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。
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