Understanding Health Insurance in Japan
Complete guide to Japanese health insurance for foreigners. Learn about National Health Insurance, employee insurance, costs, coverage, and how to enroll.
Overview
Health insurance is mandatory for all residents of Japan, including foreigners. The Japanese healthcare system provides universal coverage through two main systems: National Health Insurance (NHI) and Employee Health Insurance.
This guide explains both systems, helps you understand which applies to you, and walks through enrollment, costs, and usage. Understanding your insurance options ensures you get quality healthcare while managing costs effectively.
Types of Health Insurance
| Insurance Type | Who It's For | Premium Calculation | Coverage |
|---|---|---|---|
| National Health Insurance (国民健康保険) | Self-employed, students, unemployed | Based on previous year income | 70% |
| Employee Health Insurance (健康保険) | Full-time employees | Split 50/50 with employer | 70-80% |
| Dependents Coverage | Family of employee insurance holders | Free (covered by primary holder) | 70-80% |
Mandatory Enrollment
National Health Insurance (NHI)
Who Needs NHI
Premium Calculation
| Annual Income | Monthly Premium | Annual Total |
|---|---|---|
| ¥0 (Student/No income) | ¥2,000-4,000 | ¥24,000-48,000 |
| ¥2,000,000 | ¥10,000-15,000 | ¥120,000-180,000 |
| ¥3,000,000 | ¥15,000-20,000 | ¥180,000-240,000 |
| ¥5,000,000 | ¥25,000-35,000 | ¥300,000-420,000 |
| ¥8,000,000+ | ¥40,000-60,000 | ¥480,000-720,000 |
Employee Health Insurance (Shakai Hoken)
Employee insurance is provided through your employer and offers better benefits than NHI.
| Monthly Salary | Your Share | Employer Share | Total |
|---|---|---|---|
| ¥200,000 | ¥10,000 | ¥10,000 | ¥20,000 |
| ¥300,000 | ¥15,000 | ¥15,000 | ¥30,000 |
| ¥400,000 | ¥20,000 | ¥20,000 | ¥40,000 |
| ¥500,000 | ¥25,000 | ¥25,000 | ¥50,000 |
How to Enroll
Determine Insurance Type
Check if you qualify for employee insurance through work
Gather Documents
Residence card, passport, My Number, employment proof
Visit Ward Office (NHI) or HR (Employee)
Submit application within 14 days of arrival
Receive Insurance Card
Usually issued same day or within 1 week
Start Premium Payments
Monthly payments begin immediately
What's Covered
Japanese health insurance covers 70% of most medical expenses. You pay 30% at point of service.
High-Cost Medical Expense System
| Service | Coverage | Your Cost | Notes |
|---|---|---|---|
| Doctor visits | ✓ 70% | 30% | All necessary treatment |
| Hospitalization | ✓ 70% | 30% | Includes meals |
| Surgery | ✓ 70% | 30% | Medically necessary only |
| Prescription drugs | ✓ 70% | 30% | Approved medications |
| Dental (basic) | ✓ 70% | 30% | Fillings, extractions |
| Maternity care | ✓ 70% | 30% | Plus childbirth allowance |
| Mental health | ✓ 70% | 30% | Psychiatry covered |
| Preventive care | ✗ | 100% | Health checks not covered |
| Cosmetic procedures | ✗ | 100% | Not covered |
| Alternative medicine | ✗ | 100% | Acupuncture sometimes covered |
Using Your Insurance
Using health insurance in Japan is straightforward once you understand the process.
Special Cases and Exemptions
Private Insurance Options
Private insurance can supplement Japanese health insurance for additional coverage.
| Type | Coverage | Monthly Cost | Best For |
|---|---|---|---|
| Gap Insurance | Covers 30% copay | ¥2,000-5,000 | Reducing out-of-pocket costs |
| Hospital Cash | Daily allowance if hospitalized | ¥1,500-3,000 | Income protection |
| Cancer Insurance | Lump sum for cancer diagnosis | ¥2,000-4,000 | Major illness protection |
| International Plans | Global coverage | ¥10,000-30,000 | Frequent travelers |
Common Mistakes to Avoid
Not Enrolling Immediately
Not Updating Address
Ignoring Premium Bills
Where to Get Help
Each ward in Tokyo manages health insurance independently. Find English support at these locations:
Essential Japanese Insurance Phrases
| English | Japanese | Romaji |
|---|---|---|
| Health insurance | 健康保険 | Kenkou hoken |
| Insurance card | 保険証 | Hokenshou |
| I want to enroll | 加入したいです | Kanyuu shitai desu |
| Premium payment | 保険料 | Hokenryou |
| Coverage certificate | 資格証明書 | Shikaku shoumeisho |
| Dependent | 扶養家族 | Fuyou kazoku |
Frequently Asked Questions
Yes, health insurance is mandatory for all residents staying longer than 3 months. This includes students, workers, and dependents. You cannot opt out even if you have private international insurance.
NHI costs vary by income and municipality, typically ¥2,000-60,000/month. Employee insurance is about 5% of salary (you pay half). First-year residents often pay minimum rates around ¥2,000-4,000/month.
No, you must enroll in Japanese insurance. However, international insurance can supplement Japanese coverage for services like direct billing at international clinics or coverage while traveling.
For employee insurance, dependents with income under ¥1.3 million/year can be added for free. For NHI, each family member needs coverage but household premiums are calculated together.
Not covered: preventive health checks, cosmetic procedures, fertility treatments (mostly), private hospital rooms, experimental treatments, and some mental health therapies. Normal pregnancy/childbirth has separate support systems.
Overview
Health insurance is mandatory for all residents of Japan, including foreigners. The Japanese healthcare system provides universal coverage through two main systems: National Health Insurance (NHI) and Employee Health Insurance.
This guide explains both systems, helps you understand which applies to you, and walks through enrollment, costs, and usage. Understanding your insurance options ensures you get quality healthcare while managing costs effectively.
Types of Health Insurance
| Insurance Type | Who It's For | Premium Calculation | Coverage |
|---|---|---|---|
| National Health Insurance (国民健康保険) | Self-employed, students, unemployed | Based on previous year income | 70% |
| Employee Health Insurance (健康保険) | Full-time employees | Split 50/50 with employer | 70-80% |
| Dependents Coverage | Family of employee insurance holders | Free (covered by primary holder) | 70-80% |
Mandatory Enrollment
National Health Insurance (NHI)
Who Needs NHI
Premium Calculation
| Annual Income | Monthly Premium | Annual Total |
|---|---|---|
| ¥0 (Student/No income) | ¥2,000-4,000 | ¥24,000-48,000 |
| ¥2,000,000 | ¥10,000-15,000 | ¥120,000-180,000 |
| ¥3,000,000 | ¥15,000-20,000 | ¥180,000-240,000 |
| ¥5,000,000 | ¥25,000-35,000 | ¥300,000-420,000 |
| ¥8,000,000+ | ¥40,000-60,000 | ¥480,000-720,000 |
Employee Health Insurance (Shakai Hoken)
Employee insurance is provided through your employer and offers better benefits than NHI.
| Monthly Salary | Your Share | Employer Share | Total |
|---|---|---|---|
| ¥200,000 | ¥10,000 | ¥10,000 | ¥20,000 |
| ¥300,000 | ¥15,000 | ¥15,000 | ¥30,000 |
| ¥400,000 | ¥20,000 | ¥20,000 | ¥40,000 |
| ¥500,000 | ¥25,000 | ¥25,000 | ¥50,000 |
How to Enroll
Determine Insurance Type
Check if you qualify for employee insurance through work
Gather Documents
Residence card, passport, My Number, employment proof
Visit Ward Office (NHI) or HR (Employee)
Submit application within 14 days of arrival
Receive Insurance Card
Usually issued same day or within 1 week
Start Premium Payments
Monthly payments begin immediately
What's Covered
Japanese health insurance covers 70% of most medical expenses. You pay 30% at point of service.
High-Cost Medical Expense System
| Service | Coverage | Your Cost | Notes |
|---|---|---|---|
| Doctor visits | ✓ 70% | 30% | All necessary treatment |
| Hospitalization | ✓ 70% | 30% | Includes meals |
| Surgery | ✓ 70% | 30% | Medically necessary only |
| Prescription drugs | ✓ 70% | 30% | Approved medications |
| Dental (basic) | ✓ 70% | 30% | Fillings, extractions |
| Maternity care | ✓ 70% | 30% | Plus childbirth allowance |
| Mental health | ✓ 70% | 30% | Psychiatry covered |
| Preventive care | ✗ | 100% | Health checks not covered |
| Cosmetic procedures | ✗ | 100% | Not covered |
| Alternative medicine | ✗ | 100% | Acupuncture sometimes covered |
Using Your Insurance
Using health insurance in Japan is straightforward once you understand the process.
Special Cases and Exemptions
Private Insurance Options
Private insurance can supplement Japanese health insurance for additional coverage.
| Type | Coverage | Monthly Cost | Best For |
|---|---|---|---|
| Gap Insurance | Covers 30% copay | ¥2,000-5,000 | Reducing out-of-pocket costs |
| Hospital Cash | Daily allowance if hospitalized | ¥1,500-3,000 | Income protection |
| Cancer Insurance | Lump sum for cancer diagnosis | ¥2,000-4,000 | Major illness protection |
| International Plans | Global coverage | ¥10,000-30,000 | Frequent travelers |
Common Mistakes to Avoid
Not Enrolling Immediately
Not Updating Address
Ignoring Premium Bills
Where to Get Help
Each ward in Tokyo manages health insurance independently. Find English support at these locations:
Essential Japanese Insurance Phrases
| English | Japanese | Romaji |
|---|---|---|
| Health insurance | 健康保険 | Kenkou hoken |
| Insurance card | 保険証 | Hokenshou |
| I want to enroll | 加入したいです | Kanyuu shitai desu |
| Premium payment | 保険料 | Hokenryou |
| Coverage certificate | 資格証明書 | Shikaku shoumeisho |
| Dependent | 扶養家族 | Fuyou kazoku |
FAQs
Yes, health insurance is mandatory for all residents staying longer than 3 months. This includes students, workers, and dependents. You cannot opt out even if you have private international insurance.
NHI costs vary by income and municipality, typically ¥2,000-60,000/month. Employee insurance is about 5% of salary (you pay half). First-year residents often pay minimum rates around ¥2,000-4,000/month.
No, you must enroll in Japanese insurance. However, international insurance can supplement Japanese coverage for services like direct billing at international clinics or coverage while traveling.
For employee insurance, dependents with income under ¥1.3 million/year can be added for free. For NHI, each family member needs coverage but household premiums are calculated together.
Not covered: preventive health checks, cosmetic procedures, fertility treatments (mostly), private hospital rooms, experimental treatments, and some mental health therapies. Normal pregnancy/childbirth has separate support systems.