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National Health Insurance Act

国民健康保険法(こくみんけんこうほけんほう)

Chapter IX Application for Examination

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.

Chapter IX Application for Examination第九章 審査請求

Article 91第九十一条

Application for Examination(審査請求)
Article 91, paragraph (1)

A person who is dissatisfied with any action with respect to an insurance benefit (including action in response to a request pursuant to the provisions of Article 9, paragraphs (2) and (4)) or any action with respect to insurance premiums or any other money collected pursuant to the provisions of this Act may file an application for examination with the National Health Insurance Examination Board.

保険給付に関する処分(第九条第二項及び第四項の規定による求めに対する処分を含む。)又は保険料その他この法律の規定による徴収金に関する処分に不服がある者は、国民健康保険審査会に審査請求をすることができる。

Article 91, paragraph (2)

An application for examination as referred to in the preceding paragraph shall be deemed to be a judicial claim in terms of postponement of the completion and renewal of prescription.

前項の審査請求は、時効の完成猶予及び更新に関しては、裁判上の請求とみなす。

Article 92第九十二条

Establishment of an Examination Board(審査会の設置)
Article 92, paragraph (1)

Each prefecture shall have a National Health Insurance Examination Board (hereinafter referred to as an "Examination Board").

国民健康保険審査会(以下「審査会」という。)は、各都道府県に置く。

Article 93第九十三条

Organization(組織)
Article 93, paragraph (1)

Examination Boards shall be composed of three committee members representing insured persons, three committee members representing Insurers, and three committee members representing the public interest.

審査会は、被保険者を代表する委員、保険者を代表する委員及び公益を代表する委員各三人をもつて組織する。

Article 93, paragraph (2)

Committee members shall serve on a part-time basis.

委員は、非常勤とする。

Article 94第九十四条

Term of Office of Committee Members(委員の任期)
Article 94, paragraph (1)

The term of office of committee members shall be three years; provided, however, that the term of office of a substitute committee member shall be the remaining term of said member's predecessor.

委員の任期は、三年とする。ただし、補欠の委員の任期は、前任者の残任期間とする。

Article 94, paragraph (2)

Committee members may be reappointed.

委員は、再任されることができる。

Article 95第九十五条

Chairperson(会長)
Article 95, paragraph (1)

The Examination Board shall have one chairperson to be elected by the committee members from among the committee members representing the public interest.

審査会に、公益を代表する委員のうちから委員が選挙する会長一人を置く。

Article 95, paragraph (2)

When the chairperson is unable to perform their duties, a person elected in accordance with the provisions of the preceding paragraph shall perform the duties of the chairperson on their behalf.

会長に事故があるときは、前項の規定に準じて選挙された者が、その職務を代行する。

Article 96第九十六条

Quorum(定足数)
Article 96, paragraph (1)

The Examination Board may not commence proceedings or make any resolution without the attendance of a majority of committee members including one or more committee members representing insured persons, one or more committee members representing Insurers and one or more committee members representing the public interest.

審査会は、被保険者を代表する委員、保険者を代表する委員及び公益を代表する委員各一人以上を含む過半数の委員の出席がなければ、議事を開き、議決をすることができない。

Article 97第九十七条

Voting(表決)
Article 97, paragraph (1)

Examination Board decisions shall be made by a majority of the committee members present and, in the case of a tie, the chairman shall reach a verdict on said tie.

審査会の議事は、出席した委員の過半数をもつて決し、可否同数のときは、会長の決するところによる。

Article 98第九十八条

Examination Board of Competent Jurisdiction(管轄審査会)
Article 98, paragraph (1)

An application for examination must be filed with the Examination Board of the prefecture governing the location of the Municipality or Society which took the relevant action (or, in the case of action taken pursuant to the provisions of Article 80, paragraph (3), the Municipality which took such action).

審査請求は、当該処分をした市町村又は組合(第八十条第三項の規定による処分については、当該処分をした市町村とする。)の所在地の都道府県の審査会に対してしなければならない。

Article 98, paragraph (2)

When an Examination Board lacks jurisdiction over the matters for which an application for examination has been filed with said Examination Board, it must promptly transfer the case to the Examination Board of the competent jurisdiction and must also notify the person who filed the application for examination of such transfer.

審査請求が管轄違であるときは、審査会は、すみやかに、事件を所轄の審査会に移送し、かつ、その旨を審査請求人に通知しなければならない。

Article 98, paragraph (3)

When a case is transferred, the application for examination shall be deemed to have been filed originally with the Examination Board to which such case is transferred.

事件が移送されたときは、はじめから、移送を受けた審査会に審査請求があつたものとみなす。

Article 99第九十九条

Term and Means of Application for Examination(審査請求の期間及び方式)
Article 99, paragraph (1)

An application for examination must be filed in writing or orally within a period of three months from the day following the date that the relevant action was taken, to the applicant's knowledge; provided, however, that this shall not apply if the applicant makes a prima facie showing that an application could not have been filed within such period for a justifiable reason.

審査請求は、処分があつたことを知つた日の翌日から起算して三月以内に、文書又は口頭でしなければならない。ただし、正当な理由により、この期間内に審査請求をすることができなかつたことを疎明したときは、この限りでない。

Article 100第百条

Notice to Municipalities or Societies(市町村又は組合に対する通知)
Article 100, paragraph (1)

When an application for examination has been filed, the Examination Board must, except in the case where it dismisses the application for examination pursuant to Article 24 of the Administrative Complaint Review Act (Act No. 68 of 2014), notify the Municipality or Society that took the original action and other interested persons.

審査会は、審査請求がされたときは、行政不服審査法(平成二十六年法律第六十八号)第二十四条の規定により当該審査請求を却下する場合を除き、原処分をした市町村、組合その他の利害関係人に通知しなければならない。

Article 101第百一条

Disposition for Proceedings(審理のための処分)
Article 101, paragraph (1)

When the Examination Board finds it necessary to conduct proceedings, it may request a report or an opinion from the person who filed the application for examination or any person concerned, may order any of these persons to appear for inquiry, or may direct a physician or dentist to perform a diagnosis or examination.

審査会は、審理を行うため必要があると認めるときは、審査請求人若しくは関係人に対して報告若しくは意見を求め、その出頭を命じて審問し、又は医師若しくは歯科医師に診断若しくは検案をさせることができる。

Article 101, paragraph (2)

To any person concerned who appeared at the Examination Board or any physician or dentist who performed diagnosis or examination pursuant to the provisions of the preceding paragraph, the prefecture must pay said person's travel expenses, daily expenses and accommodation expenses or remuneration pursuant to Cabinet Order provisions.

都道府県は、前項の規定により審査会に出頭した関係人又は診断若しくは検案をした医師若しくは歯科医師に対し、政令の定めるところにより、旅費、日当及び宿泊料又は報酬を支給しなければならない。

Article 102第百二条

Delegation to Cabinet Order(政令への委任)
Article 102, paragraph (1)

In addition to what is provided for in this Chapter and the Administrative Complaint Review Act, necessary particulars concerning the Examination Board and the procedures for filing an application for examination shall be prescribed by Cabinet Order.

この章及び行政不服審査法に規定するもののほか、審査会及び審査請求の手続に関して必要な事項は、政令で定める。

Article 103第百三条

Relationship between Application for Examination and Litigation(審査請求と訴訟との関係)
Article 103, paragraph (1)

No action for revocation of the action set forth in Article 91, paragraph (1) may be filed until a determination has been made on an application for examination of such action.

第九十一条第一項に規定する処分の取消しの訴えは、当該処分についての審査請求に対する裁決を経た後でなければ、提起することができない。

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