Article 53Medical Expenses Combined with Treatment Outside Insurance Coverage

①When an insured person has received evaluation treatment, patient-requested treatment or selective treatment at or from a health insurance-covered medical institution, etc. of said person's choice, Municipalities and Societies shall pay medical expenses combined with treatment outside insurance coverage to the Householder or Society member of the household to which said insured person belongs with respect to the expenses incurred in that treatment; provided, however, that this shall not apply during any period in which said Householder or Society member is subject to the application of Article 54-3, paragraph (1) or the main clause of paragraph (2) with respect to said insured person.

②The amount of medical expenses combined with treatment outside insurance coverage shall be the amount specified in item (i) (or the aggregate of such amount and the amount specified in item (ii) or (iii) when such medical treatment includes Dietary Treatment and Living Support, respectively):

③The provisions of Article 64 of the Health Insurance Act and paragraph (3) of Article 36, Articles 40 and 41, paragraphs (3) through (8) of Article 45, Article 45-2 and paragraphs (3) through (5) of Article 52 of this Act shall apply mutatis mutandis to evaluation treatment, patient-requested treatment and selective treatment received at or from a health insurance-covered medical institution, etc. and to the payment of medical expenses combined with treatment outside insurance coverage associated with such treatment. In this case, any technical replacement of terms necessary for these provisions shall be specified by Cabinet Order.

④The provisions of Article 42-2 shall apply mutatis mutandis to the payment of the amount calculated by deducting the amount payable as medical expenses combined with treatment outside insurance coverage with respect to expenses incurred in the relevant medical treatment from the amount of expenses calculated for such medical treatment pursuant to the provisions of paragraph (2) in the case set forth in Article 52, paragraph (3) as applied mutatis mutandis pursuant to the preceding paragraph (or, when said amount exceeds the amount of expenses actually incurred in such medical treatment, said amount of expenses actually incurred in such medical treatment).