# 健康保険法 / Health Insurance Act — 第八十六条 (Article 86) - Law: 健康保険法 (Health Insurance Act), 大正十一年法律第七十号 - English title "Health Insurance Act": Ministry of Justice translation - Kind: Act — 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: 第八十六条 (Article 86)（保険外併用療養費） — address `art-86` - Text in force since: 2026-10-01 - URL (the page that opens at this provision): https://japanlaw.org/en/health-insurance-act/art-86 - Permanent URL (e-Gov law ID, never renamed): https://japanlaw.org/l/211AC0000000070/art-86 - Every provision below carries its address and both URLs 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. --- ### 第八十六条（保険外併用療養費） — (Medical Expenses Combined with Treatment Outside Insurance Coverage) caption: Ministry of Justice translation — Japanese Law Translation Database System art-86 · https://japanlaw.org/en/health-insurance-act/art-86 · https://japanlaw.org/l/211AC0000000070/art-86 **第一項** 被保険者が、厚生労働省令で定めるところにより、保険医療機関等のうち自己の選定するものから、電子資格確認等により、被保険者であることの確認を受け、評価療養、患者申出療養又は選定療養を受けたときは、その療養に要した費用について、保険外併用療養費を支給する。 art-86/par-1 · https://japanlaw.org/en/health-insurance-act/art-86/par-1 · https://japanlaw.org/l/211AC0000000070/art-86/par-1 When an insured person, pursuant to Order of the Ministry of Health, Labour and Welfare, receives confirmation of being an insured person by electronic eligibility confirmation, etc. from a medical institution providing services covered by health insurance, etc. that the person selected, and receives evaluation treatment, patient-requested treatment or selective treatment, medical expenses combined with treatment outside insurance coverage are paid for expenses required for that treatment. machine translation, not official **第二項** 保険外併用療養費の額は、第一号に掲げる額（当該療養に食事療養が含まれるときは当該額及び第二号に掲げる額の合算額、当該療養に生活療養が含まれるときは当該額及び第三号に掲げる額の合算額）とする。 art-86/par-2 · https://japanlaw.org/en/health-insurance-act/art-86/par-2 · https://japanlaw.org/l/211AC0000000070/art-86/par-2 The amount of medical expenses combined with treatment outside insurance coverage is the amount listed in item (i) below (the aggregate of that amount and the amount listed in item (ii) if the medical treatment includes dietary treatment, or the aggregate of that amount and the amount listed in item (iii) if the medical treatment includes living support): Ministry of Justice translation — Japanese Law Translation Database System **一** 当該療養（食事療養及び生活療養を除く。）につき第七十六条第二項の定めを勘案して厚生労働大臣が定めるところにより算定した費用の額（その額が現に当該療養に要した費用の額を超えるときは、当該現に療養に要した費用の額）から、その額に第七十四条第一項各号に掲げる場合の区分に応じ、同項各号に定める割合を乗じて得た額（療養の給付に係る同項の一部負担金について第七十五条の二第一項各号の措置が採られるべきときは、当該措置が採られたものとした場合の額）を控除した額 art-86/par-2/item-1 · https://japanlaw.org/en/health-insurance-act/art-86/par-2/item-1 · https://japanlaw.org/l/211AC0000000070/art-86/par-2/item-1 the amount calculated by deducting, from the amount of expenses calculated for the medical treatment (excluding dietary treatment and living support) pursuant to the rules prescribed by the Minister of Health, Labour and Welfare taking into account the provisions of Article 76, paragraph (2) (when the calculated amount exceeds the amount of expenses actually incurred in the medical treatment, the amount of expenses actually incurred in the medical treatment), the amount obtained by multiplying that amount by the applicable ratio specified in the items of Article 74, paragraph (1) (if any of the measures listed in the items of Article 75-2, paragraph (1) need to be taken with respect to the co-payment referred to in the same paragraph for benefits for medical treatment, the amount calculated as if the relevant measures were taken), in accordance with the classifications listed in the in the same items; Ministry of Justice translation with a slip corrected by this site — not the Ministry's text; the Ministry printed: "the amount calculated by deducting, from the amount of expenses calculated for the medical treatment (excluding dietary treatment and living support) pursuant to the rules prescribed by the Minister of Health, Labour and Welfare taking into account the provisions of Article 76, paragraph (2) (when the calculated amount exceeds the amount of expenses actually incurred in the medical treatment, the amount of expenses actually incurred in the medical treatment), the amount obtained by multiplying that amount by the applicable ratio specified in the items of Article 74, paragraph (1) (if any of the measures listed in the items of Article 75, paragraph (1) need to be taken with respect to the co-payment referred to in the same paragraph for benefits for medical treatment, the amount calculated as if the relevant measures were taken), in accordance with the classifications listed in the in the same items;" — https://www.japaneselawtranslation.go.jp/en/laws/view/3266/tb **二** 当該食事療養につき第八十五条第二項に規定する厚生労働大臣が定める基準により算定した費用の額（その額が現に当該食事療養に要した費用の額を超えるときは、当該現に食事療養に要した費用の額）から食事療養標準負担額を控除した額 art-86/par-2/item-2 · https://japanlaw.org/en/health-insurance-act/art-86/par-2/item-2 · https://japanlaw.org/l/211AC0000000070/art-86/par-2/item-2 the amount calculated by deducting the amount of standard co-payment for dietary treatment from the amount calculated for the dietary treatment pursuant to the standards set by the Minister of Health, Labour and Welfare prescribed in the provisions of Article 85, paragraph (2) (when the calculated amount exceeds the amount of expenses actually incurred for the dietary treatment, the amount of expenses actually incurred for the dietary treatment); and Ministry of Justice translation — Japanese Law Translation Database System **三** 当該生活療養につき前条第二項に規定する厚生労働大臣が定める基準により算定した費用の額（その額が現に当該生活療養に要した費用の額を超えるときは、当該現に生活療養に要した費用の額）から生活療養標準負担額を控除した額 art-86/par-2/item-3 · https://japanlaw.org/en/health-insurance-act/art-86/par-2/item-3 · https://japanlaw.org/l/211AC0000000070/art-86/par-2/item-3 the amount calculated by deducting the amount of standard co-payment for living support from the amount calculated for the living support pursuant to the standards set by the Minister of Health, Labour and Welfare prescribed in the provisions of paragraph (2) of the preceding Article (when the amount exceeds the amount of expenses actually incurred in the living support, the amount of expenses actually incurred in the living support). Ministry of Justice translation — Japanese Law Translation Database System **第三項** 厚生労働大臣は、前項第一号の定めをしようとするときは、中央社会保険医療協議会に諮問するものとする。 art-86/par-3 · https://japanlaw.org/en/health-insurance-act/art-86/par-3 · https://japanlaw.org/l/211AC0000000070/art-86/par-3 When intending to specify the matters as prescribed in item (i), the Minister of Health, Labour, and Welfare is to consult with the Central Social Insurance Medical Council. Ministry of Justice translation — Japanese Law Translation Database System **第四項** 第六十四条、第七十条第一項、第七十二条第一項、第七十三条、第七十六条第三項から第六項まで、第七十七条、第七十八条、第八十四条第一項及び第八十五条第五項から第八項までの規定は、保険医療機関等から受けた評価療養、患者申出療養及び選定療養並びにこれらに伴う保険外併用療養費の支給について準用する。 art-86/par-4 · https://japanlaw.org/en/health-insurance-act/art-86/par-4 · https://japanlaw.org/l/211AC0000000070/art-86/par-4 The provisions of Article 64, Article 70, paragraph (1), Article 72, paragraph (1), Article 73, Article 76, paragraphs (3) through (6), Article 77, Article 78, Article 84, paragraph (1), Article 85, paragraphs (5) through (8) apply mutatis mutandis to the payment of evaluation treatment, patient-requested treatment, and selective treatment received at or from a medical institution providing services covered by health insurance, as well as medical expenses combined with treatment outside insurance coverage associated with the received treatment. Ministry of Justice translation — Japanese Law Translation Database System **第五項** 第七十五条の規定は、前項の規定により準用する第八十五条第五項の場合において第二項の規定により算定した費用の額（その額が現に療養に要した費用の額を超えるときは、当該現に療養に要した費用の額）から当該療養に要した費用について保険外併用療養費として支給される額に相当する額を控除した額の支払について準用する。 art-86/par-5 · https://japanlaw.org/en/health-insurance-act/art-86/par-5 · https://japanlaw.org/l/211AC0000000070/art-86/par-5 The provisions of Article 75 apply mutatis mutandis to payment of the amount calculated by deducting the amount payable as medical expenses combined with treatment outside insurance coverage with respect to expenses incurred in the relevant medical treatment from the amount of expenses calculated pursuant to the provisions of paragraph (2) in the case referred to in Article 85, paragraph (5) as applied mutatis mutandis pursuant to the preceding paragraph (when the amount exceeds the amount of expenses actually incurred in the medical treatment, the amount of expenses actually incurred in the medical treatment). Ministry of Justice translation — Japanese Law Translation Database System --- ## Cites - art-86/par-2: 第一号 → 健康保険法 第八十六条第二項第一号 (Article 86, paragraph (2), item (i)), art-86/par-2/item-1 — https://japanlaw.org/en/health-insurance-act/art-86/par-2/item-1 · https://japanlaw.org/l/211AC0000000070/art-86/par-2/item-1 - art-86/par-2: 第二号 → 健康保険法 第八十六条第二項第二号 (Article 86, paragraph (2), item (ii)), art-86/par-2/item-2 — https://japanlaw.org/en/health-insurance-act/art-86/par-2/item-2 · https://japanlaw.org/l/211AC0000000070/art-86/par-2/item-2 - art-86/par-2: 第三号 → 健康保険法 第八十六条第二項第三号 (Article 86, paragraph (2), item (iii)), art-86/par-2/item-3 — https://japanlaw.org/en/health-insurance-act/art-86/par-2/item-3 · https://japanlaw.org/l/211AC0000000070/art-86/par-2/item-3 - art-86/par-2/item-1: 第七十六条第二項 → 健康保険法 第七十六条第二項 (Article 76, paragraph (2)), art-76/par-2 — https://japanlaw.org/en/health-insurance-act/art-76/par-2 · https://japanlaw.org/l/211AC0000000070/art-76/par-2 - art-86/par-2/item-1: 第七十四条第一項 → 健康保険法 第七十四条第一項 (Article 74, paragraph (1)), art-74/par-1 — https://japanlaw.org/en/health-insurance-act/art-74/par-1 · https://japanlaw.org/l/211AC0000000070/art-74/par-1 - art-86/par-2/item-1: 第七十五条の二第一項 → 健康保険法 第七十五条の二第一項 (Article 75-2, paragraph (1)), art-75-2/par-1 — https://japanlaw.org/en/health-insurance-act/art-75-2/par-1 · https://japanlaw.org/l/211AC0000000070/art-75-2/par-1 - art-86/par-2/item-2: 第八十五条第二項 → 健康保険法 第八十五条第二項 (Article 85, paragraph (2)), art-85/par-2 — https://japanlaw.org/en/health-insurance-act/art-85/par-2 · https://japanlaw.org/l/211AC0000000070/art-85/par-2 - art-86/par-2/item-3: 前条第二項 → 健康保険法 第八十五条の二第二項 (Article 85-2, paragraph (2)), art-85-2/par-2 — https://japanlaw.org/en/health-insurance-act/art-85-2/par-2 · https://japanlaw.org/l/211AC0000000070/art-85-2/par-2 - art-86/par-3: 前項第一号 → 健康保険法 第八十六条第二項第一号 (Article 86, paragraph (2), item (i)), art-86/par-2/item-1 — https://japanlaw.org/en/health-insurance-act/art-86/par-2/item-1 · https://japanlaw.org/l/211AC0000000070/art-86/par-2/item-1 - art-86/par-4: 第六十四条 → 健康保険法 第六十四条 (Article 64), art-64 — https://japanlaw.org/en/health-insurance-act/art-64 · https://japanlaw.org/l/211AC0000000070/art-64 - art-86/par-4: 第七十条第一項 → 健康保険法 第七十条第一項 (Article 70, paragraph (1)), art-70/par-1 — https://japanlaw.org/en/health-insurance-act/art-70/par-1 · https://japanlaw.org/l/211AC0000000070/art-70/par-1 - art-86/par-4: 第七十二条第一項 → 健康保険法 第七十二条第一項 (Article 72, paragraph (1)), art-72/par-1 — https://japanlaw.org/en/health-insurance-act/art-72/par-1 · https://japanlaw.org/l/211AC0000000070/art-72/par-1 - art-86/par-4: 第七十三条 → 健康保険法 第七十三条 (Article 73), art-73 — https://japanlaw.org/en/health-insurance-act/art-73 · https://japanlaw.org/l/211AC0000000070/art-73 - art-86/par-4: 第七十六条第三項から第六項まで → 健康保険法 第七十六条第三項 (Article 76, paragraph (3)), art-76/par-3 — https://japanlaw.org/en/health-insurance-act/art-76/par-3 · https://japanlaw.org/l/211AC0000000070/art-76/par-3 - art-86/par-4: 第七十六条第三項から第六項まで → 健康保険法 第七十六条第四項 (Article 76, paragraph (4)), art-76/par-4 — https://japanlaw.org/en/health-insurance-act/art-76/par-4 · https://japanlaw.org/l/211AC0000000070/art-76/par-4 - art-86/par-4: 第七十六条第三項から第六項まで → 健康保険法 第七十六条第五項 (Article 76, paragraph (5)), art-76/par-5 — https://japanlaw.org/en/health-insurance-act/art-76/par-5 · https://japanlaw.org/l/211AC0000000070/art-76/par-5 - art-86/par-4: 第七十六条第三項から第六項まで → 健康保険法 第七十六条第六項 (Article 76, paragraph (6)), art-76/par-6 — https://japanlaw.org/en/health-insurance-act/art-76/par-6 · https://japanlaw.org/l/211AC0000000070/art-76/par-6 - art-86/par-4: 第七十七条 → 健康保険法 第七十七条 (Article 77), art-77 — https://japanlaw.org/en/health-insurance-act/art-77 · https://japanlaw.org/l/211AC0000000070/art-77 - art-86/par-4: 第七十八条 → 健康保険法 第七十八条 (Article 78), art-78 — https://japanlaw.org/en/health-insurance-act/art-78 · https://japanlaw.org/l/211AC0000000070/art-78 - art-86/par-4: 第八十四条第一項 → 健康保険法 第八十四条第一項 (Article 84, paragraph (1)), art-84/par-1 — https://japanlaw.org/en/health-insurance-act/art-84/par-1 · https://japanlaw.org/l/211AC0000000070/art-84/par-1 - art-86/par-4: 第八十五条第五項から第八項まで → 健康保険法 第八十五条第五項 (Article 85, paragraph (5)), art-85/par-5 — https://japanlaw.org/en/health-insurance-act/art-85/par-5 · https://japanlaw.org/l/211AC0000000070/art-85/par-5 - art-86/par-4: 第八十五条第五項から第八項まで → 健康保険法 第八十五条第六項 (Article 85, paragraph (6)), art-85/par-6 — https://japanlaw.org/en/health-insurance-act/art-85/par-6 · https://japanlaw.org/l/211AC0000000070/art-85/par-6 - art-86/par-4: 第八十五条第五項から第八項まで → 健康保険法 第八十五条第七項 (Article 85, paragraph (7)), art-85/par-7 — https://japanlaw.org/en/health-insurance-act/art-85/par-7 · https://japanlaw.org/l/211AC0000000070/art-85/par-7 - art-86/par-4: 第八十五条第五項から第八項まで → 健康保険法 第八十五条第八項 (Article 85, paragraph (8)), art-85/par-8 — https://japanlaw.org/en/health-insurance-act/art-85/par-8 · https://japanlaw.org/l/211AC0000000070/art-85/par-8 - art-86/par-5: 第七十五条 → 健康保険法 第七十五条 (Article 75), art-75 — https://japanlaw.org/en/health-insurance-act/art-75 · https://japanlaw.org/l/211AC0000000070/art-75 - art-86/par-5: 前項 → 健康保険法 第八十六条第四項 (Article 86, paragraph (4)), art-86/par-4 — https://japanlaw.org/en/health-insurance-act/art-86/par-4 · https://japanlaw.org/l/211AC0000000070/art-86/par-4 - art-86/par-5: 第八十五条第五項 → 健康保険法 第八十五条第五項 (Article 85, paragraph (5)), art-85/par-5 — https://japanlaw.org/en/health-insurance-act/art-85/par-5 · https://japanlaw.org/l/211AC0000000070/art-85/par-5 - art-86/par-5: 第二項 → 健康保険法 第八十六条第二項 (Article 86, paragraph (2)), art-86/par-2 — https://japanlaw.org/en/health-insurance-act/art-86/par-2 · https://japanlaw.org/l/211AC0000000070/art-86/par-2 ## Cited by 21 provisions cite this one. No official source publishes this direction. - 健康保険法 第五十一条の三第二項（被保険者の資格の確認に必要な書面の交付等） — https://japanlaw.org/en/health-insurance-act/art-51-3/par-2 · https://japanlaw.org/l/211AC0000000070/art-51-3/par-2 - 健康保険法 第五十八条第三項（不正利得の徴収等） — https://japanlaw.org/en/health-insurance-act/art-58/par-3 · https://japanlaw.org/l/211AC0000000070/art-58/par-3 - 健康保険法 第六十五条第三項第二号（保険医療機関又は保険薬局の指定） — https://japanlaw.org/en/health-insurance-act/art-65/par-3/item-2 · https://japanlaw.org/l/211AC0000000070/art-65/par-3/item-2 - 健康保険法 第七十条第二項（保険医療機関又は保険薬局の責務） — https://japanlaw.org/en/health-insurance-act/art-70/par-2 · https://japanlaw.org/l/211AC0000000070/art-70/par-2 - 健康保険法 第七十二条第二項（保険医又は保険薬剤師の責務） — https://japanlaw.org/en/health-insurance-act/art-72/par-2 · https://japanlaw.org/l/211AC0000000070/art-72/par-2 - 健康保険法 第八十条第一項第一号（保険医療機関又は保険薬局の指定の取消し） — https://japanlaw.org/en/health-insurance-act/art-80/par-1/item-1 · https://japanlaw.org/l/211AC0000000070/art-80/par-1/item-1 - 健康保険法 第八十条第一項第三号（保険医療機関又は保険薬局の指定の取消し） — https://japanlaw.org/en/health-insurance-act/art-80/par-1/item-3 · https://japanlaw.org/l/211AC0000000070/art-80/par-1/item-3 - 健康保険法 第八十条第一項第四号（保険医療機関又は保険薬局の指定の取消し） — https://japanlaw.org/en/health-insurance-act/art-80/par-1/item-4 · https://japanlaw.org/l/211AC0000000070/art-80/par-1/item-4 - 健康保険法 第八十条第一項第五号（保険医療機関又は保険薬局の指定の取消し） — https://japanlaw.org/en/health-insurance-act/art-80/par-1/item-5 · https://japanlaw.org/l/211AC0000000070/art-80/par-1/item-5 - 健康保険法 第八十一条第一項第一号（保険医又は保険薬剤師の登録の取消し） — https://japanlaw.org/en/health-insurance-act/art-81/par-1/item-1 · https://japanlaw.org/l/211AC0000000070/art-81/par-1/item-1 - 健康保険法 第八十一条第一項第三号（保険医又は保険薬剤師の登録の取消し） — https://japanlaw.org/en/health-insurance-act/art-81/par-1/item-3 · https://japanlaw.org/l/211AC0000000070/art-81/par-1/item-3 - 健康保険法 第八十二条第一項（社会保険医療協議会への諮問） — https://japanlaw.org/en/health-insurance-act/art-82/par-1 · https://japanlaw.org/l/211AC0000000070/art-82/par-1 - 健康保険法 第八十六条第二項（保険外併用療養費） — https://japanlaw.org/en/health-insurance-act/art-86/par-2 · https://japanlaw.org/l/211AC0000000070/art-86/par-2 - 健康保険法 第八十六条第三項（保険外併用療養費） — https://japanlaw.org/en/health-insurance-act/art-86/par-3 · https://japanlaw.org/l/211AC0000000070/art-86/par-3 - 健康保険法 第八十六条第五項（保険外併用療養費） — https://japanlaw.org/en/health-insurance-act/art-86/par-5 · https://japanlaw.org/l/211AC0000000070/art-86/par-5 - 健康保険法 第八十七条第三項（療養費） — https://japanlaw.org/en/health-insurance-act/art-87/par-3 · https://japanlaw.org/l/211AC0000000070/art-87/par-3 - 健康保険法 第百十条第三項（家族療養費） — https://japanlaw.org/en/health-insurance-act/art-110/par-3 · https://japanlaw.org/l/211AC0000000070/art-110/par-3 - 健康保険法 第百四十九条第一項（準用） — https://japanlaw.org/en/health-insurance-act/art-149/par-1 · https://japanlaw.org/l/211AC0000000070/art-149/par-1 - 健康保険法 第二百五条の四第一項（基盤機構等への事務の委託） — https://japanlaw.org/en/health-insurance-act/art-205-4/par-1 · https://japanlaw.org/l/211AC0000000070/art-205-4/par-1 - 健康保険法 附則第四条第一項 — https://japanlaw.org/en/health-insurance-act/suppl-4181-83/art-4/par-1 · https://japanlaw.org/l/211AC0000000070/suppl-4181-83/art-4/par-1 - 健康保険法 附則第三条第一項（中央社会保険医療協議会への諮問等に係る準備行為） — https://japanlaw.org/en/health-insurance-act/suppl-5081-31/art-3/par-1 · https://japanlaw.org/l/211AC0000000070/suppl-5081-31/art-3/par-1 --- ## Sources - claude-opus-5-5 — Corrections to the Ministry of Justice's English of paragraphs, written 2026-10-11 - e-Gov 法令検索, Digital Agency (デジタル庁) — 健康保険法 — the text in force from 2026-10-01 (https://laws.e-gov.go.jp/law/211AC0000000070/20261001_507AC0000000087), retrieved 2026-10-10 - Japanese Law Translation Database System, Ministry of Justice (法務省) — Health Insurance Act — Ministry of Justice translation (https://www.japaneselawtranslation.go.jp/en/laws/view/3266/tb), retrieved 2026-10-10 - Japanese Law Translation Database System, Ministry of Justice (法務省) — Health Insurance Act (健康保険法), Article 86, paragraph (2), item (i) — the Ministry of Justice's English as printed (https://www.japaneselawtranslation.go.jp/en/laws/view/3266/tb), retrieved 2026-10-10 - claude-sonnet-5-5 — Machine translation, batch health-insurance-act-20261010T183826-002, translated 2026-10-11 - This site's parser, version 189 — 健康保険法 — structure, counts, cross-references and defined terms, computed 2026-10-10