Things to Know about the Japan National Health Insurance

What is the Japan National Health Insurance?

Importance of Healthcare in Japan

Among the primary needs of citizens in any nation would be a stable health care system. Health care should always be accessible and affordable for all members of the society. This is a right rather than a privilege. It is impressive to say that the Japanese government has ensured this to be true for all the members of their nation.

According to studies, the Japanese have the longest life expectancy in any nation from all over the world. This is a clear indication that the standard of their healthcare services is impressively high. Not only that, health care is subsidized not only for all members of the Japanese nation but also expatriates and foreigners as long as they have been residing in Japan for more than a year.

Japan National Health Insurance System

It is by the law of the Japanese constitution, according to the National Health Care Act of 1958, that all Japanese residents must have health insurance coverage. Furthermore, the Japanese government has ensured that hospitals and clinics in Japan remain non-profit. This helps in the maintenance of standard charges and fees.

By their system, the patient usually takes care of 30% of the expenses while the government takes care of the remaining 70%. But this 30% can be lowered depending on different factors such as age and income. Interestingly, patient responsibility towards the cost can go down as low as 10%. This is to help ensure that medical expenses and fees remain accessible and affordable for all members of the nation.

On the other hand, a person can choose to remain uninsured if access to premiums is not available. Although this remains a low percentage of the total Japanese population, there are some people who have no access to health insurance (like foreign nationals who have resided in Japan less than a year). The downside to this is that the patient will be responsible for paying medical expenses fully. Exceptions for this would be low-income households and homeless people brought to the hospital by an ambulance.

The Japan National Health Insurance System is of two kinds. The first kind would be the Employees’ Health Insurance and the other is the National Health Insurance (also known as NHI). The NHI has been established for individuals who are not eligible to be a part of the Employees’ Health Insurance System. The NHI is also managed by the local municipality for which an individual resides in. Once they move or transfer, they must withdraw from their current municipality and re-apply in the municipality they are moving in.

What is the Japan National Health Insurance Premiums

Category 1 Membership (Regular members)

This category count in members who are aged up to 74 years. Usually, their premium includes their contribution for medical care, and they also contribute for their retirement. This is the most common kind of category membership and is usually the most expensive.

Usually, co-payments made by members vary depending on age. For infants, the co-payments usually is 20%. For school-aged children up to 69 years of age, the co-payment will hike up to 30%. On the other hand, for adults between the ages of 70 to 74, the co-payments will be decreased to 10% only.

Category 2 Membership (Retirement and Elderly)

Category 2 membership is for individuals who are receiving what is called as the Long Life Medical Care card. Usually, members receive this kind of card when they reach the age of 40. They start paying up a part of their premiums for their retirement benefits. This kind of card ensures that the member will receive enough care for the rest of their lives and even provide nursing assistance to the member.

The Retiree Medical System is an impressive system in Japan. Usually, people who have been paying for their Long Life Medical Care premiums can receive retirement allowances.

Category 3 Membership (Long Life Insurance System)

This kind of membership is provided for individuals who require nursing care assistance. Usually, for elderly older than 75 years of age, the co-payment of the member decreases to only 10 percent. This means that medical expenses can be reimbursed or refunded to a total of 90%.

Access for Foreign Nationals

Any information that foreign national residing in Japan have regarding the health insurance system of Japan can visit Japan Healthcare Info (or JHI). This group helps in making inquiries and appointments with health institutions (hospitals and clinics). They also provide translations and interpretations in hotels, as well as document translations. They also provide access to facilities with English speaking doctors and provides assistance in purchasing drugs and other medicine. The JHI is a popular private insurance system for foreigners.

Japan National Health Insurance for Students

It is always best to be prepared when traveling to another country, especially when there are plans of residing in that country long term. The Japanese government recognizes this fact and thus provides eligibility for foreign nationals who have resided in Japan for more than a year.

For students, their visa restricts their money-making activities to almost a minimum. Since the NHI rates are dependent on age and income, it is normal to see co-payments lower than 20%. The good thing is that the members can apply to have a limit on a number of medical bills that they would be paying for per month.

Japan National Health Insurance for Foreigners

For expatriates and foreign national who are residing in Japan for work, they are not usually classified under the NHI. Instead, they are counted under the Employees’ Health Insurance System. On the other hand, they still have the option of purchasing other insurance premiums from private insurance firms.

Other Premiums

Disability Welfare Services

There is a law in Japan known as the Self-reliance Support Law for People with Disabilities which helps in creating a standardized system to provide assistance to people with disabilities. Some of their benefits include at-home care or medical home service for those who are permanently and severely disabled. There are also facilities in every prefecture that provide work training assistance and guardians for young children with disability. The total premium to be paid by disabled individuals will usually fall below 10%.

Learning the Basics

How to Join the Insurance System

There are a number of conditions for which an individual must re-apply or re-join the NHI. The first of these would be when a person moves from one place to another. They must withdraw from their old residence and re-apply in their new residence. When giving birth as well, a person must re-apply or re-join the membership to include the new baby for the calculation of premium.

It is also important to remember that only a single application is done for every household. Even so, every individual is surely covered regardless of age. Non-citizens can also join as long as they have been a resident of Japan for more than a year.

All prefectures will have a general headquarter or office that delegates which city a person shall be registered in. There are offices that can be visited for applications, just take note of their opening hours and schedules. Every member shall receive a card or a certificate proving membership as well.  All members must receive a guidebook to help them understand calculations, premiums, and all the details of their insurance.

Japan National Health Insurance Cost

The insurance cost for every member will vary depending on a number of factors. The amount being paid for by one household will surely be different from the premium being paid by another. However, there are maximums set for annual premiums depending on the category of membership. For instance, Category 1 members can pay no greater than 500,000 yen per year. Category 2 members can only pay an annual premium of fewer than 130,000 yen per year. Lastly, Category 3 members shall only pay less than 100,000 yen a year.

Payment procedures are quite strict to failure to pay for premiums will cause the municipality to send reminder letters. If the payment is still unavailable after the reminder letter, the NHI membership card will be replaced by a short-term card.

If there are no payments made in a year, the person can receive treatment but will have to pay for medical expenses in full amount. Finally, if no payments are made at all, the municipality has the option to seize personal property until all arrears have been paid for.

There are some places in Japan, on the other hand, where young children are fully covered. One of these would be Minato-ku in Tokyo where they cover a child 100% until the kid graduates Junior High School. This is to encourage couples to have more children or to move into Minato-ku. Taito-Ku in Tokyo has followed in the footsteps of Minato-ku since April 2005.

Japan National Health Insurance Calculation

What is interesting about the Japanese Health Insurance system is the fact that it is the responsibility of the head of the household to arrange and pay for the NHI membership. There are different factors and criteria considered for calculating the NHI premium. The first is the cost of the premium will always depend on the Resident’s tax. Then, it is calculated based on the number of members there are in a household. Then, it is also calculated as per the income of the members. It is through these three considerations: resident tax, income, and a number of members, that the government co-payments are calculated.

Japan National Health Insurance Drug Price list

As part of the program on health insurance in Japan, the government also makes sure that medicines are made accessible and affordable for patients. There is a list of drugs known as the Drug Price List (NHI Price List) that can be reimbursed under the NHI policies. Other than this, the NHI also periodically reviews and revises drug prices based on market surveys.

The Coverage

Japan National Health Insurance Medical Benefits

Medical coverage includes illnesses and accidents but does not cover self-inflicted harm from suicide and the like. A person can receive allowances of hospital meals, childbirth allowances, loans for high medical expenses, and more. A person can also apply for a cash reimbursement when they receive health care from overseas.

Japan National Health Insurance Dental Benefits

The good thing about the NHI is the fact that it covers not only medical benefits and expenses but dental as well. As long as the individual presents their NHI Card or Certificate in any dental clinics accredited by the NHI, the patient will only co-pay what is required by the policy. The rest of the expenses, including drugs part of the NHI Drug list, shall be covered by government subsidies.

By Stewart, Francis, War Relocation Authority photographer, Photographer (NARA record: 8464475) (U.S. National Archives and Records Administration) [Public domain], via Wikimedia Commons

Death Benefits

Any member of the NHI can receive about 70,000 yen as a funeral allowance once they die. This is to ease the expenses of the family members left behind by the death. On the other hand, a funeral expense may not be available when a third party causes the death (say a traffic accident, murder, etc) because it will be covered by the insurance of the third party and not the member.

Expense Ceilings and Exceptions

There are expense ceilings provided by the policy especially for illnesses which are inborn. For instance, an elderly individual can receive up to 24,000 yen a year (for his or her entire household) for a certain sickness. For those under the age of 70, low-income households can receive up to 35,000 yen every year for a sickness.

The NHI can also deny reimbursements and support in certain cases. For instance, a person fails to follow doctor’s instructions regarding treatment and the illness gets worse. Another would be from self-inflicted harm from suicide attempts or crime. They also do not provide insurance for non-illness related procedures like cosmetic, abortion, preventive injections and the like. A patient suffering from work-related injuries are also not covered by the NHI solely because it is the responsibility of the company or the firm to pay for the medical expenses.