# Article 42, paragraph (4), item (iv), its wordings — Order for Enforcement of the Health Insurance Act

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How the wording of Article 42, paragraph (4), item (iv) (第四十二条第四項第四号) changed with each amendment, and how it will change.

- Law: Order for Enforcement of the Health Insurance Act (健康保険法施行令) — https://japanlaw.org/en/health-insurance-act-enforcement-order
- Provision: Article 42, paragraph (4), item (iv) (第四十二条第四項第四号) — https://japanlaw.org/en/health-insurance-act-enforcement-order/art-42/par-4/item-4 (as Markdown: https://japanlaw.org/md/en/health-insurance-act-enforcement-order/art-42/par-4/item-4)
- The law's amendments: https://japanlaw.org/en/health-insurance-act-enforcement-order/amendments
- 2 wordings, oldest first.

## 1. Before Cabinet Order No. 240 of 2026

- State: In force

Japanese:

> 前項第四号に掲げる者　四万二千九百円と、第四十一条第四項に規定する合算した額に係る療養につき厚生労働省令で定めるところにより算定した当該療養に要した費用の額（その額が十四万三千円に満たないときは、十四万三千円）から十四万三千円を控除した額に百分の一を乗じて得た額（この額に一円未満の端数がある場合において、その端数金額が五十銭未満であるときは、これを切り捨て、その端数金額が五十銭以上であるときは、これを一円に切り上げた額）との合算額。ただし、高額療養費多数回該当の場合にあっては、二万二千二百円とする。

English (Machine translation, not official):

> a person listed in item (iv) of the preceding paragraph: the total sum of 42,900 yen and the amount obtained by multiplying by 1% the amount obtained by deducting 143,000 yen from the cost of the medical treatment, calculated as provided by Order of the Ministry of Health, Labour and Welfare, relating to the total amount prescribed in Article 41, paragraph (4) (or 143,000 yen, if that cost is less than 143,000 yen) (where that amount includes a fractional amount of less than 1 yen, the amount obtained by rounding down that fractional amount if it is less than 50 sen, or by rounding it up to 1 yen if it is 50 sen or more); provided, however, that in the case of repeated high-cost medical expenses, the amount is 22,200 yen.

## 2. 1 August 2027 — Cabinet Order No. 240 of 2026

- State: Not yet in force
- Takes effect: 1 August 2027
- The amendment: Reworded (Cabinet Order No. 240 of 2026) — https://japanlaw.org/en/health-insurance-act-enforcement-order/amendments/20270801_508CO0000000240

Japanese:

> 前項第四号に掲げる者　十万四千七百円と、第四十一条第四項に規定する合算した額に係る療養につき厚生労働省令で定めるところにより算定した当該療養に要した費用の額（その額が三十四万九千円に満たないときは、三十四万九千円）から三十四万九千円を控除した額に百分の一を乗じて得た額（この額に一円未満の端数がある場合において、その端数金額が五十銭未満であるときは、これを切り捨て、その端数金額が五十銭以上であるときは、これを一円に切り上げた額）との合算額。ただし、高額療養費多数回該当の場合にあっては、四万六千五百円とする。

English (Machine translation, not official):

> a person listed in item (iv) of the preceding paragraph: the total sum of 104,700 yen and the amount obtained by multiplying by 1% the amount obtained by deducting 349,000 yen from the cost of the medical treatment, calculated as provided by Order of the Ministry of Health, Labour and Welfare, relating to the total amount prescribed in Article 41, paragraph (4) (or 349,000 yen, if that cost is less than 349,000 yen) (where that amount includes a fractional amount of less than 1 yen, the amount obtained by rounding down that fractional amount if it is less than 50 sen, or by rounding it up to 1 yen if it is 50 sen or more); provided, however, that in the case of repeated high-cost medical expenses, the amount is 46,500 yen.

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## Sources

- The dates and the amending laws: e-Gov (Digital Agency) (https://laws.e-gov.go.jp/law/215IO0000000243)
- English name of the law: Written for this site with AI
- English titles of the amending laws: Written for this site with AI
- The Japanese text before: e-Gov (Digital Agency) (https://laws.e-gov.go.jp/law/215IO0000000243/20261001_508CO0000000276)
- The Japanese text after: e-Gov (Digital Agency) (https://laws.e-gov.go.jp/law/215IO0000000243/20270801_508CO0000000240)