Residents living in Tokyo have two ways to enter the national health insurance system. The first is the 国民健康保険 (kokumin kenkō hoken), or National Health Insurance. The other is the 社会保険 (shakai hoken), or Social Insurance. The latter of which consists of both health insurance and pension. Company employees are typically enrolled in the Social Insurance system by their employers. The premiums for Social Insurance are determined by whichever union the company belongs to. Or the company’s own union, if they have one.
Social Insurance premiums are a lot more expensive than National Health Insurance (NHI) premiums and National Pension premiums put together. However, companies shoulder half the cost. In addition, unlike National Health Insurance which charges premiums for each household member, dependents are enrolled automatically and without extra cost under a registered Social Insurance member. This alleviates a lot of the burden if you are providing for a large family.
Since Social Insurance falls on the company registering the insured, we will only talk about NHI from here on.
Enrollment Process
To enroll, simply head over to the 国民健康保険課 (kokumin kenkō hokenka) or NHI section at your 区役所 (ku yakusho – ward office). Present either your passport, My Number Card (個人番号カード), Notification Card (通知カード), or 在留カード (zairyū kādo – Residence Card). Fill out the form they give you. It should look similar to the 住民異動届 (jūmin idō todoke – Notification of Change of Address) you submitted when you moved into the ward.
*Please take note that you are required to submit your application within 14 days of moving in.
When you decide to move within or out of your current ward, you will need to notify the ward office. Fill out another 住民異動届. Then, if you’re moving out of the ward, or Japan, bring the 転出証明書 (tenshutsu shōmeisho – Certificate of Change of Address) they give you to the NHI section along with either your My Number Card or Notification Card.
Even though you’re still in Tokyo, your National Health Insurance enrollment is with the ward, so always remember to re-enroll!
*For a step-by-step guide on how to move into, within, or out of your ward, see our guide here.
After a week or so, you should receive a pack in the mail containing a small guide for NHI and your NHI card. Peel it off the paper it comes in and remember to always keep it with you.
NHI Member Benefits
Obviously, one of the most important benefits of joining a social system like this is that your burden is not (entirely) yours. As a member of the NHI or Social Insurance system, your medical expenses will be greatly reduced. The system pays for 70% of whatever expenses you incur and you shoulder the remaining 30%. To receive this reduction, however, you will need to present your insurance card when paying at a hospital or buying medication at a pharmacy – the reduction does not apply to over-the-counter medication purchases from a drug store.
There are, of course, exceptions to what is covered by your insurance – such as general checkups, physical examinations, cosmetic surgeries, injuries from altercations, or as a result of drunkenness, etc.
If you ever find yourself in an emergency without your insurance card on your person, don’t worry, because you’re still entitled to the 70% discount. In these cases, however, you will have to pay the entire cost until you return to the hospital with your card.
How to Calculate NHI
To calculate your own NHI premiums follow the instructions below. Social Insurance premiums are predetermined by whichever union your company belongs to and it is based on your income.
NHI premiums consist of three parts – Medical (医療分), Elderly Support (支援分), and Nursing Care (介護分). The first two, Medical and Elderly Support, are required from everyone, while Nursing Care is only included in premiums for members aged 40 to 64.
*Please note that the calculations below only apply for National Health Insurance members in Tokyo with only one source of income received as salary.
How to Pay Your NHI
To pay your NHI bills, check that you’ve received the necessary payment slips or invoices in your mail. The easiest way to pay would be to bring these to any convenience store near you. Present the slip at the counter and pay your bill.
You can also bring your payment slips or invoices to the NHI section of your ward office and pay there if you like. If you prefer, you may also apply to pay through auto-debit from your bank account. To do this, please bring your cash card to the NHI section of your ward office and complete the application.
Finding Hospitals around Tokyo
Now that you’ve sorted out all the paperwork, you will, of course, need to know where to find a doctor when you need one. Luckily, the Japan National Tourism Organization has created a nifty little database of hospitals that service languages other than Japanese. You can even sift through the lot to find ones that will accept your credit card. The website is fast and highly intuitive so it won’t fail you in a pinch.
Mental Health Services
Finally, mental health is a serious concern in Japan. Daily stresses can be overwhelming when left unchecked and the fast-paced, urban lifestyle breeds a lot of it. Fortunately, TELL Japan offers a free emergency hotline. It’s open to anyone who is in need of immediate help in processing their thoughts and emotions.
- TELL LifeLine (03-5774-0992) 9:00AM to 11:00PM daily
- Chat Friday, Saturday, Sunday 10:30PM to 2:00AM
- Counseling Inquiries (03-4550-1146 – English) Monday to Friday 10:00AM-3:00PM
Need help with figuring out living in Tokyo? Our Tokyo 101 guides take the stress out of navigating life in Japan.
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