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:

1. 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.


2. Persons who are enrolled in the Seaman’s Insurance Scheme, or the dependents of persons enrolled in the Seaman’s Insurance Scheme.


3. Members of the National Health Insurance Union, or dependents of members of the National Health Insurance Union.


4. Persons over age 75 (specialized insurance is provided for senior citizens over 75)


5. Persons receiving welfare benefits

NHIS enrollment requires that certain conditions be met. The following are situations in which a person must enroll in the NHIS.

1. When you quit, retire, are laid off, or are dismissed from your job. (see further detail below)


2. If you end your membership with the National Health Insurance Union


3. If you are a dependent of a person who meets the criteria of 1 and 2.


4. When you no longer receive welfare benefits


5. 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.

• 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

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:

When you unenroll from the NHIS

Other situations in which you will need to perform procedures regarding your NHIS enrollment

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)

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.