Article 42Co-payment in Cases Where Benefits for Medical Treatment Are Received
第四十二条(療養の給付を受ける場合の一部負担金)
A person who receives benefit for medical treatment in relation to an Health Insurance-Covered Medical Institution, etc. pursuant to the provisions of Article 36, paragraph (3) shall pay, in accordance with the categories listed in the following items, an amount obtained by multiplying the amount calculated pursuant to the provisions of Article 45, paragraph (2) or (3) with respect to such benefit by the ratio listed in the relevant item below, as said person's co-payment to such Health Insurance-Covered Medical Institution, etc. when receiving such benefit:
in cases where the first March 31 after said person's 6th birthday has passed and the month in which said person's 70th birthday is has not yet started:0.3;
六歳に達する日以後の最初の三月三十一日の翌日以後であつて七十歳に達する日の属する月以前である場合 十分の三
in cases where the first March 31 after said person's 6th birthday has not yet passed:0.2;
六歳に達する日以後の最初の三月三十一日以前である場合 十分の二
in cases where the month in which said person's 70th birthday is has elapsed (excluding the case listed in the following item):0.2;
七十歳に達する日の属する月の翌月以後である場合(次号に掲げる場合を除く。) 十分の二
in cases where the month in which said person's 70th birthday is has elapsed and where the amount of income calculated pursuant to Cabinet Order provisions with respect to the insured persons (limited to persons whose 70th birthday is in any month before the current month and other persons specified by Cabinet Order) who belong to the household to which the person who receives such benefit for medical treatment belongs is not less than the amount specified by Cabinet Order:0.3.
七十歳に達する日の属する月の翌月以後である場合であつて、当該療養の給付を受ける者の属する世帯に属する被保険者(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その他政令で定める者に限る。)について政令の定めるところにより算定した所得の額が政令で定める額以上であるとき 十分の三
A health insurance-covered medical institution, etc. shall receive the co-payment set forth in the preceding paragraph (or, when the ratio of co-payment is reduced pursuant to the provisions of Article 43, paragraph (1), the co-payment calculated in accordance with the ratio after such reduction in the case of a health insurance-covered medical institution, etc. set forth in paragraph (2) of the same Article or, when the measure set forth in Article 44, paragraph (1), item (i) is taken, the co-payment after the relevant reduction) and, when an insured person fails to make all or part of such co-payment despite efforts of the health insurance-covered medical institution, etc. to receive such payment with the same care as due care of a prudent manager, Municipalities and Societies may impose a disposition on such insured person pursuant to the same rules as those for the monies to be collected pursuant to the provisions of this Act, at the request of such health insurance-covered medical institution, etc.
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(Benefits for Medical Treatment)
When an insured person seeks to receive the benefits set forth in paragraph (1), the insured person is to receive confirmation of being an insured person from the health insurance-covered medical…
被保険者が第一項の給付を受けようとするときは、自己の選定する保険医療機関等(健康保険法第六十三条第三項第一号に規定する保険医療機関又は保険薬局をいう。以下同じ。)から、電子資格確認(保険医療機関等から療養を受けようとする者又は第五十四条の二第一項に規定する指定訪問看護事業者から同項に規定する指定訪問看護を受けようとす…
Open this provision(Co-payment in Cases Where Benefits for Medical Treatment Are Received)
A person who receives benefit for medical treatment in relation to an Health Insurance-Covered Medical Institution, etc. pursuant to the provisions of Article 36, paragraph (3) shall pay…
第三十六条第三項の規定により保険医療機関等について療養の給付を受ける者は、その給付を受ける際、次の各号の区分に従い、当該給付につき第四十五条第二項又は第三項の規定により算定した額に当該各号に掲げる割合を乗じて得た額を、一部負担金として、当該保険医療機関等に支払わなければならない。
Open this provision(Co-payment in Cases Where Benefits for Medical Treatment Are Received)
in cases where the month in which said person's 70th birthday is has elapsed and where the amount of income calculated pursuant to Cabinet Order provisions with respect to the insured persons…
七十歳に達する日の属する月の翌月以後である場合であつて、当該療養の給付を受ける者の属する世帯に属する被保険者(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その他政令で定める者に限る。)について政令の定めるところにより算定した所得の額が政令で定める額以上であるとき 十分の三
Open this provisionMunicipalities and Societies may, pursuant to Cabinet Order provisions, reduce the ratio of co-payment set forth in Article 42, paragraph (1) by Municipal Ordinance or by constitution.
市町村及び組合は、政令で定めるところにより、条例又は規約で、第四十二条第一項に規定する一部負担金の割合を減ずることができる。
Open this provisionWhen the ratio of co-payment is reduced pursuant to the provisions of the preceding paragraph, it shall be sufficient for an insured person who receives benefits for medical treatment in relation to…
前項の規定により一部負担金の割合が減ぜられたときは、市町村又は組合が開設者の同意を得て定める保険医療機関等について療養の給付を受ける被保険者は、第四十二条第一項の規定にかかわらず、その減ぜられた割合による一部負担金を当該保険医療機関等に支払うをもつて足りる。
Open this provisionto reduce the amount of co-payment;
一部負担金を減額すること。
Open this provision(Medical Fees Payable to Health Insurance-Covered Medical Institutions, etc.)
Calculation of the amount of expenses incurred in providing the benefits for medical treatment set forth in the preceding paragraph shall be governed by the same rules as those prescribed by the…
前項の療養の給付に要する費用の額の算定については、健康保険法第七十六条第二項の規定による厚生労働大臣の定めの例による。
Open this provision(Medical Fees Payable to Health Insurance-Covered Medical Institutions, etc.)
Municipalities and Societies may, with the authorization of the prefectural governor, specify otherwise in a contract with a health insurance-covered medical institution…
市町村及び組合は、都道府県知事の認可を受け、保険医療機関等との契約により、当該保険医療機関等において行われる療養の給付に関する第一項の療養の給付に要する費用の額につき、前項の規定により算定される額の範囲内において、別段の定めをすることができる。
Open this provisionSociety
「組合」
A National Health Insurance Society (国民健康保険組合): a body made up, as its members (組合員), of people engaged in the same kind of business or occupation who live in its district, which may provide national health insurance to its members and the people in their households (Articles 3, 13 and 19).
Short name set inArticle 13, paragraph (1)
health insurance-covered medical institution, etc.machine translation
「保険医療機関等」
A hospital, clinic or pharmacy designated by the Minister of Health, Labour and Welfare under Article 63, paragraph (3), item (i) of the Health Insurance Act (a health insurance-covered medical institution (保険医療機関) or pharmacy (保険薬局)), from which an insured person of national health insurance chooses where to receive the benefits for medical treatment (療養の給付).
Defined inArticle 36, paragraph (3)