An easy-to-follow guide for anyone who is confused by Japan's national health insurance plan.
By Alfie Blincowe Oct 22, 2018 8 min read
Health insurance is an annoying little fact of life in Japan. Whether you love the system or hate it there is no escaping it. Everyone in Japan and over the age of 20 has to have health insurance.
This is mandatory and not to enroll in the national health plan is illegal. If you want to visit a doctor or a hospital during your time here and you don’t have your health insurance card you will be turned away or charged full price for the services and medication received at the time of your visit.
The system can be confusing, especially for those who have just arrived in the country and have full-time employment. In that regard, health insurance is wrapped up with pensions and employment insurance as part of shakai hoken (社会保険), or social insurance benefits, and they are all paid together. To comprehend the system as a whole, one big component you will need to grasp is the pension plan. Luckily, GaijinPot has a three-part guide to understanding the Japanese pension system.
In my home country of the U.K., hospitals work differently, so it took me a while to figure out exactly what I was supposed to pay (and how to do that) and what benefits I was entitled to receive or access once I joined the system. The result is what you’re reading — and hopefully bookmarking and sharing with others who may have similar questions — now.
In this two-part guide to understanding the Japanese health insurance system, we’ll try to answer any questions Japanese residents — new or old — might have about Japanese national health care.
First of all, you need to figure out what type of health insurance you are — or should be — enrolled in. Legally, everybody must sign up, but often Japanese employers will sort this out for people — in which case, it shouldn’t be too stressful. It’s always good to double-check you’re on the right plan, however, as there are minor differences between them.
This is the most basic type of health insurance that everybody who resides in Japan for more than 90 days must sign up for unless you have sorted out another option.
This is for unemployed people, students and those who work less than 30 hours per week. On this insurance plan, you can see the doctor about any medical problem you have and they will treat you in the most efficient way possible. It covers 70 percent of your medical bill and you pay the other 30 percent.
Those who work a full-time contract (30 hours a week or more) are entitled to this category of health insurance plan.
… it took me a while to figure out exactly what I was supposed to pay (and how to do that) and what benefits I was entitled to…
This will be deducted from your paycheck each month and your employer will be responsible for submitting the paperwork through its human resources department (or admin person, as the case may be). It covers all of the same things as the National Health Insurance plan but you get a little bit more choice over what kind of treatment you would like to receive. This also covers 70 percent of your medical cost.
You qualify for this insurance after you are 75 years old (or 65 if you have a recognized disability). It is basically the same as the National Health Insurance but it can cover up to 90 percent of your medical charges.
This type of insurance plan is usually only used by those who do not have a visa to stay in Japan. Only certain doctors will accept it but when they do it often covers 100 percent of the medical costs. Unfortunately, if you go to a regular doctor who does not accept this type of insurance you will have to pay 100 percent of the cost yourself — upfront.
Private insurance is not very popular in Japan as most people work full-time and are enrolled in kenko hoken, Japanese Health Insurance, that they find to be adequate.
The only type of private insurance that is popular is coverage for long-term illnesses. Many of these insurance plans will provide a lump-sum payment to help organize your life in the event you are diagnosed with cancer or similarly serious ailments. These are often categorized as life insurance packages and only offer payments for very specific medical problems.
When you first arrive in Japan (or when you move house), you’ll need to inform your local government. You can do this by visiting to the town or city office and talking to the staff there. Often, there isn’t any English speaking staff so it is wise to take a friend or colleague with you.
Once you’ve registered your address, you can sign yourself up for kokumin kenko hoken, the national health insurance. You only need to do this if you are new to Japan and not working over 30 hours each week.
To sign yourself up, you’ll need to go to the National Health Insurance department and fill in a form to tell them your name, address and monthly income. You will need to bring and show your passport, residence card and MyNumber card (if not, you will need to have one issued to you). Your monthly health insurance premiums are based on your previous year’s income. Once they know how much you’re earning, they will know how much to charge you. Students, unemployed and disabled people all pay less depending on their circumstances.
After providing the local government with your address, they will send you a health insurance card in the post. This card is very important and you’ll need to bring it with you whenever you visit a doctor, clinic or prescription pharmacy (basically: keep it on your person). It’s valid for one year and you will be sent a new card every year until you leave Japan.
It’s important to note that if you don’t sign up for health insurance straight away, you will still be charged for the months that you lived in Japan but did not pay, even if you did not go to the doctors in that time.
For those on those who work full time and are on kenko hoken, don’t worry, your employer will take care of enrolling you in this plan. If you are not sure whether you’ve been enrolled in the employee’s health insurance plan — please ask about this at your place of work.
The way you pay for your premiums will depend on what type of health insurance you have. Your payments will either be deducted directly from your salary (if you are on kenko hoken, the employee-type insurance plan) or you will be responsible for paying them yourself (on kokumin kenko hoken, the basic national insurance plan).
People with the basic health insurance type will receive a collection of bills every June after the start of the new tax year. It will cost around ¥16,340, but this charge also covers your pension. You can pay these bills at any convenience store.
You can ask for the price to be lowered if you are disabled, a student or unemployed.
Those working a full-time contract (30 hours a week and over) get their health insurance deducted from their wage slips. It will be combined with your pension payment and come to a total of 9.15 percent of your salary.
For example, a person earning ¥300,000 a month will have ¥27,450 deducted.
This total charge is called shakai hoken (社会保険) or social insurance, that will help with coverage in three areas of your life should things go awry.
For those between 40 and 64 years old, your health insurance will also include kaigo hoken, or nursing insurance (介護保険). This adds an extra 1.5 percent to your monthly payments.
This system is made as easy as possible for elderly people and is deducted directly from their pension. They no longer have to pay into the pension scheme as they are now taking out of it. The payments vary from city to city but should be about half of what they were when they were working.
You usually have to pay these companies from your home country and they all have different rates depending on where you are from.
Your monthly health insurance premiums are based on your previous year’s income.
To get Japanese private insurance you need to apply directly to those companies and they will assess you based on your medical history and background before quoting you a monthly premium amount.
I don’t recommend signing up for private medical insurance as it is usually more expensive and gives you a lot less options in terms of where to get medical assistance.
The best of the selection is the insurance that comes with being a salaried, full-time worker — the kenko hoken. This entitles you to full medical coverage, is automatically taken from your wages and if you check out our guide to pensions it also provides you with a better monthly payout allowance once you retire. Japan really wants you to work full-time.
Hopefully, this has answered any questions you had about enrolling and gaining access to the healthcare system in Japan. It’s obviously a very important part of life here and everyone should know the basics.
In second and last part of “Understanding the Japanese National Health Insurance System,” we’ll discuss how to use your insurance card at a clinic, hospital or doctor’s office as well as exactly what kind of treatments it covers.
If you still have questions about health insurance in Japan, let us know in the comments.
Jeff W. Richards contributed to this article.
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