National Health Insurance Act

The National Health Insurance Act (Act No. 60 of 1938) is revised in its entirety.

The purpose of this Act is to ensure the sound administration of national health insurance services, thereby contributing to the improvement of social security and the health of the people.

National health insurance programs shall pay the necessary insurance benefits in relation to an insured persons' illness, injury, childbirth or death.

①A prefecture is to provide national health insurance, together with the Municipalities (including special wards; the same applies hereinafter) within that prefecture, pursuant to the provisions of this Act.

②National health insurance societies may provide a national health insurance program pursuant to the provisions of this Act.

①The national government is to take various necessary measures so that national health insurance services are administered soundly and, in order to contribute to the achievement of the purpose prescribed in Article 1, is to actively promote measures concerning health, medical care and welfare and other related measures.

②A prefecture is to play a central role in stable financial management, ensuring the efficient implementation of national health insurance services by Municipalities, and otherwise in the sound administration of the national health insurance services of the prefecture and of the Municipalities within that prefecture.

③A Municipality is to appropriately implement national health insurance services, including matters concerning the acquisition and loss of eligibility as an insured person, the collection of national health insurance premiums (including national health insurance tax under the Local Tax Act (Act No. 226 of 1950); the same applies in Article 11, paragraph (2), Article 54-3, paragraphs (1), (2) and (4), Article 63-2, Article 81-2, paragraph (1), each item, and paragraph (10), items (ii) and (iii), and Article 82-2, paragraph (2), items (ii) and (iii), and paragraph (6)), and the implementation of health services.

④In order to fulfill the responsibilities under the preceding two paragraphs, prefectures and Municipalities are to seek organic coordination with measures concerning health and medical services and welfare services and other related measures.

⑤In addition to what is prescribed in paragraph (2) and the preceding paragraph, a prefecture is to provide necessary guidance and advice to National Health Insurance Societies and other persons involved, so that the administration of national health insurance services is carried out appropriately and smoothly.

A person who has a domicile within the area of a prefecture is an insured person under the national health insurance provided by that prefecture together with the Municipalities within that prefecture.

Notwithstanding the provisions of the preceding Article, any person who falls under any of the following items shall not be classed as an insured person under the national health insurance provided by a prefecture together with the Municipalities within that prefecture (hereinafter referred to as the "national health insurance program provided by prefectures, etc."):

An insured person under the national health insurance program provided by prefectures, etc. shall become eligible as such on the day on which said person acquires domicile within the area of the prefecture or on the first day on which said person no longer falls under any of the items of the preceding Article.

①An insured person under the national health insurance program provided by prefectures, etc. shall lose eligibility for said health insurance from the day immediately following the day on which said person loses domicile within the area of the prefecture or from the day immediately following the first day on which said person falls under any of the items (excluding items (ix) and (x)) of Article 6; provided, however, that said insured person shall lose eligibility for said health insurance from the day on which said person loses domicile within the area of the prefecture if said person acquires domicile within the area of another prefecture on the same day.

②An insured person under the national health insurance program provided by prefectures, etc. shall lose eligibility as such from the first day on which said person falls under item (ix) or (x) of Article 6.

①A Householder must notify the Municipality of particulars regarding the acquisition and loss of eligibility for each insured person belonging to said person's household and other necessary particulars, as provided by Order of the Ministry of Health, Labour and Welfare.

②If all or some of the insured persons belonging to the same household as a Householder are in a situation where they are unable to undergo the electronic eligibility confirmation prescribed in Article 36, paragraph (3), said Householder may, as provided by Order of the Ministry of Health, Labour and Welfare, request the Municipality in which said Householder has a domicile to deliver a document stating the particulars specified by Order of the Ministry of Health, Labour and Welfare as information pertaining to the eligibility of the insured persons in that situation, or to provide those particulars by electronic or magnetic means (meaning a method using an electronic data processing system or other method using information and communications technology that is specified by Order of the Ministry of Health, Labour and Welfare; the same applies hereinafter in this paragraph through paragraph (4)). In this case, the Municipality is to, as provided by Order of the Ministry of Health, Labour and Welfare, promptly deliver the document to the Householder who requested the delivery of the document, and provide the particulars by electronic or magnetic means to the Householder who requested their provision by electronic or magnetic means.

③An insured person belonging to the same household as a Householder who has received the delivery of the document set forth in the preceding paragraph pursuant to the provisions of that paragraph, or who has been provided, by electronic or magnetic means, with the particulars specified by Order of the Ministry of Health, Labour and Welfare set forth in that paragraph, may receive the confirmation under the main clause of Article 36, paragraph (3) (including as applied mutatis mutandis pursuant to Article 52, paragraph (6), Article 52-2, paragraph (3), Article 53, paragraph (3) and Article 54-3, paragraph (6)) or Article 54-2, paragraph (3) (including as applied mutatis mutandis pursuant to Article 54-3, paragraph (6)) by presenting that document, or those particulars displayed by a method specified by Order of the Ministry of Health, Labour and Welfare.

④A Householder may, for the purpose of confirming the facts pertaining to the eligibility of all or some of the insured persons belonging to the household, as provided by Order of the Ministry of Health, Labour and Welfare, request the Municipality in which said Householder has a domicile to deliver a document stating those facts, or to provide the particulars to be stated in that document by electronic or magnetic means. In this case, the Municipality is to, as provided by Order of the Ministry of Health, Labour and Welfare, promptly deliver the document to the Householder who requested the delivery of the document, and provide the particulars to be stated in the document by electronic or magnetic means to the Householder who requested their provision by electronic or magnetic means.

⑤When any of the insured persons belonging to a household loses eligibility as such, the Householder must, as provided by Order of the Ministry of Health, Labour and Welfare, promptly notify the Municipality thereof.

⑥When a notification is received pursuant to the provisions of Articles 22 through 24, Article 25, Article 30-46 or Article 30-47 of the Residential Basic Book Act (Act No. 81 of 1967) (limited to cases when a supplementary note is appended to the document pertaining to said notification pursuant to the provisions of Article 28 of the same Act), a notification pursuant to the provisions of paragraph (1) or the preceding paragraph shall be considered to have been received for the same reason as that for the above notification.

⑦In addition to what is provided for in each of the preceding paragraphs, necessary particulars concerning notification pertaining to insured persons and confirmation concerning the eligibility of insured persons shall be prescribed by Order of the Ministry of Health, Labour and Welfare.

Each prefecture and Municipality must establish a special account for income and expenses related to national health insurance, as provided by Cabinet Order.

①In order to deliberate on matters concerning the administration of national health insurance services (limited to those pertaining to affairs that are to be handled by prefectures pursuant to the provisions of this Act and that are important matters such as the collection of payments for national health insurance services expenses under Article 75-7, paragraph (1) and the formulation of the prefectural national health insurance management policy under Article 82-2, paragraph (1)), a council for the administration of the national health insurance services of the prefecture is to be established in a prefecture.

②In order to deliberate on matters concerning the administration of national health insurance services (limited to those pertaining to affairs that are to be handled by Municipalities pursuant to the provisions of this Act and that are important matters such as insurance benefits under the provisions of Chapter IV and the collection of insurance premiums under Article 76, paragraph (1)), a council for the administration of the national health insurance services of the Municipality is to be established in a Municipality.

③The councils prescribed in the preceding two paragraphs may, in addition to what is prescribed in the preceding two paragraphs, deliberate on matters concerning the administration of national health insurance services (limited, in the case of the council prescribed in paragraph (1), to those pertaining to affairs that are to be handled by prefectures pursuant to the provisions of this Act, and limited, in the case of the council prescribed in the preceding paragraph, to those pertaining to affairs that are to be handled by Municipalities pursuant to the provisions of this Act).

④In addition to what is provided for in the preceding three paragraphs, necessary particulars concerning the councils prescribed in paragraphs (1) and (2) shall be prescribed by Cabinet Order.

①National health insurance societies (hereinafter referred to as a "Society") shall be organized by incorporating those who are engaged in the same kind of business or work and are domiciled in the same district of a Society as its members.

②The district of a Society set forth in the preceding paragraph shall consist of the area covered by one, or two or more Municipalities; provided, however, that this shall not apply if any special reason exists for not basing said district on such areas.

③Notwithstanding the provisions of paragraph (1), a person shall not be eligible as a Society member if said person falls under any of the items (excluding items (viii) and (x)) of Article 6 or is an insured person under any national health insurance program provided by another Society; provided, however, that this shall not apply if said person's household includes any person who does not fall under any of the items (excluding item (x)) of the same Article and who is not an insured person under any national health insurance program provided by another Society.

④Notwithstanding the provisions of paragraph (1), a person shall be eligible as a Society member if said person is employed by said Society, does not fall under any of the items (excluding items (viii) and (x)) of Article 6, and is not an insured person under any national health insurance program provided by another Society.

A Society shall be a corporation.

①A Society shall use the characters "国民健康保険組合" (pronounced "kokumin kenko hoken kumiai" (literally meaning "national health insurance society")) in its name.

②No person other than a Society may use the name "kokumin kenko hoken kumiai" or any name similar thereto.

The domicile of a Society shall be at the location of its principal office.

①The establishment of a Society must be subject to the authorization of the prefectural governor governing the area which is the location of its principal office.

②An application for the authorization set forth in the preceding paragraph shall be filed by preparing the Society's constitution, which shall be prepared by at least fifteen founders, and by obtaining consent thereto from at least three hundred persons who will become members of said Society.

③In the case where an application for the authorization set forth in paragraph (1) is filed, the prefectural governor shall, in advance, hear the opinions of the persons specified in each of the following items for the categories of Societies set forth in those items, and shall not give the authorization set forth in the same paragraph unless said prefectural governor finds that the establishment of the Society pertaining to the application for authorization will not hinder the administration of the national health insurance services of the prefectures whose areas include the district of said Society and of the Municipalities within those prefectures.

④In stating an opinion pursuant to the provisions of the preceding paragraph, the other prefectural governor must in advance hear the opinions of the heads of the Municipalities within the prefecture governed by that other prefectural governor (limited to Municipalities whose area includes the district of the Society pertaining to the application for the authorization set forth in paragraph (1)).

⑤A Society shall be incorporated at the time of authorization of its establishment.

The constitution of a Society must contain the particulars listed in the following items:

①A Society member and all persons belonging to said member's household shall be insured persons under the national health insurance program provided by said Society; provided, however, that this shall not apply to any person who falls under any of the items (excluding item (x)) of Article 6 or is an insured person under any national health insurance program provided by another Society.

②Notwithstanding the provisions of the preceding paragraph, a Society may, pursuant to the provisions of its constitution, choose not to grant status as an insured person collectively to all persons belonging to the household of a member of such Society.

An insured person under the national health insurance program provided by a Society shall become eligible as such on the day on which said person becomes a member of said Society or on the first day on which said person belongs to such member's household or on which said person no longer falls under any of the items (excluding item (x)) of Article 6 or on the day on which said person ceases to be an insured person under the National Health Insurance provided by another Society.

①An insured person under the national health insurance program provided by a Society shall lose eligibility as such from the day immediately following the day on which said person ceases to be a member of said Society or ceases to belong to such member's household or from the day immediately following the first day on which said person falls under any of the items (excluding items (ix) and (x)) of Article 6; provided, however, that if said insured person becomes an insured person under the national health insurance program provided by prefectures, etc. or the national health insurance program provided by another Society as a result of the fact that said person ceases to be a member of said Society or ceases to belong to such member's household, said person shall lose eligibility as such from the day on which said person ceases to be a member of such Society or ceases to belong to such member's household.

②An insured person under the national health insurance program provided by a Society shall lose eligibility as such from the first day on which said person falls under item (ix) of Article 6.

The provisions of Article 9 (excluding paragraph (6)) apply mutatis mutandis to notification concerning insured persons under the national health insurance program provided by a Society and confirmation concerning the eligibility of insured persons. In this case, the term "Householder" in paragraphs (1), (3) and (5) of that Article is deemed to be replaced with "Society member"; the term "the Municipality" in paragraphs (1) and (5) of that Article with "the Society"; the phrase "as a Householder" in paragraph (2) of that Article with "as a Society member"; the phrase "Householder may" in paragraphs (2) and (4) of that Article with "Society member may"; the phrase "the Municipality in which said Householder has a domicile" in paragraphs (2) and (4) of that Article with "the Society"; the phrase "the Municipality is to" in paragraphs (2) and (4) of that Article with "the Society is to"; and the phrase "the Householder who requested" in paragraphs (2) and (4) of that Article with "the Society member who requested".

①Each Society shall have directors and auditors as its officers.

②The fixed number of directors shall be five or more and the fixed number of auditors shall be two or more, and each of these fixed numbers shall be specified by the Society's constitution.

③All directors and auditors shall be appointed at a Society meeting from among Society members pursuant to the provisions of the Society's constitution; provided, however, that this shall not preclude directors and auditors from being appointed at a Society meeting from among persons other than Society members if any special circumstances exist.

④The respective terms of office of directors and auditors shall be specified by the Society's constitution within a period not exceeding three years.

①A director shall execute the operations of the Society and shall represent the Society pursuant to the provisions of its constitution.

②Unless otherwise specified by the constitution, a Society's operations shall be determined by the majority of all directors.

③An auditor shall audit the performance of business and the status of the property of the Society.

Restrictions on directors' authority of representation may not be asserted against a third party without knowledge of such restrictions.

A director may delegate their authority on a specific action to another person unless such delegation is prohibited by the Society's constitution or a resolution of a Society meeting.

In cases where there is any vacancy in the position of director and when damage is likely to occur due to a delay in business, the prefectural governor must appoint a provisional director at the request of any interested person or by said person's authority.

A director shall have no authority of representation as to any matter involving a conflict of interest between the Society and such director. In the event of such a conflict of interest, the prefectural governor must appoint a special agent at the request of any interested person or by said person's authority.

①When a valid Society meeting fails to take place or when a Society meeting fails to make a resolution on any matter on which a resolution needs to be made, the directors may, under the direction of the prefectural governor, handle such matter on which a resolution needs to be made.

②In cases where a matter on which a resolution needs to be made at a Society meeting must be implemented temporarily and urgently, when a valid Society meeting fails to take place or when there is no time to convene a Society meeting, then the directors may handle such matter on which a resolution needs to be made.

③Any disposition made pursuant to the provisions of the two preceding paragraphs must be reported by the directors at the first Society meeting convened thereafter.

①A Society shall have Society meetings.

②A Society meeting shall be composed of Society council members, whose fixed number shall be specified by its constitution within a range not less than one-twentieth of the total number of Society members; provided, however, that in cases where a Society has more than six hundred members in total, having at least thirty Society council members will suffice.

③Society council members shall be elected by Society members from among themselves pursuant to the provisions of the Society's constitution.

④The term of office of Society council members shall be specified by the Society's constitution within a period not exceeding three years.

①The matters listed in the following items must be determined through a Society meeting:

②A resolution on any of the matters listed in items (i), (ii) and (vi) of the preceding paragraph (in the case of the matters listed in items (i) and (ii) of the same paragraph, excluding changes to the Society's constitution pertaining to an expansion of the district of said Society which will continue to exist after a merger in order to include as part of its district that of another Society which will be dissolved as a result of the merger, and other matters specified by Ordinance of the Ministry of Health, Labour and Welfare) shall not become effective without the authorization of the prefectural governor.

③The provisions of Article 17, paragraphs (3) and (4) shall apply mutatis mutandis to the authorization set forth in the preceding paragraph with respect to changes to the Society's constitution pertaining to an expansion of the district of said Society.

④When a Society decides on the matter listed in paragraph (1), item (iii) or any of the matters specified by Ordinance of the Ministry of Health, Labour and Welfare as set forth in paragraph (2), it must promptly notify the prefectural governor thereof.

①Directors must, pursuant to the provisions of a Society's constitution, convene an ordinary Society meeting once annually.

②When a Society meeting member requests, upon the consent of no less than one-third of the fixed number of Society council members, the convocation of a Society meeting by submitting a document stating the subject matter of such meeting and the reasons for such convocation to said Society, the directors must convene an extraordinary Society meeting within twenty days from the day of such request.

Each Society member shall have the right to make a single vote in elections and on resolutions.

When voting on the relationship between a Society and a specific Society meeting member, said Society meeting member shall have no voting right.

①A Society meeting may inspect documents concerning the Society's affairs, may request reports from directors or auditors, or may inspect the management of affairs, the execution of decisions, or revenue and expenditure of the Society.

②A Society meeting may have a person appointed from among the Society council members carry out any of the matters under authority of the Society meeting as set forth in the preceding paragraph.

The provisions of Article 78 of the Act Concerning General Corporations and General Foundations (Act No. 48 of 2006) shall apply mutatis mutandis to a Society.

①A Society shall be dissolved for any of the reasons listed in the following items:

②Dissolution of a Society for the reason listed in item (i) or (ii) of the preceding paragraph must obtain authorization of the prefectural governor pursuant to the provisions of Ordinance of the Ministry of Health, Labour and Welfare.

①The residual assets of a dissolved Society shall be vested in the person, if any, designated by its constitution.

②When the Society's constitution fails to designate any person with whom rights should be vested, or fails to provide the means by which to designate such person, the directors may, with the permission of the prefectural governor, dispose of the assets of the Society for any purpose which is similar to that of said Society; provided, however, that this must require a resolution made at a Society meeting.

③Any asset which is not disposed of pursuant to the provisions of the two preceding paragraphs shall be vested in the national treasury.

A dissolved Society shall be deemed to continue to exist to the extent of the purpose of its liquidation, until the conclusion of its liquidation procedure.

When a Society has been dissolved, the directors shall become liquidators, except in the cases of a dissolution effected pursuant to a decision for the commencement of bankruptcy proceedings; provided, however, that this shall not apply if it is otherwise specified in the Society's constitution or if persons other than the directors have been appointed as liquidators at a Society meeting.

When there are no persons who qualify as liquidators pursuant to the provisions of the preceding Article or when any damage is likely to occur due to a vacancy in the position of liquidators, the court may appoint a liquidator(s) at the request of an interested person or a public prosecutor, or by the court's own authority.

When any material grounds exist, the court may dismiss a liquidator at the request of any interested person or a public prosecutor, or by the court's own authority.

①Except in the case of a decision for the commencement of bankruptcy proceedings or in the case of a dissolution order issued pursuant to the provisions of Article 108, paragraph (4) or (5), a liquidator must provide notification of their name and domicile and the cause and date of said dissolution to the prefectural governor.

②A liquidator who assumes office in the course of liquidation must provide notification of their name and domicile to the prefectural governor.

③The provisions of the preceding paragraph shall apply mutatis mutandis to any liquidator who assumes office as a result of a dissolution order issued pursuant to the provisions of Article 108, paragraph (4) or (5).

①The duties of a liquidator shall be as follows:

②A liquidator may perform any and all acts in order to perform the duties listed in the items of the preceding paragraph.

①A liquidator must, within two months from the day of assuming office and by giving public notice on at least three occasions, demand that the relevant creditors file their claims within a stated period. In this case, such notice period may not be less than two months.

②The public notice set forth in the preceding paragraph must include a statement to the effect that any claim of a creditor shall be excluded from the liquidation procedure unless said creditor files such claim within the stated period; provided, however, that the liquidator may not exclude any known creditor.

③The liquidator must make a demand to each known creditor to file said creditor's claim.

④The public notice set forth in paragraph (1) shall be effected by publication in the Official Gazette.

Any creditor who files a claim after the passing of the period set forth in paragraph (1) of the preceding Article shall be entitled to file a claim only with regard to the assets which, after all debts of the Society have been paid off, have not yet been delivered to the persons with vested rights.

①The dissolution and liquidation of a Society shall be subject to supervision of the court.

②The court may, by its own authority, conduct any inspection necessary for the supervision set forth in the preceding paragraph.

③A court supervising the dissolution and liquidation of a Society may seek the opinion of, or commission an investigation from a government agency supervising the operations of such Society.

④The government agency set forth in the preceding paragraph may state its opinion to the court set forth in the same paragraph.

Upon conclusion of a liquidation procedure, the liquidator must notify the prefectural governor thereof.

Cases concerning the supervision of the liquidation of a Society, and its liquidators, shall be under the exclusive jurisdiction of the district court which has jurisdiction over the location of the principal office of such Society.

No appeal may be entered against a judicial decision on the appointment of a liquidator.

In cases where the court has appointed a liquidator(s) pursuant to the provisions of Article 32-5, the court may specify the amount of remuneration to be paid by the Society to such liquidator(s). In this case, the court must hear statements from such liquidator(s) and the auditors.

①The court may appoint an inspector(s) to conduct necessary investigations for the supervision of the dissolution and liquidation of a Society.

②The provisions of the preceding two Articles shall apply mutatis mutandis to cases where the court has appointed an inspector(s) pursuant to the provisions of the preceding paragraph. In this case, the phrase "such liquidator(s) and the auditors" in the preceding Article shall be deemed to be replaced with "the Society and its inspector(s)".

①Any merger of a Society must be subject to a resolution to such effect at a Society meeting.

②In cases where Societies have merged together, the Society newly incorporated through the merger or the Society surviving the merger shall succeed to the rights and obligations of the Society or Societies extinguished through said merger (including the rights and obligations which said Society or Societies have in relation to their respective national health insurance services based on the permission, license, approval or any other disposition by an administrative agency).

In addition to what is provided for in this Chapter, necessary matters concerning the management of a Society, retention of its assets and other aspects of a Society shall be prescribed by Cabinet Order.

①Municipalities 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:

②Benefits for the following types of medical treatment shall not be included in the benefits set forth in the preceding paragraph:

③When 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.

①The rules applicable in cases where a health insurance-covered medical institution, etc. or a health insurance-covered physician or health insurance-covered pharmacist (meaning the health insurance-covered physician or health insurance-covered pharmacist as set forth in Article 64 of the Health Insurance Act; hereinafter the same shall apply) shall be in charge of benefits for medical treatment under a national health insurance program or shall provide medical care or prescription service under a national health insurance program, shall be governed by the same rules as those in the Order of the Ministry of Health, Labour and Welfare under Article 70, paragraph (1) and Article 72, paragraph (1) of that Act.

②In the case referred to in the preceding paragraph, when it is difficult or is not found appropriate for Ordinance of Ministry of Health, Labour and Welfare set forth in the same paragraph to govern such rules, said rules shall be prescribed by another Ordinance of the Ministry of Health, Labour and Welfare.

①Guidance by the Minister of Health, Labour and Welfare or the prefectural governor must be received by Health Insurance-Covered Medical Institutions, etc. with respect to benefits for medical treatment and by health insurance-covered physicians and health insurance-covered pharmacists with respect to medical care or prescription service provided under a national health insurance program.

②In cases where the guidance set forth in the preceding paragraph is provided, the Minister of Health, Labour and Welfare or the prefectural governor shall, when finding it necessary, have a person(s) with knowledge and experience of medical care or prescription service attend such guidance in accordance with the designation by concerned organizations; provided, however, that this shall not apply where such concerned organizations make no such designation or where the person(s) so designated fail to attend.

①A person who receives benefit for medical treatment in relation to an Health Insurance-Covered Medical Institution, etc. pursuant to the provisions of Article 36, paragraph (3) shall pay, in accordance with the categories listed in the following items, an amount obtained by multiplying the amount calculated pursuant to the provisions of Article 45, paragraph (2) or (3) with respect to such benefit by the ratio listed in the relevant item below, as said person's co-payment to such Health Insurance-Covered Medical Institution, etc. when receiving such benefit:

②A health insurance-covered medical institution, etc. shall receive the co-payment set forth in the preceding paragraph (or, when the ratio of co-payment is reduced pursuant to the provisions of Article 43, paragraph (1), the co-payment calculated in accordance with the ratio after such reduction in the case of a health insurance-covered medical institution, etc. set forth in paragraph (2) of the same Article or, when the measure set forth in Article 44, paragraph (1), item (i) is taken, the co-payment after the relevant reduction) and, when an insured person fails to make all or part of such co-payment despite efforts of the health insurance-covered medical institution, etc. to receive such payment with the same care as due care of a prudent manager, Municipalities and Societies may impose a disposition on such insured person pursuant to the same rules as those for the monies to be collected pursuant to the provisions of this Act, at the request of such health insurance-covered medical institution, etc.

In cases where co-payment shall be made pursuant to the provisions of paragraph (1) of the preceding Article, any fraction of less than five yen in the amount of co-payment set forth in the same paragraph shall be rounded down to the nearest ten yen, whereas any fraction of more than five yen and less than ten yen shall be rounded up to the nearest ten yen.

①Municipalities and Societies may, pursuant to Cabinet Order provisions, reduce the ratio of co-payment set forth in Article 42, paragraph (1) by Municipal Ordinance or by constitution.

②When the ratio of co-payment is reduced pursuant to the provisions of the preceding paragraph, it shall be sufficient for an insured person who receives benefits for medical treatment in relation to one of the health insurance-covered medical institutions, etc. designated by a Municipality or Society with the consent of their respective establishers, to pay co-payment calculated in accordance with the ratio after such reduction to such health insurance-covered medical institution, etc., notwithstanding the provisions of Article 42, paragraph (1).

③In cases where the ratio of co-payment has been reduced pursuant to the provisions of paragraph (1) and when an insured person has received benefits for medical treatment at or from a health insurance-covered medical institution, etc. which is not one of those set forth in the preceding paragraph, Municipalities and Societies must pay to such insured person the difference between the amount of co-payment paid by such insured person to the health insurance-covered medical institution, etc. pursuant to the provisions of Article 42, paragraph (1) and the amount of co-payment calculated pursuant to the ratio after the reduction made pursuant to the provisions of paragraph (1).

④The provisions of the preceding Article shall apply mutatis mutandis to the making of co-payment in the case set forth in paragraph (2).

①Municipalities and Societies may take any of the measures listed in the following items with respect to any insured person who is under special circumstances and for whom it is found difficult to make co-payment to a health insurance-covered medical institution, etc. pursuant to the provisions of Article 42 or the preceding Article:

②Notwithstanding the provisions of paragraph (1) of Article 42 and paragraph (2) of the preceding Article, where the measure set forth in item (i) of the preceding paragraph has been taken with respect to an insured person, it shall be sufficient for said person to pay the amount of co-payment so reduced to the relevant Health Insurance-Covered Medical Institution, etc., and where the measure set forth in item (ii) or (iii) has been taken with respect to an insured person, said person shall not be required to make co-payment to the relevant Health Insurance-Covered Medical Institution, etc.

③The provisions of Article 42-2 shall apply mutatis mutandis to the making of co-payment in the case set forth in the preceding paragraph.

①Municipalities and Societies must pay to health insurance-covered medical institutions, etc. expenses relating to benefits for medical treatment. The amount of expenses which may be claimed by a health insurance-covered medical institution, etc. from a Municipality or Society in relation to benefits for medical treatment shall be calculated by deducting the amount of any co-payment payable to such health insurance-covered medical institution, etc. by the insured person (or the Householder or Society member of the household to which such insured person belongs in the case set forth in Article 57) in relation to the benefits for medical treatment from the amount of expenses incurred in providing said benefits for medical treatment.

②Calculation of the amount of expenses incurred in providing the benefits for medical treatment set forth in the preceding paragraph shall be governed by the same rules as those prescribed by the Minister of Health, Labour and Welfare pursuant to the provisions of Article 76, paragraph (2) of the Health Insurance Act.

③Municipalities and Societies may, with the authorization of the prefectural governor, specify otherwise in a contract with a health insurance-covered medical institution, etc. with respect to the amount of expenses incurred in providing the benefits for medical treatment set forth in paragraph (1) for the medical treatment to be provided at such health insurance-covered medical institution, etc., within the range of the amount calculated pursuant to the provisions of the preceding paragraph.

④Upon receipt of a claim by a health insurance-covered medical institution, etc. for expenses incurred in providing benefits for medical treatment, Municipalities and Societies shall make payment after conducting an examination according to the rules set forth in Article 40, and according to the method for calculating the amount set forth in paragraph (2), and the provisions of the preceding paragraph.

⑤Municipalities and Societies may entrust affairs concerning the examination and payment pursuant to the provisions of the preceding paragraph to a Federation of National Health Insurance Associations whose jurisdiction covers the area of a prefecture (excluding any such Federation the number of whose member prefectures, Municipalities and Societies is less than two-thirds of the total number of prefectures, Municipalities and Societies located within its jurisdiction) or the Medical Information Infrastructure and Medical Fee Examination and Payment Organization (hereinafter referred to as "the organization") under the Act on the Medical Information Infrastructure and Medical Fee Examination and Payment Organization (Act No. 129 of 1948).

⑥Of the affairs concerning the review of medical bills conducted by a Federation of National Health Insurance Associations as entrusted pursuant to the provisions of the preceding paragraph or those of Article 76, paragraph (5) of the Health Insurance Act, those concerned with the review of such medical bills as specified by the Minister of Health, Labour and Welfare may be entrusted by such Federation of National Health Insurance Associations to any of those general incorporated associations or general foundations designated by the Minister of Health, Labour and Welfare as those meeting the requirements specified by Ordinance of the Ministry of Health, Labour and Welfare in terms of the organization involved in such review and other matters, and as capable of conducting such affairs in a proper and reliable manner.

⑦An entity to which affairs concerning the review of medical bills as specified by the Minster of Health, Labour and Welfare pursuant to the provisions of the preceding paragraph have been entrusted must have the review of such medical bills conducted by a person who meets the requirements specified by Ordinance of the Ministry of Health, Labour and Welfare.

⑧In addition to what is provided for in each of the preceding paragraphs, necessary particulars concerning claims for expenses incurred in providing benefits for medical treatment by Health Insurance-Covered Medical Institutions, etc. shall be prescribed by Ordinance of the Ministry of Health, Labour and Welfare.

①When the Minister of Health, Labour and Welfare or a prefectural governor finds it necessary in relation to benefits for medical treatment, said minister or governor may order a Health Insurance-Covered Medical Institution, etc. or any of the persons who were establishers or administrators, health insurance-covered physicians, health insurance-covered pharmacists or other employees of a Health Insurance-Covered Medical Institution, etc. (hereinafter referred to as "Former Establishers, etc." in this paragraph) to make a report or submit or present medical records or other books and other documents, may request any of the establishers, administrators, health insurance-covered physicians, health insurance-covered pharmacists or other employees of a Health Insurance-Covered Medical Institution, etc. (including Former Establishers, etc.) to appear, or may have personnel question persons involved or inspect any equipment or medical records, the books and other documents or other articles of such Health Insurance-Covered Medical Institution, etc.

②In cases where questions are asked or inspections are conducted pursuant to the provisions of the preceding paragraph, the relevant personnel must carry an identification card and present it at the request of any person concerned.

③The authority under paragraph (1) must not be construed as being granted for criminal investigation.

④The provisions of Article 41, paragraph (2) shall apply mutatis mutandis to questions asked or inspections conducted pursuant to the provisions of paragraph (1).

⑤When a prefectural governor finds it necessary that a disposition be made pursuant to the provisions of Article 80 of the Health Insurance Act with respect to a Health Insurance-Covered Medical Institution, etc. in relation to benefits for medical treatment provided under this Act or that a disposition be made pursuant to the provisions of Article 81 of the Health Insurance Act with respect to a health insurance-covered physician or health insurance-covered pharmacist in relation to medical care or prescription service provided under this Act, said governor must notify the Minister of Health, Labour and Welfare thereof, together with the reason therefor.

The provisions of Article 64 and Article 82, paragraph (1) of the Health Insurance Act shall apply mutatis mutandis to benefits for medical treatment provided under this Act. In this case, any technical replacement of terms necessary for these provisions shall be specified by Cabinet Order.

①With respect to expenses incurred in Dietary Treatment received by an insured person (excluding a Person Specified as Hospitalized Long-term and Insured) in combination with the medical treatment listed in Article 36, paragraph (1), item (v) at or from the health insurance-covered medical institution of said person's choice, Municipalities and Societies shall pay expenses for Dietary Treatment for inpatients to the Householder or Society member of the household to which said insured person belongs; 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 expenses for Dietary Treatment for inpatients shall be calculated by deducting the amount of standard co-payment for Dietary Treatment set forth in Article 85, paragraph (2) of the Health Insurance Act (hereinafter simply referred to as "Standard Co-payment for Dietary Treatment") from the amount of expenses calculated for said Dietary Treatment in accordance with the standards set by the Minister of Health, Labour and Welfare pursuant to the provisions of the same paragraph (or, when said amount exceeds the amount of expenses actually incurred for said Dietary Treatment, the amount of expenses actually incurred for said Dietary Treatment).

③When an insured person has received Dietary Treatment at or from a health insurance-covered medical institution, Municipalities and Societies may, on behalf of the Householder or Society member of the household to which said insured person belongs, pay to said health insurance-covered medical institution expenses incurred for said Dietary Treatment payable by such Householder or Society member to said health insurance-covered medical institution, within the limit of the amount payable to such Householder or Society member as expenses for Dietary Treatment for inpatients.

④When a payment has been made pursuant to the provisions of the preceding paragraph, the Householder or Society member shall be deemed to have received expenses for Dietary Treatment for inpatients.

⑤Upon acceptance of a payment of expenses incurred for Dietary Treatment, the Health Insurance-Covered Medical Institution must, pursuant to the provisions of Ordinance of the Ministry of Health, Labour and Welfare, issue a receipt therefor to the Householder or Society member who makes such payment.

⑥The 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 and Article 45-2 of this Act shall apply mutatis mutandis to Dietary Treatment received at or from an Health Insurance-Covered Medical Institution and to the payment of expenses for Dietary Treatment for inpatients associated with such treatment. In this case, any technical replacement of terms necessary for these provisions shall be specified by Cabinet Order.

①With respect to expenses incurred in Living Support received by a Person Specified as Hospitalized Long-term and Insured in combination with the medical treatment listed in Article 36, paragraph (1), item (v) at or from the health insurance-covered medical institution of said person's choice, Municipalities and Societies shall pay Living Support expenses for inpatients to the Householder or Society member of the household to which such Person Specified as Hospitalized Long-term and Insured belongs; 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 such Person Specified as Hospitalized Long-term and Insured.

②The amount of Living Support expenses for inpatients shall be calculated by deducting the amount of Standard Co-payment for Dietary Treatment set forth in Article 85-2, paragraph (2) of the Health Insurance Act (hereinafter referred to as "Standard Living Expense Co-payment") from the Living Support expenses calculated in accordance with the standards set by the Minister of Health, Labour and Welfare pursuant to the provisions of the same paragraph (or, when said amount exceeds the actual amount of Living Support expenses, such actual amount of Living Support expenses).

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 the preceding Article of this Act shall apply mutatis mutandis to Living Support received at or from a Health Insurance-Covered Medical Institution and to the payment of Living Support expenses for inpatients associated with such treatment. In this case, any technical replacement of terms necessary for these provisions shall be specified by Cabinet Order.

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).

①Municipalities and Societies, when they find it difficult to pay benefits for medical treatment or expenses for Dietary Treatment for inpatients, Living Support expenses for inpatients or medical expenses combined with treatment outside insurance coverage (hereinafter referred to as "Benefits for Medical Treatment, etc." in this paragraph and the following paragraph), or when, in cases where an insured person has received any medical care, medication or treatment at or from a hospital, clinic, pharmacy or any other person other than a health insurance-covered medical institution, etc., a Municipality or Society finds it unavoidable, may pay medical expenses in lieu of Benefits for Medical Treatment, etc.; provided, however, that this shall not apply during any period in which the Householder or Society member of the household to which said insured person belongs is subject to the application of Article 54-3, paragraph (1) or the main clause of paragraph (2) with respect to said insured person.

②Where an insured person 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 Municipalities and Societies find that the failure to receive such confirmation was due to an emergency or any other unavoidable reason, they shall pay medical expenses in lieu of Benefits for Medical Treatment, etc.; provided, however, that this shall not apply during any period in which the Householder or Society member of the household to which said insured person belongs is subject to the application of Article 54-3, paragraph (1) or the main clause of paragraph (2) with respect to said insured person.

③The amount of medical expenses shall be determined by the Municipality or Society based on the amount calculated by deducting, from the amount calculated for such medical treatment (excluding Dietary Treatment and Living Support), the amount calculated by multiplying such amount by the applicable ratio listed in the items of paragraph (1) of Article 42, in accordance with the categories listed in the items of the same paragraph, and the amount calculated by deducting, from the amount of expenses calculated for such Dietary Treatment or Living Support, the amount of Standard Co-payment for Dietary Treatment or Standard Living Expense Co-payment, respectively.

④In calculating the amount of expenses set forth in the preceding paragraph, the provisions of Article 45, paragraph (2) shall apply mutatis mutandis to cases where benefit for medical treatment shall be received, those of Article 52, paragraph (2) shall apply mutatis mutandis to cases where expenses for Dietary Treatment for inpatients shall be received, those of Article 52-2, paragraph (2) shall apply mutatis mutandis to cases where expenses for Living Support for inpatients shall be received, and those of paragraph (2) of the preceding Article shall apply mutatis mutandis to cases where medical expenses combined with treatment outside insurance coverage shall be received; provided, however, that such amount shall not exceed the amount of expenses actually incurred in the relevant medical treatment.

①When 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; hereinafter the same shall apply), designated home nursing (meaning the designated home nursing as set forth in that paragraph; hereinafter the same shall apply), Municipalities and Societies shall pay medical expenses for home-nursing to the Householder or Society member of the household to which said insured person belongs with respect to expenses incurred in such designated home nursing; 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 medical expenses for home-nursing 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.

③When an insured person seeks to receive designated home nursing, the insured person is to, as provided by Order of the Ministry of Health, Labour and Welfare, receive confirmation of being an insured person from the designated home-nursing provider of the insured person's choice by electronic eligibility confirmation, etc., and receive that designated home nursing.

④The amount of medical expenses for home-nursing shall be calculated by deducting, from the amount calculated for such designated home-nursing in accordance with the rules prescribed by the Minister of Health, Labour and Welfare pursuant to the provisions of Article 88, paragraph (4) of the Health Insurance Act, the amount calculated by multiplying such amount by the applicable ratio listed in the items of paragraph (1) of Article 42, in accordance with the categories listed in the items of the same paragraph (or, when the ratio for co-payment has been reduced pursuant to the provisions of Article 43, paragraph (1), the ratio after such reduction) (or, when any of the measures listed in the items of paragraph (1) of Article 44 needs be taken with respect to the co-payment set forth in Article 42, paragraph (1) for benefits for the medical treatment, the amount calculated as if the relevant measures were taken).

⑤When an insured person has received designated home nursing at or from a designated home-nursing provider, Municipalities and Societies may, on behalf of the Householder or Society member of the household to which said insured person belongs, pay to said designated home-nursing provider expenses incurred in said designated home nursing that are payable by that Householder or Society member to said designated home-nursing provider, within the limit of the amount payable to that Householder or Society member as medical expenses for home-nursing.

⑥When a payment is made pursuant to the provisions of the preceding paragraph, the Householder or Society member shall be deemed to have received medical expenses for home-nursing.

⑦The provisions of Article 42-2 shall apply mutatis mutandis to the payment of the amount calculated by deducting, from the amount of expenses calculated pursuant to the provisions of paragraph (4) in the case set forth in paragraph (5), the amount payable as medical expenses for home-nursing with respect to expenses incurred in the relevant designated home-nursing.

⑧Upon acceptance of the payment of expenses incurred in designated home-nursing, the designated home-nursing provider must, pursuant to the provisions of Ordinance of the Ministry of Health, Labour and Welfare, issue a receipt therefor to the Householder or Society member who makes such payment.

⑨Upon receipt of a claim by a designated home-nursing provider for medical expenses for home-nursing, Municipalities and Societies shall make payment after conducting an examination according to the method for calculating the amount set forth in paragraph (4) and the rules set forth in the following paragraph.

⑩The rules for cases where a designated home-nursing provider provides designated home-nursing under a national health insurance program shall be governed by the standards for the operation of a designated home-nursing provider prescribed in Article 92, paragraph (2) of the Health Insurance Act (limited to the provisions concerning the handling of designated home-nursing) and, when it is difficult or is not found appropriate for said standards to govern such rules, said rules shall be prescribed by Ordinance of the Ministry of Health, Labour and Welfare.

⑪No designated home-nursing shall be included in any of the types of medical treatment listed in the items of paragraph (1) of Article 36.

⑫The provisions of paragraph (3) of Article 92 of the Health Insurance Act and paragraphs (5) through (8) of Article 45 of this Act shall apply mutatis mutandis to designated home-nursing received at or from a designated home-nursing provider and the payment of medical expenses for home-nursing associated with such service. In this case, any technical replacement of terms necessary for these provisions shall be specified by Cabinet Order.

Guidance by the Minister of Health, Labour and Welfare or prefectural governors must be received by each designated home-nursing provider and nurses and other employees at the office relevant to its designation with respect to designated home-nursing.

①When the Minister of Health, Labour and Welfare or a prefectural governor finds it necessary in relation to the payment of medical expenses for home-nursing, said minister or governor may order a designated home-nursing provider or an entity which was a designated home-nursing provider or any of the persons who were nurses or other employees at the office relevant to such designation (hereinafter referred to as a "Former Designated Home-nursing Business, etc." in this paragraph) to make a report or submit or present the books and other documents, may request a designated home-nursing provider or nurses or other employees at the office relevant to its designation (including Former Designated Home-nursing Businesses, etc.) to appear, or may have personnel question persons involved or inspect the books and other documents or other articles of such designated home-nursing provider at the office relevant to its designation.

②The provisions of Article 45-2, paragraph (2) shall apply mutatis mutandis to questions asked or inspections conducted pursuant to the provisions of the preceding paragraph, and the provisions of paragraph (3) of the same Article shall apply mutatis mutandis to the authority under the provisions of the preceding paragraph.

③When a prefectural governor finds it necessary that a disposition be made pursuant to the provisions of Article 95 of the Health Insurance Act with respect to a designated home-nursing provider in relation to designated home-nursing provided under this Act, said governor must notify the Minister of Health, Labour and Welfare thereof, together with the reason therefor.

①In 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)).

②Even 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.

③When 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.

④In 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.

⑤When 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.

⑥The 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.

⑦When 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.

⑧Where 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.

⑨The 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".

①When 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.

②The 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.

①In 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.

②Payment 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:

③Payment 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.

④Payment 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.

①Payment of benefits for medical treatment or 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 shall not be made in cases where the insured person is eligible for any benefit relating to medical services pursuant to the provisions of the Health Insurance Act, the Mariners Insurance Act, the National Public Officers Mutual Aid Association Act (including cases where applied mutatis mutandis pursuant to other Acts or where the same rule governs), the Local Public Officers, etc. Mutual Aid Association Act or the Act on Assurance of Medical Care for Elderly People or where said person is eligible for any benefit corresponding to each of the above benefits pursuant to the provisions of the Long-Term Care Insurance Act, in each case with respect to said person's relevant illness or injury. The same shall apply when such person is eligible for any medical compensation pursuant to the provisions of the Labor Standards Act (Act No. 49 of 1947), any medical compensation benefits, medical treatment benefits for multiple-job workers or medical treatment benefits under the provisions of the Industrial Accident Compensation Insurance Act (Act No. 50 of 1947), any medical compensation under the provisions of the National Public Officers' Accident Compensation Act (Act No. 191 of 1951; including cases where applied mutatis mutandis pursuant to any other Act), any medical compensation under the provisions of the Local Public Officers Accident Compensation Act (Act No. 121 of 1967) or a Prefectural or Municipal Ordinance under the same Act or any other benefit relating to medical services under any law or regulation as prescribed by Cabinet Order, or when any benefit relating to medical care is provided at the expense of the national government or a local government pursuant to any law or regulation other than these laws and regulations.

②In cases where benefits under any law or regulation set forth in the preceding paragraph are benefits in kind relating to medical services and when any co-payment is made or actual costs are collected in relation to such benefits and when the amount of such co-payment or actual costs collected exceeds the amount of co-payment which would have been required under this Act had such benefits been provided as benefits for medical treatment pursuant to this Act (or, when the ratio of co-payment set forth in Article 42, paragraph (1) has been reduced pursuant to the provisions of Article 43, paragraph (1), the amount of co-payment calculated in accordance with the ratio after such reduction), or in cases where benefits under any law or regulation set forth in the preceding paragraph (excluding the Long-Term Care Insurance Act) are payments of medical expenses and when the amount of such payment is less than the amount of expenses for Dietary Treatment for inpatients, expenses for Living Support for inpatients, medical expenses combined with treatment outside insurance coverage, medical expenses, medical expenses for home-nursing, special medical expenses or transportation expenses which would have been payable had expenses for Dietary Treatment for inpatients, expenses for Living Support for inpatients, medical expenses combined with treatment outside insurance coverage, medical expenses, medical expenses for home-nursing, special medical expenses or transportation expenses been required pursuant to this Act with respect to the relevant medical treatment, then Municipalities and Societies shall pay to the insured person the difference between the relevant amounts in each case.

③In the case referred to in the preceding paragraph, when the insured person has received the relevant medical treatment at or from a health insurance-covered medical institution, etc., Municipalities and Societies may, on behalf of such insured person, pay to such health insurance-covered medical institution, etc. expenses incurred in such medical treatment payable by said insured person to said health insurance-covered medical institution, etc. within the limits of the amount payable to said insured person pursuant to the provisions of the same paragraph; provided, however, that when the Municipality or Society concerned has reduced the ratio of co-payment pursuant to the provisions of Article 43, paragraph (1), the foregoing shall apply only where such insured person has received such medical treatment at or from one of the health insurance-covered medical institutions, etc. set forth in paragraph (2) of the same Article.

④When a payment of expenses is made to the relevant Health Insurance-Covered Medical Institution, etc. pursuant to the provisions of the preceding paragraph, the insured person shall, to the extent of such payment, be deemed to have received a payment pursuant to the provisions of paragraph (2).

In making any co-payment or in paying any difference or medical expenses pursuant to the provisions of paragraph (3) of Article 43 or paragraph (2) of the preceding Article, when the relevant illness or injury is of an insured person who is not the Householder or Society member, the Householder or Society member of the household to which such insured person belongs shall make, or be obligated to make, co-payment and shall receive payment of the difference or medical expenses pursuant to paragraph (3) of Article 43 or paragraph (2) of the preceding Article, notwithstanding the provisions of the respective Articles pertaining to these matters.

①When the amount of co-payment paid for benefits for medical treatment, or the amount obtained by deducting, from the amount of expenses incurred in medical treatment (excluding Dietary Treatment and Living Support; hereinafter the same shall apply in the following paragraph), the amount paid as medical expenses combined with treatment outside insurance coverage, medical expenses, medical expenses for home-nursing or special medical expenses with respect to expenses incurred in the relevant medical treatment or the amount equivalent to the difference paid pursuant to the provisions of Article 56, paragraph (2) (in paragraph (1) of the following Article referred to as the "amount of co-payment, etc."), is extremely large, Municipalities and Societies shall pay high-cost medical expenses to the relevant Householder or Society member; provided, however, that this shall not apply if no benefit for medical treatment, medical expenses combined with treatment outside insurance coverage, medical expenses, medical expenses for home-nursing or special medical expenses were paid and no difference was paid pursuant to the provisions of Article 56, paragraph (2) with respect to the relevant medical treatment.

②The requirements for payment and the amount of high-cost medical expenses and other necessary matters concerning the payment of high-cost medical expenses shall be prescribed by Cabinet Order by taking into consideration the impact of the burden of the expenses incurred in the relevant medical treatment on household finances, in particular the household finances of persons who continuously receive medical treatment over a long period, and the amount of expenses incurred in the medical treatment.

①When the total sum of the amount of co-payment, etc. (or, where high-cost medical expenses set forth in paragraph (1) of the preceding Article are paid, the amount obtained by deducting the amount equivalent to the amount so paid), the amount to be borne by a user of Long-Term Care Service pursuant to the provisions of Article 51, paragraph (1) of the Long-Term Care Insurance Act (or, where expenses for High-Cost Long-Term Care Service set forth in the same paragraph are paid, the amount obtained by deducting the amount so paid) and the amount to be borne by a user of Preventive Long-Term Care Service pursuant to the provisions of Article 61, paragraph (1) of the same Act (or, where expenses for High-Cost Preventive Long-Term Care Service set forth in the same paragraph are paid, the amount obtained by deducting the amount so paid) is extremely large, Municipalities and Societies shall pay expenses for high-cost medical treatment combined with long-term care to the relevant Householder or Society member; provided, however, that this shall not apply if no benefit for medical treatment, medical expenses combined with treatment outside insurance coverage, medical expenses, medical expenses for home-nursing or special medical expenses were paid and no difference was paid pursuant to the provisions of Article 56, paragraph (2) with respect to the medical treatment relevant to such amount of co-payment, etc.

②The provisions of paragraph (2) of the preceding Article shall apply mutatis mutandis to the payment of medical expenses combined with high-cost long-term care.

①With respect to an insured person's childbirth or death, Municipalities and Societies shall make a childbirth and childcare lump sum payment or pay funeral expenses or grant benefits for funeral services pursuant to the provisions of Municipal Ordinance or constitution; provided, however, that they may refrain from taking all or part of these measures when any special reason exists.

②In addition to the insurance benefits set forth in the preceding paragraph, Municipalities and Societies may pay injury and illness benefits or provide any other insurance benefit pursuant to the provisions of Municipal Ordinance or constitution.

③Municipalities and Societies may entrust affairs concerning the payment of the insurance benefits set forth in paragraph (1) and the injury and illness benefits set forth in the preceding paragraph to a Federation of National Health Insurance Associations or the organization.

Where a current or former insured person falls under any of the following items, no benefits for medical treatment or benefit for medical expenses for Dietary Treatment for inpatients, Living Support expenses for inpatients, medical expenses combined with treatment outside insurance coverage, medical expenses for home-nursing, special medical expenses or transport expenses (hereinafter referred to as "Benefits for Medical Treatment, etc." in this Section) shall be provided for the relevant period:

When an insured person suffers illness or injury intentionally, or due to said person committing a criminal act intentionally, no Benefits for Medical Treatment, etc. shall be paid for such illness or injury.

When an insured person suffers illness or injury due to a conflict, state of drunkenness or extreme misconduct, Benefits for Medical Treatment, etc. for such illness or injury may not be paid in whole or in part.

When a current or former insured person fails to follow instructions concerning medical treatment without a justifiable reason for not doing so, Municipalities and Societies may refrain from providing part of the applicable Benefits for Medical Treatment, etc.

When a current or former insured person or a person who is to receive insurance benefits fails to comply with an order issued pursuant to the provisions of Article 66 or refuses to answer questions or to undergo a medical examination without a justifiable reason for not doing so, Municipalities and Societies may refrain from providing all or part of the applicable Benefits for Medical Treatment, etc.

①In cases where a Householder or Society member who is eligible for insurance benefits (including the payment of a difference pursuant to the provisions of Article 43, paragraph (3) or Article 56, paragraph (2); hereinafter the same shall apply) has become delinquent in the payment of insurance premiums and where said person still fails to pay said 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 said insurance premiums even though the Municipality or Society concerned has carried out encouragement of insurance premium payment, etc., Municipalities and Societies shall temporarily suspend the payment of insurance benefits in whole or in part, as provided by Order of the Ministry of Health, Labour and Welfare, unless a disaster or any other special circumstances specified by Cabinet Order are deemed to exist under which such insurance premiums failed to be paid.