Japanese Health Insurance Options for Internationals
From teaching English as a second language to working in the high tech sector, Japan’s expat scene is diverse and dynamic. You’re just as likely to find an entire family relocating in their 40s to start new careers as you are to see university students taking a year or two to work, save, and travel. Happily, no matter what their career path, there are excellent Japanese health insurance options for foreigners.
Overview of the Health Insurance System
Japan has had universal healthcare since 1961 – and foreigners can be a part of the system. Under the current system of healthcare in Japan, 70% of the cost associated with medical appointments, hospital visits, tests, and prescriptions are billed to the government. Patients are responsible for the remaining 30%. In some circumstances, largely dependent on income, the patient’s share can be even less, either 20% or even 10%.
The 70% which the government is responsible for paying is covered through income generated through two systems, known as SHI and NHI. SHI, or social health insurance, is the program that all full-time employees of medium and large-sized companies are automatically enrolled in. Approximately 5% of their salary is held back as a health-based deduction. This amount is matched by the employer.
Those who are self-employed or work for small businesses contribute to the national health insurance program or NHI. Their actual contribution varies by income and the process is a bit more arduous compared to the SHI. Residents are required to complete their paperwork at one of 47 regional administrative districts.
How Expats In Japan Can Qualify for Health Insurance
Foreign residents who intend to reside in Japan for 3 months or longer can join NHI. This applies even to those who are working for the medium and large size companies associated with the SHI program. SHI requires one year to come into effect. Thus, in the beginning, it’s NHI for nearly everyone. However, until your application is completed and approved, you are on your own for health insurance costs and should carry your own insurance.
Overall, SHI is more economical than NHI. The cost of SHI is split between employee and employer. Furthermore, SHI includes coverage for family members, NHI does not. Therefore, if one family member is working and covered by NHI, the remaining family members will need to apply on their own. As well, unemployed people are required to register with NHI.
Expats moving to Japan to teach English as a second language should note that some less-than-scrupulous companies only allow employees to log 29.5 working hours a week. That’s because you must work 30 hours a week to be considered full time and eligible for SHI. This is their sneaky way of making sure they do not have to pay the employer’s share of SHI. If teaching ESL is in your future, speak with other teachers to inquire how their company handles NHI and SHI. Make sure that you read the fine print on your contract to determine how the company defines “full time”, and if it is in line with the SHI definition.
What You Need To Know About Processes
Within two weeks of moving to Japan, you are required to enroll in a health insurance plan. However “required” is a tricky word. While words like “required” and “mandatory” are often used in official documents, you cannot be deported or have your visa renewals denied because you have not enrolled. There are no penalties if you don’t enroll. But you should! Overall, it’s a very smart plan to do so. The cost is fair and the coverage is excellent. However, if you have an alternative arrangement already in place which covers your health insurance costs, you’ll want to look into just how “required” enrollment actually is with your employer.
Applying for NHI is a case of visiting your local ward or city office with your supporting documentation – passport, visas, confirmation of employment, and proof of income from the previous year. When you receive your health insurance card, don’t let it go! Without it, you’ll have to pay for 100% of your medical costs upfront instead of the usual 30%. You will eventually be reimbursed but it’s a hassle you’d rather avoid.
While it’s not part of the regular NHI and SHI paperwork, there is one important form that all expats should know about. It’s called a Yakkan Shoumei Certificate. This will allow you to legally import a year’s supply of prescription medication if no equivalent drug is available in Japan. It’s commonly used by expats to access their preferred contraceptive medication.
Pros and Cons of Using the Local Health Insurance System
Expats will rely on the public healthcare system for nearly all their primary care needs. That’s because, by law, all hospitals in Japan must be not-for-profit. All clinics must be owned and operated by physicians. The limited private healthcare system is predominantly focused on elective and cosmetic procedures.
Overall, the Japanese healthcare system offers an excellent standard of public healthcare. There is a strong emphasis on preventative care, including vaccination programs, prenatal care, and critical illness prevention. However, if the system has one weak point it is mental healthcare. Receiving mental health care and treatment is still stigmatized. Furthermore, many treatments and procedures long considered out of date in other countries (such as the use of isolation and restraints) remain relatively commonplace in Japan.
One thing which many expats won’t be expecting is that, in Japan, patient communication might be very different than it is at home. Doctors have significant authority. Questioning your doctor’s orders and instructions – or even asking for further explanations or clarifications – is rarely done. Rules are rigid. The concept of a patient’s “right to know” isn’t commonplace. This can make using the local healthcare system even more stressful than it needs to be. It helps in part to speak with other expats to know what to expect or to have a trusted friend or colleague with you for moral support.
In Japan, nearly everyone carries supplemental private healthcare insurance. This coverage augments the costs that patients are normally responsible for (the 30% of the cost associated with medical visits and so on). This savings alone can add up quickly! It can also cover some private healthcare options as well as things that aren’t normally included in the public system, such as orthodontics.
Things You Need To Know When Considering Insurance
Whether you’re visiting Japan as a traveler or a long term expat, language barriers are a significant problem for everyone accessing the Japanese health system. Not all physicians and nurses speak English. Even expats who can speak conversational Japanese may find medical terminology a challenge. Choosing a supplemental insurance plan which includes an excellent support program is key. The staff can help you connect with English speaking medical personnel. They can also arrange for hospital stays at familiar facilities. You can also inquire about packages which include provisions for support staff during a medical emergency, like homecare assistance or even interpreters.
While many countries have a lack of physicians in rural areas, the opposite is true in Japan. Urban areas are struggling to retain their physicians. Doctors favor rural areas for a less stressful life. While this doesn’t mean there are no more doctors in major cities, it does mean that wait times might be longer. Hospital wait times are a problem in large cities and hospitals have even been known to turn away patients in critical care when their beds are at capacity. This is another situation in which an insurance plan with a strong focus on customer support can come into play.
Best International Health Insurance in Japan for Foreigners
We have selected some of our most popular insurance providers and are providing them to you to guide you in your search for health insurance in Japan. The following providers are of the highest quality for product design and customer service. We stand behind these insurance companies and are available to all of our clients to support you during the entirety of your term with the plan you choose.
Best Japanese health Insurance for International Citizens in Japan
- The flexibility to tailor a plan to suit your individual needs
- Access to Cigna Global’s network of trusted hospitals, clinics, and doctors
- The convenience and confidence of 24/7/365 customer service
- Fortune 100 company with more than 800,000 expatriate members worldwide
- Access to Annual Health Exams & Medications
- Talk to global member support 24/7/365
Best Health Insurance for Americans in Japan
- Premium Benefits, Coverage and Service
- Define your deductible and prescription benefits
- For Foreigners in the US or US Citizens Abroad
How To Find A Family Physician While in Japan
In Japan, family physicians and general practitioners are far less common than they are in other countries. The majority of physicians go on to practice a specialty and patients can make appointments directly with specialists.
“Japan Healthcare Info” is an organization which offers free healthcare-related services to expats. They can recommend a specialist, book appointments, provide hospital interpretation services, and offer general advice. They’re a good first connection if you want to find a family physician.
How Routine Doctor Visits Work
It might feel very strange to go to the hospital when you’re just moderately ill. After all, you know you don’t have a proper emergency! However, unless you have a family doctor or you’re certain about the kind of specialist you need to see, going to the hospital is a reasonable first step. Hospitals in Japan are used far more often for non-emergencies than in other countries. The staff can arrange for you to have your routine follow up appointments at an appropriate clinic which specializes in your concerns. Before you leave home, make sure you have your Japan health insurance card with you!
Tip: Contact your insurance company for advice on finding a local doctor in Japan.