Article 45-4Adjustment of Finances for Health Insurance on the Basis of a Single Branch-Insured Person
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）
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。
Read this with the articles around it
JHIAmachine translation
「協会」
Short for the Japan Health Insurance Association (全国健康保険協会).
Short name set inArticle 1-2, paragraph (1)
premium rate for each prefecturemachine translation
「都道府県単位保険料率」
The premium rate for each prefecture as defined in Article 160, paragraph (2) of the Health Insurance Act: the general premium rate (一般保険料率), between 3% and 13%, that the Japan Health Insurance Association (全国健康保険協会) decides separately for the insured persons of each prefectural branch (支部被保険者), and that applies to them.
Defined inArticle 45-2, paragraph (1)· applies only in this provision and in Article 45-3; and Article 45-4, paragraph (4), item (i)
branch-insured person concernedmachine translation
「当該支部被保険者」
From Article 45-2 on, the branch-insured persons as defined in Article 160, paragraph (1) of the Health Insurance Act of the branch (支部) of the Japan Health Insurance Association (全国健康保険協会) in question: those employed at a place of business in that branch's prefecture and insured persons with optional and continued coverage (任意継続被保険者) living there.
Defined inArticle 45-2, paragraph (1), item (i), (a)
benefits for medical treatment, etc.machine translation
「療養の給付等」
In Article 45-2, paragraph (1), item (i), (a) and Article 45-4, paragraph (4), items (i) and (ii), the benefits for medical treatment, etc. as defined in Article 160, paragraph (3), item (i) of the Health Insurance Act: the benefits for medical treatment (療養の給付) under Article 52, item (i) of that Act and other insurance benefits a Ministry of Health, Labour and Welfare Order (厚生労働省令) names.
Short name set inArticle 45-2, paragraph (1), item (i), (a)· applies only in this provision and in Article 45-4, paragraph (4), items (i) and (ii)
business year following the business yearmachine translation
「事業年度の翌事業年度」
In Article 45-4, paragraph (4), the business year (事業年度) following the one business year for which Article 45-2 sets the premium rate for each prefecture (都道府県単位保険料率), or, where that rate is set under Article 45-3, the business year that includes the month of application (適用月) that Article names.
Defined inArticle 45-4, paragraph (4), item (i)· applies only in this paragraph
branch age-adjusted standard benefit costmachine translation
「支部年齢勘案標準給付費額」
In Article 45-4, paragraph (4), the sum over all age groups of the average benefit per person in each age group — the estimated cost for the following business year of benefits for medical treatment, etc. (療養の給付等) for the insured persons and dependents of that age in the health insurance the Japan Health Insurance Association (全国健康保険協会) runs, less co-payments and the national subsidy under Article 153 of the Health Insurance Act, divided by their estimated number — multiplied by the estimated number of the branch's insured persons (支部被保険者) and dependents of that age, worked out as a Ministry of Health, Labour and Welfare Order (厚生労働省令) provides.
Defined inArticle 45-4, paragraph (4), item (i)· applies only in this provision and in Article 45-4, paragraphs (2) and (3)
branch average benefit costmachine translation
「支部平均給付費額」
In Article 45-4, paragraph (4), the average benefit per person — the estimated cost for the following business year of benefits for medical treatment, etc. (療養の給付等) for all insured persons and dependents in the health insurance the Japan Health Insurance Association (全国健康保険協会) runs, less co-payments and the national subsidy under Article 153 of the Health Insurance Act, divided by their estimated number — multiplied by the estimated number of the branch's insured persons (支部被保険者) and their dependents, worked out as a Ministry of Health, Labour and Welfare Order (厚生労働省令) provides.
Defined inArticle 45-4, paragraph (4), item (ii)· applies only in this provision and in Article 45-4, paragraphs (2) and (3)
estimated total benefit costmachine translation
「総給付費見込額」
In Article 45-4, paragraph (4), items (ii) and (iii), the estimated cost for the following business year of the benefits for medical treatment, etc. (療養の給付等) for all insured persons and dependents in the health insurance the Japan Health Insurance Association (全国健康保険協会) runs, less the estimated co-payments and national subsidy under Article 153 of the Health Insurance Act.
Short name set inArticle 45-4, paragraph (4), item (ii)· applies only in this provision and in Article 45-4, paragraph (4), item (iii)
branch benefit cost apportioned by total remunerationmachine translation
「支部総報酬按分給付費額」
In Article 45-4, paragraph (4), the estimated total benefit cost (総給付費見込額) multiplied by the estimated total remuneration apportionment rate (総報酬按分率) under Article 160, paragraph (3), item (ii) of the Health Insurance Act for the following business year, worked out as a Ministry of Health, Labour and Welfare Order (厚生労働省令) provides.
Defined inArticle 45-4, paragraph (4), item (iii)· applies only in this provision and in Article 45-4, paragraphs (2) and (3)