# Article 42, paragraph (7), item (i), (b), its wordings — Order for Enforcement of the Health Insurance Act

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How the wording of Article 42, paragraph (7), item (i), (b) (第四十二条第七項第一号ロ) 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 (7), item (i), (b) (第四十二条第七項第一号ロ) — https://japanlaw.org/en/health-insurance-act-enforcement-order/art-42/par-7/item-1/sub-2 (as Markdown: https://japanlaw.org/md/en/health-insurance-act-enforcement-order/art-42/par-7/item-1/sub-2)
- 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:

> 第一項第二号に掲げる者　二十七万三百円（七十五歳到達時特例対象療養に係るものにあっては、十三万五千百五十円）と、第四十一条第一項第一号イからヘまでに掲げる額に係る特定疾病給付対象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特定疾病給付対象療養に要した費用の額（その額が九十万千円（七十五歳到達時特例対象療養に係るものにあっては、四十五万五百円。以下このロにおいて同じ。）に満たないときは、九十万千円）から九十万千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、特定疾病給付対象療養高額療養費多数回該当の場合にあっては、十四万百円（七十五歳到達時特例対象療養に係るものにあっては、七万五十円）とする。

English (Machine translation, not official):

> a person listed in paragraph (1), item (ii): the total sum of 270,300 yen (135,150 yen for that relating to medical treatment under the special rule on reaching age 75) and the amount obtained by multiplying by 1% the amount obtained by deducting 901,000 yen from the cost of the treatment subject to specified disease benefits, calculated as provided by Order of the Ministry of Health, Labour and Welfare, relating to the amounts listed in Article 41, paragraph (1), item (i), (a) through (f) (or 901,000 yen, if that cost is less than 901,000 yen (450,500 yen for that relating to medical treatment under the special rule on reaching age 75; the same applies hereinafter in this (b))) (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 for treatment subject to specified disease benefits, the amount is 140,100 yen (70,050 yen for that relating to medical treatment under the special rule on reaching age 75).

## 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:

> 第一項第二号に掲げる者　三十万三千円（七十五歳到達時特例対象療養に係るものにあっては、十五万千五百円）と、第四十一条第一項第一号イからヘまでに掲げる額に係る特定疾病給付対象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特定疾病給付対象療養に要した費用の額（その額が百一万円（七十五歳到達時特例対象療養に係るものにあっては、五十万五千円。以下このロにおいて同じ。）に満たないときは、百一万円）から百一万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、特定疾病給付対象療養高額療養費多数回該当の場合にあっては、十四万百円（七十五歳到達時特例対象療養に係るものにあっては、七万五十円）とする。

English (Machine translation, not official):

> a person listed in paragraph (1), item (ii): the total sum of 303,000 yen (151,500 yen for that relating to medical treatment under the special rule on reaching age 75) and the amount obtained by multiplying by 1% the amount obtained by deducting 1,010,000 yen from the cost of the treatment subject to specified disease benefits, calculated as provided by Order of the Ministry of Health, Labour and Welfare, relating to the amounts listed in Article 41, paragraph (1), item (i), (a) through (f) (or 1,010,000 yen, if that cost is less than 1,010,000 yen (505,000 yen for that relating to medical treatment under the special rule on reaching age 75; the same applies hereinafter in this (b))) (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 for treatment subject to specified disease benefits, the amount is 140,100 yen (70,050 yen for that relating to medical treatment under the special rule on reaching age 75).

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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)