National Health Insurance Japan for Expats: Step-by-Step Enrollment Guide
Expats living in Japan for longer than three months can enroll in the National Health Insurance (NHI). The NHI is an insurance scheme that covers self-employed, unemployed, those who work less than 30 hours a week, international students, and retired residents aged 75 or younger.
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Are you an expat moving to Japan? Are you unsure of how to secure health insurance in Japan? The insurance experts at Pacific Prime created this guide to walk expats through the steps of enrolling in Japan’s NHI scheme.
We will share why you need this insurance, an overview of the scheme, and the steps to enroll. We will also explain how expats can use their National Health Insurance to access medical services in Japan.
Why Expats Need to Enroll in Japan’s National Health Insurance
Expats who qualify for the National Health Insurance need to enroll because it is legally required to register in a public health insurance scheme after three months in Japan. Failure to enroll in a public health insurance scheme can result in fees and the inability to renew or change your visa.
Eligibility for the National Health Insurance in Japan
The National Health Insurance scheme is available for expats who are living abroad in Japan for longer than three months and fit one or more of the following criteria:
- Self-employed
- Unemployed
- Work less than 30 hours a week
- International students
- Retired and aged 75 or younger
Some expats are ineligible for the National Health Insurance. Individuals who fit one of the following criteria are not eligible to enroll with the NHI:
- Individuals and dependents covered under Employees’ Health Insurance or a different Japanese public health insurance program
- Individuals enrolled in the Health Insurance Program for Senior Citizens (seniors are transferred from the NHI to this program after they turn 75)
- Individuals receiving social assistance
- Individuals who have a “designated activities” status of residence and:
- Are in Japan to receive medical treatment or to provide everyday assistance for someone who is engaged in applicable activities
- Are in Japan for sightseeing, recreation, or similar activities, or are an accompanying spouse of such a person, and have a period of stay for less than a year
Japan’s National Health Insurance System
The National Health Insurance is one of the three health insurance schemes Japan offers its residents. There is also employer-based health insurance and health insurance for the advanced elderly (for individuals aged 75 and up).
The NHI is managed through the prefecture or municipality in which the insured lives.
The municipal insurer will handle the payment for medical expenses using the paid premium funds of those enrolled in the NHI as well as government subsidies.
Expats who are enrolled in the NHI pay their insurance premiums based on their income.
Japan NHI insurance premiums are calculated for each member of the household and totaled on a per-household basis. The resulting amount is the premium then paid by the head of that household.
National Health Insurance Benefits for Expats in Japan
The National Health Insurance covers a variety of medical expenses in Japan, including most inpatient services and dental care. They do not cover vaccines or immunizations. Refer to the table below for more information on what is and is not covered.
| National Health Insurance Coverage | |
| Medicines and medicinal supplies | Covered |
| Treatments, surgeries, and other procedures | Covered |
| Vaccines and immunizations | Not covered |
| Hospitalization | Covered |
| Cosmetic procedures and orthodontics | Not Covered |
| Nursing care and in-home nursing care | Covered |
| Physicals and medical check-ups for members under 40 | Not Covered |
NHI members aged 40 to 74 are eligible for NHI vouchers for medical check-ups to screen for diabetes, high blood pressure, and other illnesses. NHI members will also receive a lump-sum benefit of JPY 500,000 (around USD $3,246) for pregnancy and childbirth as well as for stillbirth or miscarriage.
An additional benefit is a sum paid toward funeral expenses if an insured member dies. The sum paid per member is JPY 70,000 (around USD $454). This benefit will not be paid if the insured has another insurance policy that covers funeral expenses.
To learn more about health insurance options in Japan, check out our article below:
Step-by-Step Enrollment Guide to Japan’s National Health Insurance
To enroll in Japan’s National Health Insurance, you should follow three steps: gather your documents, visit your local city office, fill out your application, and receive your insurance card. These steps will be outlined in greater detail in the following sections.
Step One: Gather Your Documents
The first step of this process is gathering your documents, including items like your Residence Card, passport, proof of address, financial documents, additional documents for your dependents, and so on. Make sure all of these documents are correct and up to date.
The exact documents you will need may vary depending on your situation and the municipality, so expats are recommended to inquire with the relevant service counter for details.
Step Two: Visit Your Local City Office and Fill Out Your Application
You will next take your documents to your local city or ward office. Japan has various municipalities, each with its own office where you will enroll in the NHI. You will need to enroll in the NHI at your local office within 14 days of moving into the municipality.
You will fill out your National Health Insurance application at the local city or ward office. Take your time with this application, ensuring all your information is correct.
Step Three: Receive Your My Number Card
Once your application is finished, you will receive a My Number Card. Your My Number Card will serve as proof that you are enrolled in the National Health Insurance and will act as your key to unlocking healthcare in Japan.
When visiting a clinic or hospital in Japan, you will be required to present your My Number Card before you can receive medical services. A physical My Number Card is the most common card type, but Japan has begun rolling out digital copies.
How Expats Can Use Their National Health Insurance in Japan
Expats can use their National Health Insurance in Japan to access medical care in clinics and hospitals and to cover medication. The National Health Insurance coverage will pay for 70% of the medical bill, with the remaining 30% being the insured’s responsibility.
Copay percentages are different for different age groups. Children up to age six and individuals aged 70 to 74 will only need to pay a 20% copayment for their medical services.
How to Pay Your National Health Insurance Premiums
Expats can pay their National Health Insurance premiums by bank transfer, in cash, or electronically. NHI premiums are due on the last day of every month. If the last day of the month is a bank holiday, the premiums will be due on the following business day.
Learn more about the different ways you can pay your premium:
- Bank Transfer: Expats interested in paying via a bank transfer can set up automatic monthly withdrawals from their savings account. This payment method is often considered the most convenient.
- Cash Pay: Expats can pay with cash at their bank, credit union, Japan Post Bank/post office, convenience store, or local municipality office that handles payments.
- Electronic Pay: Expats can pay via smartphone payments by scanning the barcode on the payment slip. To learn more, check the website of your local municipality office for smartphone apps compatible with this payment method.
Using Private Health Insurance to Supplement NHI Coverage
Expats can purchase private health insurance to supplement their NHI coverage. This private health insurance can give them access to private hospital rooms, their choice of providers, and help with out-of-pocket costs left by their NHI plans.
Private health insurance providers like AXA, Cigna Global, Bupa Global, and others offer international health insurance plans for expats in Japan. These plans have the added benefit of being globally portable, so expats can take them with them as they travel.
Private health insurance is not mandatory in Japan like the National Health Insurance is, but it can be an invaluable resource to expats looking for more coverage and peace of mind.
Frequently Asked Questions
Can international students apply to Japan’s National Health Insurance?
International students can apply for Japan’s National Health Insurance. When an international student is receiving their Residence Card at their local city or ward office, they can also apply to enroll in the National Health Insurance scheme at the same time.
What expats are eligible for the National Health Insurance in Japan?
Expats who are living in Japan for longer than 90 days and are self-employed, unemployed, those who work less than 30 hours a week, international students, and retired residents aged 75 or younger are eligible for the National Health Insurance.
How to enroll in the National Health Insurance in Japan?
Enrolling in the National Health Insurance can be done in three steps: gathering necessary documents, visiting a local city office to fill out your application, and then receiving your My Number Card. Necessary documents may vary depending on the applicant’s circumstances.
Can foreigners get free healthcare in Japan?
Free healthcare is not available for foreigners in Japan. Foreigners staying for longer than three months can be eligible for the National Health Insurance scheme, which will offer subsidized healthcare. Expats will still need to pay 30% of their medical bills out of pocket.
Does the National Health Insurance cover all medical treatments?
The National Health Insurance does not cover all medical treatments. Medical services not covered by the National Health Insurance include vaccines and immunizations, medical checkups for those under 40 years of age, cosmetic surgeries, and orthodontics.
Do dependents enrolled with the NHI pay less for copayments?
Dependents enrolled with the National Health Insurance under the age of six will only pay a 20% copayment on their medical services. Once these dependents are over the age of six, they will need to pay a 30% copayment on their medical bills.
Conclusion:
Expats who register as residents in Japan must enroll in a public health insurance scheme. Expats who are unemployed, self-employed, students, part-time workers, or retired should enroll in the National Health Insurance. The NHI grants foreigners and locals universal healthcare.
Are you interested in finding supplemental private health insurance for Japan? Contact the insurance experts at Pacific Prime. We are partnered with a wide variety of the top international health insurance providers in Japan and worldwide.
We are brokers with over 20 years of experience in offering insurance solutions to expats and digital nomads globally. We can help you understand insurance quotes and plans and offer our unbiased advice. If you’d like to compare plans on your own, feel free to use our free quote generator.
If you’d like to read more helpful guides for expats in Japan, check out our articles below:
- How to Cancel or Switch Your Health Insurance in Japan
- Japan Health Insurance Cost Breakdown: Students, Expats, and Visitors
Serena earned her Bachelor’s Degree in Psychology from the University of British Columbia, Canada. As such, she is an avid advocate of mental health and is fascinated by all things psychology (especially if it’s cognitive psychology!).
Her previous work experience includes teaching toddlers to read, writing for a travel/wellness online magazine, and then a business news blog. These combined experiences give her the skills and insights she needs to explain complex ideas in a succinct way. Being the daughter of an immigrant and a traveler herself, she is passionate about educating expats and digital nomads on travel and international health insurance.
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