With respect to expenses incurred in Living Support received by a Person Specified as Hospitalized Long-term and Insured in combination with the medical treatment listed in Article 36, paragraph (1), item (v) at or from the health insurance-covered medical institution of said person's choice, Municipalities and Societies shall pay Living Support expenses for inpatients to the Householder or Society member of the household to which such Person Specified as Hospitalized Long-term and Insured belongs; provided, however, that this shall not apply during any period in which said Householder or Society member is subject to the application of Article 54-3, paragraph (1) or the main clause of paragraph (2) with respect to such Person Specified as Hospitalized Long-term and Insured.
市町村及び組合は、特定長期入院被保険者が、自己の選定する保険医療機関について第三十六条第一項第五号に掲げる療養の給付と併せて受けた生活療養に要した費用について、当該特定長期入院被保険者の属する世帯の世帯主又は組合員に対し、入院時生活療養費を支給する。ただし、当該世帯主又は組合員が当該特定長期入院被保険者について第五十四条の三第一項又は第二項本文の規定の適用を受けている間は、この限りでない。
The amount of Living Support expenses for inpatients shall be calculated by deducting the amount of Standard Co-payment for Dietary Treatment set forth in Article 85-2, paragraph (2) of the Health Insurance Act (hereinafter referred to as "Standard Living Expense Co-payment") from the Living Support expenses calculated in accordance with the standards set by the Minister of Health, Labour and Welfare pursuant to the provisions of the same paragraph (or, when said amount exceeds the actual amount of Living Support expenses, such actual amount of Living Support expenses).
入院時生活療養費の額は、当該生活療養につき健康保険法第八十五条の二第二項の規定による厚生労働大臣の定める基準の例により算定した費用の額（その額が現に当該生活療養に要した費用の額を超えるときは、当該現に生活療養に要した費用の額とする。）から、同項に規定する生活療養標準負担額（以下「生活療養標準負担額」という。）を控除した額とする。
The provisions of Article 64 of the Health Insurance Act and paragraph (3) of Article 36, Articles 40 and 41, paragraphs (3) through (8) of Article 45, Article 45-2 and paragraphs (3) through (5) of the preceding Article of this Act shall apply mutatis mutandis to Living Support received at or from a Health Insurance-Covered Medical Institution and to the payment of Living Support expenses for inpatients associated with such treatment. In this case, any technical replacement of terms necessary for these provisions shall be specified by Cabinet Order.
健康保険法第六十四条並びに本法第三十六条第三項、第四十条、第四十一条、第四十五条第三項から第八項まで、第四十五条の二及び前条第三項から第五項までの規定は、保険医療機関について受けた生活療養及びこれに伴う入院時生活療養費の支給について準用する。この場合において、これらの規定に関し必要な技術的読替えは、政令で定める。
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(Physicians Providing Health Insurance Treatment or Pharmacists Filling Health Insurance Prescriptions)
A physician or dentist engaged in medical treatment covered by health insurance at a medical institution providing services covered by health insurance or a pharmacist engaged in prescription covered…
保険医療機関において健康保険の診療に従事する医師若しくは歯科医師又は保険薬局において健康保険の調剤に従事する薬剤師は、厚生労働大臣の登録を受けた医師若しくは歯科医師（以下「保険医」と総称する。）又は薬剤師（以下「保険薬剤師」という。）でなければならない。
Open this provision(Living Support Expenses for Inpatients)
The amount of living support expenses for inpatients is the amount obtained by deducting the amount specified by the Minister of Health, Labor and Welfare taking into consideration an amount…
入院時生活療養費の額は、当該生活療養につき生活療養に要する平均的な費用の額を勘案して厚生労働大臣が定める基準により算定した費用の額（その額が現に当該生活療養に要した費用の額を超えるときは、当該現に生活療養に要した費用の額）から…
Open this provision(Benefits for Medical Treatment)
hospitalization or visiting a clinic, and caretaking and other nursing incidental to medical treatment provided there.
病院又は診療所への入院及びその療養に伴う世話その他の看護
Open this provision(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(Responsibilities of Health Insurance-Covered Medical Institutions, etc.)
The rules applicable in cases where a health insurance-covered medical institution, etc. or a health insurance-covered physician or health insurance-covered pharmacist…
保険医療機関等又は保険医若しくは保険薬剤師（健康保険法第六十四条に規定する保険医又は保険薬剤師をいう。以下同じ。）が、国民健康保険の療養の給付を担当し、又は国民健康保険の診療若しくは調剤に当たる場合の準則については、同法第七十条第一項及び第七十二条第一項の規定による厚生労働省令の例による。
Open this provision(Guidance by the Minister of Health, Labour and Welfare or Prefectural Governor)
Guidance by the Minister of Health, Labour and Welfare or the prefectural governor must be received by Health Insurance-Covered Medical Institutions, etc. with respect to benefits for medical…
保険医療機関等は療養の給付に関し、保険医及び保険薬剤師は国民健康保険の診療又は調剤に関し、厚生労働大臣又は都道府県知事の指導を受けなければならない。
Open this provision(Reports, etc. from Health Insurance-Covered Medical Institutions, etc.)
When the Minister of Health, Labour and Welfare or a prefectural governor finds it necessary in relation to benefits for medical treatment, said minister or governor may order a Health…
厚生労働大臣又は都道府県知事は、療養の給付に関して必要があると認めるときは、保険医療機関等若しくは保険医療機関等の開設者若しくは管理者、保険医、保険薬剤師その他の従業者であつた者（以下この項において「開設者であつた者等」という。）に対し報告若しくは診療録その他の帳簿書類の提出若しくは提示を命じ…
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 provision(Medical Fees Payable to Health Insurance-Covered Medical Institutions, etc.)
Upon receipt of a claim by a health insurance-covered medical institution, etc. for expenses incurred in providing benefits for medical treatment, Municipalities and Societies shall make payment…
市町村及び組合は、保険医療機関等から療養の給付に関する費用の請求があつたときは、第四十条に規定する準則並びに第二項に規定する額の算定方法及び前項の定めに照らして審査した上、支払うものとする。
Open this provision(Medical Fees Payable to Health Insurance-Covered Medical Institutions, etc.)
Municipalities and Societies may entrust affairs concerning the examination and payment pursuant to the provisions of the preceding paragraph to a Federation of National Health Insurance Associations…
市町村及び組合は、前項の規定による審査及び支払に関する事務を都道府県の区域を区域とする国民健康保険団体連合会（加入している都道府県、市町村及び組合の数がその区域内の都道府県、市町村及び組合の総数の三分の二に達しないものを除く。）又は医療情報基盤・診療報酬審査支払機構法（昭和二十三年法律第百二十九号）による医療情報基盤…
Open this provision(Medical Fees Payable to Health Insurance-Covered Medical Institutions, etc.)
Of the affairs concerning the review of medical bills conducted by a Federation of National Health Insurance Associations as entrusted pursuant to the provisions of the preceding paragraph or those…
国民健康保険団体連合会は、前項の規定及び健康保険法第七十六条第五項の規定による委託を受けて行う診療報酬請求書の審査に関する事務のうち厚生労働大臣の定める診療報酬請求書の審査に係るものを、一般社団法人又は一般財団法人であつて、審査に関する組織その他の事項につき厚生労働省令で定める要件に該当し…
Open this provision(Medical Fees Payable to Health Insurance-Covered Medical Institutions, etc.)
An entity to which affairs concerning the review of medical bills as specified by the Minster of Health, Labour and Welfare pursuant to the provisions of the preceding paragraph have been entrusted…
前項の規定により厚生労働大臣の定める診療報酬請求書の審査に係る事務の委託を受けた者は、当該診療報酬請求書の審査を厚生労働省令で定める要件に該当する者に行わせなければならない。
Open this provision(Medical Fees Payable to Health Insurance-Covered Medical Institutions, etc.)
In addition to what is provided for in each of the preceding paragraphs, necessary particulars concerning claims for expenses incurred in providing benefits for medical treatment by Health…
前各項に規定するもののほか、保険医療機関等の療養の給付に関する費用の請求に関して必要な事項は、厚生労働省令で定める。
Open this provision(Dietary Treatment Expenses for Inpatients)
When an insured person has received Dietary Treatment at or from a health insurance-covered medical institution, Municipalities and Societies may, on behalf of the Householder or Society member of…
被保険者が保険医療機関について食事療養を受けたときは、市町村及び組合は、当該被保険者の属する世帯の世帯主又は組合員が当該保険医療機関に支払うべき食事療養に要した費用について、入院時食事療養費として当該世帯主又は組合員に対し支給すべき額の限度において、当該世帯主又は組合員に代わり、当該保険医療機関に支払うことができる。
Open this provision(Dietary Treatment Expenses for Inpatients)
When a payment has been made pursuant to the provisions of the preceding paragraph, the Householder or Society member shall be deemed to have received expenses for Dietary Treatment for inpatients.
前項の規定による支払があつたときは、世帯主又は組合員に対し入院時食事療養費の支給があつたものとみなす。
Open this provision(Dietary Treatment Expenses for Inpatients)
Upon acceptance of a payment of expenses incurred for Dietary Treatment, the Health Insurance-Covered Medical Institution must, pursuant to the provisions of Ordinance of the Ministry of Health…
保険医療機関は、食事療養に要した費用につき、その支払を受ける際、当該支払をした世帯主又は組合員に対し、厚生労働省令の定めるところにより、領収証を交付しなければならない。
Open this provision(Special Medical Expenses)
In the case where a Householder who is in arrears with insurance premiums (limited to a Householder who has a domicile within the area of the Municipality) or a Society member who is in arrears with…
市町村及び組合は、保険料を滞納している世帯主（当該市町村の区域内に住所を有する世帯主に限る。）又は組合員（その世帯に属する全ての被保険者が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（以下この項及び第四項において「原爆一般疾病医療…
Open this provision(Special Medical Expenses)
Even before the period specified by Order of the Ministry of Health, Labour and Welfare prescribed in the preceding paragraph has elapsed, in the case where a householder…
市町村及び組合は、前項に規定する厚生労働省令で定める期間が経過する前においても、当該市町村又は組合が保険料納付の勧奨等を行つてもなお保険料滞納世帯主等が当該保険料を納付しない場合においては、その世帯に属する被保険者が保険医療機関等から療養を受けたとき、又は指定訪問看護事業者から指定訪問看護を受けたときは…
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)
Person Specified as Hospitalized Long-term and Insured
「特定長期入院被保険者」
An insured person who, when receiving inpatient care in a long-term care bed (療養病床) with the care and nursing that go with it, is in or past the month after the month in which they reach 65.
Short name set inArticle 36, paragraph (2), item (i)
Living Support
「生活療養」
Meals, and a suitable care environment as to temperature, lighting and water supply, provided together with hospitalization and the nursing care that goes with it (Article 36, paragraph (1), item (v)) to a person specified as hospitalized long-term and insured (特定長期入院被保険者).
Short name set inArticle 36, paragraph (2), item (ii)
Standard Living Expense Co-payment
「生活療養標準負担額」
The amount the Minister of Health, Labour and Welfare sets, taking account of average household spending on food, heating, lighting and water and of the base costs of meals and accommodation under Article 51-3, paragraph (2) of the Long-Term Care Insurance Act, which is deducted from the cost of living support (生活療養) to give the living support expenses for inpatients (入院時生活療養費); a different amount applies to people a Ministry of Health, Labour and Welfare Order (厚生労働省令) specifies in view of their income, condition, treatment and other circumstances.
Short name set inArticle 52-2, paragraph (2)