How does the state health insurance system work?
Healthcare expenditure in Japan is high according to the OECD criteria, over 10% of GDP, and care itself is of a high standard with outcomes comparable to those experienced by the USA. Average life expectancy is around the age of 83. Staffing levels are also comparable to those in the USA.
The public insurance system is divided into two parts, covering different groups of residents. Employees’ Health Insurance is further separated into:
- Union Managed Health Insurance
- Government Managed Health Insurance
- Seaman’s Insurance
- National Public Workers Mutual Aid Association Insurance
- Local Public Workers Mutual Aid Association Insurance
- Private School Teachers’ and Employees’ Mutual Aid Association Insurance
NHI covers students, the self-employed, the unemployed, and those working fewer than 30 hours per week, and is divided into:
- National Health Insurance for each city, town or village
- National Health Insurance Union
As an expat, you will need to register for public health insurance as soon as you arrive in Japan. Your monthly contributions will be deducted from your pay cheque if you are registered with Employees’ Health Insurance, and the amount deducted will be based on your salary.
Coverage for medical costs will vary depending on which scheme you have been registered with, but overall you will need to pay 10%, 20% or 30% of the costs of your healthcare, with the government covering the remainder. Fees are established by a regulatory committee and they also set monthly thresholds, depending on income and age. If your medical fees exceed this threshold, the excess will be reimbursed or waived by the government.
If you are not insured for any reason you will be liable for 100% of your medical fees, but if your household falls beneath a low-income threshold receiving a healthcare subsidy then the government will pay.
Hospitals must by law be run on a non-profit basis in Japan, and private companies are not allowed to own hospitals. Clinics must be owned by the doctors who work there.
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Who is eligible for state healthcare?
All residents will be eligible for one of the two national health insurance schemes, and registration is technically mandatory, although around 10% of the population refuse to register with the national scheme and there is no penalty if you do not comply. You cannot be denied coverage.
You should also check to see whether your home nation has a healthcare agreement with Japan, as this can affect your need to sign up to state health insurance.
How do you apply to join the state health insurance system?
Your employer should register you with Employees’ Health Insurance. If they have not done so, you may need to sign yourself up at the local municipal office. Not all government employees speak English, so you might need to arrange for interpretation.
If you are neither employed nor self-employed, you will need to register for NHI yourself. In either case, you will need to present your Alien Registration Card at the Residential Affairs Division at your local City Office or Ward Office. You must also contact the municipal office if you are going back to your home country; moving to another town or city; or changing your name or address.
You will need:
- your passport
- your residence card
- your My Number ID card, covering social security
You will then be sent a health insurance card in the post. You will need to bring this with you whenever you visit a GP, clinic or prescription pharmacy. It is valid for a year and you will be sent a new card every year until your residency ends.
You will be able to choose your own primary care provider.
What is covered by the state health insurance system?
Coverage in either of the national insurance schemes includes:
- primary care and GP visits
- pre-natal care
- infectious disease control
There is a separate system of insurance (介護保険, Kaigo Hoken) for long-term care, which is run by the municipal governments. If you are between 40 and 64 years of age, you will be asked to make contributions of around 1.5-2% of your income to cover this.
Are retirees covered by state medical insurance?
Elderly citizens have been eligible for state health insurance since 1983.
Retirees under the age of 75 will be covered by NHI, and so will your dependents.
If you are 75 or older, or 65 with a disability, you may be entitled to sign up with the Long Life Medical Care System (長寿医療制度, Choju Iryo Seido). Premiums for this are income-dependent: if you are on a low income, the government will cover 90% of your medical costs, otherwise it will pay the standard 70%.
If you are covered, your contributions will be deducted directly from your pension, but check with whichever insurance scheme you are covered by to see how this affects contribution payments from your home nation, if you are not in receipt of a Japanese pension.
Are students covered by state medical insurance?
If you are an international student you will be covered by the national scheme if you are in the country for over a year — enrollment is compulsory for overseas visitors if they are in the country for more than 12 months. However, you will not be fully covered: typically, the national scheme will cover around 70% of your healthcare costs and you will have to pay the remaining 30%.
Will your family be covered by your insurance?
Your family will be covered if you are eligible for NHI, otherwise you will need to take out private insurance that covers your dependents.
Is dental treatment covered by state health insurance?
The state schemes cover some basic dental care, but not more advanced treatment such as crowns or dental implants.
What are the contribution rates for state health insurance?
If you are covered by ESI, insurance for individuals is paid for by both employees and employers: this comprises around 95% of individual insurance coverage, and is part of your overall social insurance benefits (社会保険, shakai hoken). Your monthly health insurance premiums are based on your previous year’s income.
Your employer will pay half the monthly contribution, with the other half being deducted from your salary. Premiums vary depending on your income level, but in general are around 9.15% of your monthly salary. So if, for example, you are earning ¥300,000 ($2,753) per month you will have ¥27,450 ($252) deducted.
If you are signed up with NHI, you will be billed in June (the start of the tax year), for around ¥16,340 ($150) for your pension contribution, but are likely to be asked to pay monthly for additional health insurance coverage. Check with the NHI scheme to see whether this applies to you. If you are a student, unemployed or disabled, you can apply for a reduction.
Why buy private health insurance?
Most Japanese residents prefer to rely on the national scheme rather than taking out separate private cover, but as an expat you may wish to have private health insurance or travel insurance (私的保険, Shiteki or 旅行保険, Ryokou Hoken) to top up any treatment gaps or if you are not eligible for a visa or residency permit. You may also opt for private insurance to cover swifter access to treatment or for an added level of comfort, such as a private room in a hospital.
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What is covered by private health insurance?
The standard range of primary and secondary care will be covered by your private health plan, along with any elective treatments such as cosmetic surgery. It may also cover some pre-natal care, deliveries and pregnancy terminations, voluntary vaccinations, orthodontics, and health check-up exams, so check the conditions of your individual policy.
Those staying for under twelve months may also need to apply for private health insurance in Japan.
How much does private health insurance cost?
This will depend on factors such as your age and any pre-existing conditions, and the kind of package you opt for; a more expensive insurance package will give you more a extensive range of treatment and facilities. As so many variables have an effect on the cost of international private medical insurance in China, it becomes very difficult to give accurate estimates without knowing the full details of the coverage required. However, as a very rough guide, using a standard profile of a 40-year-old British male with no deductibles, no co-insurance, a middle-tier plan, all modules included and worldwide coverage excluding the US, a ballpark price of around £4,000/$5,000 might be expected. Were coverage to be expanded to include the US then the premium could increase to almost double that amount.
Which companies offer private health insurance?
The main international providers offer cover for Japan. The Health Insurance Authority (HIA) is the independent statutory regulator for the private health market, including the evaluation of any new regulations or legislation for consumers. It administers a Risk Equalisation Fund: this pays health credits to insurance providers for people over 60 to help to meet their higher claims costs. The amount of health credits vary by age, gender and level of cover, and are funded by a community rating health insurance levy paid by health insurers.
All private health insurance providers must sign up to the HIA and also need to satisfy various prudential requirements relating to the Central Bank of Japan. Providers include:
- Bharti AXA
- Cigna Global
- Foyer Global Health
- Pacific Prime
Glossary of health insurance terms
長寿医療制度 Choju Iryo Seido - Long Life Medical Care System
介護保険 Kaigo Hoken – long term care insurance
健康保険 Kenkō-Hoken - Health insurance for employees
国民健康保険 Kokumin-Kenkō-Hoken or NHI - National Health Insurance
社会保険 shakai hoken - social insurance benefits
私的保険/旅行保険Shiteki or Ryokou Hoken - private health insurance /travel insurance