Guide to Health Insurance in Japan

For anyone who permanently resides in Japan for three months or more, you will need to enroll in the public health insurance system. This includes non-Japanese citizens like international students. Those under 20 years old that fall in the category are exempt, but if you’re over that age, you’ll still need to register for health insurance of some kind regardless.

Keep in mind that not registering for health insurance is illegal. A lot of people tend to avoid paying them because the entire process can seem confusing and, to some, expensive.

If you are coming to Japan for work or studies, we will help to inform you on the basics of the health insurance system, as well as share some key vocabulary that you should know about.

Do I Need Health Insurance in Japan?

Partly thanks to their high-quality and accessible healthcare, life expectancy is the highest in the world. With health insurance, most Japanese residents have 70% of their healthcare costs covered, having only to pay 30%.

Let’s say you visit a gynecologist in Japan or go to a dentist. These are basic healthcare, all of which are covered by your health insurance (for non-cosmetic procedures). But what if in the unlikely chance you got into an accident and had to be treated in an in-patient hospital? Without health insurance, the sum can be frightening. 30% of, let’s say, 10,000,000 JPY is still high for an average person.

Fortunately, if your medical costs for treatment at a hospital exceed a certain limit, you can apply for a refund of the amount paid over that limit. In other words, you don’t have to worry about high-cost medical care.

Depending on your residency status, your type of health insurance will differ. International students who reside for more than 3 months in Japan, for example, will need to enroll in the NHI (National Health Insurance), but someone who already has full-time employment once they arrive will mostly have their health insurance included in their social insurance benefit shakai hoken (社会保険), which is paid together with pension and employment insurance by their company.

How Do I Use Health Insurance in Japan?

To be able to use your health insurance, you need your National Health Insurance card (健康保険証). Be sure to present it to your healthcare provider. Your health insurance will cover when you become ill, injured or need dental care. For these cases, you will only need to pay 30% of the original cost for the treatment. Except for the elderly, who under MCS will only need to pay 10%. 

Sometimes, healthcare providers do not accept your insurance card. You may also receive treatment while not in possession of your card. In those cases, you will have to pay the full amount. But, you will be able to make a claim to your insurance provider. You will need to provide an invoice for the cost of medical treatment. They will investigate the case and may then refund you 70% to 90% of the original cost (depending on your insurance).

As for private insurance, it will depend on your insurance company, so check with them.

Types of Health Insurance

There are two main types of Health Insurance in Japan. Those being  国民健康保険(Kokumin Kenko Hoken) and 健康保険 (Kenko Hoken). Most people will apply for one of these two. Understanding which insurance applies to you is very important, so pay attention.

Remember that if you are coming to Japan for work, your company will sort out your health insurance for you. However, be sure to check with them to stay informed, as some employment contracts — such as temporary or contract employment — may not include health insurance coverage.

国民健康保険 or Japanese National Health Insurance (NHI)

NHI is the health insurance that everyone falls under if an alternative is unavailable. If you aren’t eligible for any other insurance, this is what you should apply for. This applies to the unemployed, self-employed, those without a full-time contract and students.  

People who enroll for NHI must pay premiums. Do note that the enrolled have a wide age range, low-income levels, and low payment rates. This has led to the premium becoming very unstable. It is subject to change every year, so be sure to confirm the rate on your own.

健康保険 or Employees’ Health Insurance (EHI)

This applies to those who work a full-time contract (30 hours a week or more). It also can apply to some part-time workers, but only in certain circumstances. Click here for more information. 

Luckily for you, most of the details of this plan your employer will cover. The premium payable comes out of your paycheck. Your company’s human resource department does the paperwork. Also, your employer should take care of the application process.

There are other types of health insurance, notably 長寿医療制度(Choju Iryo Seido), and private insurance.

長寿医療制度 or Long Life Medical Care System (MCS)

The MCS is for the elderly. It applies to those 75 or older or those above 65 with a registered disability. The MCS covers 90% of medical costs, unlike the 70% from other health insurances.

Private Insurance

Prvate insurance, or shiteki hoken (私的保険), and travel insurance, or ryokou hoken (旅行保険), are only relevant if your stay in Japan is short-term (Less than 90 days). It is the only form of health insurance available for short-term residents. Some plans can cover up to 100% of the medical costs. 

You are going to have to find companies that provide the insurance. Because it is private, the Japanese government will not help you. Do note that if you are staying in Japan for less than 90 days, getting health insurance is not necessary. Only go for this if you think you will need it. 

Applying for National Health Insurance

Once you’ve moved to Japan, you will need to apply at the National Health Insurance section of the ward or city office for where you live. You will need your residence card and passport. Most of the employees there only speak Japanese, so bring along a friend or colleague to act as a translator if your Japanese isn’t that good.

Once registered, visit the National Health Insurance department to fill out another form. Your form will need your name and address, passport, 在留 (Zairyu) card, MyNumber card and your monthly income. Your monthly income determines the premiums you pay.

Report to the Insurance Department if you move to a different prefecture. The cost of premiums varies based on where you live.

The department will issue you a National Health Insurance card called a kenko hokensho (健康保険証) once you complete the process. You must show the card at the reception counter of hospitals when visiting for medical care. The card is very important, so keep it with you at all times and try not to lose it. 

In the event that you do lose it, notify a local police station first. Someone may have found it and placed it with them. If not, you will have to pay the card reissue fee (1000 yen per card). Then, fill out the application form for the Reissue of Health Insurance Card to the Health Insurance Association.

If you move, you must go to the city office of the new residential area to apply for a new insurance card re-issued. If this procedure is not made, National Health Insurance will not be effective.

How to pay

As mentioned earlier, the way you pay for health insurance is through premiums. The way you pay for each premium will change depending on which insurance you are under. The amount you must pay is different too.

Japanese National Health Insurance (NHI)

For NHI, NHI premium letters get sent to the head of the household. It does not matter if the head of the household is under different insurance. They must still make the payment if a member of the household is under NHI.

You will need to pay your NHI premiums by the due date, with one of the following methods:

1. Service counters at designated banks, JP Bank or post offices, or branch offices in Saitama (including City Hall, ward offices and administrative service windows).
2. Convenience stores.

You can also apply for an automatic bank transfer to have your premiums withdrawn on the due date from your registered bank account. It will be in 8 installments.

Employees’ Health Insurance (EHI)

For those working a full-time contract, premium payments combine with your pension payments. They are both deducted from your salary. You do not have to take any further action. For more information on your pension, click here.

Long Life Medical Care System (MCS)

Payments for this insurance are made directly from their pension. Those under MCS are now taking out their pension and no longer need to pay into the pension scheme. Payments may differ from city to city.

Private Insurance

Unlike all other government-operated insurance, private insurance is from private companies. Each company is different in how they manage payment, so be sure to check with them before signing up.

Overview

In short,

• You are legally required to sign up for health insurance in Japan.
• Doing so will mean that 70% to 90% of your medical costs will be covered.
• There are 4 different types of insurance that apply to different people.
• You can apply for Health Insurance by going to your local government then the National Health Insurance department.
• For payment you will either be sent a bill or will have it done automatically.

Important phrases to know:

• 国民健康保険 – Kokumin kenkou hoken, National Health Insurance
• 健康保険 – Kenkou hoken, Health Insurance
• 長寿医療制度 – Chouju iryou seido, Long Life Medical Care System
• 健康保険証 – Kenkō hokenshou, Health Insurance card

This information was last updated April 4, 2022.