🏥 Complete Guide to National Health Insurance (NHI) in Japan

Japan has a universal healthcare system — virtually every resident is expected to be enrolled in some form of health insurance. If you live in Japan as a foreign resident, this applies to you too. National Health Insurance (NHI), known as Kokumin Kenko Hoken, is the public health insurance program managed by your local city or ward office.

When you visit a doctor, NHI covers 70% of eligible medical expenses. You pay the remaining 30% out of pocket at the hospital or clinic. For example, if a doctor visit costs 10,000 yen in total, you would pay 3,000 yen and NHI covers the rest. Children under 6 pay only 20%, and adults aged 70-74 also pay 20% (depending on income).

What NHI Covers

NHI covers a wide range of medical services. This includes regular doctor visits (outpatient care), hospitalization and surgery, prescription medications, basic dental treatments like fillings and cleanings, mental health consultations and therapy, and rehabilitation services. Most standard medical care you would need in daily life is covered.

However, some treatments are not covered by NHI. These include cosmetic surgery, certain advanced treatments not listed on the national formulary (such as some cancer treatments), fertility treatments beyond basic coverage, and any medical services you receive outside Japan. If you need a treatment that is not covered, you will need to pay the full cost yourself or consider private insurance.

NHI vs. Employer Insurance

There are two main types of health insurance in Japan. If you work for a company, your employer will likely enroll you in Shakai Hoken (employee health insurance). In this case, you do not need to join NHI — your employer handles everything, and the premium is split 50/50 between you and your employer.

NHI is for everyone else: freelancers, self-employed individuals, students, part-time workers not eligible for employer coverage, unemployed residents, and dependents not covered by a family member's employer plan. The key difference is that with NHI, you pay 100% of the premium yourself, whereas with employer insurance, your company pays half.

If you leave your job, you typically need to switch from employer insurance to NHI within 14 days. Make sure to get a "certificate of insurance loss" from your previous employer to bring to city hall.

To enroll in NHI, you need to be a foreign national living in Japan with a valid residence card and a registered address. Your period of stay must exceed 3 months. If you meet these conditions and are not already covered by your employer's insurance, you are expected to enroll.

The most common groups who need NHI include: freelancers and self-employed workers, international students studying at Japanese schools or universities, people who are between jobs or currently unemployed, part-time or contract workers whose employer does not provide health insurance, and family members (dependents) who are not covered under someone else's employer plan.

You do not need NHI if you are a short-term visitor on a tourist visa (staying less than 3 months), if you are already enrolled in employer-sponsored health insurance (Shakai Hoken), or if you are receiving public assistance (seikatsu hogo).

Not sure whether you need NHI? The simplest way to find out is to visit the National Health Insurance counter at your local city hall or ward office. The staff can check your status and walk you through enrollment if needed. Many offices have multilingual support or interpretation services available.

Enrolling in NHI is done in person at the National Health Insurance counter at your local city hall or ward office. There is no enrollment fee, and the whole process usually takes about 30 minutes. You should enroll within 14 days of becoming eligible — for most people, this means within 14 days of moving to Japan and completing your resident registration.

Step-by-Step Enrollment Process

Before you can enroll in NHI, you first need to complete your resident registration by submitting a moving-in notification (tennyuu todoke) at city hall. This registers your address, which is required for NHI.

Once your address is registered, head to the NHI counter in the same building. Look for signs that say "National Health Insurance" or ask at the information desk. A staff member will give you the enrollment application form and help you fill it out. Many city halls have multilingual support staff or interpretation tablets available.

After you submit your application and documents, you will receive a temporary insurance certificate on the same day. You can use this immediately at hospitals and clinics. Your official NHI insurance card (hokensho) will arrive by mail at your registered address in about 1-2 weeks.

Required Documents

Bring the following documents when you go to enroll:

• Residence Card — this is your primary form of ID in Japan and proves your eligibility
• Passport — for additional identity verification
• My Number Card (or the My Number notification letter you received after registering your address)
• Seal (Inkan) — a personal stamp used for official documents in Japan. If you do not have one yet, many offices will accept a signature instead

Important — do not delay enrollment. Even if you enroll late, your premiums will be calculated retroactively from the date you became eligible. This means you could owe several months of premiums at once. Enroll as soon as possible to avoid unexpected charges.

How Premiums Are Calculated

NHI premiums are not the same everywhere — they vary depending on which city or ward you live in. Your premium is calculated based on several factors. The biggest factor is your previous year's taxable income: the more you earned, the higher your premium. There is also a flat per-capita charge for each person enrolled in your household, and some municipalities add an asset-based charge if you own property. Finally, there is a flat household charge that applies regardless of how many people are in your household.

For a single person with moderate income, annual NHI premiums typically range from about 100,000 to 400,000 yen. Students or people with no income may pay as little as 20,000 yen per year, while high earners can pay up to the annual cap of around 800,000 yen.

Payment Methods

Premiums are billed in 8-10 installments throughout the year. You will receive payment slips by mail. There are three main ways to pay: set up automatic bank deduction (most convenient — the premium is pulled from your bank account each month), pay at a convenience store using the payment slips, or pay by credit card in some municipalities that support it. Setting up automatic deduction is recommended since you will not miss a payment.

Premium Reduction for Low-Income Residents

If your household income is low, you may automatically qualify for a premium reduction. The reduction tiers are 70% (lowest income), 50% (low income), and 20% (moderate-low income). To receive this reduction, you must file a tax return, even if your income is zero. The municipality uses your filed income to determine eligibility. Many international students qualify for the 70% reduction, which can bring annual premiums down to around 20,000 yen.

If you are struggling to pay: Do not ignore your premium bills. Unpaid premiums can lead to your insurance card being replaced with a short-term certificate, or in serious cases, you may be required to pay 100% of medical costs upfront. If you are having financial difficulty, visit your city hall to discuss payment plans or additional reductions — options are available, but you need to ask.

At the Hospital or Clinic

Using your NHI card is simple. When you arrive at any hospital or clinic in Japan, hand your insurance card to the receptionist at the front desk. You do not need an appointment at most clinics — just walk in during business hours. After you see the doctor, receive treatment, or get prescriptions, you pay only 30% of the total cost at the payment counter. NHI covers the other 70% automatically behind the scenes.

For example, if your total medical bill is 5,000 yen, you pay 1,500 yen. If you need prescribed medication, take your prescription to any pharmacy and show your NHI card again — the same 30% co-pay applies to prescriptions.

Cost Sharing by Age Group

The 30% co-pay rate applies to most adults aged 6-69. However, different age groups have different rates. Children under 6 pay only 20% (and many municipalities cover even this amount, making children's healthcare essentially free). Adults aged 70-74 pay 20% if their income is below a certain threshold. And those aged 75 and over pay just 10%. These lower rates help protect the most vulnerable populations.

High-Cost Medical Expense Benefit

One of the most important protections NHI offers is the high-cost medical expense benefit (Kogaku Ryoyohi). If your out-of-pocket medical costs in a single month exceed a certain amount — which depends on your income level — the excess is refunded or covered by insurance. For a person with standard income, the monthly cap is approximately 80,000 yen. This means even if you have surgery that costs 1,000,000 yen, you would pay at most around 80,000 yen out of pocket for that month.

To make this even easier, you can apply for a Limit Certificate (Gendo-gaku Tekiyo Ninteisho) in advance at your city hall. With this certificate, the hospital will only charge you up to the cap amount — so you do not have to pay the full amount and wait for a refund.

When You Lose or Damage Your Card

If your NHI card is lost, stolen, or damaged, visit your city hall as soon as possible to apply for a reissue. Bring your residence card for identification. A replacement card is usually issued within 1-2 weeks. In the meantime, you can request a temporary certificate to use at hospitals.

Moving to Another Municipality

If you move to a different city or ward, you need to transfer your NHI enrollment. First, visit your old city hall to withdraw from NHI and return your card. Then, within 14 days of moving, visit your new city hall to re-enroll. Your premiums will be recalculated based on the new municipality's rates, which may be higher or lower than your previous location.

For Students

International students are eligible — and expected — to enroll in NHI. The good news is that with little or no income, most students qualify for the maximum 70% premium reduction, bringing annual costs down to around 20,000 yen or less. To receive this reduction, you must file a simplified tax return at your local tax office, even if your income is zero. Your school's international student office can usually help you with this process.

For New Arrivals

If you just arrived in Japan and had no income here during the previous fiscal year, your initial NHI premiums will be relatively low. They will be calculated based only on the per-capita and household portions, with no income-based component. However, be aware that your premiums may increase significantly the following year once your Japan-based income is reported on your tax return. Budget accordingly.

Leaving Japan

If you are leaving Japan permanently, you need to cancel your NHI enrollment before you depart. Visit your city hall with your NHI card and residence card. Staff will calculate your final premium balance — if you owe anything, you will need to pay it before leaving. If you have overpaid (for example, if you paid for months you will not be in Japan), you can receive a refund. Since you will no longer have a Japanese bank account, you will need to designate a representative in Japan or provide a bank account to receive the refund.

Pregnancy and Childbirth

NHI provides a generous lump-sum birth allowance (shussan ikuji ichijikin) of 500,000 yen per child. In most cases, this money is paid directly to the hospital, so you do not need to pay the delivery costs upfront. Regular prenatal checkups are partially subsidized through separate municipal vouchers that you receive from your city hall when you report your pregnancy — these vouchers cover most routine checkup costs. NHI also covers complications during pregnancy and childbirth, though normal delivery itself is not considered a "medical treatment" and is covered by the lump-sum allowance instead.