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Article 68Temporary Suspensions of Insurance Benefits to a Person that has not paid an insurance premium as prescribed in the Medical Insurance Acts

第六十八条(医療保険各法の規定による保険料等に未納がある者に対する保険給付の一時差止)

With regard to an Insured Person Requiring Long-Term Care, etc. who is a Secondary Insured Person that can receive an insurance benefit, in a case when there is an insurance premium (including National Health Insurance tax pursuant to the provisions of the ) or contribution that said Insured Person Requiring Long-Term Care, etc. is obligated to pay or remit pursuant to the provisions of the Medical Insurance Acts and that was not paid by the payment deadline or remittance deadline (hereinafter referred to as "Unpaid Medical Insurance Premium, etc." in this paragraph and the following paragraph), except for a case when it is found that the existence of the Unpaid Medical Insurance Premium, etc. is due to a disaster or other special circumstance as determined by a Cabinet Order, a Municipality, pursuant to the provisions of Order of the Ministry of Health, Labour and Welfare, may request said Insured Person Requiring Long-Term Care, etc. to submit the Certificate of Insured Person and may enter on said Certificate of Insured Person that the provisions of Article 41, paragraph (6), Article 42-2, paragraph (6), Article 46, paragraph (4), Article 48, paragraph (4), Article 51-3, paragraph (4), Article 53, paragraph (4), Article 54-2, paragraph (6), Article 58, paragraph (4), and Article 61-3, paragraph (4) do not apply and that the whole or a part of the payment of an insurance benefit is to be suspended (hereinafter referred to as "Entry of Suspension of Insurance Benefit" in this Article).

市町村は、保険給付を受けることができる第二号被保険者である要介護被保険者等について、医療保険各法の定めるところにより当該要介護被保険者等が納付義務又は払込義務を負う保険料(の規定による国民健康保険税を含む。)又は掛金であってその納期限又は払込期限までに納付しなかったもの(以下この項及び次項において「未納医療保険料等」という。)がある場合においては、未納医療保険料等があることにつき災害その他の政令で定める特別の事情があると認める場合を除き、厚生労働省令で定めるところにより、当該要介護被保険者等に対し被保険者証の提出を求め、当該被保険者証に、第四十一条第六項、第四十二条の二第六項、第四十六条第四項、第四十八条第四項、第五十一条の三第四項、第五十三条第四項、第五十四条の二第六項、第五十八条第四項及び第六十一条の三第四項の規定を適用しない旨並びに保険給付の全部又は一部の支払を差し止める旨の記載(以下この条において「保険給付差止の記載」という。)をすることができる。

When an Insured Person Requiring Long-Term Care, etc., that has received an Entry of Suspension of Insurance Benefit pursuant to the provisions of the preceding paragraph completes payment of an Unpaid Medical Insurance Premium, etc., or when it is determined that there is a significant decrease of an Unpaid Medical Insurance Premium, etc., pertaining to said Insured Person Requiring Long-Term Care, etc., or due to disaster or other special circumstance as provided by a Cabinet Order, said Entry of Suspension of Insurance Benefit is to be deleted.

市町村は、前項の規定により保険給付差止の記載を受けた要介護被保険者等が、未納医療保険料等を完納したとき、又は当該要介護被保険者等に係る未納医療保険料等の著しい減少、災害その他の政令で定める特別の事情があると認めるときは、当該保険給付差止の記載を消除するものとする。

The provisions of Article 66, paragraph (4) apply mutatis mutandis to an Insured Person Requiring Long-Term Care, etc., that has received an Entry of Suspension of Insurance Benefit pursuant to the provisions of paragraph (1).

第六十六条第四項の規定は、第一項の規定により保険給付差止の記載を受けた要介護被保険者等について準用する。

With regard to an Insured Person Requiring Long-Term Care, etc., that has received an Entry of Suspension of Insurance Benefit pursuant to the provisions of paragraph (1), a Municipality is to temporarily suspend the whole or a part of an insurance benefit.

市町村は、第一項の規定により保険給付差止の記載を受けた要介護被保険者等について、保険給付の全部又は一部の支払を一時差し止めるものとする。

A Municipality, when it finds it necessary in relation to the Entry of Suspension of Insurance Benefit of an Insured Person Requiring Long-Term Care, etc., may, pursuant to the provisions of Order of the Ministry of Health, Labour and Welfare, request the medical insurer in which said Insured Person Requiring Long-Term Care, etc. is enrolled (the Minister of Health, Labour and Welfare, where said Insured Person Requiring Long-Term Care, etc. is an insured person of health insurance administered by the Japan Health Insurance Association (excluding a voluntary continuing insured person prescribed in Article 3, paragraph (4) of the Health Insurance Act) or a dependent thereof, or an insured person of mariners insurance (excluding a voluntary continuing insured person for sickness prescribed in ) or a dependent thereof, and a Municipality, where said Insured Person Requiring Long-Term Care, etc. is an insured person of National Health Insurance conducted by a prefecture together with the Municipalities within that prefecture as provided in the National Health Insurance Act (hereinafter referred to as "National Health Insurance"); the same applies hereinafter in this Article) to provide information on the status of payment of insurance premiums (including National Health Insurance tax collected pursuant to the provisions of the Local Tax Act) or contributions collected pursuant to the provisions of the Medical Insurance Acts with regard to said Insured Person Requiring Long-Term Care, etc., and other matters as determined by Order of the Ministry of Health, Labour and Welfare.

市町村は、要介護被保険者等についての保険給付差止の記載に関し必要があると認めるときは、当該要介護被保険者等の加入する医療保険者(当該要介護被保険者等が全国健康保険協会の管掌する健康保険の被保険者(健康保険法第三条第四項に規定する任意継続被保険者を除く。)若しくはその被扶養者又は船員保険の被保険者(に規定する疾病任意継続被保険者を除く。)若しくはその被扶養者である場合には、厚生労働大臣とし、当該要介護被保険者等が国民健康保険法の定めるところにより都道府県が当該都道府県内の市町村とともに行う国民健康保険(以下「国民健康保険」という。)の被保険者である場合には、市町村とする。以下この条において同じ。)に対し、当該要介護被保険者等に係る医療保険各法の規定により徴収される保険料(地方税法の規定により徴収される国民健康保険税を含む。)又は掛金の納付状況その他厚生労働省令で定める事項について、厚生労働省令で定めるところにより、当該要介護被保険者等の加入する医療保険者に対し、情報の提供を求めることができる。

Article 69Exception of Insurance Benefit in a Case of Extinction of Right to Collect an Insurance Premium

第六十九条(保険料を徴収する権利が消滅した場合の保険給付の特例)

When a Municipality has made a Certification of Needed Long-Term Care, a Renewal of Certification of Needed Long-Term Care, a Certification of Change of Category of Condition of Need for Long-Term Care pursuant to the provisions of Article 27, paragraph (7) as applied mutatis mutandis pursuant to Article 29, paragraph (2) or pursuant to the provisions of Article 30, paragraph (1), a Certification of Needed Support, a Renewal of Certification of Needed Support, or a Certification of Change of Category of Needed Support Condition pursuant to the provisions of Article 32, paragraph (6) as applied mutatis mutandis pursuant to Article 33-2, paragraph (2) or pursuant to the provisions of Article 33-3, paragraph (1) (hereinafter referred to simply as "Certification" in this paragraph), and there is a Period of Extinguished Right to Collect Insurance Premiums (meaning a period calculated pursuant to the provisions of a Cabinet Order regarding the period for which the right to collect the insurance premium pertaining to said period has been extinguished by prescription; the same applies hereinafter in this paragraph) with regard to an Insured Person Requiring Long-Term Care, etc. who is a Primary Insured Person pertaining to said Certification, the Municipality is to enter on the Certificate of Insured Person of said Insured Person Requiring Long-Term Care, etc., pursuant to the provisions of Order of the Ministry of Health, Labour and Welfare, in addition to the entry pursuant to the provisions of the second sentence of Article 27, paragraph (7) (including a case applied mutatis mutandis pursuant to Article 28, paragraph (4) and Article 29, paragraph (2)), the second sentence of Article 30, paragraph (1) or the second sentence of Article 35, paragraph (4), or the second sentence of Article 32, paragraph (6) (including a case applied mutatis mutandis pursuant to Article 33, paragraph (4) and Article 33-2, paragraph (2)), the second sentence of Article 33-3, paragraph (1) or the second sentence of Article 35, paragraph (2) or the second sentence of paragraph (6) of that Article, as pertaining to said Certification, that the amount of the Long-Term Care Benefit, etc. (excluding payment of an Allowance for In-Home Long-Term Care Service Plan, payment of an Exceptional Allowance for In-Home Long-Term Care Service Plan, payment of an Allowance for Preventive Long-Term Care Service Plan and payment of an Exceptional Allowance for Preventive Long-Term Care Service Plan, payment of an Allowance for High-Cost Long-Term Care Service, payment of an Allowance for High-Cost Medical and Long-Term Care Service Combined, payment of an Allowance for High-Cost Preventive Long-Term Care Service and payment of an Allowance for High-Cost Medical and Preventive Long-Term Care Service Combined, and payment of an Allowance for Long-Term Care Service to a Person Admitted to a Specified Facility, payment of an Exceptional Allowance for Long-Term Care Service to a Person Admitted to a Specified Facility, payment of an Allowance for Preventive Long-Term Care Service to a Person Admitted to a Specified Facility and payment of an Exceptional Allowance for Preventive Long-Term Care Service to a Person Admitted to a Specified Facility) is to be reduced, and that the Allowance for High-Cost Long-Term Care Service, the Allowance for High-Cost Medical and Long-Term Care Service Combined, the Allowance for High-Cost Preventive Long-Term Care Service and the Allowance for High-Cost Medical and Preventive Long-Term Care Service Combined, and the Allowance for Long-Term Care Service to a Person Admitted to a Specified Facility, the Exceptional Allowance for Long-Term Care Service to a Person Admitted to a Specified Facility, the Allowance for Preventive Long-Term Care Service to a Person Admitted to a Specified Facility and the Exceptional Allowance for Preventive Long-Term Care Service to a Person Admitted to a Specified Facility will not be paid, and the period during which these measures are taken (meaning a period determined by the Municipality, as specified by Cabinet Order, according to the Period of Extinguished Right to Collect Insurance Premiums; hereinafter referred to as the "Benefit Reduction Period" in this Article) (hereinafter referred to as "Entry of Benefit Reduction Amount, etc." in this Article); provided, however, that this does not apply when it is found that there is a special circumstance, such as a disaster, specified by Cabinet Order with regard to said Insured Person Requiring Long-Term Care, etc.

市町村は、要介護認定、要介護更新認定、第二十九条第二項において準用する第二十七条第七項若しくは第三十条第一項の規定による要介護状態区分の変更の認定、要支援認定、要支援更新認定、第三十三条の二第二項において準用する第三十二条第六項若しくは第三十三条の三第一項の規定による要支援状態区分の変更の認定(以下この項において単に「認定」という。)をした場合において、当該認定に係る第一号被保険者である要介護被保険者等について保険料徴収権消滅期間(当該期間に係る保険料を徴収する権利が時効によって消滅している期間につき政令で定めるところにより算定された期間をいう。以下この項において同じ。)があるときは、厚生労働省令で定めるところにより、当該要介護被保険者等の被保険者証に、当該認定に係る第二十七条第七項後段(第二十八条第四項及び第二十九条第二項において準用する場合を含む。)、第三十条第一項後段若しくは第三十五条第四項後段又は第三十二条第六項後段(第三十三条第四項及び第三十三条の二第二項において準用する場合を含む。)、第三十三条の三第一項後段若しくは第三十五条第二項後段若しくは第六項後段の規定による記載に併せて、介護給付等(居宅介護サービス計画費の支給、特例居宅介護サービス計画費の支給、介護予防サービス計画費の支給及び特例介護予防サービス計画費の支給、高額介護サービス費の支給、高額医療合算介護サービス費の支給、高額介護予防サービス費の支給及び高額医療合算介護予防サービス費の支給並びに特定入所者介護サービス費の支給、特例特定入所者介護サービス費の支給、特定入所者介護予防サービス費の支給及び特例特定入所者介護予防サービス費の支給を除く。)の額の減額を行う旨並びに高額介護サービス費、高額医療合算介護サービス費、高額介護予防サービス費及び高額医療合算介護予防サービス費並びに特定入所者介護サービス費、特例特定入所者介護サービス費、特定入所者介護予防サービス費及び特例特定入所者介護予防サービス費の支給を行わない旨並びにこれらの措置がとられる期間(市町村が、政令で定めるところにより、保険料徴収権消滅期間に応じて定める期間をいう。以下この条において「給付額減額期間」という。)の記載(以下この条において「給付額減額等の記載」という。)をするものとする。ただし、当該要介護被保険者等について、災害その他の政令で定める特別の事情があると認めるときは、この限りでない。

A Municipality, when it is determined that an Insured Person Requiring Long-Term Care, etc., that has received an Entry of Benefit Reduction Amount, etc., pursuant to the provisions of the preceding paragraph is subject to a special circumstance as provided by a Cabinet Order as set forth in the proviso of the same paragraph, and when the Benefit Reduction Period expires, is to delete said Entry of Benefit Reduction Amount, etc.

市町村は、前項の規定により給付額減額等の記載を受けた要介護被保険者等について、同項ただし書の政令で定める特別の事情があると認めるとき、又は給付額減額期間が経過したときは、当該給付額減額等の記載を消除するものとする。

With regard to the Long-Term Care Benefit, etc. listed in the following items pertaining to In-Home Service (including equivalent service; the same applies hereinafter in this Article), Community-Based Service (including equivalent service; the same applies hereinafter in this Article), Facility Service, Preventive Long-Term Care Service (including equivalent service; the same applies hereinafter in this Article), and Community-Based Service for Preventive Long-Term Care (including equivalent service; the same applies hereinafter in this Article) used, and Home Modification carried out, by an Insured Person Requiring Long-Term Care, etc. who has received an Entry of Benefit Reduction Amount, etc. pursuant to the provisions of paragraph (1), from the first day of the month following the month that includes the day on which said entry was received until said Benefit Reduction Period has elapsed, in the case of applying the provisions specified in each of those items (excluding a case when the provisions are applied as replaced pursuant to the provisions of Article 49-2 or Article 59-2), the term "90 percent" in those provisions is deemed to be replaced with "70 percent":

第一項の規定により給付額減額等の記載を受けた要介護被保険者等が、当該記載を受けた日の属する月の翌月の初日から当該給付額減額期間が経過するまでの間に利用した居宅サービス(これに相当するサービスを含む。以下この条において同じ。)、地域密着型サービス(これに相当するサービスを含む。以下この条において同じ。)、施設サービス、介護予防サービス(これに相当するサービスを含む。以下この条において同じ。)及び地域密着型介護予防サービス(これに相当するサービスを含む。以下この条において同じ。)並びに行った住宅改修に係る次の各号に掲げる介護給付等について当該各号に定める規定を適用する場合(第四十九条の二又は第五十九条の二の規定により読み替えて適用する場合を除く。)においては、これらの規定中「百分の九十」とあるのは、「百分の七十」とする。

payment of an Allowance for In-Home Long-Term Care Service:Article 41, paragraph (4), item (i) and item (ii), and Article 43, paragraph (1), paragraph (4) and paragraph (6);

居宅介護サービス費の支給 第四十一条第四項第一号及び第二号並びに第四十三条第一項、第四項及び第六項

payment of an Exceptional Allowance for In-Home Long-Term Care Service:Article 42, paragraph (3) and Article 43, paragraph (1), paragraph (4), and paragraph (6);

特例居宅介護サービス費の支給 第四十二条第三項並びに第四十三条第一項、第四項及び第六項

payment of an Allowance for Community-Based Long-Term Care Service:each item of Article 42-2, paragraph (2), and Article 43, paragraph (1), paragraph (4) and paragraph (6);

地域密着型介護サービス費の支給 第四十二条の二第二項各号並びに第四十三条第一項、第四項及び第六項

payment of an Exceptional Allowance for Community-Based Long-Term Care Service:Article 42-3, paragraph (2) and Article 43, paragraph (1), paragraph (4), and paragraph (6);

特例地域密着型介護サービス費の支給 第四十二条の三第二項並びに第四十三条第一項、第四項及び第六項

payment of an Allowance for Long-Term Care Facility Service:Article 48, paragraph (2);

施設介護サービス費の支給 第四十八条第二項

payment of an Exceptional Allowance for Long-Term Care Facility Service:Article 49, paragraph (2);

特例施設介護サービス費の支給 第四十九条第二項

payment of an Allowance for Preventive Long-Term Care Service:Article 53, paragraph (2), item (i) and item (ii), and Article 55, paragraph (1), paragraph (4), and paragraph (6);

介護予防サービス費の支給 第五十三条第二項第一号及び第二号並びに第五十五条第一項、第四項及び第六項

payment of an Exceptional Allowance for Preventive Long-Term Care Service:Article 54, paragraph (3) and Article 55, paragraph (1), paragraph (4), and paragraph (6);

特例介護予防サービス費の支給 第五十四条第三項並びに第五十五条第一項、第四項及び第六項

payment of an Allowance for Community-Based Preventive Service of Long-Term Care:Article 54-2, paragraph (2), item (i) and item (ii), and Article 55, paragraph (1), paragraph (4), and paragraph (6);

地域密着型介護予防サービス費の支給 第五十四条の二第二項第一号及び第二号並びに第五十五条第一項、第四項及び第六項

payment of an Exceptional Allowance for Community-Based Preventive Service of Long-Term Care:Article 54-3, paragraph (2) and Article 55, paragraph (1), paragraph (4), and paragraph (6);

特例地域密着型介護予防サービス費の支給 第五十四条の三第二項並びに第五十五条第一項、第四項及び第六項

payment of an Allowance for Purchasing Equipment for In-Home Long-Term Care Covered by Public Aid:Article 44, paragraph (3), paragraph (4), and paragraph (7);

居宅介護福祉用具購入費の支給 第四十四条第三項、第四項及び第七項

payment of an Allowance for Purchasing Equipment for Preventive Long-Term Care Covered by Public Aid:Article 56, paragraph (3), paragraph (4), and paragraph (7);

介護予防福祉用具購入費の支給 第五十六条第三項、第四項及び第七項

payment of an Allowance for Home Modification for In-Home Long-Term Care:Article 45, paragraph (3), paragraph (4) and paragraph (7);

居宅介護住宅改修費の支給 第四十五条第三項、第四項及び第七項

payment of an Allowance for Preventive Long-Term Care Home Modification:Article 57, paragraph (3), paragraph (4) and paragraph (7).

介護予防住宅改修費の支給 第五十七条第三項、第四項及び第七項

With regard to the Long-Term Care Benefit, etc. listed in the items of the preceding paragraph pertaining to In-Home Service, Community-Based Service, Facility Service, Preventive Long-Term Care Service, and Community-Based Service for Preventive Long-Term Care used, and Home Modification carried out, by an Insured Person Requiring Long-Term Care, etc. who has received an Entry of Benefit Reduction Amount, etc. pursuant to the provisions of paragraph (1), from the first day of the month following the month that includes the day on which said entry was received until said Benefit Reduction Period has elapsed, in the case of applying the provisions specified in each of those items (limited to a case when the provisions are applied as replaced pursuant to the provisions of Article 49-2, paragraph (1) or Article 59-2, paragraph (1)), the term "80 percent" in those provisions applied as replaced pursuant to the provisions of Article 49-2, paragraph (1) or Article 59-2, paragraph (1) is deemed to be replaced with "70 percent".

第一項の規定により給付額減額等の記載を受けた要介護被保険者等が、当該記載を受けた日の属する月の翌月の初日から当該給付額減額期間が経過するまでの間に利用した居宅サービス、地域密着型サービス、施設サービス、介護予防サービス及び地域密着型介護予防サービス並びに行った住宅改修に係る前項各号に掲げる介護給付等について当該各号に定める規定を適用する場合(第四十九条の二第一項又は第五十九条の二第一項の規定により読み替えて適用する場合に限る。)においては、第四十九条の二第一項又は第五十九条の二第一項の規定により読み替えて適用するこれらの規定中「百分の八十」とあるのは、「百分の七十」とする。

With regard to the Long-Term Care Benefit, etc. listed in the items of paragraph (3) pertaining to In-Home Service, Community-Based Service, Facility Service, Preventive Long-Term Care Service, and Community-Based Service for Preventive Long-Term Care used, and Home Modification carried out, by an Insured Person Requiring Long-Term Care, etc. who has received an Entry of Benefit Reduction Amount, etc. pursuant to the provisions of paragraph (1), from the first day of the month following the month that includes the day on which said entry was received until said Benefit Reduction Period has elapsed, in the case of applying the provisions specified in each of those items (limited to a case when the provisions are applied as replaced pursuant to the provisions of Article 49-2, paragraph (2) or Article 59-2, paragraph (2)), the term "70 percent" in those provisions applied as replaced pursuant to the provisions of Article 49-2, paragraph (2) or Article 59-2, paragraph (2) is deemed to be replaced with "60 percent".

第一項の規定により給付額減額等の記載を受けた要介護被保険者等が、当該記載を受けた日の属する月の翌月の初日から当該給付額減額期間が経過するまでの間に利用した居宅サービス、地域密着型サービス、施設サービス、介護予防サービス及び地域密着型介護予防サービス並びに行った住宅改修に係る第三項各号に掲げる介護給付等について当該各号に定める規定を適用する場合(第四十九条の二第二項又は第五十九条の二第二項の規定により読み替えて適用する場合に限る。)においては、第四十九条の二第二項又は第五十九条の二第二項の規定により読み替えて適用するこれらの規定中「百分の七十」とあるのは、「百分の六十」とする。

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