A Association of Medical Care Systems for the Elderly Aged 75 and older provides the following benefits for medical treatment with respect to sickness and injury of an insured; provided, however, that this does not apply during any period to which the provisions of Article 82, paragraph (1) or the main clause of paragraph (2) of the same Article apply to the insured:
後期高齢者医療広域連合は、被保険者の疾病又は負傷に関しては、次に掲げる療養の給付を行う。ただし、当該被保険者が第八十二条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。
medical examination;
診察
provision of medicines or treatment materials;
薬剤又は治療材料の支給
treatment, surgery, or other medical treatment;
処置、手術その他の治療
management of in-home medical treatment and care and other nursing involved in the medical treatment;
居宅における療養上の管理及びその療養に伴う世話その他の看護
admission to a hospital or clinic, and care and other nursing incidental to medical treatment 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
Benefits for the following medical treatment are not to be included in the benefits referred to in the preceding paragraph:
次に掲げる療養に係る給付は、前項の給付に含まれないものとする。
medical treatment consisting of the provision of meals, which is provided in combination with the medical treatment listed in item (v) of the preceding paragraph (excluding hospitalization in a sanatorium ward provided for in Article 7, paragraph (2), item (iv) of the Medical Care Act and care and other nursing incidental to the medical treatment (hereinafter referred to as "long-term hospitalization and medical treatment")) (hereinafter referred to as "dietary treatment");
食事の提供である療養であつて前項第五号に掲げる療養（医療法第七条第二項第四号に規定する療養病床への入院及びその療養に伴う世話その他の看護（以下「長期入院療養」という。）を除く。）と併せて行うもの（以下「食事療養」という。）
the following types of medical treatment given in combination with the type of medical treatment listed in item (v) of the preceding paragraph (limited to long-term inpatient treatment) (hereinafter referred to as "living support"):
medical treatment consisting of the provision of meals;
食事の提供である療養
medical treatment consisting of the creation of an appropriate environment for medical treatment in terms of temperature, lighting and water supply;
温度、照明及び給水に関する適切な療養環境の形成である療養
medical treatment using advanced medical care techniques specified by the Minister of Health, Labour and Welfare and other medical treatment specified by the Minister of Health, Labour and Welfare as medical treatment for which it is necessary to evaluate whether or not it should be subject to the benefits referred to in the preceding paragraph from the viewpoint of efficiently providing appropriate medical care (excluding patient-requested treatment referred to in the following item) (hereinafter referred to as "evaluation treatment");
medical treatment using advanced medical technology, which is specified by the Minister of Health, Labour and Welfare as medical treatment for which it is necessary to evaluate, from the viewpoint of efficiently providing appropriate medical care, whether or not it should be subject to benefits as set forth in the preceding paragraph, based on a request from a person who intends to receive the medical treatment (hereinafter referred to as "patient-requested treatment");
高度の医療技術を用いた療養であつて、当該療養を受けようとする者の申出に基づき、前項の給付の対象とすべきものであるか否かについて、適正な医療の効率的な提供を図る観点から評価を行うことが必要な療養として厚生労働大臣が定めるもの（以下「患者申出療養」という。）
the provision of a special sickroom pertaining to the selection of an insured and other medical treatment specified by the Minister of Health, Labour and Welfare (hereinafter referred to as "selective treatment").
被保険者の選定に係る特別の病室の提供その他の厚生労働大臣が定める療養（以下「選定療養」という。）
When an insured intends to receive the benefits under paragraph (1), the insured is to receive confirmation of being an insured and receive the benefits under paragraph (1) from a medical institution providing services covered by health insurance, etc. of the insured's own choosing, by electronic eligibility confirmation (meaning that a person who intends to receive medical treatment from a medical institution providing services covered by health insurance, etc. or to receive designated home-nursing prescribed in Article 78, paragraph (1) from a designated home-nursing provider makes an inquiry to the Association of Medical Care Systems for the Elderly Aged 75 and older about information pertaining to the status of the insured (including information necessary for claiming expenses related to insurance benefits), by a method of transmitting the electronic certificate for user certification (meaning the electronic certificate for user certification prescribed in Article 22, paragraph (1) of the Act on Certification Business of the Japan Agency for Local Authority Information Systems in Relation to Electronic Signatures, etc. (Act No. 153 of 2002)) recorded on the Individual Number Card (meaning the Individual Number Card prescribed in Article 2, paragraph (7) of the Act on the Use of Numbers to Identify a Specific Individual in Administrative Procedures (Act No. 27 of 2013)) or by any other method specified by Order of the Ministry of Health, Labour and Welfare, and, by a method using an electronic data processing system or any other method using information and communications technology, receives a reply from the Association of Medical Care Systems for the Elderly Aged 75 and older, provides that information to the medical institution providing services covered by health insurance, etc. or the designated home-nursing provider, and receives confirmation of being an insured from the medical institution providing services covered by health insurance, etc. or the designated home-nursing provider; the same applies hereinafter) or by any other method specified by Order of the Ministry of Health, Labour and Welfare (hereinafter referred to as "electronic eligibility confirmation, etc."); provided, however, that when the case falls under a case specified by Order of the Ministry of Health, Labour and Welfare, the insured need not receive that confirmation.
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指定訪問看護事業者から第七十八条第一項に規定する指定訪問看護を受けようとする者が、後期高齢者医療広域連合に対し、個人番号カード（行政手続における特定の個人を識別するための番号の利用等に関する法律（平成二十五年法律第二十七号）第二条第七項に規定する個人番号カードをいう。）に記録された利用者証明用電子証明書（電子署名等に係る地方公共団体情報システム機構の認証業務に関する法律（平成十四年法律第百五十三号）第二十二条第一項に規定する利用者証明用電子証明書をいう。）を送信する方法その他の厚生労働省令で定める方法により、被保険者の資格に係る情報（保険給付に係る費用の請求に必要な情報を含む。）の照会を行い、電子情報処理組織を使用する方法その他の情報通信の技術を利用する方法により、後期高齢者医療広域連合から回答を受けて当該情報を当該保険医療機関等又は指定訪問看護事業者に提供し、当該保険医療機関等又は指定訪問看護事業者から被保険者であることの確認を受けることをいう。以下同じ。）その他厚生労働省令で定める方法（以下「電子資格確認等」という。）により、被保険者であることの確認を受け、第一項の給付を受けるものとする。ただし、厚生労働省令で定める場合に該当するときは、当該確認を受けることを要しない。
The request referred to in paragraph (2), item (iv) is to be made to the Minister of Health, Labour and Welfare, pursuant to the provisions of the Minister of Health, Labour and Welfare, by attaching a written opinion of the establisher of the core hospital for clinical research prescribed in Article 4-3 of the Medical Care Act (limited to medical institutions providing services covered by health insurance) which provides the medical treatment pertaining to the request and other necessary documents.
If the Minister of Health, Labour and Welfare receives a request referred to in paragraph (2), item (iv), the Minister is to promptly review the request, and if the medical treatment related to the request is found to be that which requires the evaluation referred to in the same item, the Minister is to specify the medical treatment as patient-requested treatment.
If the Minister of Health, Labour and Welfare has determined that the medical treatment pertaining to the application prescribed in paragraph (2), item (iv) pursuant to the provisions of the preceding paragraph is patient-requested treatment, the Minister is to promptly notify the person who has made the application to that effect.
If the Minister of Health, Labour and Welfare has reviewed the request referred to in paragraph (2), item (iv) pursuant to the provisions of paragraph (5) and has determined that the medical treatment pertaining to the request is not to be specified as patient-requested treatment, the Minister is to promptly notify the person who has made the request to that effect by giving the reason.
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