Enrolling in National Health Insurance or Employees' Health Insurance in Japan

Researched from official sources · May 22, 2026

Every resident of Japan must enrol in one of two public health insurance routes determined by employment status.

Kokumin Kenkō Hoken (National Health Insurance, NHI) administered by the municipality covers the self-employed and non-employed; Kenkō Hoken (Employees' Health Insurance) packaged with Welfare Pension into the Shakai Hoken bundle covers full-time and qualifying part-time employees. Enrolment and withdrawal must be filed within fourteen days of the eligibility event; premiums are owed from the eligibility date regardless of filing date.

Estimated time

Same-day enrolment at the municipal counter for Kokumin Kenkō Hoken (NHI); employer-side filing for Kenkō Hoken within five days of hire, with the insurer typically issuing the qualification document within two to four weeks

Cost

¥0 for the enrolment filing itself; ongoing premiums set by route, prefecture, and income

What You Need

Tap to check off items as you gather them

Additional Items

  • Annual rate revision: the Kyōkai Kenpo employee health-insurance rate averages approximately 10.0% of standard monthly remuneration (split equally between employer and employee); the Welfare Pension rate is approximately 18.3% (also split equally). Both rates and the Hyōjun Hōshū Getsugaku (standard monthly remuneration) band schedule are revised each September; verify against the current Kyōkai Kenpo notice or your employer's HR for the figure applied to your salary.
  • NHI per-household annual premium ceilings (Medical Care portion, Late-stage Elderly Support portion, and — for ages 40–64 — Long-term Care portion) are set by Cabinet Order and revised annually. Recent municipal schedules reference Medical Care ceiling of approximately ¥660,000, Late-stage Elderly Support ceiling of approximately ¥260,000, and Long-term Care ceiling of approximately ¥170,000; verify against the current municipality notice.
  • Kumiai Kenpo society variance: several hundred company-specific health insurance societies operate in Japan; rates and supplementary benefits vary by society. The Hokenshō issued to an employee under a Kumiai shows the society's name and contact details; consult your specific society's Hokenshō for benefit details and Gendogaku Tekiyō Ninteishō issuance.
  • Long-term Care Insurance contribution (Kaigo Hokenryō) applies from the month including the 40th birthday. For Employees' Health Insurance it is added to payroll deduction (approximately 1.6% of standard monthly remuneration); for NHI it is added to the household premium notice.
  • Childbirth and Childcare Lump Sum (Shussan Ikuji Ichijikin): approximately ¥500,000 per birth, paid by the insurer (NHI municipality, Kyōkai Kenpo, or Kumiai) directly to the birthing facility under the Direct Payment System (Chokusetsu Shiharai Seido), substantially offsetting out-of-pocket childbirth costs.
  • At age 75 the resident automatically transitions to the Kōki Kōrei-sha Iryō Seido (Late-stage Elderly Medical Care System) administered by the prefecture-level Kōiki Rengō (Wide-area Union); NHI or Employees' Health Insurance coverage terminates by operation of law on the 75th birthday under Articles 50, 52, and 53 of the Act on Assurance of Medical Care for Elderly People. No separate application is required where the address-of-record is current.
  • Workplace injury and commuting injury are covered under Rōdōsha Saigai Hoshō Hoken (Workers' Accident Compensation Insurance, Rōsai) — a separate scheme. Do not present a Hokenshō for workplace-injury treatment; the Rōsai claim is filed through the employer or directly with the Labour Standards Inspection Office.
  • Health Insurance Card phase-out: since 2 December 2024, no new physical Hokenshō cards are issued. Existing physical Hokenshō cards remain valid until their printed expiry date. The Maina Hokenshō (registered My Number Card) and the paper Shikaku Kakuninshō are the two recognised certificate routes during the transition.

Step-by-Step

  1. 1

    Confirm residence registration at the city or ward office

    1. On arrival in Japan with a mid-to-long-term residence status, complete address registration at the city or ward office within 14 days of moving in
    2. Foreign residents present the Zairyū Kādo (Residence Card) and passport; the municipal counter updates the address field on the card
    3. Address registration triggers issuance of the Tsūchi Kādo (My Number Notification) and — on application — the chip-card Kojin Bangō Kādo (My Number Card)

    💡 Tip: The 14-day clock starts on the move-in date at the municipality, not the date of arrival in Japan.

  2. 2

    Determine your enrolment route

    1. If an employer has enrolled you (or will enrol you) in Employees' Health Insurance — typically a corporate employer or an unincorporated employer with five or more employees in covered industries — proceed to the employer-route steps. The Japan Pension Service administers the joint filing with Welfare Pension.
    2. Otherwise — self-employed, freelancer, agricultural or forestry worker, retiree under 75 not in employer coverage, unemployed, or part-time worker below the Employees' Health Insurance threshold — enrol in Kokumin Kenkō Hoken (NHI) at the municipal counter
    3. Part-time workers enrol in Employees' Health Insurance when working three-quarters or more of a regular full-time schedule (typically ≥ 30 hours per week), or when meeting all five conditions: weekly hours ≥ 20, expected employment period ≥ 2 months, monthly wage ≥ ¥88,000, non-student status, and employment at a specific covered workplace (employers with 51 or more enrolled employees following successive threshold reductions)

    ⚠️ Watch out: If your employer is required to enrol you in Employees' Health Insurance but has not filed within five days of hire, you remain technically eligible for NHI in the interim but only because formal acquisition of Employees' Health Insurance has not occurred. The Japan Pension Service may retroactively backdate enrolment when the employer files, requiring premium adjustments. You can request a Japan Pension Service investigation.

  3. 3

    File NHI enrolment at the municipal counter

    国民健康保険課 (Kokumin Kenkō Hoken-ka)

    Expat Resident Citizen
    Route 1 — National Health Insurance
    1. Visit the city or ward office NHI section (国民健康保険課 Kokumin Kenkō Hoken-ka or equivalent)
    2. Bring the Zairyū Kādo (foreign residents), the My Number Card or Notification Card, the Kenkō Hoken Shikaku Sōshitsu Shōmeishō (Certificate of Loss of Health Insurance Qualification) where transitioning from prior employer coverage, passport, bank account details for direct debit, and a personal seal if requested
    3. File the NHI enrolment slip (Kokumin Kenkō Hoken Hihokensha Idō-todoke) at the counter — same-day registration in most municipalities
    4. The first premium notice arrives by mail within roughly two to four weeks; choose direct debit (Kōza Furikae), payment slip at convenience store / post office / bank, or — for some municipalities — credit-card and smartphone-app payments

    💡 Tip: For a foreign resident with no prior-year Japan-source income, the income-proportional NHI component is generally zero in the first calendar year — only the per-capita and per-household components apply.

  4. 4

    Be enrolled by your employer in Employees' Health Insurance

    健康保険 (Kenkō Hoken) — 社会保険 (Shakai Hoken) bundle

    Expat Resident Citizen
    Route 2 — Employees' Health Insurance
    1. The employer collects identification documents, the Zairyū Kādo (foreign workers), My Number, and family-dependent information
    2. Within five days of employment start, the employer files the joint Employees' Pension Insurance and Employees' Health Insurance application (Kenkō Hoken / Kōsei Nenkin Hoken Hihokensha Shikaku Shutoku-todoke) with the Japan Pension Service
    3. The insurer — Kyōkai Kenpo (default for small and medium employers) or the company's Kumiai Kenpo society — is determined by the employer's arrangement; the employee does not select
    4. The insurer issues a Hokenshō (where legacy paper stock remains) or a Shikaku Kakuninshō for use until the My Number Card is registered as Maina Hokenshō — typically within two to four weeks of the filing

    💡 Tip: Dependents (Hifuyōsha) — spouse and children meeting the income threshold (general Kyōkai Kenpo ceiling around ¥1.3 million per year, with adjustments for adult dependents over 60 and persons with disabilities) — are enrolled without additional premium under the employer's joint filing.

  5. 5

    Withdraw from NHI when entering employer coverage

    Expat Resident Citizen
    If previously enrolled in NHI
    1. Bring the new Hokenshō or Shikaku Kakuninshō to the municipal NHI counter
    2. File the NHI withdrawal slip within 14 days of acquiring employer coverage
    3. Failure to withdraw causes parallel NHI and Employees' Health Insurance premium charges; refunds for overlapping NHI premiums are issued on retroactive withdrawal up to two years per the general municipal-tax statute of limitations

    ⚠️ Watch out: If the municipality does not detect employer enrolment on its own, NHI premium notices continue to be issued in parallel. Initiate the withdrawal filing as soon as the new Hokenshō or Shikaku Kakuninshō is in hand — bring identification (Zairyū Kādo, driver's licence) and the new employer document.

  6. 6

    Register the My Number Card as Maina Hokenshō

    マイナ保険証 (Maina Hokenshō)

    1. Via the Mainapōtaru online portal (mynaportal.cao.go.jp) using the My Number Card and a card reader, or an NFC-capable smartphone running the official Mainapōtaru app
    2. At a participating pharmacy or hospital reception terminal — the resident touches the My Number Card to the terminal and completes the registration on-screen
    3. Some bank-cooperated registration points also offer in-branch registration
    4. The Shikaku Kakuninshō (paper Qualification Confirmation Document) is issued by the insurer as the paper-only alternative for residents who do not register a Maina Hokenshō

    💡 Tip: The Ministry of Health, Labour and Welfare's My Number Card explainer (mhlw.go.jp/content/12400000/001406614.pdf) states: "Eligible individuals include not only Japanese citizens, but also foreign residents who meet the specified requirements, such as those residing in Japan for more than three months" — confirming foreign residents are equally subject to and beneficiaries of the Maina Hokenshō transition.

  7. 7

    Carry the certificate to medical visits

    1. At a participating clinic or hospital, present the Maina Hokenshō to the card reader at reception (or the Shikaku Kakuninshō / remaining valid paper Hokenshō where the terminal is not in service)
    2. Patient cost-share is 30% for ages 6–69, 20% for ages 70–74 (30% for high-income earners in the band), 10% for ages 75 and over under the Late-stage Elderly system (20% for above-average-income; 30% for high-income earners), and 20% for children under school age
    3. For an anticipated high-cost month, apply in advance to the insurer for the Gendogaku Tekiyō Ninteishō — presenting it at the cashier limits the upfront payment to the monthly ceiling for the applicable income bracket; Maina Hokenshō users have the ceiling applied automatically

    💡 Tip: Presenting a stale Hokenshō from a prior employer, a residence card alone, or a passport at a Japanese clinic results in the visit being billed at 100%. The current Hokenshō, Maina Hokenshō, or Shikaku Kakuninshō is the only document the facility's billing system reads.

  8. 8

    Maintain currency on life events

    1. Notify the municipality of any address change, household composition change, or income change within 14 days; the annual NHI premium recalculation occurs each June based on prior-year tax-declared income
    2. Employees' Health Insurance: marriage, child birth, dependent income changes, and Hyōjun Hōshū Getsugaku (standard monthly remuneration) band shifts (the band is revised each September based on April–June average earnings) are reported through the employer's HR or payroll function
    3. Moves within the same municipality require a Tenkyo-todoke; moves between municipalities require a Tenshutsu-todoke at the old municipality and a Tennyū-todoke at the new one — both within 14 days of moving

Local Tips from the Community

  • The 14-day enrolment clock starts on the move-in date at the municipality, not the date of arrival in Japan. Late filing does not waive premiums for the uncovered period — the system charges premiums from the eligibility date.
  • Failure to withdraw from NHI promptly on entering Employees' Health Insurance causes parallel premium charges. The municipality treats dual coverage as a clerical matter the resident must initiate; bring the new employer-issued Hokenshō to the NHI counter to file the withdrawal.
  • Since December 2024 the physical Hokenshō is no longer newly issued. A registered Maina Hokenshō (My Number Card configured as health insurance certificate) is the long-term default; a paper Shikaku Kakuninshō (Qualification Confirmation Document) is issued for residents who cannot or choose not to register a Maina Hokenshō.
  • For an anticipated high-cost month, apply in advance to the insurer for the Gendogaku Tekiyō Ninteishō (Eligibility Certificate for Ceiling-Amount Application). Presenting it at the cashier limits the upfront payment to the monthly out-of-pocket cap; Maina Hokenshō users have the ceiling applied automatically without a separate certificate.
  • Bilateral social security agreements (US, Germany, UK, France, Republic of Korea, Australia, Netherlands and others) may exempt assignees from Employees' Health Insurance for a fixed period; consult the Japan Pension Service for the current treaty list and the Certificate of Coverage process.

What Could Go Wrong

Visit the municipal NHI counter: The municipality defaults the NHI start date to the address-registration date rather than the date employer coverage was lost

Recovery: Bring the Kenkō Hoken Shikaku Sōshitsu Shōmeishō (Certificate of Loss of Health Insurance Qualification) issued by the previous employer's insurer. Without it, the municipality cannot anchor the start date to the coverage-loss event, which can produce a premium gap. The certificate is requested from the previous employer's HR or directly from the insurer (Kyōkai Kenpo branch or Kumiai).

Withdraw from NHI on entering employer coverage: Failure to withdraw from NHI promptly causes parallel premium charges on both schemes

Recovery: Bring the newly issued Hokenshō or Shikaku Kakuninshō to the municipal NHI counter and file the NHI withdrawal slip within 14 days of acquiring employer coverage. Municipalities will refund overlapping NHI premiums on retroactive withdrawal — the refund covers up to two years per the general municipal-tax statute of limitations — but the resident must initiate the withdrawal filing. The municipality does not auto-detect employer enrolment.

Present the Maina Hokenshō at a medical facility: Facility lacks a card-reader terminal and refuses to read the Maina Hokenshō

Recovery: Present the paper Shikaku Kakuninshō, a remaining valid paper Hokenshō (if still in date), or a Mainapōtaru qualification screen showing current insurance status. As a last resort, pay 100% at the facility and apply to the insurer afterwards for reimbursement of the over-co-payment portion.

Costs

Item Amount Payment Notes
NHI enrolment counter filing ¥0 N/A No fee to file NHI enrolment, NHI withdrawal, dependent registration, or address-change notification at the municipal counter.
Employer filing of Employees' Health Insurance ¥0 N/A No fee for the employer's joint Employees' Health Insurance and Welfare Pension filing with the Japan Pension Service. Employee bears no filing-counter cost.
Maina Hokenshō registration ¥0 N/A No fee to register the My Number Card as a Maina Hokenshō via Mainapōtaru, a participating pharmacy, or a hospital reception terminal.
Shikaku Kakuninshō (paper qualification document) ¥0 N/A Issued free by the insurer for residents who do not register a Maina Hokenshō or whose My Number Card has not yet been issued.
NHI annual household premium (Optional) ¥0 Direct debit, convenience-store slip, or municipal payment portal Calculated against household-aggregate prior-year taxable income, with a per-capita component, an optional per-household component, and an optional property-asset component (used by a small number of rural municipalities). For a foreign resident with no prior-year Japan-source income, the income-proportional component is generally zero in the first calendar year and only the per-capita and per-household components apply. Per-household annual ceilings are revised by Cabinet Order — see additional items.
NHI enrolment counter filing ¥0
Payment:
N/A
Notes:
No fee to file NHI enrolment, NHI withdrawal, dependent registration, or address-change notification at the municipal counter.
Employer filing of Employees' Health Insurance ¥0
Payment:
N/A
Notes:
No fee for the employer's joint Employees' Health Insurance and Welfare Pension filing with the Japan Pension Service. Employee bears no filing-counter cost.
Maina Hokenshō registration ¥0
Payment:
N/A
Notes:
No fee to register the My Number Card as a Maina Hokenshō via Mainapōtaru, a participating pharmacy, or a hospital reception terminal.
Shikaku Kakuninshō (paper qualification document) ¥0
Payment:
N/A
Notes:
Issued free by the insurer for residents who do not register a Maina Hokenshō or whose My Number Card has not yet been issued.
NHI annual household premium (Optional) ¥0
Payment:
Direct debit, convenience-store slip, or municipal payment portal
Notes:
Calculated against household-aggregate prior-year taxable income, with a per-capita component, an optional per-household component, and an optional property-asset component (used by a small number of rural municipalities). For a foreign resident with no prior-year Japan-source income, the income-proportional component is generally zero in the first calendar year and only the per-capita and per-household components apply. Per-household annual ceilings are revised by Cabinet Order — see additional items.
Total: ¥0

FAQ

Documents

Can I choose between NHI and Employees' Health Insurance?

No. Enrolment is determined by employment status. A person eligible for Employees' Health Insurance — through a corporate employer or a qualifying unincorporated employer with five or more employees — is enrolled there and is not eligible for NHI. NHI is the residual route for the self-employed, freelancers, agricultural and forestry workers, students above the dependent age, retirees under age 75 not in employer coverage, the unemployed, and part-time or short-term workers whose hours fall below the Employees' Health Insurance threshold.

What is the difference between Kyōkai Kenpo and Kumiai Kenpo?

Both are operators of Employees' Health Insurance. Kyōkai Kenpo (Japan Health Insurance Association) is the default insurer for small and medium-sized employers without their own in-house society — rates are set per prefecture and revised annually. Kenkō Hoken Kumiai societies (Kumiai Kenpo) are company-specific or industry-specific health insurance societies established by larger employers; they set their own contribution rates within statutory ranges and may provide supplementary benefits. The employee does not choose between them — the employer's existing arrangement determines which operator applies. The Hokenshō shows the operator's name.

General

How long do I have to enrol after moving in?

Fourteen days from the date of moving in to the municipality. The clock starts on the move-in date, not on arrival in Japan. Late filing does not waive premiums for the uncovered period — premiums are charged from the eligibility date regardless of when the slip is filed. A six-month delay in filing creates a six-month premium liability that must be paid.

How does the Kōgaku Ryōyōhi monthly cap work?

The Kōgaku Ryōyōhi Seido (High-cost Medical Care Benefit System) caps monthly out-of-pocket spending by income bracket. For an anticipated high-cost month, apply in advance to the insurer for the Gendogaku Tekiyō Ninteishō (Eligibility Certificate for Ceiling-Amount Application). Presenting the certificate at the cashier limits the upfront payment to the monthly ceiling for the applicable income bracket — eliminating the need to first pay the standard 30% and seek reimbursement. Maina Hokenshō users with the My Number Card registered have the ceiling applied automatically at the point of payment without a separate certificate.

Are foreign tourists covered by Japan's public health insurance?

No. Public health insurance covers only mid-to-long-term residents — those with a residence-card status of more than three months. Tourists and short-term visitors should hold private travel medical insurance; short-term tourists are not covered by Japan's public system and face substantial out-of-pocket medical costs at Japanese facilities.

Do I have to register my My Number Card as Maina Hokenshō?

Not strictly. The paper alternative — the Shikaku Kakuninshō (Qualification Confirmation Document) — remains available during the transition for residents who choose not to register a Maina Hokenshō or who have not yet been issued a My Number Card. The Maina Hokenshō route is the long-term default but is not mandatory. Existing physical Hokenshō cards already in circulation remain valid until their printed expiry date.

What happens at age 75?

NHI or Employees' Health Insurance coverage terminates by operation of law on the 75th birthday. The prefecture's Kōiki Rengō (Wide-area Union) acquires the resident under the Kōki Kōrei-sha Iryō Seido (Late-stage Elderly Medical Care System) automatically — no separate application is required where the address-of-record is current. A new insurance certificate is issued; if the existing My Number Card is already registered as a Maina Hokenshō, no re-registration is needed and the insurer identifier behind the card switches automatically.

I'm leaving Japan — what do I do?

File a moving-abroad notification (Kaigai Tenshutsu-todoke) at the municipality. NHI coverage terminates from the departure date and premiums are owed pro-rata up to the month of departure. Employees' Health Insurance coverage terminates on the last day of employment per the employer's filing with the Japan Pension Service. Welfare Pension contributions made over the qualifying period may be eligible for a Lump-sum Withdrawal Payment from the Japan Pension Service — consult the relevant guidance.

Does childbirth count as covered medical care?

Childbirth itself is not treated as a covered illness under the patient cost-share rules. However, the Shussan Ikuji Ichijikin (Childbirth and Childcare Lump Sum) of approximately ¥500,000 per birth is paid by the insurer directly to the birthing facility under the Direct Payment System, substantially offsetting out-of-pocket childbirth costs. Register the Direct Payment route at the birthing facility before delivery; otherwise the family pays the full invoice and seeks reimbursement of the lump sum from the insurer afterwards.

What if a clinic does not accept my Maina Hokenshō?

During the transition, some clinics and small facilities lack card-reader terminals. Present the Shikaku Kakuninshō, the remaining valid paper Hokenshō (if still in date), or a Mainapōtaru qualification screen as a fallback. Where the facility insists on a physical certificate and none is available, the resident can pay the full invoice up front and reimburse via the insurer afterwards, but this should be the last resort.

After This Process

  • → Register the My Number Card as Maina Hokenshō via Mainapōtaru, a participating pharmacy, or a hospital reception terminal once the card has been issued
  • → Apply in advance for the Gendogaku Tekiyō Ninteishō (Eligibility Certificate for Ceiling-Amount Application) where a high-cost month is anticipated, unless the Maina Hokenshō route applies the ceiling automatically
  • → From the month including the 40th birthday, the Kaigo Hokenryō (Long-term Care Insurance Contribution) is added — payroll deduction for Employees' Health Insurance or household premium notice for NHI
  • → At age 75, automatic transition to the Kōki Kōrei-sha Iryō Seido (Late-stage Elderly Medical Care System); no separate application where the address-of-record is current

Sources

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