★What's all the hoo-hah?

Updated: March 4, 2010

According to the Immigration Guideline Changes (March 2009), you would be required to present proof of enrolment "social insurance" if you want to renew your visa. So your visa would be linked to enrolment in government-approved health insurance (kokumin kenko hoken, shakai hoken, or shigaku kyosai). Being enrolled in a private travel insurance scheme would not satisfy immigration.

However, as of February 2010, the wording has now been revised to read:"In order to promote signing up for social insurance, foreign residents will be asked to present their health insurance card starting April 1, however renewal applications or change of visa status applications will not be rejected for failing to present the card."

Japan Times Link: http://search.japantimes.co.jp/cgi-bin/nn20100304a1.html

☆Insurance Options

■Shakai Hoken 社会保険 Employees' Health & Pension Insurance (EHPI)
Consists of both a health insurance and a pension component.

■Kokumin Kenko Hoken 国民健康保険 National Health Insurance (NHI)
Government health insurance scheme primarily for the unemployed or self-employed. Available from your ward/local city office. Those not enrolled on shakai hoken must also enrol.

■Shigaku Kyousai 私学共済Private Schools Mutual Aid Society Insurance
Similar to shakai hoken, but for those working in private schools and universities.

★Shakai Hoken 社会保険 Employees’ Health & Pension Insurance (EHPI)

By law all employers are required to have their regular employees enrolled in the health insurance system (this excludes temporary or daily workers) if the hours worked in a day or on a monthly basis by the employee equals 3/4 or more of the time worked by full-time employees.

Basically it means that as regular employees generally work a 40-hour week, If you (on average) work less than 30 hours per week your employer isn't obliged to enrol you in EHPI.

Voluntary Coverage
You may be covered as voluntary status if you have at least 2 consecutive months covered under the Employees’ Health Insurance just before your retirement/resignation from work.

Apply directly to the Social Insurance Office within 20 days after your retirement. Under this type of coverage, you are covered for up to 2 years, and your coverage ends when the 2 years has passed. It is one time only and it can not be renewed.

The Cost
Your insurance contribution is shared by you and your employer equally. Your employer is responsible for paying your share of contribution and employer’s share of contribution to the Social Insurance Office. The premiums you pay throughout the year are based upon your total annual taxable salary (excluding bonuses) divided by 12. Premiums are deducted from bonuses separately. Your average monthly salary from the employer is classified into a prescribed remuneration table, and your Standard Monthly Remuneration is determined. Up until August 2009, the medical insurance rate was a flat 8.2% across Japan. As of September 1, 2009 this was changed to a Prefectural rate. The rate for Aichi is 8.19%; Mie & Gifu are also 8.19%. Employees aged 40 -65 pay an additional 1.19% for Nursing Care Insurance.

So if you earn 3 million a year - on average 250,000 a month - you would fall into the 260,000 Standard Monthly Remuneration bracket.

As of September 2009

Medical & Nursing Insurance健康保険・介護保険 (kenkō hoken / kaigo hoken)
Aged 40 - 65: Standard Monthly Remuneration x 9.38% x ½
Aged 20 - 40: Standard Monthly Remuneration x 8.19% x ½

Pension 厚生年金 (kōsei-nenkin)
Standard Monthly Remuneration x 15.35% x ½

Employment Insurance雇用保険 (koyō-hoken)
Standard Monthly Remuneration x 4% x ½
- some industries the rate is 5%

Example: 25 year-old Kim would pay 10,647 + 19,955 + 1450 = 32,052 Yen

If you opt for the voluntary coverage after retirement, you pay the whole contribution: employer's share and your share. For this coverage purpose, the Standard Monthly Remuneration is either 280,000 Yen or your Standard Monthly Remuneration at retirement, whichever the lower.

★Kokumin Kenko Hoken 国民健康保険 National Health Insurance (NHI)

The way National Health Insurance (NHI) contributions are calculated varies from city to city. The examples and amount shown below are for Nagoya City only. If you move from Nagoya to another city (for example Toyota), you would have to withdraw from the Nagoya NHI and enrol in the Toyota NHI. In Nagoya, the amount of NHI you pay depend is based on your Residence Tax. Residence Tax is based on your income from the previous year. Residence Tax is issued in June, and NHI payments are issued in July.

☆Annual Insurance Premiums (Nagoya City - fiscal year 2009)
National Health Insurance Premium = Medical Insurance + Support Contribution + Nursing Care Insurance

The maximum annual premium for medical insurance is ¥470,000, ¥120,000 for support contributions, and ¥100,000 for nursing care insurance. These rates change each fiscal year.

☆Example Calculation - based on 2009 Nagoya City rates

Example 1
42 year-old Nic lives in Nagoya’s Midori Ward. He is married with one young child, and all 3 are covered by Nic's NHI. Nic is over 40, so has to pay 3) Nursing Care Insurance.Nic's Residence Tax bill came to ¥100,000 and his 38 year-old wife's ¥50,000; a family total of ¥150,000.

This family's 2009/10 NHI contribution would be:

1)Medical Insurance (¥262,812 ) + 2)Support Contribution (¥73,737) + 3)Nursing Care Insurance = ¥365,070

Example 2
42 year-old John lives in Nagoya's Showa Ward and arrived in Japan in May 2009. He wants to renew his one-year visa, so decides to enroll in NHI at his local ward office. He earned no income in Japan during 2008, and so paid zero in Residence Tax.

His total 2009 /10 NHI contribution would be 39,604 + 11,079 + 10,526 = ¥61,200

This is pro-rated for the 5 month period (Nov 2009 - March 2010) giving a total of ¥25,500.
Based on his 2009 salary and subsequent residence tax calculation, the ward office will issue him a bill for 2010 (Apr) - 2011 (Mar) NHI contributions in July 2010.

Example 3
25 year-old Jane lives in Nagoya's Atsuta Ward and arrived in Japan in May 2007. She wants to renew her three-year visa, so decides to enroll in NHI at her local ward office. Since she arrived she has been using a travel insurance policy.
Jane is asked by the ward office to retroactively pay NHI contributions for the past 2 years (2007/08 & 2008/09) plus the current year's contributions (2009/10).
Based on her 2007 (¥0), 2008 (¥150,000), & 2009 (¥150,000) residence tax totals the ward office calculate how much she needs to pay. To her dismay, the final total is over 500,000 Yen! The ward office decides a payment plan and Jane pays the contributions in monthly installments.

☆Key Vocabulary
Medical Insurance 医療分 - いりょうぶん
Support Contribution 支援金分 - しえんきんぶん
Nursing Care Insurance - かいごぶん
Residence Tax (aka municipal resident’s tax) 住民税 - じゅうみんぜい
Annual Insurance Premium - 年間保険料 - ねんかんほけんりょう

☆Further Reading
All About Employees'  Health Insurance - http://www.sia.go.jp/e/  
All About NHI - www.kokuho.jp 
General Union www.generalunion.org  
Nagoya City National Health Insurance Guide - http://bit.ly/nhi-nagoya  (short URL)
Japan Times Article - http://bit.ly/nhi-jt  (short URL)
Immigration Guideline Changes www.moj.go.jp/NYUKAN/nyukan70.html