Health Insurance

There are two kinds of public health insurance available in Japan: National Health Insurance (kokumin kenkou hoken) and insurance provided by your workplace (shokuba kenkou hoken), which includes social insurance (shakai hoken). Local governments manage the former, while your company arranges the latter. Both require you to pay a 30 percent deductible. The deductible is very reasonable if you are taking care of small concerns such as colds or outpatient treatment, but the costs can add up during an extended hospital stay. The law requires all those residing in Japan for more than one year to enroll in one of these plans.


Bear in mind, though, that neither plan covers preventative care or hospital bed or food costs. Nor are they valid for injuries or emergencies treated overseas. Maternity costs are essentially covered only in the event of a problem; see the Children chapter for more details. To cover these gaps, many Japanese also hold private insurance policies, and you might consider doing the same. Most medical facilities in Japan that accept national and company insurance? whether it is a private university hospital, community hospital, national hospital or clinic? charge about the same fees for services.

National Health Insurance

Anyone not receiving insurance through their job?students and the self-employed, for instance?will need to apply for National Health Insurance (NHI). The premiums vary: they are based on your salary, number of dependents, and annual municipal taxes. That means what you pay will change if you move, get a raise, or gain an addition to the family. The premiums are minimal during your first year in Japan because you have no tax records; as soon as such information becomes available, though, you can expect a rather large jump in price. It is possible to apply for a reduction in your premium payments at your local ward office if you feel they are difficult to manage or do not reflect your actual income, but remember that the entire process will be in Japanese: bring help if you need it.

Registration and Payment

To register for NHI, bring your alien registration card or Certificate on Registered Matters (toroku genpyo kisai jiko shomeisho), your personal seal (or your hand and a pen, since signatures are also acceptable) and your visa. If your visa is valid for less than a year, you?ll have to show documentation that proves you will be in Japan for 12 months, such as university entrance documents or an employment contract. After you fill out all of the appropriate paperwork, you?ll receive a National Health Insurance card, which you should present whenever you visit a medical establishment.

Premiums can be paid either to a designated officer, who will visit you once a month to collect payment, or by automatic transfer from a bank or postal deposit account. If you don?t pay the premiums for an extended period of time and have no valid excuse for the lapse (such as a government-declared state of disaster), you?ll have to turn in your NHI card. Supplemental medical benefits, such as maternity allowances, will then be withheld. In certain cases, legal action might be taken (such as seizing assets in lieu of payment). It is very much in your own interest to pay your premiums by the deadline.

Withdrawal from NHI

Unofficially, it is possible to opt out of the NHI in favor of a private scheme. Foreigners who choose not to register in the first place find that there is little enforcement of the system: as long as they get paid for the treatment they provide, hospitals seldom kick up a fuss. If you want to cancel your NHI membership you should consult your ward office. Be warned, though, that you will basically find yourself at the discretionary mercies of whichever official hears your request. This is somewhat of a grey area: opting out is not officially endorsed because private insurance is not generally legitimized as a primary form of insurance, so your local NHI official may refuse to terminate membership.

If you are unsuccessful on your first attempt, remember that your eligibility changes if you leave Japan, move to another ward, town, city or village, enroll in a plan offered through the workplace or die. The easiest and most practical way to opt out is to move to another ward and simply not reapply.

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