Public health care

The National Health Insurance system

Public health care

Japanese citizens under 75 years old are eligible for NHI (National Health Insurance), as are all foreigners who have lived in Japan for more than one year. The one major exception is people who are receiving public assistance.

To register for NHI, a family submits a single application form to the appropriate section of their municipal office. Each member of the family is then issued his or her own insurance card.

You must update your NHI registration every time you change addresses, give birth, lose dependent status, or change to another form of insurance. You will also have to replace your NHI card if it is damaged or stolen.

In order to renew or update your registration, you will need your NHI card and your alien registration card. If you are making changes to your registration, you may need to submit a document verifying the change. If you change employers, for example, you will need to submit proof of your new employment. An excellent English-language explanation of the program can be found at the Forum of National Health Insurance .

Paying the NHI premium

NHI premiums are organized as regular taxes paid to local municipal offices. Premiums are calculated based on the previous year´s income, which means that rates for students and dependents are heavily discounted. The exact amount varies depending on what month you enter the system and where in Japan you live. Each municipality uses a slightly different formula to calculate insurance premiums.

Employees covered by SHI pay around 8% of their yearly income as an insurance premium, and an equal contribution is then made by the employer. Remember that the head of household is responsible for paying the premiums for all family members: penalties are enforced for those who pay late or not at all. They can range anywhere from accelerated expiration of insurance cards up to the complete cancellation of NHI coverage.

Getting care through NHI

In order to receive treatment, simply go to at any public medical facility. You will be provided with a form to apply for reimbursement. If you are receiving specialized treatment (such as acupuncture), you need to submit a doctor´s referral to be reimbursed. For all procedures you pay 30% of your treatment costs on site, and NHI pays the remaining 70%.

If you are injured in an accident, you should first file a police report, at which point you will be issued an Accident Certificate. Submit the Accident Certificate, your NHI card and a Form for Disability Caused by Other Party to the nearest NHI office. NHI will advance you the cost of your treatment, which will be paid back by the party at fault. If you injure yourself in an accident for which you are at fault (through alcohol or fighting, for example) you are not eligible for reimbursement through NHI.

NHI and the elderly

Once a person reaches 75 years of age, he is issued a new insurance card and is transferred into the Long Life Medical Care System. An insurance premium still must be paid, but the Long Life Medical Care System refunds 90% of medical costs instead of the previous 70%.

Further reading

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