Health Insurance in Japan

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Please note, the below information is to be used for reference purposes only. To ensure you get the most current information which is relevant for your particular case, please feel free to contact us for a free consultation.

There are three kinds of public health insurance in Japan, one of which is the National Health Insurance Program (NHIP or 国民健康保険= kokumin kenko hoken), and the other refers to the Work Place Health Insurance System (WPHIS) (職場健康保険=shokuba kenko hoken). The law in Japan requires all residents to enroll in one of the above health insurance systems.

  • 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 and meet certain criteria.

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 9.33% (as of April 2010 – previously 8.19%); Mie & Gifu have a 9.34% rate. Employees aged 40 -65 pay an additional 1.5% for Nursing Care Insurance (from April 2010 – previously 1.19%).

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 April 2010 (for a person living in Aichi Prefecture)

  • Medical & Nursing Insurance 健康保険・介護保険 (kenkō hoken / kaigo hoken)
    • Aged 40 – 65: Standard Monthly Remuneration x 10.83% x ½
    • Aged 20 – 40: Standard Monthly Remuneration x 9.33% 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 (earns on average 260,000 a month) would pay 12,129 + 19,955 + 1450 = 33, 543Yen

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.

Dependents Eligible under the Work Place Health Insurance System
In the case that the insured employee supports dependants, the dependants are eligible for coverage under the health insurance plan if the dependant’s annual salary is equal to or less than 1,300,000 Yen and upon and less than half of the insured employee. The term “dependents” included the spouse, parents, grandparents, great-grandparents, children, grandchildren, or siblings of the insured employee, who do not necessarily live with the insured employee, and non-blood relatives who share the same household as the insured employee.

To apply, the insured employee may apply and request coverage for family members with a ifuyosha-todoke (被扶養者届). If there is a change in the status for any dependents (birth, death, employment status, residence), the insured employee should inform their company administration division within five days of the change and ask for a hifuyosha-ido-todoke (被扶養者異動届).

Benefits available under the Work Place Health Insurance System
People insured may utilize health insurance at hospitals to help pay for medical visits, medication, surgery or hospital stays in the case of illness or injury. The insurance covers 70% of essential medical costs while the patient is required to pay the remaining 30%. Please note that coverage only applies to illness or injury and not to physical check-ups, cosmetic surgery, healthy pregnancies, or childbirth. If an employee is injured or ill at work, or commuting to and from work, Worker’s Accident Compensation Insurance (労災保険=rosai hoken) will cover any medical costs incurred.

Compensation for High Medical Costs
If the insured employee or one of the dependents covered by the policy receives medical attention at the same hospital, for the same illness or injury in a one-month period, and the medical costs incurred are 72,300 Yen or more, then the amount surpassing 72,300 Yen will be reimbursed.

Additionally, if two or more dependents (plus the insured employee) has medical costs of 21,000Yen or more each, and the combined medical costs are 72,300 Yen or more, then the difference may also be reimbursed.

Accident and Sickness Compensation
In the case a worker is injured or becomes ill on or traveling to work, is unable to work for four consecutive days or more, and is unable to receive regular wages, from the fourth day an insured person may receive Accident and Sickness Compensation (傷病手当金=shobyo teate kin). Compensation for time off is 60% of the average daily wages, starting from the fourth day of leave due to accident or sickness for up to 18 months.

However, if an individual receives Workers Accident Compensation Insurance (労災保険=rosai hoken), they may not be able to also receive Accident and Sickness Compensation; nevertheless if payments from Workers Accident Compensation Insurance are considered low, occasionally the difference may be paid.

Child Birth
Women covered by under the Work Place Health Insurance System who give birth may receive a lump-sum allowance for childbirth and nursing (出産育児一時金=shussan ikuji ichiji-kin) of 350,000 Yen per child. If a women is a dependant spouse of an insured employee, then a spousal lump-sum allowance for childbirth and nursing (配偶者出産育児一時金=haigusha shussan ikuji ichiji-kin) of 350,000 Yen per child will be made to the husband.

Additionally, for a certain period, employed women may also receive maternity leave (出産手当金=shussan teate kin) before and after they give birth. Compensation for time off due to labor (42 days prior to labor, 98 days in the case of twins, and 56 days after labor) is 60% of normal daily wages

If the insured employee or a dependent dies, payments for a portion of burial costs (埋葬料=maiso-ryo) may be received. Compensation for burial costs incurred for the insured employee who supported the livelihood of dependents, averages around one month’s salary (minimum of 100,000 Yen) and is paid to those dependents who bear the costs of burial. For the death of a dependant, compensation of 100,000 Yen is available.

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

National Health Insurance offers similar compensation as the Employees’ Health & Pension Insurance (see above), however it does not offer Accident and Sickness Compensation or Maternity Leave Compensation.

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

1) Medical Insurance Per Income Levy = (“Heisei 21” 2009 Residence Tax × 0.96)
Per Capita Levy = (number of persons insured × ¥39,604)
Per Income Levy = (“Heisei 21” 2009 Residence Tax × 0.27)
2) Support Contribution plus
Per Capita Levy = (number of persons insured × ¥11,079)
Per Income Levy (“Heisei 21” 2009 Residence Tax of insured people aged 40 to 64 × 0.18)
3) Nursing Care Insurance plus
Per Capita Levy (number of persons insured aged 40 to 64 × ¥10,526)

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. In January 2010, he 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. In January 2010, she 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

☆Free Interpreting Service

  • When you need to contact a governmental department and need an interpreter, did you know that we offer a free 3-way telephone service to help? It’s called Trio-Phone, and it’s as easy as calling us on 052-581-6112. See this link for details.

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