# 健康保険法施行令 / Order for Enforcement of the Health Insurance Act — 第五条 (Supplementary Provisions, Article 5)

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- Law: 健康保険法施行令 (Order for Enforcement of the Health Insurance Act), 大正十五年勅令第二百四十三号
- English title "Order for Enforcement of the Health Insurance Act": claude-opus-5-5
- Kind: ImperialOrder — 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: 第五条 (Supplementary Provisions, Article 5) — address `suppl-4182-241/art-5`
- Text in force since: 2026-10-01
- URL (the page that opens at this provision): https://japanlaw.org/ja/health-insurance-act-enforcement-order/suppl-4182-241/art-5
- e-Gov law ID: 215IO0000000243 — never renamed. A permanent link, `/l/{lawId}/{address}` on this site, redirects to the page.
- Every provision below carries its address and its URL 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.

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### 第五条
<sup>suppl-4182-241/art-5 · https://japanlaw.org/ja/health-insurance-act-enforcement-order/suppl-4182-241/art-5</sup>

**第一項**  健康保険法第七十四条第一項第三号又は第百十条第二項第一号ニの規定が適用される被保険者のうち、次の各号のいずれかに該当するもの（以下この条において「特定収入被保険者」という。）に係る健康保険法施行令（以下この条において「令」という。）第四十一条第二項の高額療養費算定基準額は、令第四十二条第二項の規定にかかわらず、同項第一号に定める額とする。
<sup>suppl-4182-241/art-5/par-1 · https://japanlaw.org/ja/health-insurance-act-enforcement-order/suppl-4182-241/art-5/par-1</sup>
Among the insured persons to whom Article 74, paragraph (1), item (iii) or Article 110, paragraph (2), item (i)(d) of the Health Insurance Act applies, for those who fall under any of the following items (hereinafter referred to in this Article as "insured persons with specified income"), the base amount for calculating high-cost medical expenses under Article 41, paragraph (2) of the Order for Enforcement of the Health Insurance Act (hereinafter referred to in this Article as the "Order") is, notwithstanding Article 42, paragraph (2) of the Order, the amount specified in item (i) of that paragraph.
<sup>machine translation, not official</sup>

  **一**  療養の給付又はその被扶養者の療養を受ける月が平成十八年九月から平成十九年八月までの場合における令第三十四条第二項又は第三十九条第二項の収入の額が六百二十一万円未満である者（被扶養者がいない者にあっては、四百八十四万円未満である者）
  <sup>suppl-4182-241/art-5/par-1/item-1 · https://japanlaw.org/ja/health-insurance-act-enforcement-order/suppl-4182-241/art-5/par-1/item-1</sup>
  a person for whom the amount of income under Article 34, paragraph (2) or Article 39, paragraph (2) of the Order, in the case where the month in which benefits for medical treatment or the medical care of the person's dependent is received is from September 2006 through August 2007, is less than 6,210,000 yen (in the case of a person with no dependent, a person for whom it is less than 4,840,000 yen);
  <sup>machine translation, not official</sup>

  **二**  療養の給付又はその被扶養者の療養を受ける月が平成十九年九月から平成二十年三月までの場合における令第三十四条第二項又は第三十九条第二項の収入の額が六百二十一万円未満である者（被扶養者がいない者にあっては、四百八十四万円未満である者）
  <sup>suppl-4182-241/art-5/par-1/item-2 · https://japanlaw.org/ja/health-insurance-act-enforcement-order/suppl-4182-241/art-5/par-1/item-2</sup>
  a person for whom the amount of income under Article 34, paragraph (2) or Article 39, paragraph (2) of the Order, in the case where the month in which benefits for medical treatment or the medical care of the person's dependent is received is from September 2007 through March 2008, is less than 6,210,000 yen (in the case of a person with no dependent, a person for whom it is less than 4,840,000 yen).
  <sup>machine translation, not official</sup>

**第二項**  特定収入被保険者に係る令第四十一条第三項の高額療養費算定基準額は、令第四十二条第三項の規定にかかわらず、同項第一号に定める額とする。
<sup>suppl-4182-241/art-5/par-2 · https://japanlaw.org/ja/health-insurance-act-enforcement-order/suppl-4182-241/art-5/par-2</sup>
For an insured person with specified income, the base amount for calculating high-cost medical expenses under Article 41, paragraph (3) of the Order is, notwithstanding Article 42, paragraph (3) of the Order, the amount specified in item (i) of that paragraph.
<sup>machine translation, not official</sup>

**第三項**  令第四十三条第一項の規定により特定収入被保険者に対し支給すべき高額療養費について保険者が同項に規定する保険医療機関等に支払う額は、同項の規定にかかわらず、同項に規定する当該一部負担金の額から次の各号に掲げる療養の区分に応じ、当該各号に定める額を控除した額を限度とする。
<sup>suppl-4182-241/art-5/par-3 · https://japanlaw.org/ja/health-insurance-act-enforcement-order/suppl-4182-241/art-5/par-3</sup>
With regard to the high-cost medical expenses to be paid to an insured person with specified income pursuant to Article 43, paragraph (1) of the Order, the amount that the insurer pays to the medical institution providing services covered by health insurance, etc. prescribed in that paragraph is, notwithstanding that paragraph, limited to the amount obtained by deducting, from the amount of the co-payment concerned prescribed in that paragraph, the amount specified in each of the following items in accordance with the category of medical care listed in that item.
<sup>machine translation, not official</sup>

  **一**  令第四十三条第一項第二号に掲げる療養　同号イに定める額
  <sup>suppl-4182-241/art-5/par-3/item-1 · https://japanlaw.org/ja/health-insurance-act-enforcement-order/suppl-4182-241/art-5/par-3/item-1</sup>
  medical care listed in Article 43, paragraph (1), item (ii) of the Order: the amount specified in sub-item (a) of that item;
  <sup>machine translation, not official</sup>

  **二**  令第四十三条第一項第三号に掲げる療養　同号イに定める額
  <sup>suppl-4182-241/art-5/par-3/item-2 · https://japanlaw.org/ja/health-insurance-act-enforcement-order/suppl-4182-241/art-5/par-3/item-2</sup>
  medical care listed in Article 43, paragraph (1), item (iii) of the Order: the amount specified in sub-item (a) of that item.
  <sup>machine translation, not official</sup>

**第四項**  特定収入被保険者に対する保険外併用療養費又は家族療養費に係る高額療養費の支給については、令第四十三条第三項中「当該各号」とあるのは「当該各号イ」と読み替えて、同項の規定を適用する。
<sup>suppl-4182-241/art-5/par-4 · https://japanlaw.org/ja/health-insurance-act-enforcement-order/suppl-4182-241/art-5/par-4</sup>
With regard to the payment of high-cost medical expenses relating to medical expenses combined with treatment outside insurance coverage or dependent's medical expenses for an insured person with specified income, Article 43, paragraph (3) of the Order is applied by deeming the phrase "each of those items" in that paragraph to be replaced with "sub-item (a) of each of those items".
<sup>machine translation, not official</sup>

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## Cites
- suppl-4182-241/art-5/par-1: 健康保険法第七十四条第一項第三号 → 健康保険法 第七十四条第一項第三号 (Article 74, paragraph (1), item (iii)), art-74/par-1/item-3 — https://japanlaw.org/ja/health-insurance-act/art-74/par-1/item-3 (e-Gov law ID 211AC0000000070)
- suppl-4182-241/art-5/par-1: 第百十条第二項第一号 → 健康保険法 第百十条第二項第一号 (Article 110, paragraph (2), item (i)), art-110/par-2/item-1 — https://japanlaw.org/ja/health-insurance-act/art-110/par-2/item-1 (e-Gov law ID 211AC0000000070)
- suppl-4182-241/art-5/par-1: この条 → 健康保険法施行令 附則第五条 (Supplementary Provisions, Article 5), suppl-4182-241/art-5 — https://japanlaw.org/ja/health-insurance-act-enforcement-order/suppl-4182-241/art-5
- suppl-4182-241/art-5/par-1: 第四十一条第二項 → 健康保険法施行令 第四十一条第二項 (Article 41, paragraph (2)), art-41/par-2 — https://japanlaw.org/ja/health-insurance-act-enforcement-order/art-41/par-2
- suppl-4182-241/art-5/par-1: 令第四十二条第二項 → 健康保険法施行令 第四十二条第二項 (Article 42, paragraph (2)), art-42/par-2 — https://japanlaw.org/ja/health-insurance-act-enforcement-order/art-42/par-2
- suppl-4182-241/art-5/par-1: 同項第一号 → 健康保険法施行令 第四十二条第二項第一号 (Article 42, paragraph (2), item (i)), art-42/par-2/item-1 — https://japanlaw.org/ja/health-insurance-act-enforcement-order/art-42/par-2/item-1
- suppl-4182-241/art-5/par-1/item-1: 令第三十四条第二項 → 健康保険法施行令 第三十四条第二項 (Article 34, paragraph (2)), art-34/par-2 — https://japanlaw.org/ja/health-insurance-act-enforcement-order/art-34/par-2
- suppl-4182-241/art-5/par-1/item-2: 令第三十四条第二項 → 健康保険法施行令 第三十四条第二項 (Article 34, paragraph (2)), art-34/par-2 — https://japanlaw.org/ja/health-insurance-act-enforcement-order/art-34/par-2
- suppl-4182-241/art-5/par-2: 令第四十一条第三項 → 健康保険法施行令 第四十一条第三項 (Article 41, paragraph (3)), art-41/par-3 — https://japanlaw.org/ja/health-insurance-act-enforcement-order/art-41/par-3
- suppl-4182-241/art-5/par-2: 令第四十二条第三項 → 健康保険法施行令 第四十二条第三項 (Article 42, paragraph (3)), art-42/par-3 — https://japanlaw.org/ja/health-insurance-act-enforcement-order/art-42/par-3
- suppl-4182-241/art-5/par-2: 同項第一号 → 健康保険法施行令 第四十二条第三項第一号 (Article 42, paragraph (3), item (i)), art-42/par-3/item-1 — https://japanlaw.org/ja/health-insurance-act-enforcement-order/art-42/par-3/item-1
- suppl-4182-241/art-5/par-3: 令第四十三条第一項 → 健康保険法施行令 第四十三条第一項 (Article 43, paragraph (1)), art-43/par-1 — https://japanlaw.org/ja/health-insurance-act-enforcement-order/art-43/par-1
- suppl-4182-241/art-5/par-3/item-1: 令第四十三条第一項第二号 → 健康保険法施行令 第四十三条第一項第二号 (Article 43, paragraph (1), item (ii)), art-43/par-1/item-2 — https://japanlaw.org/ja/health-insurance-act-enforcement-order/art-43/par-1/item-2
- suppl-4182-241/art-5/par-3/item-2: 令第四十三条第一項第三号 → 健康保険法施行令 第四十三条第一項第三号 (Article 43, paragraph (1), item (iii)), art-43/par-1/item-3 — https://japanlaw.org/ja/health-insurance-act-enforcement-order/art-43/par-1/item-3
- suppl-4182-241/art-5/par-4: 令第四十三条第三項 → 健康保険法施行令 第四十三条第三項 (Article 43, paragraph (3)), art-43/par-3 — https://japanlaw.org/ja/health-insurance-act-enforcement-order/art-43/par-3

## Cited by

2 provisions cite this one. No official source publishes this direction.

- 健康保険法施行令 附則第四条第二項（健康保険法施行令の一部改正に伴う経過措置） — https://japanlaw.org/ja/health-insurance-act-enforcement-order/suppl-4182-241/art-4/par-2
- 健康保険法施行令 附則第五条第一項 — https://japanlaw.org/ja/health-insurance-act-enforcement-order/suppl-4182-241/art-5/par-1

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## Sources

- claude-opus-5-5 — English title of a law in this collection, written for this site, written 2026-11-06
- e-Gov 法令検索, Digital Agency (デジタル庁) — 健康保険法施行令 — the text in force from 2026-10-01 (https://laws.e-gov.go.jp/law/215IO0000000243/20261001_508CO0000000276), retrieved 2026-11-06
- claude-sonnet-5-5 — Machine translation, batch health-insurance-act-enforcement-order-20261106T164949-027, translated 2026-11-07
- claude-sonnet-5-5 — Machine translation, batch health-insurance-act-enforcement-order-20261106T164949-028, translated 2026-11-07
- This site's parser, version 229 — 健康保険法施行令 — structure, counts, cross-references and defined terms, computed 2026-11-06