Health Insurance for Foreign Residents in Japan: NHI vs Employee Plans

Foreign nationals living in Japan for more than three months generally join public medical insurance, regardless of nationality. Those eligible for their company’s health insurance (social insurance) join that scheme, and everyone else joins National Health Insurance (国民健康保険) at their local municipality. Which one applies depends on how you work, whether you receive officer’s remuneration, and your status of residence.

Employer health insurance versus National Health Insurance

Under both schemes, the patient’s share of costs at medical institutions is in principle 30%. It is 20% for children before primary school and 20% or 30% for those aged 70 to 74 depending on income. Both schemes also have a high-cost medical expense benefit that caps out-of-pocket costs when medical bills are large. People aged 75 and over join the Late-Stage Elderly Medical Care System.

Who joins employer health insurance (social insurance)

A corporation is a covered workplace for health insurance and employees’ pension insurance even if its only member is a president receiving officer’s remuneration. Regularly employed staff and officers receiving remuneration are enrolled regardless of nationality. Health insurance and employees’ pension insurance are in principle joined together, and those aged 40 to 64 also pay long-term care insurance premiums.

• Executives on a Business Manager visa: If you receive officer’s remuneration from your own company, you join the company’s health insurance. If you receive no remuneration, you generally join National Health Insurance and the National Pension.
• Part-time workers: Those working at least three-quarters of the hours and days of regular employees are enrolled. Even below three-quarters, people working 20 hours or more a week at companies above a certain size, among others, are covered.
• Staff seconded from mainland China: The Japan–China Social Security Agreement covers pensions only, not medical insurance. Those employed by a Japanese company join health insurance under the Japanese system.

Check pension enrolment at the same time

Everyone aged 20 to 59 living in Japan joins the public pension system, regardless of nationality. Those in employer health insurance join employees’ pension insurance, and those in National Health Insurance generally join the National Pension. People seconded from a mainland Chinese company for a planned period of up to five years may, through the social security agreement, be exempted from Japanese employees’ pension insurance if they complete the procedure. Foreign nationals with six months or more of pension coverage who leave Japan can claim a lump-sum withdrawal payment within two years of departure.

Enrolment requirements and procedural deadlines are explained in detail in Employers’ social and labor insurance obligations.

Who joins National Health Insurance, and how

Who is eligible

Eligible people are foreign nationals for whom a certificate of residence is created and who are not enrolled in employer health insurance or similar. Generally, this means mid- to long-term residents granted a period of stay exceeding three months, among others. The following people cannot join.

• Those with the Temporary Visitor or Diplomat status of residence
• Those under Designated Activities who came to Japan to receive medical treatment, and their attendants
• Those under Designated Activities staying for sightseeing or recreation, and their spouses
• Those enrolled in employer health insurance and their dependants, and those receiving public assistance

Even with a period of stay of three months or less, people with statuses such as Entertainer, Technical Intern Training or Dependent may be able to join if they can show in documents that they will stay for more than three months. Detailed practice varies by municipality, so check at your local office.

Procedure and deadline

Once you have arrived and settled on an address, complete enrolment at the municipal office together with your moving-in notification. The deadline is within 14 days of becoming eligible. Eligibility arises from the date you began living there, so even if you enrol late, you will pay premiums retroactively from that date.

How National Health Insurance premiums are set

National Health Insurance premiums (called National Health Insurance tax in some municipalities) are calculated per household and paid by the head of household. They combine an income-based portion with a portion based on the number of members and other elements, and add up the medical portion, the late-stage elderly support portion and, for those aged 40 to 64, the long-term care portion. Rates vary by municipality. If you have just arrived and have no prior-year income in Japan, also check how this is handled at the municipal office.

When you take a job and join employer health insurance, or when you leave Japan, you must withdraw from National Health Insurance. If you do not, premium bills may continue.

Insurance cards and My Number health insurance cards at medical institutions

New issuance of conventional health insurance cards ended on 2 December 2024, and the standard is now the “My Number health insurance card”, using the My Number Card as an insurance card. Those without a My Number Card, or who have not registered it for insurance use, receive an eligibility certificate from their insurer.

• Mid- to long-term residents with a residence card can also apply for a My Number Card if they have a certificate of residence.
• The My Number Card’s expiry date is linked to the expiry of the period of stay. When you extend your period of stay, also update the card’s expiry at the municipal office.
• If you receive treatment before enrolment is complete, one option is to pay the full amount and claim a refund later.

Preparing for childbirth and high medical costs

Under both employer health insurance and National Health Insurance, a lump-sum childbirth allowance is paid on giving birth. If medical costs are expected to be high, for example because of hospitalization, applying to your insurer in advance limits payment at the counter to the out-of-pocket cap. A growing number of medical institutions let you skip this application if you use a My Number health insurance card.

Covering family as dependants: the domestic residence requirement

Under employer health insurance, family members who meet income and other requirements can be covered as dependants. Since April 2020, they must in addition in principle have an address in Japan (be on a certificate of residence).

If an exception applies, submit the notification with documents such as a visa or certificate of enrolment. The procedure for bringing family to Japan is explained in Dependent visa requirements.

Unpaid premiums and immigration review

Reviews for extending the period of stay, changing status of residence and permanent residence check the payment of taxes and social insurance premiums. For permanent residence, properly fulfilling public obligations is one of the requirements. For details, see Permanent residency requirements and key points in the review.

The Ministry of Health, Labour and Welfare has indicated a policy, in cooperation with the Immigration Services Agency, of introducing from June 2027 a system under which foreign nationals with unpaid National Health Insurance or National Pension premiums will in principle not be allowed to extend their period of stay or change their status of residence. Check future announcements from the Ministry and the Immigration Services Agency for how it will operate in practice. Company executives should also make sure the company pays its social insurance premiums on time, not just their own.

If paying National Health Insurance premiums becomes difficult, for example because of a fall in income, do not leave it; consult the municipal office early. Depending on circumstances, you may be able to discuss a reduction or exemption, or payment in instalments. Private medical insurance and overseas travel insurance are not substitutes for public medical insurance. Join public insurance first and consider private cover as an addition where needed.

How TIMOA can help

For foreign nationals, which health insurance scheme applies depends on officer’s remuneration, how you work and your status of residence. Covering family as dependants is subject to a domestic residence requirement, and premium payment records also bear on immigration reviews. Working with partner labor and social security attorneys (社会保険労務士) and administrative scriveners (行政書士), TIMOA supports company social insurance procedures, family members’ status of residence and getting settled after arriving in Japan. For details, see our Private Client Services.