How Health Insurance Works in Japan

Everyone living in Japan is required to have health insurance. This is not optional, and there is no opt-out. Japan has two main systems, and which one covers you depends on your employment situation. If you are employed full time by a Japanese company, your employer enrolls you. If you are self-employed, freelancing, studying, or between jobs, you enroll yourself at the ward office. Japanese terms used throughout this guide are listed in the keyword guide at the bottom.

Which insurance system covers you

Japan has two main health insurance systems. National Health Insurance (国民健康保険こくみんけんこうほけん, kokumin kenkou hoken) is for people who are self-employed, freelancing, studying, or not covered by an employer. Employer health insurance (健康保険けんこうほけん, kenkou hoken) is for employees whose company provides coverage as part of the wider social insurance package (社会保険しゃかいほけん, shakai hoken).

Both systems cover 70% of approved medical costs. You pay the remaining 30% at the counter. The main differences are cost, who manages enrollment, and the additional benefits available under employer coverage.

Enrolling in National Health Insurance

Go to your ward office (区役所くやくしょ, ku-yakusho) and tell the clerk you want to enroll in National Health Insurance. The form is in Japanese, but the clerk will guide you through it. The process takes about 15 to 20 minutes. You receive your insurance card (保険証ほけんしょう, hokensho) on the same day.

How employer health insurance works

If you work full time for a Japanese company, your employer is required to enroll you in social insurance. You do not visit the ward office for this. Your employer submits the paperwork, and your insurance card arrives by mail within a few weeks of your start date.

Your premium is approximately 10% of your standard monthly salary, split evenly between you and your employer. The exact rate varies slightly by prefecture. Your share is deducted from your paycheck each month.

Adding dependents

Qualifying family members can be added to your employer health insurance as dependents (被扶養者ひふようしゃ, hi-fuyosha). Eligible dependents include your spouse and children whose annual income is below ¥1,300,000. Dependents pay no additional premium and receive the same coverage as the primary insured. Contact your employer’s HR department to add a dependent.

If your employer has not enrolled you

If you have been working full time for more than a few weeks and have not received an insurance card, ask your HR department directly. Employers are required by law to provide social insurance coverage. If you believe your employer is not providing legally required coverage, contact the Japan Pension Service (日本年金機構) or your local Labor Standards Inspection Office (労働基準監督署ろうどうきじゅんかんとくしょ, rodo kijun kantoku-sho).

Switching between the two systems

When you start a job

When you start working for an employer who provides social insurance, your employer enrolls you in employer health insurance. At that point, you must withdraw from National Health Insurance. Go to your ward office with your National Health Insurance card and a copy of your new employer insurance certificate. The withdrawal takes about ten minutes. Do this within 14 days of your start date.

When you leave a job

Your employer health insurance ends on your last day of employment. You have two options.

Option 1: Enroll in National Health Insurance. Go to your ward office within 14 days of leaving your job. Bring your residence card, your former employer’s certificate of loss of eligibility, and your My Number card or notification letter. Your coverage starts from the day your employer insurance ended.

Option 2: Voluntary continuation (任意継続にんいけいぞく, nin’i keizoku). You can extend your former employer’s insurance for up to two years. You pay the full premium yourself (both the employee and employer portions). You must apply within 20 days of leaving your job, directly through the health insurance society your employer used. This option is worth comparing against your expected National Health Insurance premium before deciding.

What your insurance covers

The 30% copay

Both systems cover 70% of approved medical costs. You pay 30% at the counter on the day of your visit. There is no annual deductible and no in-network or out-of-network distinction. You can visit any licensed clinic or hospital in Japan with your card. Children under three pay 20%. Adults 70 to 74 pay 20%. Adults 75 and over transition to a separate late-stage elderly insurance system.

What is covered

Both systems cover: general doctor visits, hospital stays and surgery, lab tests and imaging (X-rays, MRI, ultrasound), approved prescription medications, mental health treatment at licensed clinics, most specialist consultations, and medically necessary dental procedures (fillings, extractions, and root canals).

What is not covered

Neither system covers: cosmetic procedures, dental implants and orthodontics (unless medically necessary), elective procedures with no diagnosis, most fertility treatments, routine vaccinations (flu shots, travel vaccines), or private hospital room upgrades.

High-cost medical expense protection

If your medical costs at a single hospital exceed a monthly threshold, the government reimburses the excess through the high-cost medical expense program (高額療養費こうがくりょうようひ, kougaku ryoyouhi). The threshold depends on your income bracket. For a standard income, it is roughly ¥80,100 plus 1% of costs above ¥267,000 per month. Reimbursement is typically paid a few months after the high-cost month.

If you know you will face high costs before a hospital stay or planned surgery, apply in advance for a limit certification (限度額適用認定証げんどがくてきようにんていしょう, gendogaku tekiyo nintei-sho). Show this card at the hospital and your bill is capped at your income-based threshold from the start. Apply at your ward office (for National Health Insurance) or through your employer’s health insurance society.

Childbirth lump-sum

Both systems pay a lump sum for each birth through the childbirth and childcare lump-sum (出産育児一時金しゅっさんいくじいちじきん, shussan ikuji ichijikin). The current amount is ¥500,000 per birth. Confirm the current figure with your insurer or ward office before your due date. In most cases, the hospital collects the payment directly from your insurer, so you pay only the difference if the birth costs more than the lump-sum amount.

Employer insurance extras

Employer health insurance includes two benefits that National Health Insurance does not provide.

Sick pay (傍病手当金しょうびょうてあてきん, shobyo teate-kin). If illness or injury keeps you from working for four or more consecutive days, sick pay begins on the fourth day. You receive approximately two-thirds of your standard daily salary. You can receive this benefit for up to 18 months per condition.

Maternity leave pay. If you are an employee taking maternity leave, you receive approximately two-thirds of your daily salary for the period you are on leave. This is paid through your health insurance society, not your employer. It is separate from the childbirth lump-sum and from childcare leave allowance, which comes through employment insurance.

How to use your insurance at a clinic

Bring your insurance card or combined card to every medical visit. Hand it to the receptionist when you check in. You pay 30% of the approved cost at the end of your visit. Ask for an itemized receipt if you want a record for tax purposes or to file a reimbursement claim later.

At the pharmacy

When a doctor prescribes medication, you receive a prescription slip (処方箋しょほうせん, shohousen). Take it to any pharmacy. Hand the prescription and your insurance card to the pharmacist at the counter. You pay 30% of the medication cost.

If you do not have your card yet

If you need medical care before your insurance card arrives, pay the full cost upfront and keep your receipts. Once your card arrives, submit a reimbursement claim to your ward office (for National Health Insurance) or your employer’s health insurance society. You will be reimbursed the 70% that insurance would have covered.

How to pay NHI premiums

Your ward office calculates your National Health Insurance premium once a year in June, based on your income from the previous year. The formula includes an income-based amount plus a fixed per-household fee and a per-person fee for each enrolled family member. If you arrived in Japan recently with no Japanese income on record, your first year’s premium will usually be minimal.

Your ward office mails payment slips to your registered address. Pay at any convenience store, post office, bank, or at the ward office counter. To avoid managing individual slips, you can set up automatic bank transfer at your ward office. You need a Japanese bank account for this.

If you miss a payment

A single missed payment typically results in a reminder notice and a small late fee. Extended non-payment can affect your coverage. If you are having difficulty paying, contact your ward office before falling far behind. Many wards have hardship exemption and reduction programs for low-income residents.

Annual card renewal

What to bring for enrolling in NHI

For National Health Insurance enrollment at the ward office:

• Residence card. Your primary ID. Bring the original.
• Passport. Bring it to be safe, even if not always required.
• My Number card or notification letter. Required to link enrollment to your number. If you do not have a My Number yet, the ward office will record a placeholder and update it later.
• Personal seal (印鑑いんかん, inkan). Some wards still ask for this. Bring it if you have one.
• Certificate of loss of eligibility. Required only if switching from employer health insurance. Your former employer will issue this when you leave.

Common questions

Can I use my insurance card at any hospital in Japan?

Yes. Any licensed medical facility in Japan accepts public health insurance. There are no in-network or out-of-network restrictions. If a clinic does not accept insurance, this is posted clearly at the entrance.

Is mental health treatment covered?

Yes. Treatment at a licensed psychiatry or psychosomatic medicine clinic is covered under both systems at the standard 30% copay. Look for clinics listing (精神科せいしんか, seishin-ka) or psychosomatic medicine (心療内科しんりょうないか, shinryou naika) as their department. Talk therapy by unlicensed counselors is not covered.

Is dental treatment covered?

Medically necessary dental treatment is covered: fillings, extractions, root canals, and dentures. Cosmetic dentistry is not: teeth whitening, veneers, and most tooth-colored ceramic restorations are out of pocket. Ask your dentist before any procedure whether it is covered under insurance (hoken tekiyo) or self-pay (jibai).

I work part time. Does my employer have to cover me?

You may be covered. If you work 20 or more hours per week and your employment is expected to last two or more months, your employer is required to enroll you in social insurance. Ask your employer in writing. If they say you are not eligible and you are unsure whether that is correct, contact the Japan Pension Service to verify.

What happens to my health insurance when I renew my visa?

Your health insurance does not expire when you renew your visa. It continues automatically. However, if you use your My Number card as your health insurance card, you may need to update the card’s validity date at the ward office after your visa renewal. Ask the clerk when you go in for your address update.