Foreigners who live in Japan for more than 3 months are required by law to enroll in either National Health Insurance (Kokuho) or Social Insurance (company health insurance). If you visit a hospital without insurance, you pay 100 percent of the medical cost. This article explains the National Health Insurance system, its premiums, and how to use it.
An appendix surgery can cost about 1 million yen, and a 1-week hospital stay about 500,000 yen. With insurance, you pay only 30 percent. Be sure to enroll.
Which Insurance Should You Join?
- Working as a full-time or contract employee: automatically enrolled in your company’s Shakai Hoken (Social Insurance)
- Student, self-employed, part-timer, or unemployed: enroll in Kokumin Kenko Hoken (National Health Insurance) at the city hall
- Technical Intern Trainees and SSW: most are enrolled in the company’s Social Insurance
How to Enroll in National Health Insurance
Enrollment Flow
- Go to the Kokuho (Health Insurance) desk at your city hall or ward office
- Fill in the application form
- Your insurance card is issued on the spot (same day)
Documents You Need
- Residence Card
- Passport
- My Number
- Personal seal (some city halls accept a signature)
Premium Estimates
Premiums are calculated based on your previous year’s income. Your first year in Japan usually has low income, so the premium is low.
| Annual Income | Monthly Premium (example from 23 wards of Tokyo) |
|---|---|
| First year in Japan (no income) | About 2,000 yen |
| Annual income 2,000,000 yen | About 14,000 yen |
| Annual income 3,000,000 yen | About 21,000 yen |
| Annual income 4,000,000 yen | About 28,000 yen |
If your income is low, you can apply for a premium reduction. Ask your city hall for details.
How to Use the Insurance Card
When You Visit a Hospital
- Hand over your insurance card at the reception
- Receive consultation, treatment, and prescriptions
- At checkout, pay 30 percent of the cost (the remaining 70 percent is covered by insurance)
If You Forget Your Insurance Card
- Pay 100 percent of the cost on the spot
- Later, file a Refund of Medical Expenses application at your city hall or the hospital to get 70 percent back
High-Cost Medical Expense System
When your medical cost becomes very high due to hospitalization or surgery, there is a cap on your out-of-pocket payment.
Example: If your annual income is under about 3.7 million yen, the monthly cap is a little over 80,000 yen. Any amount above the cap is refunded later.
If you get a Limit Application Certificate at the city hall in advance, you pay only up to the cap at the hospital counter.
FAQ
Q. What happens to my insurance when I leave Japan?
Before leaving, submit a Loss-of-Qualification Notice at the city hall and return your insurance card.
Q. Can I add dependents?
With Social Insurance, you can add spouse, children, and parents as dependents. National Health Insurance is enrolled per household, so the concept of dependents does not apply.
Summary
- Foreigners staying in Japan for more than 3 months must enroll
- Company employees: Social Insurance. Others: National Health Insurance
- Apply at the city hall; insurance card is issued the same day
- You pay 30 percent of medical fees (70 percent covered by insurance)
- High-cost care has a cap under the High-Cost Medical Expense System
- Your first year in Japan has a low premium because income is low
Premium amounts and system details vary by municipality. For the latest information, check your city hall or the official Ministry of Health, Labour and Welfare website.
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