At first glance, the Japanese health insurance system my seem more than a little opaque; and employers are often unhelpful when it comes to signing up (English conversation schools and dispatch firms being the biggest culprits). 

But fear not, we at AccessJ have your back with our newest guide.

The Basics
In Japan, the term "health care" (健康保険 kenko hoken) refers to a plethora of public, semi-public, and private schemes. There are two main forms of insurance available to the public: National Health Insurance (国民健康保険 kokumin kenko hoken or NHI) and Employee Health Insurance (sometimes referred to as Social Insurance 社会保険 shakai hoken or government managed insurance 政府管掌保険 seifu kansho hoken--both of which are a bit out of date but still used). Employee Health Insurance (EHI) actually covers a whole group of public and semi-public systems (which we will cover in due time).

There is also an optional private component known as Medical Care Insurance (医療保険 iryohoken) which will reimburse the portion of medical expenses not covered by your insurance, in addition to survivor benefits. Cancer Insurance (がん保険 gan hoken) is private and, as the name implies, covers cancer treatment not covered by the aforementioned public and private systems.

Unlike the US, pre-existing conditions are not a factor for NHI and EHI but aren't typically covered by private supplementary insurance.

Who Needs Insurance?
According to the letter of the law, any individual with a valid status of residence (在留資格 zairyu shikaku) residing in Japan for a year or more must be enrolled in NHI or employee sponsored insurance insurance. Your overseas health insurance coverage is not considered sufficient reason to skip out on the Japanese system, although some universities and vocational schools don't require short term study abroad students to sign up provided they have health care back home. There are several firms that cater to short term visitors but they are usually limited to reimbursement payments.

Where to get Insurance
When it comes to NHI and EHI, there are two basic ways to sign up: go to the NHI Division (国民健康保険課 kokumin kenko hoken-ka) of your local city hall (市役所 shiyakusho) or ward office in big cities (区役所) or, in the case of EHI, your employer will do it for you.

If you sign up for NHI, bring your alien registration card (外国人登録証明書 gaikokujin toroku shomeisho) or a passport with a valid status of residence sticker. Also bring your official seal (印鑑 inkan) if you have one, although sometimes a simple signature will suffice. Usually EHI is all done behind the scenes once you are hired, although some companies may have additional paperwork. 

As we will discuss in future instalments NHI differs by prefecture, so some may issue a health insurance card on the spot while others may post it to your house. Some  prefectures only give one card per family while others give a passbook. EHI cards are mailed to you or your employer. 

An example of health insurance certificates

Well, that about covers the first half our AccessJ's introduction to the Japanese health insurance system. 

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