Insurance systems
Social insurance systems
Social insurance is the collection of premiums from policyholders to
create a fund which can offer them benefits if they get ill or injured,
become disabled or unemployed, as they age, or when they die, thereby
giving security to policyholders and their families
The type of social insurance depending on the status of the person insured.
Private medical insurance
Besides public insurance, there are private medical insurance companies. Coverage
varies from company to company. Buying cover is optional.
Employees’ Health Insurance(EHI, kenko
hoken or shakai hoken)
People working for companies and their families enroll in this scheme, generally
referred to as shakai hoken (Social Health Insurance). The premium is based
on income and the employer and employee each contribute half.
At hospitals and clinics, policyholders and their families pay 30% of medical
and medicine costs, or 20% in the case of infants under 3.
National Health Insurance (NHI, kokumin kenko hoken)
People working for companies and their families enroll in this scheme, generally
referred to as shakai hoken (Social Health Insurance). The premium is based
on income and the employer and employee each contribute half.
At hospitals and clinics, policyholders and their families pay 30% of medical
and medicine costs, or 20% in the case of infants under 3.
◆ NHI benefits
・ If you are covered by NHI, you will pay:
Children under 3 age 3 to 69 age 70 to 74
20% of total 30% of total 10% of total
(20% if you have a high income)
※See “2-2-4 Medical expenses of the elderly” for those aged 75 and over.
・If you have a child, you will get a lump-sum childbirth allowance.
・When you die, a funeral allowance is paid on your behalf.
・Note: you need to pay the full cost of medical treatment which is not covered
by NHI.
There are other benefits; contact your municipal office for details.
◆ Enrollment
You are eligible if you are registered as a foreign resident and have a valid
visa to stay in Japan for at least a year. If you have a visa of less than
one year, you may still be eligible, depending on the purpose of entry.
○Apply to the municipal office where you are registered.
○Take with you:
・ Foreign resident registration card(gaikokujin toroku shomeisho),
Authenticated copy of Foreign Resident Registration (gaikokujin toroku genpyo
kisaijiko shomeisho)
・ Seal ( or you can sign if you wish)
・ Proof that you are staying in Japan for at least one year (passport, student
card, research schedule, etc.)
◆ National Health Insurance (NHI) certificate
・ Each household under the NHI plan is issued one certificate. Be sure to present
it at reception when you go for medical treatment.
・ You may be able to get an extra copy of the certificate if members of your
household live separately for a period of time.
◆ Insurance premiums
・ The annual premium is calculated for the household, according to family size
and the policyholder’s income level for the previous year.
・ If you are 40 through 64 you must also pay nursing care insurance (kaigo
hoken) premiums to provide for possible future needs in old age.
・ During your first year in Japan, you pay the minimum rate as there is no
record of your income for the previous year. From the second year, your premiums
will depend on your income for the previous year.
・ You pay the premiums in monthly installments (Ask at your municipality for
details). The bills should be paid by the due date at a bank or post office.
You can also set up account transfer payments.
・ It is mandatory to join public insurance schemes: either the EHI or the NHI.
・ You can apply for NHI at any time, but you will be charged from the date
you registered as a foreign resident (not the date you arrived in Japan) or
the date you withdrew from your company EHI.
・ You may be able to get a reduction or exemption from premiums if you have
trouble paying due to special circumstances, such as natural disasters, unemployment,
bankruptcy, and so on.
・ If you fail to pay your premiums, you will be charged all medical fees and
may be unable to get benefits you are eligible for.
◆ You need to tell your insurance provider within 14 days if:
・ You move
・ You join a workplace EHI scheme
・ You move from a municipality
When you move, take your NHI Certificate to the municipal office in the area
you are leaving and tell them when you are moving. Notify your new office within
14 days of moving.
・ When a child is born, the head of the household changes, or a policyholder
dies.
・ If your certificate is lost or damaged
・ When you withdraw
You cannot leave the NHI unless you switch to a workplace EHI or move from
a municipality. If you withdraw in the middle of the fiscal year, your premiums
will be recalculated and you will have to pay for the corresponding part of
the year.
Note that you will need different documents for each particular case.
◆ You are not eligible for NHI if:
・ You are not registered as a foreign resident
・ You do not have status of residence
・ You are likely to stay in Japan for less than one year
・ You are covered by some other health insurance
・ You are a low-income earner and are getting special subsidies
For further information:
Contact（through the FIA）the local municipal office.
※ Overseas studentsIf you are an overseas student and join NHI, you can get
an 80% rebate on medical treatment covered by NHI. This is paid for by AIEJ
(Association for International Education, Japan) through the school or college
you are registered at.
AIEJ http://www.aiej.or.jp/
Medical care not covered by insurance
Health insurance does not cover:
・ Normal pregnancy and childbirth
・ Abortion for economic reasons
・ Health examinations or checkups
・ Vaccinations
・ Cosmetic surgery, orthodontics (tooth-straightening)
・ Injury and accident at work or on the way to work
(This is covered by Workmen’s Accident Compensation Insurance (rosai hoken)
・ Acupuncture, moxibustion, massage (these are only covered when a doctor has
recommended them)
・ Fees for private or semi-private hospital rooms
・ Other types of examination, surgery, treatment, or medication not covered
by insurance.
Long-Term Care Insurance For The Elderly (kaigo hoken)
This is a scheme designed to provide nursing care and assistance to
support Japan’s aging society as a whole, rather than putting the burden
on aging households alone. The system is funded by insurance premiums
and also through taxes. People who need home help for everyday activities
such as bathing and everyday hygiene, eating, and so on, due to bedridden,
senile dementia, and other conditions, are eligible for nursing care
from their local social services.
◆ You are covered if you are:
A resident aged 65 and over, or aged 40-64 and covered by a relevant medical
insurance plan (National Health Insurance, Employees’ Health Insurance , etc.).
①Type #1: all residents aged 65 and over
②Type #2: all residents aged 40-64 who enroll in a medical insurance plan
Premiums and services vary for Type #1 and Type #2 schemes.
◆ Premiums
Type #1 and Type #2 premiums are different.
◆ Eligibility for care, procedures
（１）Eligibility
People with Type #1 cover who need care services, and people with Type #2 cover
who need nursing care for one of fifteen specified age-related conditions,
such as Parkinson’s disease.
（２）Official recognition of care and assistance needs
In order to receive care services, your care/assistance needs must be recognized.
Apply to the local municipal office in your area. A specialist will make a
home evaluation visit. Following this and a doctor’s assessment, a panel will
evaluate your needs on a 6-point scale, ranging from yo-shien (assistance needs)
to yo-kaigo (5 levels of care needs).
（３）Preparing a care plan
Once your household care needs are recognized, a nursing care specialist (care
manager) from a home-based care provider is asked to make a home-based care
plan. You can make use of the services laid down in this plan.
For further details, ask at your municipal office.
For further information:
Contact (through the FIA) your local municipal office.
Workmen’s Accident Compensation Insurance
(WACI, rosai hoken）
Injury, illness, disability, and death which occur at work or while
commuting to and from work are covered by a national insurance scheme
called Workmen’s Accident Compensation Insurance (WACI, rosai hoken).
All Japanese companies must take out this insurance. The insurance covers
every worker employed by a company, including part-time and temporary
workers, regardless of their residential or visa status. If you do fall
ill or are injured while working or commuting to work, first talk to
your manager. If your injury or illness is acknowledged as work-related,
your medical expenses will be covered by WACI.
※ Medical treatment for injury at work or on the way to work is not
covered by other health insurance programs. If your company does not
follow the proper procedures, consult the Labor Standards Inspection
Office (rodo kijun kantokusho) with jurisdiction over the location of
your company. You cannot receive medical benefits unless you apply for
WACI. It is not your company but the Labor Standards Inspection Office
that decides whether or not your claim justifies compensation. If you
think your injury or illness may be covered by WACI, apply through the
Labor Standards Inspection Office.
◆ Medical Treatment Benefits (for treatment of work-related injury or illness)
It is advisable to go to a WACI-designated hospital or clinic (most general
hospitals are designated), where you can directly apply for WACI on your first
visit. Use a special form “ryoyo no kyufu seikyusho” available at such hospitals.
You do not need to pay your medical bills until your treatment is completed.
If you go to a non-designated hospital or clinic, explain that your injury
or illness is work-related, and you will have to pay your full bill up front.
Make sure you get all receipts. You will then need to apply for reimbursement
on a “ryoyo no hiyo seikyusho application form at the Labor Standards Inspection
Office, and attaching all your treatment receipts.
If you think your injury or illness is work-related, make sure to apply for
WACI; don’t use other health insurance. Once you start treatment using other
insurance, it is difficult to change over to WACI.
◆ Temporary Disability Benefits (for absence from work due to work-related
injury or illness)
If you apply to the Labor Standards Inspection Office using a “kyugyo hosho
kyufu shikyu seikyusho” application form, you can get Temporary Disability
Benefit as compensation for lost income from time off work.
◆ If you suffer aftereffects from work-related injury or illness
You may be eligible for a pension or a lump-sum payment, depending on the severity
of your aftereffects. If you die from injuries or illnesses sustained at work,
your family may be eligible to receive a pension.
For further Information:
Contact (through the FIA）the Labor Standards Inspection Office.
Pension plans
The National Pension, Employees’ Pension, and other pension plans offer
a minimum living standard to those unable to work due to old age, illness,
or injury.
＜National Pension Scheme (kokumin nenkin)＞
Under the National Pension Scheme, everybody receives a basic pension (kiso
nenkin). It provides income security in old age or in the event of disability
or death.
Everyone, including foreign nationals aged 20 to 59 must join the National
Pension Scheme. Your employer may offer the Employees’ Pension Scheme (kosei
nenkin) and Mutual-aid Pension Plan (kyosai kumiai) on top of the National
Pension Scheme.
◆ How to join
・ Apply at your local municipal office.
・ If you are already enrolled in the Employees’ Pension or Mutual-aid Pension
plans, you do not need to apply.
◆ Pension premiums
・ Pay your premiums through a post office or bank: details are on you bill.
You can also set up an account transfer.
・ If you are enrolled in the Employees’ Pension or Mutual-aid Pension plans,
your premiums are deducted from your salary or bonus.
◆ Payment problems
・ If you have difficulty in paying premiums because your income is very low,
you may be fully or 50% exempt from payment; ask at your local office.
・ If you are a student, you may be able to defer your premium payments until
after you finish studying. Apply through the Student Special Payment System
(gakusei nofu tokurei seido). Students on some vocational, language, dressmaking,
and other courses are not eligible for this scheme.
◆ Benefits
You are eligible for benefits under the National Pension Scheme when you become
old, disabled, or other household members may be eligible if you die. Types
of pensions include:
・ Old-age Pension (rorei kiso nenkin)
・ Disability Pension (shogai kiso nenkin)
・ Survivor’s Pension (izoku kiso nenkin)
・ Widow’s Pension (kafu nenkin)
・ Lump-sum Death Benefit (shibo ichiji-kin)
・ Old-age Welfare Pension (rorei fukushi nenkin)
Eligibility conditions vary from pension to pension. You need to apply
in order to receive any of these benefits.
◆ When you leave Japan
・ There is a lump-sum refund system for you when withdrawing from the National
Pension or the Employees’ Pension plan.
・ If you are a foreign resident and have paid pension premiums for more than
6 months, you can receive a lump-sum refund as long as you meet certain conditions
and apply within 2 years of leaving Japan.
・ In certain cases you can receive benefits after leaving Japan.
（See “Lump-sum Withdrawal Refund System” on the next page.）
Note: For details, ask (through the FIA) at the local municipal
office in your area
＜Employees’ Pension Scheme＞
・ Workers employed by companies, factories, shops, etc. enroll in this scheme.
While the main purpose is to provide living security for workers in old age,
the system also serves as a safety net for those unable to work due to injury
or illness and to those where the head of household dies.
・ All private companies, without exception, must take out this insurance. Insurance
premiums are borne by employers and employees. The amount of the premium differs
according to the employee’s wages.
(For inquiries, contact the social insurance office for your company.)
・ People not covered by the Employees’ Pension Scheme, such as the self-employed,
the unemployed, and those engaged in agriculture, forestry, and fishery fields,
must join the National Pension Scheme.
(For inquiries, contact the municipal office in your area.)
◆ Lump-sum Withdrawal Refund System (dattai ichiji-kin sikyu seido)
・ There is a lump-sum refund system for those withdrawing from the National
Pension or Employees’ Pension plans.
・ Under this system, foreign residents who have paid pension premiums for more
than 6 months can receive a lump-sum refund if they apply as required, within
2 years of leaving Japan.
・ You can get a form for claiming the lump-sum refund, called dattai ichiji-kin
seikyusho (available at the social insurance office), before leaving Japan.
After you leave, fill in the application form and send it together with any
required documents to the relevant social insurance office in Japan.
(For inquiries, contact the social insurance office for your company.)
Note: For details, inquire at each relevant office through the FIA.
Contact (through the FIA):
Local municipal office for information about the National Pension Scheme
The social insurance office for information about the Employees’ Pension Scheme.
High medical expenses
When your part of medical treatment costs exceeds a certain ceiling,
you are entitled to High Medical Expense Assistance. Apply through the
health insurance section of your municipal office if you are enrolled
in National Health Insurance, and at your company or your company’s social
insurance office in case of the Employees’ Health Insurance. For further
details, contact the relevant office.
【Ceiling on patient’s treatment costs under the High Medical Expense
Assistance System】
The ceilings for inpatient/outpatient treatment at a single hospital or clinic,
per person per month, are:
Your income range The maximum you pay
Low income ※1 \35,400
Medium income ※2 \72,300 + (medical fees － \361,500)×1%
High income ※3 \139,800 + (medical fees － \699,000)×1%
※1 Low-income households: if you are exempt from municipal (residential) tax.
※２ Medium-income households: all those except low income or high income households.
※３ High-income households: if your annual income is over \6,700,000.
For further information (in Japanese):
If you are covered by National Health Insurance, contact your local municipal
office.
If you are covered by Employees’ Health Insurance, contact your company or
social insurance office.
Medical expenses for designated diseases
There are subsidies for treatment costs for a group of serious, and
currently incurable, chronic or progressive diseases. Some municipalities
are expanding the number of diseases covered.
◆ Scope of assistance
・ For designated diseases, your part of treatment costs are eligible for subsidies.
This excludes some treatments which are not covered by insurance schemes.
・ You pay part of your treatment costs, unless the disease is in an advanced
stage.
◆ Eligibility
In principle, if you are:
・ Resident in the municipality you are applying to.
・ Suffering from a nationally-designated disease and are currently receiving
medical treatment at designated medical facilities.
・ In principle, if you are the policyholder or a family member covered by Japanese
medical insurance programs.
◆ How to apply
・The patient or a family member should apply at the public health center.
For further information:
Contact (through the FIA) the public health center in your area.
Medical expenses for disabled people
＜Rehabilitation services＞
There is public assistance to subsidize medical expenses for treatment and
rehabilitation for adults over 18.
◆ Scope of assistance
・ The difference between your actual treatment costs and the part your insurance
scheme pays for treating or reducing disability. However, you may need to pay
part of your medical expenses, depending on your income.
◆ Eligibility
You are eligible if you meet all of the following requirements:
・ You the patient are a registered foreign resident.
・ You hold a “Physical Disability Certificate (shintai shogaisha techo).”
・ In principle, you the patient are enrolled in a Japanese public medical insurance
program.
・ You are being treated at a designated medical institution.
◆ How to apply
・ Apply at your local municipal office.
◆ Work-related disabilities
・ In your disability results from a work-related accident, Workmen’s Accident
Compensation Insurance applies on a priority basis.
For further information:
Contact (through the FIA) your local municipal office.
＜Medical treatment for the severely disabled＞
There is public assistance for adults and children with severe, physical or
mental disabilities, to cover the portion of medical treatment costs not
paid by insurance.
◆ Scope of assistance
・ The difference between your actual treatment costs and the part your insurance
scheme pays is fully subsidized, regardless of your disability. In some cases,
you may have to pay some of your costs; this will be calculated according to
your income. Assistance applies to all treatment covered by public medical
insurance schemes.
◆ Eligibility
・ If you hold a grade 1 or grade 2 “Physical Disability Certificate (shintai
shogaisha techo)”.
・ Anyone holding a grade A “Mental Retardation Certificate(ryoiku techo)”.
※ Some municipalities are expanding the scope of eligibility. Be aware, however,
that benefits may be restricted, depending on household income during the previous
year.
◆ How to apply
・ Apply at your local municipal office. Since schemes vary from area to area,
check details at the relevant section in your municipal office.
For further information:
Contact (through the FIA) your local municipal office.
Medical expenses for psychiatric disorders
There is a public assistance
scheme designed to alleviate, through subsidies, the burden of medical
expenses on psychiatric patients who need outpatient
medical care.
◆ Assistance with medical expenses for outpatients
・ In principle, 95% of medical expenses are covered(the patient is charged
the remaining 5%). In some municipalities, however, medical expenses are all
covered.
・ The patient themselves, or a family member, can apply at their local municipal
office.
◆ Mental Disability Certificate (seishin shogaisha hoken fukushi techo)
・ Apply at your local municipal office.
・ The certificate entitles holders to special tax allowances and reduction
of or exemption from many public service charges, such as admission charges
to a range of social and cultural centers.
For further information:
Contact (through the FIA) your local municipal office.
Medical Expenses when you have no fixed address in Japan
You can get a public subsidy for your medical expenses if you fall ill and
need inpatient treatment while traveling, or you otherwise have no fixed address
in Japan.
◆ Scope of assistance
・ Your medical expenses during hospitalization will be paid if you are unable
to pay your medical bills yourself.
◆ Eligibility
You need to meet all of the following requirements:
・ You require hospitalization while traveling.
・ You are entirely unable to pay for medical treatment, and there is no one
who can assist you.
・ You are not covered by a public income support system or medical insurance
program.
◆ How to apply
・ Apply to the municipality where you are being treated or where you were involved
in an accident.
・ This subsidy will be given only after the case has been appropriately checked.
For further information:
Contact (through the FIA) the local municipal office.
