# 国民健康保険法 / National Health Insurance Act — 第四十五条 (Article 45) - Law: 国民健康保険法 (National Health Insurance Act), 昭和三十三年法律第百九十二号 - English title "National 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: 第四十五条 (Article 45)（保険医療機関等の診療報酬） — address `art-45` - Text in force since: 2026-10-01 - URL (the page that opens at this provision): https://japanlaw.org/en/national-health-insurance-act/art-45 - Permanent URL (e-Gov law ID, never renamed): https://japanlaw.org/l/333AC0000000192/art-45 - 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. --- ### 第四十五条（保険医療機関等の診療報酬） — (Medical Fees Payable to Health Insurance-Covered Medical Institutions, etc.) caption: Ministry of Justice translation — Japanese Law Translation Database System art-45 · https://japanlaw.org/en/national-health-insurance-act/art-45 · https://japanlaw.org/l/333AC0000000192/art-45 **第一項** 市町村及び組合は、療養の給付に関する費用を保険医療機関等に支払うものとし、保険医療機関等が療養の給付に関し市町村又は組合に請求することができる費用の額は、療養の給付に要する費用の額から、当該療養の給付に関し被保険者（第五十七条に規定する場合にあつては、当該被保険者の属する世帯の世帯主又は組合員）が当該保険医療機関等に対して支払わなければならない一部負担金に相当する額を控除した額とする。 art-45/par-1 · https://japanlaw.org/en/national-health-insurance-act/art-45/par-1 · https://japanlaw.org/l/333AC0000000192/art-45/par-1 Municipalities and Societies must pay to health insurance-covered medical institutions, etc. expenses relating to benefits for medical treatment. The amount of expenses which may be claimed by a health insurance-covered medical institution, etc. from a Municipality or Society in relation to benefits for medical treatment shall be calculated by deducting the amount of any co-payment payable to such health insurance-covered medical institution, etc. by the insured person (or the Householder or Society member of the household to which such insured person belongs in the case set forth in Article 57) in relation to the benefits for medical treatment from the amount of expenses incurred in providing said benefits for medical treatment. machine translation, not official **第二項** 前項の療養の給付に要する費用の額の算定については、健康保険法第七十六条第二項の規定による厚生労働大臣の定めの例による。 art-45/par-2 · https://japanlaw.org/en/national-health-insurance-act/art-45/par-2 · https://japanlaw.org/l/333AC0000000192/art-45/par-2 Calculation of the amount of expenses incurred in providing the benefits for medical treatment set forth in the preceding paragraph shall be governed by the same rules as those prescribed by the Minister of Health, Labour and Welfare pursuant to the provisions of Article 76, paragraph (2) of the Health Insurance Act. Ministry of Justice translation — Japanese Law Translation Database System **第三項** 市町村及び組合は、都道府県知事の認可を受け、保険医療機関等との契約により、当該保険医療機関等において行われる療養の給付に関する第一項の療養の給付に要する費用の額につき、前項の規定により算定される額の範囲内において、別段の定めをすることができる。 art-45/par-3 · https://japanlaw.org/en/national-health-insurance-act/art-45/par-3 · https://japanlaw.org/l/333AC0000000192/art-45/par-3 Municipalities and Societies may, with the authorization of the prefectural governor, specify otherwise in a contract with a health insurance-covered medical institution, etc. with respect to the amount of expenses incurred in providing the benefits for medical treatment set forth in paragraph (1) for the medical treatment to be provided at such health insurance-covered medical institution, etc., within the range of the amount calculated pursuant to the provisions of the preceding paragraph. machine translation, not official **第四項** 市町村及び組合は、保険医療機関等から療養の給付に関する費用の請求があつたときは、第四十条に規定する準則並びに第二項に規定する額の算定方法及び前項の定めに照らして審査した上、支払うものとする。 art-45/par-4 · https://japanlaw.org/en/national-health-insurance-act/art-45/par-4 · https://japanlaw.org/l/333AC0000000192/art-45/par-4 Upon receipt of a claim by a health insurance-covered medical institution, etc. for expenses incurred in providing benefits for medical treatment, Municipalities and Societies shall make payment after conducting an examination according to the rules set forth in Article 40, and according to the method for calculating the amount set forth in paragraph (2), and the provisions of the preceding paragraph. machine translation, not official **第五項** 市町村及び組合は、前項の規定による審査及び支払に関する事務を都道府県の区域を区域とする国民健康保険団体連合会（加入している都道府県、市町村及び組合の数がその区域内の都道府県、市町村及び組合の総数の三分の二に達しないものを除く。）又は医療情報基盤・診療報酬審査支払機構法（昭和二十三年法律第百二十九号）による医療情報基盤・診療報酬審査支払機構（以下「機構」という。）に委託することができる。 art-45/par-5 · https://japanlaw.org/en/national-health-insurance-act/art-45/par-5 · https://japanlaw.org/l/333AC0000000192/art-45/par-5 Municipalities and Societies may entrust affairs concerning the examination and payment pursuant to the provisions of the preceding paragraph to a Federation of National Health Insurance Associations whose jurisdiction covers the area of a prefecture (excluding any such Federation the number of whose member prefectures, Municipalities and Societies is less than two-thirds of the total number of prefectures, Municipalities and Societies located within its jurisdiction) or the Medical Information Infrastructure and Medical Fee Examination and Payment Organization (hereinafter referred to as "the organization") under the Act on the Medical Information Infrastructure and Medical Fee Examination and Payment Organization (Act No. 129 of 1948). machine translation, not official **第六項** 国民健康保険団体連合会は、前項の規定及び健康保険法第七十六条第五項の規定による委託を受けて行う診療報酬請求書の審査に関する事務のうち厚生労働大臣の定める診療報酬請求書の審査に係るものを、一般社団法人又は一般財団法人であつて、審査に関する組織その他の事項につき厚生労働省令で定める要件に該当し、当該事務を適正かつ確実に実施することができると認められるものとして厚生労働大臣が指定するものに委託することができる。 art-45/par-6 · https://japanlaw.org/en/national-health-insurance-act/art-45/par-6 · https://japanlaw.org/l/333AC0000000192/art-45/par-6 Of the affairs concerning the review of medical bills conducted by a Federation of National Health Insurance Associations as entrusted pursuant to the provisions of the preceding paragraph or those of Article 76, paragraph (5) of the Health Insurance Act, those concerned with the review of such medical bills as specified by the Minister of Health, Labour and Welfare may be entrusted by such Federation of National Health Insurance Associations to any of those general incorporated associations or general foundations designated by the Minister of Health, Labour and Welfare as those meeting the requirements specified by Ordinance of the Ministry of Health, Labour and Welfare in terms of the organization involved in such review and other matters, and as capable of conducting such affairs in a proper and reliable manner. Ministry of Justice translation — Japanese Law Translation Database System **第七項** 前項の規定により厚生労働大臣の定める診療報酬請求書の審査に係る事務の委託を受けた者は、当該診療報酬請求書の審査を厚生労働省令で定める要件に該当する者に行わせなければならない。 art-45/par-7 · https://japanlaw.org/en/national-health-insurance-act/art-45/par-7 · https://japanlaw.org/l/333AC0000000192/art-45/par-7 An entity to which affairs concerning the review of medical bills as specified by the Minster of Health, Labour and Welfare pursuant to the provisions of the preceding paragraph have been entrusted must have the review of such medical bills conducted by a person who meets the requirements specified by Ordinance of the Ministry of Health, Labour and Welfare. Ministry of Justice translation — Japanese Law Translation Database System **第八項** 前各項に規定するもののほか、保険医療機関等の療養の給付に関する費用の請求に関して必要な事項は、厚生労働省令で定める。 art-45/par-8 · https://japanlaw.org/en/national-health-insurance-act/art-45/par-8 · https://japanlaw.org/l/333AC0000000192/art-45/par-8 In addition to what is provided for in each of the preceding paragraphs, necessary particulars concerning claims for expenses incurred in providing benefits for medical treatment by Health Insurance-Covered Medical Institutions, etc. shall be prescribed by Ordinance of the Ministry of Health, Labour and Welfare. Ministry of Justice translation — Japanese Law Translation Database System --- ## Cites - art-45/par-1: 第五十七条 → 国民健康保険法 第五十七条 (Article 57), art-57 — https://japanlaw.org/en/national-health-insurance-act/art-57 · https://japanlaw.org/l/333AC0000000192/art-57 - art-45/par-2: 前項 → 国民健康保険法 第四十五条第一項 (Article 45, paragraph (1)), art-45/par-1 — https://japanlaw.org/en/national-health-insurance-act/art-45/par-1 · https://japanlaw.org/l/333AC0000000192/art-45/par-1 - art-45/par-2: 健康保険法第七十六条第二項 → 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-45/par-3: 第一項 → 国民健康保険法 第四十五条第一項 (Article 45, paragraph (1)), art-45/par-1 — https://japanlaw.org/en/national-health-insurance-act/art-45/par-1 · https://japanlaw.org/l/333AC0000000192/art-45/par-1 - art-45/par-3: 前項 → 国民健康保険法 第四十五条第二項 (Article 45, paragraph (2)), art-45/par-2 — https://japanlaw.org/en/national-health-insurance-act/art-45/par-2 · https://japanlaw.org/l/333AC0000000192/art-45/par-2 - art-45/par-4: 第四十条 → 国民健康保険法 第四十条 (Article 40), art-40 — https://japanlaw.org/en/national-health-insurance-act/art-40 · https://japanlaw.org/l/333AC0000000192/art-40 - art-45/par-4: 第二項 → 国民健康保険法 第四十五条第二項 (Article 45, paragraph (2)), art-45/par-2 — https://japanlaw.org/en/national-health-insurance-act/art-45/par-2 · https://japanlaw.org/l/333AC0000000192/art-45/par-2 - art-45/par-4: 前項 → 国民健康保険法 第四十五条第三項 (Article 45, paragraph (3)), art-45/par-3 — https://japanlaw.org/en/national-health-insurance-act/art-45/par-3 · https://japanlaw.org/l/333AC0000000192/art-45/par-3 - art-45/par-5: 前項 → 国民健康保険法 第四十五条第四項 (Article 45, paragraph (4)), art-45/par-4 — https://japanlaw.org/en/national-health-insurance-act/art-45/par-4 · https://japanlaw.org/l/333AC0000000192/art-45/par-4 - art-45/par-6: 前項 → 国民健康保険法 第四十五条第五項 (Article 45, paragraph (5)), art-45/par-5 — https://japanlaw.org/en/national-health-insurance-act/art-45/par-5 · https://japanlaw.org/l/333AC0000000192/art-45/par-5 - art-45/par-6: 健康保険法第七十六条第五項 → 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-45/par-7: 前項 → 国民健康保険法 第四十五条第六項 (Article 45, paragraph (6)), art-45/par-6 — https://japanlaw.org/en/national-health-insurance-act/art-45/par-6 · https://japanlaw.org/l/333AC0000000192/art-45/par-6 - art-45/par-8: 前各項 → 国民健康保険法 第四十五条第一項 (Article 45, paragraph (1)), art-45/par-1 — https://japanlaw.org/en/national-health-insurance-act/art-45/par-1 · https://japanlaw.org/l/333AC0000000192/art-45/par-1 - art-45/par-8: 前各項 → 国民健康保険法 第四十五条第二項 (Article 45, paragraph (2)), art-45/par-2 — https://japanlaw.org/en/national-health-insurance-act/art-45/par-2 · https://japanlaw.org/l/333AC0000000192/art-45/par-2 - art-45/par-8: 前各項 → 国民健康保険法 第四十五条第三項 (Article 45, paragraph (3)), art-45/par-3 — https://japanlaw.org/en/national-health-insurance-act/art-45/par-3 · https://japanlaw.org/l/333AC0000000192/art-45/par-3 - art-45/par-8: 前各項 → 国民健康保険法 第四十五条第四項 (Article 45, paragraph (4)), art-45/par-4 — https://japanlaw.org/en/national-health-insurance-act/art-45/par-4 · https://japanlaw.org/l/333AC0000000192/art-45/par-4 - art-45/par-8: 前各項 → 国民健康保険法 第四十五条第五項 (Article 45, paragraph (5)), art-45/par-5 — https://japanlaw.org/en/national-health-insurance-act/art-45/par-5 · https://japanlaw.org/l/333AC0000000192/art-45/par-5 - art-45/par-8: 前各項 → 国民健康保険法 第四十五条第六項 (Article 45, paragraph (6)), art-45/par-6 — https://japanlaw.org/en/national-health-insurance-act/art-45/par-6 · https://japanlaw.org/l/333AC0000000192/art-45/par-6 - art-45/par-8: 前各項 → 国民健康保険法 第四十五条第七項 (Article 45, paragraph (7)), art-45/par-7 — https://japanlaw.org/en/national-health-insurance-act/art-45/par-7 · https://japanlaw.org/l/333AC0000000192/art-45/par-7 ## Cited by 31 provisions cite this one. No official source publishes this direction. - 介護保険法 第二十一条第三項（損害賠償請求権） — https://japanlaw.org/en/long-term-care-insurance-act/art-21/par-3 · https://japanlaw.org/l/409AC0000000123/art-21/par-3 - 介護保険法 第百三十四条第七項（年金保険者の市町村に対する通知） — https://japanlaw.org/en/long-term-care-insurance-act/art-134/par-7 · https://japanlaw.org/l/409AC0000000123/art-134/par-7 - 健康保険法 第七十六条第五項（療養の給付に関する費用） — https://japanlaw.org/en/health-insurance-act/art-76/par-5 · https://japanlaw.org/l/211AC0000000070/art-76/par-5 - 医療法 第三十八条の七第二項 — https://japanlaw.org/en/medical-care-act/art-38-7/par-2 · https://japanlaw.org/l/323AC0000000205/art-38-7/par-2 - 国民健康保険法 第四十二条第一項（療養の給付を受ける場合の一部負担金） — https://japanlaw.org/en/national-health-insurance-act/art-42/par-1 · https://japanlaw.org/l/333AC0000000192/art-42/par-1 - 国民健康保険法 第四十五条第二項（保険医療機関等の診療報酬） — https://japanlaw.org/en/national-health-insurance-act/art-45/par-2 · https://japanlaw.org/l/333AC0000000192/art-45/par-2 - 国民健康保険法 第四十五条第三項（保険医療機関等の診療報酬） — https://japanlaw.org/en/national-health-insurance-act/art-45/par-3 · https://japanlaw.org/l/333AC0000000192/art-45/par-3 - 国民健康保険法 第四十五条第四項（保険医療機関等の診療報酬） — https://japanlaw.org/en/national-health-insurance-act/art-45/par-4 · https://japanlaw.org/l/333AC0000000192/art-45/par-4 - 国民健康保険法 第四十五条第五項（保険医療機関等の診療報酬） — https://japanlaw.org/en/national-health-insurance-act/art-45/par-5 · https://japanlaw.org/l/333AC0000000192/art-45/par-5 - 国民健康保険法 第四十五条第六項（保険医療機関等の診療報酬） — https://japanlaw.org/en/national-health-insurance-act/art-45/par-6 · https://japanlaw.org/l/333AC0000000192/art-45/par-6 - 国民健康保険法 第四十五条第七項（保険医療機関等の診療報酬） — https://japanlaw.org/en/national-health-insurance-act/art-45/par-7 · https://japanlaw.org/l/333AC0000000192/art-45/par-7 - 国民健康保険法 第四十五条第八項（保険医療機関等の診療報酬） — https://japanlaw.org/en/national-health-insurance-act/art-45/par-8 · https://japanlaw.org/l/333AC0000000192/art-45/par-8 - 国民健康保険法 第五十二条第六項（入院時食事療養費） — https://japanlaw.org/en/national-health-insurance-act/art-52/par-6 · https://japanlaw.org/l/333AC0000000192/art-52/par-6 - 国民健康保険法 第五十二条の二第三項（入院時生活療養費） — https://japanlaw.org/en/national-health-insurance-act/art-52-2/par-3 · https://japanlaw.org/l/333AC0000000192/art-52-2/par-3 - 国民健康保険法 第五十三条第三項（保険外併用療養費） — https://japanlaw.org/en/national-health-insurance-act/art-53/par-3 · https://japanlaw.org/l/333AC0000000192/art-53/par-3 - 国民健康保険法 第五十四条第四項（療養費） — https://japanlaw.org/en/national-health-insurance-act/art-54/par-4 · https://japanlaw.org/l/333AC0000000192/art-54/par-4 - 国民健康保険法 第五十四条の二第十二項（訪問看護療養費） — https://japanlaw.org/en/national-health-insurance-act/art-54-2/par-12 · https://japanlaw.org/l/333AC0000000192/art-54-2/par-12 - 国民健康保険法 第五十四条の三第六項（特別療養費） — https://japanlaw.org/en/national-health-insurance-act/art-54-3/par-6 · https://japanlaw.org/l/333AC0000000192/art-54-3/par-6 - 国民健康保険法 第六十四条第四項（損害賠償請求権） — https://japanlaw.org/en/national-health-insurance-act/art-64/par-4 · https://japanlaw.org/l/333AC0000000192/art-64/par-4 - 国民健康保険法 第六十六条の二第二項（市町村による保険給付に係る事務の範囲） — https://japanlaw.org/en/national-health-insurance-act/art-66-2/par-2 · https://japanlaw.org/l/333AC0000000192/art-66-2/par-2 - 国民健康保険法 第七十五条の三第一項 — https://japanlaw.org/en/national-health-insurance-act/art-75-3/par-1 · https://japanlaw.org/l/333AC0000000192/art-75-3/par-1 - 国民健康保険法 第七十五条の五第一項 — https://japanlaw.org/en/national-health-insurance-act/art-75-5/par-1 · https://japanlaw.org/l/333AC0000000192/art-75-5/par-1 - 国民健康保険法 第八十二条第十四項第一号 — https://japanlaw.org/en/national-health-insurance-act/art-82/par-14/item-1 · https://japanlaw.org/l/333AC0000000192/art-82/par-14/item-1 - 国民健康保険法 第八十五条の三第一項（業務） — https://japanlaw.org/en/national-health-insurance-act/art-85-3/par-1 · https://japanlaw.org/l/333AC0000000192/art-85-3/par-1 - 国民健康保険法 第八十七条第一項（審査委員会） — https://japanlaw.org/en/national-health-insurance-act/art-87/par-1 · https://japanlaw.org/l/333AC0000000192/art-87/par-1 - 国民健康保険法 第百十三条の三第一項（連合会又は機構への事務の委託） — https://japanlaw.org/en/national-health-insurance-act/art-113-3/par-1 · https://japanlaw.org/l/333AC0000000192/art-113-3/par-1 - 国民健康保険法 第百十九条の二第一項（事務の区分） — https://japanlaw.org/en/national-health-insurance-act/art-119-2/par-1 · https://japanlaw.org/l/333AC0000000192/art-119-2/par-1 - 国民健康保険法 第百二十一条第二項 — https://japanlaw.org/en/national-health-insurance-act/art-121/par-2 · https://japanlaw.org/l/333AC0000000192/art-121/par-2 - 所得税法 第百二十条第四項第二号（確定所得申告） — https://japanlaw.org/en/income-tax-act/art-120/par-4/item-2 · https://japanlaw.org/l/340AC0000000033/art-120/par-4/item-2 - 高齢者の医療の確保に関する法律 第十七条第一項（機構等への委託） — https://japanlaw.org/en/elderly-medical-care-act/art-17/par-1 · https://japanlaw.org/l/357AC0000000080/art-17/par-1 - 高齢者の医療の確保に関する法律 第七十条第五項（保険医療機関等の診療報酬） — https://japanlaw.org/en/elderly-medical-care-act/art-70/par-5 · https://japanlaw.org/l/357AC0000000080/art-70/par-5 --- ## Sources - e-Gov 法令検索, Digital Agency (デジタル庁) — 国民健康保険法 — the text in force from 2026-10-01 (https://laws.e-gov.go.jp/law/333AC0000000192/20261001_507AC0000000087), retrieved 2026-10-17 - Japanese Law Translation Database System, Ministry of Justice (法務省) — National Health Insurance Act — Ministry of Justice translation (https://www.japaneselawtranslation.go.jp/en/laws/view/2453/tb), retrieved 2026-10-17 - claude-sonnet-5-5 — Machine translation, batch national-health-insurance-act-20261017T183826-002, translated 2026-10-18 - This site's parser, version 209 — 国民健康保険法 — structure, counts, cross-references and defined terms, computed 2026-10-17