Municipalities and Societies shall pay benefits for the types of medical treatment listed in the following items with respect to an insured person's illness and injury; provided, however, that this shall not apply during any period in which the Householder or Society member of the household to which such insured person belongs is subject to the application of Article 54-3, paragraph (1) or the main clause of paragraph (2) with respect to such insured person:
市町村及び組合は、被保険者の疾病及び負傷に関しては、次の各号に掲げる療養の給付を行う。ただし、当該被保険者の属する世帯の世帯主又は組合員が当該被保険者について第五十四条の三第一項又は第二項本文の規定の適用を受けている間は、この限りでない。
medical examinations;
診察
provision of medication or materials for medical treatment;
薬剤又は治療材料の支給
treatment, operations or any other medical treatment;
処置、手術その他の治療
in-home medical care management as well as caretaking and any other nursing involved in in-home medical care;
居宅における療養上の管理及びその療養に伴う世話その他の看護
hospitalization or visiting a clinic, and caretaking and other nursing incidental to medical treatment provided there.
病院又は診療所への入院及びその療養に伴う世話その他の看護
Benefits for the following types of medical treatment shall not be included in the benefits set forth in the preceding paragraph:
次に掲げる療養に係る給付は、前項の給付に含まれないものとする。
medical treatment which consists of the provision of meals and is given in combination with the type of medical treatment listed in item (v) of the preceding paragraph (excluding hospitalization in a sanatorium ward as set forth in Article 7, paragraph (2), item (iv) of the Medical Treatment Act (Act No. 205 of 1948) and care and other nursing incidental to the medical treatment there which is provided to an insured person whose 65th birthday is on any month before the month in which said person receives the relevant medical treatment (hereinafter referred to as a "Person Specified as Hospitalized Long-term and Insured")) (hereinafter referred to as "Dietary Treatment");
食事の提供たる療養であつて前項第五号に掲げる療養と併せて行うもの（医療法（昭和二十三年法律第二百五号）第七条第二項第四号に規定する療養病床への入院及びその療養に伴う世話その他の看護であつて、当該療養を受ける際、六十五歳に達する日の属する月の翌月以後である被保険者（以下「特定長期入院被保険者」という。）に係るものを除く。以下「食事療養」という。）
the following types of medical treatment given in combination with the type of medical treatment listed in item (v) of the preceding paragraph (limited to medical treatment provided to a Person Specified as Hospitalized Long-term and Insured; hereinafter referred to as "Living Support"):
次に掲げる療養であつて前項第五号に掲げる療養と併せて行うもの（特定長期入院被保険者に係るものに限る。以下「生活療養」という。）
medical treatment consisting of the provision of meals;
食事の提供たる療養
medical treatment consisting of the creation of an appropriate environment for medical treatment in terms of temperature, lighting and water supply;
温度、照明及び給水に関する適切な療養環境の形成たる療養
evaluation treatment (meaning the evaluation treatment as set forth in Article 63, paragraph (2), item (iii) of the Health Insurance Act; hereinafter the same shall apply);
評価療養（健康保険法第六十三条第二項第三号に規定する評価療養をいう。以下同じ。）
patient-requested treatment (meaning the patient-requested treatment as set forth in Article 63, paragraph (2), item (iv) of the Health Insurance Act; hereinafter the same shall apply);
患者申出療養（健康保険法第六十三条第二項第四号に規定する患者申出療養をいう。以下同じ。）
selective treatment (meaning the selective treatment as set forth in Article 63, paragraph (2), item (v) of the Health Insurance Act; hereinafter the same shall apply).
選定療養（健康保険法第六十三条第二項第五号に規定する選定療養をいう。以下同じ。）
When an insured person seeks to receive the benefits set forth in paragraph (1), the insured person is to receive confirmation of being an insured person from the health insurance-covered medical institution, etc. of the insured person's choice (meaning the health insurance-covered medical institution or health insurance-covered pharmacy prescribed in Article 63, paragraph (3), item (i) of the Health Insurance Act; hereinafter the same applies) by electronic eligibility confirmation (meaning that a person seeking to receive medical treatment from a health insurance-covered medical institution, etc., or a person seeking to receive designated home nursing prescribed in Article 54-2, paragraph (1) from a designated home-nursing provider prescribed in that paragraph, makes an inquiry to a Municipality or Society about information pertaining to eligibility as an insured person (including information necessary for claims for expenses pertaining to insurance benefits) by a method of transmitting an electronic certificate for user verification (meaning the electronic certificate for user verification prescribed in Article 22, paragraph (1) of the Act on Certification Business of the Japan Agency for Local Authority Information Systems in Relation to Electronic Signatures, etc. (Act No. 153 of 2002)) recorded on an Individual Number Card (meaning the Individual Number Card prescribed in Article 2, paragraph (7) of the Act on the Use of Numbers to Identify a Specific Individual in Administrative Procedures (Act No. 27 of 2013)) or by any other method specified by Order of the Ministry of Health, Labour and Welfare, receives a response from the Municipality or Society by a method using an electronic data processing system or other method using information and communications technology, provides that information to the health insurance-covered medical institution, etc. or designated home-nursing provider, and receives confirmation of being an insured person from that health insurance-covered medical institution, etc. or designated home-nursing provider; hereinafter the same applies) or by any other method specified by Order of the Ministry of Health, Labour and Welfare (hereinafter referred to as "electronic eligibility confirmation, etc."), and then to receive the benefits set forth in paragraph (1); provided, however, that this confirmation is not required if the case falls under a case specified by Order of the Ministry of Health, Labour and Welfare.
被保険者が第一項の給付を受けようとするときは、自己の選定する保険医療機関等（健康保険法第六十三条第三項第一号に規定する保険医療機関又は保険薬局をいう。以下同じ。）から、電子資格確認（保険医療機関等から療養を受けようとする者又は第五十四条の二第一項に規定する指定訪問看護事業者から同項に規定する指定訪問看護を受けようとする者が、市町村又は組合に対し、個人番号カード（行政手続における特定の個人を識別するための番号の利用等に関する法律（平成二十五年法律第二十七号）第二条第七項に規定する個人番号カードをいう。）に記録された利用者証明用電子証明書（電子署名等に係る地方公共団体情報システム機構の認証業務に関する法律（平成十四年法律第百五十三号）第二十二条第一項に規定する利用者証明用電子証明書をいう。）を送信する方法その他の厚生労働省令で定める方法により、被保険者の資格に係る情報（保険給付に係る費用の請求に必要な情報を含む。）の照会を行い、電子情報処理組織を使用する方法その他の情報通信の技術を利用する方法により、市町村又は組合から回答を受けて当該情報を当該保険医療機関等又は指定訪問看護事業者に提供し、当該保険医療機関等又は指定訪問看護事業者から被保険者であることの確認を受けることをいう。以下同じ。）その他厚生労働省令で定める方法（以下「電子資格確認等」という。）により、被保険者であることの確認を受け、第一項の給付を受けるものとする。ただし、厚生労働省令で定める場合に該当するときは、当該確認を受けることを要しない。
Read this with the articles around it
(Benefits for Medical Treatment)
medical treatment using advanced medical care techniques specified by the Minister of Health, Labour and Welfare and other medical treatment which are specified by the Minister of Health…
厚生労働大臣が定める高度の医療技術を用いた療養その他の療養であって、前項の給付の対象とすべきものであるか否かについて、適正な医療の効率的な提供を図る観点から評価を行うことが必要な療養（次号の患者申出療養を除く。）として厚生労働大臣が定めるもの（以下「評価療養」という。）
Open this provision(Benefits for Medical Treatment)
medical treatment using advanced medical care techniques and specified by the Minister of Health, Labour and Welfare as treatment that requires evaluation to determine whether it should be subject to…
高度の医療技術を用いた療養であって、当該療養を受けようとする者の申出に基づき、前項の給付の対象とすべきものであるか否かについて、適正な医療の効率的な提供を図る観点から評価を行うことが必要な療養として厚生労働大臣が定めるもの（以下「患者申出療養」という。）
Open this provision(Benefits for Medical Treatment)
the provision of a special ward pertaining to the selection of insured persons and other medical treatment prescribed by the Minister of Health, Labour and Welfare…
被保険者の選定に係る特別の病室の提供その他の厚生労働大臣が定める療養（以下「選定療養」という。）
Open this provision(Benefits for Medical Treatment)
a hospital or clinic designated by the Minister of Health, Labour and Welfare (if the hospital or clinic has received a designation excluding all or some of its beds pursuant to the provisions of…
厚生労働大臣の指定を受けた病院若しくは診療所（第六十五条の規定により病床の全部又は一部を除いて指定を受けたときは、その除外された病床を除く。以下「保険医療機関」という。）又は薬局（以下「保険薬局」という。）
Open this provisionlong-term care beds (meaning hospital or clinic beds other than those described in the above three items that are primarily for the hospitalization of patients requiring long-term recuperation; the…
療養病床（病院又は診療所の病床のうち、前三号に掲げる病床以外の病床であつて、主として長期にわたり療養を必要とする患者を入院させるためのものをいう。以下同じ。）
Open this provision(Benefits for Medical Treatment)
Municipalities and Societies shall pay benefits for the types of medical treatment listed in the following items with respect to an insured person's illness and injury; provided, however…
市町村及び組合は、被保険者の疾病及び負傷に関しては、次の各号に掲げる療養の給付を行う。ただし、当該被保険者の属する世帯の世帯主又は組合員が当該被保険者について第五十四条の三第一項又は第二項本文の規定の適用を受けている間は、この限りでない。
Open this provision(Benefits for Medical Treatment)
hospitalization or visiting a clinic, and caretaking and other nursing incidental to medical treatment provided there.
病院又は診療所への入院及びその療養に伴う世話その他の看護
Open this provision(Medical Expenses for Home-Nursing)
When an insured person has received, at or from a designated home-nursing provider (meaning the designated home-nursing provider as set forth in Article 88, paragraph (1) of the Health Insurance Act…
市町村及び組合は、被保険者が指定訪問看護事業者（健康保険法第八十八条第一項に規定する指定訪問看護事業者をいう。以下同じ。）について指定訪問看護（同項に規定する指定訪問看護をいう。以下同じ。）を受けたときは、当該被保険者の属する世帯の世帯主又は組合員に対し、その指定訪問看護に要した費用について、訪問看護療養費を支給する。
Open this provision(Special Medical Expenses)
In the case where a Householder who is in arrears with insurance premiums (limited to a Householder who has a domicile within the area of the Municipality) or a Society member who is in arrears with…
市町村及び組合は、保険料を滞納している世帯主（当該市町村の区域内に住所を有する世帯主に限る。）又は組合員（その世帯に属する全ての被保険者が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（以下この項及び第四項において「原爆一般疾病医療…
Open this provision(Special Medical Expenses)
Even before the period specified by Order of the Ministry of Health, Labour and Welfare prescribed in the preceding paragraph has elapsed, in the case where a householder…
市町村及び組合は、前項に規定する厚生労働省令で定める期間が経過する前においても、当該市町村又は組合が保険料納付の勧奨等を行つてもなお保険料滞納世帯主等が当該保険料を納付しない場合においては、その世帯に属する被保険者が保険医療機関等から療養を受けたとき、又は指定訪問看護事業者から指定訪問看護を受けたときは…
Open this provision(Definitions)
The term "Individual Number Card" as used in this Act means the cards on which the information listed below (for a foreign resident (meaning a foreign resident as set forth in Article 30-45 of the…
この法律において「個人番号カード」とは、次に掲げる事項（外国人住民（住民基本台帳法第三十条の四十五に規定する外国人住民をいう。次項において同じ。）にあっては、第二号に掲げる事項を除く。）が記載され、第十六条の二第一項の申請の日において本人の年齢が主務省令で定める年齢に満たない場合を除き本人の写真が表示され、かつ…
Open this provisionSociety
「組合」
A National Health Insurance Society (国民健康保険組合): a body made up, as its members (組合員), of people engaged in the same kind of business or occupation who live in its district, which may provide national health insurance to its members and the people in their households (Articles 3, 13 and 19).
Short name set inArticle 13, paragraph (1)
Person Specified as Hospitalized Long-term and Insured
「特定長期入院被保険者」
An insured person who, when receiving inpatient care in a long-term care bed (療養病床) with the care and nursing that go with it, is in or past the month after the month in which they reach 65.
Short name set inArticle 36, paragraph (2), item (i)
Dietary Treatment
「食事療養」
Meals provided as medical treatment together with inpatient care at a hospital or clinic (the treatment in Article 36, paragraph (1), item (v)), other than meals given with a stay in a sanatorium ward (療養病床) to an insured person who is, at the time, past the month in which they reach the age of 65 (a Person Specified as Hospitalized Long-term and Insured, 特定長期入院被保険者).
Short name set inArticle 36, paragraph (2), item (i)
Living Support
「生活療養」
Meals, and a suitable care environment as to temperature, lighting and water supply, provided together with hospitalization and the nursing care that goes with it (Article 36, paragraph (1), item (v)) to a person specified as hospitalized long-term and insured (特定長期入院被保険者).
Short name set inArticle 36, paragraph (2), item (ii)
evaluation treatmentmachine translation
「評価療養」
Evaluation treatment as defined in Article 63, paragraph (2), item (iii) of the Health Insurance Act: treatment using advanced medical technology, and other treatment, that the Minister of Health, Labour and Welfare specifies as needing to be evaluated, with a view to providing appropriate medical care efficiently, for whether it should be covered by medical treatment benefits (療養の給付) — other than patient-requested treatment (患者申出療養); Article 36, paragraph (2) leaves it out of this Act's medical treatment benefits.
Defined inArticle 36, paragraph (2), item (iii)
patient-requested treatmentmachine translation
「患者申出療養」
Medical treatment using advanced medical technology, as defined in Article 63, paragraph (2), item (iv) of the Health Insurance Act, that the Minister of Health, Labour and Welfare designates as needing evaluation, at the request of the person who wishes to receive it, of whether it should be covered by the benefits for medical treatment (療養の給付), with a view to providing appropriate medical care efficiently.
Defined inArticle 36, paragraph (2), item (iv)
selective treatmentmachine translation
「選定療養」
Selective treatment as defined in Article 63, paragraph (2), item (v) of the Health Insurance Act: a special hospital room the insured person chooses, and other treatment the Minister of Health, Labour and Welfare specifies; Article 36, paragraph (2) leaves it out of this Act's medical treatment benefits (療養の給付).
Defined inArticle 36, paragraph (2), item (v)
health insurance-covered medical institution, etc.machine translation
「保険医療機関等」
A hospital, clinic or pharmacy designated by the Minister of Health, Labour and Welfare under Article 63, paragraph (3), item (i) of the Health Insurance Act (a health insurance-covered medical institution (保険医療機関) or pharmacy (保険薬局)), from which an insured person of national health insurance chooses where to receive the benefits for medical treatment (療養の給付).
Defined inArticle 36, paragraph (3)
electronic eligibility confirmationmachine translation
「電子資格確認」
The way a person seeking treatment from a medical institution or pharmacy covered by health insurance (保険医療機関等), or designated home nursing (指定訪問看護) from a designated home-nursing provider (指定訪問看護事業者), is confirmed as an insured person: they ask the municipality (市町村) or National Health Insurance Society (組合) about their eligibility, and the information needed to claim the cost of benefits, by sending the electronic certificate for user verification (利用者証明用電子証明書) recorded on their Individual Number Card (個人番号カード) or by another method a Ministry of Health, Labour and Welfare Order (厚生労働省令) sets, receive the answer online, and pass it to the institution or provider, which then confirms that they are insured.
Defined inArticle 36, paragraph (3)
electronic eligibility confirmation, etc.machine translation
「電子資格確認等」
Electronic eligibility confirmation (電子資格確認) or another method a Ministry of Health, Labour and Welfare Order (厚生労働省令) sets, by which an insured person seeking the medical treatment benefits (療養の給付) of Article 36, paragraph (1) is confirmed as insured by the medical institution or pharmacy covered by health insurance (保険医療機関等) of their choice.
Short name set inArticle 36, paragraph (3)
designated home nursingmachine translation
「指定訪問看護」
Home-visit nursing (訪問看護) given by a designated home-nursing provider (指定訪問看護事業者) at its place of business covered by the designation, for which insured persons receive medical expenses for home-nursing (訪問看護療養費).
Defined inArticle 54-2, paragraph (1)
designated home-nursing providermachine translation
「指定訪問看護事業者」
A provider the Minister of Health, Labour and Welfare has designated to run a home-visit nursing business: nursing care or help with medical treatment given at home by nurses and others a Ministry of Health, Labour and Welfare Order (厚生労働省令) names to people under continuing treatment at home for an illness or injury whom their doctor finds meet the Order's standard.
Defined inArticle 54-2, paragraph (1)