NHI is divided into two parts: National Health Insurance and Social Health Insurance (SHI, shakai hoken or kenko hoken). SHI covers employees, while NHI covers farmers, fishermen, small business owners, self-employed individuals, part-time workers and eligible foreigners. Dependents and spouses are covered by the same system as their financial head of household. In the context of this guide, references to NHI are understood to include SHI unless otherwise noted.
Japan´s NHI covers 70% of medical costs. Most treatments are included in the plan, but cosmetic surgeries, self-inflicted injuries, abortions, and elective dental work (such as orthodontics) are not covered. Injuries received in accidents are paid entirely by the party at fault.
Criticism of Japan´s National Health Insurance
Like any other government-administered program, NHI has its critics. Scandals involving misappropriations of funds (such as SIA employee embezzlement of nearly 200 billion yen in a failed resort chain) have led to complaints of corruption and inefficiency. As NHI is administered through individual municipalities, its premium rates can vary within a small geographic area - a frustrating financial inequality for a national social program.
As a result of these criticisms, private insurance and health care has become increasingly popular in Japan.
Cancelling NHI coverage
If you enter the NHI system, then decide you would prefer private care, be prepared for a battle. Japanese officials do not particularly care if foreigners opt out of NHI when they first arrive in Japan, but they are loathe to remove them from the system once registered. While it is possible to get off NHI, it is rarely convenient. Expect to make many trips to the municipal office if you find yourself in this position.
Save yourself the trouble and decide on your health insurance before you arrive in Japan. If you choose private insurance, do not register for NHI, even if you are directed to do so when filing your alien registration.
If you are working, make sure your employer does not automatically enrol you in the system. This is common practice in Japan and can be done without the employee´s knowledge. The last thing you want is to end up paying two insurance premiums!
For more on expat health care and related issues in Japan, visit our expat health website: ExpatHealth.org.