The National Health Insurance System (NHIS)
Japan's national health insurance system
Japan's national health insurance system is a socialized system in which all residents and citizens of Japan are entitled to affordable healthcare. In Japan, healthcare is a right, not a privilege.
The National Health Insurance System (NHIS) is one of the social security systems of Japan. Those who are enrolled in the NHIS have a portion of their medical expenses paid in the event of illness, injury, childbirth, and death.
The health insurance system in Japan is "Insurance for All". If you have a domestic address, regardless of your age or nationality (as long as you have been a registered foreign resident for 1 year or more) you are required to be enrolled in some kind of health insurance, whether through the NHIS, your employer, or another program.
However, if you are in one of the following 5 categories, you may not enroll in the NHIS:
- Persons who are enrolled in a health insurance plan through their employer, or the dependents of persons enrolled in a health insurance plan through their employer.
- Persons who are enrolled in the Seaman's Insurance Scheme, or the dependents of persons enrolled in the Seaman's Insurance Scheme.
- Members of the National Health Insurance Union, or dependents of members of the National Health Insurance Union.
- Persons over age 75 (specialized insurance is provided for senior citizens over 75)
- Persons receiving welfare benefits
Additionally, if you work less than 30 hours a week, you may enroll in the NHIS. If you are self-employed, do not have workers in your employ, and are not in one of the above 5 categories, enrollment in the NHIS is mandatory.
NHIS Enrollment Requirements
NHIS enrollment requires that certain conditions be met. The following are situations in which a person must enroll in the NHIS.
- When you quit, retire, are laid off, or are dismissed from your job. (see further detail below)
- If you end your membership with the National Health Insurance Union
- If you are a dependent of a person who meets the criteria of 1 and 2.
- When you no longer receive welfare benefits
- If you are unemployed, working less than 30 hours per week and have a baby, your newborn must be enrolled in the NHIS. If at least one parent is employed and enrolled in insurance through their employer, however, the newborn must be enrolled in that parent's insurance.
*Note about 1.
If you quit, retire, are laid off, or are dismissed from your job you are entitled to keep your employer's insurance for up to 2 years at your own expense (double the cost you paid while you were employed). If you choose not to stay on your employer's insurance, you are required to join the NHIS.
Non-covered and Partially-covered Injuries, Illnesses, Conditions, and Services
The following injuries, illnesses, conditions and services are either NOT covered or only PARTIALLY covered, depending on the circumstances.
- Annual physical
- Immunizations/vaccines
- Cosmetic Surgery
- Orthodontia
- Normal, timely, vaginal birth
- Medical expenses of injury from fighting, drunkenness, and other misconduct.
- Medical expenses of injury or illness caused by your work activities (industrial accidents, etc.) (this is covered by Workman's Compensation insurance.)
- Medical expenses of injury or illness caused by car accidents
In short, the NHIS may restrict or reduce insurance coverage for medically unnecessary procedures, illnesses and injuries caused by misconduct, and situations in which other forms of insurance are applicable.
NHIS Enrollment Procedures
National Health Insurance procedures are administered by your municipal office.
The following are things you MUST bring with you to your municipal office when applying for enrollment with the NHIS:
- My Number card or My Number Notification Card
- Identification such as passport, driver's license, or Resident Card (your ID must be originally obtained from a governmental authority)
When enrolling, unenrolling, or performing other procedures regarding NHIS status, in principle you should go to your city office to begin procedures within 14 days of your situation change.
Please note that the documents you need for each procedure may vary slightly by municipality, so please confirm what you need to bring before visiting your city office. In addition to the two items above you will need the following depending on your situation:
| Situations that require enrollment procedures | Documents you must bring |
|---|---|
| When you move to a new city | 印鑑(いんかん) (inkan) Personal Seal |
| When you quit, retire, are laid off, or dismissed from your job |
1. 健康(けんこう)保険(ほけん)の資格(しかく)喪失(そうしつ)証明書(しょうめいしょ) （kenkouhoken no shikaku soushitsu shoumeisho） Certificate of Health Insurance Coverage Loss OR 退職(たいしょく)証明書(しょうめいしょ) (taishoku shoumeisho) Certificate of Retirement OR 離職票(りしょくひょう) (rishokuhyou) Notice of Separation 2. 年金(ねんきん)手帳(てちょう) (nenkin techou) Pension Booklet 3. 印鑑(いんかん) (inkan) Personal Seal |
| When your insurance coverage from your previous employer expires (if you chose to keep using that insurance after your employment ends for any reason) |
1. 印鑑(いんかん) (inkan) Personal Seal 2. 任意(にんい)継続(けいぞく)保険(ほけん)資格(しかく)喪失(そうしつ)証明書(しょうめいしょ) Loss of Optional Continuance of Insurance Coverage Certificate |
| When you have a baby (applying on your child's behalf) |
1. 印鑑(いんかん) (inkan) Personal Seal 2. 国民(こくみん)健康(けんこう)保険証(ほけんしょう) Health insurance card of the parent |
| When you no longer receive public assistance (welfare benefits) |
1. 印鑑(いんかん) (inkan) Personal Seal 2. 保護(ほご)廃止(はいし)決定(けってい)通知書(つうちしょ) Notification of End of Public Assistance |
| If you are a foreign resident applying for NHIS |
1. 在留(ざいりゅう)カード Resident Card OR 特別(とくべつ)永住者(えいじゅうしゃ)証明書(しょうめいしょ) Special Permanent Resident Certificate |
When you unenroll from the NHIS
| Situations that require unenrollment procedures | Things you need to bring |
|---|---|
| When you move out of your city |
1. 印鑑(いんかん) Personal seal 2. 国民(こくみん)健康(けんこう)保険証(ほけんしょう) National Health Insurance Card |
| When you change from NHIS to your employer's insurance |
1. 印鑑(いんかん) Personal seal 2. 国民(こくみん)健康(けんこう)保険証(ほけんしょう) National Health Insurance Card 3. 職場(しょくば)の健康(けんこう)保険証(ほけんしょう) New insurance card from your employer |
| In the event of your death (your next of kin will carry out procedures) |
1. 印鑑(いんかん) Personal seal 2. 国民(こくみん)健康(けんこう)保険証(ほけんしょう) National Health Insurance Card |
| When you start receiving public assistance (welfare benefits) |
1. 印鑑(いんかん) Personal seal 2. 国民(こくみん)健康(けんこう)保険証(ほけんしょう) National Health Insurance Card 3. 保護開始決定通知書 Notification of Start of Public Assistance |
Other situations in which you will need to perform procedures regarding your NHIS enrollment
| Circumstance | What you need to bring |
|---|---|
| When you move to a new house or apartment within the same city |
1. 印鑑(いんかん) Personal seal 2. 国民(こくみん)健康(けんこう)保険証(ほけんしょう) National Health Insurance Card |
| When you change the name on a deed or a lease |
1. 印鑑(いんかん) Personal seal 2. 国民(こくみん)健康(けんこう)保険証(ほけんしょう) National Health Insurance Card |
| When you move out of your city for study, research, or school |
1. 印鑑(いんかん) Personal seal 2. 国民(こくみん)健康(けんこう)保険証(ほけんしょう) National Health Insurance Card 3. 在学(ざいがく)証明書(しょうめいしょ) Certificate of Student Registration 4. 転出先(てんしゅつさき)の住民票(じゅうみんひょう) Notice of Change of Address |
| If you lose your insurance card OR your card becomes unusable due to damage or soiling |
1. 印鑑(いんかん) Personal seal 2. 顔(かお)写真付き(じゃしんつき)の公的(こうてき)身分(みぶん)証明書(しょうめいしょ) Photo ID from a governmental authority (driver's license, passport, resident card, etc.) |
| Japanese | Romaji | English | Pronunciation |
|---|---|---|---|
| 身分証明書 (みぶんしょうめいしょ) |
mibunshoumeisho | Personal identification | |
| 住民票 (じゅうみんひょう) |
juuminhyou | Residence Record | |
| 本人確認 (ほんにんかくにん) |
honninkakunin | Document that confirms you are who you say you are (identification) | |
| 手続き (てつづき) |
tetsuzuki | Paperwork, procedure | |
| 住所変更 (じゅうしょへんこう) |
juushohenkou | Change of address | |
| 委任状 (いにんじょう) |
ininjou | Power of attorney (a document giving someone legal permission to fill out paperwork, etc. on your behalf) | |
| 転入 (てんにゅう) |
tennyuu | Moving into a city | |
| 転出 (てんしゅつ) |
tenshutsu | Moving out of a city | |
| 印鑑(いんかん) / はんこ | inkan / hanko | Personal Seal | |
| 在学証明書 (ざいがくしょうめいしょ) |
zaigakushoumeisho | Certificate of Student Registration | |
| 在留カード (ざいりゅうかーど) |
zairyuukaado | Resident Card |
How to Pay for your National Health Insurance
The NHIS bills on a per-household basis, so the head of household will receive a cumulative bill for all those in the household that are insured under the NHIS. Payment periods vary by municipality, so please check with your city office. The current accepted payment methods are:
- Direct pay from bank account
- Pay at a convenience store with a bill mailed to you
- Yahoo Koukin (may vary by municipality)
- Nanako (may vary by municipality)
| Japanese | Romaji | English | Pronunciation |
|---|---|---|---|
| 納付 (のうふ) |
noufu | To make a payment | |
| 納付期間 (のうふきかん) |
noufukikan | Payment period | |
| 世帯主 (せたいぬし) |
setainushi | Head of household (usually the name on the deed or lease) | |
| 郵送 (ゆうそう) |
yuusou | Send through the mail | |
| 口座振替 (こうざふりかえ) |
kouzafurikae | Direct payment from bank account | |
| 保険料 (ほけんりょう) |
hokenryou | Insurance fee |
High Cost Medical Care Benefit System
The High Cost Medical Care Benefit System helps to maintain affordable healthcare costs per household by reimbursing out-of-pocket medical expenses that exceed a certain limit over a period of 30 days, even when using the health insurance in which you are enrolled.
This system, however, is not automatic and you must enroll in it to receive benefits.
The upper limit for out-of-pocket expense is determined by your income, age, the type of insurance and coverage you have, and other factors. You can apply for this system preemptively or retroactively, and you may use it every month until it expires.
Once it expires, you may enroll again. This system covers medical costs and prescription medication costs. It does NOT cover Over-the-Counter drugs.
The chart below describes the income brackets and upper limit for out-of-pocket (OOP) medical expenses for people under 69 years of age. Foreign residents are also entitled to enroll in this program.
Please keep in mind the actual calculation for your reimbursement rate is very complicated and is determined by a number of factors other than your income and age, and the chart below is just to give you a rough idea of what you can expect.
| Annual Income Bracket | Per-Month OOP Upper Limit | |
|---|---|---|
| A | ￥11,600,000 and over | ￥252,600 + (treatment cost – 842,000) x 1% |
| B | ￥7,700,000 ~ ￥11,600,000 | ￥167,400 + (treatment cost – 558,000) x 1% |
| C | ￥3,700,000 ~ ￥7,700,000 | ￥80,100 + (treatment cost – 267,000) x 1% |
| D | ￥3,700,000 and under | ￥57,600 |
| E | Resident Tax Exempt | ￥35,400 |
So, for example, if you fall in the D category, out-of-pocket medical costs per 30 days over ￥57,600 will be reimbursed to you (see Conditions below to learn more).
Applying Preemptively
If you know in advance that you will soon have a high-cost medical treatment (e.g. Surgery, hospitalization), you can apply for the High Cost Medical Care Benefit System beforehand and have your treatment costs discounted, as opposed to receiving a reimbursement later on. It is best to apply as soon as possible to ensure you have your certificate in advance.
Note: When using this system for hospitalization or surgery, your food, bed/room, and other non-medical costs will not be discounted or reimbursed.
You can print forms from the National Health Insurance Union to fill out and take with you to your city office below (please choose ONE):
Japanese source: https://www.kyoukaikenpo.or.jp/~/media/Files/honbu/g2/cat230/161226/k_gendogaku_161226.pdf
Japanese/English (form starts on page 2): https://www.kyoukaikenpo.or.jp/~/media/Files/aichi/migration/g1/h24-8/20120426-193654.pdf
If you are on public assistance or otherwise exempt from paying resident taxes, please use the form below (unfortunately, there is no English version of this form, so please ask someone for help if you need it):
Japanese source: https://www.kyoukaikenpo.or.jp/~/media/Files/honbu/g2/cat230/161226/k_hyoujyunfutan_161226.pdf
Once you have your certificate, if you know in advance that you will be having an expensive medical treatment, submit it to the hospital ahead of time so that your total bill can be discounted.
Applying Retroactively
You can apply to be reimbursed for incurred medical expenses in excess of the 30-day upper limit. When applying retroactively, you should apply as soon as you can, as processing your application and reimbursement can take 3 months or longer.
The system is also applicable for high cost medical expenses up to two years prior, so if you had a large medical expense within the last two years and you did not use the High Cost Medical Care Benefit System, you may still be reimbursed as long as you have your receipts.
You can print forms from the National Health Insurance Union to fill out and take with you to your city office below (unfortunately, there is no English version of this form, so please ask someone for help if you need it):
Japanese source: https://www.kyoukaikenpo.or.jp/~/media/Files/honbu/g2/cat230/161226/k_kougaku_161226.pdf
Preparing to mail your application
Please check with your City Office about where to send your application form, as it varies by municipality.
When you apply for enrollment in the High Cost Medical Care Benefit System, please print out the appropriate application form from the selection above or receive one from your medical institution. The following are the things you need to send with your filled-out application form.
- A photocopy of both sides of your My Number Card.
If you do NOT have a My Number Card, you need the following two things:- A photocopy of your My Number Notification Card OR your Residence Record (original) with your My Number recorded on it.
- A photocopy of your photo ID (passport, driver's license, Resident Card, or other photo ID issued by a governmental authority)
- Any applicable receipts for medical costs (if you are applying RETROACTIVELY)
- A photocopy of your Health Insurance card
Applying in Person
If you apply in person, please bring the following things with you to your City Office:
- Your personal seal
- Any applicable receipts (if you are applying retroactively)
- Your insurance card
- Your bank book (if you are applying retroactively)
- Your My Number Card or My Number Notification Card
- Photo ID (passport, driver's license, Resident Card, or other photo ID issued by a governmental authority)
Conditions of the High Cost Medical Care Benefit System
- Your reimbursement is calculated based on a 30 day system, from the 1st day of the month to the last day of the month.
- Calculation for each department (dermatology, internal medicine, cardiology, etc.) is done separately, and the total cost for each department must be ￥21,000 or more between the 1st of the month and the last day of the month to qualify for reimbursement.
So, for example, if you spent ￥20,000 at the gynecologist and ￥1,000 at the dentist between April 1st and April 30th, you will not qualify for reimbursement because the total for EACH department separately did not meet or exceed ￥21,000. However, if you spent ￥21,000 at the gynecologist between April 1st and April 30th, you WILL qualify for reimbursement because your total expenditure for ONE department was ￥21,000 or more. - Different types of care are calculated separately. For example, regular doctor visits and hospitalization will not be calculated together.
- When you are hospitalized or have to stay in the hospital for surgery or other treatment, the cost of the room, bedding, meals, towels, gowns, etc. are not covered under the High Cost Medical Care Benefit System.
- Reimbursements will be sent to the head of household's bank account through wire transfer.
- If you have any past delinquency (total non-payment) on payments for your National Health Insurance, you are ineligible for the High Cost Medical Care Benefit System.
| Japanese | Romaji | English | Pronunciation |
|---|---|---|---|
| 高額療養費制度 (こうがくりょうようひせいど) |
kougaku ryouyouhi seido | High Cost Medical Care Benefit System | |
| 医療費 (いりょうひ) |
iryouhi | medical expense / treatment cost | |
| 病院 (びょういん) |
byouin | hospital | |
| 入院 (にゅういん) |
nyuuin | Hospitalization, in the hospital | |
| 退院 (たいいん) |
taiin | discharged (from hospitalization) | |
| 食事代 (しょくじだい) |
shokujidai | cost of meals | |
| 所得 (しょとく) |
shotoku | income | |
| 自己負担限度額 (じこふたんげんどがく) |
jikofutangendogaku | out-of-pocket expense upper limit | |
| 計算 (けいさん) |
keisan | calculation |