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Section 6 Limitation of Insurance Benefits (Articles 63 to 68)
The law as Act Partially Amending the Social Welfare Act, etc. (Act No. 51 of 2026) leaves it, with the words it changes marked.
The main text is read a page at a time: a chapter to a page, and a long chapter in runs of articles. The whole main text, and the supplementary provisions and appended tables this amendment changes. Those it leaves untouched are on the page for the text in force.
With regard to a person that is confined to penal institution, work facility, or other facility mutatis mutandis as these, a Long-Term Care Benefit, etc., pertaining to said period of confinement is not paid.
刑事施設、労役場その他これらに準ずる施設に拘禁された者については、その期間に係る介護給付等は、行わない。
With regard to the Condition of Need for Long-Term Care, etc., of an Insured Person that caused the accident that caused a Condition of Need for Long-Term Care, etc., or the cause of said condition, or who increased the degree of Condition of Need for Long-Term Care, etc., by not obeying instructions for the use of Service Covered by Long-Term Care Benefits, etc., or for a Home Modification pertaining to an Allowance for Home Modification for In-Home Long-Term Care or Allowance for Preventive Long-Term Care Home Modification due to an intentional criminal act or gross negligence or without justifiable reasons, a Municipality may not pay the whole or a part of a Long-Term Care Benefit, etc., for which the reason for payment is said Condition of Need for Long-Term Care, etc.
市町村は、自己の故意の犯罪行為若しくは重大な過失により、又は正当な理由なしに介護給付等対象サービスの利用若しくは居宅介護住宅改修費若しくは介護予防住宅改修費に係る住宅改修の実施に関する指示に従わないことにより、要介護状態等若しくはその原因となった事故を生じさせ、又は要介護状態等の程度を増進させた被保険者の当該要介護状態等については、これを支給事由とする介護給付等は、その全部又は一部を行わないことができる。
A Municipality, when a person that receives a Long-Term Care Benefit, etc., fails to respond to a request pursuant to the provisions of Article 23 (in a case when it is entrusted pursuant to the provisions of Article 24-2, paragraph (1), item (i), including a request pertaining to said entrustment) or refuses to answer without a justifiable reason, may not pay the whole or a part of a Long-Term Care Benefit, etc.
市町村は、介護給付等を受ける者が、正当な理由なしに、第二十三条の規定による求め（第二十四条の二第一項第一号の規定により委託された場合にあっては、当該委託に係る求めを含む。）に応ぜず、又は答弁を拒んだときは、介護給付等の全部又は一部を行わないことができる。
A Municipality, in a case when an Insured Person Requiring Long-Term Care, etc. who is a Primary Insured Person delinquent in payment of an insurance premium (excluding those who can receive payment of a medical allowance for general disease pursuant to the Atomic Bomb Survivors' Assistance Act (Act No. 117 of 1994) and other benefits for medical care as determined by Order of the Ministry of Health, Labour and Welfare) fails to pay said insurance premium from the payment due date of said insurance premium until the expiry of the period as determined by Order of the Ministry of Health, Labour and Welfare, except for a case when it is found that there is a special circumstance for said delinquency of insurance premium payment such as a disaster or other circumstances provided by a Cabinet Order, is to requestgive said Insured Person Requiring Long-Term Care, etc. to submit the Certificate of Insured Person, pursuant to the provisions of Order of the Ministry of Health, Labour and Welfare, and to enter on said Certificate of Insured Persona notice to the effect that the provisions of Article 41, paragraph (6), Article 42-2, paragraph (6), Article 46, paragraph (4), Article 47-2, paragraph (4), Article 48, paragraph (4), Article 51-3, paragraph (4), Article 53, paragraph (4), Article 54-2, paragraph (6), Article 58, paragraph (4) , Article 59-2, paragraph (4) and Article 61-3, paragraph (4) do not apply (hereinafter referred to as "EntryNotice of Change of Payment Method" in this Article and paragraph (3) of the following Article). In this case, the Municipality, when it determines it necessary with regard to the qualification of an Insured Person, may request said Insured Person Requiring Long-Term Care, etc. to submit the Certificate of Insured Person, pursuant to the provisions of Order of the Ministry of Health, Labour and Welfare.
市町村は、保険料を滞納している第一号被保険者である要介護被保険者等（原子爆弾被爆者に対する援護に関する法律（平成六年法律第百十七号）による一般疾病医療費の支給その他厚生労働省令で定める医療に関する給付を受けることができるものを除く。）が、当該保険料の納期限から厚生労働省令で定める期間が経過するまでの間に当該保険料を納付しない場合においては、当該保険料の滞納につき災害その他の政令で定める特別の事情があると認める場合を除き、当該要介護被保険者等に、厚生労働省令で定めるところにより、当該要介護被保険者等に対し被保険者証の提出を求め、当該被保険者証に、第四十一条第六項、第四十二条の二第六項、第四十六条第四項、第四十七条の二第四項、第四十八条第四項、第五十一条の三第四項、第五十三条第四項、第五十四条の二第六項、第五十八条第四項、第五十九条の二第四項及び第六十一条の三第四項の規定を適用しない旨の記載通知（以下この条及び次条第三項において「支払方法変更の記載通知」という。）をするものとする。この場合において、市町村は、被保険者の資格に関して必要があると認めるときは、当該要介護被保険者等に対し、厚生労働省令で定めるところにより、被保険者証の提出を求めることができる。
A Municipality, although in a case when the period as determined by Order of the Ministry of Health, Labour, and Welfare as prescribed in the preceding paragraph has not yet expired, except for a case when it is determined that said person delinquent in payment is due tothere are special circumstances provided by a Cabinet Order as prescribed in the same paragraph, may requestgive the Insured Person Requiring Long-Term Care, etc., as prescribed in the same paragraph to submit a Notice of Change of Payment Method, pursuant to the Certificateprovisions of Insured Person, Order of the Ministry of Health, Labour and include Welfare. In this case, the Entry of Change Municipality, when it determines it necessary with regard to the qualification of Payment Method on an Insured Person, may request said Insured Person Requiring Long-Term Care, etc. to submit the Certificate of Insured Person, pursuant to the provisions of Order of the Ministry of Health, Labour and Welfare.
市町村は、前項に規定する厚生労働省令で定める期間が経過しない場合においても、同項に規定する政令で定める特別の事情があると認める場合を除き、同項に規定する要介護被保険者等に対し、厚生労働省令で定めるところにより、支払方法変更通知をすることができる。この場合において、市町村は、被保険者証の提出を求めの資格に関して必要があると認めるときは、当該要介護被保険者証に支払方法変更の記載をす等に対し、厚生労働省令で定めるところにより、被保険者証の提出を求めることができる。
A Municipality, when an Insured Person Requiring Long-Term Care, etc., that has received an Entrya Notice of Change of Payment Method pursuant to the provisions of the preceding two paragraphs and has completed payment of said delinquent insurance premium or when it is determined that the delinquent payment amount pertaining to said Insured Person Requiring Long-Term Care, etc., has decreased significantly or due to a disaster or other special circumstances provided by a Cabinet Order, is to deletewithdraw said EntryNotice of Change of Payment Method and notify said Insured Person Requiring Long-Term Care, etc. of that effect, pursuant to the provisions of Order of the Ministry of Health, Labour and Welfare.
市町村は、前二項の規定により支払方法変更の記載通知を受けた要介護被保険者等が滞納している保険料を完納したとき、又は当該要介護被保険者等に係る滞納額の著しい減少、災害その他の政令で定める特別の事情があると認めるときは、当該支払方法変更の記載を消除通知を撤回し、当該要介護被保険者等に、厚生労働省令で定めるところにより、その旨を通知するものとする。
With regard to the payment of an Allowance for In-Home Long-Term Care Service, Allowance for Community-Based Long-Term Care Service, Allowance for In-Home Long-Term Care Service Plan, Allowance for Registered Facility Long-Term Care Service Plan, Allowance for Long-Term Care Facility Service, Allowance for Long-Term Care Service to a Person Admitted to a Specified Facility, Allowance for Preventive Long-Term Care Service, Allowance for Community-Based Preventive Long-Term Care Service, Allowance for Preventive Long-Term Care Service Plan, Allowance for Registered Facility Preventive Long-Term Care Service Plan, and Allowance for Preventive Long-Term Care Service to a Person Admitted to a Specified Facility, pertaining to Designated In-Home Service, Designated Community-Based Service, Designated In-Home Long-Term Care Support, Designated Registered Facility Long-Term Care Support, Designated Facility Service, etc., Designated Preventive Long-Term Care Service, Designated Community-Based Service for Preventive Long-Term Care, Designated Preventive Long-Term Care Support, and Designated Registered Facility Preventive Long-Term Care Support that an Insured Person Requiring Long-Term Care, etc. who received an Entrya Notice of Change of Payment Method pursuant to the provisions of paragraph (1) or paragraph (2) receives during the period in which said EntryNotice of Change of Payment Method remainshas been received, the provisions of Article 41, paragraph (6), Article 42-2, paragraph (6), Article 46, paragraph (4), Article 47-2, paragraph (4), Article 48, paragraph (4), Article 51-3, paragraph (4), Article 53, paragraph (4), Article 54-2, paragraph (6), Article 58, paragraph (4), Article 59-2, paragraph (4), and Article 61-3, paragraph (4) do not apply.
第一項又は第二項の規定により支払方法変更の記載通知を受けた要介護被保険者等が、当該支払方法の変更の記載がなされ変更通知を受けている間に受けた指定居宅サービス、指定地域密着型サービス、指定居宅介護支援、指定施設登録施設介護支援、指定施設サービス等、指定介護予防サービス、指定地域密着型介護予防サービス、指定介護予防支援及び指定登録施設介護予防支援に係る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、居宅介護サービス計画費の支給、登録施設介護サービス計画費の支給、施設介護サービス費の支給、特定入所者介護サービス費の支給、介護予防サービス費の支給、地域密着型介護予防サービス費の支給、介護予防サービス計画費の支給、登録施設介護予防サービス計画費の支給及び特定入所者介護予防サービス費の支給については、第四十一条第六項、第四十二条の二第六項、第四十六条第四項、第四十七条の二第四項、第四十八条第四項、第五十一条の三第四項、第五十三条第四項、第五十四条の二第六項、第五十八条第四項、第五十九条の二第四項及び第六十一条の三第四項の規定は適用しない。
A Municipality, when an Insured Person Requiring Long-Term Care, etc., that is a Primary Insured Person that can receive an insurance benefit becomes a person delinquent in the payment of an insurance premium and fails to pay said insurance premium from the due date of payment of said insurance premium until the period as determined by Order of the Ministry of Health, Labour, and Welfare expires, is to temporarily suspend the payment of the whole or a part of an insurance benefit, pursuant to the provisions of Order of the Ministry of Health, Labour, and Welfare, except for a case when it is determined that said delinquency of payment of an insurance premium is due to a disaster or other special circumstance as determined by a Cabinet Order.
市町村は、保険給付を受けることができる第一号被保険者である要介護被保険者等が保険料を滞納しており、かつ、当該保険料の納期限から厚生労働省令で定める期間が経過するまでの間に当該保険料を納付しない場合においては、当該保険料の滞納につき災害その他の政令で定める特別の事情があると認める場合を除き、厚生労働省令で定めるところにより、保険給付の全部又は一部の支払を一時差し止めるものとする。
A Municipality, in a case when an Insured Person Requiring Long-Term Care, etc., who is a Primary Insured Person that can receive an insurance benefit becomes a person delinquent in the payment of an insurance premium although the period as determined by Order of the Ministry of Health, Labour, and Welfare as prescribed in the preceding paragraph has not yet expired, except for a case when it is determined that said delinquency of an insurance premium is due to a disaster or other special circumstance as determined by a Cabinet Order as prescribed, may temporarily suspend the whole or a part of an insurance benefit pursuant to the provisions of Order of the Ministry of Health, Labour, and Welfare.
市町村は、前項に規定する厚生労働省令で定める期間が経過しない場合においても、保険給付を受けることができる第一号被保険者である要介護被保険者等が保険料を滞納している場合においては、当該保険料の滞納につき災害その他の政令で定める特別の事情があると認める場合を除き、厚生労働省令で定めるところにより、保険給付の全部又は一部の支払を一時差し止めることができる。
A Municipality, in a case when an Insured Person Requiring Long-Term Care, etc., that has received an Entrya Notice of Change of Payment Method pursuant to the provisions of paragraph (1) or paragraph (2) of the preceding Article and whose insurance benefit has been temporarily suspended in whole or in part pursuant to the provisions of the preceding two paragraphs and who has not yet paid the delinquent insurance premium, may notify in advance said Insured Person Requiring Long-Term Care, etc., pursuant to the provisions of Order of the Ministry of Health, Labour, and Welfare, and deduct the amount of delinquent insurance premium of said Insured Person Requiring Long-Term Care, etc., from the amount of insurance benefit pertaining to said temporary suspension.
市町村は、前条第一項又は第二項の規定により支払方法変更の記載通知を受けている要介護被保険者等であって、前二項の規定による保険給付の全部又は一部の支払の一時差止がなされているものが、なお滞納している保険料を納付しない場合においては、厚生労働省令で定めるところにより、あらかじめ、当該要介護被保険者等に通知して、当該一時差止に係る保険給付の額から当該要介護被保険者等が滞納している保険料額を控除することができる。
With regard to an Insured Person Requiring Long-Term Care, etc. who is a Secondary Insured Person that can receive an insurance benefit, in a case when there is an insurance premium (including National Health Insurance tax pursuant to the provisions of the Local Tax Act (Act No. 226 of 1950)) or contribution that said Insured Person Requiring Long-Term Care, etc. is obligated to pay or remit pursuant to the provisions of the Medical Insurance Acts and that was not paid by the payment deadline or remittance deadline (hereinafter referred to as "Unpaid Medical Insurance Premium, etc." in this paragraph and the following paragraph), except for a case when it is found that the existence of the Unpaid Medical Insurance Premium, etc. is due to a disaster or other special circumstance as determined by a Cabinet Order, a Municipality, pursuant to the provisions of Order of the Ministry of Health, Labour and Welfare, may requestgive said Insured Person Requiring Long-Term Care, etc. to submit the Certificate of Insured Person and may enter on said Certificate of Insured Persona notice to the effect that the provisions of Article 41, paragraph (6), Article 42-2, paragraph (6), Article 46, paragraph (4), Article 47-2, paragraph (4), Article 48, paragraph (4), Article 51-3, paragraph (4), Article 53, paragraph (4), Article 54-2, paragraph (6), Article 58, paragraph (4), Article 59-2, paragraph (4), and Article 61-3, paragraph (4) do not apply and that the whole or a part of the payment of an insurance benefit is to be suspended (hereinafter referred to as "Entrynotice of Suspensionsuspension of Insurance Benefitinsurance benefit" in this Article). In this case, the Municipality, when it determines it necessary with regard to the qualification of an Insured Person, may request said Insured Person Requiring Long-Term Care, etc. to submit the Certificate of Insured Person, pursuant to the provisions of Order of the Ministry of Health, Labour and Welfare.
市町村は、保険給付を受けることができる第二号被保険者である要介護被保険者等について、医療保険各法の定めるところにより当該要介護被保険者等が納付義務又は払込義務を負う保険料（地方税法（昭和二十五年法律第二百二十六号）の規定による国民健康保険税を含む。）又は掛金であってその納期限又は払込期限までに納付しなかったもの（以下この項及び次項において「未納医療保険料等」という。）がある場合においては、未納医療保険料等があることにつき災害その他の政令で定める特別の事情があると認める場合を除き、当該要介護被保険者等に、厚生労働省令で定めるところにより、当該要介護被保険者等に対し被保険者証の提出を求め、当該被保険者証に、第四十一条第六項、第四十二条の二第六項、第四十六条第四項、第四十七条の二第四項、第四十八条第四項、第五十一条の三第四項、第五十三条第四項、第五十四条の二第六項、第五十八条第四項、第五十九条の二第四項及び第六十一条の三第四項の規定を適用しない旨並びに保険給付の全部又は一部の支払を差し止める旨の記載通知（以下この条において「保険給付差止の記載通知」という。）をすることができる。この場合において、市町村は、被保険者の資格に関して必要があると認めるときは、当該要介護被保険者等に対し、厚生労働省令で定めるところにより、被保険者証の提出を求めることができる。
When an Insured Person Requiring Long-Term Care, etc., that has received an Entrya notice of Suspensionsuspension of Insurance Benefitinsurance benefit pursuant to the provisions of the preceding paragraph completes payment of an Unpaid Medical Insurance Premium, etc., or when it is determined that there is a significant decrease of an Unpaid Medical Insurance Premium, etc., pertaining to said Insured Person Requiring Long-Term Care, etc., or due to disaster or other special circumstance as provided by a Cabinet Order, the Municipality is to withdraw said Entrynotice of Suspensionsuspension of Insurance Benefit is insurance benefit and notify said Insured Person Requiring Long-Term Care, etc. of that effect, pursuant to be deletedthe provisions of Order of the Ministry of Health, Labour and Welfare.
市町村は、前項の規定により保険給付差止の記載通知を受けた要介護被保険者等が、未納医療保険料等を完納したとき、又は当該要介護被保険者等に係る未納医療保険料等の著しい減少、災害その他の政令で定める特別の事情があると認めるときは、当該保険給付差止の記載を消除通知を撤回し、当該要介護被保険者等に、厚生労働省令で定めるところにより、その旨を通知するものとする。
The provisions of Article 66, paragraph (4) apply mutatis mutandis to an Insured Person Requiring Long-Term Care, etc., that has received an Entrya notice of Suspensionsuspension of Insurance Benefitinsurance benefit pursuant to the provisions of paragraph (1).
第六十六条第四項の規定は、第一項の規定により保険給付差止の記載通知を受けた要介護被保険者等について準用する。
With regard to an Insured Person Requiring Long-Term Care, etc., that has received an Entrya notice of Suspensionsuspension of Insurance Benefitinsurance benefit pursuant to the provisions of paragraph (1), a Municipality is to temporarily suspend the whole or a part of an insurance benefit.
市町村は、第一項の規定により保険給付差止の記載通知を受けた要介護被保険者等について、保険給付の全部又は一部の支払を一時差し止めるものとする。
A Municipality, when it finds it necessary in relation to the Entrynotice of Suspensionsuspension of Insurance Benefit ofinsurance benefit for an Insured Person Requiring Long-Term Care, etc., may, pursuant to the provisions of Order of the Ministry of Health, Labour and Welfare, request the medical insurer in which said Insured Person Requiring Long-Term Care, etc. is enrolled (the Minister of Health, Labour and Welfare, where said Insured Person Requiring Long-Term Care, etc. is an insured person of health insurance administered by the Japan Health Insurance Association (excluding a voluntary continuing insured person prescribed in Article 3, paragraph (4) of the Health Insurance Act) or a dependent thereof, or an insured person of mariners insurance (excluding a voluntary continuing insured person for sickness prescribed in Article 2, paragraph (2) of the Mariners Insurance Act) or a dependent thereof, and a Municipality, where said Insured Person Requiring Long-Term Care, etc. is an insured person of National Health Insurance conducted by a prefecture together with the Municipalities within that prefecture as provided in the National Health Insurance Act (hereinafter referred to as "National Health Insurance"); the same applies hereinafter in this Article) to provide information on the status of payment of insurance premiums (including National Health Insurance tax collected pursuant to the provisions of the Local Tax Act) or contributions collected pursuant to the provisions of the Medical Insurance Acts with regard to said Insured Person Requiring Long-Term Care, etc., and other matters as determined by Order of the Ministry of Health, Labour and Welfare.
市町村は、要介護被保険者等についての保険給付差止の記載通知に関し必要があると認めるときは、当該要介護被保険者等の加入する医療保険者（当該要介護被保険者等が全国健康保険協会の管掌する健康保険の被保険者（健康保険法第三条第四項に規定する任意継続被保険者を除く。）若しくはその被扶養者又は船員保険の被保険者（船員保険法第二条第二項に規定する疾病任意継続被保険者を除く。）若しくはその被扶養者である場合には、厚生労働大臣とし、当該要介護被保険者等が国民健康保険法の定めるところにより都道府県が当該都道府県内の市町村とともに行う国民健康保険（以下「国民健康保険」という。）の被保険者である場合には、市町村とする。以下この条において同じ。）に対し、当該要介護被保険者等に係る医療保険各法の規定により徴収される保険料（地方税法の規定により徴収される国民健康保険税を含む。）又は掛金の納付状況その他厚生労働省令で定める事項について、厚生労働省令で定めるところにより、当該要介護被保険者等の加入する医療保険者に対し、情報の提供を求めることができる。