits for medical treatment pertaining to the amount of the co-payment, or payment of medical expenses combined with treatment outside insurance coverage, medical expenses, medical expenses for home-nursing, dependent's medical expenses, dependent's medical expenses for home-nursing, or special medical expenses.
日雇特例被保険者に係る一部負担金等の額(前条の高額療養費が支給される場合にあっては、当該支給額に相当する額を控除して得た額)並びに介護保険法第五十一条第一項に規定する介護サービス利用者負担額(同項の高額介護サービス費が支給される場合にあっては、当該支給額を控除して得た額)及び同法第六十一条第一項に規定する介護予防サービス利用者負担額(同項の高額介護予防サービス費が支給される場合にあっては、当該支給額を控除して得た額)の合計額が著しく高額であるときは、当該一部負担金等の額に係る療養の給付又は保険外併用療養費、療養費、訪問看護療養費、家族療養費、家族訪問看護療養費若しくは特別療養費の支給を受けた日雇特例被保険者に対し、高額介護合算療養費を支給する。
第百四十八条(受給方法)
A person who intends to receive payment of dietary treatment expenses for inpatients, living support expenses for inpatients, medical expenses combined with treatment outside insurance coverage, medical expenses, medical expenses for home-nursing, transport expenses, injury and sickness allowance, burial charges, lump-sum allowance for childbirth and childcare, childbirth allowance, dependent's medical expenses, dependent's medical expenses for home-nursing, dependent's transport expenses, dependent's burial charges, lump-sum allowance for dependent's childbirth and childcare, or special medical expenses pertaining to a specially-insured day laborer must submit an application for the payment with a specially-insured day laborer's insurance book, qualified recipient card, or other documents that prove that the person meets the recipient requirements pursuant to Order of the Ministry of Health, Labour and Welfare.
日雇特例被保険者に係る入院時食事療養費、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、移送費、傷病手当金、埋葬料、出産育児一時金、出産手当金、家族療養費、家族訪問看護療養費、家族移送費、家族埋葬料、家族出産育児一時金又は特別療養費の支給を受けようとする者は、厚生労働省令で定めるところにより、受給要件を備えることを証明できる日雇特例被保険者手帳又は受給資格者票及びその他の書類を添えて、申請しなければならない。
Article 149Application Mutatis Mutandis
第百四十九条(準用)
The provisions listed in the left-hand column of the following table apply mutatis mutandis to affairs pertaining to the specially-insured day laborers listed in the right-hand column of the same table.
| Articles 56 through 62 | Insurance benefits |
| Article 63, paragraph (2), Article 64, Article 70, paragraph (1), Article 72, paragraph (1), Article 73, Article 76, paragraphs (3) through (6), Article 78, and Article 84, paragraph (1) | Benefits for medical treatment, as well as payment of Dietary Treatment expenses for inpatients, living support expenses for inpatients, medical expenses combined with treatment outside insurance coverage, dependent medical expenses and special medical expenses |
| Articles 74, 75 and 75-2, Article 76, paragraphs (1) and (2), as well as Article 84, paragraph (2) | Benefits for Medical Treatment |
| Article 77 | Benefits of Medical Treatment and Payment of Medical Expenses Combined with Treatment Outside Insurance Coverage |
| Article 85, paragraphs (2) and (4) | Payment of Dietary Treatment Expenses for Inpatients |
| Article 85, paragraphs (5) and (6) | Payment of dietary treatment expenses for inpatients, living support expenses for inpatients, and medical expenses combined with treatment outside insurance coverage |
| Article 85, paragraph (8) | Payment of Dietary Treatment expenses for inpatients, living support expenses for inpatients, medical expenses combined with treatment outside insurance coverage, dependent medical expenses and special medical expenses |
| Article 85-2, paragraphs (2) and (4) | Payment of Living Support Expenses for Inpatients |
| Article 86, paragraphs (2) and (5) | Payment of Medical Expenses Combined with Treatment Outside Insurance Coverage |
| Article 87, paragraphs (2) and (3) | Payment of medical expenses |
| Article 88, paragraphs (2), (3), (6) through (11) and (13), Article 90, paragraph (1), Article 91, Article 92, paragraphs (2) and (3), as well as Article 94 | payment of medical expenses for home-nursing, dependent medical expenses for home-nursing, and special medical expenses |
| Article 88, paragraphs (4) and (12) | Payment of Medical Expenses for Home-Nursing |
| Article 97, paragraph (2) | Payment of transport expenses and dependent transport expenses |
| Article 103, paragraph (2), Article 108 paragraphs (1) through (3) and (5), as well as Article 109 | Payment of injury and sickness allowance and childbirth allowance |
| Article 110, paragraph (2) | Payment of dependent medical expenses |
| Article 110, paragraphs (3) through (5) and (8), as well as Article 110-2 | Payment of dependent medical expenses and special medical expenses |
| Article 111, paragraph (2) | Payment of Dependent Medical Expenses for Home-Nursing |
| Article 115, paragraph (2) | Payment of High-Cost Medical Expenses and Expenses for High-Cost Benefits for Medical Treatment Combined with Long-Term Care |
| Articles 116 through 121 | Specially-insured day laborer or a dependent thereof |
次の表の上欄に掲げる規定は、それぞれ同表の下欄に掲げる日雇特例被保険者に係る事項について準用する。
| 第五十六条から第六十二条まで | 保険給付 |
| 第六十三条第二項、第六十四条、第七十条第一項、第七十二条第一項、第七十三条、第七十六条第三項から第六項まで、第七十八条及び第八十四条第一項 | 療養の給付並びに入院時食事療養費、入院時生活療養費、保険外併用療養費、家族療養費及び特別療養費の支給 |
| 第七十四条、第七十五条、第七十五条の二、第七十六条第一項及び第二項並びに第八十四条第二項 | 療養の給付 |
| 第七十七条 | 療養の給付及び保険外併用療養費の支給 |
| 第八十五条第二項及び第四項 | 入院時食事療養費の支給 |
| 第八十五条第五項及び第六項 | 入院時食事療養費、入院時生活療養費及び保険外併用療養費の支給 |
| 第八十五条第八項 | 入院時食事療養費、入院時生活療養費、保険外併用療養費、家族療養費及び特別療養費の支給 |
| 第八十五条の二第二項及び第四項 | 入院時生活療養費の支給 |
| 第八十六条第二項及び第五項 | 保険外併用療養費の支給 |
| 第八十七条第二項及び第三項 | 療養費の支給 |
| 第八十八条第二項、第六項から第十一項まで及び第十三項、第九十条第一項、第九十一条、第九十二条第二項及び第三項並びに第九十四条 | 訪問看護療養費、家族訪問看護療養費及び特別療養費の支給 |
| 第八十八条第四項及び第十二項 | 訪問看護療養費の支給 |
| 第九十七条第二項 | 移送費及び家族移送費の支給 |
| 第百三条第二項、第百八条第一項から第三項まで及び第五項並びに第百九条 | 傷病手当金及び出産手当金の支給 |
| 第百十条第二項 | 家族療養費の支給 |
| 第百十条第三項から第五項まで及び第八項並びに第百十条の二 | 家族療養費及び特別療養費の支給 |
| 第百十一条第二項 | 家族訪問看護療養費の支給 |
| 第百十五条第二項 | 高額療養費及び高額介護合算療養費の支給 |
| 第百十六条から第百二十一条まで | 日雇特例被保険者又はその被扶養者 |