Article 55Cases Where an Insured Person Has Become a Day Worker or a Dependent Thereof
第五十五条（被保険者が日雇労働者又はその被扶養者となつた場合）
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 (26) 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.
被保険者が第六条第七号に該当するに至つたためその資格を喪失した場合において、その資格を喪失した際現に療養の給付、入院時食事療養費に係る療養、入院時生活療養費に係る療養、保険外併用療養費に係る療養、訪問看護療養費に係る療養若しくは特別療養費に係る療養又は介護保険法（平成九年法律第百二十三号）の規定による居宅介護サービス費に係る指定居宅サービス（同法第四十一条第一項に規定する指定居宅サービスをいう。）（療養に相当するものに限る。）、特例居宅介護サービス費に係る居宅サービス（同法第八条第一項に規定する居宅サービスをいう。）若しくはこれに相当するサービス（これらのサービスのうち療養に相当するものに限る。）、地域密着型介護サービス費に係る指定地域密着型サービス（同法第四十二条の二第一項に規定する指定地域密着型サービスをいう。）（療養に相当するものに限る。）、特例地域密着型介護サービス費に係る地域密着型サービス（同法第八条第十四項に規定する地域密着型サービスをいう。）若しくはこれに相当するサービス（これらのサービスのうち療養に相当するものに限る。）、施設介護サービス費に係る指定施設サービス等（同法第四十八条第一項に規定する指定施設サービス等をいう。）（療養に相当するものに限る。）、特例施設介護サービス費に係る施設サービス（同法第八条第二十六項に規定する施設サービスをいう。）（療養に相当するものに限る。）、介護予防サービス費に係る指定介護予防サービス（同法第五十三条第一項に規定する指定介護予防サービスをいう。）（療養に相当するものに限る。）若しくは特例介護予防サービス費に係る介護予防サービス（同法第八条の二第一項に規定する介護予防サービスをいう。）若しくはこれに相当するサービス（これらのサービスのうち療養に相当するものに限る。）を受けていたときは、その者は、当該疾病又は負傷及びこれによつて発した疾病について当該市町村又は組合から療養の給付、入院時食事療養費の支給、入院時生活療養費の支給、保険外併用療養費の支給、訪問看護療養費の支給、特別療養費の支給又は移送費の支給を受けることができる。
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:
前項の規定による療養の給付、入院時食事療養費の支給、入院時生活療養費の支給、保険外併用療養費の支給、訪問看護療養費の支給、特別療養費の支給又は移送費の支給は、次の各号のいずれかに該当するに至つたときは、行わない。
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;
当該疾病又は負傷につき、健康保険法第五章の規定による療養の給付、入院時食事療養費の支給、入院時生活療養費の支給、保険外併用療養費の支給、訪問看護療養費の支給、移送費の支給、家族療養費の支給、家族訪問看護療養費の支給又は家族移送費の支給を受けることができるに至つたとき。
when the relevant person has fallen under any of items (i) through (vi) or items (viii), (ix) or (xi) of Article 6;
その者が、第六条第一号から第六号まで、第八号、第九号又は第十一号のいずれかに該当するに至つたとき。
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;
その者が、当該疾病又は負傷につき、他の市町村又は組合から療養の給付、入院時食事療養費の支給、入院時生活療養費の支給、保険外併用療養費の支給、訪問看護療養費の支給、特別療養費の支給又は移送費の支給を受けることができるに至つたとき。
when six months have elapsed since the day on which the relevant person lost eligibility as an insured person.
被保険者の資格を喪失した日から起算して六箇月を経過したとき。
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.
第一項の規定による療養の給付、入院時食事療養費の支給、入院時生活療養費の支給、保険外併用療養費の支給、訪問看護療養費の支給、特別療養費の支給又は移送費の支給は、当該疾病又は負傷につき、健康保険法第五章の規定による特別療養費の支給又は移送費の支給若しくは家族移送費の支給を受けることができる間は、行わない。
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.
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