- Best forAll registered residents — enrollment is mandatory
- RequiredResidence card · My Number card or notification letter
- TimeKokuho: 30–60 min at city hall · Shakai Hoken: employer-handled
- Official sourceMHLW Japan
What you need to know
- Health insurance enrollment is mandatory for all registered residents in Japan
- If your employer covers you: Shakai Hoken (社会保険) — enrollment is automatic
- If self-employed, student, or part-time: enroll in Kokuho (国民健康保険) at your city hall
- Insurance covers 70% of most medical costs; you pay the remaining 30%
- You must enroll within 14 days of moving to your municipality
Every resident registered in Japan must join Japan’s public health insurance system. This guide explains the two main programs — National Health Insurance (Kokuho) and Employee Health Insurance (Shakai Hoken) — covers enrollment, monthly costs, hospital visits, and what to do if you miss the enrollment window.
The Two Insurance Systems
Japan has two public health insurance tracks. Which one you join depends entirely on your employment status — not your visa type.
| Program | Who enrolls | Coverage | Premium set by |
|---|---|---|---|
| Shakai Hoken (社会保険) | Full-time / long-term part-time employees at companies with 51+ staff (from Oct 2024) | 70% of medical costs (you pay 30%) | Employer + employee split ~50/50; deducted from salary |
| Kokuho (国民健康保険) | Self-employed, freelancers, students, part-timers not covered by employer | 70% of medical costs (you pay 30%) | Your municipality; based on prior year income |
Key rule: enrollment is mandatory from the day you register your address at city hall. There is no opt-out for residents.
Kokuho vs Shakai Hoken: Detailed Comparison
| Feature | Kokuho | Shakai Hoken |
|---|---|---|
| Monthly premium (example) | ¥2,000–¥50,000+ (income-based; minimum ~¥2,000 for low income) | ~4.9% of salary (employer pays another ~4.9%) |
| Dependent coverage | Each family member pays separately | Spouse/children free as dependents |
| High-cost medical ceiling | Yes (Kōgaku Iryō-hi) | Yes (same ceiling system) |
| Maternity lump sum | ¥500,000 (Oct 2023) | ¥500,000 (Oct 2023) |
| Dental, vision | Basic dental covered; glasses not covered | Same |
| Where to enroll | City/ward hall (住民課) | Employer handles enrollment |
| English support | Varies by municipality; Tokyo/Osaka/Nagoya better | Handled through HR department |
Enrollment: Step-by-Step
Kokuho (self-employed / freelancer / student)
- Register your address at city hall (転入届, tennyu-todoke) within 14 days of moving in — this triggers Kokuho enrollment eligibility.
- Go to the insurance counter (国保の窓口) at the same city/ward hall. Bring: residence card (在留カード), passport, and My Number card or notification letter.
- Complete the enrollment form (国民健康保険被保険者資格取得届). Staff will calculate your premium.
- Receive your insurance card (保険証) — usually issued same day or mailed within 1–2 weeks.
- Pay monthly premiums via bank transfer (口座振替) or convenience store payment slips.
Shakai Hoken (company employee)
- Your employer submits enrollment to the Japan Pension Service (日本年金機構) — you don’t need to go to city hall.
- Receive your health insurance card from your employer (typically within 2 weeks of starting work).
- Premium deducted from salary automatically each month.
- If you leave your job, you have up to 20 days to choose: continue Shakai Hoken (任意継続, up to 2 years, full premium yourself) or switch to Kokuho at city hall.
How Much Will You Pay?
| Annual income (Kokuho, Tokyo 23 wards estimate) | Monthly premium approx. |
|---|---|
| ¥0–¥1,000,000 (just arrived / low income) | ¥2,000–¥6,000 |
| ¥2,000,000 (part-time / English teacher) | ¥12,000–¥18,000 |
| ¥4,000,000 (average full-time salary) | ¥25,000–¥35,000 |
| ¥6,000,000+ | ¥40,000–¥50,000+ |
Kokuho premiums drop significantly for people with low or no Japan income (e.g., in your first year, when Japan has no record of your prior foreign income). Request a premium reduction at city hall if your income is below ~¥1.5M.
Using Your Insurance Card at a Hospital
- Present your card (保険証) at reception when you arrive — always, even for repeat visits.
- You pay 30% of the standard fee (10% for children under 15 in most municipalities; 20% for age 70–74).
- High-cost ceiling: if a single month’s bills exceed ~¥80,100 (standard bracket), you apply for a refund (高額療養費制度). You can also get an advance exemption card (限度額適用認定証) from city hall to cap out-of-pocket at the counter.
- Dental: covered for basic treatment (fillings, extractions); cosmetic procedures not covered.
- Prescriptions: fill at a pharmacy with the prescription from the doctor; show insurance card for 30% cost share.
Finding English-Language Care
Most hospitals accept public insurance regardless of your language. To find English-speaking doctors, use these directories:
- Tokyo Medical Institution Information (Himawari) — search by specialty and English support
- JNTO Medical Institutions in Japan Guide
- AMDA International Medical Information Center: 03-5285-8088 (English, weekdays)
- Your local ward/city hall international affairs desk (国際課) can refer you to nearby multilingual clinics.
See the Move to Japan Checklist — health insurance enrollment is in Phase 2 (Week 1).
FAQ
Do I need Japanese health insurance if I have travel insurance?
Travel insurance is not a substitute for Japan’s public health insurance. If you are a resident (registered address), you are legally required to enroll in either Kokuho or Shakai Hoken, regardless of any travel or private insurance policy you hold.
What happens if I miss the enrollment deadline?
You can still enroll at any time, but you will owe back-premiums from the date you registered your address (or arrived on a long-term visa). There is no penalty beyond the unpaid premiums. Hospitals may refuse or charge full price until you have a valid card.
Is dental covered?
Basic dental is covered — fillings, extractions, and standard dentures. Cosmetic procedures (tooth whitening, implants, straightening braces) are generally not covered and must be paid in full. Ask your dentist upfront which parts are covered.
Can I use my insurance card at any hospital or clinic?
Yes — any hospital or clinic that accepts public insurance (the vast majority) will take your card. Clinics (クリニック) are cheaper for non-emergency visits; hospitals (病院) charge a surcharge for initial visits without a referral letter.
What if I leave Japan? Do I get a refund?
If you de-register your address before leaving, Kokuho premiums stop from that month. Any overpayments are refunded. Shakai Hoken ends when employment ends. You cannot receive a lump-sum pension refund through the health insurance card — that is a separate pension (nenkin) procedure.