Health Insurance in Japan

Find out about the National Health Insurance (NHI) scheme in Japan and which medical costs are covered…

There are two broad health insurance schemes in Japan and anyone living in the country must be a member of one.

Neither scheme covers pregnancy and childbirth unless there are medical complications. This means that families often opt for private health insurance as well as their public insurance or employment-based insurance plans.

Employee Health Insurance (EHI)

The Employee Health Insurance or EHI (Kenkō-Hoken, 健康保険) is usually arranged by the employer, if the business has five or more employees and those employees are working for 30 hours a week or more.

Premiums for EHI schemes are calculated according to salary and are split equally between the employer and employee. The employee’s contribution is usually deducted each month before payment of the salary. Dependants are also covered.

National Health Insurance (NHI)

The National Health Insurance scheme or NHI (Kokumin Kenko Hoken, 国民健康保険) is for those who are not eligible for the EHI. Typically, members of the NHI are students, employees of small businesses (less than five employees), the self-employed, unemployed, and dependants of the above.

The NHI is run by local governments and paid for through a combination of federal government contributions and individual member's contributions. The amount contributed by the member is calculated annually according to income and the number of people in a family.

Enrolment in the NHI does not mean that medical treatment is free. Patients must pay 30 per cent of any costs while the government contributes the remaining 70 per cent. These costs, including doctors fees and prescriptions, are not billed later. Instead they must be paid on the day. The amount payable by the patient is capped to ensure affordable healthcare.

NHI Eligibility

  • Only residents of Japan are eligible for NHI membership
  • All foreigners who are Alien Residents, staying in Japan for at least three months can be members of the NHI
  • Foreigners who are self-employed are also eligible for NHI membership
  • Pensioners are eligible for NHI membership and contributions are made in the same way as for the self-employed

There might be small variations in the way local governments organise NHI.

How to register with the NHI

Foreigners who are members of a company medical aid scheme do not need to apply for NHI membership.

Foreigners who wish to be members of the NHI must first be registered as Alien Residents. Alien Resident registration must take place within 90 days after their arrival in Japan. Membership to the NHI is applied for at the same town hall where Alien Resident registration took place. The only document required is the Alien Resident registration card.

Any other family members who need to be NHI members should be enrolled at the same time. Once enrollment has taken place, the insured gets a health insurance card (hoken-sho), which must be presented for all medical treatments.

Paying Health Insurance Contributions

Employers usually deduct health insurance contributions on a monthly basis from employees' salaries.

For those making direct NHI payments, they will receive an annual bill which is paid to the local government. There are two ways of paying:

  1. Through direct debit from a bank account.
  2. With a statement called the nofusho which can be paid at a number of places which include designated banks, post offices, some convenience stores, Town halls.

Health Insurance - What is Covered?

The following are covered by health insurance schemes:

  • Consultations
  • Hospitalisation
  • Materials used in treatments
  • Medical treatment at home
  • Medicines
  • Nursing care
  • Surgery
  • Restorative dental treatments

Treatment not covered by the NHI include:

  • Comprehensive Medical Examination or Ningen Dokku,(人間ドック)
  • Cosmetic surgery
  • Birth
  • Injury or illness as a result of fighting or being drunk
  • Basic dental treatment
  • Vaccinations

The Ningen Dokku,(人間ドック) is a thorough medical check up which takes up to two days.