Article 43Other Matters Concerning Payment of High-cost Medical Expenses
第四十三条（その他高額療養費の支給に関する事項）
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。
Changes on (Cabinet Order No. 240 of 2026)
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
Changes on (Cabinet Order No. 240 of 2026)
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。
Changes on (Cabinet Order No. 240 of 2026)
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。
Changes on (Cabinet Order No. 240 of 2026)
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。
Changes and moves to (j) on (Cabinet Order No. 240 of 2026)
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。
Changes and moves to (m) on (Cabinet Order No. 240 of 2026)
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。
Changes on (Cabinet Order No. 240 of 2026)
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
Changes on (Cabinet Order No. 240 of 2026)
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。
Changes on (Cabinet Order No. 240 of 2026)
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。
Changes on (Cabinet Order No. 240 of 2026)
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。
Changes on (Cabinet Order No. 240 of 2026)
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。
Changes and moves to (m) on (Cabinet Order No. 240 of 2026)
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。
Changes and moves to (n) on (Cabinet Order No. 240 of 2026)
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
Changes on (Cabinet Order No. 240 of 2026)
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
Changes on (Cabinet Order No. 240 of 2026)
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。
Changes on (Cabinet Order No. 240 of 2026)
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。
Changes on (Cabinet Order No. 240 of 2026)
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。
Changes on (Cabinet Order No. 240 of 2026)
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。
Changes and moves to (m) on (Cabinet Order No. 240 of 2026)
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。
Changes and moves to (n) on (Cabinet Order No. 240 of 2026)
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
Changes on (Cabinet Order No. 240 of 2026)
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
Changes on (Cabinet Order No. 240 of 2026)
a person other than those listed in (b) and (c): 22,000 yen;
ロ及びハに掲げる者以外の者 二万二千円
Changes on (Cabinet Order No. 240 of 2026)
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
Changes on (Cabinet Order No. 240 of 2026)
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。
general medical expenses for atomic bomb survivorsmachine translation
「原爆一般疾病医療費」
In Article 41, paragraph (1), item (ii) and Article 43, paragraph (5), the general medical expenses (一般疾病医療費) paid under the Atomic Bomb Survivors' Assistance Act.
Short name set inArticle 41, paragraph (1), item (ii)· applies only in this provision and in Article 43, paragraph (5)
insured person of the late-stage elderly medical care systemmachine translation
「後期高齢者医療の被保険者」
An insured person of the late-stage elderly medical care system (後期高齢者医療) under Article 50 of the Act on Assurance of Medical Care for Elderly People.
Short name set inArticle 41, paragraph (4), item (i)
reference datemachine translation
「基準日」
The last day of the calculation period (計算期間), the period from 1 August each year to the following 31 July, on which high-cost medical expenses (高額療養費) and similar amounts for the whole period are worked out.
Defined inArticle 41-2, paragraph (1)
insured person on the reference datemachine translation
「基準日被保険者」
A person who, on the reference date (基準日), is an insured person (被保険者) of this insurer, other than a day-labour special insured person (日雇特例被保険者), a member of a mutual aid association (共済組合) under the National Public Officers Mutual Aid Association Act or the Local Public Officers, etc. Mutual Aid Association Act, or a participant in the mutual aid system under the Private School Personnel Mutual Aid Association Act.
Short name set inArticle 41-2, paragraph (1), item (i)
calculation periodmachine translation
「計算期間」
The period from 1 August each year to the following 31 July, over which annual amounts such as high-cost medical expenses (高額療養費) for outpatient treatment are worked out.
Defined inArticle 41-2, paragraph (4)
case of repeated high-cost medical expensesmachine translation
「高額療養費多数回該当の場合」
In Article 42 and Article 43, paragraph (1), the case where, in the 12 months up to the month of the treatment, high-cost medical expenses (高額療養費) under Article 41, paragraphs (1) to (4) have already been paid for three months or more; the base amount for calculating high-cost medical expenses (高額療養費算定基準額) is then lower.
Short name set inArticle 42, paragraph (1), item (i)· applies only in this article and in Article 43, paragraph (1)
medical institution providing services covered by health insurance, etc.machine translation
「保険医療機関等」
In Article 43, paragraphs (1) and (5), the hospitals, clinics and pharmacies designated by the Minister of Health, Labour and Welfare (保険医療機関 and 保険薬局) and those listed in Article 63, paragraph (3), item (ii) of the Health Insurance Act — the hospitals, clinics and pharmacies an insurer designates to treat or dispense to the persons it insures — to which the insurer pays high-cost medical expenses (高額療養費) directly where the co-payment or other cost has not been paid.
Short name set inArticle 43, paragraph (1)· applies only in this paragraph and in Article 43, paragraph (5)
amount borne for medical expenses combined with treatment outside insurance coveragemachine translation
「保険外併用療養費負担額」
In Article 43, paragraphs (1) and (5), where the insurer pays the medical expenses combined with treatment outside insurance coverage (保険外併用療養費) straight to the hospital, clinic or pharmacy on the insured person's behalf, or treats them as paid, under Article 85, paragraph (5) or (7) of the Health Insurance Act as applied by Article 86, paragraph (4), the cost worked out for that treatment less the amount of those medical expenses: the part left for the insured person to pay.
Defined inArticle 43, paragraph (1)· applies only in this paragraph and in Article 43, paragraph (5)
amount borne for medical expenses for home-nursingmachine translation
「訪問看護療養費負担額」
In Article 43, paragraphs (1) and (5), where the insurer pays the medical expenses for home-nursing (訪問看護療養費) straight to the designated home-visit nursing provider on the insured person's behalf under Article 88, paragraph (6) of the Health Insurance Act, the cost worked out for that home-visit nursing less the amount of those medical expenses: the part left for the insured person to pay.
Defined inArticle 43, paragraph (1)· applies only in this paragraph and in Article 43, paragraph (5)
person covered by medical insurancemachine translation
「医療保険加入者」
In Article 43, paragraph (11), Article 43-4, paragraph (1) and Article 44, paragraphs (4) and (8), a person covered by one of the medical insurance schemes — a member (加入者) as defined 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 (後期高齢者医療).
Defined inArticle 43, paragraph (11)· applies only in this provision and in Article 43-4, paragraph (1); and Article 44, paragraphs (4) and (8)