Supplementary Provisions, Article 5
第五条
With respect to the cost required for the provision of benefits for medical treatment and the payment of expenses for Dietary Treatment for inpatients, Living Support expenses for inpatients, medical expenses combined with treatment outside insurance coverage, medical expenses, medical expenses for home-nursing, special medical expenses, transport expenses, high-cost medical expenses and expenses for high-cost medical treatment combined with long-term care that are provided on or after the Effective Date to a person who, on the day before the Effective Date, is a retired insured person, etc. (meaning a retired insured person, etc. prescribed in Article 7, paragraph (1) of the Supplementary Provisions of the National Health Insurance Act before amendment by the provisions of Article 4 (referred to as the "National Health Insurance Act Before the Article 4 Amendment" in the following paragraph through paragraph (5)); the same applies hereinafter in this paragraph) (hereinafter referred to as the "cost incurred in providing benefits for medical treatment, etc." in this paragraph), and with respect to the portion claimed on or after the Effective Date of the cost incurred in providing benefits for medical treatment, etc. provided before the Effective Date to a person who was a retired insured person, etc. before the Effective Date, the provisions of Chapter V of the National Health Insurance Act apply by deeming them to be the cost incurred in providing benefits for medical treatment, etc. borne by the prefecture and the Municipality (including special wards) in which those persons have their domicile.
施行日の前日において退職被保険者等（第四条の規定による改正前の国民健康保険法（次項から第五項までにおいて「第四条改正前国保法」という。）附則第七条第一項に規定する退職被保険者等をいう。以下この項において同じ。）である者に対し施行日以後に行われる療養の給付並びに入院時食事療養費、入院時生活療養費、保険外併用療養費、療養費、訪問看護療養費、特別療養費、移送費、高額療養費及び高額介護合算療養費の支給に要する費用（以下この項において「療養の給付等に要する費用」という。）並びに施行日前に退職被保険者等であった者に対し施行日前に行われた療養の給付等に要する費用のうち施行日以後に請求されるものについては、これらの者が住所を有する都道府県及び市町村（特別区を含む。）が負担する療養の給付等に要する費用とみなして、国民健康保険法第五章の規定を適用する。
With respect to the portion claimed on or after the Effective Date of the cost required for the provision of benefits for medical treatment and the payment of expenses for Dietary Treatment for inpatients, Living Support expenses for inpatients, medical expenses combined with treatment outside insurance coverage, medical expenses, medical expenses for home-nursing, transport expenses, dependent medical expenses, dependent medical expenses for home-nursing, dependent transport expenses, high-cost medical expenses and expenses for high-cost medical treatment combined with long-term care that were provided before the Effective Date to a person who was a special retired insured person, etc. (meaning a special retired insured person prescribed in Article 21, paragraph (1) of the Supplementary Provisions of the National Health Insurance Act Before the Article 4 Amendment and that person's dependents) before the Effective Date (hereinafter in this paragraph referred to as the "costs of benefits for medical treatment, etc. for special retired insured persons, etc."), the provisions of Chapter VII of the Health Insurance Act apply by deeming it to be the costs of benefits for medical treatment, etc. for special retired insured persons, etc. borne by the health insurance Society to which those persons belong.
施行日前に特例退職被保険者等（第四条改正前国保法附則第二十一条第一項に規定する特例退職被保険者及びその被扶養者をいう。）であった者に対し施行日前に行われた療養の給付並びに入院時食事療養費、入院時生活療養費、保険外併用療養費、療養費、訪問看護療養費、移送費、家族療養費、家族訪問看護療養費、家族移送費、高額療養費及び高額介護合算療養費の支給に要する費用（以下この項において「特例退職被保険者等に係る療養の給付等に要する費用」という。）のうち施行日以後に請求されるものについては、これらの者が加入する健康保険組合が負担する特例退職被保険者等に係る療養の給付等に要する費用とみなして、健康保険法第七章の規定を適用する。
With regard to the subsidy for medical treatment benefit expenses, etc. (meaning the subsidy for medical treatment benefit expenses, etc. under Article 7, paragraph (1) of the Supplementary Provisions of the National Health Insurance Act Before the Article 4 Amendment) for the prefecture of residence of retired insured persons, etc. (meaning the prefecture of residence of retired insured persons, etc. prescribed in that paragraph; the same applies hereinafter in this paragraph) and the contribution for medical treatment benefit expenses, etc. (meaning the contribution for medical treatment benefit expenses, etc. under Article 10, paragraph (1) of the Supplementary Provisions of the National Health Insurance Act Before the Article 4 Amendment) for an insurer of employee insurance, etc. (meaning an insurer of employee insurance, etc. prescribed in Article 7, paragraph (3) of the Act on Assurance of Medical Care for Elderly People) in fiscal year 2022, as for the retiree medical care operations (meaning the retiree medical care operations prescribed in Article 17 of the Supplementary Provisions of the National Health Insurance Act Before the Article 4 Amendment; the same applies in paragraph (5)) carried out by the Health Insurance Claims Review and Reimbursement Services under the Act on Social Insurance Medical Fee Payment Fund (hereinafter referred to as the "Health Insurance Claims Review and Reimbursement Services") pursuant to the provisions of that Article, the notification given by the prefecture of residence of retired insured persons, etc. pursuant to the provisions of Article 15, paragraph (1) of the Supplementary Provisions of the National Health Insurance Act Before the Article 4 Amendment, and the notification given by a specified health insurance Society (meaning a specified health insurance Society prescribed in Article 3, paragraph (1) of the Supplementary Provisions of the Health Insurance Act) pursuant to the provisions of Article 21, paragraph (2) of the Supplementary Provisions of the National Health Insurance Act Before the Article 4 Amendment, the provisions of Articles 6 through 21 of the Supplementary Provisions of the National Health Insurance Act Before the Article 4 Amendment (including orders under those provisions) remain in force. In this case, necessary technical replacement of terms in applying those provisions and other necessary matters concerning those provisions are specified by Cabinet Order.
令和四年度における退職被保険者等所属都道府県（第四条改正前国保法附則第七条第一項に規定する退職被保険者等所属都道府県をいう。以下この項において同じ。）に係る療養給付費等交付金（同条第一項の療養給付費等交付金をいう。）及び被用者保険等保険者（高齢者の医療の確保に関する法律第七条第三項に規定する被用者保険等保険者をいう。）に係る療養給付費等拠出金（第四条改正前国保法附則第十条第一項の療養給付費等拠出金をいう。）に関し、社会保険診療報酬支払基金法による社会保険診療報酬支払基金（以下「支払基金」という。）が第四条改正前国保法附則第十七条の規定に基づき行う退職者医療関係業務（同条に規定する退職者医療関係業務をいう。第五項において同じ。）、退職被保険者等所属都道府県が第四条改正前国保法附則第十五条第一項の規定に基づき行う通知及び特定健康保険組合（健康保険法附則第三条第一項に規定する特定健康保険組合をいう。）が第四条改正前国保法附則第二十一条第二項の規定に基づき行う通知については、第四条改正前国保法附則第六条から第二十一条までの規定（これらの規定に基づく命令を含む。）は、なおその効力を有する。この場合において、これらの規定の適用に関し必要な技術的読替えその他これらの規定に関し必要な事項は、政令で定める。
While the Health Insurance Claims Review and Reimbursement Services collects the contributions (meaning the contributions prescribed in Article 10, paragraph (1) of the Supplementary Provisions of the National Health Insurance Act Before the Article 4 Amendment) for fiscal year 2024 pursuant to the provisions of that paragraph that remains in force pursuant to the provisions of the preceding paragraph, the provisions of Article 4-3 of the Supplementary Provisions of the Health Insurance Act before amendment by the provisions of Article 1, the provisions of Article 7 of the Supplementary Provisions of the Mariners Insurance Act before amendment by the provisions of Article 2 (excluding the amending provision set forth in Article 1, item (vi) of the Supplementary Provisions), the provisions of Article 13, paragraph (2) of the Supplementary Provisions of the Act on Assurance of Medical Care for Elderly People before amendment by the provisions of Article 6 (excluding the amending provisions set forth in Article 1, items (i), (iv) and (vi) of the Supplementary Provisions; the same applies in paragraph (6)) (referred to as the "Former Elderly Medical Care Assurance Act" in the following paragraph and paragraph (6)), the provisions of paragraph (25) of the Supplementary Provisions of the Private School Personnel Mutual Aid Association Act before amendment by the provisions of Article 19 of the Supplementary Provisions (excluding the amending provision set forth in Article 1, item (vi) of the Supplementary Provisions), the provisions of Article 11-3 of the Supplementary Provisions of the National Public Officers Mutual Aid Association Act before amendment by the provisions of Article 20 of the Supplementary Provisions (excluding the amending provision set forth in Article 1, item (vi) of the Supplementary Provisions), the provisions of Article 40-3-2 of the Supplementary Provisions of the Local Public Officers, etc. Mutual Aid Association Act before amendment by the provisions of Article 21 of the Supplementary Provisions (excluding the amending provision set forth in Article 1, item (vi) of the Supplementary Provisions), and the provisions of Article 13-2, paragraph (1) of the Supplementary Provisions of the Act on the Promotion and Mutual Aid Corporation for Private Schools of Japan (Act No. 48 of 1997) before amendment by the provisions of Article 22 of the Supplementary Provisions remain in force. In this case, necessary technical replacement of terms in applying those provisions and other necessary matters concerning those provisions are specified by Cabinet Order.
前項の規定によりなおその効力を有するものとされた第四条改正前国保法附則第十条第一項の規定により支払基金が令和六年度における拠出金（同項に規定する拠出金をいう。）を徴収する間、第一条の規定による改正前の健康保険法附則第四条の三の規定、第二条の規定（附則第一条第六号に掲げる改正規定を除く。）による改正前の船員保険法附則第七条の規定、第六条の規定（附則第一条第一号、第四号及び第六号に掲げる改正規定を除く。第六項において同じ。）による改正前の高齢者の医療の確保に関する法律（次項及び第六項において「旧高確法」という。）附則第十三条第二項の規定、附則第十九条の規定（附則第一条第六号に掲げる改正規定を除く。）による改正前の私立学校教職員共済法附則第二十五項の規定、附則第二十条の規定（附則第一条第六号に掲げる改正規定を除く。）による改正前の国家公務員共済組合法附則第十一条の三の規定、附則第二十一条の規定（附則第一条第六号に掲げる改正規定を除く。）による改正前の地方公務員等共済組合法附則第四十条の三の二の規定及び附則第二十二条の規定による改正前の日本私立学校振興・共済事業団法（平成九年法律第四十八号）附則第十三条の二第一項の規定は、なおその効力を有する。この場合において、これらの規定の適用に関し必要な技術的読替えその他これらの規定に関し必要な事項は、政令で定める。
With respect to the rights and obligations that belong, as of April 1, 2025, to the special account pertaining to the retiree medical care operations that is actually subject to the provisions of Article 143 of the Former Elderly Medical Care Assurance Act as applied mutatis mutandis in Article 19 of the Supplementary Provisions of the National Health Insurance Act Before the Article 4 Amendment that remains in force pursuant to the provisions of paragraph (3), they are to, as specified by Cabinet Order, vest as of that day in the special account pertaining to the operations listed in Article 139, paragraph (1), item (i) of the Act on Assurance of Medical Care for Elderly People.
令和七年四月一日において現に第三項の規定によりなおその効力を有するものとされた第四条改正前国保法附則第十九条において準用する旧高確法第百四十三条の規定の適用を受ける退職者医療関係業務に係る特別の会計に所属する権利及び義務については、政令で定めるところにより、同日において高齢者の医療の確保に関する法律第百三十九条第一項第一号に掲げる業務に係る特別の会計に帰属するものとする。
In the case of calculating, in fiscal year 2025, the amount of the finalized young-old payment for an insurer for fiscal year 2023 (meaning an insurer prescribed in Article 7, paragraph (2) of the Act on Assurance of Medical Care for Elderly People; the same applies in Article 9 of the Supplementary Provisions) pursuant to the provisions of Article 39 of the Act on Assurance of Medical Care for Elderly People as revised by the provisions of Article 6 (hereinafter referred to as the "Revised Elderly Medical Care Assurance Act"), the provisions of Article 13, paragraph (2) of the Supplementary Provisions of the Former Elderly Medical Care Assurance Act remain in force. In this case, the phrase "and the National Health Insurance Act" in that paragraph is deemed to be replaced with "and the National Health Insurance Act before amendment by the provisions of Article 4 of the Act Partially Amending the Health Insurance Act, etc. to Establish a Sustainable Social Security System for All Generations (Act No. 31 of 2023)".
令和七年度において、第六条の規定による改正後の高齢者の医療の確保に関する法律（以下「新高確法」という。）第三十九条の規定により令和五年度の保険者（高齢者の医療の確保に関する法律第七条第二項に規定する保険者をいう。附則第九条において同じ。）に係る確定前期高齢者納付金の額を算定する場合については、旧高確法附則第十三条第二項の規定は、なおその効力を有する。この場合において、同項中「及び国民健康保険法」とあるのは、「及び全世代対応型の持続可能な社会保障制度を構築するための健康保険法等の一部を改正する法律（令和五年法律第三十一号）第四条の規定による改正前の国民健康保険法」とする。