National Health Insurance Act

When an insured person has been transported to a hospital or clinic in order to receive benefits for medical treatment (including medical treatment covered by medical expenses combined with treatment outside insurance coverage and medical treatment covered by special medical expenses), Municipalities and Societies shall pay, as transport expenses, an amount calculated as provided by Order of the Ministry of Health, Labour and Welfare to the Householder or Society member of the household to which said insured person belongs.

The transport expenses set forth in the preceding paragraph shall be paid only if a Municipality or Society finds it necessary, as provided by Order of the Ministry of Health, Labour and Welfare.

In cases where an insured person has lost eligibility as such as a result of falling under Article 6, item (vii) and where, at the time of loss of such eligibility, said person actually receives benefits for medical treatment, any medical treatment covered by expenses for Dietary Treatment for inpatients, any medical treatment covered by expenses for Living Support for inpatients, any medical treatment covered by medical expenses combined with treatment outside insurance coverage, any medical treatment covered by medical expenses for home-nursing or any medical treatment covered by special medical expenses, or any Designated In-Home Service covered by expenses for In-Home Long-Term Care Service pursuant to the provisions of the Long-Term Care Insurance Act (Act No. 123 of 1997) (meaning the Designated In-Home Service as set forth in Article 41, paragraph (1) of the same Act) (limited to any such service equivalent to medical treatment), any In-Home Service covered by an Exceptional Allowance for In-Home Long-Term Care Service (meaning the In-Home Service as set forth in Article 8, paragraph (1) of the same Act) or any service equivalent thereto (of these services, limited to those equivalent to medical treatment), any Designated Community-Based Service covered by expenses for Community-Based Long-Term Care Service (meaning the Designated Community-Based Service as set forth in Article 42-2, paragraph (1) of the same Act) (limited to any such service equivalent to medical treatment), any Community-Based Service covered by an Exceptional Allowance for Community-Based Long-Term Care Service (meaning the Community-Based Service as set forth in Article 8, paragraph (14) of the same Act) or any service equivalent thereto (of these services, limited to those equivalent to medical treatment), any Designated Facility Service, etc. covered by expenses for Long-Term Care Facility Service (meaning the Designated Facility Service, etc. as set forth in Article 48, paragraph (1) of the same Act) (limited to any such service equivalent to medical treatment), any Facility Service covered by an Exceptional Allowance for Long-Term Care Facility Service (meaning the Facility Service as set forth in Article 8, paragraph (25) of the same Act) (limited to any such service equivalent to medical treatment), any Designated Preventive Service of Long-Term Care covered by expenses for Preventive Service of Long-Term Care (meaning the Designated Preventive Service of Long-Term Care as set forth in Article 53, paragraph (1) of the same Act) (limited to any such service equivalent to medical treatment), or any Preventive Long-Term Care Service covered by an Exceptional Allowance for Preventive Service of Long-Term Care (meaning the Preventive Long-Term Care Service as set forth in Article 8-2, paragraph (1) of the same Act) or any service equivalent thereto (of these services, limited to those equivalent to medical treatment), then such person may receive from that Municipality or Society benefits for medical treatment, expenses for Dietary Treatment for inpatients, expenses for Living Support for inpatients, medical expenses combined with treatment outside insurance coverage, medical expenses for home-nursing, special medical expenses or transportation expenses with respect to the relevant illness or injury and any illness arising therefrom.

Payment of benefits for medical treatment, expenses for Dietary Treatment for inpatients, expenses for Living Support for inpatients, medical expenses combined with treatment outside insurance coverage, medical expenses for home-nursing, special medical expenses or transportation expenses under the provisions of the preceding paragraph shall not be made when any of the events listed in the following items has occurred:

when the relevant person has become eligible for payment of benefits for medical treatment, expenses for Dietary Treatment for inpatients, expenses for Living Support for inpatients, medical expenses combined with treatment outside insurance coverage, medical expenses for home-nursing, transport expenses, dependent medical expenses, dependent medical expenses for home-nursing or dependent transport expenses pursuant to the provisions of Chapter V of the Health Insurance Act with respect to the relevant illness or injury;

when the relevant person has fallen under any of items (i) through (vi) or items (viii), (ix) or (xi) of Article 6;

when that person has come to be able to receive, with respect to that illness or injury, benefits for medical treatment, expenses for Dietary Treatment for inpatients, expenses for Living Support for inpatients, medical expenses combined with treatment outside insurance coverage, medical expenses for home-nursing, special medical expenses or transportation expenses from another Municipality or Society;

when six months have elapsed since the day on which the relevant person lost eligibility as an insured person.

Payment of benefits for medical treatment, expenses for Dietary Treatment for inpatients, expenses for Living Support for inpatients, medical expenses combined with treatment outside insurance coverage, medical expenses for home-nursing, special medical expenses or transportation expenses under the provisions of paragraph (1) shall not be made during any period in which the relevant person is eligible for payment of a special medical expenses or transport expenses or dependent transport expenses pursuant to the provisions of Chapter V of the Health Insurance Act with respect to the relevant illness or injury.

Payment of benefits for medical treatment, expenses for Dietary Treatment for inpatients, expenses for Living Support for inpatients, medical expenses combined with treatment outside insurance coverage, medical expenses for home-nursing or a special medical expenses under the provisions of paragraph (1) shall not be made in cases where the relevant person is eligible for any benefit corresponding to each of the above benefits pursuant to the provisions of the Long-Term Care Insurance Act with respect to the relevant illness or injury.

Payment of 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 for home-nursing, special medical expenses or transportation expenses shall not be made in cases where the insured person is eligible for any benefit relating to medical services pursuant to the provisions of the Health Insurance Act, the Mariners Insurance Act, the National Public Officers Mutual Aid Association Act (including cases where applied mutatis mutandis pursuant to other Acts or where the same rule governs), the Local Public Officers, etc. Mutual Aid Association Act or the Act on Assurance of Medical Care for Elderly People or where said person is eligible for any benefit corresponding to each of the above benefits pursuant to the provisions of the Long-Term Care Insurance Act, in each case with respect to said person's relevant illness or injury. The same shall apply when such person is eligible for any medical compensation pursuant to the provisions of the Labor Standards Act (Act No. 49 of 1947), any medical compensation benefits, medical treatment benefits for multiple-job workers or medical treatment benefits under the provisions of the Industrial Accident Compensation Insurance Act (Act No. 50 of 1947), any medical compensation under the provisions of the National Public Officers' Accident Compensation Act (Act No. 191 of 1951; including cases where applied mutatis mutandis pursuant to any other Act), any medical compensation under the provisions of the Local Public Officers Accident Compensation Act (Act No. 121 of 1967) or a Prefectural or Municipal Ordinance under the same Act or any other benefit relating to medical services under any law or regulation as prescribed by Cabinet Order, or when any benefit relating to medical care is provided at the expense of the national government or a local government pursuant to any law or regulation other than these laws and regulations.

In cases where benefits under any law or regulation set forth in the preceding paragraph are benefits in kind relating to medical services and when any co-payment is made or actual costs are collected in relation to such benefits and when the amount of such co-payment or actual costs collected exceeds the amount of co-payment which would have been required under this Act had such benefits been provided as benefits for medical treatment pursuant to this Act (or, when the ratio of co-payment set forth in Article 42, paragraph (1) has been reduced pursuant to the provisions of Article 43, paragraph (1), the amount of co-payment calculated in accordance with the ratio after such reduction), or in cases where benefits under any law or regulation set forth in the preceding paragraph (excluding the Long-Term Care Insurance Act) are payments of medical expenses and when the amount of such payment is less than the amount 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, special medical expenses or transportation expenses which would have been payable had 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, special medical expenses or transportation expenses been required pursuant to this Act with respect to the relevant medical treatment, then Municipalities and Societies shall pay to the insured person the difference between the relevant amounts in each case.

In the case referred to in the preceding paragraph, when the insured person has received the relevant medical treatment at or from a health insurance-covered medical institution, etc., Municipalities and Societies may, on behalf of such insured person, pay to such health insurance-covered medical institution, etc. expenses incurred in such medical treatment payable by said insured person to said health insurance-covered medical institution, etc. within the limits of the amount payable to said insured person pursuant to the provisions of the same paragraph; provided, however, that when the Municipality or Society concerned has reduced the ratio of co-payment pursuant to the provisions of Article 43, paragraph (1), the foregoing shall apply only where such insured person has received such medical treatment at or from one of the health insurance-covered medical institutions, etc. set forth in paragraph (2) of the same Article.

When a payment of expenses is made to the relevant Health Insurance-Covered Medical Institution, etc. pursuant to the provisions of the preceding paragraph, the insured person shall, to the extent of such payment, be deemed to have received a payment pursuant to the provisions of paragraph (2).

In making any co-payment or in paying any difference or medical expenses pursuant to the provisions of paragraph (3) of Article 43 or paragraph (2) of the preceding Article, when the relevant illness or injury is of an insured person who is not the Householder or Society member, the Householder or Society member of the household to which such insured person belongs shall make, or be obligated to make, co-payment and shall receive payment of the difference or medical expenses pursuant to paragraph (3) of Article 43 or paragraph (2) of the preceding Article, notwithstanding the provisions of the respective Articles pertaining to these matters.

When the amount of co-payment paid for benefits for medical treatment, or the amount obtained by deducting, from the amount of expenses incurred in medical treatment (excluding Dietary Treatment and Living Support; hereinafter the same shall apply in the following paragraph), the amount paid as medical expenses combined with treatment outside insurance coverage, medical expenses, medical expenses for home-nursing or special medical expenses with respect to expenses incurred in the relevant medical treatment or the amount equivalent to the difference paid pursuant to the provisions of Article 56, paragraph (2) (in paragraph (1) of the following Article referred to as the "amount of co-payment, etc."), is extremely large, Municipalities and Societies shall pay high-cost medical expenses to the relevant Householder or Society member; provided, however, that this shall not apply if no benefit for medical treatment, medical expenses combined with treatment outside insurance coverage, medical expenses, medical expenses for home-nursing or special medical expenses were paid and no difference was paid pursuant to the provisions of Article 56, paragraph (2) with respect to the relevant medical treatment.

The requirements for payment and the amount of high-cost medical expenses and other necessary matters concerning the payment of high-cost medical expenses shall be prescribed by Cabinet Order by taking into consideration the impact of the burden of the expenses incurred in the relevant medical treatment on household finances, in particular the household finances of persons who continuously receive medical treatment over a long period, and the amount of expenses incurred in the medical treatment.