Health Insurance in Japan

1) Health Insurance　 

Japan's medical insurance system includes medical insurance and national health insurance.

Medical insurance is a medical insurance system for private sector employees and their families.

Health insurance premiums are set according to the amount of the insured person's salary and are paid by the insured person and the employer.

Those who are not covered by health insurance are enrolled in the National Health Insurance Scheme under the Universal Health Insurance Scheme.

2) What is an eligible establishment? 

A "compulsory/eligible establishment" is an establishment that is required by law to be covered by social security.

Mandatory coverage applies to the following two types of establishments:

①Business establishments with at least one full-time employee.

In the case of a joint-stock company, it is a compulsorily insured establishment regardless of the type of company or the number of employees.

In the case of a company limited by shares or a limited liability company, the company is obliged to join the social security system even if it has only one director.

②Companies that regularly employ five or more employees and are engaged in the following activities

Manufacturing, construction, mining, electricity and gas, transport, cleaning, sale of goods, finance and insurance, intermediation and brokerage, collection, guidance and advertising, education and research, medical and health care, etc.

“Voluntary covered enterprises" are enterprises that are not subject to compulsory insurance and have been approved by the Minister of Health, Labour and Welfare to apply for health insurance coverage.

If more than half of the employees working at the establishment agree to become an eligible establishment, the employer may apply to become one and obtain approval from the Minister of Health, Labour and Welfare. If it becomes an applicable place of business, employees who meet the eligibility requirements must enroll.

3）Who is covered? 

Representatives, executives and full-time employees working at the above-mentioned mandatory and voluntary covered establishments must be enrolled in the medical insurance scheme.

In other words, all employees working in the relevant establishments, regardless of their nationality, must be enrolled in the health insurance scheme.

Part-time employees are also eligible for health insurance if they meet one of the following criteria

１． Work the same number of hours per week and the same number of days per month at the same location

　　3/4 or more of the regular employees and other general employees

２．501 or more employees working at least 20 hours per week *1

３．An enterprise with fewer than 500 employees that meets all of the following criteria

　　①The number of hours worked per week is 20 hours or more.

　　 ②The period of employment is expected to exceed one year *2

　　  ③Monthly wage of 88,000 yen or more

　　  ④Not a student

　　⑤Labour and management agree on social security coverage.

In October 2022, health insurance coverage will be extended to part-time and other short-time workers.

4) Health insurance procedures ~When you join the company

When an employee is hired by an employer and enrolls in health insurance, the company is required to submit a "Notification of Acquisition of Insured Status" to the Japan Pension Service within 5 days of employment by electronic application, mail, or by bringing the notification to the office.

The employee must prepare a basic pension number notification, pension notebook or my number card, which the employer will need for the procedure.

5) Health insurance procedure ~When leaving the company

If a prospective retiree is enrolled in the health insurance scheme, the company must carry out the following procedures.

The same applies to part-time employees if they are covered.

The health insurance card for the employee and his/her dependents must be collected at the time of retirement.

The "Notification of Loss of Health Insurance and Employee Pension Insurance Coverage" must be submitted to the pension office responsible for the company's location within five days of the day following the date of retirement.

The "Notification of Loss of Eligibility for Health Insurance Coverage" is required when a retiree transfers to the National Health Service, so a copy should be given to the retiree.

6)  What to do if the enrolment process is delayed

As discussed in the 4th part above, a company is required to submit the "Notification of Acquisition of Insured Status" within 5 days of hiring an employee.

But even if more than 5 days have passed, there is no problem.

The statute of limitations for social insurance is two years, so you can apply at any time within two years.

However, if more than 60 days have elapsed since the date of employment, the following documents must be attached to the declaration of acquisition of insurance status

Attendance record (a time card is acceptable)

Pay slip (payslips are also acceptable)

Letter explaining the reason for the delay

So even if you were surprised and forgot to submit these documents when you joined the company, you can submit them without any problem as long as they are within the time limit.

7) What happens if a foreign worker refuses to register? 

Some foreign nationals are reluctant to enroll for various reasons, such as "my take-home pay will be reduced if social security contributions are deducted" or "social security contributions in Japan are higher than in my home country".

However, as mentioned above in section “3) Who is covered?” Employees working in covered establishments are required to enroll.

For those establishments that have not registered, particularly egregious cases may be punished by imprisonment of up to 6 months or a fine of up to 500,000 yen under Article 208, Item 1 of the Health Insurance Law.

In addition, the company may be subject to retroactive collection of social security contributions for the past two years for non-payment.

Therefore, when joining a Japanese company, it is essential to carefully explain that membership is compulsory and that there are lot of benefits of membership from joining a social insurance.

In the case of sickness insurance,, in addition to the benefits for medical treatment, there are other benefits (sickness and maternity benefits), which are no less advantageous, and which provide a livelihood in the event of absence from work due to illness, injury, childbirth, etc.

8) Are family members of foreign workers covered? 

Any member of the insured person's family can join the health insurance scheme without paying a premium.

However, if a foreign worker enrolled in the Japanese health insurance system wishes to enroll dependents living abroad, all of the following conditions must be met.

(1) The "livelihood" of the insured foreign worker is maintained.

　　　The term "living dependents" means...

　　　　If they belong to the same household

　　　The annual income of the dependents must be less than 1.3 million yen and less than half the annual income of the insured person.

　　　　If they do not live in the same household

　　　The annual income of the dependants must be less than 1.3 million yen and less than the amount of the support provided by the insured person.

The applicant must have a certificate of residence in Japan.