Guide to Health Insurance in Japan
By Chu Thi Anh | Created March 26, 2020
When moving to Japan, you might be extremely excited about countless only-in-Japan experiences. However, before immersing yourself in the perfect mixture between this beautiful country's quirky chaos and tranquil bliss, it is crucial to settle down your own life.
In the first 14 days of staying in Japan, all foreigners are required to register for residency at the city hall where they reside. It is crucial, or you might be seen as an illegal resident. Suppose you have not found an apartment to move into and stabilize your life yet. In that case, you might find some helpful information from our Guide to find a furnished apartment in Tokyo.
In Japan, it is normal to receive several announcements and bills by mail. So, don't forget to check your house’s mailbox frequently. In your first month after arrival, you should receive a bill called Health Insurance 「保険料」(hoken ryou) and also a Health Insurance card 「保険証」(hokenshou) with your name on it. It might surprise you as you probably don’t know why you received it and is it necessary to pay by the due date. Indeed, when you register your residency for the first time, you are automatically enrolled in Japan National Health Insurance system.
Undoubtedly, only good health can help you make the most of your time experiencing life in Japan. The Healthcare System and Health Insurance system varies from country to country, and each has its uniqueness. Therefore, it is essential to educate yourself with the latest information. In this article, we are going to provide all-you-need-to-know about Japan Health Insurance System. Especially, if you are a student or worker who will be staying and working for more than 3 months in Japan, you have come to the right place. We hope that after thoroughly reading, you can come to a good decision for your healthcare when studying and working in this country.
Let us help you improve your Japanese language by visiting our BFF Learn Japanese.
What is health insurance and is it mandatory in Japan?
Health Insurance, at its core, is insurance that provides coverage of the whole or a part of required payments when visiting clinics. It reduces the financial burden whenever one meets health problems or sudden accidents. Participating in the health insurance system is also a right-thinking way to develop a routine finance structure to save money for unpredictable medical emergencies. Especially when studying or working in a foreign country, it is crucial to have a back-up financial plan to protect and secure your health because healthcare services in many countries, particularly developed countries, are usually costly.
In Japan, health insurance can be an annoying task in life, even for Japanese people. The system might be confusing, especially for those who have just arrived in the country and work full-time employment because it directly affects their income. For students who have a part-time job, the amount of health insurance payments might also vary depending on how much they have earned each month since the previous year.
Is it compulsory to enroll in Japan Health Insurance?
Although private health insurance is also available, you are required to join in the public health insurance. Enrollment in national health insurance is compulsory for all foreigners who have resided in Japan with a visa lasting 3 months or longer. The enrollment process might be conducted automatically when you first arrive and register your residency at the municipal office where you live. Paying for public health insurance is the same as paying tax. As a result, it is illegal not to join the system or elude the bills. So, don’t let the lack of knowledge put you into trouble with the law because it might affect your future work and reputation.
For working holiday people, if you have a regular work visa that allows you to have a Certificate of Alien Registration, you will qualify to subscribe to the National Japan Health Insurance. Otherwise, you only can buy private insurance or Travel Health Insurance. Nevertheless, the public national health system is managed by local municipal governments with probably different conditions. Therefore, when registering your address and residency at the municipal office, we recommend asking for further details.
Comparison between Japan’s public health insurance system and private health insurance
How much does Japan Healthcare cost on average?
As you may already know, Japan has the longest life expectancy of any country in the world, with an excellent system of hospitals and clinics that offer cutting-edge technologies. The standard of medical treatment in Japan is also exceptional, and it is reasonable to be high-cost.
The fees charged by clinics and hospitals vary depending on several factors such as the length of appointments, medical tests needed, prescriptions, and so on. Usually, the first consultation will be more expensive than the follow-up. The Japan Health Info recommends that if you have Japanese Health Insurance, you should have 5000 to 10,000 yen in your pocket when you come to a clinic for the first time and 10,000 to 15,000 yen for your first appointment at a Japanese hospital. On the other hand, without the Japanese Health Insurance, you should bring 20,000 yen for your first time at a clinic and 20,000 to 50,000 yen at a hospital.
The Japanese healthcare system provides several services, including screening examinations, prenatal care and infectious disease control. In general, healthcare in Japan is relatively inexpensive because the government supports it with a coverage of up to 70% offered to all Japanese citizens and foreigners as long as they are involved in the National Health Insurance System and fully pay their Health Insurance bills. Although the payments are unpredictable and depend on the level of treatment you need, being responsible for only 30% of the charges is still a significant deal for your health and financial status.
Japan Health Insurance contains both public system and private system
Despite the mandatory coverage of public health insurance, private health insurance can still establish its position as a growing segment of the private insurance industry. Typically, private health insurance is promoted and offered together with life insurance.
The following table will give you some essential information about these two main types of Japan Health Insurance.
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Public Japan Health Insurance (Mandatory) |
Private Health Insurance (Optional) |
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Social Insurance (Shakai Hoken) |
National Health Insurance (NHI) |
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Eligibility |
Full-time employees |
Unemployed people, students, part-time workers, workers who are not eligible for any employment-based health insurance program. |
Open to all foreigners regardless of their visa status and employment contract. |
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Coverage |
You can see more details from page 9 of this Guide to Japan’s NHI system. |
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Exceptions |
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Depends on provided companies |
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How much does it cost? |
The calculation is different from ward to ward even in the same city (Tokyo, for instance):
You can go to this Keisanki, choose the ward you are residing in, type in your income, and it will help you calculate your insurance cost. |
Depends on plans of provided companies (usually high) |
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Pros |
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Cons |
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What is the most wallet-friendly choice for your needs?
Based on the table provided above, we firmly believe that you have gained a broad view of Japan's public and private health insurance system. From now, we will recommend what we think might be the most beneficial Health Insurance for you.
For Students
As a university student, we believe that the National Health Insurance (NHI) is the best deal for you. If you do not have a part-time job or side income, your Japan health Insurance only costs about 1500 yen per month. Scholarships are not counted as income, no matter how big they are. It is encouraging to concentrate on your study and earn extra money to support your life by high academic results. Nevertheless, you can always find a part-time job to blend in with the Japanese working culture and gain more experience for yourself. If so, your Japan Health Insurance bills next year may get higher because it is calculated based on how much you have earned this year.
For any students looking for work right now, we recommend taking a look through our 25 part-time jobs in Tokyo to support your part-time job search.
Japanese language students also have to be enrolled in NHI. Their study period lasts typically two years, meaning they are eligible to NHI, and the enrollment is mandatory. If they have a scholarship, in some cases, it might cover the japan health insurance as well. Otherwise, they have to pay for it on their own.
For Workers
If you are full-time employees, you will be automatically enrolled in the company health insurance system as a part of Social Insurance (Shakai hoken). To be more detailed, employer-based Japan health insurance is divided into three groups. The first group contains employees of big companies with over 1400 plans. If they meet financial problems, they are eligible for a subsidy from the government. The second one covers public sector employees and is not eligible for any government subsidy. The third group covers small to medium-sized companies and contains only the National Health Insurance Association. Basically, based on the company you are working at, you might have to pay a different amount of Japan Health Insurance fee.
Part-timers or temporary workers who work for more than 28 hours per week may be considered to join the Japanese social insurance as well. However, you have to check your eligibility with your company. Otherwise, you can register for NHI by yourself.
90% of hospitals and clinics in Japan accept NHI
Clinics and hospitals in Japan are strictly required by law to run as non-profits and be managed by physicians, even for private facilities. As there are no restrictions on access, you can receive care from anywhere you like, anywhere near your house or your company. Therefore, we believe that enrolling in NHI and having an insurance card is beneficial for your health.
Who might need private insurance?
Public health insurance is an obligatory and somehow complicated task but generously beneficial if you stay and live in Japan for a long time. However, as we stated above, it does not cover everything. Not to mention, if you frequently need medical treatments or suffer from serious diseases (for example, cancer treatments), 30% of the bills might also cost you a fortune. In this case, we recommend you consider buying private health insurance and use it as a means to supplement what is not covered in the public health insurance plan.
Nevertheless, private health insurance is always much more expensive than public health insurance. You should consider your health status and your wallet carefully before making any decisions. It is wasteful to buy costly health insurance, which is optional, and you might hardly need it.
Some private insurance companies for your consideration
When going to a hospital in Japan, you might feel worried about communicating with Japanese doctors because not many doctors can speak English well. With private health insurance, some insurers also provide you with instructions to find English speaking medical clinics while offering services in several foreign languages. For example, we recommend that you take a look at the Viva Vida Insurance company. This company provides different insurance plans for foreigners with reasonable costs and has support services in many languages such as English, Vietnamese, Thai, French, and so on.
Another choice for you is the Kokumin Kyosai. It is a cooperative with a mutual aid system and runs as a non-profit organization that provides both life and non-life insurance for your security in life. One of its groups, Zenrosai Kyokai or the National Association for Workers, offers a lot of guidance, coordination, liaison work for workers’ welfare in addition to cooperative insurance, which is worth paying attention to if you are a full-time worker. They provide services mainly in Japanese and English.
Or, if you still find it difficult to choose a suitable private insurance provider for your needs, we can also recommend Pacific Prime for some very helpful advice. Pacific Prime offers free quotations, unbiased and helpful advice via phone and on the Internet that can help you figure out what insurance solutions are the best fit for your situation. They provide services in several foreign languages other than English, so it may be possible for you to communicate in your native language.
In addition, you can also go to these two platforms: Kakaku and Hokende to see comparisons of several private insurance options. In general, they both provide helpful comparisons in terms of ranking and prices. You can choose two or three of the provided lists to see more details. However, you will be required to register your personal information. Therefore, if it is not absolutely necessary, we recommend using it as a point of reference in your research of insurance companies in Japan. Another thing to note is that these two platforms are both Japanese-based, so you might struggle if your Japanese is still in its early stages (but there’s always Google Translate!).
If you need help to leverage your Japanese, check our BFF Tokyo’s thorough guide to advanced Japanese.
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Application and Usage of Japan Health Insurance
How to apply for public health insurance?
Enrolling in Japan Health Insurance is compulsory and the procedures must be processed within 14 days from:
- The date you landed into Japan
- The date you move to another city or prefecture
- The date you leave a company
As a student
Students have to do it themselves. If your school supports you in this part, it is great because everything is new to you and all those documents will not bother you much. However, it is still necessary to understand all the steps so that you will be able to do it yourself next time. All you need to do is go to the municipality where you live with your Passport, Resident card & Student ID card (may be required for student discounts).
As a worker
Typically, if you are a full-time worker, your company will be in charge of it for you. You only need to follow the company’s requirements. Suppose you are not considered eligible for shakai hoken due to your working hours per week or other situations. In that case, you have to do it yourself. It is also the case for freelancers. If you do it by yourself, the bottom line is to remember to sign-up for your pension separately. This part is combined with shakai hoken through the company. The procedures for japan health insurance also need your passport and resident card.
When you leave your company, you also need to re-enroll into NHI yourself unless you switch to a new company. You need to bring your resident card, passport, and document that can prove your loss of eligibility for social insurance, such as a certificate of disqualification and release form.
Some Japanese phrases when applying for Japan Health Insurance at the ward office
すみません、国民健康保険に加入したいんですが、どうすればいいですか。
(Sumimasen, kokumin kenkōhoken ni kanyū shitaindesuga, dōsureba īdesu ka.)
(Excuse me, I want to apply for National health insurance, what should I do?)
すみません、会社を辞めたので、国民健康保険の加入手続きをしたいのですが、どうしたらいいでしょうか。
(Sumimasen, kaisha o yametanode, kokumin kenkōhoken no kanyū tetsudzuki o shitai nodesuga, dōshitara īdeshou ka.)
(Excuse me, I quitted my job, I would like to re-apply for National health insurance, what do I need to do?)
How to receive a Japan Health Insurance certificate?
For workers, it might take a few days after you officially enter a company because it is combined in shakai hoken, which includes not only your health insurance but unemployment insurance, labour insurance, and national retirement plan.
For students and workers who do it themselves at the ward office for the first time, Japan Health Insurance certificates or NHI certificates are delivered to your house. The delivery cannot be completed due to an incorrect or unclear address. If so, you need to apply for redelivery at the NHI section or Residents Office. Hence, be careful when filling out your address. If you need your NHI certificate immediately, bring one of those ID documents listed below when applying for membership or reissue:
- Passport
- Residence card (or My number card)
However, if the service counter is bustling, it may be hard for you to obtain your NHI certificate on the same day. It will be delivered by mail to your house later.
How to use your Japan Health Insurance
Your NHI certificate is documental proof that you are a member of NHI and can fully receive all NHI's benefits. It is required whenever you receive medical treatments that are insurance-covered. It is an individual card so remember to keep it safe.
Present your NHI certificate at the reception desk when you visit a medical institution that accepts NHI. About 90% of hospitals and clinics do accept NHI, so it is easy to use the benefits. If the medical institution you visit does not accept NHI, you will have to pay the total cost. Therefore, look it up carefully before visiting or ask at the clinic’s reception before making an appointment. In addition, you should remember that NHI can not be used for injuries caused by intentional actions such as when you get drunk and get hurt. You can see more for what is not covered by NHI from the table above.
Please remember that NHI expires. Its expiration date is determined based on your visa. Once your NHI certificate expires, you can not use it anymore unless you got your visa extended and completed essential renewal procedures at the ward office. See how to extend your NHI certificate.
When you move to a new place, your NHI certificate also needs to be changed. Each municipality has its own system to operate and administer NHI, so it is mandatory to have your new NHI certificate according to where you move to.
Bills and Payment for Japan Health Insurance
When will you receive your Japan Health Insurance bills?
If you are a newcomer to Japan, you might receive the Japan Health Insurance bill one month after the application procedures. Normally, the bills are sent to your house’s mailbox once per year, in April or May. There will be 9 numbered bills in the envelope you received, according to each month from July to March (the following year). There are no bills from April to June because taxes are being calculated during that period. The amount of the bills you received will depend on your income last year. For more details of how they calculate your bill, you can refer to page 8 of this guide.
How to pay for Japan Health Insurance
Depending on the bills you received, you can choose to pay a lump sum of the entire amount or pay each of them monthly. In order not to be late for the due date and if it is affordable, we recommend you choose to pay a lump sum. You can pay at any convenient stores or register at the NHI Section or Residents Office for automatic Bank Transfer.
For workers, the payment for their Japan Health Insurance will be deducted automatically by your company from your monthly salary together with pension. And, for private insurance, it depends on your contracted company.
What if you don’t pay for the Japan Health Insurance?
If your Japan Health Insurance bills are not paid by the due date, you will receive a reminder notice from the ward. Moreover, you might be reminded by phone, or they will visit your residence to remind you.
After receiving many reminders and you still do not pay the bills, according to law, your assets will be checked, and administrative measures (seizing your assets, for instance) will be carried out.
If your payments will be late or if you are currently unable to afford them, you can ask for help at your ward office, and they might allow you to set the payments later, though you are still required to pay for it by next fiscal year. During the consultation sessions, they will confirm your financial situation, and you have to comply with their inquiries to avoid being punished by law.
If you need help to find a job to support your life in Japan, you can visit more articles from our BFF Jobs.
Our advice for you is not to ignore the bills. It is better to pay late than not pay at all. Joining public health insurance in Japan is required by law, and insurance payments are an obligation. If you never sign up to join the system, probably you can get away from it. However, it is somehow impossible because once you register your residency at the municipality, the procedures for joining National Health Insurance will be carried out automatically if you hold an eligible visa.
Additionally, there is a nifty formula on the back of the insurance bill, which shows how it’s calculated from your taxable income. You can use it to estimate how much you need to pay next time and save your money in advance. Or, you can refer to the part How much does it cost we provided before in this part's table.
How to withdraw from Japan Health Insurance?
When do you need to withdraw from Japan Health Insurance?
You can only withdraw from the Japan Health Insurance system if you:
- Enrol in the employer's health insurance. Because it will not be automatically switched over, you have to complete the procedures for withdrawal from the NHI system by yourself at the service counter of your ward.
- Return to your home country.
- Move to a different municipality. You need to return your NHI card and make a new one at your new city office.
Within 14 days, remember to bring with you the following documents to return your insurance card at the municipal office where your application was processed:
- Residence card/My Number Card
- Passport
- Japan Health Insurance Card
Some useful Japanese sentences for you
すみません、今社会保険に加入中ですが、国民健康保険の脱退手続きを教えていただけますでしょうか？
(Sumimasen, ima shakai hoken ni kanyū-chūdesuga, kokumin kenkōhoken no dattai tetsudzuki o oshiete itadakemasudeshou ka?）
(Excuse me, I have enrolled in my company insurance, what should I do to withdraw from the National Health Insurance?)
すみません、これから帰国しますので、国民健康保険の脱退手続きを教えていただけますでしょうか？
(Sumimasen, korekara kikoku shimasunode, kokumin kenkōhoken no dattai tetsudzuki o oshiete itadakemasudeshou ka?)
(Excuse me, I'm going back to my country, could you tell me how to withdraw from the National Health Insurance?)
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Annual Resident Tax Report - For your benefit
As we mentioned above, your Japan Health Insurance bills for this year are calculated based on your previous year’s income. As a rule, every resident has to file a Resident’s Tax Report 「特別区民税・都民税」(Tokubetsu kuminzei/ Tominzei) or 「市民税・県民税」(Shiminzei/Kenminzei) to the City Office Tax Division by March 15th every year on how much you earned during the previous year. Be careful not to miss the deadline to avoid suffering disadvantages.
For students, it is necessary to help maintain the low rates of your Japan Health Insurance you have been paying. Scholarships are not regarded as income. If you have a part-time job, normally, your company will do it for you. However, it’s better to confirm it with your boss or at the city hall. If you earned more than 1,000,000 yen, you would need to consult with the officers at the city office to complete the income tax report 「確定申告」 (Kakuteishinkō) according to their instructions. Even if you don’t have any income, you should never ignore this task.
For workers, if you have filled the income tax report 「確定申告」or you are salaried employees that have a company to submit the salary payment report to the City Office for you, you will not need to file the Resident’s tax report.
Japan Health Insurance - How to renew
When you move to a new place
Within 14 days after moving to a new ward, you have to go to the city office and process your Procedures for moving-in to a new place「転入届の手続き」(Ten'nyūtodo no tetsudzuki). Usually, it will automatically involve making a new Japan Health Insurance card for you. If not, you can ask the officers to help you process it on the same day.
After renewing your visa
After you have your visa extended and your residence card renewed, you will also have to renew your health insurance card by bringing your passport, residence card, and expired health insurance certificate to the NHI service counter and exchange for a new one.
If your Japan Health Insurance card expires before you receive a new residence card, your card can still be extended for two more months as long as you bring a document that can prove that you are waiting for the renewal of your visa to the NHI section at the office hall where you live.
In addition, if you have a ‘designated activities’ visa status, you might be required to provide other relevant documents in order to confirm that your period of stay has been extended and you are eligible for NHI.
We highly recommend reading BFF Tokyo’s Ultimate Guide to visa for a thorough understanding of the many kinds of visas in Japan.
Some Japanese sentences you can use to ask for your NHI renewal
すみません、最近～区に移り住んでるんですけど、健康保険証の更新が必要だとのことで、手伝ってもらっていいですか。
(Sumimasen, saikin ~-ku ni utsurisun deru ndesukedo, kenkōhoken-shō no kōshin ga hitsuyōda to no koto de, tetsudatte moratte īdesu ka.)
(I have moved into this ward recently and I heard that it is essential to renew my Health Insurance, could you please help me?)
すみません、ビザ更新が済みましたので、健康保険証はこれからどうしたらいいでしょうか。
(Sumimasen, biza kōshin ga sumimashitanode, kenkōhoken-shō wa korekara dōshitara īdeshou ka)
(I have just had my visa renewed, what do I need to do with my Health Insurance now?)
Prepare yourself before visiting a clinic
Before visiting a Japanese clinic, besides preparing your money and other essential documents (be careful to take your insurance card with you), it is important to look up in advance how to describe your health conditions to the doctors using several Japanese phrases.
At first, the doctors might ask you:
どうなさったんですか。/ どうなされましたか。
(Dou nasattan desu ka/ Dou nasa mashitaka) (What happened to you?)
With this basic question, you should try to precisely describe how you are feeling and where you are in pain. You can answer in this basic way:
目/頭/足/手/お腹...が痛い/痒い....です。(me/ atama/ ashi/ te/ onaka… ga itai desu.)
(My eyes/ head/ leg/ hand/ stomach… hurt)
目/頭/足/手/お腹...が痛い/痒い....です。(me/ atama/ ashi/ te/ onaka… ga kayui desu.)
(My eyes/ head/ leg/ hand/ stomach… hurt/ are itchy)
If you are looking for a comprehensive list of health-related Japanese vocabulary, you can refer to these Face and Body parts and Common Symptoms for more Japanese words and phrases to describe your conditions.
Another important question that doctors might ask you:
いつからですか.
(Itsu kara desu ka.) (Since when)
Then you should give an exact period of time by using Japanese Numbers. For instance:
昨日/先週/二日間...前からです。
(Kino/ senshuu/ futsukakan...mae kara desu.) (Yesterday/ last week/ two days ago)
After visiting a doctor and receiving your prescription (処方せん shohousen), you can go to the prescription section of your pharmacy (調剤薬局 chouzaiyakkyoku) to buy your medication. Do not forget that your Japanese Health Insurance does cover prescription medicines, so you will only need to pay 30% of the total fees. That’s a pretty good deal, right?
However, be careful in that prescriptions typically expire after 4 days. If it expires, you can not buy your medicine unless you have it reissued again by a doctor. In contrast with pharmacies, if you purchase medications at drugstores without the need of prescription from doctors, you will have to pay the total cost.
When heading to the pharmacy, you can use the following Japanese sentences to ask for their help:
処方箋に書いた薬を買いたいです. (Shohousen ni kaita kusuri o kaitaidesu.)
(I want to buy the medicine written on this prescription)
If you buy medicine at the pharmacy for the first time, they might ask for your (薬手帳 kusuritechou):
Q: 薬手帳ありますか。(Kusuri techou arimasu ka.)
(Do you have a medicine notebook?)
A: いいえ、持っていません。（Iie, motte imasen.)
(No, I don’t.)
Then they will give you one to help record your prescriptions and medications. It is useful for your next time visiting a clinic or buying medicine, so remember to take it with you.
Moreover, we recommend you to take note of these Emergency contacts in case you are in an emergency and need to call the ambulance or call the police for help.
If you are not confident with your Japanese yet, you can also find English speaking clinics and hospitals.
Conclusion
By thoroughly reading this article, we hope that you have obtained a broad view on the Japan Health Insurance system and taken our advice to helpfully secure your life in Japan. Once again, we know that the compulsory public health insurance can be quite complicated, but it is extremely beneficial for both your health and your pocket.
Although English is becoming more and more common, it is still difficult to live in this country without a good command of Japanese. Especially in emergency situations, you might find it challenging and, at times, frustrating. Don’t let it stop you from fully experiencing life and work in Japan. We hope we’ve shed some light on the process and your options in Japan!
If you need help with your Japanese, be sure to check our BFF Tokyo’s thorough guide on learning Japanese
