Medical Care and Health Insurance
Date 2007/4/9 13:55:53 | Topic: Living in Japan
| 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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Insurance through the Workplace
By law, you are eligible for company-provided insurance if you are a full- or part-time worker (a minimum of three-quarters of the time per week of a full-time worker) at a company that is a member of the Health Insurance Society. Companies with more than twelve full-time employees are legally obligated to be members of the Society, but economic conditions have led some small firms to quietly opt out. The coverage is the same as for National Health Insurance (see above). When you join, the application procedure will most likely be taken care of by the relevant personnel in your company. Premiums are based on salary (including bonuses) and are deducted from your monthly paycheck. The costs are shared roughly equally between employees and company, with approximately 15 percent of an employee`s paycheck deducted each month for social insurance charges, which includes health insurance as well as unemployment, pension, and nursing insurance. Unlike NHI, your premiums won`t change if you add another member to your family or change residence.
Japanese Private Health Insurance
It has been the goal of Japan`s Health, Labor and Welfare Ministry to offer equal access to medical treatments to all people residing in Japan regardless of their economic situation. However, aging demographics and a slack economy are increasingly forcing the government to ration care. This is especially true for expensive high-tech medications and treatments, giving rise to an increase in people buying supplemental health coverage. Some treatment methods may not be available in Japan, so the insurance can be used to seek care in other countries. This point remains a highly contentious one for socially minded politicians and bureaucrats, but this trend is expected to continue.
A number of companies offer private health insurance policies that supplement the national or company plans. Coverage for cancer treatment, high-tech or advanced procedures, home-nursing and death expenses is layered on top of the public health insurance, and covers costs ordinarily borne by the patient. It is usually offered as an option with life insurance. However, some of these companies do not accept foreigners, while others may attach conditions related to length of stay in Japan or visa status. See the Resources section for a list of private insurance providers.
Foreign-Based Private Insurance and Travel Insurance
As already mentioned, Japanese public health plans do not cover medical treatments in other countries, so it`s best to take out a separate travel insurance plan before you jet off to exotic locales. Most travel agencies offer travel insurance and the international airports have counters where this can be purchased.
Foreign-based private health insurance can provide coverage overseas and options beyond those offered by the national insurance system: specialist treatment may be included, along with the 30 percent deductible that you would otherwise pay. Do your homework. Check in your home country for insurance plans offered, or try some of the companies listed in the Resources section. When using private insurance, you will be expected to pay the cash upfront and then be reimbursed later; however, some Japanese facilities will not accept anything other than the national or company insurance.
International insurers can also provide a global healthcare package that would cover you for all procedures in and out of Japan. In cases where a particular treatment was not available in Japan (or whatever country you may be in), the insurer will make arrangements to evacuate you to a country where appropriate care is available. Of course these types of policies can be very expensive.
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