I have been in Japan for 10 years, and am currently working as an English language instructor. Rather than being employed by one school, I am a contractor for several schools. Up to now, I've never been enrolled in Japan's health insurance, but I'm thinking about enrolling. If I do sign up, what will happen with my payments?
Anyone who has an address in Japan must enroll in kenkō hoken (健康保険 / health insurance), Japan's public medical insurance. Foreign nationals who have been granted a status of residence of more than three months and are registered as residents are also required to enroll in kenkō hoken.
In principle, residents are enrolled in the Kokumin Kenkō Hoken (国民健康保険 / National Health Insurance) administered by the municipality in which they reside, except if you are enrolled in another type of kenkō hoken, for example if you are employed by a company and are enrolled in kenkō hoken through your employer. It is important to understand that kenkō hoken is public medical insurance; it does not correspond to medical insurance provided by an insurance company.
In your case, as you are unable to enroll in kenkō hoken through an employer, for example, you will need to enroll in Kokumin Kenkō Hoken. In principle, enrolment is compulsory from the time you register as a resident of your municipality, as is the obligation to pay insurance fees (hokenryō / 保険料. Some municipalities refer to this as hokenzei / 保険税 or "insurance tax," and collect fees as a tax.).
Although you are obliged to pay insurance fees/tax from the time you are required to enroll in kenkō hoken, there are limits specified by law concerning the period for which municipalities can demand payment of unpaid insurance fees/tax. For insurance fees (hokenryō), the limit is two years of unpaid fees; for insurance tax (hokenzei), the limit is five years of unpaid tax. Unless there is a suspension in the time limit, you will not be asked to pay unpaid insurance fees/tax from before this period.
In a case such as yours, where you were required to enroll in kenkō hoken 10 years ago and pay insurance fees/tax from that point, if you were to complete the enrolment procedure now, it is expected that you will be asked to pay either two or five years of your unpaid insurance fees/tax.
In any case, please consult the appropriate counter at your municipal office about enrolling in Kokumin Kenkō Hoken, and the fees/tax you will need to pay, as early as you can.
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