New to Japan? This guide explains who must join National Health Insurance (NHI), how copayments work, what’s covered (and what isn’t), how premiums are calculated, step-by-step enrollment at your city/ward office, My Number card changes, key benefits, and money-saving tips.

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What National Health Insurance is

Japan requires all residents to enroll in public health insurance so you can receive care at hospitals, clinics, and pharmacies by paying only a portion of the bill (typically 10–30%). Foreign residents who meet the requirements are also eligible.

NHI (国民健康保険, “Kokumin Kenkō Hoken”) is run by each municipality. If you are not enrolled in an employer plan, you will generally enter NHI through your city or ward office after you register your address.

Who needs to join

You must join NHI if you live in Japan and are not covered by Employees’ Health Insurance (EHI) or the separate system for residents aged 75+. Typical NHI members include the self-employed, students, those between jobs, part-time workers, and family members who are not certified as dependents under an employee plan.

Foreign residents staying more than three months fall under Japan’s public health insurance rules. Enroll in the appropriate system (EHI via your employer, or NHI via your municipality).

Who is exempt or ineligible

• Short stays: Visitors or residents staying three months or less are not eligible for Japan’s public schemes.
• Covered by another country: If your country has a social security agreement with Japan and you bring a Certificate of Coverage, you may be exempt from joining NHI. Check with your city office.
• Already insured: If you are (or become) covered by Employees’ Health Insurance, you don’t join NHI. Your HR handles EHI enrollment; coverage is compulsory for eligible company workers.

NHI versus Employees’ Health Insurance

EHI (employee plans) covers the worker and certified dependents (spouse/children who meet income and residence tests). NHI treats each resident as a separate member; households pay premiums as a unit, but there is no “dependent certification” like EHI. If your partner and children are not certified dependents on an EHI card, they typically need their own NHI enrollment.

For choosing the right path: if you’re on a standard work contract, you’ll usually be placed on EHI; otherwise, expect NHI via your city/ward office. For finding English-friendly hospitals after you enroll, see International Patient Services.

What NHI covers (and what it doesn’t)

Under Japan’s public insurance, you show proof of insurance at the clinic/hospital/pharmacy and pay only your copay. The insurer pays the rest directly to providers. Coverage includes medically necessary outpatient care, hospitalization, many dental treatments, and prescription medicines under the national fee schedule. You pay full price for items not covered (e.g., most routine adult checkups, cosmetic procedures, private hospital room upgrades).

High-cost protection: When monthly out-of-pocket expenses exceed your income-based cap, the High-Cost Medical Expense Benefit reimburses the excess. You can apply in advance for an Eligibility Certificate for Ceiling-Amount Application to avoid large upfront payments.

To prepare for costs like vaccines or dental extras, see Vaccinations and Health Check-ups for Expats in Japan and Dental and Vision Care in Japan.

How copayments work at the counter

At the point of service, your copayment depends on age (and, for seniors, income). The standard rates are:

• Under compulsory school age (before elementary school): 20%
• From elementary school start to age 69: 30%
• Ages 70–74: 20% (30% for higher-income households)
• Ages 75+: 10%, with a 20% bracket for some since Oct 1, 2022; 30% for those with income comparable to working-age earners.

If you verify insurance at the clinic or pharmacy, you’ll generally pay only 10–30% instead of 100%.

Need urgent care now? Read Navigating Emergency Medical Services in Japan for 119/ER tips.

Specific Health Checkups

If you are 40–74 and on NHI, you’ll be invited annually to Specific Health Checkups aimed at preventing lifestyle diseases. If your results exceed certain standards, the city offers tailored health guidance.

For preventive care options and private screening packages, see Full-Body Health Screenings in Japan.

Childbirth and other cash benefits

While normal childbirth costs are generally not covered as “treatment,” NHI provides a Childbirth Lump-Sum Allowance of ¥500,000 per child (including stillbirths/miscarriages at ≥85 days), typically paid directly to the facility through a direct payment system. Application windows and proofs vary by city.

Some municipalities also offer funeral expense benefits under NHI. Check your ward’s guide for the amount and procedure.

For maternity-related care, visit Pregnancy and Childbirth in Japan.

Premiums: what you’ll pay and why it varies

NHI premiums are determined by your municipality, household composition, and prior-year income. The annual bill is a sum of:

1. an income-based amount (using the previous year’s income of household NHI members), and
2. a per-capita amount charged per enrolled person.

There are three portions: the medical treatment portion, the support portion for the older-adult system, and a long-term care portion (only if your household has members age 40–64).

Premiums are billed to the head of household (even for non-NHI members) and are typically paid monthly by bank auto-debit or with payment slips. If you join mid-year, charges start from the month you became eligible, not the day you applied—so you may owe back premiums from that month.

If you move into a new city, the office may first charge only the per-capita amount and recalculate once it obtains your income data; your bill can change later.

Reductions and exemptions

Municipalities offer targeted relief:

• Preschoolers: The per-capita portion for preschoolers is halved automatically.
• Special hardship: Disasters (windstorm, flood, fire) or a sharp income drop due to death, injury, or illness may qualify your household for temporary reduction/exemption of premiums (consult the city first; documentation required).
• Older dependent transitions: When a person over 65 moves from being a dependent under employee insurance to older-adult coverage, certain NHI reductions can apply for a limited period if they join NHI in the interim.

If you’re struggling to pay, contact your Payment Guidance Center promptly to discuss options; late or missing payments can curtail your certificate’s validity, and in some cases you may need to pay 100% at the counter and later claim the insured portion back from the city.

How to enroll step by step

Most enrollments happen at the city/ward office right after you file your address (moving-in) notification.

Deadline: Submit the NHI enrollment within 14 days of becoming eligible (e.g., moving into the ward or losing EHI). Likewise, submit a withdrawal within 14 days when you leave the ward or switch to EHI, and return your insurance card/certificate.

Bring:

• Residence card and passport (ID)
• My Number (for you and each household member enrolling)
• Moving-in slip or proof of address registration
• Proof of disqualification from another insurance (if switching)

Municipal lists vary; confirm with your ward office.

Students: Long-term student residents generally join NHI through their municipality (unless exempt via a Certificate of Coverage). See International Patient Services: Getting English Help at Hospitals for language support, and your school’s guidance.

Using your My Number card as your health insurance certificate

Japan is phasing out the paper health insurance card. You can verify insurance at clinics and pharmacies using:

• My Number Card (after registration),
• the traditional Health Insurance Certificate (valid until Dec 1, 2025 at the latest), or
• a Health Insurance Eligibility Certificate (issued from Dec 2, 2024) if you don’t have a My Number card.

Presenting one of these normally lets you pay just 10–30% of the total cost.

Tip: Bring your My Number card to the ward office or register via Mynaportal so you can start using it as your insurance certificate.

High-Cost Medical Expense Benefit and how to use it

If your monthly out-of-pocket costs exceed the cap for your income/age bracket, the excess is reimbursed under the High-Cost Medical Expense system. To avoid large upfront bills for scheduled hospitalizations, apply in advance for the Eligibility Certificate for Ceiling-Amount Application and show it at admission. (Meal costs, private room fees, and non-covered care are excluded.)

Planning a surgery or long stay? Ask your ward about the certificate before admission. For guidance in English, try the Tokyo Metropolitan Health and Medical Information Center’s hotline.

Moving, switching, or leaving Japan

• Changing wards/cities: Notify the old and new municipalities and re-enroll in the new city; premiums will be recalculated.
• Switching to EHI: When your EHI begins, file NHI withdrawal within 14 days and return your card.
• Leaving Japan: File NHI withdrawal and settle any remaining premiums or refunds when you depart. Using an invalid card after losing eligibility requires you to reimburse the insurer.

For hospital finder tips and English support lines, see Top 5 English-Speaking Hospitals in Tokyo and International Patient Services.

Quick reference tables

Copayment rates by age (standard cases)

Age group	Typical copay
Preschool (before elementary school)	20%
Elementary school start to 69	30%
70–74	20% (30% for higher-income)
75+	10% or 20% (30% for income comparable to working-age)

Notes: Exact brackets for seniors depend on income. Check your municipality’s notice.

What NHI commonly covers vs not covered

Covered with copay	Not covered (full self-pay)
Doctor visits, tests, hospitalization, surgeries	Cosmetic procedures, most routine adult checkups, private room surcharges, some advanced (non-insured) treatments
Many dental treatments and prescriptions under the national fee schedule	Some dental materials/upgrades beyond insured options

Confirm details with your provider before treatment.

Enrollment steps and documents

Step	What to do	Where	Bring
1	Register your address	City/ward office	Residence card, passport
2	Enroll in NHI within 14 days of eligibility	City/ward office NHI counter	My Number for each member, ID, proof of losing prior insurance (if switching)
3	Choose payment method	City/ward office or online forms	Bankbook/card for auto-debit (recommended)
4	Consider high-cost certificate if planning hospitalization	City/ward office (benefits section)	ID, application form

Premium components at a glance

Component	What it is	Who it applies to
Medical treatment portion	Income-based + per-capita amounts	All NHI households
Support portion (older senior support)	Nation-wide cost sharing	All NHI households
Long-term care portion	Income-based + per-capita	Only if household has members 40–64

Premium math and caps differ by municipality.

Money-smart tips for expats

• Enroll on time. Waiting too long doesn’t erase premiums—you may be charged back to the month of eligibility.
• Set up auto-debit. It helps you avoid missed payments that could limit your certificate’s validity.
• Use the high-cost certificate before planned admissions to keep upfront costs manageable.
• Bring your My Number card and register it so your copay is applied smoothly at reception. Paper cards end by Dec 1, 2025; eligibility certificates are available if you don’t have My Number.
• Keep your receipts (and itemized statements) after care, especially if you expect high-cost refunds or are filing taxes.

For related guidance, explore Claiming Health Insurance Reimbursements in Japan, Mental Health for Expats, and International Patient Services.

Frequently asked questions

Do I need private insurance too?
Japan’s public insurance is comprehensive for medically necessary care. Some people add private policies for income protection or private-room options, but it’s not required.

Can my spouse/child be on my card?
Under EHI, dependents can be certified and covered on the worker’s plan. Under NHI, each resident joins individually (household is the billing unit). Check which system your family should use.

Are vaccinations and routine health checks covered?
Many adult vaccines and routine checkups are outside standard insurance; municipalities often subsidize them separately. NHI members aged 40–74 get Specific Health Checkups invitations. See Vaccinations and Health Check-ups for Expats in Japan for practical options.

What happens when I turn 75?
You automatically move to the Medical Care System for Older Senior Citizens, and your NHI premiums are adjusted accordingly up to the month before your 75th birthday.

I’m leaving Japan. What should I do?
File withdrawal within 14 days and return your card; settle any premiums or refunds. Using an invalid card later requires paying back the insurer.

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Final checklist for a smooth start

• Register your address and join NHI (or EHI) right away.
• Bring My Number, residence card, and IDs for enrollment.
• Set up bank auto-debit for premiums.
• Consider the high-cost certificate before big procedures.
• Keep an eye on Specific Health Checkups invitations if you’re 40–74.

For more living-in-Japan essentials, you might like International Patient Services: Getting English Help at Hospitals, Top 5 English-Speaking Hospitals in Tokyo, and Claiming Health Insurance Reimbursements in Japan.

Disclaimer

This article is for general informational purposes only and does not constitute professional advice. Laws, prices and regulations vary by location and change over time. Consult a qualified professional for guidance on your specific situation.