Live

Understanding the Japanese Health Insurance System Part 2/2

How to access the medical care and services you need.

By 8 min read

Visiting the doctor in Japan can be stressful, especially if you don’t have such a good grasp of the language. Never mind any mistranslated diagnoses, just getting past the check in desk can be a struggle. The last thing you want to do is make a mistake with your paperwork and get turned away, but it can be hard to navigate all of the rules when you’re unfamiliar with the system.

On my first few trips to a doctor in Japan, my arrival always sent the staff into a panic. They didn’t seem to know any English and my Japanese wasn’t good enough to understand this totally new program. It took me a while to realize they were asking me for my national health insurance card. I eventually learnt to listen out for them asking if I had my “kenkouhoken-shou.”

This will happen at the start of any visit — whenever you go to a doctor or dentist, to pick up a prescription or do anything related to medical care, you will need to bring along your health insurance card. Not just the first time you go, but every time. This card proves that you are covered and allows the staff to bill you correctly.This will happen at the start of any visit — whenever you go to a doctor or dentist, to pick up a prescription or do anything related to medical care, you will need to bring along your health insurance card. Not just the first time you go, but every time. This card proves that you are covered and allows the staff to bill you correctly.

If you’re unsure of how to get your health insurance card or how to sign up for the national plan, check out part one of our guide to understanding the Japanese health insurance system.

How do I use my insurance at a clinic?  

In Japan, everybody pays for their visit each time they go to a doctor, dentist or pharmacist. Luckily, thanks to the national health insurance system, you will only ever have to pay 30 percent of the cost upfront while the national health insurance fund covers the rest.

When you first arrive at a clinic or hospital, you will need to provide them with you health insurance card so that they can put you into the system. Some places don’t ask for the cards until after you have seen the doctor — but you will definitely need it when you pay.

Even just a consultation will cost a fee, though perhaps only a few hundred yen. The prices differ depending on the type of doctor (a brain surgeon versus and orthodontist, for example), how long your appointment takes and what kind of tests they ask you to do. You should be looking at something between ¥1,000 to ¥3,000 to get a diagnosis. This amount is the 30 percent of the total fee that you actually pay — without insurance, seeing the doctor would cost considerably more. You will also be charged a one time extra fee of between ¥3,000 and ¥10,000 for a first time visit to a new clinic, so be prepared for that.

What does my health insurance cover?

Japanese health insurance is very versatile. No matter the type of insurance you have (Japanese National Health Insurance, employee’s insurance, or Japanese advanced elderly insurance) it can be used at all facilities: hospitals, clinics and dentists. You can visit all of these professionals to receive any necessary medical treatment.

Insurance covers treatments the government deems medically necessary, so doctors can only provide services for what you need to be healthy — nothing additional (unless you are willing to underwrite the extra cost yourself). For example, physical checkups and cosmetic surgery are both not covered. Surprisingly,  anything to do with healthy pregnancies or childbirth is also not covered — but if you have any problems with the pregnancy or need a cesarean section, that would be covered.

This is one of the reasons why people get supplemental private insurance in Japan (usually packaged with life insurance policies). Some companies do offer help with paying pregnancy-related medical fees or allow you to charge cosmetic surgery to you insurance. It’s the difference between having healthy teeth or paying extra to get a perfect Tom Cruise megawatt smile.

Note that your health insurance also doesn’t cover optometry, chiropractic or alternative medicine.

… you will only ever have to pay 30 percent of the cost upfront while the national health insurance fund covers the rest.

If, for some reason, you need intense treatment and the 30 percent of the cost that you pay exceeds ¥80,100 in one month then you can reclaim that from your insurance. To do this, you will need to ask for an “Eligibility Certificate for Ceiling-Amount Application” or an “Eligibility Certificate for Ceiling-Amount Application and Reduction of the Standard Amount of Patient Liability” from the NHI section at your local ward office. You then present this to hospital staff before paying. You still have to pay the cost upfront — but the money will be refunded to you in a month.

This ensures that if you find yourself diagnosed with a debilitating disease or are in a terrible accident, your bank account isn’t ruined.

Are there differences in coverage between the insurance plans? 

Yes, if you are on kokumin kenko hoken, Japanese National Health Insurance (see part one) you are entitled to everything above but you do not receive shobyo teate kin (sickness compensation) or shussan teate kin (maternity leave). You do get these if you are a full-time worker with the kenko koken, or Japanese Health Insurance (sometimes called “employee’s insurance”).

The shobyo teate kin is 60 percent of your average wage paid to you for any time you have to take off work because of a medical issue. The time off needs to exceed four consecutive days. After the fourth day, the insurance payments will be made into your account. This can last up to 18 months.

The shussan ikuji ichiji-kin, or childbirth and nursing allowance, is a lump-sum payment of between ¥390,000 and ¥420,000 per child. If the mother is your dependent, then the lump-sum amounts will be paid to you.

Mothers who are on kenko koken will receive sickness compensation, maternity leave before and after giving birth. For 42 days prior to labor and 56 days after they are entitled to receive 60 percent of their normal salary. If they are carrying twins, they are entitled to 98 days of compensation prior to giving birth.

Kenko koken also helps out your family and dependents if you die. The person who takes care of your funeral arrangements will be reimbursed for the costs and any of your dependents over the age of 18 will be be given ¥50,000 each to help them financially until they sort out their new insurance.

What about dependent family members? 

The head of the household is responsible for paying the family’s health insurance. Legally, you are required to insure your children, spouse and any other dependents if they are unemployed. You don’t need to pay any extra money to do this.

Your children and spouse are automatically counted as dependents on your insurance.

Dependents in Japan can be any of the following:

  • spouse
  • child
  • parent
  • grandparent
  • great-grandparent
  • grandchild
  • sibling

If you want to register a non-blood relative as a dependent, they need to be living in the same residence as you.

Dependents must be earning less than ¥109,000 a month. Once you have shown proof of their earnings (or lack thereof) to the local ward office or your employer, you will then have to fill out a form called a ifuyosha todoke, or notification of dependents (被扶養者届). In order to take them off your insurance, you need to fill out a hifuyosha ido todoke (notification of change of dependents, 被扶養者異動届). Both of these can be requested from you local ward office or your employer.

Everybody in Japan is entitled to health insurance that is meant to make medical care more affordable.

After giving birth, you need to renew your health insurance in order to add the child to your kenko hoken plan and to receive any lump-sum payments.

If a legal dependent dies, kenko koken will provide a lump-sum payment of ¥50,000 to you so that you have some money to help you with expenses while you organize your new insurance.

What if something is not covered by my health insurance? 

If something is not covered by your medical insurance, you can usually get a doctor to do it anyway — but you will be responsible for 100 percent of the cost. For example, this is what you would have to do if you need to get a physical check-up to show you are fit and healthy for a job application or to get your teeth cosmetically straightened.

Optometry may not be covered by basic insurance in Japan, but it is cheaper here than in many other countries, such as the U.K. So if you’re not happy with the Japanese prices, there is cheaper optometry available in neighboring countries.

As an example, many Japanese people get glasses when they visit South Korea because it’s less expensive and quite fashionable. People also go to South Korea for plastic surgery treatments as it is a lot more common there, as well as much cheaper.

To sum up

Everybody in Japan is entitled to health insurance that is meant to make medical care more affordable. People on kenko koken, or the insurance deducted from your pay, may get extra maternity leave and help with sickness but the basic NHI gives you enough to help with everyday medical payments. Your job situation (full time, part time or freelance) and circumstances also determine which plan you end up enrolling in, but the system is designed so that nobody should be left with huge medical bills.

This guide should give you everything you need to know about Japanese health insurance. It is a complicated topic, though, and there may be some things we missed. If you have any questions, please leave them in the comments below.

Jeff W. Richards contributed to this article.

Topics: /

Japan101: Doctors, Dentists and Staying Healthy

Related

Explore

Ultimate Guide to Skiing and Snowboarding in Japan

Shred world-class powder in the mountains of Japan.

By 8 min read

Live

Japan’s Cybersecurity Minister Admits He Has Never Used Computer

Said: “I think you plug USBs into a hole or something, but I don’t know the details.”

By 3 min read