# Article 43, paragraph (1), item (ii), (c), its wordings — Order for Enforcement of the Health Insurance Act

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How the wording of Article 43, paragraph (1), item (ii), (c) (第四十三条第一項第二号ハ) 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 43, paragraph (1), item (ii), (c) (第四十三条第一項第二号ハ) — https://japanlaw.org/en/health-insurance-act-enforcement-order/art-43/par-1/item-2/sub-3 (as Markdown: https://japanlaw.org/md/en/health-insurance-act-enforcement-order/art-43/par-1/item-2/sub-3)
- 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:

> 前条第三項第三号に掲げる者に該当していることにつき厚生労働省令で定めるところにより保険者の認定を受けている者　十七万九千百円と、当該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（その額が五十九万七千円に満たないときは、五十九万七千円）から五十九万七千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、九万三千円とする。

English (Machine translation, not official):

> a person who has received certification by the insurer, as provided by Order of the Ministry of Health, Labour and Welfare, as falling under a person listed in paragraph (3), item (iii) of the preceding Article: the total sum of 179,100 yen and the amount obtained by multiplying by 1% the amount obtained by deducting 597,000 yen from the amount of expenses required for that medical treatment, calculated for that medical treatment as provided by Order of the Ministry of Health, Labour and Welfare (or 597,000 yen, if that amount is less than 597,000 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 93,000 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:

> 前条第三項第三号に掲げる者に該当していることにつき厚生労働省令で定めるところにより保険者の認定を受けている者　二十七万三百円と、当該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（その額が九十万千円に満たないときは、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、高額療養費多数回該当の場合にあっては、十四万百円とする。

English (Machine translation, not official):

> a person who has received certification by the insurer, as provided by Order of the Ministry of Health, Labour and Welfare, as falling under a person listed in paragraph (3), item (iii) of the preceding Article: the total sum of 270,300 yen and the amount obtained by multiplying by 1% the amount obtained by deducting 901,000 yen from the amount of expenses required for that medical treatment, calculated for that medical treatment as provided by Order of the Ministry of Health, Labour and Welfare (or 901,000 yen, if that amount is less than 901,000 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 140,100 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)
