Health insurance in Japan is not optional. Every person living in Japan with a valid residence status is required by law to be enrolled in some form of public health insurance. This applies to Filipinos on work visas, long-term resident visas, spouse visas, and most other residence categories.
The good news is that once you are enrolled, the system works well. You pay a portion of your premiums regularly, and when you visit a clinic or hospital, the insurance covers a significant share of the bill. For most people, you only pay 30 percent of the cost of treatment out of pocket. The remaining 70 percent is covered by your insurance.
This guide explains the two main types of health insurance in Japan, how to enroll in each, how to actually use your insurance card at a clinic, and what to watch out for.
The Two Main Health Insurance Systems
Japan has two public health insurance systems. Which one you belong to depends on your employment situation.
1. Shakai Hoken (社会保険) – Employee Health Insurance
Shakai Hoken is the health insurance system for employees of companies that are required to provide it. If you work full-time for a registered company in Japan, your employer is almost certainly enrolled in Shakai Hoken and you will be automatically enrolled as well when you start the job.
Under Shakai Hoken, your premium is split between you and your employer. You pay roughly half and your company pays the other half. Your share is deducted directly from your monthly salary, so you never have to make a separate payment. The premium amount depends on your salary.
Your spouse and children can be added to your Shakai Hoken coverage as dependents (扶養, fuyou) at no additional premium cost, as long as they meet the income threshold. This is a significant benefit for families.
Shakai Hoken also includes Kosei Nenkin, the employee pension system, which is enrolled and deducted at the same time.
2. Kokumin Kenko Hoken (国民健康保険 / NHI) – National Health Insurance
Kokumin Kenko Hoken, also referred to as NHI (National Health Insurance), is for everyone who is not covered by Shakai Hoken. This includes:
- Self-employed individuals
- Part-time workers whose hours do not qualify them for Shakai Hoken
- Students
- People between jobs
- Those on certain visa categories that are not tied to company employment
Unlike Shakai Hoken, NHI premiums are not split with an employer. You pay the full amount yourself. Premiums are calculated by your local municipality based on your previous year’s income, the number of people in your household enrolled in NHI, and where you live. This means premiums vary from city to city.
You enroll in NHI at your local city hall. If you are new to Japan and not covered by an employer’s Shakai Hoken, you should go to the city hall and enroll as soon as possible after registering your address.
How to Enroll
If your employer provides Shakai Hoken: You do not need to do anything. Your employer handles the enrollment paperwork. You will receive your health insurance card (健康保険証, kenko hoken sho) by mail or from your HR department, usually within a few weeks of starting work.
If you need to enroll in NHI: Go to your local city hall (役所, yakusho) with the following:
- Your residence card (在留カード, zairyu card)
- Your passport
- Your personal seal (hanko) if you have one, though a signature is accepted at most offices
Enrollment is free. The city hall will calculate your monthly premium based on your income and issue your NHI card, usually on the same day or within a week.
One important note: enrollment in NHI is retroactive. If you have been living in Japan without health insurance for several months, the city hall can and often does calculate premiums going back to when you first registered your address. Do not put off enrolling thinking you will avoid the cost. You will likely be billed for the missed months when you eventually enroll.
Understanding Your Health Insurance Card
Your health insurance card (健康保険証) is one of the most important documents you carry in Japan. It shows your name, date of birth, the name of your insurance provider, your insured person number, and the validity period.
Always carry it when going to a clinic or hospital. If you forget it, most clinics will still treat you but may charge you the full amount upfront. You can then submit a claim to your insurance provider for reimbursement, but this is extra paperwork and delay you want to avoid.
From 2024, Japan has been transitioning toward using the My Number card (マイナンバーカード) as a combined health insurance card at many medical facilities. If you have a My Number card with the health insurance linkage set up, you can use it in place of your paper card at clinics equipped with the card reader system. However, traditional paper cards are still widely accepted and will continue to be so during the transition period.
How to Use Your Insurance at a Clinic or Hospital
Using your health insurance in Japan is straightforward once you know the steps.
Step 1: Find a clinic or hospital For non-emergency situations, go to a clinic (クリニック or 診療所) rather than a hospital. Clinics are smaller, handle common illnesses and general care, and have shorter wait times. Large hospitals are for serious conditions and referrals. Going directly to a large hospital for a minor issue often results in an extra fee for not having a referral.
Step 2: Register at reception Hand your health insurance card to the receptionist when you arrive. First-time patients will also fill out a basic registration form with your name, date of birth, address, and any existing conditions or medications. At some clinics this form is available in English or other languages, but most are in Japanese.
Step 3: See the doctor After waiting, you will be called in to see the doctor. Bring a written note of your symptoms in Japanese if your language ability is limited. Google Translate can help prepare this in advance. Some clinics in larger cities have English-speaking staff or doctors.
Step 4: Pay at the counter After your consultation, you return to the reception counter to pay. Your insurance covers 70 percent of the bill and you pay the remaining 30 percent at the counter. For a standard clinic visit this is often between 500 and 3,000 yen depending on what was done.
If you were prescribed medication, you take the prescription slip (処方箋, shohousen) to a pharmacy (薬局, yakkyoku). There is usually one near most clinics. Hand over your insurance card there as well. Your insurance applies to prescribed medications too, so you pay only 30 percent of the medication cost.
What Is and Is Not Covered
Japan’s public health insurance covers a wide range of medical services. This includes:
- Doctor consultations and examinations
- Diagnostic tests such as blood tests and X-rays
- Hospitalization and surgery
- Prescription medications
- Dental treatment for medically necessary procedures
- Maternity care (with some specific programs layered on top)
Not covered by standard health insurance:
- Cosmetic procedures
- Most routine dental check-ups and cosmetic dental work
- Elective eye treatments such as LASIK
- Some alternative therapies
- Medical certificates and forms requested by an employer or immigration office
- Treatment received outside Japan
For dental care, many Filipinos are surprised to find that routine check-ups and teeth cleaning are not fully covered in the same way they might expect. Basic dental treatment for cavities, extractions, and medically necessary procedures is covered, but anything cosmetic is out of pocket.
High-Cost Medical Care: The Kouhi Seido and Kougaku Ryoyou Hi System
If you ever face a serious illness or surgery in Japan, the out-of-pocket costs could become significant even at 30 percent. Japan has a system called Kougaku Ryoyou Hi (高額療養費), or the High-Cost Medical Expense Benefit, that caps how much you pay per month regardless of your actual medical bills.
The monthly cap depends on your income bracket. For someone on an average salary, the cap is roughly 80,000 to 90,000 yen per month. For lower income earners the cap is lower. Any amount above the cap is covered by your insurance.
To use this benefit, you can apply in advance for a certificate (限度額適用認定証, gendo gaku tekiyo nintei sho) from your city hall or health insurance provider. Present this certificate when you are admitted to a hospital so the billing is adjusted from the start rather than requiring you to file for reimbursement afterward.
If you did not get the certificate in advance, you can still apply for reimbursement after the fact by submitting a claim to your insurance provider. The reimbursement process takes a few months but the money does come back.
What Happens If You Lose Your Job
If you leave a job where you were covered by Shakai Hoken, your coverage ends when your employment ends. At that point you have two options:
Option 1: Enroll in NHI Go to your city hall within 14 days of losing Shakai Hoken coverage and enroll in NHI. You will need your certificate of loss of Shakai Hoken coverage (健康保険資格喪失証明書) which your former employer must provide.
Option 2: Continue Shakai Hoken voluntarily Japan allows you to continue your previous Shakai Hoken coverage for up to two years after leaving employment. The catch is that you now pay the full premium, including the portion your employer previously covered, which can be significantly more than NHI premiums depending on your income. Compare both options before deciding.
Do not let your insurance lapse. If you go without insurance and need medical care, you will pay 100 percent of the cost. And as noted earlier, when you do eventually enroll in NHI, premiums may be backdated.
Premiums: What to Expect
NHI premiums vary by municipality and income. As a rough guide:
- Someone earning around 2 million yen per year (roughly 167,000 yen per month) might pay between 15,000 and 25,000 yen per month in NHI premiums depending on the city.
- Someone with zero income (for example, a newly arrived spouse who is not yet working) may pay a minimum premium set by their city, often around 2,000 to 5,000 yen per month.
- NHI premiums are reduced for low-income households. If your income is below a certain threshold, you can apply for a reduction at city hall.
Shakai Hoken premiums are a fixed percentage of your salary, split with your employer. The total rate is approximately 10 percent of your monthly salary for the health insurance portion alone, with you and your employer each paying around 5 percent.
Tips for Filipinos Using the Health System in Japan
Bring a translation of your medical history. If you have existing conditions, allergies, or are on regular medication, prepare a brief summary in Japanese to hand to doctors. This avoids miscommunication and helps you get the right treatment faster.
Use a clinic first, not a hospital. Unless it is an emergency, always start at a local clinic. Large hospitals in Japan require either a referral or will charge an additional fee for walk-in patients without one. Clinics are faster, cheaper for routine care, and more accessible.
Pay your premiums on time. Falling behind on NHI premiums can result in reduced benefits. After a certain period of non-payment, your insurance card may be replaced with a short-term card that needs frequent renewal, and eventually you may lose access to the standard 70 percent coverage and have to pay 100 percent upfront with reimbursement later.
Know the emergency number. For medical emergencies in Japan, call 119. This connects you to both ambulance and fire services. Ambulance calls in Japan are free. You are taken to the nearest hospital equipped to treat your condition. Bring your insurance card if you can.
Mental health is covered. Psychiatric consultations and treatment at licensed mental health clinics are covered by Japan’s public health insurance. If you are struggling emotionally or mentally, visiting a psychiatrist (精神科, seishinka) or psychosomatic medicine clinic (心療内科, shinryo naika) is covered under the same 30 percent co-pay system.
Useful Resources
Japan Pension Service (combined enrollment info): nenkin.go.jp
Ministry of Health, Labour and Welfare (health insurance overview): mhlw.go.jp
Japan Health Insurance Association (Shakai Hoken): kyoukaikenpo.or.jp
Your local city hall (NHI enrollment and premium reduction applications)
