# 国民健康保険法 / National Health Insurance Act — 第五十四条 (Article 54) - 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: 第五十四条 (Article 54)（療養費） — address `art-54` - Text in force since: 2026-10-01 - URL (the page that opens at this provision): https://japanlaw.org/ja/national-health-insurance-act/art-54 - Permanent URL (e-Gov law ID, never renamed): https://japanlaw.org/l/333AC0000000192/art-54 - 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. --- ### 第五十四条（療養費） — (Medical Expenses) caption: Ministry of Justice translation — Japanese Law Translation Database System art-54 · https://japanlaw.org/ja/national-health-insurance-act/art-54 · https://japanlaw.org/l/333AC0000000192/art-54 **第一項** 市町村及び組合は、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（以下この項及び次項において「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、診療所若しくは薬局その他の者について診療、薬剤の支給若しくは手当を受けた場合において、市町村又は組合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。ただし、当該被保険者の属する世帯の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-54/par-1 · https://japanlaw.org/ja/national-health-insurance-act/art-54/par-1 · https://japanlaw.org/l/333AC0000000192/art-54/par-1 Municipalities and Societies, when they find it difficult to pay benefits for medical treatment or 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 and the following paragraph), or when, 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 health insurance-covered medical institution, etc., a Municipality or Society finds it unavoidable, may pay medical expenses in lieu of Benefits for Medical Treatment, etc.; provided, however, that this shall not apply during any period in which the Householder or Society member of the household to which said insured person belongs 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** 市町村及び組合は、被保険者が電子資格確認等により被保険者であることの確認を受けないで保険医療機関等について診療又は薬剤の支給を受けた場合において、当該確認を受けなかつたことが、緊急その他やむを得ない理由によるものと認めるときは、療養の給付等に代えて、療養費を支給するものとする。ただし、当該被保険者の属する世帯の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-54/par-2 · https://japanlaw.org/ja/national-health-insurance-act/art-54/par-2 · https://japanlaw.org/l/333AC0000000192/art-54/par-2 Where an insured person has received any medical care or medication at or from a health insurance-covered medical institution, etc. without receiving confirmation of being an insured person by electronic eligibility confirmation, etc., and when Municipalities and Societies find that the failure to receive such confirmation was due to an emergency or any other unavoidable reason, they shall pay medical expenses in lieu of Benefits for Medical Treatment, etc.; provided, however, that this shall not apply during any period in which the Householder or Society member of the household to which said insured person belongs 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 **第三項** 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、市町村又は組合が定める。 art-54/par-3 · https://japanlaw.org/ja/national-health-insurance-act/art-54/par-3 · https://japanlaw.org/l/333AC0000000192/art-54/par-3 The amount of medical expenses shall be determined by the Municipality or Society based on the amount calculated by deducting, from the amount calculated for such medical treatment (excluding Dietary Treatment and Living Support), the amount calculated 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, and the amount calculated by deducting, from the amount of expenses calculated for such Dietary Treatment or Living Support, the amount of Standard Co-payment for Dietary Treatment or Standard Living Expense Co-payment, respectively. machine translation, not official **第四項** 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四十五条第二項の規定を、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五十二条第二項の規定を、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五十二条の二第二項の規定を、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規定を準用する。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-54/par-4 · https://japanlaw.org/ja/national-health-insurance-act/art-54/par-4 · https://japanlaw.org/l/333AC0000000192/art-54/par-4 In calculating the amount of expenses set forth in the preceding paragraph, the provisions of Article 45, paragraph (2) shall apply mutatis mutandis to cases where benefit for medical treatment shall be received, those of Article 52, paragraph (2) shall apply mutatis mutandis to cases where expenses for Dietary Treatment for inpatients shall be received, those of Article 52-2, paragraph (2) shall apply mutatis mutandis to cases where expenses for Living Support for inpatients shall be received, and those of paragraph (2) of the preceding Article shall apply mutatis mutandis to cases where medical expenses combined with treatment outside insurance coverage shall be received; provided, however, that such amount shall not exceed the amount of expenses actually incurred in the relevant medical treatment. Ministry of Justice translation — Japanese Law Translation Database System --- ## Cites - art-54/par-1: この項 → 国民健康保険法 第五十四条第一項 (Article 54, paragraph (1)), art-54/par-1 — https://japanlaw.org/ja/national-health-insurance-act/art-54/par-1 · https://japanlaw.org/l/333AC0000000192/art-54/par-1 - art-54/par-1: 次項 → 国民健康保険法 第五十四条第二項 (Article 54, paragraph (2)), art-54/par-2 — https://japanlaw.org/ja/national-health-insurance-act/art-54/par-2 · https://japanlaw.org/l/333AC0000000192/art-54/par-2 - art-54/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/ja/national-health-insurance-act/art-54-3/par-1 · https://japanlaw.org/l/333AC0000000192/art-54-3/par-1 - art-54/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/ja/national-health-insurance-act/art-54-3/par-2 · https://japanlaw.org/l/333AC0000000192/art-54-3/par-2 - art-54/par-2: 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/ja/national-health-insurance-act/art-54-3/par-1 · https://japanlaw.org/l/333AC0000000192/art-54-3/par-1 - art-54/par-2: 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/ja/national-health-insurance-act/art-54-3/par-2 · https://japanlaw.org/l/333AC0000000192/art-54-3/par-2 - art-54/par-3: 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/ja/national-health-insurance-act/art-42/par-1 · https://japanlaw.org/l/333AC0000000192/art-42/par-1 - art-54/par-4: 前項 → 国民健康保険法 第五十四条第三項 (Article 54, paragraph (3)), art-54/par-3 — https://japanlaw.org/ja/national-health-insurance-act/art-54/par-3 · https://japanlaw.org/l/333AC0000000192/art-54/par-3 - art-54/par-4: 第四十五条第二項 → 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/ja/national-health-insurance-act/art-45/par-2 · https://japanlaw.org/l/333AC0000000192/art-45/par-2 - art-54/par-4: 第五十二条第二項 → 国民健康保険法 第五十二条第二項 (Article 52, paragraph (2)), art-52/par-2 — https://japanlaw.org/ja/national-health-insurance-act/art-52/par-2 · https://japanlaw.org/l/333AC0000000192/art-52/par-2 - art-54/par-4: 第五十二条の二第二項 → 国民健康保険法 第五十二条の二第二項 (Article 52-2, paragraph (2)), art-52-2/par-2 — https://japanlaw.org/ja/national-health-insurance-act/art-52-2/par-2 · https://japanlaw.org/l/333AC0000000192/art-52-2/par-2 - art-54/par-4: 前条第二項 → 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/ja/national-health-insurance-act/art-53/par-2 · https://japanlaw.org/l/333AC0000000192/art-53/par-2 ## Cited by 5 provisions cite this one. No official source publishes this direction. - 国民健康保険法 第五十四条第一項（療養費） — https://japanlaw.org/ja/national-health-insurance-act/art-54/par-1 · https://japanlaw.org/l/333AC0000000192/art-54/par-1 - 国民健康保険法 第五十四条第四項（療養費） — https://japanlaw.org/ja/national-health-insurance-act/art-54/par-4 · https://japanlaw.org/l/333AC0000000192/art-54/par-4 - 国民健康保険法 第五十四条の三第七項（特別療養費） — https://japanlaw.org/ja/national-health-insurance-act/art-54-3/par-7 · https://japanlaw.org/l/333AC0000000192/art-54-3/par-7 - 国民健康保険法 第五十四条の三第九項（特別療養費） — https://japanlaw.org/ja/national-health-insurance-act/art-54-3/par-9 · https://japanlaw.org/l/333AC0000000192/art-54-3/par-9 - 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/ja/national-health-insurance-act/art-66-2/par-1 · https://japanlaw.org/l/333AC0000000192/art-66-2/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 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