Demystifying Health Care in Japan, Part 1: Types of Health Insurance

WaNavi Japan offers “Demystifying the Japanese Healthcare System” workshop for international residents where you can learn how the healthcare system works in Japan and understand how to utilize various services. The workshop comes with hands-on activities including critical Japanese language learning exercises on essential words in case of a medical emergency, as well as CPR and AED training with the local fire department. Please contact us at contact@wanavi.org if you would like us to hold a healthcare workshop in your community!

If you are living in Japan for work, school, or as a family member of someone in Japan for school or work, you automatically have access to health care. But understanding the types, coverage available, and where and how to get care can be confusing and complicated, especially when it differs from our experience with our home country’s health care system. In Part 1 of our series Demystifying Health Care in Japan, we will explain the primary health insurance options available.

Types of Health Insurance in Japan

The two health insurance options are Social/Employees’ Health Insurance (SHI) or Kenkō Hoken(健康保険), and National Health Insurance (NHI) or Kokumin Kenkō Hoken(国民健康保険). SHI is for company employees or members of organizations and their dependents. NHI is for local residents, usually students, retired, self-employed workers or freelance workers. Foreign residents who intend to reside in Japan for 3 months or longer can join NHI.

The biggest difference between SHI and NHI is coverage of family members. SHI covers the employee as well as the employee’s family as dependents, and the premium is divided between the employer and the employee.
*An important note: To be an eligible dependent, the dependent’s income must be less than 1.3 million yen per year. If a dependent’s income exceeds this amount, that person will have to enroll in NHI or SHI him/herself separately.

For NHI, each member of the household has to be enrolled as an individual member and all the premiums, which are scaled according to annual income and differ according to each municipality, are charged to the head of the household. For both SHI and NHI, an insurance card is issued for each member to be presented when receiving medical care.

What Does Health Insurance Cover in Japan?

The benefit of these two types of health insurance is the availability of medical treatment at 10-30% of the total fee. The basic kinds of coverage include: acute and ongoing illness, chronic and/or preexisting conditions, tests and lab work with clinical indications, dental care excluding orthodontics, and psychiatric services.

Things not covered include injuries caused by traffic accidents or criminal cases, normal pregnancy and birth, cosmetic surgeries and orthodontics, health check-ups, vaccines, second opinions, psychological therapy or counseling services, and birth control. However, there may be some exceptions to these items, including subsidies granted by municipalities especially for health and pregnancy check-ups and vaccines. More information on what subsidies a municipality offers can be found at the respective ward/city office.

Pregnancy check-ups and children’s vaccinations are not covered by Japanese health insurance. Instead, after the pregnant person reports the pregnancy at the ward/city office, a Maternal and Child Health Handbook or Boshi Kenkō Techō(母子健康手帳)and coupons will be issued to cover the cost of prenatal check-ups. Likewise, after registering the birth of a child to the ward/city office, coupons will be issued to cover the cost of the recommended vaccinations. The Japanese immunization register might differ from your home country, so please check.

How are Children Covered under Japanese Health Insurance?

Children with NHI or SHI are eligible to receive Medical Care Certificate or Iryō-shō (医療証). The local municipality issues the card, with coverage varying slightly depending on the area. For example, in the main 23 wards of Tokyo, all medical costs for children up to 15 years of age are free. In Yokohama, all medical costs are free until the end of Grade 3, but from Grade 4 to 6, a maximum payment of 500 yen is incurred for each visit. You can check with your municipality for details.

What are the Rules on Enrolling in Health Insurance in Japan?
Health insurance is mandatory in Japan. However, there is no penalty for not having insurance (aside from being responsible for 100% of your medical fees). Every resident of Japan (except those residing in Japan for less than 3 months) has access to Japanese Health Insurance regardless of pre-existing conditions.

Image: example of an NHI

If you still have questions about health insurance and health care in Japan, please leave a comment below and keep an eye out for our additional posts on seeking health care!

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