# 国民健康保険法 / National Health Insurance Act — 第八章 (Chapter 8) - 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: 第八章 (Chapter 8) — address `ch-8` - Text: the text as amended with effect from 2028-06-04 (On a day set by Cabinet Order, no later than 4 June 2028 — the amending law allows up to two years from promulgation. The exact day is not fixed yet.), standing until 2028-06-23 as now scheduled, since the next amendment's day is not fixed — NOT yet in force (revision 20280604_508AC0000000031) - URL (this text's page, at this provision): https://japanlaw.org/ja/national-health-insurance-act/amendments/20280604_508AC0000000031/text/ch-8 - The same address in the text in force (its wording there may differ): https://japanlaw.org/ja/national-health-insurance-act/ch-8 - Every provision below carries its address and its place on this text's page 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. The Ministry's English is given only where this text's Japanese is a wording the Ministry translated — the same as the text in force, or for a text not yet in force, a wording it translated ahead; every other paragraph's English is machine translation. --- ## 第八章　診療報酬審査委員会 — Chapter VIII Medical Fees Review Committee heading: Ministry of Justice translation — Japanese Law Translation Database System ch-8 · https://japanlaw.org/ja/national-health-insurance-act/amendments/20280604_508AC0000000031/text/ch-8 ### 第八十七条（審査委員会） — (Review Committee) caption: Ministry of Justice translation — Japanese Law Translation Database System art-87 · https://japanlaw.org/ja/national-health-insurance-act/amendments/20280604_508AC0000000031/text/ch-8#art-87 **第一項** 第四十五条第五項の規定による委託を受けて診療報酬請求書の審査を行い、又は第五十四条の五第七項において準用する第四十五条第五項の規定による委託を受けて分娩費に係る請求書の審査を行うため、都道府県の区域を区域とする連合会（その区域内の都道府県若しくは市町村又は組合の三分の二以上が加入しないものを除く。）に、国民健康保険診療報酬審査委員会（以下「審査委員会」という。）を置く。 art-87/par-1 · https://japanlaw.org/ja/national-health-insurance-act/amendments/20280604_508AC0000000031/text/ch-8#art-87/par-1 In order to review medical bills as entrusted pursuant to the provisions of Article 45, paragraph (5) or review bills for delivery expenses as entrusted pursuant to the provisions of Article 45, paragraph (5) as applied mutatis mutandis pursuant to Article 54-5, paragraph (7), a Federation whose district covers the area of a prefecture (excluding any such Federation that has not been joined by two-thirds or more of the prefectures or Municipalities, or Societies within its district) shall have a National Health Insurance Medical Fees Review Committee (hereinafter referred to as the "Review Committee"). machine translation, not official **第二項** 連合会は、前項の規定による事務の遂行に支障のない範囲内で、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又は同法第九十八条の二第八項の規定による委託を受けて行う分娩費に係る請求書の審査を審査委員会に行わせることができる。 art-87/par-2 · https://japanlaw.org/ja/national-health-insurance-act/amendments/20280604_508AC0000000031/text/ch-8#art-87/par-2 A Federation may, as far as not hindering the carrying out of the affairs set forth in the preceding paragraph, have the Review Committee conduct the review of medical bills to be conducted as entrusted pursuant to the provisions of Article 76, paragraph (5) of the Health Insurance Act or the review of bills for delivery expenses to be conducted as entrusted pursuant to the provisions of Article 98-2, paragraph (8) of that Act. machine translation, not official ### 第八十八条（審査委員会の組織） — (Organization of the Review Committee) caption: Ministry of Justice translation — Japanese Law Translation Database System art-88 · https://japanlaw.org/ja/national-health-insurance-act/amendments/20280604_508AC0000000031/text/ch-8#art-88 **第一項** 審査委員会は、都道府県知事が定める保険医及び保険薬剤師を代表する委員、都道府県及び当該都道府県内の市町村並びに組合（以下「保険者」という。）を代表する委員並びに公益を代表する委員をもつて組織する。 art-88/par-1 · https://japanlaw.org/ja/national-health-insurance-act/amendments/20280604_508AC0000000031/text/ch-8#art-88/par-1 The Review Committee shall be composed of committee members representing health insurance-covered physicians and health insurance-covered pharmacists, committee members representing the prefecture and the Municipalities and Societies within the prefecture (hereinafter referred to as "insurers"), and committee members representing the public interest, as specified by the prefectural governor. machine translation, not official **第二項** 委員は、都道府県知事が委嘱するものとし、その数は、保険医及び保険薬剤師を代表する委員並びに保険者を代表する委員については、それぞれ同数とする。 art-88/par-2 · https://japanlaw.org/ja/national-health-insurance-act/amendments/20280604_508AC0000000031/text/ch-8#art-88/par-2 Committee members are to be commissioned by the prefectural governor, and the number of committee members is to be the same, respectively, for committee members representing health insurance-covered physicians and health insurance-covered pharmacists and committee members representing insurers. machine translation, not official **第三項** 前項の委嘱は、保険医及び保険薬剤師を代表する委員並びに保険者を代表する委員については、それぞれ関係団体の推薦によつて行わなければならない。 art-88/par-3 · https://japanlaw.org/ja/national-health-insurance-act/amendments/20280604_508AC0000000031/text/ch-8#art-88/par-3 Committee members representing health insurance-covered physicians and health insurance-covered pharmacists and committee members representing Insurers must be commissioned pursuant to the preceding paragraph based on recommendations made by concerned organizations in each category. Ministry of Justice translation — Japanese Law Translation Database System ### 第八十九条（審査委員会の権限） — (Authority of the Review Committee) caption: Ministry of Justice translation — Japanese Law Translation Database System art-89 · https://japanlaw.org/ja/national-health-insurance-act/amendments/20280604_508AC0000000031/text/ch-8#art-89 **第一項** 審査委員会は、診療報酬請求書の審査又は分娩費に係る請求書の審査を行うため必要があると認めるときは、都道府県知事の承認を得て、当該保険医療機関等、指定訪問看護の事業を行う事業所若しくは指定助産所に対して、報告若しくは診療録、助産録その他の帳簿書類の提出若しくは提示を求め、又は当該保険医療機関等の開設者若しくは管理者、指定訪問看護事業者、当該指定助産所の開設者若しくは管理者、当該保険医療機関等において療養を担当する保険医若しくは保険薬剤師若しくは当該分娩取扱保険医療機関若しくは指定助産所において分娩の手当を担当する保険医（医師であるものに限る。）若しくは登録助産師に対して、出頭若しくは説明を求めることができる。 art-89/par-1 · https://japanlaw.org/ja/national-health-insurance-act/amendments/20280604_508AC0000000031/text/ch-8#art-89/par-1 When the Review Committee finds it necessary in order to review medical bills or review bills for delivery expenses, it may, upon the approval of the prefectural governor, request the relevant health insurance-covered medical institution, etc., the relevant office providing designated home nursing or the relevant designated birthing center to make a report or submit or present medical records, birth records or other books and documents, or may request any of the establishers or administrators of such health insurance-covered medical institution, etc., the designated home-nursing provider, any of the establishers or administrators of such designated birthing center, any of the health insurance-covered physicians or health insurance-covered pharmacists who are in charge of medical treatment at such health insurance-covered medical institution, etc., or any of the health insurance-covered physicians (limited to physicians) or registered midwives who are in charge of delivery care at the relevant delivery-handling medical institution providing services covered by health insurance or designated birthing center to appear or provide an explanation. machine translation, not official **第二項** 連合会は、前項の規定により審査委員会に出頭した者に対し、旅費、日当及び宿泊料を支給しなければならない。ただし、当該保険医療機関等、指定訪問看護の事業を行う事業所又は指定助産所が提出した診療報酬請求書若しくは分娩費に係る請求書又は診療録、助産録その他の帳簿書類の記載が不備又は不当であつたため出頭を求められて出頭した者に対しては、この限りでない。 art-89/par-2 · https://japanlaw.org/ja/national-health-insurance-act/amendments/20280604_508AC0000000031/text/ch-8#art-89/par-2 The Federation must pay travel expenses, daily expenses and accommodation expenses to any person who appeared at the Review Committee pursuant to the provisions of the preceding paragraph; provided, however, that this shall not apply to any person who appeared in response to a request for appearance issued due to defective or misleading entries in medical bills or bills for delivery expenses or medical records, birth records or other books and documents submitted by the relevant health insurance-covered medical institution, etc., the relevant office providing designated home nursing or the relevant designated birthing center. machine translation, not official ### 第九十条（省令への委任） — (Delegation to Ministerial Ordinance) caption: Ministry of Justice translation — Japanese Law Translation Database System art-90 · https://japanlaw.org/ja/national-health-insurance-act/amendments/20280604_508AC0000000031/text/ch-8#art-90 **第一項** この章に規定するもののほか、審査委員会に関して必要な事項は、厚生労働省令で定める。 art-90/par-1 · https://japanlaw.org/ja/national-health-insurance-act/amendments/20280604_508AC0000000031/text/ch-8#art-90/par-1 In addition to what is provided for in this Chapter, necessary particulars concerning the Review Committee shall be prescribed by Ordinance of the Ministry of Health, Labour and Welfare. Ministry of Justice translation — Japanese Law Translation Database System --- ## Cites - art-87/par-1: 第四十五条第五項 → 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/ja/national-health-insurance-act/amendments/20280604_508AC0000000031/text/ch-4/from-art-45#art-45/par-5 - art-87/par-1: 第五十四条の五第七項 → 国民健康保険法 第五十四条の五第七項 (Article 54-5, paragraph (7)), art-54-5/par-7 — https://japanlaw.org/ja/national-health-insurance-act/amendments/20280604_508AC0000000031/text/ch-4/from-art-54-5#art-54-5/par-7 - art-87/par-2: 前項 → 国民健康保険法 第八十七条第一項 (Article 87, paragraph (1)), art-87/par-1 — https://japanlaw.org/ja/national-health-insurance-act/amendments/20280604_508AC0000000031/text/ch-8#art-87/par-1 - art-87/par-2: 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/ja/health-insurance-act/art-76/par-5 · https://japanlaw.org/l/211AC0000000070/art-76/par-5 - art-88/par-3: 前項 → 国民健康保険法 第八十八条第二項 (Article 88, paragraph (2)), art-88/par-2 — https://japanlaw.org/ja/national-health-insurance-act/amendments/20280604_508AC0000000031/text/ch-8#art-88/par-2 - art-89/par-2: 前項 → 国民健康保険法 第八十九条第一項 (Article 89, paragraph (1)), art-89/par-1 — https://japanlaw.org/ja/national-health-insurance-act/amendments/20280604_508AC0000000031/text/ch-8#art-89/par-1 --- ## Sources - e-Gov 法令検索, Digital Agency (デジタル庁) — 国民健康保険法 — the text as 令和八年法律第三十一号 leaves it, from a date not yet fixed (https://laws.e-gov.go.jp/law/333AC0000000192/20280604_508AC0000000031), 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-20261017T183826-009, translated 2026-10-18 - claude-sonnet-5-5 — Machine translation of amended wording, batch national-health-insurance-act-amendments-20261017T183826-003, translated 2026-10-18 - claude-sonnet-5-5 — Machine translation of amended wording, batch national-health-insurance-act-amendments-20261017T193814-012, 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