Article 54-3Special Medical Expenses
第五十四条の三（特別療養費）
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 insurance premiums (excluding a Householder or Society member all of whose insured persons belonging to the household are able to receive payment of general medical expenses under the Atomic Bomb Survivors' Assistance Act (Act No. 117 of 1994) or other benefits relating to medical care specified by Order of the Ministry of Health, Labour and Welfare (referred to as "payment of general medical expenses for atomic bomb survivors, etc." in this paragraph and paragraph (4)); hereinafter referred to as a "householder, etc. in arrears with insurance premiums" in this Article) still does not pay those insurance premiums during the period until the period specified by Order of the Ministry of Health, Labour and Welfare has elapsed from the due date for payment of those insurance premiums even though the Municipality or Society concerned has taken measures contributing to payment of insurance premiums specified by Order of the Ministry of Health, Labour and Welfare, such as encouraging payment of those insurance premiums and ensuring opportunities for consultation on payment of those insurance premiums (referred to as "encouragement of insurance premium payment, etc." in the following paragraph and Article 63-2, paragraphs (1) and (2)), then, except where it is found that there are special circumstances specified by Cabinet Order, such as a disaster, in the arrears of those insurance premiums, when an insured person belonging to that household (excluding persons able to receive payment of general medical expenses for atomic bomb survivors, etc. and persons in the period until the first March 31 on or after the day on which they reach the age of 18; the same applies hereinafter in this Article (excluding paragraphs (4) and (5))) receives medical treatment from a health insurance-covered medical institution, etc. or receives designated home nursing from a designated home-nursing provider, Municipalities and Societies are to pay special medical expenses to the householder, etc. in arrears with insurance premiums with respect to the expenses incurred in that medical treatment or designated home nursing, in lieu of benefits for medical treatment or payment of expenses for Dietary Treatment for inpatients, etc. (meaning expenses for Dietary Treatment for inpatients, Living Support expenses for inpatients, medical expenses combined with treatment outside insurance coverage, medical expenses or medical expenses for home-nursing; the same applies in paragraphs (4) and (5)) (referred to as "Benefits for Medical Treatment, etc." in the following paragraph and paragraph (5)).
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「原爆一般疾病医療費の支給等」という。）を受けることができる世帯主又は組合員を除く。以下この条において「保険料滞納世帯主等」という。）が、当該保険料の納期限から厚生労働省令で定める期間が経過するまでの間に、当該市町村又は組合が当該保険料の納付の勧奨及び当該保険料の納付に係る相談の機会の確保その他厚生労働省令で定める保険料の納付に資する取組（次項並びに第六十三条の二第一項及び第二項において「保険料納付の勧奨等」という。）を行つてもなお当該保険料を納付しない場合においては、当該保険料の滞納につき災害その他の政令で定める特別の事情があると認められる場合を除き、当該世帯に属する被保険者（原爆一般疾病医療費の支給等を受けることができる者及び十八歳に達する日以後の最初の三月三十一日までの間にある者を除く。以下この条（第四項及び第五項を除く。）において同じ。）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、その療養又は指定訪問看護に要した費用について、療養の給付又は入院時食事療養費等（入院時食事療養費、入院時生活療養費、保険外併用療養費、療養費又は訪問看護療養費をいう。第四項及び第五項において同じ。）の支給（次項及び第五項において「療養の給付等」という。）に代えて、当該保険料滞納世帯主等に対し、特別療養費を支給する。
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, etc. in arrears with insurance premiums still does not pay the insurance premiums even though the Municipality or Society concerned has carried out encouragement of insurance premium payment, etc., when an insured person belonging to the household receives medical treatment from a health insurance-covered medical institution, etc. or receives designated home nursing from a designated home-nursing provider, Municipalities and Societies may pay special medical expenses to that householder, etc. in arrears with insurance premiums with respect to the expenses incurred in that medical treatment or designated home nursing, in lieu of Benefits for Medical Treatment, etc.; provided, however, that this does not apply when it is found that there are special circumstances specified by Cabinet Order in that paragraph.
When paying special medical expenses pursuant to the provisions of paragraph (1) or the main clause of the preceding paragraph, Municipalities and Societies are to notify in advance the householder, etc. in arrears with insurance premiums, as provided by Order of the Ministry of Health, Labour and Welfare, that special medical expenses will be paid when an insured person belonging to the household receives medical treatment from a health insurance-covered medical institution, etc. or receives designated home nursing from a designated home-nursing provider.
In the case where a householder, etc. in arrears with insurance premiums who is subject to the application of paragraph (1) or the main clause of paragraph (2) has paid the arrears of insurance premiums in full, or where it is found that there are special circumstances specified by Cabinet Order, such as a significant decrease in the amount in arrears pertaining to that person or a disaster, or where an insured person belonging to that household has become a person able to receive payment of general medical expenses for atomic bomb survivors, etc., when an insured person belonging to the household of the Householder or Society member who falls under these cases (in the case where an insured person belonging to the household of that householder, etc. in arrears with insurance premiums has become a person able to receive payment of general medical expenses for atomic bomb survivors, etc., limited to that insured person; the same applies hereinafter in this paragraph and the following paragraph) receives medical treatment from a health insurance-covered medical institution, etc. or receives designated home nursing from a designated home-nursing provider, Municipalities and Societies are to provide benefits for medical treatment to the insured person belonging to the household of that Householder or Society member, or pay expenses for Dietary Treatment for inpatients, etc. to that Householder or Society member.
市町村及び組合は、第一項又は第二項本文の規定の適用を受けている保険料滞納世帯主等が滞納している保険料を完納した場合若しくはその者に係る滞納額の著しい減少、災害その他の政令で定める特別の事情があると認められる場合又はその世帯に属する被保険者が原爆一般疾病医療費の支給等を受けることができる者となつた場合において、これらの場合に該当する世帯主又は組合員の世帯に属する被保険者（当該保険料滞納世帯主等の世帯に属する被保険者が原爆一般疾病医療費の支給等を受けることができる者となつた場合にあつては、当該被保険者に限る。以下この項及び次項において同じ。）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、当該世帯主若しくは組合員の世帯に属する被保険者に対し療養の給付を行い、又は当該世帯主若しくは組合員に対し入院時食事療養費等を支給する。
When providing benefits for medical treatment or paying expenses for Dietary Treatment for inpatients, etc. pursuant to the provisions of the preceding paragraph, Municipalities and Societies are to notify in advance the Householder or Society member who falls under the case prescribed in that paragraph, as provided by Order of the Ministry of Health, Labour and Welfare, that Benefits for Medical Treatment, etc. will be provided when an insured person belonging to the household receives medical treatment from a health insurance-covered medical institution, etc. or receives designated home nursing from a designated home-nursing provider.
The provisions of Article 64 of the Health Insurance Act and paragraph (3) of Article 36, Articles 40 and 41, paragraph (3) of Article 45, Article 45-2, paragraph (5) of Article 52, paragraph (2) of Article 53, paragraphs (3), (8) and (10) of Article 54-2, Article 54-2-2 and the preceding Article of this Act shall apply mutatis mutandis to medical treatment or designated home nursing covered by special medical expenses received at or from a health insurance-covered medical institution, etc. or a designated home-nursing provider and to the payment of special medical expenses associated with such medical treatment or designated home nursing. In this case, the phrase "The amount of medical expenses combined with treatment outside insurance coverage" in Article 53, paragraph (2) shall be deemed to be replaced with "The amount of special medical expenses" and the phrase "Article 86, paragraph (2), item (i) of the Health Insurance Act" in that paragraph shall be deemed to be replaced with "Article 76, paragraph (2) of the Health Insurance Act in the case where benefits for medical treatment can be received, those prescribed by the Minister of Health, Labour and Welfare pursuant to the provisions of Article 86, paragraph (2), item (i) of the same Act in the case where payment of medical expenses combined with treatment outside insurance coverage can be received, or those prescribed by the Minister of Health, Labour and Welfare pursuant to the provisions of Article 88, paragraph (4) of the same Act in the case where payment of medical expenses for home-nursing can be received", and any technical replacement of terms necessary for the other provisions shall be specified by Cabinet Order.
健康保険法第六十四条並びに本法第三十六条第三項、第四十条、第四十一条、第四十五条第三項、第四十五条の二、第五十二条第五項、第五十三条第二項、第五十四条の二第三項、第八項及び第十項、第五十四条の二の二並びに前条の規定は、保険医療機関等又は指定訪問看護事業者について受けた特別療養費に係る療養又は指定訪問看護及びこれらに伴う特別療養費の支給について準用する。この場合において、第五十三条第二項中「保険外併用療養費の額」とあるのは「特別療養費の額」と、「健康保険法第八十六条第二項第一号」とあるのは「、療養の給付を受けることができる場合は健康保険法第七十六条第二項の規定による厚生労働大臣の定めの例により、保険外併用療養費の支給を受けることができる場合は同法第八十六条第二項第一号の規定による厚生労働大臣の定めの例により、訪問看護療養費の支給を受けることができる場合は同法第八十八条第四項」と読み替えるほか、その他の規定に関し必要な技術的読替えは、政令で定める。
When the provisions of Article 54, paragraph (1) would apply to an insured person belonging to the household of a householder, etc. in arrears with insurance premiums who is subject to the application of paragraph (1) or the main clause of paragraph (2) if the insured person were not subject to the application of those provisions, Municipalities and Societies may pay medical expenses.
Where an insured person belonging to the household of a householder, etc. in arrears with insurance premiums who is subject to the application of paragraph (1) or the main clause of paragraph (2) has received any medical care or medication at or from a health insurance-covered medical institution, etc. without receiving confirmation of being an insured person by electronic eligibility confirmation, etc., and when it is found that the failure to receive such confirmation was due to an emergency situation or any other unavoidable reason, Municipalities and Societies shall pay medical expenses.
The provisions of Article 54, paragraphs (3) and (4) shall apply mutatis mutandis to the medical expenses under the preceding two paragraphs. In this case, the phrase "shall be received" in paragraph (4) of that Article shall be deemed to be replaced with "can be received".
Article 54-4Transport Expenses
第五十四条の四（移送費）
When an insured person has been transported to a hospital or clinic in order to receive benefits for medical treatment (including medical treatment covered by medical expenses combined with treatment outside insurance coverage and medical treatment covered by special medical expenses), Municipalities and Societies shall pay, as transport expenses, an amount calculated as provided by Order of the Ministry of Health, Labour and Welfare to the Householder or Society member of the household to which said insured person belongs.
市町村及び組合は、被保険者が療養の給付（保険外併用療養費に係る療養及び特別療養費に係る療養を含む。）を受けるため病院又は診療所に移送されたときは、当該被保険者の属する世帯の世帯主又は組合員に対し、移送費として、厚生労働省令で定めるところにより算定した額を支給する。
The transport expenses set forth in the preceding paragraph shall be paid only if a Municipality or Society finds it necessary, as provided by Order of the Ministry of Health, Labour and Welfare.