# 国民健康保険法 / National Health Insurance Act — 第五十三条 (Article 53) - 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: 第五十三条 (Article 53)（保険外併用療養費） — address `art-53` - Text in force since: 2026-10-01 - URL (the page that opens at this provision): https://japanlaw.org/en/national-health-insurance-act/art-53 - Permanent URL (e-Gov law ID, never renamed): https://japanlaw.org/l/333AC0000000192/art-53 - 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. --- ### 第五十三条（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-53 · https://japanlaw.org/en/national-health-insurance-act/art-53 · https://japanlaw.org/l/333AC0000000192/art-53 **第一項** 市町村及び組合は、被保険者が自己の選定する保険医療機関等について評価療養、患者申出療養又は選定療養を受けたときは、当該被保険者の属する世帯の世帯主又は組合員に対し、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。ただし、当該世帯主又は組合員が当該被保険者について第五十四条の三第一項又は第二項本文の規定の適用を受けている間は、この限りでない。 art-53/par-1 · https://japanlaw.org/en/national-health-insurance-act/art-53/par-1 · https://japanlaw.org/l/333AC0000000192/art-53/par-1 When an insured person has received evaluation treatment, patient-requested treatment or selective treatment at or from a health insurance-covered medical institution, etc. of said person's choice, Municipalities and Societies shall pay medical expenses combined with treatment outside insurance coverage to the Householder or Society member of the household to which said insured person belongs with respect to the expenses incurred in that treatment; provided, however, that this shall not apply during any period in which said Householder or Society member is subject to the application of Article 54-3, paragraph (1) or the main clause of paragraph (2) with respect to said insured person. machine translation, not official **第二項** 保険外併用療養費の額は、第一号に規定する額（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規定する額の合算額、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規定する額の合算額）とする。 art-53/par-2 · https://japanlaw.org/en/national-health-insurance-act/art-53/par-2 · https://japanlaw.org/l/333AC0000000192/art-53/par-2 The amount of medical expenses combined with treatment outside insurance coverage shall be the amount specified in item (i) (or the aggregate of such amount and the amount specified in item (ii) or (iii) when such medical treatment includes Dietary Treatment and Living Support, respectively): 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。）につき健康保険法第八十六条第二項第一号の規定による厚生労働大臣の定めの例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とする。）から、その額に第四十二条第一項各号の区分に応じ、同項各号に掲げる割合（第四十三条第一項の規定により一部負担金の割合が減ぜられたときは、当該減ぜられた割合とする。）を乗じて得た額（療養の給付に係る第四十二条第一項の一部負担金について第四十四条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とする。）を控除した額 art-53/par-2/item-1 · https://japanlaw.org/en/national-health-insurance-act/art-53/par-2/item-1 · https://japanlaw.org/l/333AC0000000192/art-53/par-2/item-1 the amount calculated by deducting, from the amount of expenses calculated for such medical treatment (excluding Dietary Treatment and Living Support) in accordance with the rules prescribed by the Minister of Health, Labour and Welfare pursuant to the provisions of Article 86, paragraph (2), item (i) of the Health Insurance Act (or, when said amount exceeds the amount of expenses actually incurred in such medical treatment, such amount of expenses actually incurred in such medical treatment), the amount obtained by multiplying such amount by the applicable ratio listed in the items of paragraph (1) of Article 42, in accordance with the categories listed in the items of the same paragraph (or, where the ratio for co-payment has been reduced pursuant to the provisions of Article 43, paragraph (1), the ratio after such reduction) (or, if any of the measures listed in the items of paragraph (1) of Article 44 needs to be taken with respect to the co-payment set forth in Article 42, paragraph (1) for benefits for medical treatment, the amount calculated as if the relevant measures were taken); Ministry of Justice translation — Japanese Law Translation Database System **二** 当該食事療養につき健康保険法第八十五条第二項の規定による厚生労働大臣の定める基準の例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とする。）から、食事療養標準負担額を控除した額 art-53/par-2/item-2 · https://japanlaw.org/en/national-health-insurance-act/art-53/par-2/item-2 · https://japanlaw.org/l/333AC0000000192/art-53/par-2/item-2 the amount calculated by deducting the amount of Standard Co-payment for Dietary Treatment from the amount calculated for such Dietary Treatment in accordance with the standards set by the Minister of Health, Labour and Welfare pursuant to the provisions of the Article 85, paragraph (2) of the Health Insurance Act (or, when said amount exceeds the amount of expenses actually incurred for such Dietary Treatment, such amount of expenses actually incurred for such Dietary Treatment); Ministry of Justice translation — Japanese Law Translation Database System **三** 当該生活療養につき健康保険法第八十五条の二第二項の規定による厚生労働大臣の定める基準の例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とする。）から、生活療養標準負担額を控除した額 art-53/par-2/item-3 · https://japanlaw.org/en/national-health-insurance-act/art-53/par-2/item-3 · https://japanlaw.org/l/333AC0000000192/art-53/par-2/item-3 the amount calculated by deducting the amount of Standard Co-payment for Living Support from the amount calculated for such Living Support in accordance with the standards set by the Minister of Health, Labour and Welfare pursuant to the provisions of the Article 85-2, paragraph (2) of the Health Insurance Act (or, when said amount exceeds the amount of expenses actually incurred in such Living Support, such amount of expenses actually incurred in such Living Support). Ministry of Justice translation — Japanese Law Translation Database System **第三項** 健康保険法第六十四条並びに本法第三十六条第三項、第四十条、第四十一条、第四十五条第三項から第八項まで、第四十五条の二及び第五十二条第三項から第五項までの規定は、保険医療機関等について受けた評価療養、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。この場合において、これらの規定に関し必要な技術的読替えは、政令で定める。 art-53/par-3 · https://japanlaw.org/en/national-health-insurance-act/art-53/par-3 · https://japanlaw.org/l/333AC0000000192/art-53/par-3 The provisions of Article 64 of the Health Insurance Act and paragraph (3) of Article 36, Articles 40 and 41, paragraphs (3) through (8) of Article 45, Article 45-2 and paragraphs (3) through (5) of Article 52 of this Act shall apply mutatis mutandis to evaluation treatment, patient-requested treatment and selective treatment received at or from a health insurance-covered medical institution, etc. and to the payment of medical expenses combined with treatment outside insurance coverage associated with such treatment. In this case, any technical replacement of terms necessary for these provisions shall be specified by Cabinet Order. machine translation, not official **第四項** 第四十二条の二の規定は、前項において準用する第五十二条第三項の場合において当該療養につき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とする。）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-53/par-4 · https://japanlaw.org/en/national-health-insurance-act/art-53/par-4 · https://japanlaw.org/l/333AC0000000192/art-53/par-4 The provisions of Article 42-2 shall apply mutatis mutandis to the 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 for such medical treatment pursuant to the provisions of paragraph (2) in the case set forth in Article 52, paragraph (3) as applied mutatis mutandis pursuant to the preceding paragraph (or, when said amount exceeds the amount of expenses actually incurred in such medical treatment, said amount of expenses actually incurred in such medical treatment). Ministry of Justice translation — Japanese Law Translation Database System --- ## Cites - art-53/par-1: 第五十四条の三第一項 → 国民健康保険法 第五十四条の三第一項 (Article 54-3, paragraph (1)), art-54-3/par-1 — https://japanlaw.org/en/national-health-insurance-act/art-54-3/par-1 · https://japanlaw.org/l/333AC0000000192/art-54-3/par-1 - art-53/par-1: 第二項 → 国民健康保険法 第五十四条の三第二項 (Article 54-3, paragraph (2)), art-54-3/par-2 — https://japanlaw.org/en/national-health-insurance-act/art-54-3/par-2 · https://japanlaw.org/l/333AC0000000192/art-54-3/par-2 - art-53/par-2: 第一号 → 国民健康保険法 第五十三条第二項第一号 (Article 53, paragraph (2), item (i)), art-53/par-2/item-1 — https://japanlaw.org/en/national-health-insurance-act/art-53/par-2/item-1 · https://japanlaw.org/l/333AC0000000192/art-53/par-2/item-1 - art-53/par-2: 第二号 → 国民健康保険法 第五十三条第二項第二号 (Article 53, paragraph (2), item (ii)), art-53/par-2/item-2 — https://japanlaw.org/en/national-health-insurance-act/art-53/par-2/item-2 · https://japanlaw.org/l/333AC0000000192/art-53/par-2/item-2 - art-53/par-2: 第三号 → 国民健康保険法 第五十三条第二項第三号 (Article 53, paragraph (2), item (iii)), art-53/par-2/item-3 — https://japanlaw.org/en/national-health-insurance-act/art-53/par-2/item-3 · https://japanlaw.org/l/333AC0000000192/art-53/par-2/item-3 - art-53/par-2/item-1: 健康保険法第八十六条第二項第一号 → 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-53/par-2/item-1: 第四十二条第一項 → 国民健康保険法 第四十二条第一項 (Article 42, paragraph (1)), art-42/par-1 — https://japanlaw.org/en/national-health-insurance-act/art-42/par-1 · https://japanlaw.org/l/333AC0000000192/art-42/par-1 - art-53/par-2/item-1: 第四十三条第一項 → 国民健康保険法 第四十三条第一項 (Article 43, paragraph (1)), art-43/par-1 — https://japanlaw.org/en/national-health-insurance-act/art-43/par-1 · https://japanlaw.org/l/333AC0000000192/art-43/par-1 - art-53/par-2/item-1: 第四十四条第一項 → 国民健康保険法 第四十四条第一項 (Article 44, paragraph (1)), art-44/par-1 — https://japanlaw.org/en/national-health-insurance-act/art-44/par-1 · https://japanlaw.org/l/333AC0000000192/art-44/par-1 - art-53/par-2/item-2: 健康保険法第八十五条第二項 → 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-53/par-2/item-3: 健康保険法第八十五条の二第二項 → 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-53/par-3: 健康保険法第六十四条 → 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-53/par-3: 第三十六条第三項 → 国民健康保険法 第三十六条第三項 (Article 36, paragraph (3)), art-36/par-3 — https://japanlaw.org/en/national-health-insurance-act/art-36/par-3 · https://japanlaw.org/l/333AC0000000192/art-36/par-3 - art-53/par-3: 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-53/par-3: 第四十一条 → 国民健康保険法 第四十一条 (Article 41), art-41 — https://japanlaw.org/en/national-health-insurance-act/art-41 · https://japanlaw.org/l/333AC0000000192/art-41 - art-53/par-3: 第四十五条第三項から第八項まで → 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-53/par-3: 第四十五条第三項から第八項まで → 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-53/par-3: 第四十五条第三項から第八項まで → 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-53/par-3: 第四十五条第三項から第八項まで → 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-53/par-3: 第四十五条第三項から第八項まで → 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 - art-53/par-3: 第四十五条第三項から第八項まで → 国民健康保険法 第四十五条第八項 (Article 45, paragraph (8)), 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 - art-53/par-3: 第四十五条の二 → 国民健康保険法 第四十五条の二 (Article 45-2), art-45-2 — https://japanlaw.org/en/national-health-insurance-act/art-45-2 · https://japanlaw.org/l/333AC0000000192/art-45-2 - art-53/par-3: 第五十二条第三項から第五項まで → 国民健康保険法 第五十二条第三項 (Article 52, paragraph (3)), art-52/par-3 — https://japanlaw.org/en/national-health-insurance-act/art-52/par-3 · https://japanlaw.org/l/333AC0000000192/art-52/par-3 - art-53/par-3: 第五十二条第三項から第五項まで → 国民健康保険法 第五十二条第四項 (Article 52, paragraph (4)), art-52/par-4 — https://japanlaw.org/en/national-health-insurance-act/art-52/par-4 · https://japanlaw.org/l/333AC0000000192/art-52/par-4 - art-53/par-3: 第五十二条第三項から第五項まで → 国民健康保険法 第五十二条第五項 (Article 52, paragraph (5)), art-52/par-5 — https://japanlaw.org/en/national-health-insurance-act/art-52/par-5 · https://japanlaw.org/l/333AC0000000192/art-52/par-5 - art-53/par-4: 第四十二条の二 → 国民健康保険法 第四十二条の二 (Article 42-2), art-42-2 — https://japanlaw.org/en/national-health-insurance-act/art-42-2 · https://japanlaw.org/l/333AC0000000192/art-42-2 - art-53/par-4: 前項 → 国民健康保険法 第五十三条第三項 (Article 53, paragraph (3)), art-53/par-3 — https://japanlaw.org/en/national-health-insurance-act/art-53/par-3 · https://japanlaw.org/l/333AC0000000192/art-53/par-3 - art-53/par-4: 第五十二条第三項 → 国民健康保険法 第五十二条第三項 (Article 52, paragraph (3)), art-52/par-3 — https://japanlaw.org/en/national-health-insurance-act/art-52/par-3 · https://japanlaw.org/l/333AC0000000192/art-52/par-3 - art-53/par-4: 第二項 → 国民健康保険法 第五十三条第二項 (Article 53, paragraph (2)), art-53/par-2 — https://japanlaw.org/en/national-health-insurance-act/art-53/par-2 · https://japanlaw.org/l/333AC0000000192/art-53/par-2 ## Cited by 15 provisions cite this one. No official source publishes this direction. - 国民健康保険法 第九条第三項（届出等） — https://japanlaw.org/en/national-health-insurance-act/art-9/par-3 · https://japanlaw.org/l/333AC0000000192/art-9/par-3 - 国民健康保険法 第五十三条第二項（保険外併用療養費） — https://japanlaw.org/en/national-health-insurance-act/art-53/par-2 · https://japanlaw.org/l/333AC0000000192/art-53/par-2 - 国民健康保険法 第五十三条第四項（保険外併用療養費） — https://japanlaw.org/en/national-health-insurance-act/art-53/par-4 · https://japanlaw.org/l/333AC0000000192/art-53/par-4 - 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 第六十五条第三項（不正利得の徴収等） — https://japanlaw.org/en/national-health-insurance-act/art-65/par-3 · https://japanlaw.org/l/333AC0000000192/art-65/par-3 - 国民健康保険法 第六十六条の二第一項（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-1 · https://japanlaw.org/l/333AC0000000192/art-66-2/par-1 - 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 第百十九条第一項（厚生労働大臣と都道府県知事との連携） — https://japanlaw.org/en/national-health-insurance-act/art-119/par-1 · https://japanlaw.org/l/333AC0000000192/art-119/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 --- ## 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