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Social insurance · 健康保険 · kenkō hoken

Health insurance in Japan for foreign residents

Health insurance is compulsory for everyone who lives in Japan for more than 3 months, foreigners included. It pays 70% of your medical bills and caps what you pay in a month when the bills are large. Which insurance is yours, how to join, what it costs, what replaced the old insurance cards, and what you get when you are ill or have a baby.

Which insurance is yours

Social insurance overview

Checked against the websites of the Ministry of Health, Labour and Welfare, Kyōkai Kenpo and city offices on October 7, 2026 · Pension · Family and dependents

Of the bill you pay; insurance pays 70%30%

Monthly cap on your medical costs, income up to about ¥3.7M¥61,500

Old insurance cards no longer accepted fromAug 1, 2026

To join National Health Insurance after arriving or leaving a job14 days

In short

Health insurance in five lines

  • Two kinds: employees are insured through the company (Health Insurance, 健康保険, kenkō hoken); everyone else is in their city’s National Health Insurance (国民健康保険, kokumin kenkō hoken).
  • 30%: that is the share of the bill you pay; insurance pays the rest.
  • The old cards are gone from August 1, 2026. At the doctor you use the My Number Card as Health Insurance Certificate (マイナ保険証) or the Health Insurance Eligibility Certificate (資格確認書).
  • Large bills: you never pay more than a monthly cap — for example ¥61,500 with an income up to about ¥3.7 million a year.
  • Deadlines: join National Health Insurance within 14 days. The premium is charged even if you never see a doctor.

Two kinds of health insurance

Through your job, or National Health Insurance

National Health Insurance is the basic scheme that everyone living in Japan for more than 3 months must join if they are not insured at work — students, the unemployed, freelancers. An employee gets Health Insurance through the company.

Through work (健康保険) National (国民健康保険)
Who full-time employees; part-timers with 20 hours a week or more at companies with more than 50 insured staff (students excepted) students, freelancers, the unemployed — everyone living in Japan for more than 3 months who is not insured at work
Who enrolls you your employer, within 5 days you, at the city office, within 14 days
Premium a percentage of your standard monthly remuneration, half paid by the employer (your share in Tokyo: 4.925%) based on last year’s income plus a fixed part for each family member
Family dependents are insured free a premium is charged for each family member
Injury and sickness allowance (傷病手当金) yes — 2/3 of standard pay no
Childbirth allowance (出産手当金) yes no
Lump-sum childbirth payment (出産育児一時金) ¥500,000 ¥500,000
Your share of medical bills 30% 30%

Who is in which system with a part-time job, and who cannot join National Health Insurance: Social insurance in Japan.

What it covers: you pay 30%, insurance pays the rest

Seeing a doctor for a simple cold without insurance can cost ¥10,000; with insurance you pay ¥3,000.

Who Your share
Children before school age 20%
From school age to 69 30%
Ages 70–74 20% (30% with a high income)

Show your insurance every time you see a doctor or go to the hospital. It covers consultations, treatment and prescription medicine, but not every procedure. Many cities also pay part or all of children’s medical costs — Yokohama, for example, covers them in full up to age 18 from June 1, 2026. More: children in Japan.

What it does not cover

  • Care that is not treatment of an illness: routine checkups, preventive procedures, abortion without a medical reason, plastic and cosmetic surgery.
  • Treatment outside the insurance, such as dental implants. Ordinary dental treatment is covered at the usual 30%.
  • The fixed charge for hospital meals and the extra charge for a private room (差額ベッド代).
  • The costs of a normal pregnancy and birth. A Caesarean section done for medical reasons is covered. For the birth itself, insurance pays a lump sum of ¥500,000 (see below).

Some language schools take out extra insurance for their students that refunds the 30% — then treatment can be free. It is the school’s decision; ask yours.

Your insurance document

マイナ保険証 or 資格確認書

The old plastic health insurance cards (健康保険証) are no longer valid in Japan. If a clinic cannot confirm your insurance, you may be charged 100% of the bill — you can claim the insurer’s share back later.

  1. December 2, 2024No new ordinary insurance cards are issued.
  2. December 1, 2025All cards already issued have expired — at the latest on this day.
  3. July 31, 2026The grace period in which hospitals still accepted expired cards ended.
  4. From August 1, 2026At the doctor: only the My Number Card as Health Insurance Certificate or the eligibility certificate.

Two documents instead of the card

  • My Number Card as Health Insurance Certificate (マイナ保険証, maina hokenshō) — your My Number Card, registered once for use as health insurance. At the clinic you hold the card to a reader and confirm it is you with a PIN or face recognition. Since September 19, 2025 a smartphone also works where the equipment allows it.
  • Health Insurance Eligibility Certificate (資格確認書, shikaku kakuninsho) — a paper proof of insurance. Your insurer sends it free and without an application to everyone who has no My Number insurance registration. With it you are treated under insurance exactly as with the old card and pay the usual 30%.

What to do as a newcomer

  • Right after you arrive. A My Number Card usually takes a month to a month and a half. If you came from abroad, within 30 days of registering your address you can ask the city office for express issue (特急発行) — the card then arrives in about a week. After you join National Health Insurance, the city mails you the eligibility certificate. If you need a doctor urgently before that, ask at the insurance desk which temporary document they can give you.
  • Once you have the My Number Card, register it as your health insurance: in the マイナポータル (Mynaportal) app, at the card reader in a hospital or pharmacy, at a Seven Bank ATM or at the city office.
  • If you have neither document, pay 100%, keep the receipt and the itemized statement, and claim the 70% back from your insurer.
  • After you extend your period of stay. A foreign resident’s My Number Card is valid only until the end of the period of stay. After an extension, update the card’s validity at the city office — otherwise it stops working, also as health insurance.
  • To stop using the My Number Card as insurance, ask your insurer (the city office, or through your employer) — you will get an eligibility certificate instead.

Advantages of the My Number insurance registration: no waiting for a new document when you change jobs; with your consent the doctor can see your medication history; with large bills the counter charges no more than the cap. The chip holds no tax or medical details. Disadvantages: you have to carry the card to every appointment, replacing a lost card takes time, and readers sometimes fail. Details on the Ministry of Health, Labour and Welfare page (in Japanese).

How to join National Health Insurance

Address registration and insurance in one visit

Every foreigner who comes to Japan on a long-term status of residence must register their address at the city office within 14 days. You can join the insurance in the same visit. If you come with a work status of residence, your employer handles insurance; a student joins National Health Insurance themselves. The spouse of an employee with a low income usually becomes a dependent in the employee’s insurance; otherwise they join the national scheme too.

  1. Find your city officeAsk your employer, spouse or school where the office for your area is. In smaller cities it is the city hall (市役所, shiyakusho); in large cities the ward office (区役所, kuyakusho).
  2. Register your addressAsk at the resident registration desk (住民登録) for the form. Sample forms in Japanese or English are usually on display. Hand in the form with your residence card: within 5 minutes to an hour you get the card back with your address on the back.
  3. Join National Health InsuranceAt the insurance desk, fill in the application and show your residence card. The eligibility certificate comes by mail.
  4. File an income declarationEven if you had no income in Japan. Without it you get no premium reduction. How and when: resident tax.
  5. Pay with the payment slipsThe city mails you payment slips — you can pay at a convenience store, for example. Some language schools collect the premium together with the tuition; ask your school.

What to bring

  • Your residence card (在留カード, zairyū kādo).
  • Your exact address in Japanese or English.
  • Your passport, just in case.
  • If possible, someone who speaks Japanese.

When you move, register out at the old city office and in at the new address — and join National Health Insurance again in the new city, also within 14 days.

What National Health Insurance costs

The premium depends on your city and last year’s income

Premium = a fixed part for each family member + a percentage of last year’s income after the deduction for employment income (所得) minus ¥430,000. Rates for Shinjuku City, FY2026:

Part Per person a year Of income
Medical part ¥47,600 7.51%
Support for the elderly ¥17,600 2.80%
Child and childcare support (fixed part for members aged 18+ only) ¥1,873 0.27%
Long-term care (ages 40–64 only) ¥17,800 2.43%

Example: a student with no income

If you had no income in Japan last year, the fixed part is reduced by 70%. A student in Shinjuku pays about ¥20,120 a year (about ¥1,677 a month) — but only after filing an income declaration, even a zero one. With a small income the reduction is 50% or 20%.

Example: an employee who left a job in 2026

Step Amount
Salary for 2025 ¥3,600,000
− Deduction for employment income (給与所得控除) ¥1,160,000
= Income after the deduction (所得) ¥2,440,000
− ¥430,000 ¥2,010,000
× 10.58% (income-based part) ¥212,658
+ Fixed per-person part ¥67,073
Premium for FY2026 about ¥279,700 a year (≈ ¥23,300 a month)

A single person under 40, Shinjuku. Other cities have other rates; the city sends you the exact amount.

The head of household pays the premium, even if they are insured at work themselves. The premium is charged even if you never see a doctor. From April 2026 some cities may ask newly arrived foreign residents to pay the first year in advance.

Large medical bills

The monthly cap on what you pay (高額療養費)

The high-cost medical expense benefit (高額療養費制度, kōgaku ryōyōhi seido) limits what a patient pays for treatment in one calendar month — in National Health Insurance and in insurance through work. If your 30% goes above the cap, the insurance pays the difference. Caps from August 1, 2026 (under 70):

Annual income (approx.) Monthly cap From the 4th time in 12 months Annual cap
about ¥11.6M and over ¥270,300 + 1% ¥140,100 ¥1,680,000
¥7.7M–¥11.6M ¥179,100 + 1% ¥93,000 ¥1,110,000
¥3.7M–¥7.7M ¥85,800 + 1% ¥44,400 ¥530,000
up to ¥3.7M ¥61,500 ¥44,400 ¥530,000 (¥410,000 with a standard monthly remuneration up to ¥150,000)
exempt from resident tax (住民税非課税) ¥36,900 ¥24,600 ¥290,000

“+ 1%” means 1% of the part of the total medical cost above a set threshold is added to the fixed amount. The annual cap is new: it runs from August to July (the first period is August 2026 – July 2027), and the insurer refunds anything you pay above it. The ¥410,000 annual cap is refunded from August 2027. Source: Ministry of Health, Labour and Welfare table (PDF, in Japanese).

Example. An operation and a hospital stay in one month cost ¥1,000,000. Under the normal rules you would pay 30%, or ¥300,000. With the cap, at an income up to about ¥3.7 million a year you pay ¥61,500, and if you are exempt from resident tax ¥36,900 (meals and a private room not included).

How not to overpay

  • Use the My Number insurance registration or a limit certificate (限度額適用認定証 — get it in advance from your insurer). Then the counter charges no more than the cap; otherwise you pay everything and get the difference back later.
  • Add up your family’s costs. Under 70, the costs of family members in the same insurance can be combined if each clinic or hospital charged ¥21,000 or more in the month.
  • Keep treatment within one month where you can. A hospital stay from June 25 to July 5 is split over two months, and the cap may not apply in either.
  • File your income declaration. If anyone in a National Health Insurance household has not filed one, the household is put in the highest bracket.
  • Keep your receipts. You can claim a refund for 2 years. If you spent more than ¥100,000 on medical care in a year (or more than 5% of your income if it is under ¥2 million), you can get part of your income tax back with the medical expense deduction (医療費控除) — see tax deductions.

Planned from August 2027: more income brackets. For low incomes the caps hardly change (up to about ¥2 million: ¥61,500, from the 4th time ¥34,500); for middle and high incomes they rise — for example ¥98,100 + 1% at ¥5.1–6.5 million. We will check the figures again before August 2027.

Illness and birth

Health insurance benefits

Insurance through work only

Injury and sickness allowance (傷病手当金)

  • If you are ill or injured (not at work) and cannot work for 3 days in a row, you are paid from day 4 for the days without salary.
  • A day’s payment is 2/3 of your average standard monthly remuneration over the last 12 months, divided by 30. With ¥300,000 that is about ¥6,667 a day.
  • For at most 1 year and 6 months in total from the first payment.
  • Payments continue after you leave the job if you were insured for 1 year or more and the right had already begun.
  • National Health Insurance has no such allowance.

Birth

Childbirth payments

  • Lump-sum childbirth payment (出産育児一時金) — ¥500,000 per child (births from April 1, 2023), in insurance through work (also for a dependent wife) and in National Health Insurance. Usually the insurance pays the hospital directly.
  • Childbirth allowance (出産手当金) — only for a woman insured at work: for days without pay from 42 days before the birth (98 for twins or more) to 56 days after, 2/3 of standard pay a day.
  • The childcare leave benefit is paid by Employment Insurance — details on children in Japan.

After you leave a job

Three options — choose within 14 to 20 days

  • Keep the company insurance (任意継続, optional and continued coverage) — if you were insured without a break for 2 months or more. Apply within 20 days from the day after you leave. It lasts 2 years and you pay the whole premium, but the standard monthly remuneration is capped at ¥320,000 (FY2026). You can quit earlier. Dependents stay free, but there is no sickness or childbirth allowance for new cases.
  • Join National Health Insurance at the city office — within 14 days. The premium is based on last year’s income and charged for each family member.
  • Become the dependent of a working spouse if your expected income for the next 12 months is under ¥1.3 million (unemployment benefits count as income).

Example. Your standard monthly remuneration was ¥300,000, you are under 40, Tokyo. Keeping the company insurance costs 9.85% + 0.23% = ¥30,240 a month (¥362,880 a year). National Health Insurance in Shinjuku on a ¥3.6 million salary last year is about ¥279,700 a year. For a single person the national scheme is cheaper here; for a family with dependents keeping the company insurance can be cheaper. Ask the city office for the exact amount before the 20 days are up.

What When If you miss it
Join National Health Insurance (arrival, leaving a job, birth of a child) 14 days premiums are charged back (up to 2 years; 3 years where the city levies it as a tax, 国民健康保険税), and bills before you join are paid in full
Leave National Health Insurance (you became an employee, you moved) 14 days if you used the old insurance, you repay what it covered
Keep the company insurance (任意継続) 20 days from the day after you leave this option is gone
Claim a refund for high medical costs 2 years from the month after the treatment the money is not refunded

Linked to your visa.

  • Cities are due to share National Health Insurance payment data with immigration from June 2027 (planned). Then, at an extension or change of status of residence, arrears without an installment plan or an agreement with the city office are, as a rule, a reason for refusal.
  • For permanent residency you need proof of health insurance (and pension) payments for the last 2 years — for the whole household.
  • If paying is hard, go to the city office at once and agree on installments — the record of that agreement counts at an extension.

Taxes and your visa · Permanent residency · Extending your period of stay

If you have a family

Spouse, children, parents: what changes

A dependent for tax and a dependent for health insurance are two different things with different income limits. All the rules for families: Family and dependents.

  • In insurance through work, a spouse, children and parents living in Japan with an expected income under ¥1.3 million a year (ages 19–22: under ¥1.5 million; aged 60 or older or disabled: under ¥1.8 million) can be your dependents; if they live with you, their income must also be under half of yours. There are no premiums for them. Your employer files the notification within 5 days.
  • If both spouses work, the children are registered with the one who earns more.
  • National Health Insurance has no dependents: a premium is charged for each family member, 50% less for preschool children. The head of household pays.
  • Parents who live abroad cannot be your dependents: a dependent must, as a rule, live in Japan.
  • The lump-sum childbirth payment of ¥500,000 is also paid for a dependent wife.

FAQ

Health insurance questions

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Ask us a question

Is health insurance compulsory for foreigners in Japan?

Yes. Everyone who lives in Japan for more than 3 months must be in public health insurance: employees through the company, everyone else in their city’s National Health Insurance. Private or travel insurance does not replace it.

Usually 30% of the bill; children before school age and most people aged 70 to 74 pay 20%. When the bills in one month are large, the high-cost medical expense benefit caps what you pay, for example at ¥61,500 a month with an income up to about ¥3.7 million a year.

No. The old cards expired by December 1, 2025, and the grace period ended on July 31, 2026. Use your My Number Card registered as health insurance or the Health Insurance Eligibility Certificate that your insurer sends free to people without that registration.

It depends on the city. In Shinjuku a student with no income last year pays about ¥20,120 a year in FY2026, because the fixed part is reduced by 70%. The reduction applies only if you file an income declaration at the city office, even with zero income.

The city charges premiums back to the month you became eligible, for up to 2 years (3 years where the city levies it as a tax, 国民健康保険税), and until you join you have no insurance document, so any medical bills in that gap are paid in full by you. Join within 14 days of arriving or leaving a job.

Only insurance through work does. If you cannot work for 3 days in a row because of an illness or injury outside work, you get about 2/3 of your standard pay from day 4, for up to 1 year and 6 months. National Health Insurance has no sick pay.

A normal birth is not treated as illness, but both kinds of insurance pay a lump-sum childbirth payment of ¥500,000 per child, usually directly to the hospital. Women insured at work also get a childbirth allowance of 2/3 of pay for the days off around the birth.

No. As a rule a dependent in Japanese health insurance must live in Japan. Family members living with you in Japan can be dependents if their expected income is under ¥1.3 million a year (¥1.8 million at 60 or older) and under half of yours.

Sources

Where this information comes from

Rates, limits and deadlines on this page were checked against the official websites of the Ministry of Health, Labour and Welfare, Kyōkai Kenpo, the National Tax Agency and city offices on October 7, 2026. Amounts are in Japanese yen. When a rule changes we update the page and the date above.

This page is general information. Your employer, the health insurance association, the Japan Pension Service and your city office decide your actual premiums and benefits. A Labor and Social Security Attorney (社会保険労務士, sharōshi) can help with a dispute.

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