# 健康保険法施行令 / Order for Enforcement of the Health Insurance Act — 第四十一条の三 (Article 41-3)

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- Law: 健康保険法施行令 (Order for Enforcement of the Health Insurance Act), 大正十五年勅令第二百四十三号
- English title "Order for Enforcement of the Health Insurance Act": claude-opus-5-5
- Kind: ImperialOrder — the distinction between 法律 (Act), 政令 (Cabinet Order), 省令 (Ministerial Order) and 条例 (local ordinance) decides who may issue it and what it may say.
- Provision: 第四十一条の三 (Article 41-3) — address `art-41-3`
- Text in force since: 2026-10-01
- URL (the page that opens at this provision): https://japanlaw.org/en/health-insurance-act-enforcement-order/art-41-3
- e-Gov law ID: 215IO0000000243 — never renamed. A permanent link, `/l/{lawId}/{address}` on this site, redirects to the page.
- Every provision below carries its address and its URL on the line under it.
- Japanese text: e-Gov 法令検索, Digital Agency (デジタル庁). English: as marked on each line below.

Only the Japanese as published by the government has legal effect; the text
below is a copy of it. Every English rendering below is a translation and
says which kind: the Ministry of Justice's translation, or this
site's machine translation, whose model and date the Sources list names.
They are never merged and never substituted for one another.

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### 第四十一条の三
<sup>art-41-3 · https://japanlaw.org/en/health-insurance-act-enforcement-order/art-41-3</sup>

**第一項**  高額療養費は、計算期間において、基準日被保険者又はその被扶養者がそれぞれ当該保険者の被保険者又はその被扶養者として受けた療養（法第九十八条第一項（法第百十条第七項及び第百十一条第三項において準用する場合を含む。）の規定による保険給付に係る療養（次項及び第四十三条の二において「継続給付に係る療養」という。）を含む。）に係る次に掲げる額の合算額（第四十一条第一項から第五項まで又は前条の規定により高額療養費が支給される場合にあっては、当該支給額を控除した額とし、法第五十三条に規定するその他の給付として次に掲げる額に係る負担を軽減するための金品が支給される場合にあっては、当該金品に相当する額を控除した額とする。）から七十歳以上年間世帯支給総額（次項に規定する七十歳以上一部負担金等年間世帯合算額から同項の七十歳以上年間高額療養費算定基準額を控除した額（当該額が零を下回る場合には、零とする。）をいう。）を控除した額（以下この項において「一部負担金等年間世帯合算額」という。）が高額療養費算定基準額を超える場合に基準日被保険者に支給するものとし、その額は、一部負担金等年間世帯合算額から高額療養費算定基準額を控除した額とする。
<sup>art-41-3/par-1 · https://japanlaw.org/en/health-insurance-act-enforcement-order/art-41-3/par-1</sup>
High-cost medical expenses are to be paid to the insured person on the reference date where the amount obtained by deducting the total annual household payment for persons aged 70 or over (meaning the amount obtained by deducting the annual base amount for calculating high-cost medical expenses for persons aged 70 or over under paragraph (2) from the annual household total of co-payments, etc. for persons aged 70 or over prescribed in that paragraph (or zero, if that amount is less than zero)) from the total sum of the following amounts relating to medical treatment that the insured person on the reference date or the dependents thereof respectively received during the calculation period as an insured person of the relevant insurer or as dependents thereof (including medical treatment relating to insurance benefits under Article 98, paragraph (1) of the Act (including as applied mutatis mutandis under Article 110, paragraph (7) and Article 111, paragraph (3) of the Act) (referred to in the following paragraph and Article 43-2 as "medical treatment under continued benefits")) (where high-cost medical expenses are paid pursuant to Article 41, paragraphs (1) through (5) or the preceding Article, the amount after deducting the amount paid, and where money or goods to reduce the burden relating to the following amounts are provided as other benefits prescribed in Article 53 of the Act, the amount after deducting the amount equivalent to that money or those goods) (hereinafter referred to as the "annual household total of co-payments, etc." in this paragraph) exceeds the base amount for calculating high-cost medical expenses, and the amount of those expenses is to be the amount obtained by deducting the base amount for calculating high-cost medical expenses from the annual household total of co-payments, etc.
<sup>machine translation, not official</sup>

  **一**  当該療養（特定給付対象療養を除く。）に係る第四十一条第一項第一号イからヘまでに掲げる額（七十歳に達する日の属する月以前の当該療養に係るものにあっては、同一の月にそれぞれ一の病院等から受けた当該療養について二万千円（同条第四項各号に掲げる療養（以下「七十五歳到達時特例対象療養」という。）に係るものにあっては、一万五百円）以上のものに限る。）を合算した額
  <sup>art-41-3/par-1/item-1 · https://japanlaw.org/en/health-insurance-act-enforcement-order/art-41-3/par-1/item-1</sup>
  the total sum of the amounts listed in Article 41, paragraph (1), item (i), (a) through (f) relating to that medical treatment (excluding treatment subject to specified benefits) (for those relating to that medical treatment on or before the month that includes the day on which the person reaches the age of 70, limited to those of 21,000 yen or more for that medical treatment received from each single hospital, etc. in the same month (10,500 yen or more for those relating to the medical treatment listed in the items of paragraph (4) of that Article (hereinafter referred to as "medical treatment under the special rule on reaching age 75")));
  <sup>machine translation, not official</sup>

  **二**  当該療養（特定給付対象療養に限る。）について、当該療養を受けた者がなお負担すべき額（七十歳に達する日の属する月以前の特定給付対象療養に係るものにあっては、当該特定給付対象療養に係る第四十一条第一項第一号イからヘまでに掲げる額が同一の月にそれぞれ一の病院等から受けた当該特定給付対象療養について二万千円（七十五歳到達時特例対象療養に係るものにあっては、一万五百円）以上のものに限る。）を合算した額
  <sup>art-41-3/par-1/item-2 · https://japanlaw.org/en/health-insurance-act-enforcement-order/art-41-3/par-1/item-2</sup>
  the total sum of the amounts that the person who received that medical treatment (limited to treatment subject to specified benefits) still has to bear for that treatment (for those relating to treatment subject to specified benefits on or before the month that includes the day on which the person reaches the age of 70, limited to those for which the amounts listed in Article 41, paragraph (1), item (i), (a) through (f) relating to that treatment subject to specified benefits are 21,000 yen or more for that treatment subject to specified benefits received from each single hospital, etc. in the same month (10,500 yen or more for those relating to medical treatment under the special rule on reaching age 75)).
  <sup>machine translation, not official</sup>

**第二項**  前項各号に掲げる額のうち、七十歳に達する日の属する月の翌月以後に受けた療養（継続給付に係る療養を含む。）に係る額を合算した額（第四十一条第一項から第五項まで又は前条の規定により高額療養費が支給される場合にあっては、当該支給額を控除した額とし、法第五十三条に規定するその他の給付として前項各号に掲げる額に係る負担を軽減するための金品が支給される場合にあっては、当該金品に相当する額を控除した額とする。以下この項において「七十歳以上一部負担金等年間世帯合算額」という。）が七十歳以上年間高額療養費算定基準額を超える場合は、七十歳以上一部負担金等年間世帯合算額から七十歳以上年間高額療養費算定基準額を控除した額を高額療養費として基準日被保険者に支給する。
<sup>art-41-3/par-2 · https://japanlaw.org/en/health-insurance-act-enforcement-order/art-41-3/par-2</sup>
Where the total sum of the amounts, among the amounts listed in the items of the preceding paragraph, relating to medical treatment (including medical treatment under continued benefits) received on or after the month following the month that includes the day on which the person reaches the age of 70 (where high-cost medical expenses are paid pursuant to Article 41, paragraphs (1) through (5) or the preceding Article, the amount after deducting the amount paid, and where money or goods to reduce the burden relating to the amounts listed in the items of the preceding paragraph are provided as other benefits prescribed in Article 53 of the Act, the amount after deducting the amount equivalent to that money or those goods; hereinafter referred to as the "annual household total of co-payments, etc. for persons aged 70 or over" in this paragraph) exceeds the annual base amount for calculating high-cost medical expenses for persons aged 70 or over, the amount obtained by deducting the annual base amount for calculating high-cost medical expenses for persons aged 70 or over from the annual household total of co-payments, etc. for persons aged 70 or over is to be paid to the insured person on the reference date as high-cost medical expenses.
<sup>machine translation, not official</sup>

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## Cites
- art-41-3/par-1: 法第九十八条第一項 → 健康保険法 第九十八条第一項 (Article 98, paragraph (1)), art-98/par-1 — https://japanlaw.org/en/health-insurance-act/art-98/par-1 (e-Gov law ID 211AC0000000070)
- art-41-3/par-1: 法第百十条第七項 → 健康保険法 第百十条第七項 (Article 110, paragraph (7)), art-110/par-7 — https://japanlaw.org/en/health-insurance-act/art-110/par-7 (e-Gov law ID 211AC0000000070)
- art-41-3/par-1: 第百十一条第三項 → 健康保険法 第百十一条第三項 (Article 111, paragraph (3)), art-111/par-3 — https://japanlaw.org/en/health-insurance-act/art-111/par-3 (e-Gov law ID 211AC0000000070)
- art-41-3/par-1: 次項 → 健康保険法施行令 第四十一条の三第二項 (Article 41-3, paragraph (2)), art-41-3/par-2 — https://japanlaw.org/en/health-insurance-act-enforcement-order/art-41-3/par-2
- art-41-3/par-1: 第四十三条の二 → 健康保険法施行令 第四十三条の二 (Article 43-2), art-43-2 — https://japanlaw.org/en/health-insurance-act-enforcement-order/art-43-2
- art-41-3/par-1: 第四十一条第一項から第五項まで → 健康保険法施行令 第四十一条第一項 (Article 41, paragraph (1)), art-41/par-1 — https://japanlaw.org/en/health-insurance-act-enforcement-order/art-41/par-1
- art-41-3/par-1: 第四十一条第一項から第五項まで → 健康保険法施行令 第四十一条第二項 (Article 41, paragraph (2)), art-41/par-2 — https://japanlaw.org/en/health-insurance-act-enforcement-order/art-41/par-2
- art-41-3/par-1: 第四十一条第一項から第五項まで → 健康保険法施行令 第四十一条第三項 (Article 41, paragraph (3)), art-41/par-3 — https://japanlaw.org/en/health-insurance-act-enforcement-order/art-41/par-3
- art-41-3/par-1: 第四十一条第一項から第五項まで → 健康保険法施行令 第四十一条第四項 (Article 41, paragraph (4)), art-41/par-4 — https://japanlaw.org/en/health-insurance-act-enforcement-order/art-41/par-4
- art-41-3/par-1: 第四十一条第一項から第五項まで → 健康保険法施行令 第四十一条第五項 (Article 41, paragraph (5)), art-41/par-5 — https://japanlaw.org/en/health-insurance-act-enforcement-order/art-41/par-5
- art-41-3/par-1: 前条 → 健康保険法施行令 第四十一条の二 (Article 41-2), art-41-2 — https://japanlaw.org/en/health-insurance-act-enforcement-order/art-41-2
- art-41-3/par-1: 法第五十三条 → 健康保険法 第五十三条 (Article 53), art-53 — https://japanlaw.org/en/health-insurance-act/art-53 (e-Gov law ID 211AC0000000070)
- art-41-3/par-1: この項 → 健康保険法施行令 第四十一条の三第一項 (Article 41-3, paragraph (1)), art-41-3/par-1 — https://japanlaw.org/en/health-insurance-act-enforcement-order/art-41-3/par-1
- art-41-3/par-1/item-1: 第四十一条第一項第一号 → 健康保険法施行令 第四十一条第一項第一号 (Article 41, paragraph (1), item (i)), art-41/par-1/item-1 — https://japanlaw.org/en/health-insurance-act-enforcement-order/art-41/par-1/item-1
- art-41-3/par-1/item-1: 同条第四項 → 健康保険法施行令 第四十一条第四項 (Article 41, paragraph (4)), art-41/par-4 — https://japanlaw.org/en/health-insurance-act-enforcement-order/art-41/par-4
- art-41-3/par-1/item-2: 第四十一条第一項第一号 → 健康保険法施行令 第四十一条第一項第一号 (Article 41, paragraph (1), item (i)), art-41/par-1/item-1 — https://japanlaw.org/en/health-insurance-act-enforcement-order/art-41/par-1/item-1
- art-41-3/par-2: 前項 → 健康保険法施行令 第四十一条の三第一項 (Article 41-3, paragraph (1)), art-41-3/par-1 — https://japanlaw.org/en/health-insurance-act-enforcement-order/art-41-3/par-1
- art-41-3/par-2: 第四十一条第一項から第五項まで → 健康保険法施行令 第四十一条第一項 (Article 41, paragraph (1)), art-41/par-1 — https://japanlaw.org/en/health-insurance-act-enforcement-order/art-41/par-1
- art-41-3/par-2: 第四十一条第一項から第五項まで → 健康保険法施行令 第四十一条第二項 (Article 41, paragraph (2)), art-41/par-2 — https://japanlaw.org/en/health-insurance-act-enforcement-order/art-41/par-2
- art-41-3/par-2: 第四十一条第一項から第五項まで → 健康保険法施行令 第四十一条第三項 (Article 41, paragraph (3)), art-41/par-3 — https://japanlaw.org/en/health-insurance-act-enforcement-order/art-41/par-3
- art-41-3/par-2: 第四十一条第一項から第五項まで → 健康保険法施行令 第四十一条第四項 (Article 41, paragraph (4)), art-41/par-4 — https://japanlaw.org/en/health-insurance-act-enforcement-order/art-41/par-4
- art-41-3/par-2: 第四十一条第一項から第五項まで → 健康保険法施行令 第四十一条第五項 (Article 41, paragraph (5)), art-41/par-5 — https://japanlaw.org/en/health-insurance-act-enforcement-order/art-41/par-5
- art-41-3/par-2: 前条 → 健康保険法施行令 第四十一条の二 (Article 41-2), art-41-2 — https://japanlaw.org/en/health-insurance-act-enforcement-order/art-41-2
- art-41-3/par-2: 法第五十三条 → 健康保険法 第五十三条 (Article 53), art-53 — https://japanlaw.org/en/health-insurance-act/art-53 (e-Gov law ID 211AC0000000070)
- art-41-3/par-2: この項 → 健康保険法施行令 第四十一条の三第二項 (Article 41-3, paragraph (2)), art-41-3/par-2 — https://japanlaw.org/en/health-insurance-act-enforcement-order/art-41-3/par-2

## Cited by

17 provisions cite this one. No official source publishes this direction.

- 健康保険法施行令 第四十一条第一項第一号（月間の高額療養費の支給要件及び支給額） — https://japanlaw.org/en/health-insurance-act-enforcement-order/art-41/par-1/item-1
- 健康保険法施行令 第四十一条第一項第二号（月間の高額療養費の支給要件及び支給額） — https://japanlaw.org/en/health-insurance-act-enforcement-order/art-41/par-1/item-2
- 健康保険法施行令 第四十一条第二項（月間の高額療養費の支給要件及び支給額） — https://japanlaw.org/en/health-insurance-act-enforcement-order/art-41/par-2
- 健康保険法施行令 第四十一条の三第一項 — https://japanlaw.org/en/health-insurance-act-enforcement-order/art-41-3/par-1
- 健康保険法施行令 第四十一条の三第二項 — https://japanlaw.org/en/health-insurance-act-enforcement-order/art-41-3/par-2
- 健康保険法施行令 第四十二条第十一項（高額療養費算定基準額） — https://japanlaw.org/en/health-insurance-act-enforcement-order/art-42/par-11
- 健康保険法施行令 第四十二条第十二項（高額療養費算定基準額） — https://japanlaw.org/en/health-insurance-act-enforcement-order/art-42/par-12
- 健康保険法施行令 第四十三条第九項（その他高額療養費の支給に関する事項） — https://japanlaw.org/en/health-insurance-act-enforcement-order/art-43/par-9
- 健康保険法施行令 第四十三条第十項（その他高額療養費の支給に関する事項） — https://japanlaw.org/en/health-insurance-act-enforcement-order/art-43/par-10
- 健康保険法施行令 第四十三条第十二項（その他高額療養費の支給に関する事項） — https://japanlaw.org/en/health-insurance-act-enforcement-order/art-43/par-12
- 健康保険法施行令 第四十三条の二第一項第一号（高額介護合算療養費の支給要件及び支給額） — https://japanlaw.org/en/health-insurance-act-enforcement-order/art-43-2/par-1/item-1
- 健康保険法施行令 第四十四条第二項（準用） — https://japanlaw.org/en/health-insurance-act-enforcement-order/art-44/par-2
- 健康保険法施行令 第四十四条第五項（準用） — https://japanlaw.org/en/health-insurance-act-enforcement-order/art-44/par-5
- 健康保険法施行令 附則第四条第一項（健康保険法施行令の一部改正に伴う経過措置） — https://japanlaw.org/en/health-insurance-act-enforcement-order/suppl-4202-357/art-4/par-1
- 健康保険法施行令 附則第十九条第一項 — https://japanlaw.org/en/health-insurance-act-enforcement-order/suppl-5082-240/art-19/par-1
- 健康保険法施行令 附則第十九条第二項 — https://japanlaw.org/en/health-insurance-act-enforcement-order/suppl-5082-240/art-19/par-2
- 健康保険法施行令 附則第十九条第三項 — https://japanlaw.org/en/health-insurance-act-enforcement-order/suppl-5082-240/art-19/par-3

---

## Sources

- claude-opus-5-5 — English title of a law in this collection, written for this site, written 2026-11-06
- e-Gov 法令検索, Digital Agency (デジタル庁) — 健康保険法施行令 — the text in force from 2026-10-01 (https://laws.e-gov.go.jp/law/215IO0000000243/20261001_508CO0000000276), retrieved 2026-11-06
- claude-sonnet-5-5 — Machine translation, batch health-insurance-act-enforcement-order-20261106T164949-009, translated 2026-11-07
- claude-sonnet-5-5, corrected on review by claude-opus-5-5 — Machine translation corrected on review, batch health-insurance-act-enforcement-order-20261106T164949-009, translated 2026-11-07
- This site's parser, version 229 — 健康保険法施行令 — structure, counts, cross-references and defined terms, computed 2026-11-06