健康保険法施行令
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第一章 適用事業所の事業の範囲
Chapter I Scope of Business of Applicable Places of Business
Article 1
Persons specified by Cabinet Order as referred to in Article 3, paragraph (3), item (i), (q) of the Health Insurance Act (Act No. 70 of 1922; hereinafter referred to as the "Act") are as follows:
健康保険法（大正十一年法律第七十号。以下「法」という。）第三条第三項第一号レの政令で定める者は、次のとおりとする。
notary public;
公証人
judicial scrivener;
司法書士
land and house investigator;
土地家屋調査士
administrative scrivener;
行政書士
maritime procedure agent;
海事代理士
certified public tax accountant;
税理士
labor and social security attorney;
社会保険労務士
Okinawa attorney prescribed in Article 1 of the Cabinet Order on Okinawa Attorneys (Cabinet Order No. 169 of 1972);
沖縄弁護士に関する政令（昭和四十七年政令第百六十九号）第一条に規定する沖縄弁護士
registered foreign lawyer;
外国法事務弁護士
patent attorney.
弁理士
第二章 全国健康保険協会の資金の運用
Chapter II Investment of Funds of the Japan Health Insurance Association
Article 1-2Investment of Funds
The Japan Health Insurance Association (hereinafter referred to as the "JHIA") must not invest its operational surplus funds except by the following methods:
全国健康保険協会（以下「協会」という。）は、次の方法による場合を除くほか、業務上の余裕金を運用してはならない。
acquisition of national government bonds, local government bonds, government-guaranteed bonds (meaning bonds for which the government guarantees the redemption of principal and the payment of interest), and other securities designated by the Minister of Health, Labour and Welfare;
国債、地方債、政府保証債（その元本の償還及び利息の支払について政府が保証する債券をいう。）その他厚生労働大臣の指定する有価証券の取得
deposits with banks and other financial institutions designated by the Minister of Health, Labour and Welfare;
銀行その他厚生労働大臣の指定する金融機関への預金
money trusts with financial institutions engaged in trust business (meaning financial institutions that have obtained authorization under Article 1, paragraph (1) of the Act on Engagement in Trust Business by Financial Institutions (Act No. 43 of 1943)).
信託業務を営む金融機関（金融機関の信託業務の兼営等に関する法律（昭和十八年法律第四十三号）第一条第一項の認可を受けた金融機関をいう。）への金銭信託
第一節 設立
Section 1 Establishment
Article 1-3Number of Insured Persons Necessary for Establishing a Health Insurance Society
The number specified by Cabinet Order as referred to in Article 11, paragraph (1) of the Act is 700.
法第十一条第一項の政令で定める数は、七百人とする。
The number specified by Cabinet Order as referred to in Article 11, paragraph (2) of the Act is 3,000.
法第十一条第二項の政令で定める数は、三千人とする。
Article 2Public Notice of Authorization of Establishment, etc.
When the Minister of Health, Labour and Welfare has authorized the establishment of a health insurance society, the Minister is to give public notice of the following matters:
厚生労働大臣は、健康保険組合の設立の認可をしたときは、次に掲げる事項を告示するものとする。
the name of the health insurance society;
健康保険組合の名称
the location of its office;
事務所の所在地
the name and location of the establishment (meaning the applicable place of business for which the health insurance society has been established; the same applies hereinafter);
設立事業所（健康保険組合が設立された適用事業所をいう。以下同じ。）の名称及び所在地
the date of the authorization of establishment.
設立の認可の年月日
When the Minister of Health, Labour and Welfare has authorized a change to the constitution or accepted a notification of a change to the constitution, and that change relates to the matters set out in item (i) or (ii) of the preceding paragraph, the Minister is to give public notice of those matters.
Article 3Public Notice of the Constitution
When the establishment of a health insurance society has been authorized, the employer of the applicable place of business that applied for authorization of the establishment of the health insurance society must promptly give public notice of its constitution.
健康保険組合の設立の認可の申請をした適用事業所の事業主は、健康保険組合の設立の認可があったときは、速やかに、規約を公告しなければならない。
When the constitution has been changed, the president must promptly give public notice of it.
理事長は、規約が変更されたときは、速やかに、これを公告しなければならない。
Article 4Report of Important Matters
When the establishment of a health insurance society has been authorized, the employer of the applicable place of business that applied for authorization of the establishment of the health insurance society must promptly convene a society meeting and report on the process of establishing the health insurance society and other important matters.
健康保険組合の設立の認可の申請をした適用事業所の事業主は、健康保険組合の設立の認可があったときは、速やかに、組合会を招集して健康保険組合の設立の経過その他重要な事項を報告しなければならない。
Article 5Performance of the President's Duties on the President's Behalf
When a health insurance society has been established, until a president is elected, the employer of the applicable place of business that applied for authorization of the establishment of the health insurance society is to perform the duties of the president.
健康保険組合が成立したときは、理事長が選任されるまでの間、健康保険組合の設立の認可の申請をした適用事業所の事業主が、理事長の職務を行う。
第二節 管理
Section 2 Management
Article 6Term of Office of Society Meeting Members
The term of office of a society meeting member is the period specified by the constitution within a period not exceeding three years; provided, however, that the term of office of a substitute society meeting member is the remainder of the term of office of the predecessor.
組合会議員の任期は、三年を超えない範囲内で規約で定める期間とする。ただし、補欠の組合会議員の任期は、前任者の残任期間とする。
Article 7Convocation of Society Meetings
A society meeting is convened by the president. When one-third or more of the fixed number of society meeting members submit to the president a document stating the matters to be submitted to the meeting and the reasons for convening it, and request that a society meeting be convened, the president must convene a society meeting within 20 days from the day of the request.
組合会は、理事長が招集する。組合会議員の定数の三分の一以上の者が会議に付議すべき事項及び招集の理由を記載した書面を理事長に提出して組合会の招集を請求したときは、理事長は、その請求のあった日から二十日以内に組合会を招集しなければならない。
The president must convene an ordinary society meeting once every fiscal year as specified by the constitution.
理事長は、規約で定めるところにより、毎年度一回通常組合会を招集しなければならない。
The president may convene an extraordinary society meeting at any time when necessary.
理事長は、必要があるときは、いつでも臨時組合会を招集することができる。
When a society meeting cannot be formed, or when the president finds it urgent, the president may dispose of any matter that requires a resolution of a society meeting and that needs to be dealt with urgently.
理事長は、組合会が成立しないとき、又は理事長において緊急を要すると認めるときは、組合会の議決を経なければならない事項で緊急に行う必要があるものを処分することができる。
The president must report on a measure taken under the preceding paragraph at the next society meeting and seek its approval.
理事長は、前項の規定による処置については、次の組合会においてこれを報告し、その承認を求めなければならない。
Article 8Procedures for Convening a Society Meeting
Except in the case of urgency, a society meeting must be convened by the end of the day that is the fifth day before the day preceding the opening day, counting from that preceding day, by indicating the matters to be submitted to the meeting, the date and time, and the place, in accordance with the method specified by the constitution.
組合会の招集は、緊急を要する場合を除き、開会の日の前日から起算して前五日目に当たる日が終わるまでに、会議に付議すべき事項、日時及び場所を示し、規約で定める方法に従ってしなければならない。
Article 9Quorum
A society meeting may not open proceedings or adopt a resolution unless at least half of the fixed number of society meeting members (excluding the number of society meeting members who cannot exercise voting rights under Article 11) are present.
組合会は、組合会議員の定数（第十一条の規定により議決権を行使することができない組合会議員の数を除く。）の半数以上が出席しなければ、議事を開き、議決をすることができない。
Article 10Proceedings of a Society Meeting, etc.
A society meeting has a chairperson. The president serves as chairperson.
組合会に議長を置く。議長は、理事長をもって充てる。
Except as otherwise provided by the Act and this Cabinet Order, the proceedings of a society meeting are decided by a majority of the society meeting members present, and in the case of a tie, the chairperson decides.
組合会の議事は、法及びこの政令に別段の定めがある場合を除き、出席した組合会議員の過半数で決し、可否同数のときは、議長が決する。
Proceedings on a change to the constitution (excluding a change pertaining to matters specified by Order of the Ministry of Health, Labour and Welfare as referred to in Article 16, paragraph (2) of the Act) are decided by a majority of at least two-thirds of the fixed number of society meeting members.
規約の変更（法第十六条第二項の厚生労働省令で定める事項に係るものを除く。）の議事は、組合会議員の定数の三分の二以上の多数で決する。
Article 11Exclusion of Society Meeting Members
A society meeting member may not take part in the proceedings on a matter in which the member has a special interest; provided, however, that if the society meeting consents, the member may attend the meeting and speak.
組合会議員は、特別の利害関係のある事項については、その議事に加わることができない。ただし、組合会の同意があった場合は、会議に出席して発言することができる。
Article 12Proxies
A society meeting member may, as specified by the constitution, exercise the right to vote or the right to elect, by document or through a proxy, on a matter notified in advance under Article 8; provided, however, that only another society meeting member may act as a proxy.
組合会議員は、規約で定めるところにより、第八条の規定によりあらかじめ通知のあった事項につき、書面又は代理人をもって、議決権又は選挙権を行使することができる。ただし、他の組合会議員でなければ、代理人となることができない。
A person who exercises the right to vote or the right to elect under the preceding paragraph is deemed to be present.
前項の規定により議決権又は選挙権を行使する者は、出席者とみなす。
A proxy may not act on behalf of five or more society meeting members.
代理人は、五人以上の組合会議員を代理することができない。
A proxy must submit to the society meeting a document certifying the authority of proxy.
代理人は、代理権を証する書面を組合会に提出しなければならない。
Article 13Minutes
For each session of a society meeting, minutes must be prepared, stating the names of the society meeting members present, a summary of the course of the proceedings, and the results.
組合会の会議については、会議録を作成し、出席した組合会議員の氏名並びに議事の経過の要領及びその結果を記載しなければならない。
The chairperson and two or more society meeting members designated by the society meeting must sign the minutes.
会議録には、議長及び組合会において定めた二人以上の組合会議員が署名しなければならない。
A health insurance society must keep the minutes at its principal office.
健康保険組合は、会議録を健康保険組合の主たる事務所に備え付けて置かなければならない。
Members and persons who were members may request a health insurance society to allow them to inspect the minutes. In this case, the health insurance society must not refuse the request except where there is a justifiable reason.
組合員及び組合員であった者は、健康保険組合に対し、会議録の閲覧を請求することができる。この場合において、健康保険組合は、正当な理由がある場合を除き、これを拒んではならない。
Article 14Officers
The term of office of an officer is the period specified by the constitution, not exceeding three years; provided, however, that the term of office of an officer elected to fill a vacancy is the remaining term of the predecessor.
役員の任期は、三年を超えない範囲内で規約で定める期間とする。ただし、補欠の役員の任期は、前任者の残任期間とする。
Even after the expiration of their term of office, an officer continues to perform their duties until a successor officer assumes office.
役員は、その任期が満了しても、後任の役員が就任するまでの間は、なお、その職務を行う。
第三節 財務及び会計
Section 3 Finance and Accounting
Article 15Fiscal Year
The fiscal year of a health insurance society begins on April 1 of each year and ends on March 31 of the following year; provided, however, that for the first fiscal year of the commencement of operations, it begins on the date operations are commenced and ends on March 31 of the following year (or, if the date operations are commenced is on or after January 1 and on or before March 31, of that year).
健康保険組合の会計年度は、毎年四月一日に始まり、翌年三月三十一日に終わる。ただし、事業開始の初年度にあっては、事業開始の日に始まり、翌年（事業開始の日が一月一日以降三月三十一日以前であるときは、その年）の三月三十一日に終わる。
Article 16Notification of Budget, etc.
A health insurance society must prepare a budget of revenue and expenditure for each fiscal year and notify the Minister of Health, Labour and Welfare of it before the start of that fiscal year. The same applies when the society changes the budget.
健康保険組合は、毎年度、収入支出の予算を作成し、当該年度の開始前に、厚生労働大臣に届け出なければならない。これを変更したときも、同様とする。
The amounts of the categories set in the budget may not be diverted among one another.
予算に定めた各款の金額は、相互に流用することができない。
The amounts of the sub-categories set in the budget may be diverted among one another with a resolution of the society meeting.
予算に定めた各項の金額は、組合会の議決を経て、相互に流用することができる。
Article 17Continuing Expenditures
A health insurance society may establish continuing expenditures with a resolution of the society meeting.
健康保険組合は、組合会の議決を経て継続費を設けることができる。
Article 18Contingency Fund
A health insurance society must establish a contingency fund to cover expenditures exceeding the budget or expenditures outside the budget.
健康保険組合は、予算超過の支出又は予算外の支出に充てるため、予備費を設けなければならない。
The contingency fund may not be applied to a purpose that the society meeting has rejected.
予備費は、組合会の否決した使途に充てることができない。
Article 19Closing Period for Accounts
In a health insurance society, revenue funds are to be received only up to May 31 of the following fiscal year, and expenditure funds are to be paid only up to April 30 of the following fiscal year.
健康保険組合において、収入金を収納するのは翌年度の五月三十一日、支出金を支払うのは翌年度の四月三十日限りとする。
Article 20Drawing Down of Reserves
A health insurance society must not draw down its reserves except to make up a shortfall in the expenses required for insurance benefits (including the expenses required for paying the young-old payments, etc. under the provisions of the Act on Assurance of Medical Care for Elderly People (Act No. 80 of 1982) (hereinafter referred to as "young-old payments, etc."), the aid for the old-old, the contribution for administrative expenses related to the old-old and the contribution for administrative expenses related to childbirth and childcare under the provisions of that Act (hereinafter referred to as "aid for the old-old, etc."), the contributions under Article 173 of the Act (hereinafter referred to as "day laborer contribution"), the Levy under the provisions of the Long-Term Care Insurance Act (Act No. 123 of 1997) (referred to as "long-term care payment" in Article 29 and Article 46), the contribution for securing medical care in the early phase of an epidemic, etc. under the provisions of the Act on the Prevention of Infectious Diseases and Medical Care for Patients with Infectious Diseases (Act No. 114 of 1998) (hereinafter referred to as "contribution for securing medical care in the early phase of an epidemic, etc."), and the children and child-rearing support levy under the provisions of the Act on Support for Children and Child-rearing (Act No. 65 of 2012) (hereinafter referred to as "children and child-rearing support levy")).
健康保険組合は、保険給付に要する費用（高齢者の医療の確保に関する法律（昭和五十七年法律第八十号）の規定による前期高齢者納付金等（以下「前期高齢者納付金等」という。）、同法の規定による後期高齢者支援金、後期高齢者関係事務費拠出金及び出産育児関係事務費拠出金（以下「後期高齢者支援金等」という。）並びに法第百七十三条の規定による拠出金（以下「日雇拠出金」という。）、介護保険法（平成九年法律第百二十三号）の規定による納付金（第二十九条及び第四十六条において「介護納付金」という。）、感染症の予防及び感染症の患者に対する医療に関する法律（平成十年法律第百十四号）の規定による流行初期医療確保拠出金等（以下「流行初期医療確保拠出金等」という。）並びに子ども・子育て支援法（平成二十四年法律第六十五号）の規定による子ども・子育て支援納付金（以下「子ども・子育て支援納付金」という。）の納付に要する費用を含む。）の不足を補う場合を除いては、準備金を取り崩してはならない。
Article 21Temporary Diversion, etc.
When a health insurance society has a shortage of cash for payments, it may temporarily divert cash belonging to the reserves or make temporary borrowings.
健康保険組合は、支払上現金に不足を生じたときは、準備金に属する現金を繰替使用し、又は一時借入金をすることができる。
The amount temporarily diverted and the temporary borrowings under the preceding paragraph must be returned within that fiscal year.
前項の規定により繰替使用した金額及び一時借入金は、当該会計年度内に返還しなければならない。
Article 22Society Bonds
When a health insurance society intends to issue society bonds, or to change the method of issuing bonds, the interest rate or the method of redemption, it must obtain the authorization of the Minister of Health, Labour and Welfare; provided, however, that this does not apply when it intends to make a minor change specified by Order of the Ministry of Health, Labour and Welfare.
健康保険組合は、組合債を起こし、又は起債の方法、利率若しくは償還の方法を変更しようとするときは、厚生労働大臣の認可を受けなければならない。ただし、厚生労働省令で定める軽微な変更をしようとするときは、この限りでない。
When a health insurance society has made a minor change specified by Order of the Ministry of Health, Labour and Welfare as referred to in the proviso to the preceding paragraph, it must notify the Minister of Health, Labour and Welfare to that effect without delay.
健康保険組合は、前項ただし書の厚生労働省令で定める軽微な変更をしたときは、遅滞なく、その旨を厚生労働大臣に届け出なければならない。
Article 23Disposition of Important Property
When a health insurance society intends to dispose of important property, it must obtain the authorization of the Minister of Health, Labour and Welfare.
健康保険組合は、重要な財産を処分しようとするときは、厚生労働大臣の認可を受けなければならない。
Article 24Submission of a Report
A health insurance society must, within six months after the end of each fiscal year, prepare a report on its business and settlement of accounts, as provided by Order of the Ministry of Health, Labour and Welfare, and submit it to the Minister of Health, Labour and Welfare.
健康保険組合は、毎年度終了後六月以内に、厚生労働省令で定めるところにより、事業及び決算に関する報告書を作成し、厚生労働大臣に提出しなければならない。
A health insurance society must keep the documents referred to in the preceding paragraph at the principal office of the health insurance society.
健康保険組合は、前項の書類を健康保険組合の主たる事務所に備え付けて置かなければならない。
Members and persons who were members may request the health insurance society to allow inspection of the documents referred to in the preceding paragraph. In this case, the health insurance society must not refuse this, except where there is a justifiable reason.
組合員及び組合員であった者は、健康保険組合に対し、前項の書類の閲覧を請求することができる。この場合において、健康保険組合は、正当な理由がある場合を除き、これを拒んではならない。
第四節 特定健康保険組合の認可
Section 4 Authorization of Specified Health Insurance Societies
Article 25
When a health insurance society intends to obtain the authorization under Article 3, paragraph (1) of the Supplementary Provisions of the Act, or intends to have the authorization under that paragraph rescinded, it must adopt a resolution in a society meeting by a majority of two-thirds or more of the fixed number of society meeting members.
第五節 地域型健康保険組合の一般保険料率の認可
Section 5 Authorization of General Premium Rates of Regional Health Insurance Societies
Article 25-2
When a regional health insurance society prescribed in Article 3-2, paragraph (1) of the Supplementary Provisions of the Act intends to obtain the authorization under paragraph (2) of that Article, it is to set a non-uniform general premium rate with each health insurance society before the merger as a unit, and must adopt a resolution in the society meeting of that regional health insurance society, by a majority of two-thirds or more of the fixed number of society meeting members, on that general premium rate and the requirements for the insured persons to whom it is to apply and the period of its application.
法附則第三条の二第一項に規定する地域型健康保険組合は、同条第二項の認可を受けようとするときは、合併前の健康保険組合を単位として不均一の一般保険料率を設定することとし、当該一般保険料率並びにこれを適用すべき被保険者の要件及び期間について、当該地域型健康保険組合の組合会において組合会議員の定数の三分の二以上の多数により議決しなければならない。
第六節 合併及び分割並びに解散
Section 6 Merger and Split, and Dissolution
Article 26Public Notice of Merger or Split
When the Minister of Health, Labour and Welfare has granted authorization for the merger or split of a health insurance society, the Minister is to give public notice of the following matters regarding the health insurance societies established or extinguished by the merger or split and the health insurance societies that continue to exist after the merger or split:
厚生労働大臣は、健康保険組合の合併又は分割の認可をしたときは、合併若しくは分割により設立し、又は消滅した健康保険組合及び合併又は分割後存続する健康保険組合について、次に掲げる事項を告示するものとする。
the name of the health insurance society;
健康保険組合の名称
the location of its office;
事務所の所在地
the name and location of the establishment;
設立事業所の名称及び所在地
the date of the authorization of the merger or split.
合併又は分割の認可の年月日
Article 27Request for Bearing of Expenses to Fully Repay Debts
The amount of expenses that may be requested to be borne by the employer of the establishment pursuant to Article 26, paragraph (3) of the Act is to be an amount equivalent to the whole of the expenses required to fully repay the debts; provided, however, that where that employer is unable to bear those expenses due to a decision to commence bankruptcy proceedings or other special reasons, the health insurance society may, with the approval of the Minister of Health, Labour and Welfare, reduce or waive them.
Article 28Public Notice of Dissolution
When a health insurance society has been dissolved, the Minister of Health, Labour and Welfare is to give public notice of the following matters:
厚生労働大臣は、健康保険組合が解散したときは、次に掲げる事項を告示するものとする。
the name of the health insurance society;
健康保険組合の名称
the location of its office;
事務所の所在地
the name and location of the establishment;
設立事業所の名称及び所在地
the date of the authorization of dissolution or of the order of dissolution.
解散の認可又は解散の命令の年月日
Article 29Requirements for Designation
The requirements specified by Cabinet Order referred to in Article 28, paragraph (1) of the Act are to be that, with regard to a health insurance society for which the state in which the amount of expenditure (limited to that specified by the Minister of Health, Labour and Welfare as recurring) exceeds the amount of income (limited to that specified by the Minister of Health, Labour and Welfare as recurring) in the settlement of accounts for one fiscal year continues, and for which the state in which the rate obtained by dividing the amount obtained by deducting the amount of expenses required for the other benefits prescribed in Article 53 of the Act from the amount of expenses required for the insurance benefits of the health insurance society in one fiscal year (including the amount of expenses required for the payment of young-old payments, etc., aid for the old-old, etc. and day laborer contribution, and contribution for securing medical care in the early phase of an epidemic, etc. (where there is a young-old subsidy under the provisions of the Act on Assurance of Medical Care for Elderly People (hereinafter referred to as the "young-old subsidy" in this Article, Article 46, Article 65, paragraph (1), item (i), (a) and Article 67, paragraph (3)), the amount after deducting it), and excluding the amount of expenses required for insurance benefits relating to medical treatment that an insured person or a dependent thereof received from a hospital, clinic or pharmacy listed in Article 63, paragraph (3), item (iii) of the Act and the amount of the childbirth and childcare grant prescribed in Article 152-2 of the Act (hereinafter referred to as the "childbirth and childcare grant")) by the total sum of the total amount of the standard monthly remuneration and the total amount of the standard bonus amounts of the insured persons who are members of that health insurance society in that fiscal year exceeds 95/1,000 continues, the amount of reserves and other property specified by the Minister of Health, Labour and Welfare has fallen below the total sum of the amount equivalent to 3/12 of the average per fiscal year of the amount of expenses required for the insurance benefits provided in the three fiscal years immediately preceding the fiscal year for which the designation under Article 28, paragraph (1) of the Act is to be made (excluding the amount of expenses required for insurance benefits relating to medical treatment that an insured person or a dependent thereof received from a hospital, clinic or pharmacy listed in Article 63, paragraph (3), item (iii) of the Act and the amount of the childbirth and childcare grant), the amount equivalent to 1/12 of the average per business year of the amount of expenses required for the payment of young-old payments, etc., aid for the old-old, etc. and day laborer contribution, long-term care payment, and contribution for securing medical care in the early phase of an epidemic, etc. made in those three fiscal years (where there is a young-old subsidy, the amount after deducting it), and the amount determined by the Minister of Health, Labour and Welfare in consultation with the Prime Minister, within a range not exceeding the amount equivalent to 1/12 of the amount of expenses required for the payment of the children and child-rearing support levy made in the fiscal year immediately preceding the fiscal year for which the designation under that paragraph is to be made, taking into consideration the expenses required for the insurer's payment of the children and child-rearing support levy in that immediately preceding fiscal year.
法第二十八条第一項の政令で定める要件は、一の年度の決算において支出（経常的なものとして厚生労働大臣が定めるものに限る。）の額が収入（経常的なものとして厚生労働大臣が定めるものに限る。）の額を超える状態が継続し、かつ、一の年度における健康保険組合の保険給付に要した費用の額（前期高齢者納付金等、後期高齢者支援金等及び日雇拠出金並びに流行初期医療確保拠出金等の納付に要した費用の額（高齢者の医療の確保に関する法律の規定による前期高齢者交付金（以下この条、第四十六条、第六十五条第一項第一号イ及び第六十七条第三項において「前期高齢者交付金」という。）がある場合には、これを控除した額）を含み、被保険者又はその被扶養者が法第六十三条第三項第三号に掲げる病院若しくは診療所又は薬局から受けた療養に係る保険給付に要した費用の額及び法第百五十二条の二に規定する出産育児交付金（以下「出産育児交付金」という。）の額を除く。）から法第五十三条に規定するその他の給付に要した費用の額を控除した額を当該年度における当該健康保険組合の組合員である被保険者の標準報酬月額の総額及び標準賞与額の総額の合算額で除して得た率が千分の九十五を超える状態が継続する健康保険組合であって、準備金その他厚生労働大臣が定める財産の額が法第二十八条第一項の指定をすべき年度の直前の三箇年度において行った保険給付に要した費用の額（被保険者又はその被扶養者が法第六十三条第三項第三号に掲げる病院若しくは診療所又は薬局から受けた療養に係る保険給付に要した費用の額及び出産育児交付金の額を除く。）の一年度当たりの平均額の十二分の三に相当する額と法第二十八条第一項の指定をすべき年度の直前の三箇年度において行った前期高齢者納付金等、後期高齢者支援金等及び日雇拠出金、介護納付金並びに流行初期医療確保拠出金等の納付に要した費用の額（前期高齢者交付金がある場合には、これを控除した額）の一事業年度当たりの平均額の十二分の一に相当する額並びに同項の指定をすべき年度の直前の年度において行った子ども・子育て支援納付金の納付に要した費用の額の十二分の一に相当する額を超えない範囲内において当該直前の年度における保険者の子ども・子育て支援納付金の納付に要する費用を勘案して厚生労働大臣が内閣総理大臣と協議して定める額とを合算した額を下回ったものとする。
Article 30Soundness Improvement Plan
The soundness improvement plan prescribed in Article 28, paragraph (1) of the Act (referred to simply as the "soundness improvement plan" in the following paragraph and the following Article) is to be a three-year plan whose first fiscal year is the fiscal year following the fiscal year that includes the date of designation under Article 28, paragraph (1) of the Act.
The following matters must be stated in the soundness improvement plan:
健全化計画には、次に掲げる事項を記載しなければならない。
the current state of operations and property;
事業及び財産の現状
the goal for improving financial soundness;
財政の健全化の目標
the specific measures necessary to achieve the goal referred to in the preceding item, and the estimated amounts of increases and decreases in revenue and expenditure that accompany them.
前号の目標を達成するために必要な具体的措置及びこれに伴う収入支出の増減の見込額
Article 31Designated Health Insurance Societies That May Be Ordered to Dissolve
The designated health insurance societies specified by Cabinet Order as referred to in Article 29, paragraph (2) of the Act are as follows:
法第二十九条第二項の政令で定める指定健康保険組合は、次のとおりとする。
a designated health insurance society that does not apply for approval of a soundness improvement plan by the date designated by the Minister of Health, Labour and Welfare;
厚生労働大臣が指定する期日までに健全化計画の承認を申請しない指定健康保険組合
a designated health insurance society that cannot obtain approval of a soundness improvement plan.
健全化計画の承認を受けることができない指定健康保険組合
第七節 雑則
Section 7 Miscellaneous Provisions
Article 32Delegation of Authority
Part of the authority of the Minister of Health, Labour and Welfare prescribed in this Chapter may be delegated to the Director-General of a Regional Bureau of Health and Welfare, as specified by Order of the Ministry of Health, Labour and Welfare.
この章に規定する厚生労働大臣の権限の一部は、厚生労働省令で定めるところにより、地方厚生局長に委任することができる。
The authority delegated to the Director-General of a Regional Bureau of Health and Welfare pursuant to the provisions of the preceding paragraph may be delegated to the Director-General of a Regional Branch Bureau of Health and Welfare as specified by Order of the Ministry of Health, Labour and Welfare.
前項の規定により地方厚生局長に委任された権限は、厚生労働省令で定めるところにより、地方厚生支局長に委任することができる。
Article 33Delegation to Order of the Ministry of Health, Labour and Welfare
In addition to what is prescribed in this Chapter, necessary matters concerning health insurance societies are specified by Order of the Ministry of Health, Labour and Welfare.
この章に規定するもののほか、健康保険組合に関して必要な事項は、厚生労働省令で定める。
第四章 育児休業の根拠法令
Chapter IV Laws and Regulations on Which Childcare Leave Is Based
Article 33-2
The laws and regulations specified by Cabinet Order as referred to in Article 43-2, paragraph (1) of the Act are as follows:
法第四十三条の二第一項の政令で定める法令は、次のとおりとする。
the Act on Childcare Leave, etc. of Diet Officers (Act No. 108 of 1991);
国会職員の育児休業等に関する法律（平成三年法律第百八号）
the Act on Childcare Leave, etc. of National Public Officers (Act No. 109 of 1991) (including where applied mutatis mutandis under the Act on Temporary Measures concerning Court Officials (Act No. 299 of 1951) (limited to the portion pertaining to item (vii) of that Act));
国家公務員の育児休業等に関する法律（平成三年法律第百九号）（裁判所職員臨時措置法（昭和二十六年法律第二百九十九号）（第七号に係る部分に限る。）において準用する場合を含む。）
the Act on Childcare Leave, etc. of Local Public Officers (Act No. 110 of 1991).
地方公務員の育児休業等に関する法律（平成三年法律第百十号）
Article 33-3Acts Concerning Refusal of Designation of Medical Institutions Providing Services Covered by Health Insurance, etc.
The Acts specified by Cabinet Order as referred to in Article 65, paragraph (3), item (iii), Article 71, paragraph (2), item (ii), Article 80, item (viii), Article 81, item (v), Article 89, paragraph (4), item (v) and Article 95, item (viii) of the Act are as follows:
法第六十五条第三項第三号、第七十一条第二項第二号、第八十条第八号、第八十一条第五号、第八十九条第四項第五号及び第九十五条第八号の政令で定める法律は、次のとおりとする。
Mariners Insurance Act (Act No. 73 of 1939);
船員保険法（昭和十四年法律第七十三号）
Dental Practitioners Act (Act No. 202 of 1948);
歯科医師法（昭和二十三年法律第二百二号）
Act on Public Health Nurses, Midwives and Nurses (Act No. 203 of 1948);
保健師助産師看護師法（昭和二十三年法律第二百三号）
Private School Personnel Mutual Aid Association Act (Act No. 245 of 1953);
私立学校教職員共済法（昭和二十八年法律第二百四十五号）
National Public Officers Mutual Aid Association Act (Act No. 128 of 1958);
国家公務員共済組合法（昭和三十三年法律第百二十八号）
Act on Securing Quality, Efficacy and Safety of Products Including Pharmaceuticals and Medical Devices (Act No. 145 of 1960);
医薬品、医療機器等の品質、有効性及び安全性の確保等に関する法律（昭和三十五年法律第百四十五号）
Pharmacists Act (Act No. 146 of 1960);
薬剤師法（昭和三十五年法律第百四十六号）
Local Public Officers, etc. Mutual Aid Association Act (Act No. 152 of 1962);
地方公務員等共済組合法（昭和三十七年法律第百五十二号）
Act on the Safety of Regenerative Medicine (Act No. 85 of 2013);
再生医療等の安全性の確保等に関する法律（平成二十五年法律第八十五号）
Clinical Trials Act (Act No. 16 of 2017).
臨床研究法（平成二十九年法律第十六号）
The Acts specified by Cabinet Order as referred to in Article 80, item (x), Article 81, item (vii) and Article 95, item (x) of the Act are as follows:
Mariners Insurance Act;
船員保険法
Medical Practitioners' Act;
Dental Practitioners Act;
歯科医師法
Act on Public Health Nurses, Midwives and Nurses;
保健師助産師看護師法
Medical Care Act;
Private School Personnel Mutual Aid Association Act;
私立学校教職員共済法
National Public Officers Mutual Aid Association Act;
国家公務員共済組合法
National Health Insurance Act;
Act on Securing Quality, Efficacy and Safety of Products Including Pharmaceuticals and Medical Devices;
医薬品、医療機器等の品質、有効性及び安全性の確保等に関する法律
Pharmacists Act;
薬剤師法
Local Public Officers, etc. Mutual Aid Association Act;
地方公務員等共済組合法
Act on the Safety of Regenerative Medicine;
再生医療等の安全性の確保等に関する法律
Clinical Trials Act.
臨床研究法
Article 34Cases Where the Co-payment Ratio Is 30%
The amount of remuneration calculated as specified by Cabinet Order as referred to in Article 74, paragraph (1), item (iii) of the Act is the standard monthly remuneration for the month in which the person receives benefits for medical treatment, and the amount specified by Cabinet Order as referred to in that item is 280,000 yen.
法第七十四条第一項第三号の政令で定めるところにより算定した報酬の額は療養の給付を受ける月の標準報酬月額とし、同号の政令で定める額は二十八万円とする。
The provisions of the preceding paragraph do not apply to a person who falls under any of the following items:
前項の規定は、次の各号のいずれかに該当する者については、適用しない。
a person for whom the amount of income calculated as specified by Order of the Ministry of Health, Labour and Welfare for the insured person and the insured person's dependents (limited to those falling under the case of being on or after the month following the month that includes the day on which they reach the age of 70) is less than 5,200,000 yen (3,830,000 yen for a person who has no such dependent);
被保険者及びその被扶養者（七十歳に達する日の属する月の翌月以後である場合に該当する者に限る。）について厚生労働省令で定めるところにより算定した収入の額が五百二十万円（当該被扶養者がいない者にあっては、三百八十三万円）に満たない者
a person for whom the amount of income calculated as specified by Order of the Ministry of Health, Labour and Welfare as referred to in the preceding item for the insured person (limited to one who has no dependents (limited to those falling under the case of being on or after the month following the month that includes the day on which they reach the age of 70) and who has a person who was a dependent (meaning a person who has ceased to be a dependent by coming to fall under the proviso to Article 3, paragraph (7) of the Act and who, only until the month in which five years have elapsed from the month that includes the day on which the person came to fall under that proviso, has continuously fallen under the proviso to that paragraph on and after that day; the same applies hereinafter in this item)) and that person who was a dependent is less than 5,200,000 yen.
Article 35Amount of Burial Charges
The amount specified by Cabinet Order as referred to in Article 100, paragraph (1) of the Act is 50,000 yen.
法第百条第一項の政令で定める金額は、五万円とする。
Article 36Amount of Lump-Sum Allowance for Childbirth and Childcare
The amount specified by Cabinet Order as referred to in Article 101 of the Act is 488,000 yen; provided, however, that when the insurer finds that the childbirth takes place under the medical management of a hospital, clinic, birthing center or other person that meets all of the requirements listed in the following items, the amount is 488,000 yen plus an amount determined by the insurer within a range not exceeding 30,000 yen, based on the amount of additional expenses that the insured person necessarily incurs in relation to the insurance contract prescribed in item (i).
that, for childbirth under the medical management of that hospital, clinic, birthing center or other person, an insurance contract that meets the requirements specified by Order of the Ministry of Health, Labour and Welfare has been concluded, to provide for the expenditure of the costs required for paying compensation intended to reduce the financial burden of raising the person born, in the case where a specified childbirth accident (meaning an accident relating to childbirth (limited to childbirth that meets the standards specified by Order of the Ministry of Health, Labour and Welfare) (excluding one that has occurred due to a reason specified by Order of the Ministry of Health, Labour and Welfare) as a result of which the person born has contracted cerebral palsy and has come to be in a state of disability of a degree specified by Order of the Ministry of Health, Labour and Welfare; the same applies in the following item) has occurred;
当該病院、診療所、助産所その他の者による医学的管理の下における出産について、特定出産事故（出産（厚生労働省令で定める基準に該当する出産に限る。）に係る事故（厚生労働省令で定める事由により発生したものを除く。）のうち、出生した者が当該事故により脳性麻痺にかかり、厚生労働省令で定める程度の障害の状態となったものをいう。次号において同じ。）が発生した場合において、当該出生した者の養育に係る経済的負担の軽減を図るための補償金の支払に要する費用の支出に備えるための保険契約であって厚生労働省令で定める要件に該当するものが締結されていること。
that, in order to ensure the safety of medical care relating to childbirth and improve its quality, measures have been taken, as specified by Order of the Ministry of Health, Labour and Welfare, for the proper and reliable implementation of the collection, organization, analysis and provision of information on specified childbirth accidents.
出産に係る医療の安全を確保し、当該医療の質の向上を図るため、厚生労働省令で定めるところにより、特定出産事故に関する情報の収集、整理、分析及び提供の適正かつ確実な実施のための措置を講じていること。
Article 36-2Coordination of Injury and Sickness Allowance with Disability Allowance, etc.
The cases specified by Cabinet Order in the proviso to Article 108, paragraph (4) of the Act are the cases listed in the following items, and the difference specified by Cabinet Order in the proviso to that paragraph is the amount specified in each of those items in accordance with the classification of the cases listed in it.
a case where the person cannot receive remuneration and cannot receive payment of childbirth allowance: the difference between the total amount of injury and sickness allowance (meaning the total, as of the day on which it reaches the amount of the disability allowance, of the amounts calculated under Article 99, paragraph (2) of the Act if the person were to receive injury and sickness allowance on or after the day on which the person comes to receive payment of the disability allowance under the Employees' Pension Insurance Act (Act No. 115 of 1954); the same applies hereinafter in this Article) and the amount of the disability allowance;
報酬を受けることができない場合であって、かつ、出産手当金の支給を受けることができない場合 傷病手当金合計額（厚生年金保険法（昭和二十九年法律第百十五号）による障害手当金の支給を受けることとなった日以後に傷病手当金の支給を受けるとする場合の法第九十九条第二項の規定により算定される額の合計額が当該障害手当金の額に達するに至る日における当該合計額をいう。以下この条において同じ。）と障害手当金の額との差額
a case where the person cannot receive remuneration and can receive payment of childbirth allowance: the lesser of the difference between the amount calculated under Article 99, paragraph (2) of the Act and the amount of childbirth allowance (where that amount exceeds the amount calculated under that paragraph, that amount), and the difference between the total amount of injury and sickness allowance and the amount of the disability allowance;
a case where the person can receive all or part of remuneration and cannot receive payment of childbirth allowance: the lesser of the difference between the amount calculated under Article 99, paragraph (2) of the Act and the amount of all or part of the remuneration that the person can receive (where that amount exceeds the amount calculated under that paragraph, that amount), and the difference between the total amount of injury and sickness allowance and the amount of the disability allowance;
a case where the person can receive all or part of remuneration and can receive payment of childbirth allowance: the lesser of the difference between the amount calculated under Article 99, paragraph (2) of the Act and the total sum of the amount of all or part of the remuneration that the person can receive and the amount of childbirth allowance calculated under the proviso to Article 108, paragraph (2) of the Act (where that total sum exceeds the amount calculated under Article 99, paragraph (2) of the Act, that amount), and the difference between the total amount of injury and sickness allowance and the amount of the disability allowance.
Article 37Requirements for Persons Subject to Coordination of Injury and Sickness Allowance
The requirements specified by Cabinet Order as referred to in Article 108, paragraph (5) of the Act are that the person is not a specially-insured day laborer who can receive injury and sickness allowance under Article 135, paragraph (1) of the Act (including a person who was a specially-insured day laborer; the same applies hereinafter in this Chapter, except in Article 41-2, Article 43-3 and Article 44, paragraphs (2) through (8)).
法第百八条第五項の政令で定める要件は、法第百三十五条第一項の規定により傷病手当金の支給を受けることができる日雇特例被保険者（日雇特例被保険者であった者を含む。第四十一条の二、第四十三条の三及び第四十四条第二項から第八項までを除き、以下この章において同じ。）でないこととする。
第三十八条（傷病手当金の併給調整の対象となる年金である給付）
Article 38Benefits That Are Pensions Subject to Coordination of Injury and Sickness Allowance
The pension benefits with aging or retirement as the grounds for payment, as referred to in Article 108, paragraph (5) of the Act, that are specified by Cabinet Order are as follows; provided, however, that this excludes a benefit whose payment is suspended in its entirety.
法第百八条第五項の老齢又は退職を支給事由とする年金である給付であって政令で定めるものは、次のとおりとする。ただし、その全額につき支給を停止されている給付を除く。
the old-age basic pension under the National Pension Act (Act No. 141 of 1959) and the old-age pension under Article 9-3, paragraph (1) of the Supplementary Provisions of that Act, and the old-age pension (excluding the old-age welfare pension) and the aggregated old-age pension under the National Pension Act prior to its amendment by Article 1 of the Act Partially Amending the National Pension Act, etc. (Act No. 34 of 1985; referred to as the "1985 National Pension Amendment Act" in the following item and item (iii));
国民年金法（昭和三十四年法律第百四十一号）による老齢基礎年金及び同法附則第九条の三第一項の規定による老齢年金並びに国民年金法等の一部を改正する法律（昭和六十年法律第三十四号。次号及び第三号において「昭和六十年国民年金等改正法」という。）第一条の規定による改正前の国民年金法による老齢年金（老齢福祉年金を除く。）及び通算老齢年金
the old-age employees' pension and the special old-age pension under the Employees' Pension Insurance Act, and the old-age pension, the aggregated old-age pension and the special old-age pension under the Employees' Pension Insurance Act prior to its amendment by Article 3 of the 1985 National Pension Amendment Act;
the old-age pension, the aggregated old-age pension and the special old-age pension under the Mariners Insurance Act prior to its amendment by Article 5 of the 1985 National Pension Amendment Act;
昭和六十年国民年金等改正法第五条の規定による改正前の船員保険法による老齢年金、通算老齢年金及び特例老齢年金
those among the occupational addition amounts under the pre-amendment National Public Officers Mutual Aid Association Act prescribed in Article 36, paragraph (5) of the Supplementary Provisions of the Act Partially Amending the Employees' Pension Insurance Act, etc. to Unify, etc. the Employees' Pension Systems (Act No. 63 of 2012; hereinafter referred to as the "2012 Pension Unification Act") that have retirement as the ground for benefit, and those among the benefits prescribed in Article 37, paragraph (1) of the Supplementary Provisions of the 2012 Pension Unification Act that have retirement as the ground for benefit;
被用者年金制度の一元化等を図るための厚生年金保険法等の一部を改正する法律（平成二十四年法律第六十三号。以下「平成二十四年一元化法」という。）附則第三十六条第五項に規定する改正前国共済法による職域加算額のうち退職を給付事由とするもの及び平成二十四年一元化法附則第三十七条第一項に規定する給付のうち退職を給付事由とするもの
the retirement mutual aid pension under Article 41, paragraph (1) of the Supplementary Provisions of the 2012 Pension Unification Act;
平成二十四年一元化法附則第四十一条第一項の規定による退職共済年金
those among the occupational addition amounts under the pre-amendment Local Public Officers, etc. Mutual Aid Association Act prescribed in Article 60, paragraph (5) of the Supplementary Provisions of the 2012 Pension Unification Act that have retirement as the ground for benefit, and those among the benefits prescribed in Article 61, paragraph (1) of the Supplementary Provisions of the 2012 Pension Unification Act that have retirement as the ground for benefit;
平成二十四年一元化法附則第六十条第五項に規定する改正前地共済法による職域加算額のうち退職を給付事由とするもの及び平成二十四年一元化法附則第六十一条第一項に規定する給付のうち退職を給付事由とするもの
the retirement mutual aid pension under Article 65, paragraph (1) of the Supplementary Provisions of the 2012 Pension Unification Act;
平成二十四年一元化法附則第六十五条第一項の規定による退職共済年金
those among the benefits prescribed in Article 78, paragraph (3) of the Supplementary Provisions of the 2012 Pension Unification Act that have retirement as the ground for benefit, and those among the benefits prescribed in Article 79 of the Supplementary Provisions of the 2012 Pension Unification Act that have retirement as the ground for benefit;
平成二十四年一元化法附則第七十八条第三項に規定する給付のうち退職を給付事由とするもの及び平成二十四年一元化法附則第七十九条に規定する給付のうち退職を給付事由とするもの
those among the benefits that are pensions to be paid by the government, as the administrator of Employees' Pension Insurance, pursuant to Article 16, paragraph (3) of the Supplementary Provisions of the Act for Abolishing the Mutual Aid Association Act for Employees of Agricultural, Forestry and Fishery Organizations, etc. to Integrate the Employees' Pension Insurance System and the Mutual Aid Association System for Employees of Agricultural, Forestry and Fishery Organizations (Act No. 101 of 2001) that have retirement as the ground for benefit;
厚生年金保険制度及び農林漁業団体職員共済組合制度の統合を図るための農林漁業団体職員共済組合法等を廃止する等の法律（平成十三年法律第百一号）附則第十六条第三項の規定により厚生年金保険の実施者たる政府が支給するものとされた年金である給付のうち退職を給付事由とするもの
those among the benefits that are pensions paid by the mutual aid association prescribed in Article 28 of the Supplementary Provisions of the Employees' Pension Insurance Act that have retirement as the ground for payment;
厚生年金保険法附則第二十八条に規定する共済組合が支給する年金である給付のうち退職を支給事由とするもの
those among the benefits that are pensions paid by the federation of National Public Service Personnel Mutual Aid Associations under the Act on Special Measures concerning Beneficiaries of Pension of Mutual Aid Association Established under Former Ordinances (Act No. 256 of 1950) that have retirement as the ground for payment.
旧令による共済組合等からの年金受給者のための特別措置法（昭和二十五年法律第二百五十六号）によって国家公務員共済組合連合会が支給する年金である給付のうち退職を支給事由とするもの
この部分の英訳はまだありません。
削除
この部分の英訳はまだありません。
削除
Article 41Requirements for Payment and Amount of Monthly High-Cost Medical Expenses
High-cost medical expenses are to be paid when the amount (hereinafter in this paragraph referred to as the "household total of co-payments, etc.") obtained by deducting the amount of high-cost medical expenses paid under the provisions of the following paragraph through paragraph (5) from the total of the following amounts exceeds the base amount for calculating high-cost medical expenses, and the amount of the high-cost medical expenses is the amount obtained by deducting the base amount for calculating high-cost medical expenses from the household total of co-payments, etc.:
高額療養費は、次に掲げる額を合算した額から次項から第五項までの規定により支給される高額療養費の額を控除した額（以下この項において「一部負担金等世帯合算額」という。）が高額療養費算定基準額を超える場合に支給するものとし、その額は、一部負担金等世帯合算額から高額療養費算定基準額を控除した額とする。
the total of the amounts listed in (a) through (f) below (for those relating to medical treatment received in or before the month that includes the day on which the person reaches the age of 70, limited to those of 21,000 yen or more (10,500 yen or more for those relating to medical treatment under the special rule on reaching age 75 prescribed in Article 41-3, paragraph (1), item (i))) that relate to medical treatment (excluding dietary treatment prescribed in Article 63, paragraph (2), item (i) of the Act (hereinafter referred to simply as "dietary treatment" in this Article), living support prescribed in item (ii) of that paragraph (hereinafter referred to simply as "living support" in this Article), and the treatment prescribed in paragraph (8) where the insured person or the insured person's dependent falls under that paragraph; the same applies hereinafter from this paragraph through paragraph (5), in Article 41-3, in Article 43, paragraphs (1) and (3), and in Article 43-2), other than the treatment subject to specified benefits prescribed in the following item, that an insured person (including a person who receives benefits for medical treatment, or medical expenses combined with treatment outside insurance coverage or medical expenses for home-nursing, under Article 98, paragraph (1) of the Act, and excluding a specially-insured day laborer; the same applies hereinafter in this Article, Article 42 and Article 43) or the insured person's dependent (including a person receiving treatment for which dependent's medical expenses are paid under Article 98, paragraph (1) of the Act as applied mutatis mutandis pursuant to Article 110, paragraph (7) of the Act, and a person receiving treatment for which dependent's medical expenses for home-nursing are paid under Article 98, paragraph (1) of the Act as applied mutatis mutandis pursuant to Article 111, paragraph (3) of the Act; the same applies hereinafter in this Article, Article 42 and Article 43) received in the same month from each single hospital, clinic, pharmacy or other person (hereinafter referred to as a "hospital, etc.");
被保険者（法第九十八条第一項の規定により療養の給付又は保険外併用療養費若しくは訪問看護療養費の支給を受けている者を含み、日雇特例被保険者を除く。以下この条、第四十二条及び第四十三条において同じ。）又はその被扶養者（法第百十条第七項において準用する法第九十八条第一項の規定により支給される家族療養費に係る療養を受けている者又は法第百十一条第三項において準用する法第九十八条第一項の規定により支給される家族訪問看護療養費に係る療養を受けている者を含む。以下この条、第四十二条及び第四十三条において同じ。）が同一の月にそれぞれ一の病院、診療所、薬局その他の者（以下「病院等」という。）から受けた療養（法第六十三条第二項第一号に規定する食事療養（以下この条において単に「食事療養」という。）、同項第二号に規定する生活療養（以下この条において単に「生活療養」という。）及び当該被保険者又はその被扶養者が第八項の規定に該当する場合における同項に規定する療養を除く。以下この項から第五項まで、第四十一条の三、第四十三条第一項及び第三項並びに第四十三条の二において同じ。）であって次号に規定する特定給付対象療養以外のものに係る次のイからヘまでに掲げる額（七十歳に達する日の属する月以前の療養に係るものにあっては、二万千円（第四十一条の三第一項第一号に規定する七十五歳到達時特例対象療養に係るものにあっては、一万五百円）以上のものに限る。）を合算した額
the amount of the co-payment;
一部負担金の額
where the treatment includes evaluation treatment prescribed in Article 63, paragraph (2), item (iii) of the Act, patient-requested treatment prescribed in item (iv) of that paragraph or selective treatment prescribed in item (v) of that paragraph, the amount obtained by adding to the amount of the co-payment the amount obtained by deducting, from the amount of expenses calculated as specified by the Minister of Health, Labour and Welfare as referred to in Article 86, paragraph (2), item (i) of the Act (or, where that amount exceeds the amount of expenses actually required for the treatment, the amount of expenses actually required for the treatment), the amount equivalent to the amount paid as medical expenses combined with treatment outside insurance coverage for the expenses required for the treatment;
当該療養が法第六十三条第二項第三号に規定する評価療養、同項第四号に規定する患者申出療養又は同項第五号に規定する選定療養を含む場合における一部負担金の額に法第八十六条第二項第一号に規定する厚生労働大臣が定めるところにより算定した費用の額（その額が現に当該療養に要した費用の額を超えるときは、現に当該療養に要した費用の額）から当該療養に要した費用につき保険外併用療養費として支給される額に相当する額を控除した額を加えた額
the amount obtained by deducting, from the amount of expenses calculated for the treatment (or, where that amount exceeds the amount of expenses actually required for the treatment, the amount of expenses actually required for the treatment), the amount equivalent to the amount paid as medical expenses for the expenses required for the treatment;
当該療養につき算定した費用の額（その額が現に当該療養に要した費用の額を超えるときは、現に当該療養に要した費用の額）から当該療養に要した費用につき療養費として支給される額に相当する額を控除した額
the amount obtained by deducting, from the amount of expenses calculated as specified by the Minister of Health, Labour and Welfare prescribed in Article 88, paragraph (4) of the Act, an amount equivalent to the amount paid as medical expenses for home-nursing for the expenses required for the relevant designated home nursing;
法第八十八条第四項に規定する厚生労働大臣が定めるところにより算定した費用の額からその指定訪問看護に要した費用につき訪問看護療養費として支給される額に相当する額を控除した額
the amount obtained by deducting, from the amount of expenses calculated for the relevant medical treatment (if that amount exceeds the amount of expenses actually required for the relevant medical treatment, the amount of expenses actually required for the relevant medical treatment), an amount equivalent to the amount paid as dependent's medical expenses (including medical expenses paid in lieu of dependent's medical expenses pursuant to Article 87, paragraph (1) of the Act as applied mutatis mutandis pursuant to Article 110, paragraph (7) of the Act) for the expenses required for the relevant medical treatment;
the amount obtained by deducting, from the amount of expenses calculated pursuant to Article 111, paragraph (2) of the Act, an amount equivalent to the amount paid as dependent's medical expenses for home-nursing for the expenses required for the relevant designated home nursing;
法第百十一条第二項の規定により算定した費用の額からその指定訪問看護に要した費用につき家族訪問看護療養費として支給される額に相当する額を控除した額
the total sum of the amounts that the insured person or a dependent thereof still has to bear for treatment subject to specified benefits (meaning medical treatment for which payment of general medical expenses for atomic bomb survivors under the Atomic Bomb Survivors' Assistance Act (Act No. 117 of 1994) (referred to as "general medical expenses for atomic bomb survivors" in Article 43, paragraph (5)) or other benefits for medical care specified by Order of the Ministry of Health, Labour and Welfare are to be provided, and the treatment prescribed in paragraph (9) in the case where the insured person or a dependent thereof has received certification by the insurer under that paragraph; the same applies hereinafter) that the insured person or a dependent thereof received in the same month as in the preceding item from each single hospital, etc. (for those relating to treatment subject to specified benefits on or before the month that includes the day on which the person reaches the age of 70, limited to those for which the amounts listed in (a) through (f) of the preceding item relating to that treatment subject to specified benefits are 21,000 yen or more (10,500 yen or more for those relating to medical treatment under the special rule on reaching age 75 prescribed in Article 41-3, paragraph (1), item (i))).
被保険者又はその被扶養者が前号と同一の月にそれぞれ一の病院等から受けた特定給付対象療養（原子爆弾被爆者に対する援護に関する法律（平成六年法律第百十七号）による一般疾病医療費（第四十三条第五項において「原爆一般疾病医療費」という。）の支給その他厚生労働省令で定める医療に関する給付が行われるべき療養及び当該被保険者又はその被扶養者が第九項の規定による保険者の認定を受けた場合における同項に規定する療養をいう。以下同じ。）について、当該被保険者又はその被扶養者がなお負担すべき額（七十歳に達する日の属する月以前の特定給付対象療養に係るものにあっては、当該特定給付対象療養に係る前号イからヘまでに掲げる額が二万千円（第四十一条の三第一項第一号に規定する七十五歳到達時特例対象療養に係るものにあっては、一万五百円）以上のものに限る。）を合算した額
If a dependent of an insured person receives medical treatment (limited to medical treatment under the special rule on reaching age 75 prescribed in Article 41-3, paragraph (1), item (i) that was received on or before the month that includes the day on which the person reaches the age of 70), and the amount obtained by totaling, for each dependent, the amounts listed in the following items relating to that medical treatment that the dependent received in the same month from each single hospital, etc. exceeds the base amount for calculating high-cost medical expenses, the total sum of the amounts obtained by deducting the base amount for calculating high-cost medical expenses from the respective totals is paid as high-cost medical expenses.
被保険者の被扶養者が療養（第四十一条の三第一項第一号に規定する七十五歳到達時特例対象療養であって、七十歳に達する日の属する月以前のものに限る。）を受けた場合において、当該被扶養者が同一の月にそれぞれ一の病院等から受けた当該療養に係る次に掲げる額を当該被扶養者ごとにそれぞれ合算した額が高額療養費算定基準額を超えるときは、当該それぞれ合算した額から高額療養費算定基準額を控除した額の合算額を高額療養費として支給する。
the total sum of the amounts listed in item (i), (a) through (f) of the preceding paragraph relating to that medical treatment received by the dependent (excluding treatment subject to specified benefits) (limited to those of 10,500 yen or more);
the total sum of the amounts that the dependent still has to bear for that medical treatment received by the dependent (limited to treatment subject to specified benefits) (limited to those for which the amounts listed in item (i), (a) through (f) of the preceding paragraph relating to that treatment subject to specified benefits are 10,500 yen or more).
If an insured person or a dependent thereof receives medical treatment (limited to medical treatment on or after the month following the month that includes the day on which the person reaches the age of 70; the same applies in paragraph (5)), and the amount obtained by deducting the amount of high-cost medical expenses paid pursuant to the following paragraph or paragraph (5) from the total sum of the following amounts relating to that medical treatment that the insured person or a dependent thereof received in the same month from each single hospital, etc. (hereinafter in this paragraph referred to as the "household total of co-payments, etc. for persons aged 70 or over") exceeds the base amount for calculating high-cost medical expenses, the amount obtained by deducting the base amount for calculating high-cost medical expenses from the household total of co-payments, etc. for persons aged 70 or over is paid as high-cost medical expenses.
the total sum of the amounts listed in paragraph (1), item (i), (a) through (f) relating to that medical treatment received by the insured person or a dependent thereof (excluding treatment subject to specified benefits);
the total sum of the amounts that the insured person or a dependent thereof still has to bear for that medical treatment received by the insured person or a dependent thereof (limited to treatment subject to specified benefits).
被保険者又はその被扶養者が受けた当該療養（特定給付対象療養に限る。）について、当該被保険者又はその被扶養者がなお負担すべき額を合算した額
If an insured person receives the medical treatment listed in item (i), or a dependent thereof receives the medical treatment listed in item (ii) or the medical treatment listed in item (iii) (limited to medical treatment on or after the month following the month that includes the day on which the person reaches the age of 70), and the amount obtained by deducting, from the amount obtained by totaling, for each insured person or dependent thereof, the amounts listed in the items of the preceding paragraph relating to that medical treatment that the insured person or dependent received in the same month from each single hospital, etc., the portion of the amount of high-cost medical expenses paid pursuant to the following paragraph that relates to that insured person or dependent exceeds the base amount for calculating high-cost medical expenses, the total sum of the amounts obtained by deducting the base amount for calculating high-cost medical expenses from the respective amounts so deducted is paid as high-cost medical expenses.
the medical treatment received by a person who falls under Article 52, item (i) of the Act on Assurance of Medical Care for Elderly People and has lost status as an insured person of health insurance by acquiring, on a day other than the first day of a month, status as an insured person under Article 50 of that Act (hereinafter referred to as an "insured person of the late-stage elderly medical care system") (referred to as a "former insured person before reaching age 75" in item (iii)), in the month that includes the day preceding that day (limited to the period on or before that day; referred to as the "month in which the former insured person reaches age 75" in item (iii));
高齢者の医療の確保に関する法律第五十二条第一号に該当し、月の初日以外の日において同法第五十条の規定による被保険者（以下「後期高齢者医療の被保険者」という。）の資格を取得したことにより健康保険の被保険者の資格を喪失した者（第三号において「七十五歳到達前旧被保険者」という。）が、同日の前日の属する月（同日以前の期間に限る。第三号において「旧被保険者七十五歳到達月」という。）に受けた療養
the medical treatment received by a person who falls under Article 52, item (i) of the Act on Assurance of Medical Care for Elderly People and has ceased to be a dependent by acquiring, on a day other than the first day of a month, status as an insured person of the late-stage elderly medical care system, in the month that includes the day preceding that day (limited to the period on or before that day);
高齢者の医療の確保に関する法律第五十二条第一号に該当し、月の初日以外の日において後期高齢者医療の被保険者の資格を取得したことにより被扶養者でなくなった者が、同日の前日の属する月（同日以前の期間に限る。）に受けた療養
the medical treatment received, in the month in which the former insured person reaches age 75 for the relevant former insured person before reaching age 75, by a person who was a dependent of a former insured person before reaching age 75 (limited to a person who ceased to be a dependent of that former insured person before reaching age 75 by reason of that former insured person before reaching age 75 acquiring status as an insured person of the late-stage elderly medical care system).
七十五歳到達前旧被保険者の被扶養者であった者（当該七十五歳到達前旧被保険者が後期高齢者医療の被保険者の資格を取得したことによりその被扶養者でなくなった者に限る。）が、当該七十五歳到達前旧被保険者に係る旧被保険者七十五歳到達月に受けた療養
If an insured person (excluding a case where the person is one to whom the provisions of Article 74, paragraph (1), item (iii) of the Act apply) or a dependent thereof receives medical treatment (limited to outpatient treatment (meaning the medical treatment listed in Article 63, paragraph (1), items (i) through (iv) of the Act (excluding that accompanying the medical treatment listed in item (v) of that paragraph); the same applies in the following Article and in Article 42, paragraph (6), item (iii), paragraph (7), item (iii) and paragraph (8), item (iii))), and the amount obtained by totaling, for each insured person or dependent thereof, the amounts listed in the items of paragraph (3) relating to that medical treatment that the insured person or dependent received in the same month from each single hospital, etc. exceeds the base amount for calculating high-cost medical expenses, the total sum of the amounts obtained by deducting the base amount for calculating high-cost medical expenses from the respective totals is paid as high-cost medical expenses.
被保険者（法第七十四条第一項第三号の規定が適用される者である場合を除く。）又はその被扶養者が療養（外来療養（法第六十三条第一項第一号から第四号までに掲げる療養（同項第五号に掲げる療養に伴うものを除く。）をいう。次条並びに第四十二条第六項第三号、第七項第三号及び第八項第三号において同じ。）に限る。）を受けた場合において、当該被保険者又はその被扶養者が同一の月にそれぞれ一の病院等から受けた当該療養に係る第三項各号に掲げる額を当該被保険者又はその被扶養者ごとにそれぞれ合算した額が高額療養費算定基準額を超えるときは、当該それぞれ合算した額から高額療養費算定基準額を控除した額の合算額を高額療養費として支給する。
If an insured person or a dependent thereof receives treatment subject to specified benefits (excluding treatment subject to specified disease benefits prescribed in the following paragraph in the case where the insured person or a dependent thereof has received certification by the insurer under that paragraph, and the treatment prescribed in paragraph (9) in the case where the insured person or a dependent thereof has received certification by the insurer under that paragraph), and the amounts listed in paragraph (1), item (i), (a) through (f) relating to that treatment subject to specified benefits that the insured person or dependent received in the same month from each single hospital, etc. exceed the base amount for calculating high-cost medical expenses, the amount obtained by deducting the base amount for calculating high-cost medical expenses from the amounts listed in (a) through (f) of that item is paid as high-cost medical expenses.
If an insured person or a dependent thereof receives treatment subject to specified disease benefits (meaning, among treatment subject to specified benefits (excluding the treatment prescribed in paragraph (9) in the case where the insured person or a dependent thereof has received certification by the insurer under that paragraph), treatment for which benefits for medical care specified by the Minister of Health, Labour and Welfare as benefits for reducing the burden of the costs necessary for the treatment of a disease for which a treatment method has not been established or another disease that, by being contracted, requires treatment over a long period are to be provided; the same applies in Article 42, paragraph (7)), the insured person or dependent who received that treatment subject to specified disease benefits has received certification by the insurer as provided by Order of the Ministry of Health, Labour and Welfare, and the amounts listed in paragraph (1), item (i), (a) through (f) relating to that treatment subject to specified disease benefits that the insured person or dependent received in the same month from each single hospital, etc. exceed the base amount for calculating high-cost medical expenses, the amount obtained by deducting the base amount for calculating high-cost medical expenses from the amounts listed in (a) through (f) of that item is paid as high-cost medical expenses.
被保険者又はその被扶養者が特定疾病給付対象療養（特定給付対象療養（当該被保険者又はその被扶養者が第九項の規定による保険者の認定を受けた場合における同項に規定する療養を除く。）のうち、治療方法が確立していない疾病その他の疾病であって、当該疾病にかかることにより長期にわたり療養を必要とすることとなるものの当該療養に必要な費用の負担を軽減するための医療に関する給付として厚生労働大臣が定めるものが行われるべきものをいう。第四十二条第七項において同じ。）を受けた場合において、当該特定疾病給付対象療養を受けた被保険者又はその被扶養者が厚生労働省令で定めるところにより保険者の認定を受けたものであり、かつ、当該被保険者又はその被扶養者が同一の月にそれぞれ一の病院等から受けた当該特定疾病給付対象療養に係る第一項第一号イからヘまでに掲げる額が高額療養費算定基準額を超えるときは、当該同号イからヘまでに掲げる額から高額療養費算定基準額を控除した額を高額療養費として支給する。
If an insured person or a dependent thereof is a public assistance recipient prescribed in Article 6, paragraph (1) of the Public Assistance Act (Act No. 144 of 1950), and the amounts listed in paragraph (1), item (i), (a) through (f) relating to medical treatment (excluding dietary treatment, living support and treatment subject to specified benefits) that the insured person or dependent received in the same month from each single hospital, etc. exceed the base amount for calculating high-cost medical expenses, the amount obtained by deducting the base amount for calculating high-cost medical expenses from the amounts listed in (a) through (f) of that item is paid as high-cost medical expenses.
If an insured person or a dependent thereof receives medical treatment (excluding dietary treatment and living support) for a disease specified by the Minister of Health, Labour and Welfare that falls under all of the following items, the insured person or dependent who received that treatment has received certification by the insurer as provided by Order of the Ministry of Health, Labour and Welfare, and the amounts listed in paragraph (1), item (i), (a) through (f) relating to that treatment that the insured person or dependent received in the same month from each single hospital, etc. exceed the base amount for calculating high-cost medical expenses, the amount obtained by deducting the base amount for calculating high-cost medical expenses from the amounts listed in (a) through (f) of that item is paid as high-cost medical expenses.
that the disease requires treatment specified by the Minister of Health, Labour and Welfare as a certain treatment the cost of which is extremely high;
費用が著しく高額な一定の治療として厚生労働大臣が定める治療を要すること。
that the treatment prescribed in the preceding item must be continued over an extremely long period.
前号に規定する治療を著しく長期間にわたり継続しなければならないこと。
Article 41-2Requirements for Payment and Amount of Annual High-Cost Medical Expenses
High-cost medical expenses are paid to the insured person on the reference date prescribed in item (i) if any of the total sum of the amounts listed in items (i) through (vi) (hereinafter in this paragraph referred to as the "total for the insured person on the reference date"), the total sum of the amounts listed in items (vii) through (xii) (hereinafter in this paragraph referred to as the "total for the dependent on the reference date"), or the total sum of the amounts listed in items (xiii) through (xviii) (hereinafter in this paragraph referred to as the "total for former dependents") exceeds the base amount for calculating high-cost medical expenses, and the amount paid is the total sum of the amount obtained by multiplying the amount obtained by deducting the base amount for calculating high-cost medical expenses from the total for the insured person on the reference date (if that amount is less than zero, zero) by the high-cost medical expenses apportionment rate (meaning the rate obtained by dividing the amount listed in item (i) by the total for the insured person on the reference date), the amount obtained by multiplying the amount obtained by deducting the base amount for calculating high-cost medical expenses from the total for the dependent on the reference date (if that amount is less than zero, zero) by the high-cost medical expenses apportionment rate (meaning the rate obtained by dividing the amount listed in item (vii) by the total for the dependent on the reference date), and the amount obtained by multiplying the amount obtained by deducting the base amount for calculating high-cost medical expenses from the total for former dependents (if that amount is less than zero, zero) by the high-cost medical expenses apportionment rate (meaning the rate obtained by dividing the amount listed in item (xiii) by the total for former dependents); provided, however, that this does not apply if the insured person on the reference date is, on the reference date (meaning the last day of the calculation period (meaning the period from August 1 each year to July 31 of the following year; the same applies hereinafter); the same applies hereinafter), a person to whom the provisions of Article 74, paragraph (1), item (iii) of the Act apply.
高額療養費は、第一号から第六号までに掲げる額を合算した額（以下この項において「基準日被保険者合算額」という。）、第七号から第十二号までに掲げる額を合算した額（以下この項において「基準日被扶養者合算額」という。）又は第十三号から第十八号までに掲げる額を合算した額（以下この項において「元被扶養者合算額」という。）のいずれかが高額療養費算定基準額を超える場合に第一号に規定する基準日被保険者に支給するものとし、その額は、基準日被保険者合算額から高額療養費算定基準額を控除した額（当該額が零を下回る場合には、零とする。）に高額療養費按分率（同号に掲げる額を、基準日被保険者合算額で除して得た率をいう。）を乗じて得た額、基準日被扶養者合算額から高額療養費算定基準額を控除した額（当該額が零を下回る場合には、零とする。）に高額療養費按分率（第七号に掲げる額を、基準日被扶養者合算額で除して得た率をいう。）を乗じて得た額及び元被扶養者合算額から高額療養費算定基準額を控除した額（当該額が零を下回る場合には、零とする。）に高額療養費按分率（第十三号に掲げる額を、元被扶養者合算額で除して得た率をいう。）を乗じて得た額の合算額とする。ただし、当該基準日被保険者が基準日（計算期間（毎年八月一日から翌年七月三十一日までの期間をいう。以下同じ。）の末日をいう。以下同じ。）において法第七十四条第一項第三号の規定が適用される者である場合は、この限りでない。
the total sum of the following amounts relating to outpatient treatment (limited to outpatient treatment on or after the month following the month that includes the day on which the person reaches the age of 70; the same applies hereinafter in this Article) (including outpatient treatment for insurance benefits under Article 98, paragraph (1) of the Act (including as applied mutatis mutandis pursuant to Article 110, paragraph (7) and Article 111, paragraph (3) of the Act) (hereinafter in this Article referred to as "outpatient treatment under continued benefits")) that the insured person on the reference date received, during the calculation period (limited to the period during which a person who is, on the reference date, an insured person of the relevant insurer (excluding specially-insured day laborers, members of mutual aid associations under the National Public Officers Mutual Aid Association Act and the Local Public Officers, etc. Mutual Aid Association Act, and subscribers to the Private School Personnel Mutual Aid System under the Private School Personnel Mutual Aid Association Act; the same applies hereinafter in this Article, Article 43, paragraph (11) and Articles 43-2 through 43-4) (hereinafter referred to as the "insured person on the reference date") was an insured person of the relevant insurer), as an insured person of the relevant insurer (excluding a case where the person is one to whom the provisions of Article 74, paragraph (1), item (iii) of the Act apply) (if high-cost medical expenses are paid pursuant to the provisions of paragraphs (1) through (5) of the preceding Article, the amount obtained by deducting the amount paid to the insured person on the reference date, and if money or goods for reducing the burden relating to the following amounts are provided as other benefits prescribed in Article 53 of the Act, the amount obtained by deducting the amount equivalent to that money or those goods relating to the insured person on the reference date):
計算期間（基準日において当該保険者の被保険者（日雇特例被保険者、国家公務員共済組合法及び地方公務員等共済組合法に基づく共済組合の組合員並びに私立学校教職員共済法の規定による私立学校教職員共済制度の加入者を除く。以下この条、第四十三条第十一項及び第四十三条の二から第四十三条の四までにおいて同じ。）である者（以下「基準日被保険者」という。）が当該保険者の被保険者であった間に限る。）において、当該基準日被保険者が当該保険者の被保険者（法第七十四条第一項第三号の規定が適用される者である場合を除く。）として受けた外来療養（七十歳に達する日の属する月の翌月以後の外来療養に限る。以下この条において同じ。）（法第九十八条第一項（法第百十条第七項及び第百十一条第三項において準用する場合を含む。）の規定による保険給付に係る外来療養（以下この条において「継続給付に係る外来療養」という。）を含む。）に係る次に掲げる額の合算額（前条第一項から第五項までの規定により高額療養費が支給される場合にあっては、当該者に係る支給額を控除した額とし、法第五十三条に規定するその他の給付として次に掲げる額に係る負担を軽減するための金品が支給される場合にあっては、当該者に係る当該金品に相当する額を控除した額とする。）
the total sum of the amounts listed in paragraph (1), item (i), (a) through (f) of the preceding Article relating to the relevant outpatient treatment (excluding treatment subject to specified benefits);
the amount that that person still has to bear for the relevant outpatient treatment (limited to treatment subject to specified benefits);
the total sum prescribed in the preceding item for outpatient treatment (including outpatient treatment under continued benefits) that the insured person on the reference date received, during the calculation period (limited to the period during which the insured person on the reference date was an insured person of the insurer of another health insurance), as an insured person of the insurer of that other health insurance (excluding a case where the person is one to whom the provisions of Article 74, paragraph (1), item (iii) of the Act apply);
計算期間（基準日被保険者が他の健康保険の保険者の被保険者であった間に限る。）において、当該基準日被保険者が当該他の健康保険の保険者の被保険者（法第七十四条第一項第三号の規定が適用される者である場合を除く。）として受けた外来療養（継続給付に係る外来療養を含む。）に係る前号に規定する合算額
the total sum prescribed in item (i) for outpatient treatment (including outpatient treatment under continued benefits) that the insured person on the reference date received, during the calculation period (limited to the period during which the dependent of the insured person on the reference date (limited to a person who is, on the reference date, a dependent of an insured person of the relevant insurer; hereinafter in this Article, Article 43-2, paragraph (1) (including as applied mutatis mutandis pursuant to paragraph (3) of that Article), paragraph (3) and paragraph (5) referred to as the "dependent on the reference date") was an insured person of the relevant insurer and the insured person on the reference date was a dependent of that dependent on the reference date), as a dependent of an insured person of the relevant insurer (excluding a case where the person is one to whom the provisions of Article 110, paragraph (2), item (i), (d) of the Act apply);
計算期間（基準日被保険者の被扶養者（基準日において当該保険者の被保険者の被扶養者である者に限る。以下この条並びに第四十三条の二第一項（同条第三項において準用する場合を含む。）、第三項及び第五項において「基準日被扶養者」という。）が当該保険者の被保険者であり、かつ、当該基準日被保険者が当該基準日被扶養者の被扶養者であった間に限る。）において、当該基準日被保険者が当該保険者の被保険者の被扶養者（法第百十条第二項第一号ニの規定が適用される者である場合を除く。）として受けた外来療養（継続給付に係る外来療養を含む。）に係る第一号に規定する合算額
the total sum prescribed in item (i) for outpatient treatment (including outpatient treatment under continued benefits) that the insured person on the reference date received, during the calculation period (limited to the period during which the dependent on the reference date was an insured person of the insurer of another health insurance and the insured person on the reference date was a dependent of that dependent on the reference date), as a dependent of an insured person of the insurer of that other health insurance (excluding a case where the person is one to whom the provisions of Article 110, paragraph (2), item (i), (d) of the Act apply);
計算期間（基準日被扶養者が他の健康保険の保険者の被保険者であり、かつ、基準日被保険者が当該基準日被扶養者の被扶養者であった間に限る。）において、当該基準日被保険者が当該他の健康保険の保険者の被保険者の被扶養者（法第百十条第二項第一号ニの規定が適用される者である場合を除く。）として受けた外来療養（継続給付に係る外来療養を含む。）に係る第一号に規定する合算額
the amount calculated, as provided by Order of the Ministry of Health, Labour and Welfare, as an amount equivalent to the total sum prescribed in item (i) for outpatient treatment that the insured person on the reference date received, during the calculation period (limited to the period during which the insured person on the reference date was a member, etc. of an insurer body, etc.), as a member, etc. of that insurer body, etc. (excluding a case where the person is equivalent to a person to whom the provisions of Article 74, paragraph (1), item (iii) of the Act apply);
計算期間（基準日被保険者が組合等の組合員等であった間に限る。）において、当該基準日被保険者が当該組合等の組合員等（法第七十四条第一項第三号の規定が適用される者に相当する者である場合を除く。）として受けた外来療養について第一号に規定する合算額に相当する額として厚生労働省令で定めるところにより算定した額
the amount calculated, as provided by Order of the Ministry of Health, Labour and Welfare, as an amount equivalent to the total sum prescribed in item (i) for outpatient treatment that the insured person on the reference date received, during the calculation period (limited to the period during which the dependent on the reference date was a member, etc. (excluding an insured person of the late-stage elderly medical care system) of an insurer body, etc. (excluding an Association of Medical Care Systems for the Elderly Aged 75 and older under the Act on Assurance of Medical Care for Elderly People) and the insured person on the reference date was a dependent, etc. of that dependent on the reference date), as a dependent, etc. of a member, etc. of that insurer body, etc. (excluding a case where the person is equivalent to a person to whom the provisions of Article 110, paragraph (2), item (i), (d) of the Act apply);
計算期間（基準日被扶養者が組合等（高齢者の医療の確保に関する法律に基づく後期高齢者医療広域連合を除く。）の組合員等（後期高齢者医療の被保険者を除く。）であり、かつ、基準日被保険者が当該基準日被扶養者の被扶養者等であった間に限る。）において、当該基準日被保険者が当該組合等の組合員等の被扶養者等（法第百十条第二項第一号ニの規定が適用される者に相当する者である場合を除く。）として受けた外来療養について第一号に規定する合算額に相当する額として厚生労働省令で定めるところにより算定した額
the total sum prescribed in item (i) for outpatient treatment (including outpatient treatment under continued benefits) that the dependent on the reference date received, during the calculation period (limited to the period during which the insured person on the reference date was an insured person of the relevant insurer and the dependent on the reference date was a dependent of that insured person on the reference date), as a dependent of an insured person of the relevant insurer (excluding a case where the person is one to whom the provisions of Article 110, paragraph (2), item (i), (d) of the Act apply);
計算期間（基準日被保険者が当該保険者の被保険者であり、かつ、基準日被扶養者が当該基準日被保険者の被扶養者であった間に限る。）において、当該基準日被扶養者が当該保険者の被保険者の被扶養者（法第百十条第二項第一号ニの規定が適用される者である場合を除く。）として受けた外来療養（継続給付に係る外来療養を含む。）に係る第一号に規定する合算額
the total sum prescribed in item (i) for outpatient treatment (including outpatient treatment under continued benefits) that the dependent on the reference date received, during the calculation period (limited to the period during which the insured person on the reference date was an insured person of the insurer of another health insurance and the dependent on the reference date was a dependent of that insured person on the reference date), as a dependent of an insured person of the insurer of that other health insurance (excluding a case where the person is one to whom the provisions of Article 110, paragraph (2), item (i), (d) of the Act apply);
計算期間（基準日被保険者が他の健康保険の保険者の被保険者であり、かつ、基準日被扶養者が当該基準日被保険者の被扶養者であった間に限る。）において、当該基準日被扶養者が当該他の健康保険の保険者の被保険者の被扶養者（法第百十条第二項第一号ニの規定が適用される者である場合を除く。）として受けた外来療養（継続給付に係る外来療養を含む。）に係る第一号に規定する合算額
the total sum prescribed in item (i) for outpatient treatment (including outpatient treatment under continued benefits) that the dependent on the reference date received, during the calculation period (limited to the period during which the dependent on the reference date was an insured person of the relevant insurer), as an insured person of the relevant insurer (excluding a case where the person is one to whom the provisions of Article 74, paragraph (1), item (iii) of the Act apply);
計算期間（基準日被扶養者が当該保険者の被保険者であった間に限る。）において、当該基準日被扶養者が当該保険者の被保険者（法第七十四条第一項第三号の規定が適用される者である場合を除く。）として受けた外来療養（継続給付に係る外来療養を含む。）に係る第一号に規定する合算額
the total sum prescribed in item (i) for outpatient treatment (including outpatient treatment under continued benefits) that the dependent on the reference date received, during the calculation period (limited to the period during which the dependent on the reference date was an insured person of the insurer of another health insurance), as an insured person of the insurer of that other health insurance (excluding a case where the person is one to whom the provisions of Article 74, paragraph (1), item (iii) of the Act apply);
計算期間（基準日被扶養者が他の健康保険の保険者の被保険者であった間に限る。）において、当該基準日被扶養者が当該他の健康保険の保険者の被保険者（法第七十四条第一項第三号の規定が適用される者である場合を除く。）として受けた外来療養（継続給付に係る外来療養を含む。）に係る第一号に規定する合算額
the amount calculated, as provided by Order of the Ministry of Health, Labour and Welfare, as an amount equivalent to the total sum prescribed in item (i) for outpatient treatment that the dependent on the reference date received, during the calculation period (limited to the period during which the insured person on the reference date was a member, etc. (excluding an insured person of the late-stage elderly medical care system) of an insurer body, etc. (excluding an Association of Medical Care Systems for the Elderly Aged 75 and older under the Act on Assurance of Medical Care for Elderly People) and the dependent on the reference date was a dependent, etc. of that insured person on the reference date), as a dependent, etc. of a member, etc. of that insurer body, etc. (excluding a case where the person is equivalent to a person to whom the provisions of Article 110, paragraph (2), item (i), (d) of the Act apply);
計算期間（基準日被保険者が組合等（高齢者の医療の確保に関する法律に基づく後期高齢者医療広域連合を除く。）の組合員等（後期高齢者医療の被保険者を除く。）であり、かつ、基準日被扶養者が当該基準日被保険者の被扶養者等であった間に限る。）において、当該基準日被扶養者が当該組合等の組合員等の被扶養者等（法第百十条第二項第一号ニの規定が適用される者に相当する者である場合を除く。）として受けた外来療養について第一号に規定する合算額に相当する額として厚生労働省令で定めるところにより算定した額
the amount calculated, as provided by Order of the Ministry of Health, Labour and Welfare, as an amount equivalent to the total sum prescribed in item (i) for outpatient treatment that the dependent on the reference date received, during the calculation period (limited to the period during which the dependent on the reference date was a member, etc. of an insurer body, etc.), as a member, etc. of that insurer body, etc. (excluding a case where the person is equivalent to a person to whom the provisions of Article 74, paragraph (1), item (iii) of the Act apply);
計算期間（基準日被扶養者が組合等の組合員等であった間に限る。）において、当該基準日被扶養者が当該組合等の組合員等（法第七十四条第一項第三号の規定が適用される者に相当する者である場合を除く。）として受けた外来療養について第一号に規定する合算額に相当する額として厚生労働省令で定めるところにより算定した額
the total sum prescribed in item (i) for outpatient treatment (including outpatient treatment under continued benefits) that a person who was a dependent of the insured person on the reference date (excluding the dependent on the reference date) received, during the calculation period (limited to the period during which the insured person on the reference date was an insured person of the relevant insurer and the person who was a dependent of that insured person on the reference date (excluding the dependent on the reference date) was a dependent of that insured person on the reference date), as a dependent of an insured person of the relevant insurer (excluding a case where the person is one to whom the provisions of Article 110, paragraph (2), item (i), (d) of the Act apply);
計算期間（基準日被保険者が当該保険者の被保険者であり、かつ、当該基準日被保険者の被扶養者であった者（基準日被扶養者を除く。）が当該基準日被保険者の被扶養者であった間に限る。）において、当該基準日被保険者の被扶養者であった者（基準日被扶養者を除く。）が当該保険者の被保険者の被扶養者（法第百十条第二項第一号ニの規定が適用される者である場合を除く。）として受けた外来療養（継続給付に係る外来療養を含む。）に係る第一号に規定する合算額
the total sum prescribed in item (i) for outpatient treatment (including outpatient treatment under continued benefits) that a person who was a dependent of the insured person on the reference date (excluding the dependent on the reference date) received, during the calculation period (limited to the period during which the insured person on the reference date was an insured person of the insurer of another health insurance and the person who was a dependent of that insured person on the reference date (excluding the dependent on the reference date) was a dependent of that insured person on the reference date), as a dependent of an insured person of the insurer of that other health insurance (excluding a case where the person is one to whom the provisions of Article 110, paragraph (2), item (i), (d) of the Act apply);
計算期間（基準日被保険者が他の健康保険の保険者の被保険者であり、かつ、当該基準日被保険者の被扶養者であった者（基準日被扶養者を除く。）が当該基準日被保険者の被扶養者であった間に限る。）において、当該基準日被保険者の被扶養者であった者（基準日被扶養者を除く。）が当該他の健康保険の保険者の被保険者の被扶養者（法第百十条第二項第一号ニの規定が適用される者である場合を除く。）として受けた外来療養（継続給付に係る外来療養を含む。）に係る第一号に規定する合算額
the total sum prescribed in item (i) for outpatient treatment (including outpatient treatment under continued benefits) that a person who was a dependent of the dependent on the reference date (excluding the insured person on the reference date) received, during the calculation period (limited to the period during which the dependent on the reference date was an insured person of the relevant insurer and the person who was a dependent of that dependent on the reference date (excluding the insured person on the reference date) was a dependent of that dependent on the reference date), as a dependent of an insured person of the relevant insurer (excluding a case where the person is one to whom the provisions of Article 110, paragraph (2), item (i), (d) of the Act apply);
計算期間（基準日被扶養者が当該保険者の被保険者であり、かつ、当該基準日被扶養者の被扶養者であった者（基準日被保険者を除く。）が当該基準日被扶養者の被扶養者であった間に限る。）において、当該基準日被扶養者の被扶養者であった者（基準日被保険者を除く。）が当該保険者の被保険者の被扶養者（法第百十条第二項第一号ニの規定が適用される者である場合を除く。）として受けた外来療養（継続給付に係る外来療養を含む。）に係る第一号に規定する合算額
the total sum prescribed in item (i) for outpatient treatment (including outpatient treatment under continued benefits) that a person who was a dependent of the dependent on the reference date (excluding the insured person on the reference date) received, during the calculation period (limited to the period during which the dependent on the reference date was an insured person of the insurer of another health insurance and the person who was a dependent of that dependent on the reference date (excluding the insured person on the reference date) was a dependent of that dependent on the reference date), as a dependent of an insured person of the insurer of that other health insurance (excluding a case where the person is one to whom the provisions of Article 110, paragraph (2), item (i), (d) of the Act apply);
計算期間（基準日被扶養者が他の健康保険の保険者の被保険者であり、かつ、当該基準日被扶養者の被扶養者であった者（基準日被保険者を除く。）が当該基準日被扶養者の被扶養者であった間に限る。）において、当該基準日被扶養者の被扶養者であった者（基準日被保険者を除く。）が当該他の健康保険の保険者の被保険者の被扶養者（法第百十条第二項第一号ニの規定が適用される者である場合を除く。）として受けた外来療養（継続給付に係る外来療養を含む。）に係る第一号に規定する合算額
the amount calculated, as provided by Order of the Ministry of Health, Labour and Welfare, as an amount equivalent to the total sum prescribed in item (i) for outpatient treatment that a person who was a dependent, etc. of the insured person on the reference date (excluding the dependent on the reference date) received, during the calculation period (limited to the period during which the insured person on the reference date was a member, etc. (excluding an insured person of the late-stage elderly medical care system) of an insurer body, etc. (excluding an Association of Medical Care Systems for the Elderly Aged 75 and older under the Act on Assurance of Medical Care for Elderly People) and the person who was a dependent, etc. of that insured person on the reference date (excluding the dependent on the reference date) was a dependent, etc. of that insured person on the reference date), as a dependent, etc. of a member, etc. of that insurer body, etc. (excluding a case where the person is equivalent to a person to whom the provisions of Article 110, paragraph (2), item (i), (d) of the Act apply);
計算期間（基準日被保険者が組合等（高齢者の医療の確保に関する法律に基づく後期高齢者医療広域連合を除く。）の組合員等（後期高齢者医療の被保険者を除く。）であり、かつ、当該基準日被保険者の被扶養者等であった者（基準日被扶養者を除く。）が当該基準日被保険者の被扶養者等であった間に限る。）において、当該基準日被保険者の被扶養者等であった者（基準日被扶養者を除く。）が当該組合等の組合員等の被扶養者等（法第百十条第二項第一号ニの規定が適用される者に相当する者である場合を除く。）として受けた外来療養について第一号に規定する合算額に相当する額として厚生労働省令で定めるところにより算定した額
the amount calculated, as provided by Order of the Ministry of Health, Labour and Welfare, as an amount equivalent to the total sum prescribed in item (i) for outpatient treatment that a person who was a dependent, etc. of the dependent on the reference date (excluding the insured person on the reference date) received, during the calculation period (limited to the period during which the dependent on the reference date was a member, etc. (excluding an insured person of the late-stage elderly medical care system) of an insurer body, etc. (excluding an Association of Medical Care Systems for the Elderly Aged 75 and older under the Act on Assurance of Medical Care for Elderly People) and the person who was a dependent, etc. of that dependent on the reference date (excluding the insured person on the reference date) was a dependent, etc. of that dependent on the reference date), as a dependent, etc. of a member, etc. of that insurer body, etc. (excluding a case where the person is equivalent to a person to whom the provisions of Article 110, paragraph (2), item (i), (d) of the Act apply).
計算期間（基準日被扶養者が組合等（高齢者の医療の確保に関する法律に基づく後期高齢者医療広域連合を除く。）の組合員等（後期高齢者医療の被保険者を除く。）であり、かつ、当該基準日被扶養者の被扶養者等であった者（基準日被保険者を除く。）が当該基準日被扶養者の被扶養者等であった間に限る。）において、当該基準日被扶養者の被扶養者等であった者（基準日被保険者を除く。）が当該組合等の組合員等の被扶養者等（法第百十条第二項第一号ニの規定が適用される者に相当する者である場合を除く。）として受けた外来療養について第一号に規定する合算額に相当する額として厚生労働省令で定めるところにより算定した額
The provisions of the preceding paragraph apply mutatis mutandis to the payment of high-cost medical expenses to a person who was an insured person of the relevant insurer during the calculation period (limited to a dependent on the reference date). In this case, the phrase "(meaning the rate obtained by dividing the amount listed in item (i)" in that paragraph is deemed to be replaced with "(meaning the rate obtained by dividing the amount listed in item (iii)", "(meaning the rate obtained by dividing the amount listed in item (vii)" with "(meaning the rate obtained by dividing the amount listed in item (ix)", and "(meaning the rate obtained by dividing the amount listed in item (xiii)" with "(meaning the rate obtained by dividing the amount listed in item (xv)", and the term "Article 74, paragraph (1), item (iii)" in the proviso to that paragraph is deemed to be replaced with "Article 110, paragraph (2), item (i), (d)".
The provisions of paragraph (1) apply mutatis mutandis to the payment of high-cost medical expenses to a person who was an insured person of the relevant insurer during the calculation period (limited to a person who, on the reference date, is an insured person of the insurer of another health insurance). In this case, the terms listed in the middle column of the following table in the provisions listed in the left-hand column of the table are deemed to be replaced with the terms listed in the right-hand column of the table, respectively.
| Paragraph (1) | listed in item (i) | listed in item (ii), limited to the amount that relates to the outpatient treatment prescribed in item (ii) that the person prescribed in paragraph (3) received, during the calculation period (meaning the period from August 1 each year to July 31 of the following year; the same applies hereinafter) (limited to the period during which the person prescribed in paragraph (3) was an insured person of the relevant insurer), as an insured person of the relevant insurer (excluding a case where the person is one to whom the provisions of Article 74, paragraph (1), item (iii) of the Act apply) |
| listed in item (vii) | listed in item (viii), limited to the amount that relates to the outpatient treatment prescribed in item (viii) that the dependent on the reference date received, during the calculation period (limited to the period during which the person prescribed in paragraph (3) was an insured person of the relevant insurer and the dependent on the reference date prescribed in item (iii) was a dependent of that person prescribed in that paragraph), as a dependent of an insured person of the relevant insurer (excluding a case where the person is one to whom the provisions of Article 110, paragraph (2), item (i), (d) of the Act apply) | |
| listed in item (xiii) | listed in item (xiv), limited to the amount that relates to the outpatient treatment prescribed in item (xiv) that a person who was a dependent of the person prescribed in paragraph (3) (excluding that dependent on the reference date) received, during the calculation period (limited to the period during which the person prescribed in paragraph (3) was an insured person of the relevant insurer and the person who was a dependent of the person prescribed in that paragraph (excluding that dependent on the reference date) was a dependent of the person prescribed in that paragraph), as a dependent of an insured person of the relevant insurer (excluding a case where the person is one to whom the provisions of Article 110, paragraph (2), item (i), (d) of the Act apply) | |
| Paragraph (1), proviso | the last day of the calculation period (meaning the period from August 1 each year to July 31 of the following year; the same applies hereinafter) | the last day of the calculation period |
| Paragraph (1), item (i) | on the reference date, an insured person of the relevant insurer | on the reference date, an insured person of the insurer of another health insurance |
| ) was an insured person of the relevant insurer | ) was an insured person of the insurer of that other health insurance (hereinafter referred to as the "insurer on the reference date" in this paragraph) | |
| as an insured person of the relevant insurer (excluding a case | as an insured person of the insurer on the reference date (excluding a case | |
| Paragraph (1), item (ii) | another health insurance | a health insurance other than that of the insurer on the reference date |
| Paragraph (1), item (iii) | on the reference date, a dependent of an insured person of the relevant insurer | on the reference date, a dependent of an insured person of the insurer on the reference date |
| the relevant insurer | that insurer on the reference date | |
| Paragraph (1), item (iv) | another health insurance | a health insurance other than that of the insurer on the reference date |
| Paragraph (1), item (vii) | an insured person of the relevant insurer and | an insured person of the insurer on the reference date and |
| of an insured person of the relevant insurer | of an insured person of the insurer on the reference date | |
| Paragraph (1), item (viii) | another health insurance | a health insurance other than that of the insurer on the reference date |
| Paragraph (1), item (ix) | was an insured person of the relevant insurer | was an insured person of the insurer on the reference date |
| an insured person of the relevant insurer ( | an insured person of the insurer on the reference date ( | |
| Paragraph (1), item (x) | another health insurance | a health insurance other than that of the insurer on the reference date |
| Paragraph (1), item (xiii) | an insured person of the relevant insurer and | an insured person of the insurer on the reference date and |
| of an insured person of the relevant insurer | of an insured person of the insurer on the reference date | |
| Paragraph (1), item (xiv) | another health insurance | a health insurance other than that of the insurer on the reference date |
| Paragraph (1), item (xv) | an insured person of the relevant insurer and | an insured person of the insurer on the reference date and |
| of an insured person of the relevant insurer | of an insured person of the insurer on the reference date | |
| Paragraph (1), item (xvi) | another health insurance | a health insurance other than that of the insurer on the reference date |
第一項の規定は、計算期間において当該保険者の被保険者であった者（基準日において他の健康保険の保険者の被保険者である者に限る。）に対する高額療養費の支給について準用する。この場合において、次の表の上欄に掲げる規定中同表の中欄に掲げる字句は、それぞれ同表の下欄に掲げる字句に読み替えるものとする。
| 第一項 | 同号に掲げる | 第二号に掲げる額のうち、計算期間（毎年八月一日から翌年七月三十一日までの期間をいう。以下同じ。）（第三項に規定する者が当該保険者の被保険者であった間に限る。）において、当該第三項に規定する者が当該保険者の被保険者（法第七十四条第一項第三号の規定が適用される者である場合を除く。）として受けた第二号に規定する外来療養に係る |
| 第七号に掲げる | 第八号に掲げる額のうち、計算期間（第三項に規定する者が当該保険者の被保険者であり、かつ、第三号に規定する基準日被扶養者が当該同項に規定する者の被扶養者であった間に限る。）において、当該基準日被扶養者が当該保険者の被保険者の被扶養者（法第百十条第二項第一号ニの規定が適用される者である場合を除く。）として受けた第八号に規定する外来療養に係る | |
| 第十三号に掲げる | 第十四号に掲げる額のうち、計算期間（第三項に規定する者が当該保険者の被保険者であり、かつ、当該同項に規定する者の被扶養者であった者（当該基準日被扶養者を除く。）が当該同項に規定する者の被扶養者であった間に限る。）において、当該同項に規定する者の被扶養者であった者（当該基準日被扶養者を除く。）が当該保険者の被保険者の被扶養者（法第百十条第二項第一号ニの規定が適用される者である場合を除く。）として受けた第十四号に規定する外来療養に係る | |
| 第一項ただし書 | （毎年八月一日から翌年七月三十一日までの期間をいう。以下同じ。）の末日 | の末日 |
| 第一項第一号 | おいて当該 | おいて他の健康保険の |
| ）が当該保険者 | ）が当該他の健康保険の保険者（以下この項において「基準日保険者」という。） | |
| 保険者の被保険者（法 | 基準日保険者の被保険者（法 | |
| 第一項第二号 | 他の | 基準日保険者以外の |
| 第一項第三号 | おいて当該保険者 | おいて基準日保険者 |
| が当該保険者 | が当該基準日保険者 | |
| 第一項第四号 | 他の | 基準日保険者以外の |
| 第一項第七号 | 当該保険者の被保険者で | 基準日保険者の被保険者で |
| 保険者の被保険者の | 基準日保険者の被保険者の | |
| 第一項第八号 | 他の | 基準日保険者以外の |
| 第一項第九号 | 当該保険者の被保険者で | 基準日保険者の被保険者で |
| 保険者の被保険者（ | 基準日保険者の被保険者（ | |
| 第一項第十号 | 他の | 基準日保険者以外の |
| 第一項第十三号 | 当該保険者の被保険者で | 基準日保険者の被保険者で |
| 保険者の被保険者の | 基準日保険者の被保険者の | |
| 第一項第十四号 | 他の | 基準日保険者以外の |
| 第一項第十五号 | 当該保険者の被保険者で | 基準日保険者の被保険者で |
| 保険者の被保険者の | 基準日保険者の被保険者の | |
| 第一項第十六号 | 他の | 基準日保険者以外の |
The provisions of paragraph (1) apply mutatis mutandis to the payment of high-cost medical expenses to a person who was an insured person of the relevant insurer during the calculation period (limited to a person who, on the reference date, is a dependent of an insured person of the insurer of another health insurance). In this case, the terms listed in the middle column of the following table in the provisions listed in the left-hand column of the table are deemed to be replaced with the terms listed in the right-hand column of the table, respectively.
| Paragraph (1) | listed in item (i) | listed in item (iv), limited to the amount that relates to the outpatient treatment prescribed in item (iv) that the insured person on the reference date prescribed in item (i) received, during the calculation period (meaning the period from August 1 each year to July 31 of the following year; the same applies hereinafter) (limited to the period during which the person prescribed in paragraph (4) was an insured person of the relevant insurer and the insured person on the reference date prescribed in item (i) was a dependent of the person prescribed in that paragraph), as a dependent of an insured person of the relevant insurer (excluding a case where the person is one to whom the provisions of Article 110, paragraph (2), item (i), (d) of the Act apply) |
| listed in item (vii) | listed in item (x), limited to the amount that relates to the outpatient treatment prescribed in item (x) that the person prescribed in paragraph (4) received, during the calculation period (limited to the period during which the person prescribed in paragraph (4) was an insured person of the relevant insurer), as an insured person of the relevant insurer (excluding a case where the person is one to whom the provisions of Article 74, paragraph (1), item (iii) of the Act apply) | |
| listed in item (xiii) | listed in item (xvi), limited to the amount that relates to the outpatient treatment prescribed in item (xvi) that a person who was a dependent of the person prescribed in paragraph (4) (excluding that insured person on the reference date) received, during the calculation period (limited to the period during which the person prescribed in paragraph (4) was an insured person of the relevant insurer and the person who was a dependent of the person prescribed in that paragraph (excluding that insured person on the reference date) was a dependent of the person prescribed in that paragraph), as a dependent of an insured person of the relevant insurer (excluding a case where the person is one to whom the provisions of Article 110, paragraph (2), item (i), (d) of the Act apply) | |
| Paragraph (1), proviso | the last day of the calculation period (meaning the period from August 1 each year to July 31 of the following year; the same applies hereinafter) | the last day of the calculation period |
| Article 74, paragraph (1), item (iii) | Article 110, paragraph (2), item (i), (d) | |
| Paragraph (1), item (i) | on the reference date, an insured person of the relevant insurer | on the reference date, an insured person of the insurer of another health insurance |
| ) was an insured person of the relevant insurer | ) was an insured person of the insurer of that other health insurance (hereinafter referred to as the "insurer on the reference date" in this paragraph) | |
| as an insured person of the relevant insurer (excluding a case | as an insured person of the insurer on the reference date (excluding a case | |
| Paragraph (1), item (ii) | another health insurance | a health insurance other than that of the insurer on the reference date |
| Paragraph (1), item (iii) | on the reference date, a dependent of an insured person of the relevant insurer | on the reference date, a dependent of an insured person of the insurer on the reference date |
| the relevant insurer | that insurer on the reference date | |
| Paragraph (1), item (iv) | another health insurance | a health insurance other than that of the insurer on the reference date |
| Paragraph (1), item (vii) | an insured person of the relevant insurer and | an insured person of the insurer on the reference date and |
| of an insured person of the relevant insurer | of an insured person of the insurer on the reference date | |
| Paragraph (1), item (viii) | another health insurance | a health insurance other than that of the insurer on the reference date |
| Paragraph (1), item (ix) | was an insured person of the relevant insurer | was an insured person of the insurer on the reference date |
| an insured person of the relevant insurer ( | an insured person of the insurer on the reference date ( | |
| Paragraph (1), item (x) | another health insurance | a health insurance other than that of the insurer on the reference date |
| Paragraph (1), item (xiii) | an insured person of the relevant insurer and | an insured person of the insurer on the reference date and |
| of an insured person of the relevant insurer | of an insured person of the insurer on the reference date | |
| Paragraph (1), item (xiv) | another health insurance | a health insurance other than that of the insurer on the reference date |
| Paragraph (1), item (xv) | an insured person of the relevant insurer and | an insured person of the insurer on the reference date and |
| of an insured person of the relevant insurer | of an insured person of the insurer on the reference date | |
| Paragraph (1), item (xvi) | another health insurance | a health insurance other than that of the insurer on the reference date |
第一項の規定は、計算期間において当該保険者の被保険者であった者（基準日において他の健康保険の保険者の被保険者の被扶養者である者に限る。）に対する高額療養費の支給について準用する。この場合において、次の表の上欄に掲げる規定中同表の中欄に掲げる字句は、それぞれ同表の下欄に掲げる字句に読み替えるものとする。
| 第一項 | 同号に掲げる | 第四号に掲げる額のうち、計算期間（毎年八月一日から翌年七月三十一日までの期間をいう。以下同じ。）（第四項に規定する者が当該保険者の被保険者であり、かつ、第一号に規定する基準日被保険者が当該同項に規定する者の被扶養者であった間に限る。）において、当該基準日被保険者が当該保険者の被保険者の被扶養者（法第百十条第二項第一号ニの規定が適用される者である場合を除く。）として受けた第四号に規定する外来療養に係る |
| 第七号に掲げる | 第十号に掲げる額のうち、計算期間（第四項に規定する者が当該保険者の被保険者であった間に限る。）において、当該第四項に規定する者が当該保険者の被保険者（法第七十四条第一項第三号の規定が適用される者である場合を除く。）として受けた第十号に規定する外来療養に係る | |
| 第十三号に掲げる | 第十六号に掲げる額のうち、計算期間（第四項に規定する者が当該保険者の被保険者であり、かつ、当該同項に規定する者の被扶養者であった者（当該基準日被保険者を除く。）が当該同項に規定する者の被扶養者であった間に限る。）において、当該同項に規定する者の被扶養者であった者（当該基準日被保険者を除く。）が当該保険者の被保険者の被扶養者（法第百十条第二項第一号ニの規定が適用される者である場合を除く。）として受けた第十六号に規定する外来療養に係る | |
| 第一項ただし書 | （毎年八月一日から翌年七月三十一日までの期間をいう。以下同じ。）の末日 | の末日 |
| 第七十四条第一項第三号 | 第百十条第二項第一号ニ | |
| 第一項第一号 | おいて当該 | おいて他の健康保険の |
| ）が当該保険者 | ）が当該他の健康保険の保険者（以下この項において「基準日保険者」という。） | |
| 保険者の被保険者（法 | 基準日保険者の被保険者（法 | |
| 第一項第二号 | 他の | 基準日保険者以外の |
| 第一項第三号 | おいて当該保険者 | おいて基準日保険者 |
| が当該保険者 | が当該基準日保険者 | |
| 第一項第四号 | 他の | 基準日保険者以外の |
| 第一項第七号 | 当該保険者の被保険者で | 基準日保険者の被保険者で |
| 保険者の被保険者の | 基準日保険者の被保険者の | |
| 第一項第八号 | 他の | 基準日保険者以外の |
| 第一項第九号 | 当該保険者の被保険者で | 基準日保険者の被保険者で |
| 保険者の被保険者（ | 基準日保険者の被保険者（ | |
| 第一項第十号 | 他の | 基準日保険者以外の |
| 第一項第十三号 | 当該保険者の被保険者で | 基準日保険者の被保険者で |
| 保険者の被保険者の | 基準日保険者の被保険者の | |
| 第一項第十四号 | 他の | 基準日保険者以外の |
| 第一項第十五号 | 当該保険者の被保険者で | 基準日保険者の被保険者で |
| 保険者の被保険者の | 基準日保険者の被保険者の | |
| 第一項第十六号 | 他の | 基準日保険者以外の |
High-cost medical expenses for a person who was an insured person of the relevant insurer during the calculation period (limited to a person who, on the reference date, is a member, etc. (excluding a householder, etc. under National Health Insurance prescribed in paragraph (9) who is an insured person or a dependent thereof, and an insured person of the late-stage elderly medical care system) of an insurer body, etc. (excluding an Association of Medical Care Systems for the Elderly Aged 75 and older under the Act on Assurance of Medical Care for Elderly People); hereinafter in this paragraph referred to as the "member, etc. on the reference date") are to be paid where any of the amounts listed in the left-hand column of the following table exceeds the base amount for calculating high-cost medical expenses, and the amount of those expenses is to be the total sum of the amounts obtained by multiplying the amount listed in the middle column of the table (or zero, if that amount is less than zero) by the rate listed in the right-hand column of the table respectively; provided, however, that this does not apply if the member, etc. on the reference date is, on the reference date, a person equivalent to a person to whom the provisions of Article 74, paragraph (1), item (iii) of the Act apply.
| the amount obtained by totaling the amounts equivalent to the amounts listed in paragraph (1), items (i) through (vi), calculated as provided by Order of the Ministry of Health, Labour and Welfare by deeming the member, etc. on the reference date to be the insured person on the reference date, and the dependent, etc. on the reference date (meaning a person who, on the reference date, is a dependent, etc. of that member, etc. on the reference date; the same applies hereinafter in this table) to be the dependent on the reference date (hereinafter referred to as the "total for the member, etc. on the reference date" in this table) | the amount obtained by deducting the base amount for calculating high-cost medical expenses from the total for the member, etc. on the reference date | the rate obtained by dividing, of the total for the member, etc. on the reference date, the amount equivalent to the amount listed in paragraph (1), item (i), calculated as provided by Order of the Ministry of Health, Labour and Welfare by deeming the member, etc. on the reference date to be the insured person on the reference date, and the dependent, etc. on the reference date to be the dependent on the reference date, by the total for the member, etc. on the reference date |
| the amount obtained by totaling the amounts equivalent to the amounts listed in paragraph (1), items (vii) through (xii), calculated as provided by Order of the Ministry of Health, Labour and Welfare by deeming the member, etc. on the reference date to be the insured person on the reference date, and the dependent, etc. on the reference date to be the dependent on the reference date (hereinafter referred to as the "total for dependents, etc. on the reference date" in this table) | the amount obtained by deducting the base amount for calculating high-cost medical expenses from the total for dependents, etc. on the reference date | the rate obtained by dividing, of the total for dependents, etc. on the reference date, the amount equivalent to the amount listed in paragraph (1), item (vii), calculated as provided by Order of the Ministry of Health, Labour and Welfare by deeming the member, etc. on the reference date to be the insured person on the reference date, and the dependent, etc. on the reference date to be the dependent on the reference date, by the total for dependents, etc. on the reference date |
| the amount obtained by totaling the amounts equivalent to the amounts listed in paragraph (1), items (xiii) through (xviii), calculated as provided by Order of the Ministry of Health, Labour and Welfare by deeming the member, etc. on the reference date to be the insured person on the reference date, and the dependent, etc. on the reference date to be the dependent on the reference date (hereinafter referred to as the "total for former dependents" in this table) | the amount obtained by deducting the base amount for calculating high-cost medical expenses from the total for former dependents | the rate obtained by dividing, of the total for former dependents, the amount equivalent to the amount listed in paragraph (1), item (xiii), calculated as provided by Order of the Ministry of Health, Labour and Welfare by deeming the member, etc. on the reference date to be the insured person on the reference date, and the dependent, etc. on the reference date to be the dependent on the reference date, by the total for former dependents |
計算期間において当該保険者の被保険者であった者（基準日において組合等（高齢者の医療の確保に関する法律に基づく後期高齢者医療広域連合を除く。）の組合員等（第九項に規定する国民健康保険の世帯主等であって被保険者又はその被扶養者である者及び後期高齢者医療の被保険者を除く。）である者に限る。以下この項において「基準日組合員等」という。）に対する高額療養費は、次の表の上欄に掲げる額のいずれかが高額療養費算定基準額を超える場合に支給するものとし、その額は、同表の中欄に掲げる額（当該額が零を下回る場合には、零とする。）にそれぞれ同表の下欄に掲げる率を乗じて得た額の合算額とする。ただし、当該基準日組合員等が基準日において法第七十四条第一項第三号の規定が適用される者に相当する者である場合は、この限りでない。
| 基準日組合員等を基準日被保険者と、基準日被扶養者等（基準日において当該基準日組合員等の被扶養者等である者をいう。以下この表において同じ。）を基準日被扶養者とそれぞれみなして厚生労働省令で定めるところにより算定した第一項第一号から第六号までに掲げる額に相当する額を合算した額（以下この表において「基準日組合員等合算額」という。） | 基準日組合員等合算額から高額療養費算定基準額を控除した額 | 基準日組合員等合算額のうち、基準日組合員等を基準日被保険者と、基準日被扶養者等を基準日被扶養者とそれぞれみなして厚生労働省令で定めるところにより算定した第一項第一号に掲げる額に相当する額を、基準日組合員等合算額で除して得た率 |
| 基準日組合員等を基準日被保険者と、基準日被扶養者等を基準日被扶養者とそれぞれみなして厚生労働省令で定めるところにより算定した第一項第七号から第十二号までに掲げる額に相当する額を合算した額（以下この表において「基準日被扶養者等合算額」という。） | 基準日被扶養者等合算額から高額療養費算定基準額を控除した額 | 基準日被扶養者等合算額のうち、基準日組合員等を基準日被保険者と、基準日被扶養者等を基準日被扶養者とそれぞれみなして厚生労働省令で定めるところにより算定した第一項第七号に掲げる額に相当する額を、基準日被扶養者等合算額で除して得た率 |
| 基準日組合員等を基準日被保険者と、基準日被扶養者等を基準日被扶養者とそれぞれみなして厚生労働省令で定めるところにより算定した第一項第十三号から第十八号までに掲げる額に相当する額を合算した額（以下この表において「元被扶養者合算額」という。） | 元被扶養者合算額から高額療養費算定基準額を控除した額 | 元被扶養者合算額のうち、基準日組合員等を基準日被保険者と、基準日被扶養者等を基準日被扶養者とそれぞれみなして厚生労働省令で定めるところにより算定した第一項第十三号に掲げる額に相当する額を、元被扶養者合算額で除して得た率 |
The provisions of the preceding paragraph apply mutatis mutandis to the payment of high-cost medical expenses to a person who was an insured person of the relevant insurer during the calculation period (limited to a person who, on the reference date, is a dependent, etc. of a member, etc. (excluding an insured person of the late-stage elderly medical care system) of an insurer body, etc. (excluding an Association of Medical Care Systems for the Elderly Aged 75 and older under the Act on Assurance of Medical Care for Elderly People)). In this case, the term "Article 74, paragraph (1), item (iii)" in the proviso to that paragraph is deemed to be replaced with "Article 110, paragraph (2), item (i), (d)", the term "to be the insured person on the reference date, and the dependent, etc. on the reference date (" in the table of that paragraph with "(meaning a person who, on the reference date, is a member, etc. (excluding an insured person of the late-stage elderly medical care system) of an insurer body, etc. (excluding an Association of Medical Care Systems for the Elderly Aged 75 and older under the Act on Assurance of Medical Care for Elderly People); the same applies hereinafter in this table) to be the insured person on the reference date, and the dependent, etc. on the reference date (", "paragraph (1), item (i)" with "paragraph (1), item (iii)", "paragraph (1), item (vii)" with "paragraph (1), item (ix)", and "paragraph (1), item (xiii)" with "paragraph (1), item (xv)".
前項の規定は、計算期間において当該保険者の被保険者であった者（基準日において組合等（高齢者の医療の確保に関する法律に基づく後期高齢者医療広域連合を除く。）の組合員等（後期高齢者医療の被保険者を除く。）の被扶養者等である者に限る。）に対する高額療養費の支給について準用する。この場合において、同項ただし書中「第七十四条第一項第三号」とあるのは「第百十条第二項第一号ニ」と、同項の表中「を基準日被保険者と、基準日被扶養者等（」とあるのは「（基準日において組合等（高齢者の医療の確保に関する法律に基づく後期高齢者医療広域連合を除く。）の組合員等（後期高齢者医療の被保険者を除く。）である者をいう。以下この表において同じ。）を基準日被保険者と、基準日被扶養者等（」と、「第一項第一号に」とあるのは「第一項第三号に」と、「第一項第七号に」とあるのは「第一項第九号に」と、「第一項第十三号に」とあるのは「第一項第十五号に」と読み替えるものとする。
High-cost medical expenses for a person who was an insured person of the relevant insurer during the calculation period (limited to a person who, on the reference date, is an insured person of the late-stage elderly medical care system; hereinafter in this paragraph referred to as the "late-stage elderly insured person on the reference date") are to be paid where any of the amounts listed in the left-hand column of the following table exceeds the base amount for calculating high-cost medical expenses, and the amount of those expenses is to be the total sum of the amounts obtained by multiplying the amount listed in the middle column of the table (or zero, if that amount is less than zero) by the rate listed in the right-hand column of the table respectively; provided, however, that this does not apply if the late-stage elderly insured person on the reference date is, on the reference date, a person equivalent to a person to whom the provisions of Article 74, paragraph (1), item (iii) of the Act apply.
| the amount obtained by totaling the amounts equivalent to the amounts listed in paragraph (1), items (i) through (vi), calculated as provided by Order of the Ministry of Health, Labour and Welfare by deeming the late-stage elderly insured person on the reference date to be the insured person on the reference date, and the other late-stage elderly insured person in the household on the reference date (meaning an insured person of the late-stage elderly medical care system, other than that late-stage elderly insured person on the reference date, who on the reference date belongs to the same household as that late-stage elderly insured person on the reference date; the same applies hereinafter in this table) to be the dependent on the reference date (hereinafter referred to as the "total for the late-stage elderly insured person on the reference date" in this table) | the amount obtained by deducting the base amount for calculating high-cost medical expenses from the total for the late-stage elderly insured person on the reference date | the rate obtained by dividing, of the total for the late-stage elderly insured person on the reference date, the amount equivalent to the amount listed in paragraph (1), item (i), calculated as provided by Order of the Ministry of Health, Labour and Welfare by deeming the late-stage elderly insured person on the reference date to be the insured person on the reference date, and the other late-stage elderly insured person in the household on the reference date to be the dependent on the reference date, by the total for the late-stage elderly insured person on the reference date |
| the amount obtained by totaling the amounts equivalent to the amounts listed in paragraph (1), items (vii) through (xii), calculated as provided by Order of the Ministry of Health, Labour and Welfare by deeming the late-stage elderly insured person on the reference date to be the insured person on the reference date, and the other late-stage elderly insured person in the household on the reference date to be the dependent on the reference date (hereinafter referred to as the "total for other late-stage elderly insured persons in the household on the reference date" in this table) | the amount obtained by deducting the base amount for calculating high-cost medical expenses from the total for other late-stage elderly insured persons in the household on the reference date | the rate obtained by dividing, of the total for other late-stage elderly insured persons in the household on the reference date, the amount equivalent to the amount listed in paragraph (1), item (vii), calculated as provided by Order of the Ministry of Health, Labour and Welfare by deeming the late-stage elderly insured person on the reference date to be the insured person on the reference date, and the other late-stage elderly insured person in the household on the reference date to be the dependent on the reference date, by the total for other late-stage elderly insured persons in the household on the reference date |
| the amount obtained by totaling the amounts equivalent to the amounts listed in paragraph (1), items (xiii) through (xviii), calculated as provided by Order of the Ministry of Health, Labour and Welfare by deeming the late-stage elderly insured person on the reference date to be the insured person on the reference date, and the other late-stage elderly insured person in the household on the reference date to be the dependent on the reference date (hereinafter referred to as the "total for former dependents" in this table) | the amount obtained by deducting the base amount for calculating high-cost medical expenses from the total for former dependents | the rate obtained by dividing, of the total for former dependents, the amount equivalent to the amount listed in paragraph (1), item (xiii), calculated as provided by Order of the Ministry of Health, Labour and Welfare by deeming the late-stage elderly insured person on the reference date to be the insured person on the reference date, and the other late-stage elderly insured person in the household on the reference date to be the dependent on the reference date, by the total for former dependents |
計算期間において当該保険者の被保険者であった者（基準日において後期高齢者医療の被保険者である者に限る。以下この項において「基準日後期高齢者医療被保険者」という。）に対する高額療養費は、次の表の上欄に掲げる額のいずれかが高額療養費算定基準額を超える場合に支給するものとし、その額は、同表の中欄に掲げる額（当該額が零を下回る場合には、零とする。）にそれぞれ同表の下欄に掲げる率を乗じて得た額の合算額とする。ただし、当該基準日後期高齢者医療被保険者が基準日において法第七十四条第一項第三号の規定が適用される者に相当する者である場合は、この限りでない。
| 基準日後期高齢者医療被保険者を基準日被保険者と、基準日後期高齢者医療被保険者以外後期高齢者医療被保険者（基準日において当該基準日後期高齢者医療被保険者と同一の世帯に属する当該基準日後期高齢者医療被保険者以外の後期高齢者医療の被保険者をいう。以下この表において同じ。）を基準日被扶養者とそれぞれみなして厚生労働省令で定めるところにより算定した第一項第一号から第六号までに掲げる額に相当する額を合算した額（以下この表において「基準日後期高齢者医療被保険者合算額」という。） | 基準日後期高齢者医療被保険者合算額から高額療養費算定基準額を控除した額 | 基準日後期高齢者医療被保険者合算額のうち、基準日後期高齢者医療被保険者を基準日被保険者と、基準日後期高齢者医療被保険者以外後期高齢者医療被保険者を基準日被扶養者とそれぞれみなして厚生労働省令で定めるところにより算定した第一項第一号に掲げる額に相当する額を、基準日後期高齢者医療被保険者合算額で除して得た率 |
| 基準日後期高齢者医療被保険者を基準日被保険者と、基準日後期高齢者医療被保険者以外後期高齢者医療被保険者を基準日被扶養者とそれぞれみなして厚生労働省令で定めるところにより算定した第一項第七号から第十二号までに掲げる額に相当する額を合算した額（以下この表において「基準日後期高齢者医療被保険者以外後期高齢者医療被保険者合算額」という。） | 基準日後期高齢者医療被保険者以外後期高齢者医療被保険者合算額から高額療養費算定基準額を控除した額 | 基準日後期高齢者医療被保険者以外後期高齢者医療被保険者合算額のうち、基準日後期高齢者医療被保険者を基準日被保険者と、基準日後期高齢者医療被保険者以外後期高齢者医療被保険者を基準日被扶養者とそれぞれみなして厚生労働省令で定めるところにより算定した第一項第七号に掲げる額に相当する額を、基準日後期高齢者医療被保険者以外後期高齢者医療被保険者合算額で除して得た率 |
| 基準日後期高齢者医療被保険者を基準日被保険者と、基準日後期高齢者医療被保険者以外後期高齢者医療被保険者を基準日被扶養者とそれぞれみなして厚生労働省令で定めるところにより算定した第一項第十三号から第十八号までに掲げる額に相当する額を合算した額（以下この表において「元被扶養者合算額」という。） | 元被扶養者合算額から高額療養費算定基準額を控除した額 | 元被扶養者合算額のうち、基準日後期高齢者医療被保険者を基準日被保険者と、基準日後期高齢者医療被保険者以外後期高齢者医療被保険者を基準日被扶養者とそれぞれみなして厚生労働省令で定めるところにより算定した第一項第十三号に掲げる額に相当する額を、元被扶養者合算額で除して得た率 |
In paragraph (1) (including where applied mutatis mutandis in paragraphs (2) through (4)), paragraph (5) (including where applied mutatis mutandis in paragraph (6)) and paragraph (6), "insurer body, etc." means the Japan Health Insurance Association as an insurer under Article 123, paragraph (1) of the Act, the Japan Health Insurance Association that provides benefits relating to medical care under the provisions of the Mariners Insurance Act, a municipality (including a special ward; the same applies hereinafter), a National Health Insurance Society, a mutual aid association under the National Public Officers Mutual Aid Association Act or the Local Public Officers, etc. Mutual Aid Association Act, the Promotion and Mutual Aid Corporation for Private Schools of Japan, or an Association of Medical Care Systems for the Elderly Aged 75 and older under the Act on Assurance of Medical Care for Elderly People.
第一項（第二項から第四項までにおいて準用する場合を含む。）、第五項（第六項において準用する場合を含む。）及び第六項において「組合等」とは、法第百二十三条第一項の規定による保険者としての全国健康保険協会、船員保険法の規定により医療に関する給付を行う全国健康保険協会、市町村（特別区を含む。以下同じ。）、国民健康保険組合、国家公務員共済組合法若しくは地方公務員等共済組合法に基づく共済組合、日本私立学校振興・共済事業団又は高齢者の医療の確保に関する法律に基づく後期高齢者医療広域連合をいう。
In paragraph (1) (including where applied mutatis mutandis in paragraphs (2) through (4)), paragraph (5) (including where applied mutatis mutandis in paragraph (6)) and paragraph (6), "member, etc." means a specially-insured day laborer (including a person who was a specially-insured day laborer (limited to a person who is within the period until there is no blank space left on the specially-insured day laborer's insurance book issued pursuant to Article 126 of the Act on which to affix a health insurance stamp, and excluding a person who is within a period in which the person does not become a specially-insured day laborer under Article 3, paragraph (2) of the Act owing to approval under the proviso to that paragraph, or a person who has returned that specially-insured day laborer's insurance book pursuant to Article 126, paragraph (3) of the Act); the same applies in the following paragraph, Article 43-3, paragraph (5) and Article 44, paragraphs (2) through (8)), an insured person of Mariners Insurance, a member of a mutual aid association under the National Public Officers Mutual Aid Association Act or the Local Public Officers, etc. Mutual Aid Association Act, a subscriber to the Private School Personnel Mutual Aid System under the provisions of the Private School Personnel Mutual Aid Association Act, the head of a household to which an insured person of National Health Insurance belongs or a member of a National Health Insurance Society (hereinafter referred to as a "householder, etc. under National Health Insurance"), or an insured person of the late-stage elderly medical care system.
第一項（第二項から第四項までにおいて準用する場合を含む。）、第五項（第六項において準用する場合を含む。）及び第六項において「組合員等」とは、日雇特例被保険者（日雇特例被保険者であった者（法第百二十六条の規定により日雇特例被保険者手帳の交付を受け、その手帳に健康保険印紙を貼り付けるべき余白がなくなるに至るまでの間にある者に限り、法第三条第二項ただし書の規定による承認を受けて同項の規定による日雇特例被保険者とならない期間内にある者又は法第百二十六条第三項の規定により当該日雇特例被保険者手帳を返納した者を除く。）を含む。次項、第四十三条の三第五項及び第四十四条第二項から第八項までにおいて同じ。）、船員保険の被保険者、国家公務員共済組合法若しくは地方公務員等共済組合法に基づく共済組合の組合員、私立学校教職員共済法の規定による私立学校教職員共済制度の加入者、国民健康保険の被保険者の属する世帯の世帯主若しくは国民健康保険組合の組合員（以下「国民健康保険の世帯主等」という。）又は後期高齢者医療の被保険者をいう。
In paragraph (1) (including where applied mutatis mutandis in paragraphs (2) through (4)), paragraph (5) (including where applied mutatis mutandis in paragraph (6)) and paragraph (6), "dependent, etc." means a dependent of a specially-insured day laborer, a dependent under the provisions of the Mariners Insurance Act, the National Public Officers Mutual Aid Association Act (including as applied mutatis mutandis pursuant to other Acts) or the Local Public Officers, etc. Mutual Aid Association Act, or an insured person of National Health Insurance who belongs to the same household as a householder, etc. under National Health Insurance, other than that householder, etc. under National Health Insurance.
第一項（第二項から第四項までにおいて準用する場合を含む。）、第五項（第六項において準用する場合を含む。）及び第六項において「被扶養者等」とは、日雇特例被保険者の被扶養者若しくは船員保険法、国家公務員共済組合法（他の法律において準用する場合を含む。）若しくは地方公務員等共済組合法の規定による被扶養者又は国民健康保険の世帯主等と同一の世帯に属する当該国民健康保険の世帯主等以外の国民健康保険の被保険者をいう。
Article 41-3
High-cost medical expenses are to be paid to the insured person on the reference date where the amount obtained by deducting the total annual household payment for persons aged 70 or over (meaning the amount obtained by deducting the annual base amount for calculating high-cost medical expenses for persons aged 70 or over under paragraph (2) from the annual household total of co-payments, etc. for persons aged 70 or over prescribed in that paragraph (or zero, if that amount is less than zero)) from the total sum of the following amounts relating to medical treatment that the insured person on the reference date or the dependents thereof respectively received during the calculation period as an insured person of the relevant insurer or as dependents thereof (including medical treatment relating to insurance benefits under Article 98, paragraph (1) of the Act (including as applied mutatis mutandis under Article 110, paragraph (7) and Article 111, paragraph (3) of the Act) (referred to in the following paragraph and Article 43-2 as "medical treatment under continued benefits")) (where high-cost medical expenses are paid pursuant to Article 41, paragraphs (1) through (5) or the preceding Article, the amount after deducting the amount paid, and where money or goods to reduce the burden relating to the following amounts are provided as other benefits prescribed in Article 53 of the Act, the amount after deducting the amount equivalent to that money or those goods) (hereinafter referred to as the "annual household total of co-payments, etc." in this paragraph) exceeds the base amount for calculating high-cost medical expenses, and the amount of those expenses is to be the amount obtained by deducting the base amount for calculating high-cost medical expenses from the annual household total of co-payments, etc.
高額療養費は、計算期間において、基準日被保険者又はその被扶養者がそれぞれ当該保険者の被保険者又はその被扶養者として受けた療養（法第九十八条第一項（法第百十条第七項及び第百十一条第三項において準用する場合を含む。）の規定による保険給付に係る療養（次項及び第四十三条の二において「継続給付に係る療養」という。）を含む。）に係る次に掲げる額の合算額（第四十一条第一項から第五項まで又は前条の規定により高額療養費が支給される場合にあっては、当該支給額を控除した額とし、法第五十三条に規定するその他の給付として次に掲げる額に係る負担を軽減するための金品が支給される場合にあっては、当該金品に相当する額を控除した額とする。）から七十歳以上年間世帯支給総額（次項に規定する七十歳以上一部負担金等年間世帯合算額から同項の七十歳以上年間高額療養費算定基準額を控除した額（当該額が零を下回る場合には、零とする。）をいう。）を控除した額（以下この項において「一部負担金等年間世帯合算額」という。）が高額療養費算定基準額を超える場合に基準日被保険者に支給するものとし、その額は、一部負担金等年間世帯合算額から高額療養費算定基準額を控除した額とする。
the total sum of the amounts listed in Article 41, paragraph (1), item (i), (a) through (f) relating to that medical treatment (excluding treatment subject to specified benefits) (for those relating to that medical treatment on or before the month that includes the day on which the person reaches the age of 70, limited to those of 21,000 yen or more for that medical treatment received from each single hospital, etc. in the same month (10,500 yen or more for those relating to the medical treatment listed in the items of paragraph (4) of that Article (hereinafter referred to as "medical treatment under the special rule on reaching age 75")));
当該療養（特定給付対象療養を除く。）に係る第四十一条第一項第一号イからヘまでに掲げる額（七十歳に達する日の属する月以前の当該療養に係るものにあっては、同一の月にそれぞれ一の病院等から受けた当該療養について二万千円（同条第四項各号に掲げる療養（以下「七十五歳到達時特例対象療養」という。）に係るものにあっては、一万五百円）以上のものに限る。）を合算した額
the total sum of the amounts that the person who received that medical treatment (limited to treatment subject to specified benefits) still has to bear for that treatment (for those relating to treatment subject to specified benefits on or before the month that includes the day on which the person reaches the age of 70, limited to those for which the amounts listed in Article 41, paragraph (1), item (i), (a) through (f) relating to that treatment subject to specified benefits are 21,000 yen or more for that treatment subject to specified benefits received from each single hospital, etc. in the same month (10,500 yen or more for those relating to medical treatment under the special rule on reaching age 75)).
当該療養（特定給付対象療養に限る。）について、当該療養を受けた者がなお負担すべき額（七十歳に達する日の属する月以前の特定給付対象療養に係るものにあっては、当該特定給付対象療養に係る第四十一条第一項第一号イからヘまでに掲げる額が同一の月にそれぞれ一の病院等から受けた当該特定給付対象療養について二万千円（七十五歳到達時特例対象療養に係るものにあっては、一万五百円）以上のものに限る。）を合算した額
Where the total sum of the amounts, among the amounts listed in the items of the preceding paragraph, relating to medical treatment (including medical treatment under continued benefits) received on or after the month following the month that includes the day on which the person reaches the age of 70 (where high-cost medical expenses are paid pursuant to Article 41, paragraphs (1) through (5) or the preceding Article, the amount after deducting the amount paid, and where money or goods to reduce the burden relating to the amounts listed in the items of the preceding paragraph are provided as other benefits prescribed in Article 53 of the Act, the amount after deducting the amount equivalent to that money or those goods; hereinafter referred to as the "annual household total of co-payments, etc. for persons aged 70 or over" in this paragraph) exceeds the annual base amount for calculating high-cost medical expenses for persons aged 70 or over, the amount obtained by deducting the annual base amount for calculating high-cost medical expenses for persons aged 70 or over from the annual household total of co-payments, etc. for persons aged 70 or over is to be paid to the insured person on the reference date as high-cost medical expenses.
前項各号に掲げる額のうち、七十歳に達する日の属する月の翌月以後に受けた療養（継続給付に係る療養を含む。）に係る額を合算した額（第四十一条第一項から第五項まで又は前条の規定により高額療養費が支給される場合にあっては、当該支給額を控除した額とし、法第五十三条に規定するその他の給付として前項各号に掲げる額に係る負担を軽減するための金品が支給される場合にあっては、当該金品に相当する額を控除した額とする。以下この項において「七十歳以上一部負担金等年間世帯合算額」という。）が七十歳以上年間高額療養費算定基準額を超える場合は、七十歳以上一部負担金等年間世帯合算額から七十歳以上年間高額療養費算定基準額を控除した額を高額療養費として基準日被保険者に支給する。
Article 42Base Amount for Calculating High-Cost Medical Expenses
The base amount for calculating high-cost medical expenses under Article 41, paragraph (1) is, in accordance with the category of persons listed in the following items, the amount specified in each of those items.
第四十一条第一項の高額療養費算定基準額は、次の各号に掲げる者の区分に応じ、当該各号に定める額とする。
a person other than those listed in the following item through item (v): the total sum of 85,800 yen and the amount obtained by multiplying by 1% the amount obtained by deducting 286,000 yen from the cost of the medical treatment, calculated as provided by Order of the Ministry of Health, Labour and Welfare, relating to the total sum of the amounts listed in the items of Article 41, paragraph (1) (or 286,000 yen, if that cost is less than 286,000 yen) (where that amount includes a fractional amount of less than 1 yen, the amount obtained by rounding down that fractional amount if it is less than 50 sen, or by rounding it up to 1 yen if it is 50 sen or more); provided, however, that in the case where the number of months in which high-cost medical expenses (limited to those under paragraphs (1) through (4) of that Article) have already been paid within 12 months on or before the month in which that medical treatment was received is three or more (hereinafter referred to as a "case of repeated high-cost medical expenses" in this Article and paragraph (1) of the following Article), the amount is 44,400 yen.
次号から第五号までに掲げる者以外の者 八万五千八百円と、第四十一条第一項各号に掲げる額を合算した額に係る療養につき厚生労働省令で定めるところにより算定した当該療養に要した費用の額（その額が二十八万六千円に満たないときは、二十八万六千円）から二十八万六千円を控除した額に百分の一を乗じて得た額（この額に一円未満の端数がある場合において、その端数金額が五十銭未満であるときは、これを切り捨て、その端数金額が五十銭以上であるときは、これを一円に切り上げた額）との合算額。ただし、当該療養のあった月以前の十二月以内に既に高額療養費（同条第一項から第四項までの規定によるものに限る。）が支給されている月数が三月以上ある場合（以下この条及び次条第一項において「高額療養費多数回該当の場合」という。）にあっては、四万四千四百円とする。
an insured person whose standard monthly remuneration for the month in which the medical treatment was received is 830,000 yen or more, or a dependent of such a person: the total sum of 270,300 yen and the amount obtained by multiplying by 1% the amount obtained by deducting 901,000 yen from the cost of the medical treatment, calculated as provided by Order of the Ministry of Health, Labour and Welfare, relating to the total sum of the amounts listed in the items of Article 41, paragraph (1) (or 901,000 yen, if that cost is less than 901,000 yen) (where that amount includes a fractional amount of less than 1 yen, the amount obtained by rounding down that fractional amount if it is less than 50 sen, or by rounding it up to 1 yen if it is 50 sen or more); provided, however, that in the case of repeated high-cost medical expenses, the amount is 140,100 yen.
療養のあった月の標準報酬月額が八十三万円以上の被保険者又はその被扶養者 二十七万三百円と、第四十一条第一項各号に掲げる額を合算した額に係る療養につき厚生労働省令で定めるところにより算定した当該療養に要した費用の額（その額が九十万千円に満たないときは、九十万千円）から九十万千円を控除した額に百分の一を乗じて得た額（この額に一円未満の端数がある場合において、その端数金額が五十銭未満であるときは、これを切り捨て、その端数金額が五十銭以上であるときは、これを一円に切り上げた額）との合算額。ただし、高額療養費多数回該当の場合にあっては、十四万百円とする。
an insured person whose standard monthly remuneration for the month in which the medical treatment was received is 530,000 yen or more and less than 830,000 yen, or a dependent of such a person: the total sum of 179,100 yen and the amount obtained by multiplying by 1% the amount obtained by deducting 597,000 yen from the cost of the medical treatment, calculated as provided by Order of the Ministry of Health, Labour and Welfare, relating to the total sum of the amounts listed in the items of Article 41, paragraph (1) (or 597,000 yen, if that cost is less than 597,000 yen) (where that amount includes a fractional amount of less than 1 yen, the amount obtained by rounding down that fractional amount if it is less than 50 sen, or by rounding it up to 1 yen if it is 50 sen or more); provided, however, that in the case of repeated high-cost medical expenses, the amount is 93,000 yen.
療養のあった月の標準報酬月額が五十三万円以上八十三万円未満の被保険者又はその被扶養者 十七万九千百円と、第四十一条第一項各号に掲げる額を合算した額に係る療養につき厚生労働省令で定めるところにより算定した当該療養に要した費用の額（その額が五十九万七千円に満たないときは、五十九万七千円）から五十九万七千円を控除した額に百分の一を乗じて得た額（この額に一円未満の端数がある場合において、その端数金額が五十銭未満であるときは、これを切り捨て、その端数金額が五十銭以上であるときは、これを一円に切り上げた額）との合算額。ただし、高額療養費多数回該当の場合にあっては、九万三千円とする。
an insured person whose standard monthly remuneration for the month in which the medical treatment was received is less than 280,000 yen, or a dependent of such a person (excluding those listed in the following item): 61,500 yen; provided, however, that in the case of repeated high-cost medical expenses, the amount is 44,400 yen.
療養のあった月の標準報酬月額が二十八万円未満の被保険者又はその被扶養者（次号に掲げる者を除く。） 六万千五百円。ただし、高額療養費多数回該当の場合にあっては、四万四千四百円とする。
a person exempt from municipal inhabitant tax (meaning a person on whom municipal inhabitant tax under the provisions of the Local Tax Act (Act No. 226 of 1950) for the fiscal year that includes the month in which the medical treatment was received (the previous fiscal year, if the month in which the medical treatment was received is from April through July) (including special ward inhabitant tax under the provisions of that Act, and excluding the income levy imposed pursuant to Article 328 of that Act; the same applies in paragraph (10), item (ii), paragraph (11), item (iv) and Article 43-3, paragraph (1), item (v)) is not imposed (including a person exempted from that municipal inhabitant tax as provided by a municipal ordinance, and excluding a person who does not have an address in the area where that Act is in force on the assessment date of that municipal inhabitant tax); the same applies in paragraph (3), item (v)) who is an insured person or a dependent thereof, or an insured person or a dependent thereof who falls under a person specified by Order of the Ministry of Health, Labour and Welfare among persons who, in the month in which the medical treatment was received, are persons requiring public assistance (meaning a person requiring public assistance prescribed in Article 6, paragraph (2) of the Public Assistance Act (Act No. 144 of 1950); the same applies hereinafter in this Article) (excluding those listed in item (ii) or item (iii)): 36,900 yen; provided, however, that in the case of repeated high-cost medical expenses, the amount is 24,600 yen.
市町村民税非課税者（療養のあった月の属する年度（療養のあった月が四月から七月までの場合にあっては、前年度）分の地方税法（昭和二十五年法律第二百二十六号）の規定による市町村民税（同法の規定による特別区民税を含むものとし、同法第三百二十八条の規定によって課する所得割を除く。第十項第二号、第十一項第四号及び第四十三条の三第一項第五号において同じ。）が課されない者（市町村の条例で定めるところにより当該市町村民税を免除された者を含むものとし、当該市町村民税の賦課期日において同法の施行地に住所を有しない者を除く。）をいう。第三項第五号において同じ。）である被保険者若しくはその被扶養者又は療養のあった月において要保護者（生活保護法第六条第二項に規定する要保護者をいう。以下この条において同じ。）である者であって厚生労働省令で定めるものに該当する被保険者若しくはその被扶養者（第二号又は第三号に掲げる者を除く。） 三万六千九百円。ただし、高額療養費多数回該当の場合にあっては、二万四千六百円とする。
The base amount for calculating high-cost medical expenses under Article 41, paragraph (2) is, in accordance with the category of insured persons listed in the following items relating to that dependent, the amount specified in each of those items.
第四十一条第二項の高額療養費算定基準額は、当該被扶養者に係る次の各号に掲げる被保険者の区分に応じ、当該各号に定める額とする。
an insured person other than those listed in the following item through item (v): the total sum of 42,900 yen and the amount obtained by multiplying by 1% the amount obtained by deducting 143,000 yen from the cost of the medical treatment, calculated as provided by Order of the Ministry of Health, Labour and Welfare, relating to the total sum of the amounts listed in the items of Article 41, paragraph (2) (or 143,000 yen, if that cost is less than 143,000 yen) (where that amount includes a fractional amount of less than 1 yen, the amount obtained by rounding down that fractional amount if it is less than 50 sen, or by rounding it up to 1 yen if it is 50 sen or more); provided, however, that in the case of repeated high-cost medical expenses, the amount is 22,200 yen.
次号から第五号までに掲げる被保険者以外の被保険者 四万二千九百円と、第四十一条第二項各号に掲げる額を合算した額に係る療養につき厚生労働省令で定めるところにより算定した当該療養に要した費用の額（その額が十四万三千円に満たないときは、十四万三千円）から十四万三千円を控除した額に百分の一を乗じて得た額（この額に一円未満の端数がある場合において、その端数金額が五十銭未満であるときは、これを切り捨て、その端数金額が五十銭以上であるときは、これを一円に切り上げた額）との合算額。ただし、高額療養費多数回該当の場合にあっては、二万二千二百円とする。
an insured person listed in item (ii) of the preceding paragraph: the total sum of 135,150 yen and the amount obtained by multiplying by 1% the amount obtained by deducting 450,500 yen from the cost of the medical treatment, calculated as provided by Order of the Ministry of Health, Labour and Welfare, relating to the total sum of the amounts listed in the items of Article 41, paragraph (2) (or 450,500 yen, if that cost is less than 450,500 yen) (where that amount includes a fractional amount of less than 1 yen, the amount obtained by rounding down that fractional amount if it is less than 50 sen, or by rounding it up to 1 yen if it is 50 sen or more); provided, however, that in the case of repeated high-cost medical expenses, the amount is 70,050 yen.
前項第二号に掲げる被保険者 十三万五千百五十円と、第四十一条第二項各号に掲げる額を合算した額に係る療養につき厚生労働省令で定めるところにより算定した当該療養に要した費用の額（その額が四十五万五百円に満たないときは、四十五万五百円）から四十五万五百円を控除した額に百分の一を乗じて得た額（この額に一円未満の端数がある場合において、その端数金額が五十銭未満であるときは、これを切り捨て、その端数金額が五十銭以上であるときは、これを一円に切り上げた額）との合算額。ただし、高額療養費多数回該当の場合にあっては、七万五十円とする。
an insured person listed in item (iii) of the preceding paragraph: the total sum of 89,550 yen and the amount obtained by multiplying by 1% the amount obtained by deducting 298,500 yen from the cost of the medical treatment, calculated as provided by Order of the Ministry of Health, Labour and Welfare, relating to the total sum of the amounts listed in the items of Article 41, paragraph (2) (or 298,500 yen, if that cost is less than 298,500 yen) (where that amount includes a fractional amount of less than 1 yen, the amount obtained by rounding down that fractional amount if it is less than 50 sen, or by rounding it up to 1 yen if it is 50 sen or more); provided, however, that in the case of repeated high-cost medical expenses, the amount is 46,500 yen.
前項第三号に掲げる被保険者 八万九千五百五十円と、第四十一条第二項各号に掲げる額を合算した額に係る療養につき厚生労働省令で定めるところにより算定した当該療養に要した費用の額（その額が二十九万八千五百円に満たないときは、二十九万八千五百円）から二十九万八千五百円を控除した額に百分の一を乗じて得た額（この額に一円未満の端数がある場合において、その端数金額が五十銭未満であるときは、これを切り捨て、その端数金額が五十銭以上であるときは、これを一円に切り上げた額）との合算額。ただし、高額療養費多数回該当の場合にあっては、四万六千五百円とする。
an insured person listed in item (iv) of the preceding paragraph: 30,750 yen; provided, however, that in the case of repeated high-cost medical expenses, the amount is 22,200 yen.
前項第四号に掲げる被保険者 三万七百五十円。ただし、高額療養費多数回該当の場合にあっては、二万二千二百円とする。
an insured person listed in item (v) of the preceding paragraph: 18,450 yen; provided, however, that in the case of repeated high-cost medical expenses, the amount is 12,300 yen.
前項第五号に掲げる被保険者 一万八千四百五十円。ただし、高額療養費多数回該当の場合にあっては、一万二千三百円とする。
The base amount for calculating high-cost medical expenses under Article 41, paragraph (3) is, in accordance with the category of persons listed in the following items, the amount specified in each of those items.
第四十一条第三項の高額療養費算定基準額は、次の各号に掲げる者の区分に応じ、当該各号に定める額とする。
a person other than those listed in the following item through item (vi): 61,500 yen; provided, however, that in the case of repeated high-cost medical expenses, the amount is 44,400 yen.
次号から第六号までに掲げる者以外の者 六万千五百円。ただし、高額療養費多数回該当の場合にあっては、四万四千四百円とする。
a person to whom the provisions of Article 74, paragraph (1), item (iii) of the Act apply who is an insured person whose standard monthly remuneration for the month in which the medical treatment was received is 830,000 yen or more, or a dependent of such a person: the total sum of 270,300 yen and the amount obtained by multiplying by 1% the amount obtained by deducting 901,000 yen from the cost of the medical treatment, calculated as provided by Order of the Ministry of Health, Labour and Welfare, relating to the total sum of the amounts listed in the items of Article 41, paragraph (3) (or 901,000 yen, if that cost is less than 901,000 yen) (where that amount includes a fractional amount of less than 1 yen, the amount obtained by rounding down that fractional amount if it is less than 50 sen, or by rounding it up to 1 yen if it is 50 sen or more); provided, however, that in the case of repeated high-cost medical expenses, the amount is 140,100 yen.
法第七十四条第一項第三号の規定が適用される者であって療養のあった月の標準報酬月額が八十三万円以上の被保険者又はその被扶養者 二十七万三百円と、第四十一条第三項各号に掲げる額を合算した額に係る療養につき厚生労働省令で定めるところにより算定した当該療養に要した費用の額（その額が九十万千円に満たないときは、九十万千円）から九十万千円を控除した額に百分の一を乗じて得た額（この額に一円未満の端数がある場合において、その端数金額が五十銭未満であるときは、これを切り捨て、その端数金額が五十銭以上であるときは、これを一円に切り上げた額）との合算額。ただし、高額療養費多数回該当の場合にあっては、十四万百円とする。
a person to whom the provisions of Article 74, paragraph (1), item (iii) of the Act apply who is an insured person whose standard monthly remuneration for the month in which the medical treatment was received is 530,000 yen or more and less than 830,000 yen, or a dependent of such a person: the total sum of 179,100 yen and the amount obtained by multiplying by 1% the amount obtained by deducting 597,000 yen from the cost of the medical treatment, calculated as provided by Order of the Ministry of Health, Labour and Welfare, relating to the total sum of the amounts listed in the items of Article 41, paragraph (3) (or 597,000 yen, if that cost is less than 597,000 yen) (where that amount includes a fractional amount of less than 1 yen, the amount obtained by rounding down that fractional amount if it is less than 50 sen, or by rounding it up to 1 yen if it is 50 sen or more); provided, however, that in the case of repeated high-cost medical expenses, the amount is 93,000 yen.
法第七十四条第一項第三号の規定が適用される者であって療養のあった月の標準報酬月額が五十三万円以上八十三万円未満の被保険者又はその被扶養者 十七万九千百円と、第四十一条第三項各号に掲げる額を合算した額に係る療養につき厚生労働省令で定めるところにより算定した当該療養に要した費用の額（その額が五十九万七千円に満たないときは、五十九万七千円）から五十九万七千円を控除した額に百分の一を乗じて得た額（この額に一円未満の端数がある場合において、その端数金額が五十銭未満であるときは、これを切り捨て、その端数金額が五十銭以上であるときは、これを一円に切り上げた額）との合算額。ただし、高額療養費多数回該当の場合にあっては、九万三千円とする。
a person to whom the provisions of Article 74, paragraph (1), item (iii) of the Act apply who is an insured person whose standard monthly remuneration for the month in which the medical treatment was received is less than 530,000 yen, or a dependent of such a person: the total sum of 85,800 yen and the amount obtained by multiplying by 1% the amount obtained by deducting 286,000 yen from the cost of the medical treatment, calculated as provided by Order of the Ministry of Health, Labour and Welfare, relating to the total sum of the amounts listed in the items of Article 41, paragraph (3) (or 286,000 yen, if that cost is less than 286,000 yen) (where that amount includes a fractional amount of less than 1 yen, the amount obtained by rounding down that fractional amount if it is less than 50 sen, or by rounding it up to 1 yen if it is 50 sen or more); provided, however, that in the case of repeated high-cost medical expenses, the amount is 44,400 yen.
法第七十四条第一項第三号の規定が適用される者であって療養のあった月の標準報酬月額が五十三万円未満の被保険者又はその被扶養者 八万五千八百円と、第四十一条第三項各号に掲げる額を合算した額に係る療養につき厚生労働省令で定めるところにより算定した当該療養に要した費用の額（その額が二十八万六千円に満たないときは、二十八万六千円）から二十八万六千円を控除した額に百分の一を乗じて得た額（この額に一円未満の端数がある場合において、その端数金額が五十銭未満であるときは、これを切り捨て、その端数金額が五十銭以上であるときは、これを一円に切り上げた額）との合算額。ただし、高額療養費多数回該当の場合にあっては、四万四千四百円とする。
an insured person who is a person exempt from municipal inhabitant tax or a dependent thereof, or an insured person or a dependent thereof who falls under a person specified by Order of the Ministry of Health, Labour and Welfare among persons who, in the month in which the medical treatment was received, are persons requiring public assistance (excluding those listed in the preceding three items or the following item): 25,700 yen; provided, however, that in the case of repeated high-cost medical expenses, the amount is 24,600 yen.
市町村民税非課税者である被保険者若しくはその被扶養者又は療養のあった月において要保護者である者であって厚生労働省令で定めるものに該当する被保険者若しくはその被扶養者（前三号又は次号に掲げる者を除く。） 二万五千七百円。ただし、高額療養費多数回該当の場合にあっては、二万四千六百円とする。
an insured person where the insured person and all of the dependents thereof have no Income in Each Class prescribed in Article 2, paragraph (1), item (xxii) of the Income Tax Act (Act No. 33 of 1965) relating to the gross income and the amount of timber income prescribed in Article 313, paragraph (1) of the Local Tax Act for municipal inhabitant tax under the provisions of that Act (including special ward inhabitant tax under the provisions of that Act; the same applies in paragraph (12), item (v) and Article 43-3, paragraph (2), item (vi)) for the fiscal year that includes the month in which the medical treatment was received (the previous fiscal year, if the month in which the medical treatment was received is from April through July) (with respect to a person who receives a public pension or retirement package prescribed in Article 35, paragraph (2) of the Income Tax Act, the gross income calculated by applying the provisions of paragraph (4) of that Article with the phrase "the amount that each of the following items prescribes for the category of case set forth in the item" in that paragraph deemed to be replaced with "826,500 yen", and where salary income prescribed in Article 28, paragraph (1) of that Act is included in the gross income, with respect to that salary income, the amount obtained by deducting 100,000 yen from the amount calculated pursuant to the provisions of paragraph (2) of that Article (or zero, if that amount is less than zero); the same applies in paragraph (12), item (v) and Article 43-3, paragraph (2), item (vi)) and no amount of income calculated separately from other income (meaning the amount of dividend income, etc. on listed shares, etc. prescribed in Article 33-2, paragraph (5) of the Supplementary Provisions of the Local Tax Act (if Article 35-2-6, paragraph (8) or paragraph (11) of the Supplementary Provisions of that Act applies, the amount after that application), the amount of business income, etc. relating to land, etc. prescribed in Article 33-3, paragraph (5) of the Supplementary Provisions of that Act, the amount of long-term capital gains prescribed in Article 34, paragraph (4) of the Supplementary Provisions of that Act (if the provisions of Article 33-4, paragraph (1) or (2), Article 34, paragraph (1), Article 34-2, paragraph (1), Article 34-3, paragraph (1), Article 35, paragraph (1), Article 35-2, paragraph (1), Article 35-3, paragraph (1) or Article 36 of the Act on Special Measures Concerning Taxation (Act No. 26 of 1957) apply, the amount after deducting the amount to be deducted, by the application of those provisions, from the amount of long-term capital gains prescribed in Article 31, paragraph (1) of that Act), the amount of short-term capital gains prescribed in Article 35, paragraph (5) of the Supplementary Provisions of the Local Tax Act (if the provisions of Article 33-4, paragraph (1) or (2), Article 34, paragraph (1), Article 34-2, paragraph (1), Article 34-3, paragraph (1), Article 35, paragraph (1) or Article 36 of the Act on Special Measures Concerning Taxation apply, the amount after deducting the amount to be deducted, by the application of those provisions, from the amount of short-term capital gains prescribed in Article 32, paragraph (1) of that Act), the amount of capital gains, etc. on general shares, etc. prescribed in Article 35-2, paragraph (5) of the Supplementary Provisions of the Local Tax Act (if Article 35-3, paragraph (15) of the Supplementary Provisions of that Act applies, the amount after that application), the amount of capital gains, etc. on listed shares, etc. prescribed in Article 35-2-2, paragraph (5) of the Supplementary Provisions of that Act (if Article 35-2-6, paragraph (11) or Article 35-3, paragraph (13) or (15) of the Supplementary Provisions of that Act applies, the amount after that application), the amount of miscellaneous income, etc. from futures transactions prescribed in Article 35-4, paragraph (4) of the Supplementary Provisions of that Act (if Article 35-4-2, paragraph (7) of the Supplementary Provisions of that Act applies, the amount after that application), the amount of interest, etc. subject to the special provisions prescribed in Article 8, paragraph (2) of the Act on Exemption, etc. of Income Tax, etc. on Income of Foreign Residents, etc. Based on the Principle of Reciprocity (Act No. 144 of 1962) (including as applied mutatis mutandis pursuant to Article 12, paragraph (5) and Article 16, paragraph (2) of that Act), the amount of dividends, etc. subject to the special provisions prescribed in Article 8, paragraph (4) of that Act (including as applied mutatis mutandis pursuant to Article 12, paragraph (6) and Article 16, paragraph (3) of that Act), the amount of interest, etc. subject to a tax treaty prescribed in Article 3-2-2, paragraph (10) of the Act on Special Provisions of the Income Tax Act, the Corporation Tax Act and the Local Tax Act Incidental to Enforcement of Tax Treaties, etc. (Act No. 46 of 1969), and the amount of dividends, etc. subject to a tax treaty prescribed in paragraph (12) of that Article; the same applies in paragraph (12), item (v) and Article 43-3, paragraph (2), item (vi)), or a dependent of that insured person, or an insured person or a dependent thereof who falls under a person specified by Order of the Ministry of Health, Labour and Welfare among persons who, in the month in which the medical treatment was received, are persons requiring public assistance (excluding those listed in items (ii) through (iv)): 15,700 yen.
被保険者及びその被扶養者の全てが療養のあった月の属する年度（療養のあった月が四月から七月までの場合にあっては、前年度）分の地方税法の規定による市町村民税（同法の規定による特別区民税を含む。第十二項第五号及び第四十三条の三第二項第六号において同じ。）に係る同法第三百十三条第一項に規定する総所得金額及び山林所得金額に係る所得税法（昭和四十年法律第三十三号）第二条第一項第二十二号に規定する各種所得の金額（同法第三十五条第二項に規定する公的年金等の支給を受ける者については、同条第四項中「次の各号に掲げる場合の区分に応じ当該各号に定める金額」とあるのは「八十二万六千五百円」として同項の規定を適用して算定した総所得金額とし、総所得金額に同法第二十八条第一項に規定する給与所得が含まれている場合においては、当該給与所得については、同条第二項の規定によって計算した金額から十万円を控除して得た金額（当該金額が零を下回る場合には、零とする。）によるものとする。第十二項第五号及び第四十三条の三第二項第六号において同じ。）並びに他の所得と区分して計算される所得の金額（地方税法附則第三十三条の二第五項に規定する上場株式等に係る配当所得等の金額（同法附則第三十五条の二の六第八項又は第十一項の規定の適用がある場合には、その適用後の金額）、同法附則第三十三条の三第五項に規定する土地等に係る事業所得等の金額、同法附則第三十四条第四項に規定する長期譲渡所得の金額（租税特別措置法（昭和三十二年法律第二十六号）第三十三条の四第一項若しくは第二項、第三十四条第一項、第三十四条の二第一項、第三十四条の三第一項、第三十五条第一項、第三十五条の二第一項、第三十五条の三第一項又は第三十六条の規定の適用がある場合には、これらの規定の適用により同法第三十一条第一項に規定する長期譲渡所得の金額から控除する金額を控除した金額）、地方税法附則第三十五条第五項に規定する短期譲渡所得の金額（租税特別措置法第三十三条の四第一項若しくは第二項、第三十四条第一項、第三十四条の二第一項、第三十四条の三第一項、第三十五条第一項又は第三十六条の規定の適用がある場合には、これらの規定の適用により同法第三十二条第一項に規定する短期譲渡所得の金額から控除する金額を控除した金額）、地方税法附則第三十五条の二第五項に規定する一般株式等に係る譲渡所得等の金額（同法附則第三十五条の三第十五項の規定の適用がある場合には、その適用後の金額）、同法附則第三十五条の二の二第五項に規定する上場株式等に係る譲渡所得等の金額（同法附則第三十五条の二の六第十一項又は第三十五条の三第十三項若しくは第十五項の規定の適用がある場合には、その適用後の金額）、同法附則第三十五条の四第四項に規定する先物取引に係る雑所得等の金額（同法附則第三十五条の四の二第七項の規定の適用がある場合には、その適用後の金額）、外国居住者等の所得に対する相互主義による所得税等の非課税等に関する法律（昭和三十七年法律第百四十四号）第八条第二項（同法第十二条第五項及び第十六条第二項において準用する場合を含む。）に規定する特例適用利子等の額、同法第八条第四項（同法第十二条第六項及び第十六条第三項において準用する場合を含む。）に規定する特例適用配当等の額、租税条約等の実施に伴う所得税法、法人税法及び地方税法の特例等に関する法律（昭和四十四年法律第四十六号）第三条の二の二第十項に規定する条約適用利子等の額及び同条第十二項に規定する条約適用配当等の額をいう。第十二項第五号及び第四十三条の三第二項第六号において同じ。）がない被保険者若しくはその被扶養者又は療養のあった月において要保護者である者であって厚生労働省令で定めるものに該当する被保険者若しくはその被扶養者（第二号から第四号までに掲げる者を除く。） 一万五千七百円
The base amount for calculating high-cost medical expenses under Article 41, paragraph (4) is, in accordance with the category of persons listed in the following items, the amount specified in each of those items.
第四十一条第四項の高額療養費算定基準額は、次の各号に掲げる者の区分に応じ、当該各号に定める額とする。
a person listed in item (i) of the preceding paragraph: 30,750 yen; provided, however, that in the case of repeated high-cost medical expenses, the amount is 22,200 yen.
前項第一号に掲げる者 三万七百五十円。ただし、高額療養費多数回該当の場合にあっては、二万二千二百円とする。
a person listed in item (ii) of the preceding paragraph: the total sum of 135,150 yen and the amount obtained by multiplying by 1% the amount obtained by deducting 450,500 yen from the cost of the medical treatment, calculated as provided by Order of the Ministry of Health, Labour and Welfare, relating to the total amount prescribed in Article 41, paragraph (4) (or 450,500 yen, if that cost is less than 450,500 yen) (where that amount includes a fractional amount of less than 1 yen, the amount obtained by rounding down that fractional amount if it is less than 50 sen, or by rounding it up to 1 yen if it is 50 sen or more); provided, however, that in the case of repeated high-cost medical expenses, the amount is 70,050 yen.
前項第二号に掲げる者 十三万五千百五十円と、第四十一条第四項に規定する合算した額に係る療養につき厚生労働省令で定めるところにより算定した当該療養に要した費用の額（その額が四十五万五百円に満たないときは、四十五万五百円）から四十五万五百円を控除した額に百分の一を乗じて得た額（この額に一円未満の端数がある場合において、その端数金額が五十銭未満であるときは、これを切り捨て、その端数金額が五十銭以上であるときは、これを一円に切り上げた額）との合算額。ただし、高額療養費多数回該当の場合にあっては、七万五十円とする。
a person listed in item (iii) of the preceding paragraph: the total sum of 89,550 yen and the amount obtained by multiplying by 1% the amount obtained by deducting 298,500 yen from the cost of the medical treatment, calculated as provided by Order of the Ministry of Health, Labour and Welfare, relating to the total amount prescribed in Article 41, paragraph (4) (or 298,500 yen, if that cost is less than 298,500 yen) (where that amount includes a fractional amount of less than 1 yen, the amount obtained by rounding down that fractional amount if it is less than 50 sen, or by rounding it up to 1 yen if it is 50 sen or more); provided, however, that in the case of repeated high-cost medical expenses, the amount is 46,500 yen.
前項第三号に掲げる者 八万九千五百五十円と、第四十一条第四項に規定する合算した額に係る療養につき厚生労働省令で定めるところにより算定した当該療養に要した費用の額（その額が二十九万八千五百円に満たないときは、二十九万八千五百円）から二十九万八千五百円を控除した額に百分の一を乗じて得た額（この額に一円未満の端数がある場合において、その端数金額が五十銭未満であるときは、これを切り捨て、その端数金額が五十銭以上であるときは、これを一円に切り上げた額）との合算額。ただし、高額療養費多数回該当の場合にあっては、四万六千五百円とする。
a person listed in item (iv) of the preceding paragraph: the total sum of 42,900 yen and the amount obtained by multiplying by 1% the amount obtained by deducting 143,000 yen from the cost of the medical treatment, calculated as provided by Order of the Ministry of Health, Labour and Welfare, relating to the total amount prescribed in Article 41, paragraph (4) (or 143,000 yen, if that cost is less than 143,000 yen) (where that amount includes a fractional amount of less than 1 yen, the amount obtained by rounding down that fractional amount if it is less than 50 sen, or by rounding it up to 1 yen if it is 50 sen or more); provided, however, that in the case of repeated high-cost medical expenses, the amount is 22,200 yen.
前項第四号に掲げる者 四万二千九百円と、第四十一条第四項に規定する合算した額に係る療養につき厚生労働省令で定めるところにより算定した当該療養に要した費用の額（その額が十四万三千円に満たないときは、十四万三千円）から十四万三千円を控除した額に百分の一を乗じて得た額（この額に一円未満の端数がある場合において、その端数金額が五十銭未満であるときは、これを切り捨て、その端数金額が五十銭以上であるときは、これを一円に切り上げた額）との合算額。ただし、高額療養費多数回該当の場合にあっては、二万二千二百円とする。
a person listed in item (v) of the preceding paragraph: 12,850 yen; provided, however, that in the case of repeated high-cost medical expenses, the amount is 12,300 yen.
前項第五号に掲げる者 一万二千八百五十円。ただし、高額療養費多数回該当の場合にあっては、一万二千三百円とする。
a person listed in item (vi) of the preceding paragraph: 7,850 yen.
前項第六号に掲げる者 七千八百五十円
The base amount for calculating high-cost medical expenses under Article 41, paragraph (5) is, in accordance with the category of persons listed in the following items, the amount specified in each of those items (for that relating to medical treatment under the special rule on reaching age 75, the amount obtained by multiplying the amount specified in each of those items by 1/2).
第四十一条第五項の高額療養費算定基準額は、次の各号に掲げる者の区分に応じ、当該各号に定める額（七十五歳到達時特例対象療養に係るものにあっては、当該各号に定める額に二分の一を乗じて得た額）とする。
The base amount for calculating high-cost medical expenses under Article 41, paragraph (6) is, in accordance with the category of cases listed in the following items, the amount specified in each of those items.
第四十一条第六項の高額療養費算定基準額は、次の各号に掲げる場合の区分に応じ、当該各号に定める額とする。
in a case other than those listed in the following item and item (iii): the total sum of 85,800 yen (42,900 yen for that relating to medical treatment under the special rule on reaching age 75) and the amount obtained by multiplying by 1% the amount obtained by deducting 286,000 yen from the cost of the treatment subject to specified benefits prescribed in Article 41, paragraph (6) relating to the amounts listed in paragraph (1), item (i), (a) through (f) of that Article, calculated as provided by Order of the Ministry of Health, Labour and Welfare (or 286,000 yen, if that cost is less than 286,000 yen (143,000 yen for that relating to medical treatment under the special rule on reaching age 75; the same applies hereinafter in this item)) (where that amount includes a fractional amount of less than 1 yen, the amount obtained by rounding down that fractional amount if it is less than 50 sen, or by rounding it up to 1 yen if it is 50 sen or more);
次号及び第三号に掲げる場合以外の場合 八万五千八百円（七十五歳到達時特例対象療養に係るものにあっては、四万二千九百円）と、第四十一条第一項第一号イからヘまでに掲げる額に係る同条第六項に規定する特定給付対象療養につき厚生労働省令で定めるところにより算定した当該特定給付対象療養に要した費用の額（その額が二十八万六千円（七十五歳到達時特例対象療養に係るものにあっては、十四万三千円。以下この号において同じ。）に満たないときは、二十八万六千円）から二十八万六千円を控除した額に百分の一を乗じて得た額（この額に一円未満の端数がある場合において、その端数金額が五十銭未満であるときは、これを切り捨て、その端数金額が五十銭以上であるときは、これを一円に切り上げた額）との合算額
in the case of the treatment subject to specified benefits in the preceding item that is received on or after the month following the month that includes the day on which the person reaches the age of 70 and is inpatient treatment (meaning the medical treatment listed in Article 63, paragraph (1), item (v) of the Act (including the medical treatment listed in items (i) through (iii) of that paragraph accompanying that treatment); the same applies in the following paragraph and paragraph (8), item (ii)): 61,500 yen (30,750 yen for that relating to medical treatment under the special rule on reaching age 75);
七十歳に達する日の属する月の翌月以後の前号の特定給付対象療養であって、入院療養（法第六十三条第一項第五号に掲げる療養（当該療養に伴う同項第一号から第三号までに掲げる療養を含む。）をいう。次項及び第八項第二号において同じ。）である場合 六万千五百円（七十五歳到達時特例対象療養に係るものにあっては、三万七百五十円）
in the case of the treatment subject to specified benefits in item (i) that is received on or after the month following the month that includes the day on which the person reaches the age of 70 and is outpatient treatment: 22,000 yen (11,000 yen for that relating to medical treatment under the special rule on reaching age 75).
七十歳に達する日の属する月の翌月以後の第一号の特定給付対象療養であって、外来療養である場合 二万二千円（七十五歳到達時特例対象療養に係るものにあっては、一万千円）
The base amount for calculating high-cost medical expenses under Article 41, paragraph (7) is, in accordance with the category of cases listed in the following items, the amount specified in each of those items.
第四十一条第七項の高額療養費算定基準額は、次の各号に掲げる場合の区分に応じ、当該各号に定める額とする。
in a case other than those listed in the following item and item (iii): the amount specified in each of (a) through (e) in accordance with the category of persons listed in (a) through (e) below:
a person listed in paragraph (1), item (i): the total sum of 85,800 yen (42,900 yen for that relating to medical treatment under the special rule on reaching age 75) and the amount obtained by multiplying by 1% the amount obtained by deducting 286,000 yen from the cost of the treatment subject to specified disease benefits, calculated as provided by Order of the Ministry of Health, Labour and Welfare, relating to the amounts listed in Article 41, paragraph (1), item (i), (a) through (f) (or 286,000 yen, if that cost is less than 286,000 yen (143,000 yen for that relating to medical treatment under the special rule on reaching age 75; the same applies hereinafter in this (a))) (where that amount includes a fractional amount of less than 1 yen, the amount obtained by rounding down that fractional amount if it is less than 50 sen, or by rounding it up to 1 yen if it is 50 sen or more); provided, however, that in the case where the number of months in which high-cost medical expenses (limited to those paid pursuant to paragraph (7) of that Article for inpatient treatment received from the same hospital or clinic by the insured person or dependent who received the treatment subject to specified disease benefits (limited to inpatient treatment)) have already been paid within 12 months on or before the month in which that treatment subject to specified disease benefits (limited to inpatient treatment) was received is three or more (hereinafter referred to as a "case of repeated high-cost medical expenses for treatment subject to specified disease benefits" in this paragraph), the amount is 44,400 yen (22,200 yen for that relating to medical treatment under the special rule on reaching age 75).
第一項第一号に掲げる者 八万五千八百円（七十五歳到達時特例対象療養に係るものにあっては、四万二千九百円）と、第四十一条第一項第一号イからヘまでに掲げる額に係る特定疾病給付対象療養につき厚生労働省令で定めるところにより算定した当該特定疾病給付対象療養に要した費用の額（その額が二十八万六千円（七十五歳到達時特例対象療養に係るものにあっては、十四万三千円。以下このイにおいて同じ。）に満たないときは、二十八万六千円）から二十八万六千円を控除した額に百分の一を乗じて得た額（この額に一円未満の端数がある場合において、その端数金額が五十銭未満であるときは、これを切り捨て、その端数金額が五十銭以上であるときは、これを一円に切り上げた額）との合算額。ただし、当該特定疾病給付対象療養（入院療養に限る。）のあった月以前の十二月以内に既に高額療養費（当該特定疾病給付対象療養（入院療養に限る。）を受けた被保険者又はその被扶養者がそれぞれ同一の病院又は診療所から受けた入院療養に係るものであって、同条第七項の規定によるものに限る。）が支給されている月数が三月以上ある場合（以下この項において「特定疾病給付対象療養高額療養費多数回該当の場合」という。）にあっては、四万四千四百円（七十五歳到達時特例対象療養に係るものにあっては、二万二千二百円）とする。
a person listed in paragraph (1), item (ii): the total sum of 270,300 yen (135,150 yen for that relating to medical treatment under the special rule on reaching age 75) and the amount obtained by multiplying by 1% the amount obtained by deducting 901,000 yen from the cost of the treatment subject to specified disease benefits, calculated as provided by Order of the Ministry of Health, Labour and Welfare, relating to the amounts listed in Article 41, paragraph (1), item (i), (a) through (f) (or 901,000 yen, if that cost is less than 901,000 yen (450,500 yen for that relating to medical treatment under the special rule on reaching age 75; the same applies hereinafter in this (b))) (where that amount includes a fractional amount of less than 1 yen, the amount obtained by rounding down that fractional amount if it is less than 50 sen, or by rounding it up to 1 yen if it is 50 sen or more); provided, however, that in the case of repeated high-cost medical expenses for treatment subject to specified disease benefits, the amount is 140,100 yen (70,050 yen for that relating to medical treatment under the special rule on reaching age 75).
第一項第二号に掲げる者 二十七万三百円（七十五歳到達時特例対象療養に係るものにあっては、十三万五千百五十円）と、第四十一条第一項第一号イからヘまでに掲げる額に係る特定疾病給付対象療養につき厚生労働省令で定めるところにより算定した当該特定疾病給付対象療養に要した費用の額（その額が九十万千円（七十五歳到達時特例対象療養に係るものにあっては、四十五万五百円。以下このロにおいて同じ。）に満たないときは、九十万千円）から九十万千円を控除した額に百分の一を乗じて得た額（この額に一円未満の端数がある場合において、その端数金額が五十銭未満であるときは、これを切り捨て、その端数金額が五十銭以上であるときは、これを一円に切り上げた額）との合算額。ただし、特定疾病給付対象療養高額療養費多数回該当の場合にあっては、十四万百円（七十五歳到達時特例対象療養に係るものにあっては、七万五十円）とする。
a person listed in paragraph (1), item (iii): the total sum of 179,100 yen (89,550 yen for that relating to medical treatment under the special rule on reaching age 75) and the amount obtained by multiplying by 1% the amount obtained by deducting 597,000 yen from the cost of the treatment subject to specified disease benefits, calculated as provided by Order of the Ministry of Health, Labour and Welfare, relating to the amounts listed in Article 41, paragraph (1), item (i), (a) through (f) (or 597,000 yen, if that cost is less than 597,000 yen (298,500 yen for that relating to medical treatment under the special rule on reaching age 75; the same applies hereinafter in this (c))) (where that amount includes a fractional amount of less than 1 yen, the amount obtained by rounding down that fractional amount if it is less than 50 sen, or by rounding it up to 1 yen if it is 50 sen or more); provided, however, that in the case of repeated high-cost medical expenses for treatment subject to specified disease benefits, the amount is 93,000 yen (46,500 yen for that relating to medical treatment under the special rule on reaching age 75).
第一項第三号に掲げる者 十七万九千百円（七十五歳到達時特例対象療養に係るものにあっては、八万九千五百五十円）と、第四十一条第一項第一号イからヘまでに掲げる額に係る特定疾病給付対象療養につき厚生労働省令で定めるところにより算定した当該特定疾病給付対象療養に要した費用の額（その額が五十九万七千円（七十五歳到達時特例対象療養に係るものにあっては、二十九万八千五百円。以下このハにおいて同じ。）に満たないときは、五十九万七千円）から五十九万七千円を控除した額に百分の一を乗じて得た額（この額に一円未満の端数がある場合において、その端数金額が五十銭未満であるときは、これを切り捨て、その端数金額が五十銭以上であるときは、これを一円に切り上げた額）との合算額。ただし、特定疾病給付対象療養高額療養費多数回該当の場合にあっては、九万三千円（七十五歳到達時特例対象療養に係るものにあっては、四万六千五百円）とする。
a person listed in paragraph (1), item (iv): 61,500 yen (30,750 yen for that relating to medical treatment under the special rule on reaching age 75); provided, however, that in the case of repeated high-cost medical expenses for treatment subject to specified disease benefits, the amount is 44,400 yen (22,200 yen for that relating to medical treatment under the special rule on reaching age 75).
第一項第四号に掲げる者 六万千五百円（七十五歳到達時特例対象療養に係るものにあっては、三万七百五十円）。ただし、特定疾病給付対象療養高額療養費多数回該当の場合にあっては、四万四千四百円（七十五歳到達時特例対象療養に係るものにあっては、二万二千二百円）とする。
a person listed in paragraph (1), item (v): 36,900 yen (18,450 yen for that relating to medical treatment under the special rule on reaching age 75); provided, however, that in the case of repeated high-cost medical expenses for treatment subject to specified disease benefits, the amount is 24,600 yen (12,300 yen for that relating to medical treatment under the special rule on reaching age 75).
第一項第五号に掲げる者 三万六千九百円（七十五歳到達時特例対象療養に係るものにあっては、一万八千四百五十円）。ただし、特定疾病給付対象療養高額療養費多数回該当の場合にあっては、二万四千六百円（七十五歳到達時特例対象療養に係るものにあっては、一万二千三百円）とする。
in the case of treatment subject to specified disease benefits that is received on or after the month following the month that includes the day on which the person reaches the age of 70 and is inpatient treatment: the amount specified in each of (a) through (f) in accordance with the category of persons listed in (a) through (f) below:
七十歳に達する日の属する月の翌月以後の特定疾病給付対象療養であって、入院療養である場合 次のイからヘまでに掲げる者の区分に応じ、それぞれイからヘまでに定める額
a person listed in paragraph (3), item (i): 61,500 yen (30,750 yen for that relating to medical treatment under the special rule on reaching age 75); provided, however, that in the case of repeated high-cost medical expenses for treatment subject to specified disease benefits, the amount is 44,400 yen (22,200 yen for that relating to medical treatment under the special rule on reaching age 75).
第三項第一号に掲げる者 六万千五百円（七十五歳到達時特例対象療養に係るものにあっては、三万七百五十円）。ただし、特定疾病給付対象療養高額療養費多数回該当の場合にあっては、四万四千四百円（七十五歳到達時特例対象療養に係るものにあっては、二万二千二百円）とする。
a person listed in paragraph (3), item (ii): the total sum of 270,300 yen (135,150 yen for that relating to medical treatment under the special rule on reaching age 75) and the amount obtained by multiplying by 1% the amount obtained by deducting 901,000 yen from the cost of the treatment subject to specified disease benefits, calculated as provided by Order of the Ministry of Health, Labour and Welfare, relating to the amounts listed in Article 41, paragraph (1), item (i), (a) through (f) (or 901,000 yen, if that cost is less than 901,000 yen (450,500 yen for that relating to medical treatment under the special rule on reaching age 75; the same applies hereinafter in this (b))) (where that amount includes a fractional amount of less than 1 yen, the amount obtained by rounding down that fractional amount if it is less than 50 sen, or by rounding it up to 1 yen if it is 50 sen or more); provided, however, that in the case of repeated high-cost medical expenses for treatment subject to specified disease benefits, the amount is 140,100 yen (70,050 yen for that relating to medical treatment under the special rule on reaching age 75).
第三項第二号に掲げる者 二十七万三百円（七十五歳到達時特例対象療養に係るものにあっては、十三万五千百五十円）と、第四十一条第一項第一号イからヘまでに掲げる額に係る特定疾病給付対象療養につき厚生労働省令で定めるところにより算定した当該特定疾病給付対象療養に要した費用の額（その額が九十万千円（七十五歳到達時特例対象療養に係るものにあっては、四十五万五百円。以下このロにおいて同じ。）に満たないときは、九十万千円）から九十万千円を控除した額に百分の一を乗じて得た額（この額に一円未満の端数がある場合において、その端数金額が五十銭未満であるときは、これを切り捨て、その端数金額が五十銭以上であるときは、これを一円に切り上げた額）との合算額。ただし、特定疾病給付対象療養高額療養費多数回該当の場合にあっては、十四万百円（七十五歳到達時特例対象療養に係るものにあっては、七万五十円）とする。
a person listed in paragraph (3), item (iii): the total sum of 179,100 yen (89,550 yen for that relating to medical treatment under the special rule on reaching age 75) and the amount obtained by multiplying by 1% the amount obtained by deducting 597,000 yen from the cost of the treatment subject to specified disease benefits, calculated as provided by Order of the Ministry of Health, Labour and Welfare, relating to the amounts listed in Article 41, paragraph (1), item (i), (a) through (f) (or 597,000 yen, if that cost is less than 597,000 yen (298,500 yen for that relating to medical treatment under the special rule on reaching age 75; the same applies hereinafter in this (c))) (where that amount includes a fractional amount of less than 1 yen, the amount obtained by rounding down that fractional amount if it is less than 50 sen, or by rounding it up to 1 yen if it is 50 sen or more); provided, however, that in the case of repeated high-cost medical expenses for treatment subject to specified disease benefits, the amount is 93,000 yen (46,500 yen for that relating to medical treatment under the special rule on reaching age 75).
第三項第三号に掲げる者 十七万九千百円（七十五歳到達時特例対象療養に係るものにあっては、八万九千五百五十円）と、第四十一条第一項第一号イからヘまでに掲げる額に係る特定疾病給付対象療養につき厚生労働省令で定めるところにより算定した当該特定疾病給付対象療養に要した費用の額（その額が五十九万七千円（七十五歳到達時特例対象療養に係るものにあっては、二十九万八千五百円。以下このハにおいて同じ。）に満たないときは、五十九万七千円）から五十九万七千円を控除した額に百分の一を乗じて得た額（この額に一円未満の端数がある場合において、その端数金額が五十銭未満であるときは、これを切り捨て、その端数金額が五十銭以上であるときは、これを一円に切り上げた額）との合算額。ただし、特定疾病給付対象療養高額療養費多数回該当の場合にあっては、九万三千円（七十五歳到達時特例対象療養に係るものにあっては、四万六千五百円）とする。
a person listed in paragraph (3), item (iv): the total sum of 85,800 yen (42,900 yen for that relating to medical treatment under the special rule on reaching age 75) and the amount obtained by multiplying by 1% the amount obtained by deducting 286,000 yen from the cost of the treatment subject to specified disease benefits, calculated as provided by Order of the Ministry of Health, Labour and Welfare, relating to the amounts listed in Article 41, paragraph (1), item (i), (a) through (f) (or 286,000 yen, if that cost is less than 286,000 yen (143,000 yen for that relating to medical treatment under the special rule on reaching age 75; the same applies hereinafter in this (d))) (where that amount includes a fractional amount of less than 1 yen, the amount obtained by rounding down that fractional amount if it is less than 50 sen, or by rounding it up to 1 yen if it is 50 sen or more); provided, however, that in the case of repeated high-cost medical expenses for treatment subject to specified disease benefits, the amount is 44,400 yen (22,200 yen for that relating to medical treatment under the special rule on reaching age 75).
第三項第四号に掲げる者 八万五千八百円（七十五歳到達時特例対象療養に係るものにあっては、四万二千九百円）と、第四十一条第一項第一号イからヘまでに掲げる額に係る特定疾病給付対象療養につき厚生労働省令で定めるところにより算定した当該特定疾病給付対象療養に要した費用の額（その額が二十八万六千円（七十五歳到達時特例対象療養に係るものにあっては、十四万三千円。以下このニにおいて同じ。）に満たないときは、二十八万六千円）から二十八万六千円を控除した額に百分の一を乗じて得た額（この額に一円未満の端数がある場合において、その端数金額が五十銭未満であるときは、これを切り捨て、その端数金額が五十銭以上であるときは、これを一円に切り上げた額）との合算額。ただし、特定疾病給付対象療養高額療養費多数回該当の場合にあっては、四万四千四百円（七十五歳到達時特例対象療養に係るものにあっては、二万二千二百円）とする。
a person listed in paragraph (3), item (v): 25,700 yen (12,850 yen for that relating to medical treatment under the special rule on reaching age 75); provided, however, that in the case of repeated high-cost medical expenses for treatment subject to specified disease benefits, the amount is 24,600 yen (12,300 yen for that relating to medical treatment under the special rule on reaching age 75).
第三項第五号に掲げる者 二万五千七百円（七十五歳到達時特例対象療養に係るものにあっては、一万二千八百五十円）。ただし、特定疾病給付対象療養高額療養費多数回該当の場合にあっては、二万四千六百円（七十五歳到達時特例対象療養に係るものにあっては、一万二千三百円）とする。
a person listed in paragraph (3), item (vi): 15,700 yen (7,850 yen for that relating to medical treatment under the special rule on reaching age 75);
第三項第六号に掲げる者 一万五千七百円（七十五歳到達時特例対象療養に係るものにあっては、七千八百五十円）
in the case of treatment subject to specified disease benefits that is received on or after the month following the month that includes the day on which the person reaches the age of 70 and is outpatient treatment: the amount specified in each of (a) through (c) in accordance with the category of persons listed in (a) through (c) below (for that relating to medical treatment under the special rule on reaching age 75, the amount obtained by multiplying the amount specified in each of (a) through (c) by 1/2):
七十歳に達する日の属する月の翌月以後の特定疾病給付対象療養であって、外来療養である場合 次のイからハまでに掲げる者の区分に応じ、それぞれイからハまでに定める額（七十五歳到達時特例対象療養に係るものにあっては、それぞれイからハまでに定める額に二分の一を乗じて得た額）
The base amount for calculating high-cost medical expenses under Article 41, paragraph (8) is, in accordance with the category of cases listed in the following items, the amount specified in each of those items (for that relating to medical treatment under the special rule on reaching age 75, the amount obtained by multiplying the amount specified in each of those items by 1/2).
第四十一条第八項の高額療養費算定基準額は、次の各号に掲げる場合の区分に応じ、当該各号に定める額（七十五歳到達時特例対象療養に係るものにあっては、当該各号に定める額に二分の一を乗じて得た額）とする。
in a case other than those listed in the following item and item (iii): 36,900 yen;
in the case of the medical treatment prescribed in Article 41, paragraph (8) that is received on or after the month following the month that includes the day on which the person reaches the age of 70 and is inpatient treatment: 15,700 yen;
in the case of the medical treatment prescribed in Article 41, paragraph (8) that is received on or after the month following the month that includes the day on which the person reaches the age of 70 and is outpatient treatment: 8,000 yen.
The base amount for calculating high-cost medical expenses under Article 41, paragraph (9) is, in accordance with the category of persons listed in the following items, the amount specified in each of those items (for that relating to medical treatment under the special rule on reaching age 75, the amount obtained by multiplying the amount specified in each of those items by 1/2).
第四十一条第九項の高額療養費算定基準額は、次の各号に掲げる者の区分に応じ、当該各号に定める額（七十五歳到達時特例対象療養に係るものにあっては、当該各号に定める額に二分の一を乗じて得た額）とする。
a person other than those listed in the following item: 10,000 yen;
次号に掲げる者以外の者 一万円
a person listed in paragraph (1), item (ii) or (iii) (excluding a person who received the medical treatment prescribed in Article 41, paragraph (9) on or after the month following the month that includes the day on which the person reaches the age of 70, and a person who received medical treatment for a disease specified by the Minister of Health, Labour and Welfare as a disease relating to treatment, among the medical treatment prescribed in that paragraph, for which the State is to bear the costs): 20,000 yen.
The base amount for calculating high-cost medical expenses under Article 41-2, paragraph (1) (including as applied mutatis mutandis pursuant to paragraphs (2) through (4) of that Article), paragraph (5) of that Article (including as applied mutatis mutandis pursuant to paragraph (6) of that Article) and paragraph (7) of that Article is, in accordance with the category of persons listed in the following items, respectively, the amount specified in each of those items.
第四十一条の二第一項（同条第二項から第四項までにおいて準用する場合を含む。）、第五項（同条第六項において準用する場合を含む。）及び第七項の高額療養費算定基準額は、それぞれ次の各号に掲げる者の区分に応じ、当該各号に定める額とする。
a person other than those listed in the following item: 216,000 yen;
次号に掲げる者以外の者 二十一万六千円
a person exempt from municipal inhabitant tax (meaning a person on whom municipal inhabitant tax under the provisions of the Local Tax Act for the previous fiscal year of the fiscal year that includes the reference date (if, pursuant to paragraph (11) of the following Article, any day from August 1 of the previous year to March 31 is deemed to be the reference date, the fiscal year that includes the day deemed to be the reference date) is not imposed (including a person exempted from that municipal inhabitant tax as provided by a municipal ordinance, and excluding a person who does not have an address in the area where that Act is in force on the assessment date of that municipal inhabitant tax)) who is an insured person, or an insured person who falls under a person specified by Order of the Ministry of Health, Labour and Welfare among persons who are persons requiring public assistance on the reference date: 96,000 yen.
The base amount for calculating high-cost medical expenses under paragraph (1) of the preceding Article is, in accordance with the category of persons listed in the following items, the amount specified in each of those items.
前条第一項の高額療養費算定基準額は、次の各号に掲げる者の区分に応じ、当該各号に定める額とする。
a person other than those listed in the following item through item (iv): 530,000 yen;
次号から第四号までに掲げる者以外の者 五十三万円
an insured person whose standard monthly remuneration for the month that includes the reference date is 830,000 yen or more: 1,680,000 yen;
基準日の属する月の標準報酬月額が八十三万円以上の被保険者 百六十八万円
an insured person whose standard monthly remuneration for the month that includes the reference date is 530,000 yen or more and less than 830,000 yen: 1,110,000 yen;
基準日の属する月の標準報酬月額が五十三万円以上八十三万円未満の被保険者 百十一万円
a person exempt from municipal inhabitant tax (meaning a person on whom municipal inhabitant tax under the provisions of the Local Tax Act for the previous fiscal year of the fiscal year that includes the reference date (if, pursuant to paragraph (12) of the following Article, any day from August 1 of the previous year to March 31 is deemed to be the reference date, the fiscal year that includes the day deemed to be the reference date) is not imposed (including a person exempted from that municipal inhabitant tax as provided by a municipal ordinance, and excluding a person who does not have an address in the area where that Act is in force on the assessment date of that municipal inhabitant tax); the same applies in item (iv) of the following paragraph) who is an insured person, or an insured person who falls under a person specified by Order of the Ministry of Health, Labour and Welfare among persons who are persons requiring public assistance on the reference date (excluding those listed in the preceding two items): 290,000 yen.
The annual base amount for calculating high-cost medical expenses for persons aged 70 or over under paragraph (2) of the preceding Article is, in accordance with the category of persons listed in the following items, the amount specified in each of those items.
前条第二項の七十歳以上年間高額療養費算定基準額は、次の各号に掲げる者の区分に応じ、当該各号に定める額とする。
a person other than those listed in the following item through item (v): 530,000 yen;
次号から第五号までに掲げる者以外の者 五十三万円
a person to whom the provisions of Article 74, paragraph (1), item (iii) of the Act would apply if the person were to receive benefits for medical treatment on the reference date (hereinafter referred to as a "person to whom item (iii) applies" in the following item and Article 43-3, paragraph (2), items (ii) through (iv)) whose standard monthly remuneration for the month that includes the reference date is 830,000 yen or more: 1,680,000 yen;
基準日において療養の給付を受けることとした場合に法第七十四条第一項第三号の規定が適用される者（次号及び第四十三条の三第二項第二号から第四号までにおいて「第三号適用者」という。）であって、基準日の属する月の標準報酬月額が八十三万円以上のもの 百六十八万円
a person to whom item (iii) applies whose standard monthly remuneration for the month that includes the reference date is 530,000 yen or more and less than 830,000 yen: 1,110,000 yen;
an insured person who is a person exempt from municipal inhabitant tax, or an insured person who falls under a person specified by Order of the Ministry of Health, Labour and Welfare among persons who are persons requiring public assistance on the reference date (excluding those listed in the preceding two items or the following item): 290,000 yen;
an insured person where the insured person and all of the persons who are dependents of the insured person on the day specified by Order of the Ministry of Health, Labour and Welfare in the month that includes the reference date have no Income in Each Class prescribed in Article 2, paragraph (1), item (xxii) of the Income Tax Act relating to the gross income and the amount of timber income prescribed in Article 313, paragraph (1) of the Local Tax Act for municipal inhabitant tax under the provisions of that Act for the previous fiscal year of the fiscal year that includes the reference date (if, pursuant to paragraph (12) of the following Article, any day from August 1 of the previous year to March 31 is deemed to be the reference date, the fiscal year that includes the day deemed to be the reference date) and no amount of income calculated separately from other income, or an insured person who falls under a person specified by Order of the Ministry of Health, Labour and Welfare among persons who are persons requiring public assistance on the reference date (excluding those listed in item (ii) or item (iii)): 180,000 yen.
被保険者及び基準日の属する月における厚生労働省令で定める日においてその被扶養者である者の全てが基準日の属する年度の前年度（次条第十二項の規定により前年八月一日から三月三十一日までのいずれかの日を基準日とみなした場合にあっては、当該基準日とみなした日の属する年度）分の地方税法の規定による市町村民税に係る同法第三百十三条第一項に規定する総所得金額及び山林所得金額に係る所得税法第二条第一項第二十二号に規定する各種所得の金額並びに他の所得と区分して計算される所得の金額がない被保険者又は基準日において要保護者である者であって厚生労働省令で定めるものに該当する被保険者（第二号又は第三号に掲げる者を除く。） 十八万円
Article 43Other Matters Concerning Payment of High-cost Medical Expenses
If an insured person has received medical treatment in the same month from a single medical institution providing services covered by health insurance, pharmacy providing services covered by health insurance, or hospital, clinic or pharmacy listed in Article 63, paragraph (3), item (ii) of the Act (hereinafter collectively referred to as a "medical institution providing services covered by health insurance, etc." in this paragraph and paragraph (5)), or from a designated home-nursing provider, and the co-payment payable pursuant to the provisions of the Act, the amount borne for medical expenses combined with treatment outside insurance coverage (meaning, where Article 85, paragraph (5) or (7) of the Act as applied mutatis mutandis pursuant to Article 86, paragraph (4) of the Act applies to the payment of medical expenses combined with treatment outside insurance coverage, the amount obtained by deducting the amount of those medical expenses combined with treatment outside insurance coverage from the amount of expenses calculated for the medical treatment relating to the payment of those medical expenses combined with treatment outside insurance coverage; the same applies hereinafter in this paragraph and paragraph (5)) or the amount borne for medical expenses for home-nursing (meaning, where Article 88, paragraph (6) of the Act applies to the payment of medical expenses for home-nursing, the amount obtained by deducting the amount of those medical expenses for home-nursing from the amount of expenses calculated for the designated home nursing relating to the payment of those medical expenses for home-nursing; the same applies hereinafter in this paragraph and paragraph (5)) has not been paid, the insurer is to pay, with respect to high-cost medical expenses under Article 41, paragraph (1) and paragraphs (3) through (5), to that medical institution providing services covered by health insurance, etc. or designated home-nursing provider, up to the amount obtained by deducting, from the amount of that co-payment, the amount borne for medical expenses combined with treatment outside insurance coverage or the amount borne for medical expenses for home-nursing, the amount specified in each of the following items in accordance with the category of cases listed in those items.
被保険者が同一の月に一の保険医療機関若しくは保険薬局若しくは法第六十三条第三項第二号に掲げる病院若しくは診療所若しくは薬局（以下この項及び第五項において「保険医療機関等」と総称する。）又は指定訪問看護事業者から療養を受けた場合において、法の規定により支払うべき一部負担金、保険外併用療養費負担額（保険外併用療養費の支給につき法第八十六条第四項において準用する法第八十五条第五項又は第七項の規定の適用がある場合における当該保険外併用療養費の支給に係る療養につき算定した費用の額から当該保険外併用療養費の額を控除した額をいう。以下この項及び第五項において同じ。）又は訪問看護療養費負担額（訪問看護療養費の支給につき法第八十八条第六項の規定の適用がある場合における当該訪問看護療養費の支給に係る指定訪問看護につき算定した費用の額から当該訪問看護療養費の額を控除した額をいう。以下この項及び第五項において同じ。）の支払が行われなかったときは、保険者は、第四十一条第一項及び第三項から第五項までの規定による高額療養費について、当該一部負担金の額、保険外併用療養費負担額又は訪問看護療養費負担額から次の各号に掲げる場合の区分に応じ、当該各号に定める額を控除した額の限度において、当該保険医療機関等又は指定訪問看護事業者に支払うものとする。
in the case where high-cost medical expenses are paid pursuant to Article 41, paragraph (1): the amount specified in each of (a) through (e) in accordance with the category of persons listed in (a) through (e) below:
第四十一条第一項の規定により高額療養費を支給する場合 次のイからホまでに掲げる者の区分に応じ、それぞれイからホまでに定める額
a person who has received certification by the insurer, as provided by Order of the Ministry of Health, Labour and Welfare, as falling under a person listed in paragraph (1), item (i) of the preceding Article: the total sum of 85,800 yen and the amount obtained by multiplying by 1% the amount obtained by deducting 286,000 yen from the amount of expenses required for that medical treatment, calculated for that medical treatment as provided by Order of the Ministry of Health, Labour and Welfare (or 286,000 yen, if that amount is less than 286,000 yen) (where that amount includes a fractional amount of less than 1 yen, the amount obtained by rounding down that fractional amount if it is less than 50 sen, or by rounding it up to 1 yen if it is 50 sen or more); provided, however, that in the case of repeated high-cost medical expenses, the amount is 44,400 yen.
前条第一項第一号に掲げる者に該当していることにつき厚生労働省令で定めるところにより保険者の認定を受けている者 八万五千八百円と、当該療養につき厚生労働省令で定めるところにより算定した当該療養に要した費用の額（その額が二十八万六千円に満たないときは、二十八万六千円）から二十八万六千円を控除した額に百分の一を乗じて得た額（この額に一円未満の端数がある場合において、その端数金額が五十銭未満であるときは、これを切り捨て、その端数金額が五十銭以上であるときは、これを一円に切り上げた額）との合算額。ただし、高額療養費多数回該当の場合にあっては、四万四千四百円とする。
a person who has received certification by the insurer, as provided by Order of the Ministry of Health, Labour and Welfare, as falling under a person listed in paragraph (1), item (ii) of the preceding Article: the total sum of 270,300 yen and the amount obtained by multiplying by 1% the amount obtained by deducting 901,000 yen from the amount of expenses required for that medical treatment, calculated for that medical treatment as provided by Order of the Ministry of Health, Labour and Welfare (or 901,000 yen, if that amount is less than 901,000 yen) (where that amount includes a fractional amount of less than 1 yen, the amount obtained by rounding down that fractional amount if it is less than 50 sen, or by rounding it up to 1 yen if it is 50 sen or more); provided, however, that in the case of repeated high-cost medical expenses, the amount is 140,100 yen.
前条第一項第二号に掲げる者に該当していることにつき厚生労働省令で定めるところにより保険者の認定を受けている者 二十七万三百円と、当該療養につき厚生労働省令で定めるところにより算定した当該療養に要した費用の額（その額が九十万千円に満たないときは、九十万千円）から九十万千円を控除した額に百分の一を乗じて得た額（この額に一円未満の端数がある場合において、その端数金額が五十銭未満であるときは、これを切り捨て、その端数金額が五十銭以上であるときは、これを一円に切り上げた額）との合算額。ただし、高額療養費多数回該当の場合にあっては、十四万百円とする。
a person who has received certification by the insurer, as provided by Order of the Ministry of Health, Labour and Welfare, as falling under a person listed in paragraph (1), item (iii) of the preceding Article: the total sum of 179,100 yen and the amount obtained by multiplying by 1% the amount obtained by deducting 597,000 yen from the amount of expenses required for that medical treatment, calculated for that medical treatment as provided by Order of the Ministry of Health, Labour and Welfare (or 597,000 yen, if that amount is less than 597,000 yen) (where that amount includes a fractional amount of less than 1 yen, the amount obtained by rounding down that fractional amount if it is less than 50 sen, or by rounding it up to 1 yen if it is 50 sen or more); provided, however, that in the case of repeated high-cost medical expenses, the amount is 93,000 yen.
前条第一項第三号に掲げる者に該当していることにつき厚生労働省令で定めるところにより保険者の認定を受けている者 十七万九千百円と、当該療養につき厚生労働省令で定めるところにより算定した当該療養に要した費用の額（その額が五十九万七千円に満たないときは、五十九万七千円）から五十九万七千円を控除した額に百分の一を乗じて得た額（この額に一円未満の端数がある場合において、その端数金額が五十銭未満であるときは、これを切り捨て、その端数金額が五十銭以上であるときは、これを一円に切り上げた額）との合算額。ただし、高額療養費多数回該当の場合にあっては、九万三千円とする。
a person who has received certification by the insurer, as provided by Order of the Ministry of Health, Labour and Welfare, as falling under a person listed in paragraph (1), item (iv) of the preceding Article: 61,500 yen; provided, however, that in the case of repeated high-cost medical expenses, the amount is 44,400 yen.
前条第一項第四号に掲げる者に該当していることにつき厚生労働省令で定めるところにより保険者の認定を受けている者 六万千五百円。ただし、高額療養費多数回該当の場合にあっては、四万四千四百円とする。
a person who has received certification by the insurer, as provided by Order of the Ministry of Health, Labour and Welfare, as falling under a person listed in paragraph (1), item (v) of the preceding Article: 36,900 yen; provided, however, that in the case of repeated high-cost medical expenses, the amount is 24,600 yen.
前条第一項第五号に掲げる者に該当していることにつき厚生労働省令で定めるところにより保険者の認定を受けている者 三万六千九百円。ただし、高額療養費多数回該当の場合にあっては、二万四千六百円とする。
in the case where high-cost medical expenses are paid pursuant to Article 41, paragraph (3): the amount specified in each of (a) through (f) in accordance with the category of persons listed in (a) through (f) below:
第四十一条第三項の規定により高額療養費を支給する場合 次のイからヘまでに掲げる者の区分に応じ、それぞれイからヘまでに定める額
a person other than those listed in (b) through (f): 61,500 yen; provided, however, that in the case of repeated high-cost medical expenses, the amount is 44,400 yen.
ロからヘまでに掲げる者以外の者 六万千五百円。ただし、高額療養費多数回該当の場合にあっては、四万四千四百円とする。
a person listed in paragraph (3), item (ii) of the preceding Article: the total sum of 270,300 yen and the amount obtained by multiplying by 1% the amount obtained by deducting 901,000 yen from the amount of expenses required for that medical treatment, calculated for that medical treatment as provided by Order of the Ministry of Health, Labour and Welfare (or 901,000 yen, if that amount is less than 901,000 yen) (where that amount includes a fractional amount of less than 1 yen, the amount obtained by rounding down that fractional amount if it is less than 50 sen, or by rounding it up to 1 yen if it is 50 sen or more); provided, however, that in the case of repeated high-cost medical expenses, the amount is 140,100 yen.
前条第三項第二号に掲げる者 二十七万三百円と、当該療養につき厚生労働省令で定めるところにより算定した当該療養に要した費用の額（その額が九十万千円に満たないときは、九十万千円）から九十万千円を控除した額に百分の一を乗じて得た額（この額に一円未満の端数がある場合において、その端数金額が五十銭未満であるときは、これを切り捨て、その端数金額が五十銭以上であるときは、これを一円に切り上げた額）との合算額。ただし、高額療養費多数回該当の場合にあっては、十四万百円とする。
a person who has received certification by the insurer, as provided by Order of the Ministry of Health, Labour and Welfare, as falling under a person listed in paragraph (3), item (iii) of the preceding Article: the total sum of 179,100 yen and the amount obtained by multiplying by 1% the amount obtained by deducting 597,000 yen from the amount of expenses required for that medical treatment, calculated for that medical treatment as provided by Order of the Ministry of Health, Labour and Welfare (or 597,000 yen, if that amount is less than 597,000 yen) (where that amount includes a fractional amount of less than 1 yen, the amount obtained by rounding down that fractional amount if it is less than 50 sen, or by rounding it up to 1 yen if it is 50 sen or more); provided, however, that in the case of repeated high-cost medical expenses, the amount is 93,000 yen.
前条第三項第三号に掲げる者に該当していることにつき厚生労働省令で定めるところにより保険者の認定を受けている者 十七万九千百円と、当該療養につき厚生労働省令で定めるところにより算定した当該療養に要した費用の額（その額が五十九万七千円に満たないときは、五十九万七千円）から五十九万七千円を控除した額に百分の一を乗じて得た額（この額に一円未満の端数がある場合において、その端数金額が五十銭未満であるときは、これを切り捨て、その端数金額が五十銭以上であるときは、これを一円に切り上げた額）との合算額。ただし、高額療養費多数回該当の場合にあっては、九万三千円とする。
a person who has received certification by the insurer, as provided by Order of the Ministry of Health, Labour and Welfare, as falling under a person listed in paragraph (3), item (iv) of the preceding Article: the total sum of 85,800 yen and the amount obtained by multiplying by 1% the amount obtained by deducting 286,000 yen from the amount of expenses required for that medical treatment, calculated for that medical treatment as provided by Order of the Ministry of Health, Labour and Welfare (or 286,000 yen, if that amount is less than 286,000 yen) (where that amount includes a fractional amount of less than 1 yen, the amount obtained by rounding down that fractional amount if it is less than 50 sen, or by rounding it up to 1 yen if it is 50 sen or more); provided, however, that in the case of repeated high-cost medical expenses, the amount is 44,400 yen.
前条第三項第四号に掲げる者に該当していることにつき厚生労働省令で定めるところにより保険者の認定を受けている者 八万五千八百円と、当該療養につき厚生労働省令で定めるところにより算定した当該療養に要した費用の額（その額が二十八万六千円に満たないときは、二十八万六千円）から二十八万六千円を控除した額に百分の一を乗じて得た額（この額に一円未満の端数がある場合において、その端数金額が五十銭未満であるときは、これを切り捨て、その端数金額が五十銭以上であるときは、これを一円に切り上げた額）との合算額。ただし、高額療養費多数回該当の場合にあっては、四万四千四百円とする。
a person who has received certification by the insurer, as provided by Order of the Ministry of Health, Labour and Welfare, as falling under a person listed in paragraph (3), item (v) of the preceding Article: 25,700 yen; provided, however, that in the case of repeated high-cost medical expenses, the amount is 24,600 yen.
前条第三項第五号に掲げる者に該当していることにつき厚生労働省令で定めるところにより保険者の認定を受けている者 二万五千七百円。ただし、高額療養費多数回該当の場合にあっては、二万四千六百円とする。
a person who has received certification by the insurer, as provided by Order of the Ministry of Health, Labour and Welfare, as falling under a person listed in paragraph (3), item (vi) of the preceding Article: 15,700 yen;
前条第三項第六号に掲げる者に該当していることにつき厚生労働省令で定めるところにより保険者の認定を受けている者 一万五千七百円
in the case where high-cost medical expenses are paid pursuant to Article 41, paragraph (4): the amount specified in each of (a) through (f) in accordance with the category of persons listed in (a) through (f) below:
第四十一条第四項の規定により高額療養費を支給する場合 次のイからヘまでに掲げる者の区分に応じ、それぞれイからヘまでに定める額
a person other than those listed in (b) through (f): 30,750 yen; provided, however, that in the case of repeated high-cost medical expenses, the amount is 22,200 yen.
ロからヘまでに掲げる者以外の者 三万七百五十円。ただし、高額療養費多数回該当の場合にあっては、二万二千二百円とする。
a person listed in paragraph (4), item (ii) of the preceding Article: the total sum of 135,150 yen and the amount obtained by multiplying by 1% the amount obtained by deducting 450,500 yen from the amount of expenses required for that medical treatment, calculated for that medical treatment as provided by Order of the Ministry of Health, Labour and Welfare (or 450,500 yen, if that amount is less than 450,500 yen) (where that amount includes a fractional amount of less than 1 yen, the amount obtained by rounding down that fractional amount if it is less than 50 sen, or by rounding it up to 1 yen if it is 50 sen or more); provided, however, that in the case of repeated high-cost medical expenses, the amount is 70,050 yen.
前条第四項第二号に掲げる者 十三万五千百五十円と、当該療養につき厚生労働省令で定めるところにより算定した当該療養に要した費用の額（その額が四十五万五百円に満たないときは、四十五万五百円）から四十五万五百円を控除した額に百分の一を乗じて得た額（この額に一円未満の端数がある場合において、その端数金額が五十銭未満であるときは、これを切り捨て、その端数金額が五十銭以上であるときは、これを一円に切り上げた額）との合算額。ただし、高額療養費多数回該当の場合にあっては、七万五十円とする。
a person who has received certification by the insurer, as provided by Order of the Ministry of Health, Labour and Welfare, as falling under a person listed in paragraph (4), item (iii) of the preceding Article: the total sum of 89,550 yen and the amount obtained by multiplying by 1% the amount obtained by deducting 298,500 yen from the amount of expenses required for that medical treatment, calculated for that medical treatment as provided by Order of the Ministry of Health, Labour and Welfare (or 298,500 yen, if that amount is less than 298,500 yen) (where that amount includes a fractional amount of less than 1 yen, the amount obtained by rounding down that fractional amount if it is less than 50 sen, or by rounding it up to 1 yen if it is 50 sen or more); provided, however, that in the case of repeated high-cost medical expenses, the amount is 46,500 yen.
前条第四項第三号に掲げる者に該当していることにつき厚生労働省令で定めるところにより保険者の認定を受けている者 八万九千五百五十円と、当該療養につき厚生労働省令で定めるところにより算定した当該療養に要した費用の額（その額が二十九万八千五百円に満たないときは、二十九万八千五百円）から二十九万八千五百円を控除した額に百分の一を乗じて得た額（この額に一円未満の端数がある場合において、その端数金額が五十銭未満であるときは、これを切り捨て、その端数金額が五十銭以上であるときは、これを一円に切り上げた額）との合算額。ただし、高額療養費多数回該当の場合にあっては、四万六千五百円とする。
a person who has received certification by the insurer, as provided by Order of the Ministry of Health, Labour and Welfare, as falling under a person listed in paragraph (4), item (iv) of the preceding Article: the total sum of 42,900 yen and the amount obtained by multiplying by 1% the amount obtained by deducting 143,000 yen from the amount of expenses required for that medical treatment, calculated for that medical treatment as provided by Order of the Ministry of Health, Labour and Welfare (or 143,000 yen, if that amount is less than 143,000 yen) (where that amount includes a fractional amount of less than 1 yen, the amount obtained by rounding down that fractional amount if it is less than 50 sen, or by rounding it up to 1 yen if it is 50 sen or more); provided, however, that in the case of repeated high-cost medical expenses, the amount is 22,200 yen.
前条第四項第四号に掲げる者に該当していることにつき厚生労働省令で定めるところにより保険者の認定を受けている者 四万二千九百円と、当該療養につき厚生労働省令で定めるところにより算定した当該療養に要した費用の額（その額が十四万三千円に満たないときは、十四万三千円）から十四万三千円を控除した額に百分の一を乗じて得た額（この額に一円未満の端数がある場合において、その端数金額が五十銭未満であるときは、これを切り捨て、その端数金額が五十銭以上であるときは、これを一円に切り上げた額）との合算額。ただし、高額療養費多数回該当の場合にあっては、二万二千二百円とする。
a person who has received certification by the insurer, as provided by Order of the Ministry of Health, Labour and Welfare, as falling under a person listed in paragraph (4), item (v) of the preceding Article: 12,850 yen; provided, however, that in the case of repeated high-cost medical expenses, the amount is 12,300 yen.
前条第四項第五号に掲げる者に該当していることにつき厚生労働省令で定めるところにより保険者の認定を受けている者 一万二千八百五十円。ただし、高額療養費多数回該当の場合にあっては、一万二千三百円とする。
a person who has received certification by the insurer, as provided by Order of the Ministry of Health, Labour and Welfare, as falling under a person listed in paragraph (4), item (vi) of the preceding Article: 7,850 yen;
前条第四項第六号に掲げる者に該当していることにつき厚生労働省令で定めるところにより保険者の認定を受けている者 七千八百五十円
in the case where high-cost medical expenses are paid pursuant to Article 41, paragraph (5): the amount specified in each of (a) through (c) in accordance with the category of persons listed in (a) through (c) below:
第四十一条第五項の規定により高額療養費を支給する場合 次のイからハまでに掲げる者の区分に応じ、それぞれイからハまでに定める額
a person who has received certification by the insurer, as provided by Order of the Ministry of Health, Labour and Welfare, as falling under a person listed in paragraph (5), item (ii) of the preceding Article: 11,000 yen;
前条第五項第二号に掲げる者に該当していることにつき厚生労働省令で定めるところにより保険者の認定を受けている者 一万千円
a person who has received certification by the insurer, as provided by Order of the Ministry of Health, Labour and Welfare, as falling under a person listed in paragraph (5), item (iii) of the preceding Article: 8,000 yen.
前条第五項第三号に掲げる者に該当していることにつき厚生労働省令で定めるところにより保険者の認定を受けている者 八千円
When the payment under the preceding paragraph has been made, it is deemed, to that extent, that high-cost medical expenses under Article 41, paragraph (1) and paragraphs (3) through (5) have been paid to the insured person.
前項の規定による支払があったときは、その限度において、被保険者に対し第四十一条第一項及び第三項から第五項までの規定による高額療養費の支給があったものとみなす。
The provisions of Article 110, paragraphs (4) through (6) of the Act apply mutatis mutandis to the payment of high-cost medical expenses under Article 41, paragraphs (1) through (5) for medical treatment for which dependent's medical expenses are paid (limited to payment within the limit of the amount obtained by deducting, from the amount borne for dependent's medical expenses (meaning, where Article 110, paragraph (4) or (6) of the Act applies to the payment of dependent's medical expenses, the amount obtained by deducting the amount of those dependent's medical expenses from the amount of expenses calculated for the medical treatment relating to the payment of those dependent's medical expenses), in the cases listed in the items of paragraph (1), the amount specified in each of those items in accordance with the category of those cases, and in the case where high-cost medical expenses are paid pursuant to Article 41, paragraph (2) where the person has received certification by the insurer, as provided by Order of the Ministry of Health, Labour and Welfare, as falling under any of the categories listed in the items of paragraph (2) of the preceding Article, the amount specified in each of those items in accordance with that category).
法第百十条第四項から第六項までの規定は、家族療養費に係る療養についての第四十一条第一項から第五項までの規定による高額療養費の支給（家族療養費負担額（家族療養費の支給につき法第百十条第四項又は第六項の規定の適用がある場合における当該家族療養費の支給に係る療養につき算定した費用の額から当該家族療養費の額を控除した額をいう。）から第一項各号に掲げる場合については当該場合の区分に応じ当該各号に定める額を、第四十一条第二項の規定により高額療養費を支給する場合であって前条第二項各号のいずれかに掲げる区分に該当していることにつき厚生労働省令で定めるところにより保険者の認定を受けているときについては当該区分に応じ当該各号に定める額を控除した額を限度とするものに限る。）について準用する。
The provisions of Article 88, paragraphs (6) and (7) of the Act apply mutatis mutandis to the payment of high-cost medical expenses under Article 41, paragraphs (1) through (5) for designated home nursing for which dependent's medical expenses for home-nursing are paid (limited to payment within the limit of the amount obtained by deducting, from the amount borne for dependent's medical expenses for home-nursing (meaning, where Article 88, paragraph (6) of the Act as applied mutatis mutandis pursuant to Article 111, paragraph (3) of the Act applies to the payment of dependent's medical expenses for home-nursing, the amount obtained by deducting the amount of those dependent's medical expenses for home-nursing from the amount of expenses calculated for the designated home nursing relating to the payment of those dependent's medical expenses for home-nursing), in the cases listed in the items of paragraph (1), the amount specified in each of those items in accordance with the category of those cases, and in the case where high-cost medical expenses are paid pursuant to Article 41, paragraph (2) where the person has received certification by the insurer, as provided by Order of the Ministry of Health, Labour and Welfare, as falling under any of the categories listed in the items of paragraph (2) of the preceding Article, the amount specified in each of those items in accordance with that category). In this case, the phrase "an insured person" in Article 88, paragraph (6) of the Act is deemed to be replaced with "a dependent".
法第八十八条第六項及び第七項の規定は、家族訪問看護療養費に係る指定訪問看護についての第四十一条第一項から第五項までの規定による高額療養費の支給（家族訪問看護療養費負担額（家族訪問看護療養費の支給につき法第百十一条第三項において準用する法第八十八条第六項の規定の適用がある場合における当該家族訪問看護療養費の支給に係る指定訪問看護につき算定した費用の額から当該家族訪問看護療養費の額を控除した額をいう。）から第一項各号に掲げる場合については当該場合の区分に応じ当該各号に定める額を、第四十一条第二項の規定により高額療養費を支給する場合であって前条第二項各号のいずれかに掲げる区分に該当していることにつき厚生労働省令で定めるところにより保険者の認定を受けているときについては当該区分に応じ当該各号に定める額を控除した額を限度とするものに限る。）について準用する。この場合において、法第八十八条第六項中「被保険者が」とあるのは、「被扶養者が」と読み替えるものとする。
If an insured person has received, from a medical institution providing services covered by health insurance, etc. or a designated home-nursing provider, medical treatment for which payment of general medical expenses for atomic bomb survivors or other benefits for medical care specified by Order of the Ministry of Health, Labour and Welfare are to be provided, if an insured person falling under Article 41, paragraph (8) has received from a medical institution providing services covered by health insurance, etc. or a designated home-nursing provider the medical treatment prescribed in that paragraph, or if an insured person who has received certification by the insurer under paragraph (9) of that Article has received from a medical institution providing services covered by health insurance, etc. or a designated home-nursing provider the medical treatment prescribed in that paragraph, and the co-payment payable pursuant to the provisions of the Act, the amount borne for medical expenses combined with treatment outside insurance coverage or the amount borne for medical expenses for home-nursing has not been paid, the insurer is to pay to that medical institution providing services covered by health insurance, etc. or designated home-nursing provider, from the expenses required for that medical treatment, an amount equivalent to the amount to be paid to the insured person as high-cost medical expenses under paragraphs (6) through (9) of that Article.
被保険者が保険医療機関等若しくは指定訪問看護事業者から原爆一般疾病医療費の支給その他厚生労働省令で定める医療に関する給付が行われるべき療養を受けた場合、第四十一条第八項の規定に該当する被保険者が保険医療機関等若しくは指定訪問看護事業者から同項に規定する療養を受けた場合又は同条第九項の規定による保険者の認定を受けた被保険者が保険医療機関等若しくは指定訪問看護事業者から同項に規定する療養を受けた場合において、法の規定により支払うべき一部負担金、保険外併用療養費負担額又は訪問看護療養費負担額の支払が行われなかったときは、保険者は、当該療養に要した費用のうち同条第六項から第九項までの規定による高額療養費として被保険者に支給すべき額に相当する額を当該保険医療機関等又は指定訪問看護事業者に支払うものとする。
When the payment under the preceding paragraph has been made, it is deemed that high-cost medical expenses under Article 41, paragraphs (6) through (9) have been paid to the insured person.
前項の規定による支払があったときは、被保険者に対し第四十一条第六項から第九項までの規定による高額療養費の支給があったものとみなす。
The provisions of Article 110, paragraphs (4) through (6) of the Act apply mutatis mutandis to the payment of high-cost medical expenses under Article 41, paragraphs (6) through (9) for medical treatment for which dependent's medical expenses are paid. In this case, the phrase "receives medical treatment" in Article 110, paragraphs (4) and (6) of the Act is deemed to be replaced with "receives medical treatment for which payment of general medical expenses for atomic bomb survivors under the Atomic Bomb Survivors' Assistance Act (Act No. 117 of 1994) or other benefits for medical care specified by Order of the Ministry of Health, Labour and Welfare are to be provided", and the phrase "for the medical treatment" in paragraph (4) of that Article and the phrase "for medical treatment" in paragraph (6) of that Article with "for that medical treatment".
法第百十条第四項から第六項までの規定は、家族療養費に係る療養についての第四十一条第六項から第九項までの規定による高額療養費の支給について準用する。この場合において、法第百十条第四項及び第六項中「療養を」とあるのは「原子爆弾被爆者に対する援護に関する法律（平成六年法律第百十七号）による一般疾病医療費の支給その他厚生労働省令で定める医療に関する給付が行われるべき療養を」と、「療養に」とあるのは「その療養に」と読み替えるものとする。
The provisions of Article 88, paragraphs (6) and (7) of the Act apply mutatis mutandis to the payment of high-cost medical expenses under Article 41, paragraphs (6) through (9) for designated home nursing for which dependent's medical expenses for home-nursing are paid. In this case, the phrase "an insured person" in Article 88, paragraph (6) of the Act is deemed to be replaced with "a dependent", and the phrase "has received designated home-nursing" in that paragraph with "has received designated home-nursing for which payment of general medical expenses for atomic bomb survivors under the Atomic Bomb Survivors' Assistance Act (Act No. 117 of 1994) or other benefits for medical care specified by Order of the Ministry of Health, Labour and Welfare are to be provided".
法第八十八条第六項及び第七項の規定は、家族訪問看護療養費に係る指定訪問看護についての第四十一条第六項から第九項までの規定による高額療養費の支給について準用する。この場合において、法第八十八条第六項中「被保険者が」とあるのは「被扶養者が」と、「指定訪問看護を」とあるのは「原子爆弾被爆者に対する援護に関する法律（平成六年法律第百十七号）による一般疾病医療費の支給その他厚生労働省令で定める医療に関する給付が行われるべき指定訪問看護を」と読み替えるものとする。
A medical institution providing services covered by health insurance that provides both dental care and medical care other than dental care is, for the purpose of applying the provisions of Articles 41 and 41-3, deemed to be separate medical institutions providing services covered by health insurance for dental care and for medical care other than dental care, respectively.
If an insured person or a dependent thereof has, in the same month, received from each single medical institution providing services covered by health insurance medical treatment including the medical treatment listed in Article 63, paragraph (1), item (v) of the Act and medical treatment other than that, then, for the purpose of applying the provisions of Articles 41 and 41-3, the medical treatment including the medical treatment listed in that item and the medical treatment other than that are deemed to have been received from separate medical institutions providing services covered by health insurance, respectively.
被保険者又はその被扶養者が同一の月にそれぞれ一の保険医療機関から法第六十三条第一項第五号に掲げる療養を含む療養及びそれ以外の療養を受けた場合は、第四十一条及び第四十一条の三の規定の適用については、当該同号に掲げる療養を含む療養及びそれ以外の療養は、それぞれ別個の保険医療機関から受けたものとみなす。
With regard to the payment of high-cost medical expenses under Article 41-2 in the case where an insured person loses status as an insured person during the calculation period and does not become a person covered by medical insurance (meaning a participant prescribed in Article 7, paragraph (4) of the Act on Assurance of Medical Care for Elderly People or an insured person of the late-stage elderly medical care system; the same applies in Article 43-4, paragraph (1) and Article 44, paragraphs (4) and (8)) during the calculation period on or after the day on which the person lost that eligibility, and in other cases specified by Order of the Ministry of Health, Labour and Welfare, the provisions of that Article and paragraph (10) of the preceding Article apply by deeming the day preceding that day (in a case specified by that Order, the day specified by Order of the Ministry of Health, Labour and Welfare) to be the reference date.
被保険者が計算期間において当該被保険者の資格を喪失し、かつ、当該資格を喪失した日以後の当該計算期間において医療保険加入者（高齢者の医療の確保に関する法律第七条第四項に規定する加入者又は後期高齢者医療の被保険者をいう。第四十三条の四第一項並びに第四十四条第四項及び第八項において同じ。）とならない場合その他厚生労働省令で定める場合における第四十一条の二の規定による高額療養費の支給については、当該日の前日（当該厚生労働省令で定める場合にあっては、厚生労働省令で定める日）を基準日とみなして、同条及び前条第十項の規定を適用する。
With regard to the payment of high-cost medical expenses under Article 41-3 in the case where an insured person (excluding the insured person on the reference date) loses status as an insured person during the calculation period, the provisions of that Article and paragraphs (11) and (12) of the preceding Article apply by deeming the day preceding the day on which the person lost that eligibility (if there are multiple days on which the person lost that eligibility during the calculation period, the latest of those days) to be the reference date.
Necessary matters concerning procedures for the payment of high-cost medical expenses are specified by Order of the Ministry of Health, Labour and Welfare.
高額療養費の支給に関する手続に関して必要な事項は、厚生労働省令で定める。
Article 43-2Requirements for Payment and Amount of Expenses for High-cost Medical Treatment Combined with Long-term Care
Expenses for high-cost medical treatment combined with long-term care are to be paid to the insured person on the reference date where the amount (hereinafter referred to as the "household total of co-payments, etc. combined with long-term care" in this paragraph) obtained by deducting the total payment for combined long-term care for persons aged 70 or over (meaning the amount obtained by deducting the base amount for the combined long-term care calculation for persons aged 70 or over under the following paragraph from the household total of co-payments, etc. combined with long-term care for persons aged 70 or over prescribed in that paragraph (or zero, where that amount is equal to or less than the payment threshold specified by the Minister of Health, Labour and Welfare in consideration of the costs required for administering the payment of expenses for high-cost medical treatment combined with long-term care (hereinafter referred to as the "payment threshold" in this Article) or where the proviso to that paragraph applies to the calculation of that household total of co-payments, etc. combined with long-term care for persons aged 70 or over)) from the total sum of the following amounts exceeds the amount obtained by adding the payment threshold to the base amount for the combined long-term care calculation, and the amount of those expenses is to be the amount obtained by multiplying the amount obtained by deducting the base amount for the combined long-term care calculation from the household total of co-payments, etc. combined with long-term care by the apportionment rate for the combined long-term care calculation (meaning the rate obtained by dividing the amount obtained by deducting the amount of expenses for high-cost medical treatment combined with long-term care to be paid under the provisions of the following paragraph from the amount listed in item (i), by the household total of co-payments, etc. combined with long-term care); provided, however, that this does not apply where the total sum of the amounts listed in that item through item (v) or the total sum of the amounts listed in items (vi) and (vii) is zero.
高額介護合算療養費は、次に掲げる額を合算した額から七十歳以上介護合算支給総額（次項に規定する七十歳以上介護合算一部負担金等世帯合算額から同項の七十歳以上介護合算算定基準額を控除した額（当該額が高額介護合算療養費の支給の事務の執行に要する費用を勘案して厚生労働大臣が定める支給基準額（以下この条において「支給基準額」という。）以下である場合又は当該七十歳以上介護合算一部負担金等世帯合算額の算定につき同項ただし書に該当する場合には、零とする。）をいう。）を控除した額（以下この項において「介護合算一部負担金等世帯合算額」という。）が介護合算算定基準額に支給基準額を加えた額を超える場合に基準日被保険者に支給するものとし、その額は、介護合算一部負担金等世帯合算額から介護合算算定基準額を控除した額に介護合算按分率（第一号に掲げる額から次項の規定により支給される高額介護合算療養費の額を控除した額を、介護合算一部負担金等世帯合算額で除して得た率をいう。）を乗じて得た額とする。ただし、同号から第五号までに掲げる額を合算した額又は第六号及び第七号に掲げる額を合算した額が零であるときは、この限りでない。
the total sum of the following amounts relating to medical treatment (including medical treatment under continued benefits) that the insured person on the reference date or a dependent thereof respectively received during the calculation period as an insured person of the relevant insurer or a dependent thereof (where high-cost medical expenses are paid pursuant to Article 41, paragraphs (1) through (5), Article 41-2 or Article 41-3, the amount after deducting the amount paid, and where money or goods to reduce the burden relating to the following amounts are provided as other benefits prescribed in Article 53 of the Act, the amount after deducting the amount equivalent to that money or those goods):
the total sum of the amounts listed in Article 41, paragraph (1), item (i), (a) through (f) relating to that medical treatment (excluding treatment subject to specified benefits) (for those relating to that medical treatment on or before the month that includes the day on which the person reaches the age of 70, limited to those of 21,000 yen or more for that medical treatment received from each single hospital, etc. in the same month (10,500 yen or more for those relating to medical treatment under the special rule on reaching age 75));
当該療養（特定給付対象療養を除く。）に係る第四十一条第一項第一号イからヘまでに掲げる額（七十歳に達する日の属する月以前の当該療養に係るものにあっては、同一の月にそれぞれ一の病院等から受けた当該療養について二万千円（七十五歳到達時特例対象療養に係るものにあっては、一万五百円）以上のものに限る。）を合算した額
the total sum of the amounts that the person who received that medical treatment (limited to treatment subject to specified benefits) still has to bear for that treatment (for those relating to treatment subject to specified benefits on or before the month that includes the day on which the person reaches the age of 70, limited to those for which the amounts listed in Article 41, paragraph (1), item (i), (a) through (f) relating to that treatment subject to specified benefits are 21,000 yen or more for that treatment subject to specified benefits received from each single hospital, etc. in the same month (10,500 yen or more for those relating to medical treatment under the special rule on reaching age 75));
当該療養（特定給付対象療養に限る。）について、当該療養を受けた者がなお負担すべき額（七十歳に達する日の属する月以前の特定給付対象療養に係るものにあっては、当該特定給付対象療養に係る第四十一条第一項第一号イからヘまでに掲げる額が同一の月にそれぞれ一の病院等から受けた当該特定給付対象療養について二万千円（七十五歳到達時特例対象療養に係るものにあっては、一万五百円）以上のものに限る。）を合算した額
the total sum prescribed in item (i) for medical treatment that the insured person on the reference date received while that person was an insured person of the insurer of another health insurance in the calculation period, or medical treatment that a person who was a dependent of that person received while being a dependent of that person;
the total sum prescribed in item (i) for medical treatment (including medical treatment under continued benefits) that the dependent on the reference date received while that person was an insured person of the relevant insurer in the calculation period, or medical treatment (including medical treatment under continued benefits) that a person who was a dependent of that person received while being a dependent of that person;
the total sum prescribed in item (i) for medical treatment that the dependent on the reference date received while that person was an insured person of the insurer of another health insurance in the calculation period, or medical treatment that a person who was a dependent of that person received while being a dependent of that person;
the amount calculated, as provided by Order of the Ministry of Health, Labour and Welfare, as an amount equivalent to the total sum prescribed in item (i) for medical treatment (excluding the medical treatment prescribed in the preceding items) that the member, etc. received while the insured person on the reference date or the dependent on the reference date was a member, etc. (meaning a member, etc. prescribed in Article 41-2, paragraph (9); the same applies hereinafter in this item and paragraph (5)) in the calculation period, or medical treatment that a person who was a dependent, etc. (meaning a dependent, etc. prescribed in paragraph (10) of that Article; the same applies hereinafter in this item and paragraph (5)) of that member, etc. received while being a dependent, etc. thereof;
the total sum of the amounts listed in Article 22-2-2, paragraph (2), items (i) and (ii) of the Order for Enforcement of the Long-Term Care Insurance Act (Cabinet Order No. 412 of 1998) relating to in-home services, etc. (meaning in-home services, etc. prescribed in paragraph (1) of that Article; the same applies in the following paragraph) that the insured person on the reference date or the dependent on the reference date received during the calculation period (where expenses for high-cost long-term care service are paid pursuant to the provisions of paragraph (2) of that Article, the amount after deducting the amount paid);
the total sum of the amounts listed in Article 22-2-2, paragraph (2), items (iii) and (iv) of the Order for Enforcement of the Long-Term Care Insurance Act relating to preventive long-term care services, etc. (meaning preventive long-term care services, etc. prescribed in paragraph (2) of that Article; the same applies in the following paragraph) that the insured person on the reference date or the dependent on the reference date received during the calculation period (where expenses for high-cost preventive long-term care service are paid pursuant to the provisions of Article 29-2-2, paragraph (2) of that Order, the amount after deducting the amount paid).
Where the total sum (hereinafter referred to as the "household total of co-payments, etc. combined with long-term care for persons aged 70 or over" in this paragraph) of the amounts calculated as provided by Order of the Ministry of Health, Labour and Welfare as amounts equivalent to those relating to medical treatment received on or after the month following the month that includes the day on which the person reaches the age of 70, or in-home services, etc. or preventive long-term care services, etc. (hereinafter referred to as "services subject to combination for persons aged 70 or over" in this paragraph and paragraph (6)), among the amounts listed in the items of the preceding paragraph, exceeds the amount obtained by adding the payment threshold to the base amount for the combined long-term care calculation for persons aged 70 or over, the amount obtained by multiplying the amount obtained by deducting the base amount for the combined long-term care calculation for persons aged 70 or over from the household total of co-payments, etc. combined with long-term care for persons aged 70 or over by the apportionment rate for the combined long-term care calculation for persons aged 70 or over (meaning the rate obtained by dividing the amount calculated as provided by Order of the Ministry of Health, Labour and Welfare as an amount equivalent to the amount listed in item (i) of the preceding paragraph relating to services subject to combination for persons aged 70 or over, by the household total of co-payments, etc. combined with long-term care for persons aged 70 or over) is paid to the insured person on the reference date as expenses for high-cost medical treatment combined with long-term care; provided, however, that this does not apply where the total sum of the amounts calculated as provided by Order of the Ministry of Health, Labour and Welfare as amounts equivalent to the amounts listed in items (i) through (v) of the preceding paragraph relating to services subject to combination for persons aged 70 or over, or the total sum of the amounts calculated as provided by Order of the Ministry of Health, Labour and Welfare as amounts equivalent to the amounts listed in items (vi) and (vii) of that paragraph relating to services subject to combination for persons aged 70 or over, is zero.
前項各号に掲げる額のうち、七十歳に達する日の属する月の翌月以後に受けた療養又は居宅サービス等若しくは介護予防サービス等（以下この項及び第六項において「七十歳以上合算対象サービス」という。）に係る額に相当する額として厚生労働省令で定めるところにより算定した額を合算した額（以下この項において「七十歳以上介護合算一部負担金等世帯合算額」という。）が七十歳以上介護合算算定基準額に支給基準額を加えた額を超える場合は、七十歳以上介護合算一部負担金等世帯合算額から七十歳以上介護合算算定基準額を控除した額に七十歳以上介護合算按分率（七十歳以上合算対象サービスに係る前項第一号に掲げる額に相当する額として厚生労働省令で定めるところにより算定した額を、七十歳以上介護合算一部負担金等世帯合算額で除して得た率をいう。）を乗じて得た額を高額介護合算療養費として基準日被保険者に支給する。ただし、七十歳以上合算対象サービスに係る前項第一号から第五号までに掲げる額に相当する額として厚生労働省令で定めるところにより算定した額を合算した額又は七十歳以上合算対象サービスに係る同項第六号及び第七号に掲げる額に相当する額として厚生労働省令で定めるところにより算定した額を合算した額が零であるときは、この限りでない。
The provisions of the preceding two paragraphs apply mutatis mutandis to the payment of expenses for high-cost medical treatment combined with long-term care to a person who was an insured person of the relevant insurer during the calculation period (limited to a dependent on the reference date). In this case, the phrase "listed in item (i)" in paragraph (1) is deemed to be replaced with "listed in item (iii)", the phrase "that item" in the proviso to that paragraph with "item (i)", and the phrase "item (i) of the preceding paragraph" in the preceding paragraph with "item (iii) of the preceding paragraph".
The provisions of paragraphs (1) and (2) apply mutatis mutandis to the payment of expenses for high-cost medical treatment combined with long-term care to a person who was an insured person of the relevant insurer during the calculation period (limited to a person who, on the reference date, is an insured person of the insurer of another health insurance or a dependent thereof). In this case, the phrase "the amount listed in item (i)" in paragraph (1) is deemed to be replaced with "the total sum prescribed in item (i) for medical treatment (including medical treatment under continued benefits) that the person prescribed in paragraph (4) received while that person was an insured person of the relevant insurer in the calculation period, or medical treatment (including medical treatment under continued benefits) that a person who was a dependent of that person received while being a dependent of that person", the phrase "the insured person on the reference date" in item (i) of that paragraph with "an insured person of the insurer of another health insurance (limited to a person who, on the reference date, is an insured person of the insurer of that other health insurance; hereinafter referred to as the "insured person on the reference date" in this paragraph and the following paragraph)", "of the relevant insurer" with "of the insurer of that other health insurance (hereinafter referred to as the "insurer on the reference date" in this paragraph)", the phrase "another health insurance" in item (ii) of that paragraph with "a health insurance other than that of the insurer on the reference date", the phrase "the dependent on the reference date" in item (iii) of that paragraph with "a dependent of the insured person on the reference date (limited to a person who, on the reference date, is a dependent of an insured person of the insurer on the reference date; hereinafter referred to as the "dependent on the reference date" in this paragraph)", "of the relevant insurer" with "of the insurer on the reference date", the phrase "another health insurance" in item (iv) of that paragraph with "a health insurance other than that of the insurer on the reference date", and the phrase "the amount listed in item (i) of the preceding paragraph relating to services subject to combination for persons aged 70 or over" in paragraph (2) with "the total sum prescribed in item (i) of the preceding paragraph for medical treatment (limited to medical treatment received on or after the month following the month that includes the day on which the person reaches the age of 70, and including medical treatment under continued benefits) that the person prescribed in paragraph (4) received while that person was an insured person of the relevant insurer in the calculation period, or medical treatment (limited to medical treatment received on or after the month following the month that includes the day on which the person reaches the age of 70, and including medical treatment under continued benefits) that a person who was a dependent of that person received while being a dependent of that person".
第一項及び第二項の規定は、計算期間において当該保険者の被保険者であった者（基準日において他の健康保険の保険者の被保険者又はその被扶養者である者に限る。）に対する高額介護合算療養費の支給について準用する。この場合において、第一項中「第一号に掲げる額」とあるのは「第四項に規定する者が計算期間における当該保険者の被保険者であった間に、当該者が受けた療養（継続給付に係る療養を含む。）又はその被扶養者であった者がその被扶養者であった間に受けた療養（継続給付に係る療養を含む。）に係る第一号に規定する合算額」と、同項第一号中「基準日被保険者」とあるのは「他の健康保険の保険者の被保険者（基準日において当該他の健康保険の保険者の被保険者である者に限る。以下この項及び次項において「基準日被保険者」という。）」と、「保険者の」とあるのは「他の健康保険の保険者（以下この項において「基準日保険者」という。）の」と、同項第二号中「他の」とあるのは「基準日保険者以外の」と、同項第三号中「基準日被扶養者」とあるのは「基準日被保険者の被扶養者（基準日において基準日保険者の被保険者の被扶養者である者に限る。以下この項において「基準日被扶養者」という。）」と、「保険者の」とあるのは「基準日保険者の」と、同項第四号中「他の」とあるのは「基準日保険者以外の」と、第二項中「七十歳以上合算対象サービスに係る前項第一号に掲げる額」とあるのは「第四項に規定する者が計算期間における当該保険者の被保険者であった間に、当該者が受けた療養（七十歳に達する日の属する月の翌月以後に受けた療養に限り、継続給付に係る療養を含む。）又はその被扶養者であった者がその被扶養者であった間に受けた療養（七十歳に達する日の属する月の翌月以後に受けた療養に限り、継続給付に係る療養を含む。）に係る前項第一号に規定する合算額」と読み替えるものとする。
Expenses for high-cost medical treatment combined with long-term care for a person who was an insured person of the relevant insurer during the calculation period (limited to a person who, on the reference date, is a member, etc. (excluding a householder, etc. under National Health Insurance who is an insured person or a dependent thereof, and an insured person of the late-stage elderly medical care system) or a dependent, etc.) are to be paid where the amount (hereinafter referred to as the "household total of co-payments, etc. combined with long-term care" in this paragraph) obtained by deducting the total payment for combined long-term care for persons aged 70 or over (meaning the amount obtained by deducting the base amount for the combined long-term care calculation for persons aged 70 or over under the following paragraph from the household total of co-payments, etc. combined with long-term care for persons aged 70 or over prescribed in that paragraph (or zero, where that amount is equal to or less than the payment threshold or where the proviso to that paragraph applies to the calculation of that household total of co-payments, etc. combined with long-term care for persons aged 70 or over)) from the total sum of the amounts equivalent to the amounts listed in the items of paragraph (1) (hereinafter referred to as the "aggregated burden amount" in this paragraph and the following paragraph), calculated as provided by Order of the Ministry of Health, Labour and Welfare by deeming that member, etc. to be the insured person on the reference date and that dependent, etc. to be the dependent on the reference date, exceeds the amount obtained by adding the payment threshold to the base amount for the combined long-term care calculation, and the amount of those expenses is to be the amount obtained by multiplying the amount obtained by deducting the base amount for the combined long-term care calculation from the household total of co-payments, etc. combined with long-term care by the apportionment rate for the combined long-term care calculation (meaning the rate obtained by dividing the amount obtained by deducting the amount of expenses for high-cost medical treatment combined with long-term care to be paid under the provisions of the following paragraph from the aggregated burden amount relating to medical treatment (including medical treatment under continued benefits) that the person prescribed in this paragraph received while that person was an insured person of the relevant insurer in the calculation period, or medical treatment (including medical treatment under continued benefits) that a person who was a dependent of that person received while being a dependent of that person, by the household total of co-payments, etc. combined with long-term care); provided, however, that this does not apply where the total sum of the aggregated burden amounts relating to paragraph (1), items (i) through (v), or the total sum of the aggregated burden amounts relating to items (vi) and (vii) of that paragraph, is zero.
計算期間において当該保険者の被保険者であった者（基準日において組合員等（国民健康保険の世帯主等であって被保険者又はその被扶養者である者及び後期高齢者医療の被保険者を除く。）である者又は被扶養者等である者に限る。）に対する高額介護合算療養費は、当該組合員等である者を基準日被保険者と、当該被扶養者等である者を基準日被扶養者とそれぞれみなして厚生労働省令で定めるところにより算定した第一項各号に掲げる額に相当する額（以下この項及び次項において「通算対象負担額」という。）を合算した額から七十歳以上介護合算支給総額（次項に規定する七十歳以上介護合算一部負担金等世帯合算額から同項の七十歳以上介護合算算定基準額を控除した額（当該額が支給基準額以下である場合又は当該七十歳以上介護合算一部負担金等世帯合算額の算定につき同項ただし書に該当する場合には、零とする。）をいう。）を控除した額（以下この項において「介護合算一部負担金等世帯合算額」という。）が介護合算算定基準額に支給基準額を加えた額を超える場合に支給するものとし、その額は、介護合算一部負担金等世帯合算額から介護合算算定基準額を控除した額に介護合算按分率（この項に規定する者が計算期間における当該保険者の被保険者であった間に、当該者が受けた療養（継続給付に係る療養を含む。）又はその被扶養者であった者がその被扶養者であった間に受けた療養（継続給付に係る療養を含む。）に係る通算対象負担額から次項の規定により支給される高額介護合算療養費の額を控除した額を、介護合算一部負担金等世帯合算額で除して得た率をいう。）を乗じて得た額とする。ただし、第一項第一号から第五号までに係る通算対象負担額を合算した額又は同項第六号及び第七号に係る通算対象負担額を合算した額が零であるときは、この限りでない。
Where the total sum (hereinafter referred to as the "household total of co-payments, etc. combined with long-term care for persons aged 70 or over" in this paragraph) of the amounts calculated as provided by Order of the Ministry of Health, Labour and Welfare (hereinafter referred to as the "aggregated burden amount for persons aged 70 or over" in this paragraph) as amounts equivalent to those relating to services subject to combination for persons aged 70 or over, among the aggregated burden amounts, exceeds the amount obtained by adding the payment threshold to the base amount for the combined long-term care calculation for persons aged 70 or over, the amount obtained by multiplying the amount obtained by deducting the base amount for the combined long-term care calculation for persons aged 70 or over from the household total of co-payments, etc. combined with long-term care for persons aged 70 or over by the apportionment rate for the combined long-term care calculation for persons aged 70 or over (meaning the rate obtained by dividing the aggregated burden amount for persons aged 70 or over relating to medical treatment (including medical treatment under continued benefits) that the person prescribed in the preceding paragraph received while that person was an insured person of the relevant insurer in the calculation period, or medical treatment (including medical treatment under continued benefits) that a person who was a dependent of that person received while being a dependent of that person, by the household total of co-payments, etc. combined with long-term care for persons aged 70 or over) is to be paid as expenses for high-cost medical treatment combined with long-term care to the person prescribed in that paragraph; provided, however, that this does not apply where the total sum of the aggregated burden amounts for persons aged 70 or over relating to paragraph (1), items (i) through (v), or the total sum of the aggregated burden amounts for persons aged 70 or over relating to items (vi) and (vii) of that paragraph, is zero.
通算対象負担額のうち、七十歳以上合算対象サービスに係る額に相当する額として厚生労働省令で定めるところにより算定した額（以下この項において「七十歳以上通算対象負担額」という。）を合算した額（以下この項において「七十歳以上介護合算一部負担金等世帯合算額」という。）が七十歳以上介護合算算定基準額に支給基準額を加えた額を超える場合は、七十歳以上介護合算一部負担金等世帯合算額から七十歳以上介護合算算定基準額を控除した額に七十歳以上介護合算按分率（前項に規定する者が計算期間における当該保険者の被保険者であった間に、当該者が受けた療養（継続給付に係る療養を含む。）又はその被扶養者であった者がその被扶養者であった間に受けた療養（継続給付に係る療養を含む。）に係る七十歳以上通算対象負担額を、七十歳以上介護合算一部負担金等世帯合算額で除して得た率をいう。）を乗じて得た額を高額介護合算療養費として同項に規定する者に支給する。ただし、第一項第一号から第五号までに係る七十歳以上通算対象負担額を合算した額又は同項第六号及び第七号に係る七十歳以上通算対象負担額を合算した額が零であるときは、この限りでない。
Expenses for high-cost medical treatment combined with long-term care for a person who was an insured person of the relevant insurer during the calculation period (limited to a person who, on the reference date, is an insured person of the late-stage elderly medical care system) are to be paid where the total sum (hereinafter referred to as the "household total of co-payments, etc. combined with long-term care" in this paragraph) of the amounts equivalent to the amounts listed in the items of paragraph (1), calculated as provided by Order of the Ministry of Health, Labour and Welfare by deeming that insured person of the late-stage elderly medical care system to be the insured person on the reference date (hereinafter referred to as the "aggregated burden amount" in this paragraph) exceeds the amount obtained by adding the payment threshold to the base amount for the combined long-term care calculation, and the amount of those expenses is to be the amount obtained by multiplying the amount obtained by deducting the base amount for the combined long-term care calculation from the household total of co-payments, etc. combined with long-term care by the apportionment rate for the combined long-term care calculation (meaning the rate obtained by dividing the aggregated burden amount relating to medical treatment (including medical treatment under continued benefits) that the person prescribed in this paragraph received while that person was an insured person of the relevant insurer in the calculation period, or medical treatment (including medical treatment under continued benefits) that a person who was a dependent of that person received while being a dependent of that person, by the household total of co-payments, etc. combined with long-term care); provided, however, that this does not apply where the total sum of the aggregated burden amounts relating to paragraph (1), items (i) through (v), or the total sum of the aggregated burden amounts relating to items (vi) and (vii) of that paragraph, is zero.
計算期間において当該保険者の被保険者であった者（基準日において後期高齢者医療の被保険者である者に限る。）に対する高額介護合算療養費は、当該後期高齢者医療の被保険者である者を基準日被保険者とみなして厚生労働省令で定めるところにより算定した第一項各号に掲げる額に相当する額（以下この項において「通算対象負担額」という。）を合算した額（以下この項において「介護合算一部負担金等世帯合算額」という。）が介護合算算定基準額に支給基準額を加えた額を超える場合に支給するものとし、その額は、介護合算一部負担金等世帯合算額から介護合算算定基準額を控除した額に介護合算按分率（この項に規定する者が計算期間における当該保険者の被保険者であった間に、当該者が受けた療養（継続給付に係る療養を含む。）又はその被扶養者であった者がその被扶養者であった間に受けた療養（継続給付に係る療養を含む。）に係る通算対象負担額を、介護合算一部負担金等世帯合算額で除して得た率をいう。）を乗じて得た額とする。ただし、第一項第一号から第五号までに係る通算対象負担額を合算した額又は同項第六号及び第七号に係る通算対象負担額を合算した額が零であるときは、この限りでない。
Article 43-3Base Amount for the Combined Long-Term Care Calculation
The base amount for the combined long-term care calculation under paragraph (1) of the preceding Article (excluding where applied mutatis mutandis pursuant to paragraphs (3) and (4) of that Article) is, in accordance with the category of persons listed in the following items, the amount specified in each of those items.
a person other than those listed in the following item through item (v): 670,000 yen;
次号から第五号までに掲げる者以外の者 六十七万円
an insured person whose standard monthly remuneration for the month that includes the reference date is 830,000 yen or more: 2,120,000 yen;
基準日の属する月の標準報酬月額が八十三万円以上の被保険者 二百十二万円
an insured person whose standard monthly remuneration for the month that includes the reference date is 530,000 yen or more and less than 830,000 yen: 1,410,000 yen;
基準日の属する月の標準報酬月額が五十三万円以上八十三万円未満の被保険者 百四十一万円
an insured person whose standard monthly remuneration for the month that includes the reference date is less than 280,000 yen (excluding a person listed in the following item): 600,000 yen;
an insured person who is a person exempt from municipal inhabitant tax (meaning a person on whom municipal inhabitant tax under the provisions of the Local Tax Act is not imposed for the previous fiscal year of the fiscal year that includes the reference date (or, where any day from August 1 of the previous year to March 31 is deemed to be the reference date pursuant to paragraph (1) of the following Article, the fiscal year that includes the day deemed to be the reference date) (including a person exempted from that municipal inhabitant tax as provided by a municipal ordinance, and excluding a person who has no domicile in the area in which that Act is in force on the assessment date of that municipal inhabitant tax); the same applies in item (v) of the following paragraph) (excluding persons listed in items (ii) and (iii)): 340,000 yen.
The base amount for the combined long-term care calculation for persons aged 70 or over under paragraph (2) of the preceding Article (excluding where applied mutatis mutandis pursuant to paragraphs (3) and (4) of that Article) is, in accordance with the category of persons listed in the following items, the amount specified in each of those items.
a person other than those listed in the following item through item (vi): 560,000 yen;
次号から第六号までに掲げる者以外の者 五十六万円
a person to whom item (iii) applies whose standard monthly remuneration for the month that includes the reference date is 830,000 yen or more: 2,120,000 yen;
a person to whom item (iii) applies whose standard monthly remuneration for the month that includes the reference date is 530,000 yen or more and less than 830,000 yen: 1,410,000 yen;
a person to whom item (iii) applies whose standard monthly remuneration for the month that includes the reference date is less than 530,000 yen: 670,000 yen;
an insured person who is a person exempt from municipal inhabitant tax (excluding a person listed in the preceding three items or the following item): 310,000 yen;
an insured person for whom neither the insured person nor any person who is a dependent of the insured person on the day specified by Order of the Ministry of Health, Labour and Welfare in the month that includes the reference date has any Income in Each Class prescribed in Article 2, paragraph (1), item (xxii) of the Income Tax Act relating to the total amount of income and forestry income prescribed in Article 313, paragraph (1) of the Local Tax Act, nor any amount of income calculated separately from other income, with respect to municipal inhabitant tax under the provisions of the Local Tax Act for the previous fiscal year of the fiscal year that includes the reference date (or, where any day from August 1 of the previous year to March 31 is deemed to be the reference date pursuant to paragraph (1) of the following Article, the fiscal year that includes the day deemed to be the reference date) (excluding persons listed in items (ii) through (iv)): 190,000 yen.
被保険者及び基準日の属する月における厚生労働省令で定める日においてその被扶養者である者の全てが基準日の属する年度の前年度（次条第一項の規定により前年八月一日から三月三十一日までのいずれかの日を基準日とみなした場合にあっては、当該基準日とみなした日の属する年度）分の地方税法の規定による市町村民税に係る同法第三百十三条第一項に規定する総所得金額及び山林所得金額に係る所得税法第二条第一項第二十二号に規定する各種所得の金額並びに他の所得と区分して計算される所得の金額がない被保険者（第二号から第四号までに掲げる者を除く。） 十九万円
The provisions of paragraph (1) apply mutatis mutandis to the base amount for the combined long-term care calculation under paragraph (1) of the preceding Article as applied mutatis mutandis pursuant to paragraph (3) of that Article, and the provisions of the preceding paragraph apply mutatis mutandis to the base amount for the combined long-term care calculation for persons aged 70 or over under paragraph (2) of that Article as applied mutatis mutandis pursuant to paragraph (3) of that Article, respectively. In this case, the phrase "paragraph (1) of the preceding Article (excluding where applied mutatis mutandis pursuant to paragraphs (3) and (4) of that Article)" in paragraph (1) is deemed to be replaced with "paragraph (1) of the preceding Article as applied mutatis mutandis pursuant to paragraph (3) of that Article", the phrase "persons listed in the following items" with "insured persons listed in the following items who, on the reference date, support the person prescribed in paragraph (3) of that Article", the phrase "paragraph (2) of the preceding Article (excluding where applied mutatis mutandis pursuant to paragraphs (3) and (4) of that Article)" in the preceding paragraph with "paragraph (2) of the preceding Article as applied mutatis mutandis pursuant to paragraph (3) of that Article", and the phrase "persons listed in the following items" with "insured persons listed in the following items who, on the reference date, support the person prescribed in paragraph (3) of that Article".
第一項の規定は前条第三項において準用する同条第一項の介護合算算定基準額について、前項の規定は同条第三項において準用する同条第二項の七十歳以上介護合算算定基準額について、それぞれ準用する。この場合において、第一項中「前条第一項（同条第三項及び第四項において準用する場合を除く。）」とあるのは「前条第三項において準用する同条第一項」と、「次の各号に掲げる者」とあるのは「同条第三項に規定する者について基準日において当該者を扶養する次の各号に掲げる被保険者」と、前項中「前条第二項（同条第三項及び第四項において準用する場合を除く。）」とあるのは「前条第三項において準用する同条第二項」と、「次の各号に掲げる者」とあるのは「同条第三項に規定する者について基準日において当該者を扶養する次の各号に掲げる被保険者」と読み替えるものとする。
The provisions of paragraph (1) apply mutatis mutandis to the base amount for the combined long-term care calculation under paragraph (1) of the preceding Article as applied mutatis mutandis pursuant to paragraph (4) of that Article, and the provisions of paragraph (2) apply mutatis mutandis to the base amount for the combined long-term care calculation for persons aged 70 or over under paragraph (2) of that Article as applied mutatis mutandis pursuant to paragraph (4) of that Article, respectively. In this case, the phrase "paragraph (1) of the preceding Article (excluding where applied mutatis mutandis pursuant to paragraphs (3) and (4) of that Article)" in paragraph (1) is deemed to be replaced with "paragraph (1) of the preceding Article as applied mutatis mutandis pursuant to paragraph (4) of that Article", the phrase "in accordance with the category of persons listed in the following items" with "for the person prescribed in paragraph (4) of that Article, where the person is, on the reference date, an insured person of the insurer of another health insurance, in accordance with the category of that person listed in the following items, and where the person is, on the reference date, a dependent of an insured person of the insurer of another health insurance, in accordance with the category of that insured person listed in the following items", the phrase "each of those items" with "each of those items, respectively", the phrase "paragraph (2) of the preceding Article (excluding where applied mutatis mutandis pursuant to paragraphs (3) and (4) of that Article)" in paragraph (2) with "paragraph (2) of the preceding Article as applied mutatis mutandis pursuant to paragraph (4) of that Article", the phrase "in accordance with the category of persons listed in the following items" with "for the person prescribed in paragraph (4) of that Article, where the person is, on the reference date, an insured person of the insurer of another health insurance, in accordance with the category of that person listed in the following items, and where the person is, on the reference date, a dependent of an insured person of the insurer of another health insurance, in accordance with the category of that insured person listed in the following items", and the phrase "each of those items" with "each of those items, respectively".
第一項の規定は前条第四項において準用する同条第一項の介護合算算定基準額について、第二項の規定は同条第四項において準用する同条第二項の七十歳以上介護合算算定基準額について、それぞれ準用する。この場合において、第一項中「前条第一項（同条第三項及び第四項において準用する場合を除く。）」とあるのは「前条第四項において準用する同条第一項」と、「次の各号に掲げる者」とあるのは「同条第四項に規定する者であって、基準日において他の健康保険の保険者の被保険者である者にあっては次の各号に掲げる当該者の区分に応じ、基準日において他の健康保険の保険者の被保険者の被扶養者である者にあっては次の各号に掲げる当該被保険者」と、「当該各号」とあるのは「それぞれ当該各号」と、第二項中「前条第二項（同条第三項及び第四項において準用する場合を除く。）」とあるのは「前条第四項において準用する同条第二項」と、「次の各号に掲げる者」とあるのは「同条第四項に規定する者であって、基準日において他の健康保険の保険者の被保険者である者にあっては次の各号に掲げる当該者の区分に応じ、基準日において他の健康保険の保険者の被保険者の被扶養者である者にあっては次の各号に掲げる当該被保険者」と、「当該各号」とあるのは「それぞれ当該各号」と読み替えるものとする。
For the base amount for the combined long-term care calculation under paragraph (5) of the preceding Article, the provisions listed in the middle column of the following table apply mutatis mutandis, in accordance with the category of persons listed in the left-hand column of the table, and for the base amount for the combined long-term care calculation for persons aged 70 or over under paragraph (6) of that Article, the provisions listed in the right-hand column of the table apply mutatis mutandis, in accordance with the category of persons listed in the left-hand column of the table. In this case, the necessary technical replacement of terms is specified by Order of the Ministry of Health, Labour and Welfare.
| a person who is, on the reference date, a specially-insured day laborer or a dependent thereof | Article 43-3, paragraph (1) as applied mutatis mutandis pursuant to Article 44, paragraph (6) (including where applied mutatis mutandis pursuant to Article 43-3, paragraph (3) as applied mutatis mutandis pursuant to Article 44, paragraph (6)) and Article 44, paragraph (8) | Article 43-3, paragraph (2) as applied mutatis mutandis pursuant to Article 44, paragraph (6) (including where applied mutatis mutandis pursuant to Article 43-3, paragraph (3) as applied mutatis mutandis pursuant to Article 44, paragraph (6)) and Article 44, paragraph (8) |
| a person who is, on the reference date, an insured person of Mariners Insurance (excluding a member of a mutual aid association under the National Public Officers Mutual Aid Association Act or the Local Public Officers, etc. Mutual Aid Association Act) or a dependent thereof | Article 12, paragraph (1) (including where applied mutatis mutandis pursuant to paragraph (3) of that Article) and Article 13, paragraph (1) of the Order for Enforcement of the Mariners Insurance Act (Cabinet Order No. 240 of 1953) | Article 12, paragraph (2) (including where applied mutatis mutandis pursuant to paragraph (3) of that Article) and Article 13, paragraph (1) of the Order for Enforcement of the Mariners Insurance Act |
| a person who is, on the reference date, a member of a mutual aid association under the provisions of the National Public Officers Mutual Aid Association Act (excluding SDF personnel, etc. prescribed in Article 17-3, paragraph (1) of the Order for Enforcement of the Act on Remuneration, etc. of Ministry of Defense Personnel (Cabinet Order No. 368 of 1952) (hereinafter referred to as "SDF personnel, etc." in this table)) or a dependent thereof (including a dependent of SDF personnel, etc.) | Article 11-3-6-3, paragraph (1) (including where applied mutatis mutandis pursuant to paragraph (3) of that Article) and Article 11-3-6-4, paragraph (1) of the Order for Enforcement of the National Public Officers Mutual Aid Association Act (Cabinet Order No. 207 of 1958) | Article 11-3-6-3, paragraph (2) (including where applied mutatis mutandis pursuant to paragraph (3) of that Article) and Article 11-3-6-4, paragraph (1) of the Order for Enforcement of the National Public Officers Mutual Aid Association Act |
| a person who is SDF personnel, etc. on the reference date | Article 17-6-5, paragraph (1) and Article 17-6-6, paragraph (1) of the Order for Enforcement of the Act on Remuneration, etc. of Ministry of Defense Personnel | Article 11-3-6-3, paragraph (2) and Article 11-3-6-4, paragraph (1) of the Order for Enforcement of the National Public Officers Mutual Aid Association Act |
| a person who is, on the reference date, a member of a mutual aid association under the provisions of the Local Public Officers, etc. Mutual Aid Association Act or a dependent thereof | Article 23-3-7, paragraph (1) (including where applied mutatis mutandis pursuant to paragraph (3) of that Article) and Article 23-3-8, paragraph (1) of the Order for Enforcement of the Local Public Officers, etc. Mutual Aid Association Act (Cabinet Order No. 352 of 1962) | Article 23-3-7, paragraph (2) (including where applied mutatis mutandis pursuant to paragraph (3) of that Article) and Article 23-3-8, paragraph (1) of the Order for Enforcement of the Local Public Officers, etc. Mutual Aid Association Act |
| a person who is, on the reference date, a subscriber to the Private School Personnel Mutual Aid System under the provisions of the Private School Personnel Mutual Aid Association Act or a dependent thereof | Article 11-3-6-3, paragraph (1) (including where applied mutatis mutandis pursuant to Article 11-3-6-3, paragraph (3) of the Order for Enforcement of the National Public Officers Mutual Aid Association Act as applied mutatis mutandis pursuant to Article 6 of the Order for Enforcement of the Private School Personnel Mutual Aid Association Act (Cabinet Order No. 425 of 1953)) and Article 11-3-6-4, paragraph (1) of the Order for Enforcement of the National Public Officers Mutual Aid Association Act as applied mutatis mutandis pursuant to Article 6 of the Order for Enforcement of the Private School Personnel Mutual Aid Association Act | Article 11-3-6-3, paragraph (2) (including where applied mutatis mutandis pursuant to Article 11-3-6-3, paragraph (3) of the Order for Enforcement of the National Public Officers Mutual Aid Association Act as applied mutatis mutandis pursuant to Article 6 of the Order for Enforcement of the Private School Personnel Mutual Aid Association Act) and Article 11-3-6-4, paragraph (1) of the Order for Enforcement of the National Public Officers Mutual Aid Association Act as applied mutatis mutandis pursuant to Article 6 of the Order for Enforcement of the Private School Personnel Mutual Aid Association Act |
| a person who is, on the reference date, a householder, etc. under National Health Insurance, or an insured person of National Health Insurance, other than that householder, etc. under National Health Insurance, who belongs to the same household as that householder, etc. under National Health Insurance | Article 29-4-3, paragraph (1) and Article 29-4-4, paragraphs (1) and (2) of the Order for Enforcement of the National Health Insurance Act (Cabinet Order No. 362 of 1958) | Article 29-4-3, paragraph (3) and Article 29-4-4, paragraphs (1) and (2) of the Order for Enforcement of the National Health Insurance Act |
前条第五項の介護合算算定基準額については、次の表の上欄に掲げる者の区分に応じ、それぞれ同表の中欄に掲げる規定を、同条第六項の七十歳以上介護合算算定基準額については、同表の上欄に掲げる者の区分に応じ、それぞれ同表の下欄に掲げる規定を準用する。この場合において、必要な技術的読替えは、厚生労働省令で定める。
| 基準日において日雇特例被保険者である者又はその被扶養者である者 | 第四十四条第六項において準用する第四十三条の三第一項（第四十四条第六項において準用する第四十三条の三第三項において準用する場合を含む。）及び第四十四条第八項 | 第四十四条第六項において準用する第四十三条の三第二項（第四十四条第六項において準用する第四十三条の三第三項において準用する場合を含む。）及び第四十四条第八項 |
| 基準日において船員保険の被保険者（国家公務員共済組合法及び地方公務員等共済組合法に基づく共済組合の組合員を除く。）である者又はその被扶養者である者 | 船員保険法施行令（昭和二十八年政令第二百四十号）第十二条第一項（同条第三項において準用する場合を含む。）及び第十三条第一項 | 船員保険法施行令第十二条第二項（同条第三項において準用する場合を含む。）及び第十三条第一項 |
| 基準日において国家公務員共済組合法の規定に基づく共済組合の組合員（防衛省の職員の給与等に関する法律施行令（昭和二十七年政令第三百六十八号）第十七条の三第一項に規定する自衛官等（以下この表において「自衛官等」という。）を除く。）である者又はその被扶養者（自衛官等の被扶養者を含む。）である者 | 国家公務員共済組合法施行令（昭和三十三年政令第二百七号）第十一条の三の六の三第一項（同条第三項において準用する場合を含む。）及び第十一条の三の六の四第一項 | 国家公務員共済組合法施行令第十一条の三の六の三第二項（同条第三項において準用する場合を含む。）及び第十一条の三の六の四第一項 |
| 基準日において自衛官等である者 | 防衛省の職員の給与等に関する法律施行令第十七条の六の五第一項及び第十七条の六の六第一項 | 国家公務員共済組合法施行令第十一条の三の六の三第二項及び第十一条の三の六の四第一項 |
| 基準日において地方公務員等共済組合法の規定に基づく共済組合の組合員である者又はその被扶養者である者 | 地方公務員等共済組合法施行令（昭和三十七年政令第三百五十二号）第二十三条の三の七第一項（同条第三項において準用する場合を含む。）及び第二十三条の三の八第一項 | 地方公務員等共済組合法施行令第二十三条の三の七第二項（同条第三項において準用する場合を含む。）及び第二十三条の三の八第一項 |
| 基準日において私立学校教職員共済法の規定による私立学校教職員共済制度の加入者である者又はその被扶養者である者 | 私立学校教職員共済法施行令（昭和二十八年政令第四百二十五号）第六条において準用する国家公務員共済組合法施行令第十一条の三の六の三第一項（私立学校教職員共済法施行令第六条において準用する国家公務員共済組合法施行令第十一条の三の六の三第三項において準用する場合を含む。）及び第十一条の三の六の四第一項 | 私立学校教職員共済法施行令第六条において準用する国家公務員共済組合法施行令第十一条の三の六の三第二項（私立学校教職員共済法施行令第六条において準用する国家公務員共済組合法施行令第十一条の三の六の三第三項において準用する場合を含む。）及び第十一条の三の六の四第一項 |
| 基準日において国民健康保険の世帯主等である者又は当該国民健康保険の世帯主等と同一の世帯に属する当該国民健康保険の世帯主等以外の国民健康保険の被保険者である者 | 国民健康保険法施行令（昭和三十三年政令第三百六十二号）第二十九条の四の三第一項並びに第二十九条の四の四第一項及び第二項 | 国民健康保険法施行令第二十九条の四の三第三項並びに第二十九条の四の四第一項及び第二項 |
For the base amount for the combined long-term care calculation under paragraph (7) of the preceding Article, the provisions of Article 16-3, paragraph (1) and Article 16-4, paragraph (1) of the Order for Enforcement of the Act on Assurance of Medical Care for Elderly People (Cabinet Order No. 318 of 2007) apply mutatis mutandis. In this case, the necessary technical replacement of terms is specified by Order of the Ministry of Health, Labour and Welfare.
前条第七項の介護合算算定基準額については、高齢者の医療の確保に関する法律施行令（平成十九年政令第三百十八号）第十六条の三第一項及び第十六条の四第一項の規定を準用する。この場合において、必要な技術的読替えは、厚生労働省令で定める。
第四十三条の四（その他高額介護合算療養費の支給に関する事項）
Article 43-4Other Matters Concerning the Payment of Expenses for High-Cost Medical Treatment Combined with Long-Term Care
With regard to the payment of expenses for high-cost medical treatment combined with long-term care in the case where an insured person loses status as an insured person during the calculation period and does not become a person covered by medical insurance during that calculation period on or after the day on which the person lost that eligibility, or in any other case specified by Order of the Ministry of Health, Labour and Welfare, the provisions of the preceding two Articles apply by deeming the day before that day (or, in the case of that other case specified by Order of the Ministry of Health, Labour and Welfare, the day specified by Order of the Ministry of Health, Labour and Welfare) to be the reference date.
Matters necessary for procedures concerning the payment of expenses for high-cost medical treatment combined with long-term care are specified by Order of the Ministry of Health, Labour and Welfare.
高額介護合算療養費の支給に関する手続に関して必要な事項は、厚生労働省令で定める。
Article 44Mutatis Mutandis Application
The provisions of Article 41, Article 42 (excluding the parts relating to paragraph (1), items (ii) through (iv), paragraph (2), items (ii) through (iv), paragraph (3), items (ii) through (iv), paragraph (4), items (ii) through (iv), paragraph (7), item (i), (b) through (d) and item (ii), (b) through (d), paragraph (9), item (ii), and paragraphs (10) through (12)) and Article 43 (excluding the parts relating to paragraph (1), item (i), (b) through (d), item (ii), (b) through (d) and item (iii), (b) through (d)) apply mutatis mutandis to the payment of high-cost medical expenses for specially-insured day laborers.
第四十一条、第四十二条（第一項第二号から第四号まで、第二項第二号から第四号まで、第三項第二号から第四号まで、第四項第二号から第四号まで、第七項第一号ロからニまで及び第二号ロからニまで、第九項第二号並びに第十項から第十二項までに係る部分を除く。）及び第四十三条（第一項第一号ロからニまで、第二号ロからニまで及び第三号ロからニまでに係る部分を除く。）の規定は、日雇特例被保険者に係る高額療養費の支給について準用する。
The provisions of Article 41-2, paragraph (1) (excluding the parts relating to items (ii), (iv), (viii), (x), (xiv) and (xvi)), paragraph (2) of that Article (excluding the parts relating to items (ii), (iv), (viii), (x), (xiv) and (xvi) of paragraph (1)), paragraphs (8) through (10) of that Article, Article 41-3, Article 42, paragraph (10), paragraph (11) of that Article (excluding the parts relating to items (ii) and (iii)) and paragraph (12) of that Article (excluding the parts relating to items (ii) and (iii)) apply mutatis mutandis to the payment of high-cost medical expenses for persons who are, on the reference date, specially-insured day laborers and persons who are dependents thereof.
The provisions of Article 41-2, paragraphs (5) through (10) and Article 42, paragraph (10) apply mutatis mutandis to the payment of high-cost medical expenses for persons who were specially-insured day laborers and persons who were dependents thereof during the calculation period (limited to persons who, on the reference date, are persons listed in Article 7, paragraph (4), items (i) through (v) of the Act on Assurance of Medical Care for Elderly People or insured persons of the late-stage elderly medical care system).
第四十一条の二第五項から第十項まで及び第四十二条第十項の規定は、計算期間において日雇特例被保険者であった者及びその被扶養者であった者（基準日において高齢者の医療の確保に関する法律第七条第四項第一号から第五号までに掲げる者又は後期高齢者医療の被保険者である者に限る。）に係る高額療養費の支給について準用する。
With regard to the payment of high-cost medical expenses under Article 41-2 in the case where a specially-insured day laborer, during the calculation period, is approved under the proviso to Article 3, paragraph (2) of the Act or returns the specially-insured day laborer's insurance book pursuant to Article 126, paragraph (3) of the Act, and does not become a person covered by medical insurance in the calculation period on or after the day on which the person received that approval or returned that insurance book, and in other cases specified by Order of the Ministry of Health, Labour and Welfare, the provisions of the preceding two paragraphs and the provisions applied mutatis mutandis therein apply by deeming the day preceding the day on which the person received that approval or the day preceding the day on which the person returned that insurance book (in a case specified by that Order, the day specified by Order of the Ministry of Health, Labour and Welfare) to be the reference date.
With regard to the payment of high-cost medical expenses under Article 41-3 in the case where a specially-insured day laborer (excluding a person who is a specially-insured day laborer on the reference date) is approved under the proviso to Article 3, paragraph (2) of the Act or returns the specially-insured day laborer's insurance book pursuant to Article 126, paragraph (3) of the Act during the calculation period, the provisions of paragraph (2) and the provisions applied mutatis mutandis therein apply by deeming the day preceding the day on which the person received that approval or returned that insurance book (if there are multiple days on which the person received that approval or returned that insurance book in the calculation period, the latest of those days) to be the reference date.
The provisions of Article 43-2, paragraphs (1) through (3) (excluding the portions relating to paragraph (1), items (ii) and (iv)), Article 43-3, paragraphs (1) through (3) (excluding the portions relating to paragraph (1), items (ii) through (iv) and paragraph (2), items (ii) through (iv)) and paragraph (2) of the preceding Article apply mutatis mutandis to the payment of expenses for high-cost medical treatment combined with long-term care to a person who is a specially-insured day laborer on the reference date and a person who is a dependent thereof.
第四十三条の二第一項から第三項まで（第一項第二号及び第四号に係る部分を除く。）、第四十三条の三第一項から第三項まで（第一項第二号から第四号まで及び第二項第二号から第四号までに係る部分を除く。）及び前条第二項の規定は、基準日において日雇特例被保険者である者及びその被扶養者である者に係る高額介護合算療養費の支給について準用する。
The provisions of Article 43-2, paragraphs (5) through (7), Article 43-3, paragraphs (5) and (6) and paragraph (2) of the preceding Article apply mutatis mutandis to the payment of expenses for high-cost medical treatment combined with long-term care to a person who was a specially-insured day laborer and a person who was a dependent thereof during the calculation period (limited to a person who, on the reference date, is a person listed in Article 7, paragraph (4), items (i) through (v) of the Act on Assurance of Medical Care for Elderly People or an insured person of the late-stage elderly medical care system).
第四十三条の二第五項から第七項まで、第四十三条の三第五項及び第六項並びに前条第二項の規定は、計算期間において日雇特例被保険者であった者及びその被扶養者であった者（基準日において高齢者の医療の確保に関する法律第七条第四項第一号から第五号までに掲げる者又は後期高齢者医療の被保険者である者に限る。）に係る高額介護合算療養費の支給について準用する。
With regard to the payment of expenses for high-cost medical treatment combined with long-term care in the case where a specially-insured day laborer, during the calculation period, is approved under the proviso to Article 3, paragraph (2) of the Act or returns the specially-insured day laborer's insurance book pursuant to Article 126, paragraph (3) of the Act, and does not become a person covered by medical insurance in the calculation period on or after the day on which the person received that approval or returned that insurance book, and in other cases specified by Order of the Ministry of Health, Labour and Welfare, the provisions of the preceding two paragraphs and the provisions applied mutatis mutandis therein apply by deeming the day preceding the day on which the person received that approval or the day preceding the day on which the person returned that insurance book (in a case specified by that Order, the day specified by Order of the Ministry of Health, Labour and Welfare) to be the reference date.
第六章 手数料
Chapter VI Fees
Article 44-2Amount of Fees, etc.
The amount of the fee to be paid by a user of anonymized medical care-related information (meaning a user of anonymized medical care-related information prescribed in Article 150-3 of the Act; the same applies in paragraphs (2) and (3) of the following Article) pursuant to Article 150-10, paragraph (1) of the Act is 4,350 yen for each period of up to one hour of time required for the provision of anonymized medical care-related information (meaning anonymized medical care-related information prescribed in Article 150-2, paragraph (1) of the Act; the same applies in paragraph (3) of the following Article).
法第百五十条の十第一項の規定により匿名診療等関連情報利用者（法第百五十条の三に規定する匿名診療等関連情報利用者をいう。次条第二項及び第三項において同じ。）が納付すべき手数料の額は、匿名診療等関連情報（法第百五十条の二第一項に規定する匿名診療等関連情報をいう。次条第三項において同じ。）の提供に要する時間一時間までごとに四千三百五十円とする。
The fee referred to in the preceding paragraph must be paid by affixing revenue stamps to a document specified by Order of the Ministry of Health, Labour and Welfare; provided, however, that this does not apply where the fee is paid to an Infrastructure Organization, etc. (meaning an Infrastructure Organization, etc. prescribed in Article 150-9 of the Act; the same applies in paragraph (3) of the following Article) pursuant to Article 150-10, paragraph (1) of the Act.
前項の手数料は、厚生労働省令で定める書面に収入印紙を貼って納付しなければならない。ただし、法第百五十条の十第一項の規定により基盤機構等（法第百五十条の九に規定する基盤機構等をいう。次条第三項において同じ。）に対し手数料を納付する場合は、この限りでない。
Article 44-3Exemption from Fees
The persons specified by Cabinet Order referred to in Article 150-10, paragraph (2) of the Act are as follows:
法第百五十条の十第二項の政令で定める者は、次のとおりとする。
a prefecture or any other person listed in Article 150-2, paragraph (1), item (i) of the Act;
都道府県その他の法第百五十条の二第一項第一号に掲げる者
among the persons listed in Article 150-2, paragraph (1), item (ii) or (iii) of the Act, a person who carries out the business specified in item (ii) or (iii) of that paragraph, respectively (limited to a business conducted using subsidies, etc. prescribed in Article 2, paragraph (1) of the Act on Regulation of Execution of Budget Pertaining to Subsidies, etc. (Act No. 179 of 1955), subsidies paid by a local government pursuant to Article 232-2 of the Local Autonomy Act (Act No. 67 of 1947) (including as applied pursuant to Article 283, paragraph (1) of that Act), or grants disbursed by the Japan Agency for Medical Research and Development, National Research and Development Agency as the business listed in Article 16, item (iii) of the Act on the Japan Agency for Medical Research and Development, National Research and Development Agency (Act No. 49 of 2014));
法第百五十条の二第一項第二号又は第三号に掲げる者のうち、それぞれ同項第二号又は第三号に定める業務（補助金等に係る予算の執行の適正化に関する法律（昭和三十年法律第百七十九号）第二条第一項に規定する補助金等、地方自治法（昭和二十二年法律第六十七号）第二百三十二条の二（同法第二百八十三条第一項の規定により適用する場合を含む。）の規定により地方公共団体が支出する補助金又は国立研究開発法人日本医療研究開発機構法（平成二十六年法律第四十九号）第十六条第三号に掲げる業務として国立研究開発法人日本医療研究開発機構が交付する助成金を充てて行うものに限る。）を行う者
among the persons listed in Article 150-2, paragraph (1), item (ii) or (iii) of the Act, a person who has been entrusted by a person listed in item (i) with the business specified in item (i) of that paragraph (including entrustment through two or more stages; the same applies hereinafter in this item), or a person who has been entrusted by a person listed in the preceding item with the business prescribed in that item;
an organization composed solely of persons listed in the preceding three items.
前三号に掲げる者のみにより構成されている団体
If a user of anonymized medical care-related information is any of the persons listed in the items of the preceding paragraph, the Minister of Health, Labour and Welfare exempts that user from the fee under Article 150-10, paragraph (1) of the Act.
厚生労働大臣は、匿名診療等関連情報利用者が前項各号に掲げる者のいずれかである場合には、法第百五十条の十第一項の手数料を免除する。
A user of anonymized medical care-related information who seeks exemption from the fee under the preceding paragraph must submit a document stating that the user requests the exemption and the reasons therefor to the Minister of Health, Labour and Welfare (or, where, pursuant to Article 150-9 of the Act, an Infrastructure Organization, etc. entrusted by the Minister of Health, Labour and Welfare performs the whole of the affairs relating to the provision of anonymized medical care-related information under Article 150-2, paragraph (1) of the Act, the Infrastructure Organization, etc.).
前項の規定による手数料の免除を受けようとする匿名診療等関連情報利用者は、当該免除を求める旨及びその理由を記載した書面を厚生労働大臣（法第百五十条の九の規定により厚生労働大臣からの委託を受けて、基盤機構等が法第百五十条の二第一項の規定による匿名診療等関連情報の提供に係る事務の全部を行う場合にあっては、基盤機構等）に提出しなければならない。
Article 44-4Childbirth and Childcare Grants
The childbirth and childcare grant for each fiscal year is to be applied to a portion of the expenses required for the payment of the lump-sum allowance for childbirth and childcare, etc. prescribed in Article 152-2 of the Act for that fiscal year.
第四十四条の五（出産育児交付金に関する高齢者の医療の確保に関する法律の規定の読替え）
Article 44-5Replacement of Terms in the Provisions of the Act on Assurance of Medical Care for Elderly People Concerning Childbirth and Childcare Grants
Where the provisions of Articles 41 and 42 of the Act on Assurance of Medical Care for Elderly People are applied mutatis mutandis pursuant to Article 152-6 of the Act, the term "Insurer" in Article 41 of that Act (including the heading) is deemed to be replaced with "health insurance society", and the phrase "to each Insurer" in Article 42, paragraph (1) of that Act with "to each Insurer (meaning the Japan Health Insurance Association and health insurance societies as insurers of health insurance (excluding insurance for specially-insured day laborers (meaning specially-insured day laborers prescribed in Article 3, paragraph (2) of the Health Insurance Act)); the same applies hereinafter)".
法第百五十二条の六の規定により高齢者の医療の確保に関する法律第四十一条及び第四十二条の規定を準用する場合においては、同法第四十一条（見出しを含む。）中「保険者」とあるのは「健康保険組合」と、同法第四十二条第一項中「、各保険者」とあるのは「、各保険者（健康保険（日雇特例被保険者（健康保険法第三条第二項に規定する日雇特例被保険者をいう。）の保険を除く。）の保険者としての全国健康保険協会及び健康保険組合をいう。以下同じ。）」と読み替えるものとする。
第四十四条の六（健康保険組合の合併等の場合における出産育児交付金の額の算定の特例）
Article 44-6Special Provisions for Calculation of the Amount of Childbirth and Childcare Grants in Cases of Merger, etc. of Health Insurance Societies
The provisions of Article 2, paragraphs (1) through (4) of the Cabinet Order on the Calculation, etc. of Grants for Early-Stage Elderly People and National Treasury Contributions for Latter-Stage Elderly Medical Care (Cabinet Order No. 325 of 2007) apply mutatis mutandis to the special provisions for calculation of the amount of childbirth and childcare grants under Article 41 of the Act on Assurance of Medical Care for Elderly People as applied mutatis mutandis pursuant to Article 152-6 of the Act. In this case, the words listed in the middle column of the following table in the provisions of that Cabinet Order listed in the left-hand column of the table are deemed to be replaced with the words listed in the right-hand column of the table, respectively.
| Heading of Article 2 | insurer | health insurance society |
| Article 2, paragraph (1) | insurer, | health insurance society, |
| insurer or a dissolved insurer | health insurance society or a dissolved health insurance society | |
| succeeding insurer | succeeding health insurance society | |
| newly established insurer, etc. | newly established health insurance society, etc. | |
| Article 2, paragraph (1), item (i) | insurer | health insurance society |
| the amount of claims or the obligations relating to young-old payments, etc. | claims | |
| Article 2, paragraph (1), items (ii) and (iii) | insurer | health insurance society |
| in accordance with the category of the amounts listed in (a) and (b) below, respectively in (a) and (b) | in (a) | |
| Portion of Article 2, paragraph (2) other than the table | newly established insurer, etc. | newly established health insurance society, etc. |
| the proviso to Article 33, paragraph (1) of the Act on Assurance of Medical Care for Elderly People | the proviso to Article 152-3, paragraph (1) of the Health Insurance Act (Act No. 70 of 1922) | |
| estimated young-old subsidy | estimated childbirth and childcare grant | |
| fixed young-old subsidy | fixed childbirth and childcare grant | |
| Table in Article 2, paragraph (2) | insurer | health insurance society |
| estimated young-old subsidy | estimated childbirth and childcare grant | |
| fixed young-old subsidy | fixed childbirth and childcare grant | |
| Article 2, paragraph (3) | newly established insurer, etc. | newly established health insurance society, etc. |
| Portion of Article 2, paragraph (4) other than the table | newly established insurer, etc. | newly established health insurance society, etc. |
| the proviso to Article 33, paragraph (1) of the Act on Assurance of Medical Care for Elderly People | the proviso to Article 152-3, paragraph (1) of the Health Insurance Act | |
| estimated young-old subsidy | estimated childbirth and childcare grant | |
| fixed young-old subsidy | fixed childbirth and childcare grant | |
| Table in Article 2, paragraph (4) | insurer | health insurance society |
| estimated young-old subsidy | estimated childbirth and childcare grant | |
| fixed young-old subsidy | fixed childbirth and childcare grant |
前期高齢者交付金及び後期高齢者医療の国庫負担金の算定等に関する政令（平成十九年政令第三百二十五号）第二条第一項から第四項までの規定は、法第百五十二条の六において準用する高齢者の医療の確保に関する法律第四十一条の規定による出産育児交付金の額の算定の特例について準用する。この場合において、次の表の上欄に掲げる同令の規定中同表の中欄に掲げる字句は、それぞれ同表の下欄に掲げる字句に読み替えるものとする。
| 第二条の見出し | 保険者 | 健康保険組合 |
| 第二条第一項 | 保険者、 | 健康保険組合、 |
| 保険者又は解散をした保険者 | 健康保険組合又は解散をした健康保険組合 | |
| 承継した保険者 | 承継した健康保険組合 | |
| 成立保険者等 | 成立健康保険組合等 | |
| 第二条第一項第一号 | 保険者 | 健康保険組合 |
| 債権の額又は前期高齢者納付金等に係る債務 | 債権 | |
| 第二条第一項第二号及び第三号 | 保険者 | 健康保険組合 |
| 次のイ及びロに掲げる額の区分に応じ、それぞれイ及びロに | イに | |
| 第二条第二項の表以外の部分 | 成立保険者等 | 成立健康保険組合等 |
| 法第三十三条第一項ただし書 | 健康保険法（大正十一年法律第七十号）第百五十二条の三第一項ただし書 | |
| 概算前期高齢者交付金 | 概算出産育児交付金 | |
| 確定前期高齢者交付金 | 確定出産育児交付金 | |
| 第二条第二項の表 | 保険者 | 健康保険組合 |
| 概算前期高齢者交付金 | 概算出産育児交付金 | |
| 確定前期高齢者交付金 | 確定出産育児交付金 | |
| 第二条第三項 | 成立保険者等 | 成立健康保険組合等 |
| 第二条第四項の表以外の部分 | 成立保険者等 | 成立健康保険組合等 |
| 法第三十三条第一項ただし書 | 健康保険法第百五十二条の三第一項ただし書 | |
| 概算前期高齢者交付金 | 概算出産育児交付金 | |
| 確定前期高齢者交付金 | 確定出産育児交付金 | |
| 第二条第四項の表 | 保険者 | 健康保険組合 |
| 概算前期高齢者交付金 | 概算出産育児交付金 | |
| 確定前期高齢者交付金 | 確定出産育児交付金 |
Article 44-7Delivery of Grant from Premiums, etc.
Except in the case referred to in the following paragraph, when the premiums and other amounts collected by the Minister of Health, Labour and Welfare pursuant to the provisions of the Act and the payments pursuant to the provisions of the Act on Payment of Government Charges with Stamps (Act No. 142 of 1948) (hereinafter referred to as "premiums, etc." in this paragraph and the following paragraph) have been received in the health account of the Pension Special Account (referred to as the "health account" in that paragraph), the Government is to deliver to JHIA, on each such occasion without delay, as the grant under Article 155-2 of the Act (hereinafter referred to as the "grant from premiums, etc." in this Article), the amount obtained by deducting, from the amount of the premiums, etc. so received, the amount calculated as provided by Order of the Ministry of Health, Labour and Welfare as an amount equivalent to the expenses required for the execution of the affairs of the health insurance business administered by the Minister of Health, Labour and Welfare (excluding the amount of the national treasury share for those expenses under Article 151 of the Act).
政府は、次項の場合を除き、厚生労働大臣が徴収した保険料その他法の規定による徴収金及び印紙をもつてする歳入金納付に関する法律（昭和二十三年法律第百四十二号）の規定による納付金（以下この項及び次項において「保険料等」という。）が年金特別会計の健康勘定（同項において「健康勘定」という。）において収納されたときは、その都度遅滞なく、協会に対し、当該収納された保険料等の額から厚生労働大臣が行う健康保険事業の事務の執行に要する費用に相当する額（法第百五十一条の規定による当該費用に係る国庫負担金の額を除く。）として厚生労働省令で定めるところにより算定した額を控除した額を法第百五十五条の二の規定による交付金（以下この条において「保険料等交付金」という。）として交付する。
When the surplus in the final accounts of the previous fiscal year has been transferred to the health account for that fiscal year, the Government is to deliver to JHIA without delay, as the grant from premiums, etc., the amount so transferred (excluding the amount specified by the Minister of Health, Labour and Welfare as that other than relating to premiums, etc.).
For each month, the Government is to make clear to JHIA the basis for calculating the amount of the grant from premiums, etc. delivered in that month.
Beyond what is provided for in the preceding three paragraphs, necessary matters concerning the delivery of the grant from premiums, etc. are specified by Order of the Ministry of Health, Labour and Welfare.
Article 45Cases in Which the Amount of Long-Term Care Insurance Premium Is Collected
The cases specified by Cabinet Order as referred to in the proviso to Article 156, paragraph (2) of the Act (including as applied mutatis mutandis pursuant to Article 7, paragraph (3) of the Supplementary Provisions of the Act) are cases where a person ceases to be an item (ii) insured person (meaning an insured person prescribed in Article 9, item (ii) of the Long-Term Care Insurance Act; the same applies hereinafter) in the month in which the person became an item (ii) insured person.
法第百五十六条第二項ただし書（法附則第七条第三項において準用する場合を含む。）の政令で定める場合は、介護保険第二号被保険者（介護保険法第九条第二号に規定する被保険者をいう。以下同じ。）となった月において介護保険第二号被保険者に該当しなくなった場合とする。
Article 45-2Method of Calculating the Premium Rate for Each Prefecture
As specified by Order of the Ministry of Health, Labour and Welfare, JHIA is to calculate the premium rate for each prefecture (meaning the premium rate for each prefecture prescribed in Article 160, paragraph (2) of the Act; the same applies in the following Article and Article 45-4, paragraph (4), item (i)) to be used from March of a business year, by dividing the amount obtained by dividing the amount listed in item (i) by the projected premium payment rate (meaning the rate calculated, as specified by Order of the Ministry of Health, Labour and Welfare, as the proportion that the total amount of premiums expected to be paid in the business year following the business year represents of the estimated amount to be collected as premiums for the period from March of a business year to February of the business year following that business year (for premiums relating to insured persons with optional and continued coverage, premiums for the period from April to March of that following business year); the same applies in the following Article) by the amount listed in item (ii), for the business year following the business year.
協会は、厚生労働省令で定めるところにより、一の事業年度の翌事業年度における、第一号に掲げる額を予定保険料納付率（一の事業年度の三月分から当該一の事業年度の翌事業年度の二月分までの保険料（任意継続被保険者に係る保険料にあっては、当該翌事業年度の四月分から三月分までの保険料）として徴収すべき額の見込額に占める当該翌事業年度において納付が見込まれる保険料の額の総額の割合として厚生労働省令で定めるところにより算定される率をいう。次条において同じ。）で除して得た額を第二号に掲げる額で除することにより、当該一の事業年度の三月から用いる都道府県単位保険料率（法第百六十条第二項に規定する都道府県単位保険料率をいう。次条及び第四十五条の四第四項第一号において同じ。）を算定するものとする。
the amount obtained by deducting the amount listed in (d) from the total sum of the amounts listed in (a) through (c);
次のイからハまでに掲げる額を合算した額からニに掲げる額を控除した額
the amount obtained by deducting, from the amount listed in Article 160, paragraph (3), item (i) of the Act, the estimated amount of the amount equivalent to the partial co-payment payable pursuant to the provisions of the Act out of the expenses required for the benefits for medical treatment, etc. prescribed in that item (referred to as "benefits for medical treatment, etc." in Article 45-4, paragraph (4), items (i) and (ii)) relating to the branch-insured person concerned (meaning the single branch-insured person prescribed in Article 160, paragraph (1) of the Act; the same applies hereinafter);
法第百六十条第三項第一号に掲げる額から当該支部被保険者（同条第一項に規定する支部被保険者をいう。以下同じ。）に係る同号に規定する療養の給付等（第四十五条の四第四項第一号及び第二号において「療養の給付等」という。）に要する費用のうち法の規定により支払うべき一部負担金に相当する額の見込額を控除した額
the amount obtained by adding together the amount obtained by deducting, from the amount listed in Article 160, paragraph (3), item (ii) of the Act, the estimated amount of the amount equivalent to the partial co-payment payable pursuant to the provisions of the Act out of the expenses required for the insurance benefits prescribed in that item relating to the branch-insured person concerned, and the amount obtained by multiplying by 0.1/1,000 the total sum of the total amount of the total remuneration (meaning the total of the standard monthly remuneration and the standard bonus amount; the same applies in this Article and the following Article) of the branch-insured person concerned (excluding insured persons with optional and continued coverage) for each month from March of the business year before the previous business year of a business year through February of the business year previous to that business year, and the total amount of the total remuneration of the branch-insured person concerned (limited to insured persons with optional and continued coverage) for each month from April through March of the business year previous to that business year;
法第百六十条第三項第二号に掲げる額から当該支部被保険者に係る同号に規定する保険給付に要する費用のうち法の規定により支払うべき一部負担金に相当する額の見込額を控除した額と一の事業年度の前々事業年度の三月から当該一の事業年度の前事業年度の二月までの各月の当該支部被保険者（任意継続被保険者を除く。）の総報酬額（標準報酬月額及び標準賞与額の合計額をいう。以下この条及び次条において同じ。）の総額及び当該一の事業年度の前事業年度の四月から三月までの各月の当該支部被保険者（任意継続被保険者に限る。）の総報酬額の総額の合算額に千分の〇・一を乗じて得た額とを合算して得た額
the amount listed in Article 160, paragraph (3), item (iii) of the Act; and
法第百六十条第三項第三号に掲げる額
the amount specified by JHIA as the amount to be deemed revenue in the finances of a business year of health insurance on the basis of the branch-insured person concerned, out of the estimated amount of revenue for expenses required for health insurance business, such as the amount of reserves expected to be drawn down in that business year, and the amount of incentive payment calculated, as specified by Order of the Ministry of Health, Labour and Welfare, taking into account the status of implementation of the special health examination prescribed in Article 18, paragraph (1) of the Act on Assurance of Medical Care for Elderly People and the specified health guidance prescribed in the same paragraph, and other efforts of the relevant branch (meaning the branch prescribed in Article 7-4, paragraph (1) of the Act) concerning the maintenance and promotion of the health of the branch-insured person concerned and the dependents of that person and the optimization of medical expenses;
一の事業年度において取り崩すことが見込まれる準備金の額その他健康保険事業に要する費用のための収入の見込額のうち当該支部被保険者を単位とする健康保険の当該一の事業年度の財政においてその収入とみなすべき額として協会が定める額並びに高齢者の医療の確保に関する法律第十八条第一項に規定する特定健康診査及び同項に規定する特定保健指導の実施状況その他の当該支部被保険者及びその被扶養者の健康の保持増進並びに医療に要する費用の適正化に係る当該支部（法第七条の四第一項に規定する支部をいう。）の取組の状況を勘案して厚生労働省令で定めるところにより算定した報奨金の額
the estimated amount of the total sum of the total amount of the total remuneration of the branch-insured person concerned (excluding insured persons with optional and continued coverage) for each month from March of a business year through February of the business year following that business year, and the total amount of the total remuneration of the branch-insured person concerned (limited to insured persons with optional and continued coverage) for each month from April through March of the business year following that business year.
第四十五条の三（三月以外の月から用いる都道府県単位保険料率の算定方法）
Article 45-3Method of Calculating the Premium Rate for Each Prefecture to Be Used from a Month Other than March
Notwithstanding the provisions of the preceding Article, when JHIA intends to use a premium rate for each prefecture that it is about to change from a month other than March, JHIA is to calculate that premium rate for each prefecture, as specified by Order of the Ministry of Health, Labour and Welfare, by dividing the amount obtained by dividing the amount obtained by deducting the amount listed in item (ii) from the amount listed in item (i) by the projected premium payment rate by the amount listed in item (iii).
the amount listed in item (i) of the preceding Article in the business year to which the first month in which the premium rate for each prefecture after the change is to be used (referred to as the "month of application" in the following item and item (iii)) belongs;
当該変更後の都道府県単位保険料率を用いる最初の月（次号及び第三号において「適用月」という。）の属する事業年度における前条第一号に掲げる額
the amount specified respectively in (a) through (c) in accordance with the classification of months of application listed in (a) through (c):
次のイからハまでに掲げる適用月の区分に応じ、それぞれイからハまでに定める額
a month other than a month listed in (b) or (c): the amount obtained by multiplying the estimated amount of the total sum of the total amount of the total remuneration of the branch-insured person concerned (excluding insured persons with optional and continued coverage) for each month from March of the business year previous to the business year to which the month of application belongs through the month preceding the month of application, and the total amount of the total remuneration of the branch-insured person concerned (limited to insured persons with optional and continued coverage) for each month from April of the business year to which the month of application belongs through the month preceding the month of application, by the premium rate for each prefecture before the change, and then multiplying the amount so obtained by the projected premium payment rate in the business year to which the month of application belongs;
ロ又はハに掲げる月以外の月 適用月の属する事業年度の前事業年度の三月から当該適用月の前月までの各月の当該支部被保険者（任意継続被保険者を除く。）の総報酬額の総額及び当該適用月の属する事業年度の四月から当該適用月の前月までの各月の当該支部被保険者（任意継続被保険者に限る。）の総報酬額の総額の合算額の見込額に当該変更前の都道府県単位保険料率を乗じて得た額に当該適用月の属する事業年度における予定保険料納付率を乗じて得た額
April: the amount obtained by multiplying the estimated amount of the total amount of the total remuneration of the branch-insured person concerned (excluding insured persons with optional and continued coverage) for the month preceding that April by the premium rate for each prefecture before the change, and then multiplying the amount so obtained by the projected premium payment rate in the business year to which that April belongs;
四月 当該四月の前月の当該支部被保険者（任意継続被保険者を除く。）の総報酬額の総額の見込額に当該変更前の都道府県単位保険料率を乗じて得た額に当該四月の属する事業年度における予定保険料納付率を乗じて得た額
May: the amount obtained by multiplying the estimated amount of the total sum of the total amount of the total remuneration of the branch-insured person concerned (excluding insured persons with optional and continued coverage) for the month two months before that May and the month preceding that May, and the total amount of the total remuneration of the branch-insured person concerned (limited to insured persons with optional and continued coverage) for the month preceding that May, by the premium rate for each prefecture before the change, and then multiplying the amount so obtained by the projected premium payment rate in the business year to which that May belongs;
五月 当該五月の前々月及び前月の当該支部被保険者（任意継続被保険者を除く。）の総報酬額の総額並びに当該五月の前月の当該支部被保険者（任意継続被保険者に限る。）の総報酬額の総額の合算額の見込額に当該変更前の都道府県単位保険料率を乗じて得た額に当該五月の属する事業年度における予定保険料納付率を乗じて得た額
the estimated amount of the total sum of the total amount of the total remuneration of the branch-insured person concerned (excluding insured persons with optional and continued coverage) for each month from the month of application through February of the business year to which the month of application belongs (where the month of application is February, that February), and the total amount of the total remuneration of the branch-insured person concerned (limited to insured persons with optional and continued coverage) for each month from the month of application through March of the business year to which the month of application belongs.
第四十五条の四（支部被保険者を単位とする健康保険の財政の調整）
Article 45-4Adjustment of Finances for Health Insurance on the Basis of a Single Branch-Insured Person
The adjustment of finances for health insurance on the basis of a single branch-insured person that is carried out pursuant to the provisions of Article 160, paragraph (4) of the Act is to be age adjustment and financial capability adjustment.
法第百六十条第四項の規定により行う支部被保険者を単位とする健康保険の財政の調整は、年齢調整及び財政力調整とする。
The age adjustment referred to in the preceding paragraph is to be carried out, in accordance with the classification of cases listed in the following items, as specified respectively in those items.
前項の年齢調整は、次の各号に掲げる場合の区分に応じ、当該各号に定めるところにより行うものとする。
in the case where the branch age-adjusted standard benefit cost is the branch average benefit cost or more: to deduct the amount obtained by deducting that branch average benefit cost from that branch age-adjusted standard benefit cost;
支部年齢勘案標準給付費額が支部平均給付費額以上である場合 当該支部年齢勘案標準給付費額から当該支部平均給付費額を控除した額を控除すること。
in the case where the branch age-adjusted standard benefit cost is less than the branch average benefit cost: to add the amount obtained by deducting that branch age-adjusted standard benefit cost from that branch average benefit cost.
支部年齢勘案標準給付費額が支部平均給付費額未満である場合 当該支部平均給付費額から当該支部年齢勘案標準給付費額を控除した額を加算すること。
The financial capability adjustment referred to in paragraph (1) is to be carried out, in accordance with the classification of cases listed in the following items, as specified respectively in those items.
第一項の財政力調整は、次の各号に掲げる場合の区分に応じ、当該各号に定めるところにより行うものとする。
in the case where the branch benefit cost apportioned by total remuneration is the branch average benefit cost or more: to add the amount obtained by deducting that branch average benefit cost from that branch benefit cost apportioned by total remuneration;
支部総報酬按分給付費額が支部平均給付費額以上である場合 当該支部総報酬按分給付費額から当該支部平均給付費額を控除した額を加算すること。
in the case where the branch benefit cost apportioned by total remuneration is less than the branch average benefit cost: to deduct the amount obtained by deducting that branch benefit cost apportioned by total remuneration from that branch average benefit cost.
支部総報酬按分給付費額が支部平均給付費額未満である場合 当該支部平均給付費額から当該支部総報酬按分給付費額を控除した額を控除すること。
In the preceding two paragraphs, the meanings of the terms listed in the following items are as prescribed respectively in those items.
前二項において、次の各号に掲げる用語の意義は、当該各号に定めるところによる。
"branch age-adjusted standard benefit cost" means the total sum of the amounts obtained, for each age group, as specified by Order of the Ministry of Health, Labour and Welfare, by multiplying the average benefit per person by age group relating to that age group (meaning the amount obtained, as specified by Order of the Ministry of Health, Labour and Welfare, by dividing the amount obtained by deducting, from the estimated amount of expenses required in the business year following the business year (meaning the business year following the business year prescribed in Article 45-2 and, where the premium rate for each prefecture is calculated pursuant to the preceding Article, the business year to which the month of application prescribed in that Article belongs; the same applies hereinafter in this paragraph) for the benefits for medical treatment, etc. relating to insured persons of health insurance administered by JHIA and their dependents belonging to that age group, the estimated total sum of the amount equivalent to the partial co-payment payable pursuant to the provisions of the Act out of that estimated amount and the amount of national subsidy pursuant to the provisions of Article 153 of the Act, by the estimated total number of insured persons of health insurance administered by JHIA and their dependents belonging to that age group in the business year following the business year) by the estimated total number of the branch-insured person concerned and the dependents of that person belonging to that age group in the business year following the business year;
支部年齢勘案標準給付費額 厚生労働省令で定めるところにより、年齢階級ごとに、当該年齢階級に係る年齢階級別平均一人当たり給付額（厚生労働省令で定めるところにより、療養の給付等のうち協会が管掌する健康保険の被保険者及びその被扶養者であって当該年齢階級に属する者に係るものについて当該一の事業年度の翌事業年度（第四十五条の二に規定する当該一の事業年度の翌事業年度をいい、前条の規定に基づき都道府県単位保険料率を算定する場合にあっては、同条に規定する当該適用月の属する事業年度をいう。以下この項において同じ。）に要する費用の見込額から当該見込額のうち法の規定により支払うべき一部負担金に相当する額及び法第百五十三条の規定による国庫補助の額の合算額の見込額を控除した額を、当該一の事業年度の翌事業年度において協会が管掌する健康保険の被保険者及びその被扶養者であって当該年齢階級に属する者の合計数の見込数で除して得た額をいう。）に当該一の事業年度の翌事業年度において当該支部被保険者及びその被扶養者であって当該年齢階級に属する者の合計数の見込数を乗じて得た額を合算した額をいう。
"branch average benefit cost" means the amount obtained by multiplying, as specified by Order of the Ministry of Health, Labour and Welfare, the average benefit per person (meaning the amount obtained, as specified by Order of the Ministry of Health, Labour and Welfare, by dividing the amount obtained by deducting, from the estimated amount of expenses required in the business year following the business year for the benefits for medical treatment, etc. relating to insured persons of health insurance administered by JHIA and their dependents, the estimated total sum of the amount equivalent to the partial co-payment payable pursuant to the provisions of the Act out of that estimated amount and the amount of national subsidy pursuant to the provisions of Article 153 of the Act (referred to as the "estimated total benefit cost" in the following item), by the estimated total number of insured persons of health insurance administered by JHIA and their dependents in the business year following the business year) by the estimated total number of the branch-insured person concerned and the dependents of that person in the business year following the business year;
支部平均給付費額 厚生労働省令で定めるところにより、平均一人当たり給付額（厚生労働省令で定めるところにより、療養の給付等のうち協会が管掌する健康保険の被保険者及びその被扶養者に係るものについて当該一の事業年度の翌事業年度に要する費用の見込額から当該見込額のうち法の規定により支払うべき一部負担金に相当する額及び法第百五十三条の規定による国庫補助の額の合算額の見込額を控除した額（次号において「総給付費見込額」という。）を、当該一の事業年度の翌事業年度における協会が管掌する健康保険の被保険者及びその被扶養者の合計数の見込数で除して得た額をいう。）に当該一の事業年度の翌事業年度における当該支部被保険者及びその被扶養者の合計数の見込数を乗じて得た額をいう。
"branch benefit cost apportioned by total remuneration" means the amount obtained by multiplying, as specified by Order of the Ministry of Health, Labour and Welfare, the estimated total benefit cost by the estimated value of the total remuneration proportion ratio prescribed in Article 160, paragraph (3), item (ii) of the Act in the business year following the business year.
支部総報酬按分給付費額 厚生労働省令で定めるところにより、総給付費見込額に当該一の事業年度の翌事業年度における法第百六十条第三項第二号に規定する総報酬按分率の見込値を乗じて得た額をいう。
Article 45-5Upper Limit of the Children and Child-Rearing Support Contribution Rate
The rate specified by Cabinet Order as referred to in Article 160-2, paragraph (1) of the Act is 2.5/1,000.
法第百六十条の二第一項の政令で定める率は、千分の二・五とする。
Article 46Accumulation of Reserves
JHIA must, at the end of each business year, accumulate the amount of surplus of that business year as a reserve until it reaches the sum of the amount equivalent to one-twelfth of the average per business year of the amount of expenses required for insurance benefits provided in that business year and the two business years immediately preceding it (including the amount of expenses required for payment of young-old payments, etc., aid for the old-old, etc., and day laborer contributions, long-term care payments, and contributions for securing medical care in the early phase of an epidemic, etc. (where there is a young-old subsidy, the amount after deducting it), and excluding the amount of childbirth and childcare grants and the amount of national subsidies pursuant to the provisions of Articles 153 and 154 of the Act), and the amount determined by the Minister of Health, Labour and Welfare in consultation with the Prime Minister, within a range not exceeding the amount equivalent to one-twelfth of the amount of expenses required for payment of the children and child-rearing support levy made in that business year, taking into account the expenses required for the payment of the children and child-rearing support levy by insurers in that year.
協会は、毎事業年度末において、当該事業年度及びその直前の二事業年度内において行った保険給付に要した費用の額（前期高齢者納付金等、後期高齢者支援金等及び日雇拠出金、介護納付金並びに流行初期医療確保拠出金等の納付に要した費用の額（前期高齢者交付金がある場合には、これを控除した額）を含み、出産育児交付金の額並びに法第百五十三条及び第百五十四条の規定による国庫補助の額を除く。）の一事業年度当たりの平均額の十二分の一に相当する額並びに当該事業年度において行った子ども・子育て支援納付金の納付に要した費用の額の十二分の一に相当する額を超えない範囲内において当該年度における保険者の子ども・子育て支援納付金の納付に要する費用を勘案して厚生労働大臣が内閣総理大臣と協議して定める額とを合算した額に達するまでは、当該事業年度の剰余金の額を準備金として積み立てなければならない。
A health insurance society must, at the end of each business year, accumulate the amount of surplus of that business year as a reserve until it reaches the sum of the amount equivalent to three-twelfths of the average per business year of the amount of expenses required for insurance benefits provided in that business year and the two business years immediately preceding it (excluding the amount of expenses required for insurance benefits relating to medical treatment that an insured person or the dependent of that person received from a hospital, clinic, or pharmacy listed in Article 63, paragraph (3), item (iii) of the Act, and the amount of childbirth and childcare grants), the amount equivalent to one-twelfth of the average per business year of the amount of expenses required for payment of young-old payments, etc., aid for the old-old, etc., and day laborer contributions, long-term care payments, and contributions for securing medical care in the early phase of an epidemic, etc. provided in that business year and the two business years immediately preceding it (where there is a young-old subsidy, the amount after deducting it), and the amount determined by the Minister of Health, Labour and Welfare in consultation with the Prime Minister, within a range not exceeding the amount equivalent to one-twelfth of the amount of expenses required for payment of the children and child-rearing support levy made in that business year, taking into account the expenses required for the payment of the children and child-rearing support levy by insurers in that year.
健康保険組合は、毎事業年度末において、当該事業年度及びその直前の二事業年度内において行った保険給付に要した費用の額（被保険者又はその被扶養者が法第六十三条第三項第三号に掲げる病院若しくは診療所又は薬局から受けた療養に係る保険給付に要した費用の額及び出産育児交付金の額を除く。）の一事業年度当たりの平均額の十二分の三に相当する額と当該事業年度及びその直前の二事業年度内において行った前期高齢者納付金等、後期高齢者支援金等及び日雇拠出金、介護納付金並びに流行初期医療確保拠出金等の納付に要した費用の額（前期高齢者交付金がある場合には、これを控除した額）の一事業年度当たりの平均額の十二分の一に相当する額並びに当該事業年度において行った子ども・子育て支援納付金の納付に要した費用の額の十二分の一に相当する額を超えない範囲内において当該年度における保険者の子ども・子育て支援納付金の納付に要する費用を勘案して厚生労働大臣が内閣総理大臣と協議して定める額とを合算した額に達するまでは、当該事業年度の剰余金の額を準備金として積み立てなければならない。
Article 47Premiums When Employed at Two or More Places of Business
Where, pursuant to Article 161, paragraph (4) of the Act, an insured person (excluding specially-insured day laborers; the same applies hereinafter) is employed at two or more places of business or offices (hereinafter simply referred to as "places of business") at the same time, the amount of premiums relating to the standard monthly remuneration to be borne by each employer is the amount obtained by multiplying the amount listed in item (i) by the number listed in item (ii).
法第百六十一条第四項の規定により被保険者（日雇特例被保険者を除く。以下同じ。）が同時に二以上の事業所又は事務所（以下単に「事業所」という。）に使用される場合における各事業主の負担すべき標準報酬月額に係る保険料の額は、第一号に掲げる額に第二号に掲げる数を乗じて得た額とする。
half of the premium of the insured person concerned (where Article 162 of the Act is applied, the amount obtained by multiplying the amount of premium by the proportion to be borne by the employer);
当該被保険者の保険料の半額（法第百六十二条の規定が適用された場合にあっては、保険料の額に事業主の負担すべき割合を乗じて得た額）
the number obtained by dividing the amount calculated for each place of business pursuant to Article 41, paragraph (1), Article 42, paragraph (1), Article 43, paragraph (1), or Article 44, paragraph (1) of the Act by the monthly remuneration of the insured person concerned.
Where, pursuant to Article 161, paragraph (4) of the Act, an insured person is employed at two or more places of business at the same time, the amount of premiums relating to the standard bonus amount to be borne by each employer is the amount obtained by multiplying the amount listed in item (i) of the preceding paragraph by the number obtained by dividing the amount of bonus paid by each employer in that month for each place of business by the amount of bonus received by the insured person in that month.
法第百六十一条第四項の規定により被保険者が同時に二以上の事業所に使用される場合における各事業主の負担すべき標準賞与額に係る保険料の額は、前項第一号に掲げる額に各事業所についてその月に各事業主が支払った賞与額をその月に当該被保険者が受けた賞与額で除して得た数を乗じて得た額とする。
Where an insured person referred to in Article 161, paragraph (4) of the Act is employed at two or more places of business at the same time, the premiums to be paid by each employer are the premiums to be borne by each employer pursuant to the preceding two paragraphs and the corresponding premiums to be borne by that insured person.
法第百六十一条第四項の被保険者が同時に二以上の事業所に使用される場合における各事業主が納付すべき保険料は、前二項の規定により各事業主が負担すべき保険料及びこれに応ずる当該被保険者が負担すべき保険料とする。
Article 48Period for Advance Payment of Premiums
Advance payment of premiums pursuant to Article 165, paragraph (1) of the Act is to be made in units of six months, from April to September or from October to March of the following year, or 12 months, from April to March of the following year; provided, however, that for a person who acquires status as an insured person with optional and continued coverage, or who is clearly to lose that status, during those six or 12 months, advance payment may be made of the premiums for the period, within those six or 12 months, from the month following the month containing the day on which the person acquires that status, or up to the month preceding the month containing the day on which the person loses that status.
法第百六十五条第一項の規定による保険料の前納は、四月から九月まで若しくは十月から翌年三月までの六月間又は四月から翌年三月までの十二月間を単位として行うものとする。ただし、当該六月又は十二月の間において、任意継続被保険者の資格を取得した者又はその資格を喪失することが明らかである者については、当該六月間又は十二月間のうち、その資格を取得した日の属する月の翌月以降の期間又はその資格を喪失する日の属する月の前月までの期間の保険料について前納を行うことができる。
Article 49Amount Deducted upon Advance Payment
The amount specified by Cabinet Order as referred to in Article 165, paragraph (2) of the Act is the amount obtained by deducting, from the total sum of the premiums for each month of the period covered by advance payment, the total sum of the amounts obtained by discounting the amount of the premium for each month of that period by the compound present value method at an annual interest rate of 4%, according to the respective periods from the first month of the period covered by the advance payment to each such month (where that total has a fractional amount of less than one yen, a fractional amount of less than 50 sen is rounded down, and a fractional amount of 50 sen or more is calculated as one yen).
法第百六十五条第二項の政令で定める額は、前納に係る期間の各月の保険料の合計額から、その期間の各月の保険料の額を年四分の利率による複利現価法によって前納に係る期間の最初の月から当該各月までのそれぞれの期間に応じて割り引いた額の合計額（この額に一円未満の端数がある場合において、その端数金額が五十銭未満であるときは、これを切り捨て、その端数金額が五十銭以上であるときは、これを一円として計算する。）を控除した額とする。
Article 50Appropriation of Premiums Paid in Advance
Where, after premiums are paid in advance pursuant to Article 165, paragraph (1) of the Act, the amount of premiums relating to an insured person with optional and continued coverage is to be raised before the period covered by the advance payment elapses, the portion of the premiums paid in advance that relates to the period after the raise is to be appropriated, in order from the earliest month, to the premiums to be paid for each month of that period.
法第百六十五条第一項の規定により保険料が前納された後、前納に係る期間の経過前において任意継続被保険者に係る保険料の額の引上げが行われることとなった場合においては、前納された保険料のうち当該保険料の額の引上げが行われることとなった後の期間に係るものは、当該期間の各月につき納付すべきこととなる保険料に、先に到来する月の分から順次充当するものとする。
Article 51Refund of Premiums Paid in Advance
Where an insured person with optional and continued coverage loses that status before the period covered by advance payment elapses, after paying premiums in advance pursuant to Article 165, paragraph (1) of the Act, the portion of the premiums paid in advance that relates to the unelapsed period is to be refunded upon the request of that person (where the person has come to fall under Article 38, item (ii) of the Act, the heir of that person).
法第百六十五条第一項の規定により保険料を前納した後、前納に係る期間の経過前において任意継続被保険者がその資格を喪失した場合においては、その者（法第三十八条第二号に該当するに至った場合においては、その者の相続人）の請求に基づき、前納した保険料のうち未経過期間に係るものを還付する。
The refund amount relating to the unelapsed period prescribed in the preceding paragraph is the amount equivalent to the amount that would be payable if the premiums for that unelapsed period were to be paid in advance at the time of losing status as an insured person with optional and continued coverage.
前項に規定する未経過期間に係る還付額は、任意継続被保険者の資格を喪失した時において当該未経過期間につき保険料を前納するものとした場合におけるその前納すべき額に相当する額とする。
Article 52Mutatis Mutandis Application
The provisions of Article 48 through the preceding Article apply mutatis mutandis to advance payment of premiums of a special retired insured person prescribed in Article 3, paragraph (1) of the Supplementary Provisions of the Act.
第四十八条から前条までの規定は、法附則第三条第一項に規定する特例退職被保険者の保険料の前納について準用する。
Article 53Delegation to Order of the Ministry of Health, Labour and Welfare
In addition to what is provided for in Article 48 through the preceding Article, procedures for advance payment of premiums and other matters necessary for advance payment of premiums are specified by Order of the Ministry of Health, Labour and Welfare.
第四十八条から前条までに定めるもののほか、保険料の前納の手続その他保険料の前納に関して必要な事項は、厚生労働省令で定める。
Article 54Amount of Premium for Specially-Insured Day Laborers
Where the amount of premium relating to a specially-insured day laborer is calculated pursuant to Article 168, paragraph (1) of the Act, and where the amount to be borne by a specially-insured day laborer and the amount to be borne by an employer employing specially-insured day laborers are calculated pursuant to Article 169, paragraph (1) of the Act, if the amounts listed in Article 168, paragraph (1), item (i), (a) and (b) of the Act have a fractional amount of less than 10 yen, the fractional amount is to be rounded down.
法第百六十八条第一項の規定により日雇特例被保険者に関する保険料額を算定する場合並びに法第百六十九条第一項の規定により日雇特例被保険者の負担すべき額及び日雇特例被保険者を使用する事業主の負担すべき額を算定する場合において、法第百六十八条第一項第一号イ及びロに掲げる額に十円未満の端数があるときは、その端数を切り捨てるものとする。
The Minister of Health, Labour and Welfare is to give public notice of the amount of premium relating to specially-insured day laborers, the amount to be borne by specially-insured day laborers, and the amount to be borne by employers employing specially-insured day laborers.
厚生労働大臣は、日雇特例被保険者に関する保険料額並びに日雇特例被保険者の負担すべき額及び日雇特例被保険者を使用する事業主の負担すべき額を告示するものとする。
Article 55Due Dates and Amounts of Payment of Day Laborer Contributions
The due dates for day laborer contributions are September 30 and March 31.
日雇拠出金の納期は、九月三十日及び三月三十一日とする。
The amount of day laborer contributions to be paid on each due date is the amount equivalent to one-half of the amount of day laborer contributions for the relevant fiscal year pursuant to Article 174 of the Act.
Notwithstanding the preceding paragraph, where the amount of day laborer contributions for the fiscal year has a fractional amount of less than 2,000 yen, the amount to be paid on the due date of September 30 is the amount equivalent to one-half of the amount obtained by adding that fractional amount to the amount of day laborer contributions for that fiscal year, and the amount to be paid on the due date of March 31 is the amount equivalent to one-half of the amount obtained by deducting that fractional amount from the amount of day laborer contributions for that fiscal year.
Article 56Deferment of Payment of Day Laborer Contributions
Where the Minister of Health, Labour and Welfare finds that, due to unavoidable circumstances, it is extremely difficult for a health insurance society established by an employer employing specially-insured day laborers or an insurer of national health insurance prescribed in Article 179 of the Act (referred to as a "day laborer health society" in this paragraph and the following paragraph) to pay day laborer contributions, the Minister may, as specified by Order of the Ministry of Health, Labour and Welfare, upon application of the day laborer health society, defer payment of part of them for a period of up to one year from the due date.
When the Minister of Health, Labour and Welfare has granted deferment pursuant to the provisions of the preceding paragraph, the Minister must notify the day laborer health society of that fact, the amount of day laborer contributions subject to the deferment, the deferment period, and other necessary matters.
When the Minister of Health, Labour and Welfare has granted deferment pursuant to the provisions of paragraph (1), the Minister may not, during the deferment period, newly make a demand pursuant to the provisions of Article 180, paragraph (1) of the Act or a request for disposition or collection pursuant to the provisions of paragraph (4) of that Article regarding the day laborer contributions subject to the deferment.
第八章 健康保険組合連合会
Chapter VIII Federation of Health Insurance Societies
Article 57Bearing of Expenses of Establishment
The expenses required for the establishment of the federation of Health Insurance Societies (hereinafter referred to as the "federation") are to be borne by the federation; provided, however, that where the federation is not formed, those expenses are to be borne by the health insurance societies that applied for authorization of its establishment.
健康保険組合連合会（以下「連合会」という。）の設立に要する費用は、連合会が負担するものとする。ただし、連合会が成立しなかった場合においては、その費用は、その設立の認可の申請をした健康保険組合の負担とする。
Article 58Officers
The term of office of an officer is two years; provided, however, that the term of office of an officer elected or appointed to fill a vacancy is the remaining term of the predecessor.
役員の任期は、二年とする。ただし、補欠の役員の任期は、前任者の残任期間とする。
Article 59Vesting of Residual Assets
The assets of a dissolved federation vest in the person designated by the constitution.
解散した連合会の財産は、規約で指定した者に帰属する。
Where the constitution neither designates the person to whom the rights are to vest nor provides a method of designating that person, the president may, with the permission of the Minister of Health, Labour and Welfare, dispose of the assets for a purpose similar to the purpose of the federation; provided, however, that a resolution of the general meeting must be obtained.
規約で権利の帰属すべき者を指定せず、又はその者を指定する方法を定めなかったときは、会長は、厚生労働大臣の許可を得て、連合会の目的に類似する目的のために、その財産を処分することができる。ただし、総会の決議を経なければならない。
Assets not disposed of pursuant to the provisions of the preceding two paragraphs vest in the National Treasury.
前二項の規定により処分されない財産は、国庫に帰属する。
Article 59-2Capacity of a Federation in Liquidation
A dissolved federation is deemed to continue to exist within the scope of the purpose of liquidation until the conclusion of its liquidation.
解散した連合会は、清算の目的の範囲内において、その清算の結了に至るまではなお存続するものとみなす。
Article 59-3Liquidators
When a federation is dissolved, except in the case of dissolution due to an order commencing bankruptcy proceedings, the president, the vice presidents, and the directors become its liquidators; provided, however, that this does not apply where the constitution provides otherwise or where the general meeting has elected persons other than the president, the vice presidents, and the directors.
連合会が解散したときは、破産手続開始の決定による解散の場合を除き、会長、副会長及び理事がその清算人となる。ただし、規約に別段の定めがあるとき、又は総会において会長、副会長及び理事以外の者を選任したときは、この限りでない。
Article 59-4Appointment of a Liquidator by the Court
If there is no person to become a liquidator pursuant to the provisions of the preceding Article or if damage is likely to occur due to a vacancy in the office of liquidator, the court may appoint a liquidator at the request of an interested person or the public prosecutor, or by its own authority.
前条の規定により清算人となる者がないとき、又は清算人が欠けたため損害を生ずるおそれがあるときは、裁判所は、利害関係人若しくは検察官の請求により又は職権で、清算人を選任することができる。
Article 59-5Dismissal of Liquidators
At the request of an interested person or the public prosecutor or by its own authority, the court may dismiss the liquidator if there are material grounds for it to do so.
重要な事由があるときは、裁判所は、利害関係人若しくは検察官の請求により又は職権で、清算人を解任することができる。
Article 59-6Notification of Liquidators and Dissolution
A liquidator must notify the Minister of Health, Labour and Welfare of the liquidator's name and address and the cause and date of dissolution, except in the case of an order commencing bankruptcy proceedings and in the case of an order of dissolution pursuant to the provisions of Article 29, paragraph (2) of the Act as applied mutatis mutandis with replacement of terms pursuant to Article 188 of the Act.
A liquidator who assumed office during liquidation must notify the Minister of Health, Labour and Welfare of the liquidator's name and address.
清算中に就職した清算人は、その氏名及び住所を厚生労働大臣に届け出なければならない。
The provisions of the preceding paragraph apply mutatis mutandis to a liquidator who assumed office at the time of an order of dissolution pursuant to the provisions of Article 29, paragraph (2) of the Act as applied mutatis mutandis with replacement of terms pursuant to Article 188 of the Act.
Article 59-7Duties and Authority of a Liquidator
The duties of a liquidator are as follows:
清算人の職務は、次のとおりとする。
the conclusion of current business;
現務の結了
the collection of debts and the performance of obligations; and
債権の取立て及び債務の弁済
delivery of residual assets.
残余財産の引渡し
A liquidator may undertake any and all acts that are necessary for performing the duties prescribed in the items of the preceding paragraph.
清算人は、前項各号に掲げる職務を行うために必要な一切の行為をすることができる。
Article 59-8Demanding the Filing of Claims
A liquidator must, within two months from the date of assuming office, demand of creditors, by public notice made at least three times, that they file their claims within a certain period; in this case, that period must not be less than two months.
清算人は、その就職の日から二月以内に、少なくとも三回の公告をもって、債権者に対し、一定の期間内にその債権の申出をすべき旨の催告をしなければならない。この場合において、その期間は、二月を下ることができない。
The public notice under the preceding paragraph must include a statement that a creditor who does not submit a claim within that period is to be excluded from the liquidation; provided, however, that a liquidator may not exclude a known creditor.
前項の公告には、債権者がその期間内に申出をしないときは清算から除斥されるべき旨を付記しなければならない。ただし、清算人は、知れている債権者を除斥することができない。
The liquidator must issue an individual demand to each known creditor requiring that creditor to file its claim.
清算人は、知れている債権者には、各別にその申出の催告をしなければならない。
The public notice under paragraph (1) is given by publication in the Official Gazette.
第一項の公告は、官報に掲載してする。
Article 59-9Filing of a Claim After the Lapse of a Period of Time
A creditor who has filed a claim after the lapse of the period under paragraph (1) of the preceding Article may make a claim only against property that, after the debts of the federation have been fully repaid, has not yet been delivered to the persons to whom rights are to be vested.
Article 59-10Supervision by the Court
The dissolution and liquidation of a federation are subject to the supervision of the court.
連合会の解散及び清算は、裁判所の監督に属する。
The court may, by its own authority, conduct any examination that is necessary for the supervision referred to in the preceding paragraph, at any time.
裁判所は、職権で、いつでも前項の監督に必要な検査をすることができる。
The court that supervises the dissolution and liquidation of a federation may ask the Minister of Health, Labour and Welfare for an opinion or entrust the Minister with an investigation.
連合会の解散及び清算を監督する裁判所は、厚生労働大臣に対し、意見を求め、又は調査を嘱託することができる。
The Minister of Health, Labour and Welfare may state an opinion to the court prescribed in the preceding paragraph.
厚生労働大臣は、前項に規定する裁判所に対し、意見を述べることができる。
Article 59-11Notification of the Completion of Liquidation
When the liquidation has been completed, the liquidator must notify the Minister of Health, Labour and Welfare to that effect.
清算が結了したときは、清算人は、その旨を厚生労働大臣に届け出なければならない。
Article 59-12Jurisdiction over Cases Concerning Supervision of Dissolution and Liquidation
Cases concerning the supervision of the dissolution and liquidation of a federation and cases concerning liquidators fall under the jurisdiction of the district court that has jurisdiction over the location of the federation's principal office.
連合会の解散及び清算の監督並びに清算人に関する事件は、その主たる事務所の所在地を管轄する地方裁判所の管轄に属する。
Article 59-13Restrictions on Appeal
No appeal may be entered against a judicial decision on the appointment of a liquidator.
清算人の選任の裁判に対しては、不服を申し立てることができない。
Article 59-14Remuneration for Liquidators Appointed by the Court
Where the court has appointed a liquidator pursuant to the provisions of Article 59-4, it may determine the amount of remuneration to be paid by the federation to that liquidator. In this case, the court must hear statements from that liquidator and the auditor.
Article 59-15Appointment of an Examiner
The court may appoint an examiner to have the investigation necessary for the supervision of the dissolution and liquidation of a federation conducted.
裁判所は、連合会の解散及び清算の監督に必要な調査をさせるため、検査役を選任することができる。
The provisions of the preceding two Articles apply mutatis mutandis where the court has appointed an examiner pursuant to the preceding paragraph. In this case, the phrase "that liquidator and the auditor" in the preceding Article is deemed to be replaced with "the federation and the examiner".
Article 60Mutatis Mutandis Application
The provisions of Article 2 (excluding paragraph (1), item (iii)), Articles 3 through 5, Articles 7 through 13, Article 14, paragraph (2), Articles 15 through 19, Articles 22 through 24, Article 28 (excluding item (iii)) and Article 33 apply mutatis mutandis to a federation. In this case, the term "president" in these provisions is deemed to be replaced with "chairperson", the term "society meeting" with "general meeting", the phrase "employer of the applicable place of business" in Article 3, paragraph (1), Article 4 and Article 5 with "president of the health insurance society", the phrase "Article 11" in Article 9 with "Article 11 as applied mutatis mutandis pursuant to Article 60", the term "the Act" in Article 10, paragraph (3) with "the Act as applied mutatis mutandis pursuant to Article 188 of the Act", and the phrase "Article 8" in Article 10, paragraph (4) and Article 12, paragraph (1) with "Article 8 as applied mutatis mutandis pursuant to Article 60".
第二条（第一項第三号を除く。）、第三条から第五条まで、第七条から第十三条まで、第十四条第二項、第十五条から第十九条まで、第二十二条から第二十四条まで、第二十八条（第三号を除く。）及び第三十三条の規定は、連合会について準用する。この場合において、これらの規定中「理事長」とあるのは「会長」と、「組合会」とあるのは「総会」と、第三条第一項、第四条及び第五条中「適用事業所の事業主」とあるのは「健康保険組合の理事長」と、第九条中「第十一条」とあるのは「第六十条において準用する第十一条」と、第十条第三項中「法」とあるのは「法第百八十八条において準用する法」と、第十条第四項及び第十二条第一項中「第八条」とあるのは「第六十条において準用する第八条」と読み替えるものとする。
Article 61Affairs Handled by Municipalities
Pursuant to Article 203, paragraph (1) of the Act, the following affairs concerning specially-insured day laborers (including persons who were specially-insured day laborers; the same applies hereinafter) residing in an area designated by the Minister of Health, Labour and Welfare are to be performed by the head of the municipality whose district includes that area (in the case of a designated city under Article 252-19, paragraph (1) of the Local Autonomy Act, the ward or general ward):
法第二百三条第一項の規定により、厚生労働大臣が指定する地域に居住する日雇特例被保険者（日雇特例被保険者であった者を含む。以下同じ。）に係る次に掲げる事務は、当該地域をその区域に含む市町村（地方自治法第二百五十二条の十九第一項の指定都市にあっては、区又は総合区とする。）の長が行うものとする。
the issuance and receipt of specially-insured day laborer's insurance books and other affairs concerning specially-insured day laborer's insurance books;
日雇特例被保険者手帳の交付及び収受その他日雇特例被保険者手帳に関する事務
affairs concerning ascertaining which specially-insured day laborers are item (ii) insured persons and which are other specially-insured day laborers.
介護保険第二号被保険者である日雇特例被保険者及びそれ以外の日雇特例被保険者の把握に関する事務
Pursuant to Article 203, paragraph (2) of the Act, JHIA is to entrust to the municipalities whose districts include the area prescribed in the preceding paragraph the following affairs concerning specially-insured day laborers residing in that area:
the issuance of qualified recipient cards, the indication of confirmation on qualified recipient cards, and other affairs concerning qualified recipient cards;
受給資格者票の発行及び受給資格者票への確認の表示その他受給資格者票に関する事務
the issuance of special medical expense cards and other affairs concerning special medical expense cards;
特別療養費受給票の交付その他特別療養費受給票に関する事務
affairs concerning the confirmation of the payment status of premiums necessary for providing insurance benefits (excluding the provision of burial charges) and affairs concerning the confirmation of dependents regarding insurance benefits relating to dependents.
保険給付（埋葬料の支給を除く。）を行うために必要な保険料の納付状況の確認に関する事務及び被扶養者に係る保険給付に関する被扶養者の確認に関する事務
Where, in the case referred to in paragraph (1) or where a municipality carries out the affairs entrusted pursuant to the provisions of the preceding paragraph, the provisions of the Act concerning the Minister of Health, Labour and Welfare or JHIA with respect to the affairs prescribed in those paragraphs are to apply to the mayor of the municipality or the municipality as provisions concerning the mayor of the municipality (including the mayor of a special ward, and, for a designated city under Article 252-19, paragraph (1) of the Local Autonomy Act, the mayor of a ward or the mayor of a consolidated ward; the same applies hereinafter in this paragraph) or the municipality, respectively.
Article 62Category of Administrative Affairs
The affairs that are to be processed by municipalities pursuant to the provisions of paragraph (1) of the preceding Article are Type I statutory entrusted functions prescribed in Article 2, paragraph (9), item (i) of the Local Autonomy Act.
前条第一項の規定により市町村が処理することとされている事務は、地方自治法第二条第九項第一号に規定する第一号法定受託事務とする。
Article 63Circumstances Specified by Cabinet Order as Referred to in Article 204-2, Paragraph (1) of the Act
The circumstances specified by Cabinet Order as referred to in Article 204-2, paragraph (1) of the Act are to be those that fall under all of the following items:
法第二百四条の二第一項の政令で定める事情は、次の各号のいずれにも該当するものであることとする。
the person liable for payment is in arrears with premiums for the number of months specified by Order of the Ministry of Health, Labour and Welfare or more;
納付義務者が厚生労働省令で定める月数分以上の保険料を滞納していること。
there is a risk that the person liable for payment is concealing the person's property in order to evade the execution of the dispositions for arrears and other dispositions prescribed in Article 204-2, paragraph (1) of the Act (hereinafter referred to as "dispositions for arrears and other dispositions");
納付義務者が法第二百四条の二第一項に規定する滞納処分等その他の処分（以下「滞納処分等その他の処分」という。）の執行を免れる目的でその財産について隠ぺいしているおそれがあること。
the amount of premiums, etc. (meaning the premiums, etc. prescribed in Article 204-2, paragraph (1) of the Act; the same applies in the following item, Articles 64-4, 64-5, and 64-7, Article 64-8, paragraph (1), and Article 64-9) in arrears of the person liable for payment (where the person liable for payment is in arrears with premiums under the provisions of the Employees' Pension Insurance Act, contributions under the provisions of the Act on Support for Children and Child-rearing, special payment premiums under the provisions of the Act on Special Provisions for Insurance Benefit and Premium Payment in Relation to Employee's Pension Insurance (Act No. 131 of 2007), or other amounts to be collected under the provisions of those Acts, the amount obtained by adding the total sum of those premiums, contributions, special payment premiums, or amounts to be collected under the provisions of those Acts that are in arrears) is the amount specified by Order of the Ministry of Health, Labour and Welfare or more;
納付義務者が滞納している保険料等（法第二百四条の二第一項に規定する保険料等をいう。次号、第六十四条の四、第六十四条の五、第六十四条の七、第六十四条の八第一項及び第六十四条の九において同じ。）の額（納付義務者が、厚生年金保険法の規定による保険料、子ども・子育て支援法の規定による拠出金、厚生年金保険の保険給付及び保険料の納付の特例等に関する法律（平成十九年法律第百三十一号）の規定による特例納付保険料その他これらの法律の規定による徴収金を滞納しているときは、当該滞納している保険料、拠出金、特例納付保険料又はこれらの法律の規定による徴収金の合計額を加算した額）が厚生労働省令で定める金額以上であること。
notwithstanding having received dispositions for arrears and other dispositions, the person liable for payment is not found to have a sincere intention to pay the premiums, etc. in arrears.
滞納処分等その他の処分を受けたにもかかわらず、納付義務者が滞納している保険料等の納付について誠実な意思を有すると認められないこと。
Article 64Delegation of Authority to the Minister of Finance
Where the Minister of Health, Labour and Welfare delegates authority for dispositions for arrears and other dispositions pursuant to Article 204-2, paragraph (1) of the Act, the Minister delegates all of it to the Minister of Finance, except for the following:
厚生労働大臣は、法第二百四条の二第一項の規定により滞納処分等その他の処分の権限を委任する場合においては、次に掲げるものを除き、その全部を財務大臣に委任する。
the notice under Article 138 of the National Tax Collection Act (Act No. 147 of 1959), which is to be governed by the same rules pursuant to the provisions of Article 183 of the Act;
法第百八十三条の規定によりその例によるものとされる国税徴収法（昭和三十四年法律第百四十七号）第百三十八条の規定による告知
the suspension of the execution of a disposition for arrears under Article 153, paragraph (1) of the National Tax Collection Act, which is to be governed by the same rules pursuant to the provisions of Article 183 of the Act;
法第百八十三条の規定によりその例によるものとされる国税徴収法第百五十三条第一項の規定による滞納処分の執行の停止
the extension under Article 11 of the Act on General Rules for National Taxes (Act No. 66 of 1962), which is to be governed by the same rules pursuant to the provisions of Article 183 of the Act;
法第百八十三条の規定によりその例によるものとされる国税通則法（昭和三十七年法律第六十六号）第十一条の規定による延長
the notice under Article 36, paragraph (1) of the Act on General Rules for National Taxes, which is to be governed by the same rules pursuant to the provisions of Article 183 of the Act;
法第百八十三条の規定によりその例によるものとされる国税通則法第三十六条第一項の規定による告知
the acceptance of entrustment under Article 55, paragraph (1) of the Act on General Rules for National Taxes, which is to be governed by the same rules pursuant to the provisions of Article 183 of the Act;
法第百八十三条の規定によりその例によるものとされる国税通則法第五十五条第一項の規定による受託
the exemption under Article 63 of the Act on General Rules for National Taxes, which is to be governed by the same rules pursuant to the provisions of Article 183 of the Act;
法第百八十三条の規定によりその例によるものとされる国税通則法第六十三条の規定による免除
the delivery under Article 123, paragraph (1) of the Act on General Rules for National Taxes, which is to be governed by the same rules pursuant to the provisions of Article 183 of the Act; and
法第百八十三条の規定によりその例によるものとされる国税通則法第百二十三条第一項の規定による交付
authority specified by Order of the Ministry of Health, Labour and Welfare, in addition to that listed in the preceding items.
前各号に掲げるもののほか、厚生労働省令で定める権限
第六十四条の二（国税局長又は税務署長への権限の委任に関する厚生年金保険法の規定の読替え）
Article 64-2Replacement of Terms in the Provisions of the Employees' Pension Insurance Act Concerning Delegation of Authority to a Regional Commissioner or a District Director
Where the provisions of Article 100-5, paragraphs (6) and (7) of the Employees' Pension Insurance Act apply mutatis mutandis pursuant to Article 204-2, paragraph (2) of the Act, the phrase "locality of the place of business or office" in those provisions is deemed to be replaced with "locality of the place of business or office (in the case of an applicable place of business under Article 34, paragraph (1) of the Act, the locality of the place of business or office designated by the Minister of Health, Labour and Welfare from among the two or more places of business or offices that became one applicable place of business pursuant to that paragraph)".
法第二百四条の二第二項の規定により厚生年金保険法第百条の五第六項及び第七項の規定を準用する場合においては、これらの規定中「所在地」とあるのは、「所在地（法第三十四条第一項の適用事業所にあつては、同項の規定により一の適用事業所となつた二以上の事業所又は事務所のうちから厚生労働大臣が指定する事業所又は事務所の所在地）」と読み替えるものとする。
Article 64-3Delegation of Authority to a Regional Commissioner or a District Director
The Commissioner of the National Tax Agency delegates all of the authority delegated pursuant to the provisions of Article 100-5, paragraph (5) of the Employees' Pension Insurance Act as applied mutatis mutandis pursuant to Article 204-2, paragraph (2) of the Act, to the regional commissioner having jurisdiction over the locality of the place of business of the person liable for payment (in the case of an applicable place of business under Article 34, paragraph (1) of the Act, the locality of the place of business designated by the Minister of Health, Labour and Welfare from among the two or more places of business that became one applicable place of business pursuant to that paragraph; the same applies in the following paragraph).
国税庁長官は、法第二百四条の二第二項において準用する厚生年金保険法第百条の五第五項の規定により委任された権限の全部を、納付義務者の事業所の所在地（法第三十四条第一項の適用事業所にあっては、同項の規定により一の適用事業所となった二以上の事業所のうちから厚生労働大臣が指定する事業所の所在地。次項において同じ。）を管轄する国税局長に委任する。
A regional commissioner, when finding it necessary, delegates all of the authority delegated pursuant to the provisions of Article 100-5, paragraph (6) of the Employees' Pension Insurance Act as applied mutatis mutandis pursuant to Article 204-2, paragraph (2) of the Act, to the district director having jurisdiction over the locality of the place of business of the person liable for payment.
国税局長は、必要があると認めるときは、法第二百四条の二第二項において準用する厚生年金保険法第百条の五第六項の規定により委任された権限の全部を、納付義務者の事業所の所在地を管轄する税務署長に委任する。
Article 64-4Cases Where JPS Carries Out Receipt
The cases specified by Cabinet Order as referred to in Article 204-6, paragraph (1) of the Act are the following cases:
法第二百四条の六第一項の政令で定める場合は、次に掲げる場合とする。
where a person liable for payment who has received a demand pursuant to the provisions of Article 180, paragraph (2) of the Act has made a request to the effect that the person wishes to pay premiums, etc. at a pension office prescribed in Article 29 of the Japan Pension Organization Act (Act No. 109 of 2007) (referred to as a "pension office" in the following item and paragraph (2) of the following Article);
where a person liable for payment who has received notice of payment of premiums with the due date advanced, owing to falling under any of the items of Article 172 of the Act, has made a request to the effect that the person wishes to pay premiums at a pension office;
where an employee of the Japan Pension Service (hereinafter referred to as "JPS") that carries out the receipt under Article 204-6, paragraph (1) of the Act, appointed pursuant to the provisions of Article 100-11, paragraph (2) of the Employees' Pension Insurance Act as applied mutatis mutandis pursuant to Article 204-6, paragraph (2) of the Act (referred to as a "receiving employee" in item (v) and Article 64-9), who has also been appointed as a collection official under Article 204-3, paragraph (1) of the Act pursuant to the provisions of Article 100-6, paragraph (2) of the Employees' Pension Insurance Act as applied mutatis mutandis pursuant to Article 204-3, paragraph (2) of the Act (hereinafter referred to as an "employee" in this item and the following item), visits a person liable for payment prescribed in the preceding two items in order to collect premiums, etc., and that person liable for payment requests that the employee receive the premiums, etc.;
法第二百四条の六第二項において準用する厚生年金保険法第百条の十一第二項の規定により任命された法第二百四条の六第一項の収納を行う日本年金機構（以下「機構」という。）の職員（第五号及び第六十四条の九において「収納職員」という。）であって併せて法第二百四条の三第一項の徴収職員として同条第二項において準用する厚生年金保険法第百条の六第二項の規定により任命された者（以下この号及び次号において「職員」という。）が、保険料等を徴収するため、前二号に規定する納付義務者を訪問した際に、当該納付義務者が当該職員による保険料等の収納を希望した場合
where an employee has obtained money, in order to collect premiums, etc., through a disposition listed in Article 204, paragraph (1), item (xv) of the Act that is governed by the same rules as dispositions of a national tax delinquency;
職員が、保険料等を徴収するため法第二百四条第一項第十五号に掲げる国税滞納処分の例による処分により金銭を取得した場合
in addition to the cases listed in the preceding items, cases specified by Order of the Ministry of Health, Labour and Welfare as cases where receipt of premiums, etc. by receiving employees contributes to the convenience of persons liable for payment, or other cases where receipt of premiums, etc. by receiving employees is appropriate and effective.
Article 64-5Public Notice
When the Minister of Health, Labour and Welfare has JPS carry out the receipt of premiums, etc. pursuant to the provisions of Article 204-6, paragraph (1) of the Act, the Minister must give public notice to that effect.
厚生労働大臣は、法第二百四条の六第一項の規定により機構に保険料等の収納を行わせるに当たり、その旨を公示しなければならない。
When the public notice referred to in the preceding paragraph has been given, JPS must, without delay, make public the names and locations of pension offices and other matters necessary for the receipt of premiums, etc. as specified by Order of the Ministry of Health, Labour and Welfare; the same applies when it has changed them.
第六十四条の六（機構が行う収納に関する厚生年金保険法の規定の読替え）
Article 64-6Replacement of Terms in the Provisions of the Employees' Pension Insurance Act Concerning Receipt by JPS
The technical replacement of terms in the application mutatis mutandis of the Employees' Pension Insurance Act pursuant to Article 204-6, paragraph (2) of the Act is as set out in the following table, in which the words listed in the middle column in the provisions listed in the left-hand column are deemed to be replaced with the words listed in the right-hand column.
| Provision of the Employees' Pension Insurance Act in which words are to be replaced | Words to be replaced | Words to replace them |
| Article 100-11, paragraph (2) | the preceding paragraph | Article 204-6, paragraph (1) of the Health Insurance Act |
| JPS officials undertaking | officials of the Japan Pension Service (hereinafter referred to as "JPS") undertaking | |
| Article 100-11, paragraph (3) | paragraph (1) | Article 204-6, paragraph (1) of the Health Insurance Act |
| premiums or other such monies | premiums or other such monies (meaning the premiums, etc. prescribed in Article 204-2, paragraph (1) of the Health Insurance Act; the same applies in paragraph (6)) | |
| Article 100-11, paragraph (5) | the preceding two paragraphs | the preceding two paragraphs as applied mutatis mutandis pursuant to Article 204-6, paragraph (2) of the Health Insurance Act |
| Article 100-11, paragraph (6) | each of the preceding paragraphs | Article 204-6, paragraph (1) of the Health Insurance Act and paragraph (2) through the preceding paragraph as applied mutatis mutandis pursuant to paragraph (2) of that Article |
| receipt of premiums and other such monies | receipt of premiums and other such monies under paragraph (1) of that Article |
法第二百四条の六第二項の規定による厚生年金保険法の準用についての技術的読替えは、次の表のとおりとする。
| 厚生年金保険法の規定中読み替える規定 | 読み替えられる字句 | 読み替える字句 |
| 第百条の十一第二項 | 前項 | 健康保険法第二百四条の六第一項 |
| 行う機構 | 行う日本年金機構（以下「機構」という。） | |
| 第百条の十一第三項 | 第一項 | 健康保険法第二百四条の六第一項 |
| 保険料等 | 保険料等（同法第二百四条の二第一項に規定する保険料等をいう。第六項において同じ。） | |
| 第百条の十一第五項 | 前二項 | 健康保険法第二百四条の六第二項において準用する前二項 |
| 第百条の十一第六項 | 前各項 | 健康保険法第二百四条の六第一項及び同条第二項において準用する第二項から前項まで |
| 第一項 | 同条第一項 |
Article 64-7Deadline for Receipt of Premiums, etc.
JPS may receive premiums, etc. belonging to each fiscal year of the national government only up to April 30 of the following fiscal year.
Article 64-8Procedures for Receipt by JPS
When JPS has carried out receipt under Article 204-6, paragraph (1) of the Act with respect to premiums, etc., it must issue a receipt to the person who paid those premiums, etc., as specified by Order of the Ministry of Health, Labour and Welfare. In this case, JPS must, without delay, report to the revenue collection officer of the Pension Special Account that it has carried out that receipt, as specified by Order of the Ministry of Health, Labour and Welfare.
機構は、保険料等につき、法第二百四条の六第一項の規定による収納を行ったときは、当該保険料等の納付をした者に対し、厚生労働省令で定めるところにより、領収証書を交付しなければならない。この場合において、機構は、厚生労働省令で定めるところにより、遅滞なく、当該収納を行った旨を年金特別会計の歳入徴収官に報告しなければならない。
When the Minister of Health, Labour and Welfare establishes the Order of the Ministry of Health, Labour and Welfare prescribed in the preceding paragraph, the Minister must consult the Minister of Finance in advance.
厚生労働大臣は、前項に規定する厚生労働省令を定めるときは、あらかじめ、財務大臣に協議しなければならない。
Article 64-9Keeping of Books
JPS must keep books concerning the receipt of premiums, etc. by receiving employees and the remittance to the Bank of Japan of the premiums, etc. so received, and must record in them the matters concerning the receipt and remittance of those premiums, etc.
Article 64-10Delegation to Order of the Ministry of Health, Labour and Welfare
In addition to what is provided for in Article 64-4 through the preceding Article, matters necessary for receipt by JPS pursuant to Article 204-6 of the Act are specified by Order of the Ministry of Health, Labour and Welfare.
第六十四条の四から前条までに定めるもののほか、法第二百四条の六の規定により機構が行う収納について必要な事項は、厚生労働省令で定める。
When the Minister of Health, Labour and Welfare establishes the Order of the Ministry of Health, Labour and Welfare prescribed in the preceding paragraph, the Minister must consult the Minister of Finance in advance.
厚生労働大臣は、前項に規定する厚生労働省令を定めるときは、あらかじめ、財務大臣に協議しなければならない。
第六十四条の十一（機構への事務の委託に関する厚生年金保険法の規定の読替え）
Article 64-11Replacement of Terms in the Provisions of the Employees' Pension Insurance Act Concerning Delegation of Administration to JPS
The technical replacement of terms in the application mutatis mutandis of the Employees' Pension Insurance Act pursuant to Article 205-2, paragraph (2) of the Act is as set out in the following table, in which the words listed in the middle column in the provisions listed in the left-hand column are deemed to be replaced with the words listed in the right-hand column.
| Provision of the Employees' Pension Insurance Act in which words are to be replaced | Words to be replaced | Words to replace them |
| Article 100-10, paragraph (2) | for JPS to implement | for the Japan Pension Service (referred to as "JPS" in the following paragraph) to implement |
| the items of the preceding paragraph | the items of Article 205-2, paragraph (1) of the Health Insurance Act | |
| Article 100-10, paragraph (3) | the preceding two paragraphs | Article 205-2, paragraph (1) of the Health Insurance Act and the preceding paragraph as applied mutatis mutandis pursuant to paragraph (2) of that Article |
| the items of paragraph (1) | the items of paragraph (1) of that Article |
法第二百五条の二第二項の規定による厚生年金保険法の準用についての技術的読替えは、次の表のとおりとする。
| 厚生年金保険法の規定中読み替える規定 | 読み替えられる字句 | 読み替える字句 |
| 第百条の十第二項 | 機構 | 日本年金機構（次項において「機構」という。） |
| 前項各号 | 健康保険法第二百五条の二第一項各号 | |
| 第百条の十第三項 | 前二項 | 健康保険法第二百五条の二第一項及び同条第二項において準用する前項 |
| 第一項各号 | 同条第一項各号 |
Article 65Grant
The project for the provision of grants carried out by the federation pursuant to Article 2, paragraph (1) of the Supplementary Provisions of the Act must conform to the following standards:
a health insurance society that is to be covered by the provision of grants is to fall under either of the following:
交付金の交付の対象となる健康保険組合は、次のいずれかに該当するものであること。
a health insurance society whose required premium rate (meaning the rate obtained by dividing the estimated amount of the expenses required for the benefits relating to medical care provided by each health insurance society in that year (excluding other benefits prescribed in Article 53 of the Act; hereinafter referred to as "medical care benefits") and for payment of young-old payments, etc., aid for the old-old, etc., day laborer contributions, and contributions for securing medical care in the early phase of an epidemic, etc. (the amount after deducting the amount of childbirth and childcare grants (where there is a young-old subsidy, the amount of childbirth and childcare grants and the young-old subsidy)) by the estimated amount of the total sum of the total amount of standard monthly remuneration and the total amount of standard bonus amounts of the insured persons who are members of that health insurance society in that year; the same applies hereinafter) is the average required premium rate of all health insurance societies that are members of the federation or more, and for which it is found necessary to lighten the financial burden relating to the provision of medical care benefits, the implementation of healthcare services and welfare services, and the payment of young-old payments, etc., aid for the old-old, etc., day laborer contributions, and contributions for securing medical care in the early phase of an epidemic, etc.;
その所要保険料率（当該年度において各健康保険組合が行った医療に関する給付（法第五十三条に規定するその他の給付を除く。以下「医療給付」という。）並びに前期高齢者納付金等、後期高齢者支援金等及び日雇拠出金並びに流行初期医療確保拠出金等の納付に要した費用の額（出産育児交付金（前期高齢者交付金がある場合には、出産育児交付金及び前期高齢者交付金）の額を控除した額）の見込額を当該年度における当該各健康保険組合の組合員である被保険者の標準報酬月額の総額及び標準賞与額の総額の合算額の見込額で除して得た率をいう。以下同じ。）が連合会の会員である全健康保険組合の平均の所要保険料率以上である健康保険組合であって、医療給付、保健事業及び福祉事業の実施並びに前期高齢者納付金等、後期高齢者支援金等及び日雇拠出金並びに流行初期医療確保拠出金等の納付に係る財政の負担を軽減することが必要であると認められるもの
a health insurance society other than a health insurance society listed in (a), for which it is found necessary to mitigate the impact in light of the occurrence of high-cost medical care benefits, a decline in the level of remuneration and other factors having a considerable impact on the financial situation of health insurance societies relating to the provision of medical care benefits, the implementation of healthcare services and welfare services, and the payment of young-old payments, etc., aid for the old-old, etc., day laborer contributions, and contributions for securing medical care in the early phase of an epidemic, etc.;
イに掲げる健康保険組合以外の健康保険組合であって、高額な医療給付の発生、報酬の水準の低下その他医療給付、保健事業及び福祉事業の実施並びに前期高齢者納付金等、後期高齢者支援金等及び日雇拠出金並びに流行初期医療確保拠出金等の納付に係る健康保険組合の財政状況に相当程度の影響を及ぼす要因に照らし、その影響を緩和することが必要であると認められるもの
the scale of the project for the provision of grants and the method of their provision are to be such that, with respect to the projects carried out by health insurance societies, consideration is given so as not to impede the autonomous management of health insurance societies and not to cause the business efforts of health insurance societies to be lost.
交付金の交付事業の規模及び交付方法は、健康保険組合が行う事業について、健康保険組合の自主的な運営を妨げず、かつ、健康保険組合の事業努力を失わせないよう配慮されたものであること。
Matters necessary for the application of the standards in the preceding paragraph, matters necessary for the calculation of the amount of grants, and other matters necessary for the provision of grants are specified by Order of the Ministry of Health, Labour and Welfare.
前項の基準の適用に関し必要な事項、交付金の額の算定に関し必要な事項その他交付金の交付に関して必要な事項は、厚生労働省令で定める。
The federation must, in accordance with the Order of the Ministry of Health, Labour and Welfare referred to in the preceding paragraph, specify the details concerning the provision of grants.
Article 66Contributions
The amount of contributions that a health insurance society is to contribute to the federation pursuant to Article 2, paragraph (2) of the Supplementary Provisions of the Act is, for each fiscal year, the total amount of the adjusted premiums collected by that health insurance society pursuant to paragraph (3) of that Article.
In addition to what is provided for in the preceding paragraph, the method of payment of contributions and other matters necessary for the making of contributions are specified by the federation.
Article 67Adjustment Rate for Premiums
The adjustment rate for premiums referred to in Article 2, paragraph (4) of the Supplementary Provisions of the Act is the rate obtained by multiplying the basic adjustment rate for premiums by the revision rate.
法附則第二条第四項の調整保険料率は、基本調整保険料率に修正率を乗じて得た率とする。
The basic adjustment rate for premiums referred to in the preceding paragraph is, for the period from March of each year to February of the following year, the rate determined by the Minister of Health, Labour and Welfare as the rate obtained by dividing the estimated amount of the total amount of grants to be granted by the federation in the fiscal year following the fiscal year to which that March belongs by the estimated amount of the total sum of the total amount of standard monthly remuneration and the total amount of standard bonus amounts of the insured persons who are members of all health insurance societies that are members of the federation in that following fiscal year.
The revision rate referred to in paragraph (1) is to be determined by the federation, for each health insurance society and for the period from March of each year to February of the following year, on the basis of the ratio of the rate obtained by dividing the estimated amount of the expenses required for the medical care benefits to be provided by that health insurance society in the fiscal year to which that March belongs and for payment of young-old payments, etc., aid for the old-old, etc., day laborer contributions, and contributions for securing medical care in the early phase of an epidemic, etc. (the amount after deducting the amount of childbirth and childcare grants (where there is a young-old subsidy, the amount of childbirth and childcare grants and the young-old subsidy)) by the estimated amount of the total sum of the total amount of standard monthly remuneration and the total amount of standard bonus amounts of the insured persons who are members of that health insurance society in that fiscal year (hereinafter referred to in this paragraph as the "estimated required premium rate") to the average estimated required premium rate of all health insurance societies that are members of the federation; provided, however, that it must not exceed the rate determined by the Minister of Health, Labour and Welfare.
第一項の修正率は、各健康保険組合につき、各年の三月から翌年の二月までの期間について、当該三月の属する年度において当該健康保険組合が行う医療給付並びに前期高齢者納付金等、後期高齢者支援金等及び日雇拠出金並びに流行初期医療確保拠出金等の納付に要する費用の見込額（出産育児交付金（前期高齢者交付金がある場合には、出産育児交付金及び前期高齢者交付金）の額を控除した額）を当該年度における当該健康保険組合の組合員である被保険者の標準報酬月額の総額及び標準賞与額の総額の合算額の見込額で除して得た率（以下この項において「見込所要保険料率」という。）の連合会の会員である全健康保険組合の平均の見込所要保険料率に対する比率を基準として、連合会が定める。ただし、厚生労働大臣の定める率を超えてはならない。
Article 68Details Concerning the Granting of Grants, etc.
When the federation intends to specify or change the details concerning the provision of grants or the matters necessary for the contribution of contributions pursuant to the provisions of Article 65, paragraph (3) or Article 66, paragraph (2), or intends to specify the revision rate pursuant to the provisions of paragraph (3) of the preceding Article, it must obtain the approval of the Minister of Health, Labour and Welfare.
Article 68-2National Treasury Burden Pursuant to Article 2-2 of the Supplementary Provisions of the Act
The societies specified by Cabinet Order as referred to in Article 2-2 of the Supplementary Provisions of the Act are the health insurance societies prescribed in Article 65, paragraph (1), item (i), (b).
法附則第二条の二の政令で定める組合は、第六十五条第一項第一号ロに規定する健康保険組合とする。
The national government is to bear, for each fiscal year, with respect to part of the expenses required for granting to the federation the grants referred to in Article 2, paragraph (1) of the Supplementary Provisions of the Act that target the health insurance societies prescribed in the preceding paragraph in that fiscal year, the amount specified in the budget for that fiscal year.
Article 69Corporations Specified by Cabinet Order
The corporations specified by Cabinet Order as referred to in Article 4, paragraph (1) of the Supplementary Provisions of the Act are as follows:
法附則第四条第一項の政令で定めるものは、次のとおりとする。
a corporation organized by the employers of places of business other than places of business at which a health insurance society is organized and the insured persons employed at those places of business, the purpose of which is to carry out the business of benefits prescribed in Article 4, paragraph (1) of the Supplementary Provisions of the Act (referred to as "benefit business" in the following Article);
in addition to what is listed in the preceding item, a corporation whose members are the employers prescribed in that item.
Article 70Requirements for Approved Corporations, etc.
The requirements specified by Cabinet Order as referred to in Article 4, paragraph (1) of the Supplementary Provisions of the Act are as follows:
法附則第四条第一項の政令で定める要件は、次のとおりとする。
for a corporation listed in item (i) of the preceding Article, not to carry out business of benefits other than the benefits prescribed in Article 4, paragraph (1) of the Supplementary Provisions of the Act, and for a corporation listed in item (ii) of the preceding Article, not to carry out business of benefits similar to the benefits prescribed in Article 4, paragraph (1) of the Supplementary Provisions of the Act;
the great majority of the insured persons employed at the place of business concerned participate in the benefit business;
the expenses required for the benefit business are covered by the contributions under Article 4, paragraph (3) of the Supplementary Provisions of the Act, and those contributions are not applied to expenses other than the expenses required for the benefit business;
accounting for the benefit business is conducted separately from accounting for other businesses;
給付事業に係る経理は、他の事業に係る経理と区分して行うものであること。
its articles of incorporation provide that, where the benefit business is abolished, the residual assets relating to the benefit business vest in a corporation that conducts business relating to health insurance;
その定款において、給付事業を廃止した場合に給付事業に係る残余の資産が健康保険に関する事業を行う法人に帰属する旨の定めがあること。
in addition to what is listed in the preceding items, it satisfies the requirements specified by Order of the Ministry of Health, Labour and Welfare as necessary for the benefit business to be implemented appropriately and reliably.
When an approved corporation referred to in Article 4, paragraph (1) of the Supplementary Provisions of the Act ceases to satisfy any of the requirements listed in the items of the preceding paragraph, the Minister of Health, Labour and Welfare is to rescind the approval referred to in paragraph (1) of that Article.
Article 71Special Provisions for Calculating the Long-Term Care Insurance Rate for Specified Insured Persons
With respect to the application of Article 160, paragraph (16) of the Act to a health insurance society that has, pursuant to the provisions of Article 7, paragraph (1) of the Supplementary Provisions of the Act, made the amount of premium for specified insured persons (meaning the specified insured persons prescribed in that paragraph; the same applies hereinafter) the total sum of the amount of general premium, etc. and the amount of long-term care insurance premium, the phrase "the insured persons administered by the insurer who are item (ii) insured persons" in Article 160, paragraph (16) of the Act is deemed to be replaced with "the insured persons administered by the insurer who are item (ii) insured persons and the specified insured persons prescribed in Article 7, paragraph (1) of the Supplementary Provisions of the Act whose amount of premium has been made the total sum of the amount of general premium, etc. and the amount of long-term care insurance premium pursuant to the provisions of that paragraph".
Article 72Requirements for Approved Health Insurance Societies
The requirements specified by Cabinet Order as referred to in Article 8, paragraph (1) of the Supplementary Provisions of the Act are that the society meeting of the health insurance society concerned has resolved, by a majority of two-thirds or more of the fixed number of society meeting members, to make the amount of premium for insured persons who are item (ii) insured persons (including specified insured persons) the total sum of the amount of general premium, etc. and the amount of special long-term care insurance premium.
Article 73Standards for Calculating the Amount of Special Long-Term Care Insurance Premium
The standards for calculating the amount of special long-term care insurance premium specified by Cabinet Order as referred to in Article 8, paragraph (2) of the Supplementary Provisions of the Act are as follows:
法附則第八条第二項の政令で定める特別介護保険料額の算定の基準は、次のとおりとする。
the amount of special long-term care insurance premium relating to each insured person who is an item (ii) insured person or specified insured person (hereinafter referred to as an "insured person, etc. bearing the special long-term care insurance premium" in this Article) is not to exceed the amount obtained by multiplying the standard long-term care insurance premium amount prescribed in the following item by the total number of insured persons who are item (ii) insured persons and dependents relating to that insured person, etc. bearing the special long-term care insurance premium;
the standard long-term care insurance premium amount is to fall under all of the following:
基準介護保険料額は、次のいずれにも該当するものであること。
it is a fixed amount for one grade, or two or more grades, of standard monthly remuneration;
一又は二以上の標準報酬月額の等級区分について一定の額であること。
the standard long-term care insurance premium amount for insured persons, etc. bearing the special long-term care insurance premium who belong to a grade of lower standard monthly remuneration does not exceed the standard long-term care insurance premium amount for insured persons, etc. bearing the special long-term care insurance premium who belong to a grade of higher standard monthly remuneration.
標準報酬月額の低い等級区分に属する特別介護保険料負担被保険者等の基準介護保険料額が標準報酬月額の高い等級区分に属する特別介護保険料負担被保険者等の基準介護保険料額を上回るものでないこと。
第七十三条の二（特定減額特例対象者であった者の被保険者資格の取得の時期に関する読替え）
Article 73-2Reading of Terms Concerning the Time of Acquisition of Status as an Insured Person by a Person Who Was a Specified Person under the Reduced Minimum Wage Exception
In the application of Article 35 of the Act to a case where a person who was a specified person under the reduced minimum wage exception (meaning a specified person under the reduced minimum wage exception prescribed in Article 8-3-2, paragraph (1) of the Supplementary Provisions of the Act; the same applies hereinafter in this Article) has continued to be employed at the same place of business from before the day on which the person ceased to fall under a specified person under the reduced minimum wage exception, and on that day does not fall under any of the items of Article 3, paragraph (1) of the Act, the phrase "the day on which the person has become an employee of an applicable place of business, the day on which the place of business employing the person has become an applicable place of business, or the day on which the provisions of the proviso to Article 3, paragraph (1) are no longer applicable" in Article 35 of the Act is deemed to be replaced with "the most recent day among the days on which the person ceased to fall under a specified person under the reduced minimum wage exception prescribed in Article 8-3-2, paragraph (1) of the Supplementary Provisions".
特定減額特例対象者（法附則第八条の三の二第一項に規定する特定減額特例対象者をいう。以下この条において同じ。）であった者が特定減額特例対象者に該当しなくなった日前から引き続き同一の事業所に使用され、かつ、同日において法第三条第一項各号のいずれにも該当しない場合における法第三十五条の規定の適用については、同条中「適用事業所に使用されるに至った日若しくはその使用される事業所が適用事業所となった日又は第三条第一項ただし書の規定に該当しなくなった日」とあるのは、「附則第八条の三の二第一項に規定する特定減額特例対象者に該当しなくなった日のうち直近の日」とする。
第七十三条の三（法附則第八条の三の二第二項被保険者の被保険者資格の取得及び喪失についての取扱い）
Article 73-3Treatment of the Acquisition and Loss of Status as an Insured Person of an Insured Person under Article 8-3-2, Paragraph (2) of the Supplementary Provisions of the Act
In the case where an insured person under Article 8-3-2, paragraph (2) of the Supplementary Provisions of the Act (meaning an insured person under paragraph (2) of that Article prescribed in paragraph (5) of that Article; the same applies in the following paragraph) has continued to be employed at the same place of business from before the day on which the person came to fall under paragraph (6), item (ii) of that Article, and on that day does not fall under any of the items of Article 3, paragraph (1) of the Act, the main clause of Article 39, paragraph (1), Article 41, paragraph (3) and Article 42, paragraph (1) of the Act, and other provisions specified by Order of the Ministry of Health, Labour and Welfare (including cases where they are cited, applied mutatis mutandis, or applied by following them in other laws and regulations) do not apply.
法附則第八条の三の二第二項被保険者（法附則第八条の三の二第五項に規定する同条第二項の規定による被保険者をいう。次項において同じ。）が同条第六項第二号に該当するに至った日前から引き続き同一の事業所に使用され、かつ、同日において法第三条第一項各号のいずれにも該当しない場合においては、法第三十九条第一項本文、第四十一条第三項及び第四十二条第一項の規定その他厚生労働省令で定める規定（他の法令において、引用し、準用し、又はその例による場合を含む。）は、適用しない。
In the application of Article 48, Article 104, Article 105, paragraph (1), Article 106, Article 156, paragraph (3) and the main clause of Article 158 of the Act, and other provisions specified by Order of the Ministry of Health, Labour and Welfare (including cases where they are cited, applied mutatis mutandis, or applied by following them in other laws and regulations), to a case where an insured person under Article 8-3-2, paragraph (2) of the Supplementary Provisions of the Act has continued to be employed at the same place of business from before the day on which the person came to fall under Article 8-3-2, paragraph (6), item (ii) of the Supplementary Provisions of the Act, and on that day does not fall under any of the items of Article 3, paragraph (1) of the Act, the person is deemed not to have acquired or lost status as an insured person on the day on which the person came to fall under Article 8-3-2, paragraph (6), item (ii) of the Supplementary Provisions of the Act.
法附則第八条の三の二第二項被保険者が法附則第八条の三の二第六項第二号に該当するに至った日前から引き続き同一の事業所に使用され、かつ、同日において法第三条第一項各号のいずれにも該当しない場合における法第四十八条、第百四条、第百五条第一項、第百六条、第百五十六条第三項及び第百五十八条本文の規定その他厚生労働省令で定める規定（他の法令において、引用し、準用し、又はその例による場合を含む。）の適用については、法附則第八条の三の二第六項第二号に該当するに至った日に被保険者の資格を取得し、又は喪失しなかったものとみなす。
略称規定第二十条第一項・この規定及び第二十九条及び第四十六条の中だけ
健康保険組合は、保険給付に要する費用（高齢者の医療の確保に関する法律（昭和五十七年法律第八十号）の規定による前期高齢者納付金等（以下「前期高齢者納付金等」という。）、同法の規定による後期高齢者支援金、後期高齢者関係事務費拠出金及び出産育児…
わかりやすく言うと
介護保険法の規定により医療保険者から徴収される介護給付費・地域支援事業支援納付金のことです。健康保険組合の保険給付に要する費用には、この納付に要する費用も含まれます。
略称規定第二十条第一項
健康保険組合は、保険給付に要する費用（高齢者の医療の確保に関する法律（昭和五十七年法律第八十号）の規定による前期高齢者納付金等（以下「前期高齢者納付金等」という。）、同法の規定による後期高齢者支援金、後期高齢者関係事務費拠出金及び出産育児…
わかりやすく言うと
高齢者の医療の確保に関する法律により、保険者から年度ごとに徴収される前期高齢者納付金と前期高齢者関係事務費拠出金をまとめた呼び名です。
略称規定第二十条第一項
健康保険組合は、保険給付に要する費用（高齢者の医療の確保に関する法律（昭和五十七年法律第八十号）の規定による前期高齢者納付金等（以下「前期高齢者納付金等」という。）、同法の規定による後期高齢者支援金、後期高齢者関係事務費拠出金及び出産育児…
わかりやすく言うと
子ども・子育て支援法に基づき、一定の交付金の交付、出生後休業支援給付金と育児時短就業給付金の支給、国民年金の保険料に相当する額の補塡、子ども・子育て支援特例公債等の償還などの費用に充てるため、政府が令和八年度から毎年度、健康保険者等から徴収する納付金です。
略称規定第二十条第一項
健康保険組合は、保険給付に要する費用（高齢者の医療の確保に関する法律（昭和五十七年法律第八十号）の規定による前期高齢者納付金等（以下「前期高齢者納付金等」という。）、同法の規定による後期高齢者支援金、後期高齢者関係事務費拠出金及び出産育児…
わかりやすく言うと
高齢者の医療の確保に関する法律により保険者から徴収される後期高齢者支援金と後期高齢者関係事務費拠出金、それに出産育児関係事務費拠出金をまとめた呼び名です。
略称規定第二十条第一項
健康保険組合は、保険給付に要する費用（高齢者の医療の確保に関する法律（昭和五十七年法律第八十号）の規定による前期高齢者納付金等（以下「前期高齢者納付金等」という。）、同法の規定による後期高齢者支援金、後期高齢者関係事務費拠出金及び出産育児…
わかりやすく言うと
日雇特例被保険者に係る健康保険事業の費用に充てるため、厚生労働大臣が毎年度、日雇特例被保険者を使用する事業主が設立した健康保険組合などから徴収する拠出金のことです（健康保険法第百七十三条）。
略称規定第二十条第一項
健康保険組合は、保険給付に要する費用（高齢者の医療の確保に関する法律（昭和五十七年法律第八十号）の規定による前期高齢者納付金等（以下「前期高齢者納付金等」という。）、同法の規定による後期高齢者支援金、後期高齢者関係事務費拠出金及び出産育児…
わかりやすく言うと
感染症の予防及び感染症の患者に対する医療に関する法律により、医療情報基盤・診療報酬審査支払機構が保険者などから徴収する流行初期医療確保拠出金と流行初期医療確保関係事務費拠出金をまとめた呼び名です。
略称規定第二十九条第一項
法第二十八条第一項の政令で定める要件は、一の年度の決算において支出（経常的なものとして厚生労働大臣が定めるものに限る。）の額が収入（経常的なものとして厚生労働大臣が定めるものに限る。）の額を超える状態が継続し、かつ…
わかりやすく言うと
出産育児一時金と家族出産育児一時金の支給に要する費用の一部に充てるため、高齢者の医療の確保に関する法律の規定により保険者に交付されるお金のことです（健康保険法第百五十二条の二）。
略称規定第二十九条第一項・この条及び第四十六条、第六十七条第三項及び第六十五条第一項第一号イの中だけ
法第二十八条第一項の政令で定める要件は、一の年度の決算において支出（経常的なものとして厚生労働大臣が定めるものに限る。）の額が収入（経常的なものとして厚生労働大臣が定めるものに限る。）の額を超える状態が継続し、かつ…
わかりやすく言うと
各保険者の加入者のうち前期高齢者である加入者の割合によって生じる負担の不均衡を調整するため、高齢者の医療の確保に関する法律に基づいて保険者に交付されるお金のことです。
略称規定第三十条第一項・この規定及び第三十条第二項及び第三十一条の中だけ
法第二十八条第一項に規定する健全化計画（次項及び次条において単に「健全化計画」という。）は、法第二十八条第一項の規定による指定の日の属する年度の翌年度を初年度とする三箇年間の計画とする。
わかりやすく言うと
収支が均衡せず、一定の要件に当たるとして厚生労働大臣の指定を受けた健康保険組合が定め、大臣の承認を受ける財政の健全化に関する計画のことです。指定の日の属する年度の翌年度から三年間の計画とされます。
定義第三十六条第一項第一号・この規定及び第三十六条第一項第二号の中だけ
出産（厚生労働省令で定める基準に該当する出産に限る。）に係る事故（厚生労働省令で定める事由により発生したものを除く。）のうち、出生した者が当該事故により脳性麻痺にかかり、厚生労働省令で定める程度の障害の状態となったもの
わかりやすく言うと
厚生労働省令で定める基準に当たる出産に関する事故（厚生労働省令で定める事由によるものを除きます）のうち、生まれた子がその事故で脳性麻痺になり、厚生労働省令で定める程度の障害の状態になったもののことです。
定義第三十六条の二第一項第一号・この条の中だけ
厚生年金保険法（昭和二十九年法律第百十五号）による障害手当金の支給を受けることとなった日以後に傷病手当金の支給を受けるとする場合の法第九十九条第二項の規定により算定される額の合計額が当該障害手当金の額に達するに至る日における当該合計額
わかりやすく言うと
厚生年金保険法の障害手当金を受けることになった日以後も傷病手当金を受けるとした場合に、その日額（標準報酬月額の平均をもとに健康保険法第九十九条第二項で算定）を積み上げた合計額が、障害手当金の額に達する日における、その合計額のことです。
略称規定第三十八条第一項第一号・この規定及び第三十八条第一項第二号及び第三号の中だけ
国民年金法（昭和三十四年法律第百四十一号）による老齢基礎年金及び同法附則第九条の三第一項の規定による老齢年金並びに国民年金法等の一部を改正する法律（昭和六十年法律第三十四号。次号及び第三号において「昭和六十年国民年金等改正法」という。）第…
わかりやすく言うと
国民年金法等の一部を改正する法律（昭和六十年法律第三十四号）を短く呼ぶ名前です。
略称規定第三十八条第一項第四号
被用者年金制度の一元化等を図るための厚生年金保険法等の一部を改正する法律（平成二十四年法律第六十三号。以下「平成二十四年一元化法」という。）附則第三十六条第五項に規定する改正前国共済法による職域加算額のうち退職を給付事由とするもの及び平成…
わかりやすく言うと
被用者年金制度の一元化等を図るための厚生年金保険法等の一部を改正する法律（平成二十四年法律第六十三号）を短く呼ぶ名前です。
略称規定第四十一条第一項・この項の中だけ
高額療養費は、次に掲げる額を合算した額から次項から第五項までの規定により支給される高額療養費の額を控除した額（以下この項において「一部負担金等世帯合算額」という。）が高額療養費算定基準額を超える場合に支給するものとし、その額は…
わかりやすく言うと
被保険者とその被扶養者が同じ月に病院や薬局などごとに受けた療養（食事療養と生活療養を除きます）の一部負担金など自己負担として残る額を合算し、第二項から第五項で支給される高額療養費を差し引いた額です。七十歳になる月までの療養は、一定額（二万千円など）以上のものだけを合算します。
略称規定第四十一条第一項第一号・この条の中だけ
…診療所、薬局その他の者（以下「病院等」という。）から受けた療養（法第六十三条第二項第一号に規定する食事療養（以下この条において単に「食事療養」という。）、同項第二号に規定する生活療養（以下この条において単に「生活療養」という。）及び当該…
わかりやすく言うと
療養病床に入院する六十五歳になった月の翌月以後の被保険者（特定長期入院被保険者）が、入院と併せて受ける食事の提供と、温度、照明、給水に関する適切な療養環境の形成である療養のことです（健康保険法第六十三条第二項第二号）。
略称規定第四十一条第一項第一号
…診療所、薬局その他の者（以下「病院等」という。）から受けた療養（法第六十三条第二項第一号に規定する食事療養（以下この条において単に「食事療養」という。）、同項第二号に規定する生活療養（以下この条において単に「生活療養」という。）及び当該…
わかりやすく言うと
病院、診療所、薬局その他の者をまとめた呼び名です。高額療養費の計算では、同じ月に受けた療養の自己負担額をこの病院等ごとに数えます。
略称規定第四十一条第一項第一号・この条の中だけ
…診療所、薬局その他の者（以下「病院等」という。）から受けた療養（法第六十三条第二項第一号に規定する食事療養（以下この条において単に「食事療養」という。）、同項第二号に規定する生活療養（以下この条において単に「生活療養」という。）及び当該…
わかりやすく言うと
病院や診療所への入院と併せて行う、食事の提供である療養のことです。療養病床に入院する六十五歳になった月の翌月以後の被保険者（特定長期入院被保険者）の分は除きます（健康保険法第六十三条第二項第一号）。
略称規定第四十一条第一項第二号・この規定及び第四十三条第五項の中だけ
被保険者又はその被扶養者が前号と同一の月にそれぞれ一の病院等から受けた特定給付対象療養（原子爆弾被爆者に対する援護に関する法律（平成六年法律第百十七号）による一般疾病医療費（第四十三条第五項において「原爆一般疾病医療費」という。）の支給そ…
わかりやすく言うと
原子爆弾被爆者に対する援護に関する法律により、被爆者が一定の負傷や病気について医療を受けたときに、その医療に要した費用の額を限度として支給される一般疾病医療費のことです。
定義第四十一条第一項第二号
原子爆弾被爆者に対する援護に関する法律（平成六年法律第百十七号）による一般疾病医療費（第四十三条第五項において「原爆一般疾病医療費」という。）の支給その他厚生労働省令で定める医療に関する給付が行われるべき療養及び当該被保険者又はその被扶養者が第九項の規定による保険者の認定を受けた場合における同項に規定する療養
わかりやすく言うと
原子爆弾被爆者に対する援護に関する法律による一般疾病医療費の支給その他厚生労働省令で定める医療に関する給付が行われるべき療養と、著しく高額な治療を著しく長期間続ける必要がある病気として厚生労働大臣が定めるものについて、第九項の保険者の認定を受けた場合のその療養のことです。
略称規定第四十一条第三項・この項の中だけ
…当該被保険者又はその被扶養者が同一の月にそれぞれ一の病院等から受けた当該療養に係る次に掲げる額を合算した額から次項又は第五項の規定により支給される高額療養費の額を控除した額（以下この項において「七十歳以上一部負担金等世帯合算額」という。…
わかりやすく言うと
七十歳になった月の翌月以後の療養について、被保険者とその被扶養者が同じ月に病院や薬局などごとに受けた療養の自己負担額を合算し、第四項や第五項で支給される高額療養費を差し引いた額です。これが高額療養費算定基準額を超えると、超えた分が高額療養費として支給されます。
略称規定第四十一条第四項第一号・この規定及び第四十一条第四項第三号の中だけ
…月の初日以外の日において同法第五十条の規定による被保険者（以下「後期高齢者医療の被保険者」という。）の資格を取得したことにより健康保険の被保険者の資格を喪失した者（第三号において「七十五歳到達前旧被保険者」という。）が…
わかりやすく言うと
後期高齢者医療広域連合の区域内に住む人（障害の認定を受けた人を除きます）が七十五歳になり、月の初日以外の日に後期高齢者医療の被保険者となったことで、健康保険の被保険者の資格を失った人のことです。
略称規定第四十一条第四項第一号
高齢者の医療の確保に関する法律第五十二条第一号に該当し、月の初日以外の日において同法第五十条の規定による被保険者（以下「後期高齢者医療の被保険者」という。）の資格を取得したことにより健康保険の被保険者の資格を喪失した者（第三号において「七…
わかりやすく言うと
後期高齢者医療広域連合が行う後期高齢者医療の被保険者のことです。広域連合の区域内に住む七十五歳以上の人と、六十五歳以上七十五歳未満で一定の障害の状態にあると広域連合の認定を受けた人がこれに当たります。
略称規定第四十一条第四項第一号・この規定及び第四十一条第四項第三号の中だけ
…同日の前日の属する月（同日以前の期間に限る。第三号において「旧被保険者七十五歳到達月」という。）に受けた療養
わかりやすく言うと
七十五歳到達前旧被保険者が後期高齢者医療の被保険者の資格を取った日の前日が属する月のうち、資格を取った日以前の期間のことです。
定義第四十一条第五項・この規定及び第四十一条の二、第四十二条第六項第三号、第四十二条第七項第三号及び第四十二条第八項第三号の中だけ
法第六十三条第一項第一号から第四号までに掲げる療養（同項第五号に掲げる療養に伴うものを除く。）
わかりやすく言うと
診察、薬剤や治療材料の支給、処置・手術その他の治療、居宅での療養上の管理とそれに伴う世話その他の看護のことで、入院に伴うものは除きます（健康保険法第六十三条第一項）。
定義第四十一条第七項・この規定及び第四十二条第七項の中だけ
特定給付対象療養（当該被保険者又はその被扶養者が第九項の規定による保険者の認定を受けた場合における同項に規定する療養を除く。）のうち、治療方法が確立していない疾病その他の疾病であって、当該疾病にかかることにより長期にわたり療養を必要とすることとなるものの当該療養に必要な費用の負担を軽減するための医療に関する給付として厚生労働大臣が定めるものが行われるべきもの
わかりやすく言うと
特定給付対象療養のうち、治療方法が確立していない病気など長期の療養が必要となる病気について、その療養の費用の負担を軽くするため厚生労働大臣が定める医療に関する給付が行われるべき療養のことです。第九項の保険者の認定を受けた場合の療養は除きます。
略称規定第四十一条の二第一項・この項の中だけ
…第七号から第十二号までに掲げる額を合算した額（以下この項において「基準日被扶養者合算額」という。）又は第十三号から第十八号までに掲げる額を合算した額（以下この項において「元被扶養者合算額」という。）のいずれかが高額療養費算定基準額を超え…
わかりやすく言うと
年間の外来療養の高額療養費の計算で、計算期間中に基準日被保険者か基準日被扶養者の被扶養者だったが、基準日にはそうでない人が、その間に受けた七十歳になった月の翌月以後の外来療養の自己負担額を合算した額です。他の医療保険に入っていた間の分も含みます。
略称規定第四十一条の二第一項・この項の中だけ
高額療養費は、第一号から第六号までに掲げる額を合算した額（以下この項において「基準日被保険者合算額」という。）、第七号から第十二号までに掲げる額を合算した額（以下この項において「基準日被扶養者合算額」という。）又は第十三号から第十八号まで…
わかりやすく言うと
年間の外来療養の高額療養費の計算で、基準日被保険者自身が計算期間に受けた七十歳になった月の翌月以後の外来療養の自己負担額を合算した額です。他の健康保険や国民健康保険などに加入していた間や、被扶養者だった間の分も含み、すでに支給された高額療養費などは差し引きます。
略称規定第四十一条の二第一項・この項の中だけ
高額療養費は、第一号から第六号までに掲げる額を合算した額（以下この項において「基準日被保険者合算額」という。）、第七号から第十二号までに掲げる額を合算した額（以下この項において「基準日被扶養者合算額」という。）又は第十三号から第十八号まで…
わかりやすく言うと
年間の外来療養の高額療養費の計算で、基準日被扶養者が計算期間に受けた七十歳になった月の翌月以後の外来療養の自己負担額を合算した額です。基準日被扶養者が他の健康保険や国民健康保険などに加入していた間や、被保険者だった間の分も含みます。
略称規定第四十一条の二第一項第一号
計算期間（基準日において当該保険者の被保険者（日雇特例被保険者、国家公務員共済組合法及び地方公務員等共済組合法に基づく共済組合の組合員並びに私立学校教職員共済法の規定による私立学校教職員共済制度の加入者を除く。以下この条、第四十三条第十一…
わかりやすく言うと
計算期間の末日（基準日）にこの保険者の被保険者である人のことです。日雇特例被保険者、国家公務員や地方公務員の共済組合の組合員、私立学校教職員共済制度の加入者は除きます。
略称規定第四十一条の二第一項第一号・この条の中だけ
計算期間（基準日において当該保険者の被保険者（日雇特例被保険者、国家公務員共済組合法及び地方公務員等共済組合法に基づく共済組合の組合員並びに私立学校教職員共済法の規定による私立学校教職員共済制度の加入者を除く。以下この条、第四十三条第十一…
わかりやすく言うと
被保険者が資格を失って日雇特例被保険者かその被扶養者になった場合に、資格を失った時に受けていた療養について健康保険法第九十八条第一項（被扶養者についての準用を含みます）により引き続き受ける保険給付に係る外来療養のことです。
略称規定第四十一条の二第三項・この項の中だけ
）が当該保険者 ）が当該他の健康保険の保険者（以下この項において「基準日保険者」という。） 保険者の被保険者（法 基準日保険者の被保険者（法 第一項第二号 他の 基準日保険者以外の 第一項第三号 おいて当該保険者 おいて基準日保険者 が当…
略称規定第四十一条の二第四項・この項の中だけ
）が当該保険者 ）が当該他の健康保険の保険者（以下この項において「基準日保険者」という。） 保険者の被保険者（法 基準日保険者の被保険者（法 第一項第二号 他の 基準日保険者以外の 第一項第三号 おいて当該保険者 おいて基準日保険者 が当…
略称規定第四十一条の二第五項
基準日組合員等を基準日被保険者と、基準日被扶養者等を基準日被扶養者とそれぞれみなして厚生労働省令で定めるところにより算定した第一項第十三号から第十八号までに掲げる額に相当する額を合算した額（以下この表において「元被扶養者合算額」という。）…
わかりやすく言うと
計算期間にこの保険者の被保険者だった人で、基準日には共済組合や国民健康保険などの組合員等である人（基準日組合員等）について、その人を基準日被保険者とみなして、かつての被扶養者が受けた外来療養の自己負担額に当たる額として厚生労働省令で定めるところにより算定した額を合算したものです。
略称規定第四十一条の二第五項・この項の中だけ
計算期間において当該保険者の被保険者であった者（基準日において組合等（高齢者の医療の確保に関する法律に基づく後期高齢者医療広域連合を除く。）の組合員等（第九項に規定する国民健康保険の世帯主等であって被保険者又はその被扶養者である者及び後期…
わかりやすく言うと
計算期間にこの保険者の被保険者だった人で、基準日には共済組合や国民健康保険などの組合員等である人のことです。後期高齢者医療の被保険者と、国民健康保険の世帯主等で健康保険の被保険者か被扶養者でもある人は除きます。
略称規定第四十一条の二第五項
基準日組合員等を基準日被保険者と、基準日被扶養者等（基準日において当該基準日組合員等の被扶養者等である者をいう。以下この表において同じ。）を基準日被扶養者とそれぞれみなして厚生労働省令で定めるところにより算定した第一項第一号から第六号まで…
わかりやすく言うと
基準日組合員等を基準日被保険者と、基準日にその被扶養者等である人を基準日被扶養者とみなし、基準日組合員等が計算期間に受けた外来療養の自己負担額（第一項第一号から第六号まで）に当たる額として厚生労働省令で定めるところにより算定した額を合算したものです。
略称規定第四十一条の二第五項
基準日組合員等を基準日被保険者と、基準日被扶養者等を基準日被扶養者とそれぞれみなして厚生労働省令で定めるところにより算定した第一項第七号から第十二号までに掲げる額に相当する額を合算した額（以下この表において「基準日被扶養者等合算額」という…
わかりやすく言うと
基準日組合員等を基準日被保険者と、基準日にその被扶養者等である人を基準日被扶養者とみなし、その基準日被扶養者が計算期間に受けた外来療養の自己負担額（第一項第七号から第十二号まで）に当たる額として厚生労働省令で定めるところにより算定した額を合算したものです。
略称規定第四十一条の二第七項
…基準日後期高齢者医療被保険者以外後期高齢者医療被保険者を基準日被扶養者とそれぞれみなして厚生労働省令で定めるところにより算定した第一項第十三号から第十八号までに掲げる額に相当する額を合算した額（以下この表において「元被扶養者合算額」とい…
わかりやすく言うと
計算期間にこの保険者の被保険者だった人で、基準日には後期高齢者医療の被保険者である人について、同じ世帯のほかの後期高齢者医療の被保険者を基準日被扶養者とみなし、かつての被扶養者が受けた外来療養の自己負担額に当たる額として厚生労働省令で定めるところにより算定した額を合算したものです。
略称規定第四十一条の二第七項・この項の中だけ
計算期間において当該保険者の被保険者であった者（基準日において後期高齢者医療の被保険者である者に限る。以下この項において「基準日後期高齢者医療被保険者」という。）に対する高額療養費は…
わかりやすく言うと
計算期間にこの保険者の被保険者だった人のうち、基準日には後期高齢者医療の被保険者になっている人のことです。
定義第四十一条の二第七項・この規定の中だけ
基準日において当該基準日後期高齢者医療被保険者と同一の世帯に属する当該基準日後期高齢者医療被保険者以外の後期高齢者医療の被保険者
略称規定第四十一条の二第七項
基準日後期高齢者医療被保険者を基準日被保険者と、基準日後期高齢者医療被保険者以外後期高齢者医療被保険者を基準日被扶養者とそれぞれみなして厚生労働省令で定めるところにより算定した第一項第七号から第十二号までに掲げる額に相当する額を合算した額…
わかりやすく言うと
基準日後期高齢者医療被保険者と同じ世帯のほかの後期高齢者医療の被保険者を基準日被扶養者とみなし、その人が計算期間に受けた外来療養の自己負担額（第一項第七号から第十二号まで）に当たる額として厚生労働省令で定めるところにより算定した額を合算したものです。
略称規定第四十一条の二第七項
基準日後期高齢者医療被保険者を基準日被保険者と、基準日後期高齢者医療被保険者以外後期高齢者医療被保険者（基準日において当該基準日後期高齢者医療被保険者と同一の世帯に属する当該基準日後期高齢者医療被保険者以外の後期高齢者医療の被保険者をいう…
わかりやすく言うと
基準日後期高齢者医療被保険者を基準日被保険者とみなし、その人が計算期間に受けた外来療養の自己負担額（第一項第一号から第六号まで）に当たる額として厚生労働省令で定めるところにより算定した額を合算したものです。
定義第四十一条の二第八項・この規定の中だけ
法第百二十三条第一項の規定による保険者としての全国健康保険協会、船員保険法の規定により医療に関する給付を行う全国健康保険協会、市町村（特別区を含む。以下同じ。）、国民健康保険組合、国家公務員共済組合法若しくは地方公務員等共済組合法に基づく共済組合、日本私立学校振興・共済事業団又は高齢者の医療の確保に関する法律に基づく後期高齢者医療広域連合
わかりやすく言うと
日雇特例被保険者の保険の保険者や船員保険法の医療に関する給付を行う者としての全国健康保険協会、市町村（特別区を含みます）、国民健康保険組合、国家公務員や地方公務員の共済組合、日本私立学校振興・共済事業団と、後期高齢者医療広域連合をまとめた呼び名です。
略称規定第四十一条の二第九項
…私立学校教職員共済法の規定による私立学校教職員共済制度の加入者、国民健康保険の被保険者の属する世帯の世帯主若しくは国民健康保険組合の組合員（以下「国民健康保険の世帯主等」という。）又は後期高齢者医療の被保険者をいう。
わかりやすく言うと
国民健康保険の被保険者が属する世帯の世帯主と、国民健康保険組合の組合員をまとめた呼び名です。
定義第四十一条の二第九項・この規定の中だけ
日雇特例被保険者（日雇特例被保険者であった者（法第百二十六条の規定により日雇特例被保険者手帳の交付を受け、その手帳に健康保険印紙を貼り付けるべき余白がなくなるに至るまでの間にある者に限り、法第三条第二項ただし書の規定による承認を受けて同項の規定による日雇特例被保険者とならない期間内にある者又は法第百二十六条第三項の規定により当該日雇特例被保険者手帳を返納した者を除く。）を含む。次項、第四十三条の三第五項及び第四十四条第二項から第八項までにおいて同じ。）、船員保険の被保険者、国家公務員共済組合法若しくは地方公務員等共済組合法に基づく共済組合の組合員、私立学校教職員共済法の規定による私立学校教職員共済制度の加入者、国民健康保険の被保険者の属する世帯の世帯主若しくは国民健康保険組合の組合員（以下「国民健康保険の世帯主等」という。）又は後期高齢者医療の被保険者
わかりやすく言うと
日雇特例被保険者（日雇特例被保険者だった人のうち一定の人を含みます）、船員保険の被保険者、国家公務員や地方公務員の共済組合の組合員、私立学校教職員共済制度の加入者、国民健康保険の世帯主等と、後期高齢者医療の被保険者をまとめた呼び名です。
定義第四十一条の二第十項・この規定の中だけ
日雇特例被保険者の被扶養者若しくは船員保険法、国家公務員共済組合法（他の法律において準用する場合を含む。）若しくは地方公務員等共済組合法の規定による被扶養者又は国民健康保険の世帯主等と同一の世帯に属する当該国民健康保険の世帯主等以外の国民健康保険の被保険者
わかりやすく言うと
日雇特例被保険者の被扶養者、船員保険法や国家公務員共済組合法、地方公務員等共済組合法による被扶養者と、国民健康保険の世帯主等と同じ世帯に属するほかの国民健康保険の被保険者をまとめた呼び名です。
略称規定第四十一条の三第一項・この項の中だけ
高額療養費は、計算期間において、基準日被保険者又はその被扶養者がそれぞれ当該保険者の被保険者又はその被扶養者として受けた療養（法第九十八条第一項（法第百十条第七項及び第百十一条第三項において準用する場合を含む。）の規定による保険給付に係る…
わかりやすく言うと
計算期間（毎年八月一日から翌年七月三十一日まで）に基準日被保険者とその被扶養者が受けた療養の自己負担額（七十歳になる月までの分は一定額以上のものに限ります）を合算し、すでに支給された高額療養費などと、七十歳以上の分の年間の支給額を差し引いた額です。
略称規定第四十一条の三第一項・この規定及び第四十一条の三第二項及び第四十三条の二の中だけ
高額療養費は、計算期間において、基準日被保険者又はその被扶養者がそれぞれ当該保険者の被保険者又はその被扶養者として受けた療養（法第九十八条第一項（法第百十条第七項及び第百十一条第三項において準用する場合を含む。）の規定による保険給付に係る…
わかりやすく言うと
被保険者が資格を失って日雇特例被保険者かその被扶養者になった場合に、資格を失った時に受けていた療養について健康保険法第九十八条第一項（被扶養者についての準用を含みます）により引き続き受ける保険給付に係る療養のことです。
略称規定第四十一条の三第一項第一号
当該療養（特定給付対象療養を除く。）に係る第四十一条第一項第一号イからヘまでに掲げる額（七十歳に達する日の属する月以前の当該療養に係るものにあっては、同一の月にそれぞれ一の病院等から受けた当該療養について二万千円（同条第四項各号に掲げる療…
わかりやすく言うと
七十五歳になって月の初日以外の日に後期高齢者医療の被保険者となり、健康保険の被保険者や被扶養者でなくなった人と、そのため被扶養者でなくなった家族が、その月のうち資格が変わる日より前に受けた療養のことです（第四十一条第四項各号）。
略称規定第四十一条の三第二項・この項の中だけ
前項各号に掲げる額のうち、七十歳に達する日の属する月の翌月以後に受けた療養（継続給付に係る療養を含む。）に係る額を合算した額（第四十一条第一項から第五項まで又は前条の規定により高額療養費が支給される場合にあっては、当該支給額を控除した額と…
わかりやすく言うと
計算期間に基準日被保険者とその被扶養者が受けた療養の自己負担額のうち、七十歳になった月の翌月以後の分を合算し、すでに支給された高額療養費や、健康保険組合が負担を軽くするために支給する金品の額を差し引いた額です。
略称規定第四十二条第一項第一号・この条及び第四十三条第一項の中だけ
ただし、当該療養のあった月以前の十二月以内に既に高額療養費（同条第一項から第四項までの規定によるものに限る。）が支給されている月数が三月以上ある場合（以下この条及び次条第一項において「高額療養費多数回該当の場合」という。）にあっては…
わかりやすく言うと
療養のあった月以前の十二か月以内に、第四十一条第一項から第四項までによる高額療養費がすでに三か月以上支給されている場合のことです。
定義第四十二条第一項第五号・この規定及び第四十二条第三項第五号の中だけ
療養のあった月の属する年度（療養のあった月が四月から七月までの場合にあっては、前年度）分の地方税法（昭和二十五年法律第二百二十六号）の規定による市町村民税（同法の規定による特別区民税を含むものとし、同法第三百二十八条の規定によって課する所得割を除く。第十項第二号、第十一項第四号及び第四十三条の三第一項第五号において同じ。）が課されない者（市町村の条例で定めるところにより当該市町村民税を免除された者を含むものとし、当該市町村民税の賦課期日において同法の施行地に住所を有しない者を除く。）
わかりやすく言うと
療養のあった月の属する年度（四月から七月の療養は前年度）の市町村民税（特別区民税を含み、退職所得に対する分離課税の所得割は除きます）が課されない人のことです。条例で免除された人を含み、賦課期日に地方税法の施行地に住所がない人は除きます。
定義第四十二条第一項第五号・この条の中だけ
生活保護法第六条第二項に規定する要保護者
わかりやすく言うと
現に生活保護を受けているかどうかにかかわらず、保護を必要とする状態にある人のことです（生活保護法第六条第二項）。
定義第四十二条第六項第二号・この規定及び第四十二条第七項及び第四十二条第八項第二号の中だけ
法第六十三条第一項第五号に掲げる療養（当該療養に伴う同項第一号から第三号までに掲げる療養を含む。）
わかりやすく言うと
病院や診療所への入院とその療養に伴う世話その他の看護のことで、入院に伴う診察、薬剤や治療材料の支給、処置・手術その他の治療も含みます（健康保険法第六十三条第一項）。
略称規定第四十二条第七項第一号イ・この項の中だけ
ただし、当該特定疾病給付対象療養（入院療養に限る。）のあった月以前の十二月以内に既に高額療養費（当該特定疾病給付対象療養（入院療養に限る。）を受けた被保険者又はその被扶養者がそれぞれ同一の病院又は診療所から受けた入院療養に係るものであって…
わかりやすく言うと
特定疾病給付対象療養（入院療養に限ります）のあった月以前の十二か月以内に、同じ病院や診療所での入院療養について第四十一条第七項の高額療養費がすでに三か月以上支給されている場合のことです。
定義第四十二条第十一項第四号・この規定及び第四十二条第十二項第四号の中だけ
基準日の属する年度の前年度（次条第十二項の規定により前年八月一日から三月三十一日までのいずれかの日を基準日とみなした場合にあっては、当該基準日とみなした日の属する年度）分の地方税法の規定による市町村民税が課されない者（市町村の条例で定めるところにより当該市町村民税を免除された者を含むものとし、当該市町村民税の賦課期日において同法の施行地に住所を有しない者を除く。）
わかりやすく言うと
基準日の属する年度の前年度（次条第十二項で前年八月一日から三月三十一日までの日が基準日とみなされた場合はその日の属する年度）の市町村民税が課されない人のことです。条例で免除された人を含み、賦課期日に地方税法の施行地に住所がない人は除きます。
略称規定第四十二条第十二項第二号・この規定及び第四十二条第十二項第三号及び第四十三条の三第二項第二号から第四号までの中だけ
基準日において療養の給付を受けることとした場合に法第七十四条第一項第三号の規定が適用される者（次号及び第四十三条の三第二項第二号から第四号までにおいて「第三号適用者」という。）であって…
わかりやすく言うと
基準日に療養の給付を受けるとした場合に、健康保険法第七十四条第一項第三号（七十歳になった月の翌月以後で、一定以上の報酬があるときに一部負担金を百分の三十とする規定）が適用される人のことです。
略称規定第四十三条第一項・この項及び第四十三条第五項の中だけ
被保険者が同一の月に一の保険医療機関若しくは保険薬局若しくは法第六十三条第三項第二号に掲げる病院若しくは診療所若しくは薬局（以下この項及び第五項において「保険医療機関等」と総称する。）又は指定訪問看護事業者から療養を受けた場合において…
わかりやすく言うと
厚生労働大臣の指定を受けた病院・診療所（保険医療機関）と薬局（保険薬局）、それに特定の保険者がその被保険者の診療や調剤のために指定した病院・診療所・薬局をまとめた呼び名です。
定義第四十三条第一項・この項及び第四十三条第五項の中だけ
保険外併用療養費の支給につき法第八十六条第四項において準用する法第八十五条第五項又は第七項の規定の適用がある場合における当該保険外併用療養費の支給に係る療養につき算定した費用の額から当該保険外併用療養費の額を控除した額
わかりやすく言うと
保険者が保険外併用療養費を被保険者に代わって病院などに直接支払う場合や、健康保険組合が開設する病院などで保険者がその分の支払を免除する場合に、その療養の費用として算定した額から保険外併用療養費の額を差し引いた額のことです。
定義第四十三条第一項・この項及び第四十三条第五項の中だけ
訪問看護療養費の支給につき法第八十八条第六項の規定の適用がある場合における当該訪問看護療養費の支給に係る指定訪問看護につき算定した費用の額から当該訪問看護療養費の額を控除した額
わかりやすく言うと
保険者が訪問看護療養費を被保険者に代わって指定訪問看護事業者に直接支払う場合に、その指定訪問看護について算定した費用の額から訪問看護療養費の額を差し引いた額のことです。
定義第四十三条第十一項・この規定及び第四十三条の四第一項及び第四十四条第四項及び第八項の中だけ
高齢者の医療の確保に関する法律第七条第四項に規定する加入者又は後期高齢者医療の被保険者
わかりやすく言うと
健康保険（日雇特例被保険者を除きます）、船員保険、国民健康保険の被保険者、共済組合の組合員、私立学校教職員共済制度の加入者とこれらの被扶養者など、高齢者の医療の確保に関する法律でいう加入者と、後期高齢者医療の被保険者のことです。
略称規定第四十三条の二第一項・この項の中だけ
高額介護合算療養費は、次に掲げる額を合算した額から七十歳以上介護合算支給総額（次項に規定する七十歳以上介護合算一部負担金等世帯合算額から同項の七十歳以上介護合算算定基準額を控除した額（当該額が高額介護合算療養費の支給の事務の執行に要する費…
わかりやすく言うと
計算期間に基準日被保険者と基準日被扶養者が負担した医療の自己負担額（他の健康保険や共済組合などに加入していた間の分を含みます）と介護サービスの利用者負担額を合算し、すでに支給された高額療養費などと七十歳以上の分の支給額を差し引いた額です。
略称規定第四十三条の二第一項・この条の中だけ
高額介護合算療養費は、次に掲げる額を合算した額から七十歳以上介護合算支給総額（次項に規定する七十歳以上介護合算一部負担金等世帯合算額から同項の七十歳以上介護合算算定基準額を控除した額（当該額が高額介護合算療養費の支給の事務の執行に要する費…
わかりやすく言うと
高額介護合算療養費の支給の事務にかかる費用を考えて厚生労働大臣が定める額です。医療と介護の自己負担の合算額が、算定基準額にこの額を加えた額を超えることが、支給の条件の一つとされています。
定義第四十三条の二第一項第五号・この号及び第四十三条の二第五項の中だけ
第四十一条の二第九項に規定する組合員等
わかりやすく言うと
日雇特例被保険者（日雇特例被保険者だった人のうち一定の人を含みます）、船員保険の被保険者、国家公務員や地方公務員の共済組合の組合員、私立学校教職員共済制度の加入者、国民健康保険の世帯主等と、後期高齢者医療の被保険者をまとめた呼び名です（第四十一条の二第九項）。
定義第四十三条の二第一項第五号・この号及び第四十三条の二第五項の中だけ
同条第十項に規定する被扶養者等
わかりやすく言うと
日雇特例被保険者の被扶養者、船員保険法や国家公務員共済組合法、地方公務員等共済組合法による被扶養者と、国民健康保険の世帯主等と同じ世帯に属するほかの国民健康保険の被保険者をまとめた呼び名です（第四十一条の二第十項）。
定義第四十三条の二第一項第六号・この規定及び第四十三条の二第二項の中だけ
介護保険法施行令（平成十年政令第四百十二号）第二十二条の二の二第一項に規定する居宅サービス等
わかりやすく言うと
介護保険の居宅サービス、地域密着型サービス、施設サービスと、居宅サービスや地域密着型サービスに相当するサービスのことです（介護保険法施行令第二十二条の二の二第一項）。
定義第四十三条の二第一項第七号・この規定及び第四十三条の二第二項の中だけ
介護保険法施行令第二十二条の二の二第二項に規定する介護予防サービス等
わかりやすく言うと
介護保険の介護予防サービスや地域密着型介護予防サービス、またはこれらに相当するサービスのことです（介護保険法施行令第二十二条の二の二第二項）。
略称規定第四十三条の二第二項・この項の中だけ
前項各号に掲げる額のうち、七十歳に達する日の属する月の翌月以後に受けた療養又は居宅サービス等若しくは介護予防サービス等（以下この項及び第六項において「七十歳以上合算対象サービス」という。）に係る額に相当する額として厚生労働省令で定めるとこ…
わかりやすく言うと
高額介護合算療養費の計算で、前項の医療と介護の自己負担額のうち、七十歳になった月の翌月以後に受けた療養や介護サービス（七十歳以上合算対象サービス）の分として厚生労働省令で定めるところにより算定した額を合算した額です。
略称規定第四十三条の二第二項・この項及び第四十三条の二第六項の中だけ
前項各号に掲げる額のうち、七十歳に達する日の属する月の翌月以後に受けた療養又は居宅サービス等若しくは介護予防サービス等（以下この項及び第六項において「七十歳以上合算対象サービス」という。）に係る額に相当する額として厚生労働省令で定めるとこ…
わかりやすく言うと
療養と、居宅サービス等（介護保険の居宅サービス、地域密着型サービス、施設サービスなど）や介護予防サービス等のうち、いずれも七十歳になった月の翌月以後に受けたもののことです。高額介護合算療養費の七十歳以上の分の計算に使われます。
略称規定第四十三条の二第四項・この項の中だけ
…「保険者の」とあるのは「他の健康保険の保険者（以下この項において「基準日保険者」という。）の」と、同項第二号中「他の」とあるのは「基準日保険者以外の」と…
わかりやすく言うと
計算期間にこの保険者の被保険者だった人が、基準日には他の健康保険の保険者の被保険者かその被扶養者になっている場合の、その他の健康保険の保険者のことです。
略称規定第四十三条の二第四項・この項及び第四十三条の二第二項の中だけ
…同項第一号中「基準日被保険者」とあるのは「他の健康保険の保険者の被保険者（基準日において当該他の健康保険の保険者の被保険者である者に限る。以下この項及び次項において「基準日被保険者」という。）」と…
わかりやすく言うと
この項で準用する高額介護合算療養費の計算で、基準日に他の健康保険の保険者の被保険者である人のことです。この保険者の元被保険者が、基準日に他の健康保険の被保険者かその被扶養者になっている場合に使われます。
略称規定第四十三条の二第四項・この項の中だけ
…同項第二号中「他の」とあるのは「基準日保険者以外の」と、同項第三号中「基準日被扶養者」とあるのは「基準日被保険者の被扶養者（基準日において基準日保険者の被保険者の被扶養者である者に限る。以下この項において「基準日被扶養者」という。）」と…
わかりやすく言うと
この項で準用する高額介護合算療養費の計算で、基準日被保険者（基準日に他の健康保険の保険者の被保険者である人）の被扶養者で、基準日にその保険者の被保険者の被扶養者である人のことです。
略称規定第四十三条の二第五項・この項の中だけ
計算期間において当該保険者の被保険者であった者（基準日において組合員等（国民健康保険の世帯主等であって被保険者又はその被扶養者である者及び後期高齢者医療の被保険者を除く。）である者又は被扶養者等である者に限る。）に対する高額介護合算療養費…
わかりやすく言うと
計算期間にこの保険者の被保険者だった人で、基準日には共済組合や国民健康保険などの組合員等（後期高齢者医療の被保険者などを除きます）か被扶養者等である人について、厚生労働省令で定めるところにより算定した医療と介護の自己負担額（通算対象負担額）を合算し、七十歳以上の分の支給額を差し引いた額です。
略称規定第四十三条の二第五項・この項及び第四十三条の二第六項の中だけ
…当該組合員等である者を基準日被保険者と、当該被扶養者等である者を基準日被扶養者とそれぞれみなして厚生労働省令で定めるところにより算定した第一項各号に掲げる額に相当する額（以下この項及び次項において「通算対象負担額」という。）を合算した額…
わかりやすく言うと
計算期間にこの保険者の被保険者だった人で、基準日には共済組合や国民健康保険などの組合員等（後期高齢者医療の被保険者などを除きます）か被扶養者等である人を基準日被保険者や基準日被扶養者とみなし、厚生労働省令で定めるところにより算定した第一項各号の医療と介護の自己負担額に当たる額です。
略称規定第四十三条の二第六項・この項の中だけ
…七十歳以上合算対象サービスに係る額に相当する額として厚生労働省令で定めるところにより算定した額（以下この項において「七十歳以上通算対象負担額」という。）を合算した額（以下この項において「七十歳以上介護合算一部負担金等世帯合算額」という。…
わかりやすく言うと
基準日に共済組合や国民健康保険など他の制度に加入している元被保険者について、通算対象負担額のうち七十歳になった月の翌月以後の療養や介護サービスの分として厚生労働省令で定めるところにより算定した額（七十歳以上通算対象負担額）を合算した額です。
略称規定第四十三条の二第六項・この項の中だけ
通算対象負担額のうち、七十歳以上合算対象サービスに係る額に相当する額として厚生労働省令で定めるところにより算定した額（以下この項において「七十歳以上通算対象負担額」という。）を合算した額（以下この項において「七十歳以上介護合算一部負担金等…
わかりやすく言うと
通算対象負担額（基準日に共済組合や国民健康保険など他の制度に加入している元被保険者の医療と介護の自己負担額として算定した額）のうち、七十歳以上合算対象サービスの分として厚生労働省令で定めるところにより算定した額のことです。
略称規定第四十三条の二第七項・この項の中だけ
計算期間において当該保険者の被保険者であった者（基準日において後期高齢者医療の被保険者である者に限る。）に対する高額介護合算療養費は…
わかりやすく言うと
計算期間にこの保険者の被保険者だった人で、基準日には後期高齢者医療の被保険者になっている人について、厚生労働省令で定めるところにより算定した医療と介護の自己負担額（通算対象負担額）を合算した額です。
略称規定第四十三条の二第七項・この項の中だけ
…当該後期高齢者医療の被保険者である者を基準日被保険者とみなして厚生労働省令で定めるところにより算定した第一項各号に掲げる額に相当する額（以下この項において「通算対象負担額」という。）を合算した額（以下この項において「介護合算一部負担金等…
わかりやすく言うと
計算期間にこの保険者の被保険者だった人で、基準日には後期高齢者医療の被保険者である人について、その人を基準日被保険者とみなして、厚生労働省令で定めるところにより算定した第一項各号の医療と介護の自己負担額に当たる額のことです。
定義第四十三条の三第一項第五号・この規定及び第四十三条の三第二項第五号の中だけ
基準日の属する年度の前年度（次条第一項の規定により前年八月一日から三月三十一日までのいずれかの日を基準日とみなした場合にあっては、当該基準日とみなした日の属する年度）分の地方税法の規定による市町村民税が課されない者（市町村の条例で定めるところにより当該市町村民税を免除された者を含むものとし、当該市町村民税の賦課期日において同法の施行地に住所を有しない者を除く。）
わかりやすく言うと
基準日の属する年度の前年度（次条第一項で前年八月一日から三月三十一日までの日が基準日とみなされた場合はその日の属する年度）の市町村民税が課されない人のことです。条例で免除された人を含み、賦課期日に地方税法の施行地に住所がない人は除きます。
略称規定第四十三条の三第五項
基準日において国家公務員共済組合法の規定に基づく共済組合の組合員（防衛省の職員の給与等に関する法律施行令（昭和二十七年政令第三百六十八号）第十七条の三第一項に規定する自衛官等（以下この表において「自衛官等」という。）を除く。）である者又は…
わかりやすく言うと
自衛官、訓練招集などに応じている予備自衛官など、学生と生徒をまとめた呼び名です（防衛省の職員の給与等に関する法律施行令第十七条の三第一項）。
定義第四十四条の二第一項・この規定及び第四十四条の三第三項の中だけ
法第百五十条の二第一項に規定する匿名診療等関連情報
わかりやすく言うと
診療等関連情報を、特定の被保険者などの本人を識別できず、元の情報にも戻せないように、厚生労働省令で定める基準に従って加工したもののことです（健康保険法第百五十条の二第一項）。
定義第四十四条の二第一項・この規定及び第四十四条の三第二項及び第三項の中だけ
法第百五十条の三に規定する匿名診療等関連情報利用者
わかりやすく言うと
健康保険法第百五十条の二第一項により厚生労働大臣から匿名診療等関連情報の提供を受けて利用する者のことです。提供先は、国の他の行政機関や地方公共団体、大学などの研究機関、厚生労働省令で定める民間事業者などで、相当の公益性のある業務を行うものです。
定義第四十四条の二第二項・この規定及び第四十四条の三第三項の中だけ
法第百五十条の九に規定する基盤機構等
わかりやすく言うと
医療情報基盤・診療報酬審査支払機構、国民健康保険団体連合会、その他厚生労働省令で定める者のことです。厚生労働大臣は、匿名診療等関連情報の利用や提供に係る事務などの全部または一部を、これらに委託できます。
略称規定第四十四条の七第一項・この項及び第四十四条の七第二項の中だけ
政府は、次項の場合を除き、厚生労働大臣が徴収した保険料その他法の規定による徴収金及び印紙をもつてする歳入金納付に関する法律（昭和二十三年法律第百四十二号）の規定による納付金（以下この項及び次項において「保険料等」という。）が年金特別会計の…
わかりやすく言うと
厚生労働大臣が徴収した健康保険の保険料その他健康保険法による徴収金と、印紙をもつてする歳入金納付に関する法律による納付金をまとめた呼び名です。
略称規定第四十四条の七第一項・この条の中だけ
政府は、次項の場合を除き、厚生労働大臣が徴収した保険料その他法の規定による徴収金及び印紙をもつてする歳入金納付に関する法律（昭和二十三年法律第百四十二号）の規定による納付金（以下この項及び次項において「保険料等」という。）が年金特別会計の…
わかりやすく言うと
政府が全国健康保険協会に交付するお金で、健康勘定に収納された保険料等の額から、厚生労働大臣が行う健康保険事業の事務費に当たる額（国庫負担金の分を除きます）として厚生労働省令で定めるところにより算定した額を差し引いたものです。
略称規定第四十四条の七第一項・この規定及び第四十四条の七第二項の中だけ
政府は、次項の場合を除き、厚生労働大臣が徴収した保険料その他法の規定による徴収金及び印紙をもつてする歳入金納付に関する法律（昭和二十三年法律第百四十二号）の規定による納付金（以下この項及び次項において「保険料等」という。）が年金特別会計の…
わかりやすく言うと
国の年金特別会計に設けられた勘定の一つで、厚生労働大臣が徴収した健康保険の保険料等が収納されるところです。
定義第四十五条の二第一項・この規定及び第四十五条の三の中だけ
一の事業年度の三月分から当該一の事業年度の翌事業年度の二月分までの保険料（任意継続被保険者に係る保険料にあっては、当該翌事業年度の四月分から三月分までの保険料）として徴収すべき額の見込額に占める当該翌事業年度において納付が見込まれる保険料の額の総額の割合として厚生労働省令で定めるところにより算定される率
わかりやすく言うと
全国健康保険協会が都道府県単位保険料率の算定に使う率で、ある事業年度の三月分から翌事業年度の二月分まで（任意継続被保険者は翌事業年度の四月分から三月分まで）の保険料の徴収見込額のうち、翌事業年度に納付が見込まれる額の割合です。算定方法は厚生労働省令で定められます。
定義第四十五条の二第一項・この規定及び第四十五条の三及び第四十五条の四第四項第一号の中だけ
法第百六十条第二項に規定する都道府県単位保険料率
わかりやすく言うと
全国健康保険協会が、千分の三十から千分の百三十までの範囲内で、支部被保険者を単位として決め、その支部被保険者に適用する一般保険料率のことです（健康保険法第百六十条第一項、第二項）。
定義第四十五条の二第一項第一号イ
同条第一項に規定する支部被保険者
わかりやすく言うと
全国健康保険協会のその支部の都道府県にある適用事業所に使われる被保険者と、その都道府県の区域内に住所か居所がある任意継続被保険者のことです（健康保険法第百六十条第一項）。
略称規定第四十五条の二第一項第一号イ・この規定及び第四十五条の四第四項第一号及び第二号の中だけ
法第百六十条第三項第一号に掲げる額から当該支部被保険者（同条第一項に規定する支部被保険者をいう。以下同じ。）に係る同号に規定する療養の給付等（第四十五条の四第四項第一号及び第二号において「療養の給付等」という。）に要する費用のうち法の規定…
わかりやすく言うと
療養の給付その他の厚生労働省令で定める保険給付のことです（健康保険法第百六十条第三項第一号）。全国健康保険協会の都道府県単位保険料率や財政調整の計算に使われます。
略称規定第四十五条の三第一項第一号・この規定及び第四十五条の三第一項第二号及び第三号の中だけ
当該変更後の都道府県単位保険料率を用いる最初の月（次号及び第三号において「適用月」という。）の属する事業年度における前条第一号に掲げる額
わかりやすく言うと
全国健康保険協会が都道府県単位保険料率を変更して三月以外の月から用いようとするときの、変更後の料率を用いる最初の月のことです。
定義第四十五条の四第四項第一号・この項の中だけ
第四十五条の二に規定する当該一の事業年度の翌事業年度をいい、前条の規定に基づき都道府県単位保険料率を算定する場合にあっては、同条に規定する当該適用月の属する事業年度
わかりやすく言うと
都道府県単位保険料率を算定する対象の事業年度のことです。三月から用いる料率では第四十五条の二にいう、ある事業年度の翌事業年度を、三月以外の月から用いる料率（第四十五条の三）では、新しい料率を最初に用いる月が属する事業年度を指します。
定義第四十五条の四第四項第一号・この規定及び第四十五条の四第二項及び第三項の中だけ
厚生労働省令で定めるところにより、年齢階級ごとに、当該年齢階級に係る年齢階級別平均一人当たり給付額（厚生労働省令で定めるところにより、療養の給付等のうち協会が管掌する健康保険の被保険者及びその被扶養者であって当該年齢階級に属する者に係るものについて当該一の事業年度の翌事業年度（第四十五条の二に規定する当該一の事業年度の翌事業年度をいい、前条の規定に基づき都道府県単位保険料率を算定する場合にあっては、同条に規定する当該適用月の属する事業年度をいう。以下この項において同じ。）に要する費用の見込額から当該見込額のうち法の規定により支払うべき一部負担金に相当する額及び法第百五十三条の規定による国庫補助の額の合算額の見込額を控除した額を、当該一の事業年度の翌事業年度において協会が管掌する健康保険の被保険者及びその被扶養者であって当該年齢階級に属する者の合計数の見込数で除して得た額をいう。）に当該一の事業年度の翌事業年度において当該支部被保険者及びその被扶養者であって当該年齢階級に属する者の合計数の見込数を乗じて得た額を合算した額
わかりやすく言うと
年齢階級ごとに、協会全体でのその年齢階級の一人あたりの翌事業年度の給付費の見込額（一部負担金と国庫補助の分を除きます）に、その支部のその年齢階級の被保険者と被扶養者の見込数を掛けて合算した額です。算定方法は厚生労働省令で定められます。
定義第四十五条の四第四項第二号・この規定及び第四十五条の四第二項及び第三項の中だけ
厚生労働省令で定めるところにより、平均一人当たり給付額（厚生労働省令で定めるところにより、療養の給付等のうち協会が管掌する健康保険の被保険者及びその被扶養者に係るものについて当該一の事業年度の翌事業年度に要する費用の見込額から当該見込額のうち法の規定により支払うべき一部負担金に相当する額及び法第百五十三条の規定による国庫補助の額の合算額の見込額を控除した額（次号において「総給付費見込額」という。）を、当該一の事業年度の翌事業年度における協会が管掌する健康保険の被保険者及びその被扶養者の合計数の見込数で除して得た額をいう。）に当該一の事業年度の翌事業年度における当該支部被保険者及びその被扶養者の合計数の見込数を乗じて得た額
わかりやすく言うと
全国健康保険協会の財政調整に使う額で、協会全体の被保険者と被扶養者一人あたりの翌事業年度の給付費の見込額（一部負担金と国庫補助の分を除きます）に、その支部の被保険者と被扶養者の見込数を掛けた額です。算定方法は厚生労働省令で定められます。
略称規定第四十五条の四第四項第二号・この規定及び第四十五条の四第四項第三号の中だけ
支部平均給付費額 厚生労働省令で定めるところにより、平均一人当たり給付額（厚生労働省令で定めるところにより、療養の給付等のうち協会が管掌する健康保険の被保険者及びその被扶養者に係るものについて当該一の事業年度の翌事業年度に要する費用の見込…
わかりやすく言うと
全国健康保険協会が管掌する健康保険の被保険者と被扶養者に係る療養の給付等について、翌事業年度に必要となる費用の見込額から、一部負担金と国庫補助の分の見込額を差し引いた額のことです。
定義第四十五条の四第四項第三号・この規定及び第四十五条の四第二項及び第三項の中だけ
厚生労働省令で定めるところにより、総給付費見込額に当該一の事業年度の翌事業年度における法第百六十条第三項第二号に規定する総報酬按分率の見込値を乗じて得た額
わかりやすく言うと
協会全体の翌事業年度の給付費の見込額（一部負担金と国庫補助の分を除いた総給付費見込額）に、その支部の総報酬按分率（支部の被保険者の総報酬額を協会全体の総報酬額で割った率）の見込値を掛けた額です。算定方法は厚生労働省令で定められます。
略称規定第四十七条第一項
法第百六十一条第四項の規定により被保険者（日雇特例被保険者を除く。以下同じ。）が同時に二以上の事業所又は事務所（以下単に「事業所」という。）に使用される場合における各事業主の負担すべき標準報酬月額に係る保険料の額は…
わかりやすく言うと
事業所と事務所をまとめた呼び名です。被保険者が同時に二つ以上の事業所に使われる場合に、各事業主が負担する保険料の額を計算するときなどに使われます。
略称規定第五十六条第一項・この項及び第五十六条第二項の中だけ
厚生労働大臣は、やむを得ない事情により、日雇特例被保険者を使用する事業主の設立する健康保険組合又は法第百七十九条に規定する国民健康保険の保険者（以下この項及び次項において「日雇関係組合」という。）が日雇拠出金を納付することが著しく困難であ…
わかりやすく言うと
日雇特例被保険者を使用する事業主が設立した健康保険組合と、承認を受けて健康保険の被保険者とならず国民健康保険の被保険者となる人の国民健康保険を行う保険者（健康保険法第百七十九条）をまとめた呼び名です。
略称規定第五十七条第一項
健康保険組合連合会（以下「連合会」という。）の設立に要する費用は、連合会が負担するものとする。ただし、連合会が成立しなかった場合においては、その費用は、その設立の認可の申請をした健康保険組合の負担とする。
わかりやすく言うと
健康保険組合連合会を短く呼ぶ名前です。
略称規定第六十三条第一項第二号
納付義務者が法第二百四条の二第一項に規定する滞納処分等その他の処分（以下「滞納処分等その他の処分」という。）の執行を免れる目的でその財産について隠ぺいしているおそれがあること。
わかりやすく言うと
厚生労働大臣が日本年金機構に代わって自ら行うこととした、国税滞納処分の例による処分などの滞納処分等と国税徴収の例による徴収の権限、それに厚生労働省令で定める一部の権限をまとめた呼び名です（健康保険法第二百四条の二第一項）。
定義第六十三条第一項第三号・この規定及び第六十三条第一項第四号、第六十四条の四、第六十四条の五、第六十四条の七及び第六十四条の九及び第六十四条の八第一項の中だけ
法第二百四条の二第一項に規定する保険料等
わかりやすく言うと
健康保険の保険料その他健康保険法による徴収金のことです。ただし、不正に受けた保険給付の価額の徴収金、支払われない一部負担金の徴収金と、保険者が支給した額を事業主から徴収するもの（健康保険法第五十八条、第七十四条第二項、第百九条第二項）は除きます。
略称規定第六十四条の四第一項第一号・この規定及び第六十四条の四第一項第二号及び第六十四条の五第二項の中だけ
法第百八十条第二項の規定による督促を受けた納付義務者が保険料等の納付を日本年金機構法（平成十九年法律第百九号）第二十九条に規定する年金事務所（次号及び次条第二項において「年金事務所」という。）において行うことを希望する旨の申出があった場合
わかりやすく言うと
日本年金機構が、従たる事務所の業務の一部を分担させるため、必要な地に置く事務所のことです（日本年金機構法第二十九条）。
略称規定第六十四条の四第一項第三号・この規定及び第六十四条の四第一項第五号及び第六十四条の九の中だけ
法第二百四条の六第二項において準用する厚生年金保険法第百条の十一第二項の規定により任命された法第二百四条の六第一項の収納を行う日本年金機構（以下「機構」という。）の職員（第五号及び第六十四条の九において「収納職員」という。）であって併せて…
わかりやすく言うと
健康保険法第二百四条の六第一項により厚生労働大臣が日本年金機構に行わせる保険料等の収納を担当する機構の職員で、厚生年金保険法第百条の十一第二項の準用により任命された者のことです。
略称規定第六十四条の四第一項第三号
法第二百四条の六第二項において準用する厚生年金保険法第百条の十一第二項の規定により任命された法第二百四条の六第一項の収納を行う日本年金機構（以下「機構」という。）の職員（第五号及び第六十四条の九において「収納職員」という。）であって併せて…
わかりやすく言うと
日本年金機構のことです。健康保険法第二百四条の六第一項により、厚生労働大臣は一定の場合に保険料等の収納をこの機構に行わせることができます。
略称規定第六十四条の四第一項第三号・この号及び第六十四条の四第一項第四号の中だけ
法第二百四条の六第二項において準用する厚生年金保険法第百条の十一第二項の規定により任命された法第二百四条の六第一項の収納を行う日本年金機構（以下「機構」という。）の職員（第五号及び第六十四条の九において「収納職員」という。）であって併せて…
わかりやすく言うと
保険料等の収納を行う日本年金機構の職員（収納職員）で、あわせて健康保険法第二百四条の三第一項の徴収職員にも任命された者のことです。
略称規定第六十四条の六第一項
行う機構 行う日本年金機構（以下「機構」という。） 第百条の十一第三項 第一項 健康保険法第二百四条の六第一項 保険料等 保険料等（同法第二百四条の二第一項に規定する保険料等をいう。第六項において同じ。） 第百条の十一第五項 前二項 健康…
略称規定第六十五条第一項第一号イ
その所要保険料率（当該年度において各健康保険組合が行った医療に関する給付（法第五十三条に規定するその他の給付を除く。以下「医療給付」という。）並びに前期高齢者納付金等、後期高齢者支援金等及び日雇拠出金並びに流行初期医療確保拠出金等の納付に…
わかりやすく言うと
各健康保険組合がその年度に行った医療に関する給付のことです。健康保険組合が規約で定めて行うその他の給付（健康保険法第五十三条）は含みません。
定義第六十五条第一項第一号イ
当該年度において各健康保険組合が行った医療に関する給付（法第五十三条に規定するその他の給付を除く。以下「医療給付」という。）並びに前期高齢者納付金等、後期高齢者支援金等及び日雇拠出金並びに流行初期医療確保拠出金等の納付に要した費用の額（出産育児交付金（前期高齢者交付金がある場合には、出産育児交付金及び前期高齢者交付金）の額を控除した額）の見込額を当該年度における当該各健康保険組合の組合員である被保険者の標準報酬月額の総額及び標準賞与額の総額の合算額の見込額で除して得た率
わかりやすく言うと
健康保険組合ごとに、その年度の医療給付と、前期高齢者納付金等、後期高齢者支援金等、日雇拠出金、流行初期医療確保拠出金等の納付の費用（出産育児交付金と前期高齢者交付金の額は差し引きます）の見込額を、組合員である被保険者の標準報酬月額と標準賞与額の総額の見込額で割った率です。
略称規定第六十七条第三項・この項の中だけ
第一項の修正率は、各健康保険組合につき、各年の三月から翌年の二月までの期間について、当該三月の属する年度において当該健康保険組合が行う医療給付並びに前期高齢者納付金等…
わかりやすく言うと
健康保険組合ごとに、三月の属する年度に行う医療給付と、前期高齢者納付金等、後期高齢者支援金等、日雇拠出金、流行初期医療確保拠出金等の納付の費用の見込額（出産育児交付金と前期高齢者交付金の額は差し引きます）を、組合員である被保険者の標準報酬月額と標準賞与額の総額の見込額で割った率です。
略称規定第六十九条第一項第一号・この規定及び第七十条の中だけ
健康保険組合が組織されている事業所以外の事業所の事業主及び当該事業所に使用される被保険者により組織された法人であって、法附則第四条第一項に規定する給付の事業（次条において「給付事業」という。）を行うことを目的とするもの
わかりやすく言うと
健康保険組合のない事業所の事業主と被保険者で組織し、厚生労働大臣の承認を受けた法人などが、保険給付があった被保険者に、その人が支払った一部負担金に相当する額の範囲内で行う給付の事業のことです（健康保険法附則第四条第一項）。
定義第七十一条第一項
同項に規定する特定被保険者
わかりやすく言うと
自分は介護保険第二号被保険者ではないものの、介護保険第二号被保険者である被扶養者がいる被保険者のことです（健康保険法附則第七条第一項）。健康保険組合は、規約で定めてこの人の保険料額に介護保険料額を含めることができます。
略称規定第七十三条第一項第一号・この条の中だけ
各介護保険第二号被保険者である被保険者又は特定被保険者（以下この条において「特別介護保険料負担被保険者等」という。）に係る特別介護保険料額は…
わかりやすく言うと
介護保険第二号被保険者である各被保険者と、自分は介護保険第二号被保険者ではないものの介護保険第二号被保険者である被扶養者がいる被保険者（特定被保険者）をまとめた呼び名です。
定義第七十三条の二第一項・この条の中だけ
法附則第八条の三の二第一項に規定する特定減額特例対象者
わかりやすく言うと
当分の間、適用事業所に使われる短時間労働者のうち、最低賃金法第七条の適用を受ける労働者で、厚生労働省令で定めるところにより算定した報酬の額が八万八千円未満の人のことです。この人は原則として被保険者となりませんが、保険者（協会なら厚生労働大臣）に申し出れば被保険者となれます。
定款
会社を設立するときに発起人（持分会社では社員になろうとする者）が作成する、会社の根本規則です（会社法第二十六条・第五百七十五条）。目的・商号・本店の所在地・設立に際して出資される財産の価額又はその最低額・発起人の氏名又は名称及び住所は必ず記載します（第二十七条）。株式会社の定款は公証人の認証を受けなければ効力を生じず（第三十条第一項）、成立後は株主総会の決議で変更できます（第四百六十六条）。「定款に別段の定めがある場合を除き」とする規定が多く、会社法がその会社にどう適用されるかを定款が大きく左右します。
会社法第26条・第27条・第30条・第466条・第575条、Wikipedia「定款」を参考にAIが作成。
税務署長
国税庁の地方支分部局である国税局の事務の一部を分掌するため各地に置かれる税務署の長です（財務省設置法第二十四条）。納税者が通常相対する機関で、所得税の確定申告書は税務署長に提出し（所得税法第百二十条第一項）、更正・決定や国税の徴収は現在の納税地を所轄する税務署長が行います（国税通則法第三十条・第四十三条）。税務署長の処分に不服がある者は、その税務署長に対する再調査の請求か、国税不服審判所長に対する審査請求のいずれかを選べます（同法第七十五条第一項第一号）。ただし、調査が国税局又は国税庁の職員によってされた旨の記載がある書面で通知された処分は、国税局長又は国税庁長官がしたものとみなされ、国税庁長官がしたものとみなされた処分については国税庁長官に対する審査請求のみとなります（同条第二項）。
財務省設置法第24条、国税通則法第30条・第43条・第75条、所得税法第120条を参考にAIが作成。
健康保険組合
組合員である被保険者の健康保険の事業を行う法人で、全国健康保険協会と並ぶ健康保険の保険者です（健康保険法第四条・第六条・第九条）。適用事業所の事業主、そこに使用される被保険者と任意継続被保険者で組織されます（同法第八条）。常時、政令で定める数以上の被保険者を使用する事業主は単独で、複数の事業主は被保険者の数を合わせてその数以上であれば共同して、設立できます。設立には、その適用事業所ごとに被保険者の二分の一以上の同意を得て規約を作り、厚生労働大臣の認可を受けます（同法第十一条・第十二条）。
健康保険法第4条・第6条・第8条・第9条・第11条・第12条を参考にAIが作成。
条例
地方公共団体が自ら定めるきまりです。都道府県、市町村、東京都の特別区がそれぞれ定めます（地方自治法第一条の三・第二百八十一条・第二百八十三条）。住民が選挙した議員でつくる議会（同法第八十九条）の議決で制定され（同法第九十六条第一項第一号）、知事や市町村長などその団体の長（同法第百三十九条）が公布します（同法第十六条）。憲法は、地方公共団体が法律の範囲内で条例を制定できるとしており（日本国憲法第九十四条）、法律・政令・省令などの法令に違反することはできません（地方自治法第十四条第一項）。法令に特別の定めがある場合を除き、地方公共団体が人に義務を課したり権利を制限したりするには、条例によらなければなりません（同条第二項）。条例に違反した人に対する罰則も、同法が定める範囲で設けることができます（同条第三項）。条例はその地方公共団体の事務について定めるもの（同法第二条第二項・第十四条第一項）なので、同じ事柄でも地域によって扱いが違うことがあります。国の法令である省令（「施行規則」など）とは別のものです。
日本国憲法第94条、地方自治法第1条の3・第2条・第14条・第16条・第89条・第96条・第139条・第281条・第283条を参考にAIが作成。
国税庁長官
財務省に置かれる国税庁の長です（財務省設置法第十八条）。国税庁は内国税の適正かつ公平な賦課及び徴収の実現などを任務とします（同法第十九条）。国税不服審判所長は、国税庁長官が発した通達に示されている法令の解釈と異なる解釈により裁決をするときは、あらかじめその意見を国税庁長官に通知しなければなりません（国税通則法第九十九条第一項）。国税庁長官がした処分に対する不服申立ては、国税庁長官に対する審査請求です（同法第七十五条第一項第二号）。
財務省設置法第18条・第19条、国税通則法第75条・第99条を参考にAIが作成。
内閣総理大臣
内閣の首長です。国会議員の中から国会の議決で指名され、天皇が任命します（第六十七条第一項・第六条第一項）。国務大臣を任意に任命し罷免することができ、その過半数は国会議員でなければなりません（第六十八条）。国務大臣は、その在任中、内閣総理大臣の同意がなければ訴追されません（第七十五条）。
日本国憲法第6条・第67条・第68条・第75条、Wikipedia「内閣総理大臣」を参考にAIが作成。
検察官
犯罪について、裁判所に訴えを起こす（公訴を行う）役目を負う者です（刑事訴訟法第二百四十七条）。犯人の性格、年齢や境遇、犯罪の重さや事情、犯罪の後の状況から、訴える必要がないと考えるときは、訴えを起こさないことができます（刑事訴訟法第二百四十八条）。刑事の事件では、裁判所に法を正しく当てはめるよう求め、裁判の執行を監督します。また、社会全体の利益を代表して、ほかの法令が検察官に任せた仕事も行い、それは刑事の事件に限りません（検察庁法第四条）。どのような犯罪についても捜査をすることができます（検察庁法第六条第一項）。検察官の仕事は検察庁がまとめており、検察庁には最高検察庁、高等検察庁、地方検察庁、区検察庁があります（検察庁法第一条）。
刑事訴訟法第247条・第248条、検察庁法第1条・第4条・第6条を参考にAIが作成。
国税局長
国税庁の地方支分部局として置かれる国税局の長です（財務省設置法第二十三条）。税務署は国税局の所掌事務の一部を分掌します（同法第二十四条）。国税局長は税務署長から徴収の引継ぎを受けることができ（国税通則法第四十三条第三項）、国税局長の処分に不服がある者は、その国税局長に対する再調査の請求か、国税不服審判所長に対する審査請求のいずれかを選べます（同法第七十五条第一項第一号）。
財務省設置法第23条・第24条、国税通則法第43条・第75条を参考にAIが作成。
特別区
都の区のことです（地方自治法第二百八十一条第一項）。今ある特別区は、東京都の二十三区だけです。特別区は、市町村と同じく住民に身近な地方公共団体（基礎的な地方公共団体）で、都が特別区のある区域全体でまとめて行う仕事を除き、ふつうは市町村が行う仕事を行います（同法第二百八十一条の二第二項）。市の仕事について定めた法令の規定は、その仕事を特別区が行う場合には特別区にも当てはまります（同法第二百八十一条第二項・第二百八十三条第二項）。そのまま当てはめにくいときは、政令で特別の定めを置くことができます（同法第二百八十三条第三項）。
地方自治法第281条・第281条の2・第283条、Wikipedia「特別区」を参考にAIが作成。