# 健康保険法 / Health Insurance Act — 第八十七条 (Article 87) - 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: 第八十七条 (Article 87)（療養費） — address `art-87` - Text in force since: 2026-10-01 - URL (the page that opens at this provision): https://japanlaw.org/ja/health-insurance-act/art-87 - Permanent URL (e-Gov law ID, never renamed): https://japanlaw.org/l/211AC0000000070/art-87 - 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. --- ### 第八十七条（療養費） — (Medical Expenses) caption: Ministry of Justice translation — Japanese Law Translation Database System art-87 · https://japanlaw.org/ja/health-insurance-act/art-87 · https://japanlaw.org/l/211AC0000000070/art-87 **第一項** 保険者は、療養の給付若しくは入院時食事療養費、入院時生活療養費若しくは保険外併用療養費の支給（以下この項において「療養の給付等」という。）を行うことが困難であると認めるとき、又は被保険者が保険医療機関等以外の病院、診療所、薬局その他の者から診療、薬剤の支給若しくは手当を受けた場合において、保険者がやむを得ないものと認めるときは、療養の給付等に代えて、療養費を支給することができる。 art-87/par-1 · https://japanlaw.org/ja/health-insurance-act/art-87/par-1 · https://japanlaw.org/l/211AC0000000070/art-87/par-1 When an insurer finds it difficult to pay benefits for medical treatment, expenses for dietary treatment for inpatients, living support expenses for inpatients, or medical expenses combined with treatment outside insurance coverage (hereinafter referred to as "benefits for medical treatment, etc." in this paragraph) or finds it unavoidable in cases where an insured person has received any medical care, medication or treatment at or from a hospital, clinic, pharmacy or any other person other than a medical institution providing services covered by health insurance, it may pay medical expenses in lieu of benefits for medical treatment, etc. Ministry of Justice translation with a slip corrected by this site — not the Ministry's text; the Ministry printed: "When an insurer finds it difficult to pay benefits for medical treatment, expenses for dietary treatment for inpatients, living support expenses for inpatients, or medical expenses combined with treatment outside insurance coverage (hereinafter referred to as "benefits for medical treatment" in this paragraph) or finds it unavoidable in cases where an insured person has received any medical care, medication or treatment at or from a hospital, clinic, pharmacy or any other person other than a medical institution providing services covered by health insurance, it may pay medical expenses in lieu of benefits for medical treatment." — https://www.japaneselawtranslation.go.jp/en/laws/view/3266/tb **第二項** 療養費の額は、当該療養（食事療養及び生活療養を除く。）について算定した費用の額から、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を控除した額及び当該食事療養又は生活療養について算定した費用の額から食事療養標準負担額又は生活療養標準負担額を控除した額を基準として、保険者が定める。 art-87/par-2 · https://japanlaw.org/ja/health-insurance-act/art-87/par-2 · https://japanlaw.org/l/211AC0000000070/art-87/par-2 The amount of medical expenses is determined by the insurer based on: (a) the amount calculated by deducting, from the amount calculated for the medical treatment (excluding dietary treatment and living support), the amount calculated by multiplying the amount by the applicable ratio specified in the items of Article 74, paragraph (1) in accordance with the classifications listed in the items of the same paragraph; and (b) the amount calculated by deducting, from the amount of expenses calculated for the dietary treatment or living support, the amount of standard co-payment for dietary treatment or standard co-payment for living support, respectively. Ministry of Justice translation — Japanese Law Translation Database System **第三項** 前項の費用の額の算定については、療養の給付を受けるべき場合においては第七十六条第二項の費用の額の算定、入院時食事療養費の支給を受けるべき場合においては第八十五条第二項の費用の額の算定、入院時生活療養費の支給を受けるべき場合においては第八十五条の二第二項の費用の額の算定、保険外併用療養費の支給を受けるべき場合においては前条第二項の費用の額の算定の例による。ただし、その額は、現に療養に要した費用の額を超えることができない。 art-87/par-3 · https://japanlaw.org/ja/health-insurance-act/art-87/par-3 · https://japanlaw.org/l/211AC0000000070/art-87/par-3 The amount of expenses referred to in the preceding paragraph is calculated as the amount referred to in Article 76, paragraph (2) when a benefit for medical treatment is to be received, the amount referred to in Article 85, paragraph (2) when expenses for dietary treatment for inpatients are to be received, the amount referred to in Article 85-2, paragraph (2) when expenses for living support for inpatients are to be received, and the amount referred to in paragraph (2) of the preceding Article when medical expenses combined with treatment outside insurance coverage are to be received; however, the amount must not exceed the amount of expenses actually required for medical treatment. Ministry of Justice translation with a slip corrected by this site — not the Ministry's text; the Ministry printed: "The amount of expenses referred to in the preceding paragraph is calculated as the amount referred to in Article 76, paragraph (2) when a benefit for medical treatment is to be received, the amount referred to in Article 52, paragraph (2) when expenses for dietary treatment for inpatients are to be received, the amount referred to in Article 85-2, paragraph (2) when expenses for living support for inpatients are to be received, and the amount referred to in paragraph (2) of the preceding Article when medical expenses combined with treatment outside insurance coverage are to be received; however, the amount must not exceed the amount of expenses actually required for medical treatment." — https://www.japaneselawtranslation.go.jp/en/laws/view/3266/tb --- ## Cites - art-87/par-1: この項 → 健康保険法 第八十七条第一項 (Article 87, paragraph (1)), art-87/par-1 — https://japanlaw.org/ja/health-insurance-act/art-87/par-1 · https://japanlaw.org/l/211AC0000000070/art-87/par-1 - art-87/par-2: 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/ja/health-insurance-act/art-74/par-1 · https://japanlaw.org/l/211AC0000000070/art-74/par-1 - art-87/par-3: 前項 → 健康保険法 第八十七条第二項 (Article 87, paragraph (2)), art-87/par-2 — https://japanlaw.org/ja/health-insurance-act/art-87/par-2 · https://japanlaw.org/l/211AC0000000070/art-87/par-2 - art-87/par-3: 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/ja/health-insurance-act/art-76/par-2 · https://japanlaw.org/l/211AC0000000070/art-76/par-2 - art-87/par-3: 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/ja/health-insurance-act/art-85/par-2 · https://japanlaw.org/l/211AC0000000070/art-85/par-2 - art-87/par-3: 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/ja/health-insurance-act/art-85-2/par-2 · https://japanlaw.org/l/211AC0000000070/art-85-2/par-2 - art-87/par-3: 前条第二項 → 健康保険法 第八十六条第二項 (Article 86, paragraph (2)), art-86/par-2 — https://japanlaw.org/ja/health-insurance-act/art-86/par-2 · https://japanlaw.org/l/211AC0000000070/art-86/par-2 ## Cited by 7 provisions cite this one. No official source publishes this direction. - 健康保険法 第五十四条第一項（日雇特例被保険者に係る保険給付との調整） — https://japanlaw.org/ja/health-insurance-act/art-54/par-1 · https://japanlaw.org/l/211AC0000000070/art-54/par-1 - 健康保険法 第八十七条第一項（療養費） — https://japanlaw.org/ja/health-insurance-act/art-87/par-1 · https://japanlaw.org/l/211AC0000000070/art-87/par-1 - 健康保険法 第八十七条第三項（療養費） — https://japanlaw.org/ja/health-insurance-act/art-87/par-3 · https://japanlaw.org/l/211AC0000000070/art-87/par-3 - 健康保険法 第百十条第七項（家族療養費） — https://japanlaw.org/ja/health-insurance-act/art-110/par-7 · https://japanlaw.org/l/211AC0000000070/art-110/par-7 - 健康保険法 第百四十条第三項（家族療養費） — https://japanlaw.org/ja/health-insurance-act/art-140/par-3 · https://japanlaw.org/l/211AC0000000070/art-140/par-3 - 健康保険法 第百四十五条第七項（特別療養費） — https://japanlaw.org/ja/health-insurance-act/art-145/par-7 · https://japanlaw.org/l/211AC0000000070/art-145/par-7 - 健康保険法 第百四十九条第一項（準用） — https://japanlaw.org/ja/health-insurance-act/art-149/par-1 · https://japanlaw.org/l/211AC0000000070/art-149/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 87, paragraph (1) — the Ministry of Justice's English as printed (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 87, paragraph (3) — the Ministry of Justice's English as printed (https://www.japaneselawtranslation.go.jp/en/laws/view/3266/tb), retrieved 2026-10-10 - This site's parser, version 189 — 健康保険法 — structure, counts, cross-references and defined terms, computed 2026-10-10