Must an expatriate join health insurance in Japan?

According to the Chiba city brochure, every person residing in Japan, including foreigners, must have health insurance. If you are not covered by your company's scheme, enrollment in national insurance is provided for. Confirm your case with your municipality.

What documents are needed to enroll in national insurance?

The Chiba brochure cites the residence card or passport, plus, depending on the case, a moving notice or proof of exit from the company's scheme. These documents are those of a municipality; verify the exact list with your own.

What happens if I leave Japan or change schemes?

Report your change to the municipality or your organization and ask for the list of supporting documents as well as the termination date. The use of My Number should not be interpreted as a general exemption from formalities.

Does the My Number card replace the insurance card?

It can serve as one if you have registered it for this purpose. It is a function of the card, not a separate card. Without this registration, a certificate of eligibility is issued to you. Inquire about the modalities with your municipality.

Is international health insurance mandatory in Japan?

The mandatory scheme depends on your resident status and professional situation. International insurance can supplement this protection, particularly for stays outside Japan and assistance, but does not automatically exempt you from local affiliation.

Can routine care be covered without upfront costs with international insurance?

As a general rule, the insured pays the costs upfront and then requests a reimbursement. For costly or recurring care, direct billing can sometimes be organized with the agreement of the insurer and the provider. This is not a general rule.

Health insurance in Japan: rights and expatriate coverage

An expatriate settling long-term in Japan in principle falls under a local health insurance scheme: national insurance, or that of their employer. International health insurance can act as a supplement, particularly for major financial risks, the choice of establishment, and continuity of coverage outside the country.

The principle: local coverage for residents

According to a document from the city of Chiba intended for foreign residents, every person living in Japan, including foreigners, must have health insurance. Those who are insured pay less when they consult a health establishment. The document specifies that, if you are not affiliated with your company's scheme, you must enroll in the national insurance.

Note of attention: this document is a municipal brochure from Chiba. The illustrated procedures may differ from one municipality to another. Your ward office remains the contact to consult.

Who can enroll in national insurance

According to the Chiba brochure, foreigners residing in Japan for more than three months are subject to residence registration. Registered residents, holding a residence certificate, can benefit from national insurance.

The document lists cases where enrollment is not possible:

stay of less than three months (with a note indicating that enrollment may exist in certain cases, to be verified with the relevant department);
short-stay visa, or coming to Japan to receive care or accompany a patient;
affiliation with one's company's health scheme;
receipt of social assistance;
affiliation with the healthcare system for the elderly, which concerns those 75 and older.

The municipal brochure presents the main situations, without replacing the review of your file. Confirm your scheme and the applicable formalities with your municipality or your employer.

Employer scheme or national insurance: two different entry points

If you are an employee, your employer may affiliate you with its own health scheme. In this case, the brochure indicates that you do not fall under the national insurance. If you leave this scheme, you must then enroll in the national insurance, by presenting proof of exit from the company's scheme and your residence card or passport.

Ask your employer for proof of your affiliation, its start date, and the procedures planned if you change positions. Distinguish between the mandatory scheme and any potential supplementary insurance offered by the company.

The procedures described in the Chiba brochure

For enrollment in the national insurance, the document mentions the following documents:

upon your first arrival in Japan: residence card or passport;
in case of moving: moving notice and residence card or passport;
upon exit from the employer scheme: proof of exit and residence card or passport.

A definitive departure, a move, or entry into a company scheme may require updating your affiliation. Ask the municipality for the supporting documents and the termination date to retain. Do not consider the use of My Number as a general exemption from declaration: the return of documents and termination are two different procedures.

In case of doubt, the brochure refers to the general inquiries division of your ward. Verify the contact information on your city's website.

My Number card and certificate of eligibility

According to the brochure, during a consultation, you must present your My Number card or your certificate of eligibility. The My Number card can serve as a health insurance card if you have registered it for this purpose. It is not a separate card, but an additional function of the My Number card.

The document cites an advantage: when medical costs exceed a ceiling over a given period, no additional procedure is necessary for this ceiling to be taken into account. Those who have not requested this use receive a certificate of eligibility. To verify with your municipality: the time required for obtaining and the registration modalities.

Contributions, income, and payment delays

Those insured under the national insurance pay contributions. The brochure explains that they cover a portion of medical costs and that they are calculated based on the previous year's income. It emphasizes the importance of declaring one's income, because a drop in income can reduce the contribution.

The document also notes that a payment delay results in surcharges, and that measures regarding salaries or accounts can be taken. Deduction via automatic transfer is recommended by the municipality to avoid oversights. No amount is included here: the scales vary and must be requested from your municipality.

Costs incurred abroad: a limit to know

The Chiba brochure describes a partial reimbursement of certain care received abroad, with medical documents, information on the establishment, and verification of travel dates. It also mentions restrictions, particularly for travel organized to receive care. Before a stay in France or elsewhere, ask your scheme for the applicable conditions: do not count on direct settlement or full reimbursement of the invoice.

What international health insurance can provide

International insurance does not automatically replace mandatory local affiliation. Compare what your scheme already reimburses with the guarantees you wish to add.

Hospitalization as a base. International coverage is organized first around hospitalization and major financial risks. Optical, dental, and maternity are reinforcements to be added if needed, not isolated contracts.
Routine care. As a general rule, the insured pays the costs upfront and then requests a reimbursement. For costly or recurring care, direct billing can sometimes be organized, after agreement from the insurer and acceptance by the provider. It is not systematic.
Hospitalization. Free choice of establishment is possible, with prior agreement from the insurer for the payment guarantee.
Evacuation and repatriation. They are activated upon medical decision, according to the terms of the contract, and not at the free choice of the insured.
First-euro. This means without prior reimbursement from a basic scheme. This does not exclude a deductible.

Questions to ask yourself before choosing

What is my status: employee affiliated with an employer scheme, independent, spouse, student?
Does my employer provide supplementary coverage, and what exactly does it cover?
Do I need coverage outside of Japan, for example for professional travel?
How is the care I wish to receive in my language managed?
What level of upfront payment am I willing to bear for routine care?

These questions do not dictate a single answer. They serve to frame a request for quotes.

Verifications to make before departure

Confirm with your employer whether it will affiliate you with its health scheme.
If you are not affiliated, verify with your municipality the conditions for enrollment in the national insurance and the required documents.
Ask how to obtain and register the My Number card as an insured person's card, or failing that, the certificate of eligibility.
Plan for the management of contributions (automatic transfer) and the income declaration.
Take stock of what private coverage should add: hospitalization, evacuation, care outside Japan.

And then

If you want to compare what international coverage could supplement relative to your local scheme, you can request offers from an Izem Expat advisor. You can also, if you wish, go through the Optional diagnostic. The exchange is free and without obligation.

Consult other country guides · Understand the guarantees of international insurance

Rules and prices may change: confirm the terms applying to your situation before taking out cover.