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Article 73Assistance to Societies

第七十三条(組合に対する補助)

The national government may, pursuant to Cabinet Order provisions, provide assistance to each Society in the total sum of the amounts listed in the following items with respect to the cost incurred in providing benefits for medical treatment, etc. and the expenses incurred in paying young-old payments and old-old aid, long-term care payments, contributions for securing medical care in the early phase of an epidemic and children and child-rearing support levies:

国は、政令の定めるところにより、組合に対し、療養の給付等に要する費用並びに前期高齢者納付金及び後期高齢者支援金、介護納付金、流行初期医療確保拠出金並びに子ども・子育て支援納付金の納付に要する費用について、次の各号に掲げる額の合算額を補助することができる。

the amount obtained by multiplying the total sum of the amounts listed in the following by the ratio specified by Cabinet Order within the range of thirteen hundredths to thirty-two hundredths by taking into consideration the financial capability of the Society:

次に掲げる額の合算額に組合の財政力を勘案して百分の十三から百分の三十二までの範囲内において政令で定める割合を乗じて得た額

the amount obtained by deducting, from (1) the total sum of: (i) the amount calculated by deducting, from the expenses incurred in providing benefits for medical treatment, the amount of co-payment relating to such benefits; and (ii) the amount of expenses incurred in paying the expenses for Dietary Treatment for inpatients, Living Support expenses for inpatients, medical expenses combined with treatment outside insurance coverage, medical expenses, medical expenses for home-nursing, special medical expenses, transport expenses, high-cost medical expenses and expenses for high-cost medical treatment combined with long-term care, (2) an amount calculated pursuant to Cabinet Order provisions as the amount of such portion of said total sum as relating to the Society's Specified Insured Persons (meaning persons who are insured persons covered by such Society as a result of not being eligible as insured persons under the Health Insurance Act upon the approval under the provisions of item (viii) of paragraph (1) of Article 3 or the proviso of paragraph (2) of the same Article of the same Act as well as insured persons covered by such Society who belong to the above insured persons' respective families; the same shall apply in (b)) (hereinafter referred to as the "Specified Benefit Amount" in this Article);

療養の給付に要する費用の額から当該給付に係る一部負担金に相当する額を控除した額並びに入院時食事療養費、入院時生活療養費、保険外併用療養費、療養費、訪問看護療養費、特別療養費、移送費、高額療養費及び高額介護合算療養費の支給に要する費用の額の合算額から、当該合算額のうち組合特定被保険者(健康保険法第三条第一項第八号又は同条第二項ただし書の規定による承認を受けて同法の被保険者とならないことにより当該組合の被保険者である者及びその世帯に属する当該組合の被保険者をいう。ロにおいて同じ。)に係る額として政令の定めるところにより算定した額(以下この条において「特定給付額」という。)を控除した額

the amount calculated by deducting, from the amount of expenses incurred in paying young-old payments and old-old aid, long-term care payments, contributions for securing medical care in the early phase of an epidemic and children and child-rearing support levies (or, where any young-old subsidy is payable, the amount calculated by deducting such young-old subsidy from such amount of expenses), the amount calculated pursuant to Cabinet Order provisions as the amount of such portion of said amount of expenses as relating to the Society's Specified Insured Persons (hereinafter referred to as the "Specified Amount of Payment Cost" in this Article);

前期高齢者納付金及び後期高齢者支援金、介護納付金、流行初期医療確保拠出金並びに子ども・子育て支援納付金の納付に要する費用の額(前期高齢者交付金がある場合には、これを控除した額)から、当該費用の額のうち組合特定被保険者に係る費用の額として政令の定めるところにより算定した額(以下この条において「特定納付費用額」という。)を控除した額

the total sum of the amount obtained by multiplying the Specified Benefit Amount by a specified ratio and the amount obtained by multiplying the Specified Amount of Payment Cost by a specified ratio.

特定給付額及び特定納付費用額のそれぞれに特定割合を乗じて得た額の合算額

The specified ratio as referred to in item (ii) of the preceding paragraph shall be a ratio less than thirty-two hundredths, calculated pursuant to Cabinet Order provisions separately for the Specified Benefit Amount and the Specified Amount of Payment Cost by taking into consideration the proportion of assistance provided by the national government with respect to expenses incurred in health insurance services under the Health Insurance Act (including expenses incurred in paying young-old payments and old-old aid, long-term care payments, contributions for securing medical care in the early phase of an epidemic and children and child-rearing support levies) and the financial capability of the Society.

前項第二号の特定割合は、百分の三十二を下回る割合であつて、健康保険法による健康保険事業に要する費用(前期高齢者納付金及び後期高齢者支援金、介護納付金、流行初期医療確保拠出金並びに子ども・子育て支援納付金の納付に要する費用を含む。)に対する国の補助の割合及び組合の財政力を勘案して、特定給付額及び特定納付費用額のそれぞれについて、政令で定めるところにより算定した割合とする。

With regard to the application of the provisions of paragraph (1) to a Society which has reduced the ratios for co-payment pursuant to the provisions of Article 43, paragraph (1) or to a Society which has chosen to bear all or part of the amount of the co-payment to be made by all or some of its insured persons, the amount listed in (a) of item (1) of the same paragraph and the Specified Benefit Amount shall be the amount listed in (a) of the same item and the Specified Benefit Amount, respectively, calculated pursuant to Cabinet Order provisions as if the relevant measures to reduce the ratios for co-payment or to bear all or part of the amount of co-payment were not taken.

第四十三条第一項の規定により一部負担金の割合を減じている組合及び組合員の全部又は一部について、その一部負担金に相当する額の全部又は一部を負担することとしている組合に対する第一項の規定の適用については、同項第一号イに掲げる額及び特定給付額は、当該一部負担金の割合の軽減又は一部負担金に相当する額の全部若しくは一部の負担の措置が講ぜられないものとして、政令の定めるところにより算定した同号イに掲げる額及び特定給付額に相当する額とする。

In cases where providing assistance as set forth in paragraph (1), the national government may, pursuant to Cabinet Order provisions, increase the amount of assistance set forth in the same paragraph by taking into account the financial capability, etc. of the relevant Society.

国は、第一項の補助をする場合において、政令の定めるところにより、組合の財政力等を勘案して、同項の補助の額を増額することができる。

The total amount by which the amount of assistance may be increased pursuant to the preceding paragraph shall be within the amount equal to 15.4/100 of the total estimated amount of: the amount listed in (a) of item (i) of paragraph (1) and the Specified Benefit Amount (or, where the provisions of paragraph (3) applies to these amounts, the amount calculated by applying the provisions of the same paragraph); and the total sum of the amount listed in (b) of the same item and the Specified Amount of Payment Cost.

前項の規定により増額することができる補助の額の総額は、第一項第一号イに掲げる額及び特定給付額(これらの額について第三項の規定の適用がある場合にあつては、同項の規定を適用して算定した額)並びに同号ロに掲げる額及び特定納付費用額の合算額の見込額の総額の百分の十五・四に相当する額の範囲内の額とする。

Article 73-2Childbirth and Childcare Grants

第七十三条の二(出産育児交付金)

Part of the expenses required for the lump-sum allowance for childbirth and childcare (limited to the portion relating to the amount specified by Cabinet Order under Article 101 of the Health Insurance Act (or, where the amount specified by a Prefectural or Municipal Ordinance or constitution based on Article 58, paragraph (1) is less than the amount specified by Cabinet Order under Article 101 of that Act, the amount specified by that Prefectural or Municipal Ordinance or constitution)) is to be covered, pursuant to Cabinet Order provisions, by the childbirth and childcare grants that the organization provides to prefectures or Societies pursuant to the provisions of Article 124-4, paragraph (1) of the Act on Assurance of Medical Care for Elderly People.

出産育児一時金の支給に要する費用(健康保険法第百一条の政令で定める金額(第五十八条第一項の規定に基づく条例又は規約で定める金額が、同法第百一条の政令で定める金額に満たないときは、当該条例又は規約で定める金額とする。)に係る部分に限る。)の一部については、政令で定めるところにより、高齢者の医療の確保に関する法律第百二十四条の四第一項の規定により機構が都道府県又は組合に対して交付する出産育児交付金をもつて充てる。

The provisions of Articles 152-3 through 152-5 of the Health Insurance Act and Articles 41 and 42 of the Act on Assurance of Medical Care for Elderly People apply mutatis mutandis to childbirth and childcare grants. In this case, any technical replacement of terms necessary for these provisions shall be specified by Cabinet Order.

健康保険法第百五十二条の三から第百五十二条の五までの規定並びに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は、出産育児交付金について準用する。この場合において、必要な技術的読替えは、政令で定める。

Article 74Assistance by the National Government

第七十四条(国の補助)

In addition to what is provided for in Articles 69, 70 and 72, Article 72-3-2, paragraph (2), Article 72-3-3, paragraph (2), Article 72-4, paragraph (2), Article 72-5, paragraph (1) and Article 73, the national government may, within the limits of its budget, assist with one-third of the expenses for public health nurses and with part of the other expenses for national health insurance services.

国は、第六十九条、第七十条、第七十二条、第七十二条の三の二第二項、第七十二条の三の三第二項、第七十二条の四第二項、第七十二条の五第一項及び第七十三条に規定するもののほか、予算の範囲内において、保健師に要する費用についてはその三分の一を、国民健康保険事業に要するその他の費用についてはその一部を補助することができる。

Article 75Assistance and Lending by Prefectural and Municipal Governments

第七十五条(都道府県及び市町村の補助及び貸付)

In addition to what is provided for in Article 72-3, paragraph (2), Article 72-3-2, paragraph (3), Article 72-3-3, paragraph (3) and Article 72-4, paragraph (3), a prefectural or municipal government may provide subsidies or loans with respect to expenses incurred in national health insurance services (including expenses incurred in paying young-old payments, etc. and old-old aid, etc., long-term care payments, 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 (hereinafter referred to as "contribution for securing medical care in the early phase of an epidemic, etc.") and children and child-rearing support levies).

都道府県及び市町村は、第七十二条の三第二項、第七十二条の三の二第三項、第七十二条の三の三第三項及び第七十二条の四第三項に規定するもののほか、国民健康保険事業に要する費用(前期高齢者納付金等及び後期高齢者支援金等、介護納付金、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・子育て支援納付金の納付に要する費用を含む。)に対し、補助金を交付し、又は貸付金を貸し付けることができる。

Article 75-2Subsidy for National Health Insurance Benefit Expenses, etc.

第七十五条の二(国民健康保険保険給付費等交付金)

In order to ensure the smooth and reliable implementation of national health insurance services, including the provision of insurance benefits, and to adjust finances in accordance with the financial condition and other circumstances of the Municipalities within the prefecture, each prefecture shall, pursuant to Cabinet Order provisions, by Prefectural Ordinance, provide subsidies for national health insurance benefit expenses, etc. to the Municipalities within that prefecture with respect to the cost incurred in providing benefits for medical treatment, etc. and other expenses required for national health insurance services borne in the special account of each such Municipality for national health insurance.

都道府県は、保険給付の実施その他の国民健康保険事業の円滑かつ確実な実施を図り、及び当該都道府県内の市町村の財政状況その他の事情に応じた財政の調整を行うため、政令で定めるところにより、条例で、当該都道府県内の市町村に対し、当該市町村の国民健康保険に関する特別会計において負担する療養の給付等に要する費用その他の国民健康保険事業に要する費用について、国民健康保険保険給付費等交付金を交付する。

Efforts are to be made to ensure that the provision of subsidies for national health insurance benefit expenses, etc. under the preceding paragraph is carried out consistently with the prefectural national health insurance management policy.

前項の規定による国民健康保険保険給付費等交付金の交付は、都道府県国民健康保険運営方針との整合性を確保して行うよう努めるものとする。

Article 75-3

第七十五条の三

From a wide-area or medical specialist perspective, in order to ensure the proper implementation of insurance benefits by the Municipalities within the prefecture and to properly provide subsidies for national health insurance benefit expenses, etc., a prefecture may, as provided by Order of the Ministry of Health, Labour and Welfare, request the Municipalities within that prefecture to provide the claims made by health insurance-covered medical institutions, etc. pursuant to Article 45, paragraph (4) (including as applied mutatis mutandis pursuant to Article 52, paragraph (6), Article 52-2, paragraph (3) and Article 53, paragraph (3)), the claims made by designated home-nursing providers pursuant to Article 54-2, paragraph (9) and other information relating to the review and payment of insurance benefits by those Municipalities (including, where a Municipality has entrusted its affairs concerning insurance benefits to a Federation of National Health Insurance Associations or the organization (referred to as a "case of entrustment of affairs" in the following Article), information held by the Federation of National Health Insurance Associations or the organization with respect to the entrusted affairs).

都道府県は、広域的又は医療に関する専門的な見地から、当該都道府県内の市町村による保険給付の適正な実施を確保し、国民健康保険保険給付費等交付金を適正に交付するため、厚生労働省令で定めるところにより、当該都道府県内の市町村に対し、保険医療機関等が第四十五条第四項(第五十二条第六項、第五十二条の二第三項及び第五十三条第三項において準用する場合を含む。)の規定により行つた請求及び指定訪問看護事業者が第五十四条の二第九項の規定により行つた請求その他の当該市町村による保険給付の審査及び支払に係る情報(当該市町村が、その保険給付に関する事務を国民健康保険団体連合会又は機構に委託した場合(次条において「事務委託の場合」という。)にあつては、当該委託された事務に関し、国民健康保険団体連合会又は機構が保有する情報を含む。)の提供を求めることができる。

Article 75-4

第七十五条の四

If a prefecture finds that there is a risk that insurance benefits by a Municipality within the prefecture have been provided in violation of the provisions of this Act or other relevant laws and regulations, or improperly, it may, giving reasons, request that Municipality (including, in a case of entrustment of affairs, the Federation of National Health Insurance Associations or the organization that received the entrustment) to re-examine the insurance benefits by that Municipality.

都道府県は、当該都道府県内の市町村による保険給付がこの法律その他関係法令の規定に違反し、又は不当に行われたおそれがあると認めるときは、理由を付して、当該市町村(事務委託の場合にあつては、当該委託を受けた国民健康保険団体連合会又は機構を含む。)に対し、当該市町村による保険給付について再度の審査を求めることができる。

When a Municipality, or a Federation of National Health Insurance Associations or the organization, receives a request for re-examination under the preceding paragraph (hereinafter referred to as a "request for re-examination"), it must re-examine the insurance benefits relating to that request for re-examination and report the results to the prefectural governor.

市町村又は国民健康保険団体連合会若しくは機構は、前項の規定による再度の審査の求め(以下「再審査の求め」という。)を受けたときは、当該再審査の求めに係る保険給付について再度の審査を行い、その結果を都道府県知事に報告しなければならない。

Article 75-5

第七十五条の五

A prefecture may recommend to the Municipality concerned that it cancel all or part of the insurance benefits, if, despite the prefecture having made a request for re-examination, that Municipality does not cancel all or part of the insurance benefits relating to the request for re-examination, and the prefecture finds that those insurance benefits were provided in violation of the provisions of this Act or other relevant laws and regulations, or improperly (excluding where the examination based on the request for re-examination was conducted by the National Health Insurance Medical Fees Review Committee prescribed in Article 87, paragraph (1) (including, where a Federation of National Health Insurance Associations has, pursuant to the provisions of Article 45, paragraph (6), entrusted affairs concerning the review of medical bills to a corporation designated by the Minister of Health, Labour and Welfare prescribed in that paragraph (hereinafter referred to as a "Designated Association"), the person who conducts the review of those medical bills), or by the Review Committee prescribed in or the special Review Committee prescribed in ).

都道府県は、再審査の求めをしたにもかかわらず、当該市町村が当該再審査の求めに係る保険給付の全部又は一部を取り消さない場合であつて、当該保険給付がこの法律その他関係法令の規定に違反し、又は不当に行われたものと認めるとき(当該再審査の求めに基づく審査が第八十七条第一項に規定する国民健康保険診療報酬審査委員会(第四十五条第六項の規定により国民健康保険団体連合会が診療報酬請求書の審査に係る事務を同項に規定する厚生労働大臣が指定する法人(以下「指定法人」という。)に委託した場合において、当該診療報酬請求書の審査を行う者を含む。)又は医療情報基盤・に規定する審査委員会若しくはに規定する特別審査委員会において行われたときを除く。)は、当該市町村に対し、当該保険給付の全部又は一部を取り消すべきことを勧告することができる。

In making the recommendation under the provisions of the preceding paragraph, the prefecture must in advance hear the opinion of the Municipality concerned.

都道府県は、前項の規定による勧告を行うに当たつては、あらかじめ、当該市町村の意見を聴かなければならない。

Article 75-6

第七十五条の六

When a prefecture has recommended, pursuant to the provisions of paragraph (1) of the preceding Article, that all or part of insurance benefits be canceled, and the Municipality concerned has not complied with the recommendation, the prefecture may, in granting the subsidy for national health insurance benefit expenses, etc., reduce, as provided by Cabinet Order, an amount equivalent to those insurance benefits (limited to the portion pertaining to the recommendation) from the amount of the subsidy for national health insurance benefit expenses, etc.

都道府県は、前条第一項の規定により保険給付の全部又は一部を取り消すべきことを勧告したにもかかわらず、当該市町村が当該勧告に従わなかつたときは、国民健康保険保険給付費等交付金の交付に当たり、政令で定めるところにより、国民健康保険保険給付費等交付金の額から当該保険給付(当該勧告に係る部分に限る。)に相当する額を減額することができる。

Article 75-7Collection of Payments for National Health Insurance Services Expenses and Obligation to Pay Them

第七十五条の七(国民健康保険事業費納付金の徴収及び納付義務)

In order to cover the expenses required for national health insurance services, such as the expenses required for granting subsidies for national health insurance benefit expenses, etc. borne by the special account of the prefecture relating to national health insurance (including the expenses required for paying young-old payments, etc., old-old aid, etc., the long-term care payment, the contribution for securing medical care in the early phase of an epidemic, etc. and the children and child-rearing support levy), a prefecture is to collect payments for national health insurance services expenses from the Municipalities within the prefecture each fiscal year (meaning the period from April 1 each year to March 31 of the following year; the same applies hereinafter), by Prefectural Ordinance, as provided by Cabinet Order.

都道府県は、当該都道府県の国民健康保険に関する特別会計において負担する国民健康保険保険給付費等交付金の交付に要する費用その他の国民健康保険事業に要する費用(前期高齢者納付金等及び後期高齢者支援金等、介護納付金、流行初期医療確保拠出金等並びに子ども・子育て支援納付金の納付に要する費用を含む。)に充てるため、政令で定めるところにより、条例で、年度(毎年四月一日から翌年三月三十一日までをいう。以下同じ。)ごとに、当該都道府県内の市町村から、国民健康保険事業費納付金を徴収するものとする。

Municipalities must pay the payments for national health insurance services expenses under the preceding paragraph.

市町村は、前項の国民健康保険事業費納付金を納付しなければならない。

Article 76Insurance Premiums

第七十六条(保険料)

A Municipality must collect insurance premiums from the Householder of the household to which an insured person belongs (limited to a Householder who has a domicile within the area of the Municipality) in order to cover the expenses required for paying payments for national health insurance services expenses borne by the special account of the Municipality relating to national health insurance (including the expenses required for paying young-old payments, etc., old-old aid, etc., the long-term care payment, the contribution for securing medical care in the early phase of an epidemic, etc. and the children and child-rearing support levy borne by the special account relating to national health insurance of the prefecture to which the Municipality belongs; the same applies hereinafter), the expenses required for paying the financial stabilization fund contribution and other expenses required for national health insurance services; provided, however, that this does not apply when national health insurance tax is imposed pursuant to the provisions of the Local Tax Act.

市町村は、当該市町村の国民健康保険に関する特別会計において負担する国民健康保険事業費納付金の納付に要する費用(当該市町村が属する都道府県の国民健康保険に関する特別会計において負担する前期高齢者納付金等及び後期高齢者支援金等、介護納付金、流行初期医療確保拠出金等並びに子ども・子育て支援納付金の納付に要する費用を含む。以下同じ。)、財政安定化基金拠出金の納付に要する費用その他の国民健康保険事業に要する費用に充てるため、被保険者の属する世帯の世帯主(当該市町村の区域内に住所を有する世帯主に限る。)から保険料を徴収しなければならない。ただし、地方税法の規定により国民健康保険税を課するときは、この限りでない。

A Society shall collect insurance premiums from Society members to be allocated to the cost incurred in providing benefits for medical treatment, etc. and other expenses for national health insurance services (including expenses incurred in paying young-old payments, etc., old-old aid, etc., the long-term care payment, the contribution for securing medical care in the early phase of an epidemic, etc. and the children and child-rearing support levy and, in the case of a Society set forth in Article 179 of the Health Insurance Act, including expenses incurred in paying day worker contributions under the provisions of the same Act).

組合は、療養の給付等に要する費用その他の国民健康保険事業に要する費用(前期高齢者納付金等及び後期高齢者支援金等、介護納付金、流行初期医療確保拠出金等並びに子ども・子育て支援納付金の納付に要する費用を含み、健康保険法第百七十九条に規定する組合にあつては、同法の規定による日雇拠出金の納付に要する費用を含む。)に充てるため、組合員から保険料を徴収しなければならない。

Of the insurance premiums under the provisions of the preceding two paragraphs, those to be allocated to expenses incurred in paying the long-term care payment shall be imposed with respect to insured persons who fall under the category of insured person as set forth in Article 9, item (ii) of the Long-Term Care Insurance Act.

前二項の規定による保険料のうち、介護納付金の納付に要する費用に充てるための保険料は、介護保険法第九条第二号に規定する被保険者である被保険者について賦課するものとする。

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