- 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.
Quick Answer: Which Health Insurance System?
| Your Situation | Insurance Type | How to Enroll |
|---|---|---|
| Company employee (full-time, part-time ≥30 hrs/wk) | Shakai Hoken (社会保険) — employer-sponsored | Employer handles enrollment automatically within 5 days of hire |
| Freelancer / self-employed / part-time under threshold | Kokuho (国民健康保険) — national health insurance | Register at your city/ward office within 14 days of losing previous coverage |
| Dependent of enrolled employee | Shakai Hoken (as dependent / 扶養) | Employee’s HR registers the dependent — income thresholds apply |
| Student visa (enrolled in Japanese school/university) | Kokuho — student discount available | Register at city office; ask about student reduction (学生の軽減) |
Eligibility conditions vary. Consult your employer’s HR department or your local city/ward office for confirmation. Insurance premiums depend on your previous year’s income.
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. For the enrollment process itself, many city halls have international affairs desks (国際課 kokusaika) with multilingual staff — always call ahead to confirm English availability before visiting.
Finding an English-Speaking Counter at City Hall
- Ask for the 国際課 (kokusaika) — the international affairs section. In Tokyo wards (Shinjuku, Minato, Shibuya, etc.) this desk speaks English and can guide you through enrollment paperwork.
- Tokyo Metropolitan Government Welcome Center (Shinjuku, B1): free consultation for Tokyo residents in English, Chinese, Korean. Call 03-5321-3010.
- CLAIR (Council of Local Authorities for International Relations) operates multilingual Living Information Centers in many cities: clair.or.jp/tagengo/
- MIC (Multicultural Coexistence) offices: major prefectures (Aichi, Osaka, Kanagawa) have dedicated multilingual administrative support. Search “国際交流城” + your city name.
- If staff at your local city hall don’t speak English, ask them to call the Japan National Tourism Organization’s Japan Visitor Hotline (050-3816-2787, 24h English) — they can relay information.
Insurance Card vs. My Number Card (マイナ保険証)
Japan is transitioning from the traditional health insurance card (保険証) to using the My Number card (マイナカード) as the insurance card. This is one of the most practically confusing issues for foreign residents in 2025–2026.
| Feature | Traditional insurance card (保険証) | My Number card as insurance (マイナ保険証) |
|---|---|---|
| Format | Paper or plastic card issued by insurer | Your My Number (マイナ) card linked to insurance at clinic terminal |
| Issuance | Mailed after enrollment. Takes 1–3 weeks. | Requires My Number card (マイナカード) issued to your name, with insurance linkage activated via online or at city hall |
| Acceptance | All clinics and hospitals | Only clinics with a card reader terminal (マイナ対应). Smaller clinics may not have one yet. |
| Foreign residents | Available immediately after enrollment — no My Number card required | Requires a valid My Number card, which must be issued separately at city hall. Some foreign residents’ cards expire before the My Number card process completes. |
| Status as of 2026 | Still valid but being phased out. Original deadline was Dec 2024; extended to at least 2025. Check current government policy. | The intended long-term standard; government is pushing adoption but not all systems are ready |
- When you enroll in Kokuho or Shakai Hoken, you will receive a physical insurance card in the mail within 1–3 weeks. Use that card at clinics until you have set up My Number linkage.
- Apply for your My Number card at your city hall (takes 4–8 weeks to arrive). It is separate from enrollment and not required to use insurance.
- If your residence card and My Number card expire on the same date, renew both and re-link — the My Number linkage does not automatically transfer.
- Before any medical visit, confirm the clinic accepts your card type (traditional vs My Number card reader). When in doubt, bring both.
Official source: Ministry of Health, Labour and Welfare — My Number card as insurance card (Japanese; confirm latest status here as policy is actively evolving).
Finding English-Speaking Doctors
- Tokyo Medical Institution Information (Himawari) — search by specialty and English support
- JNTO Medical Institutions Guide
- AMDA International Medical Information Center: 03-5285-8088 (English, weekdays 9am–8pm)
- Your ward/city hall 国際課 can refer you to nearby multilingual clinics on file.
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.
Sources & Official References
- Moving to Japan Checklist
- Living in Japan Guide
- Finding a Doctor in Japan — clinics, hospitals, and specialist referrals for foreign residents
- Japan’s Hospital and Clinic System — how to navigate inpatient and outpatient care
- Mental Health Resources in Japan — English-language support services for expats
- Cost of Living in Japan — monthly budget planning for residents
Important: This page is for general informational purposes only and does not constitute medical advice. Health insurance premiums, coverage details, and enrollment procedures vary by municipality, employer, and insurance type. Procedures and eligibility rules change periodically. Consult your municipality’s international affairs desk, your employer’s HR department, or a qualified healthcare navigator for guidance specific to your situation. In a medical emergency, dial 119.
- My Number Card as insurance card (from December 2025): Physical NHI cards (green cards) are being phased out. Your My Number Card (マイナンバーカード) now functions as your health insurance card at most clinics and hospitals. Apply for your My Number Card and link it to your insurance via the My Portal online service.
- Visa renewal compliance rule (from June 2027): From June 2027, foreign residents with unpaid NHI premiums or unpaid National Pension contributions will, in principle, be denied visa renewal or status changes. Paying premiums on time is now directly linked to your immigration status. If you cannot afford premiums, apply for a reduction (減額申請) at city hall rather than skipping payment.
- Premium cap changes (August 2026): NHI income-based caps will increase in August 2026. The mid-tier cap (Tier ウ) rises from ¥80,100 to approximately ¥85,800 per month. Confirm your household’s applicable premium with your city hall after August 2026.