Employee Health Insurance (Shakai Hoken)

What shakai hoken covers

The term shakai hoken (社会保険, literally “social insurance”) refers to the bundle of employment-based insurance programs that employers in Japan are legally required to provide to qualifying employees. The health insurance component is called Kenkō Hoken (健康保険) and functions like NHI but with employer cost-sharing. The package also typically includes pension (厚生年金, kōsei nenkin) and employment insurance (雇用保険, koyō hoken), though this guide focuses on the health coverage.

Health insurance under shakai hoken is administered either by a company-specific Health Insurance Society (健康保険組合, kenkō hoken kumiai) — available at larger corporations — or by the Japan Health Insurance Association (協会けんぽ, Kyōkai Kenpo), which administers coverage for small and medium-sized companies. Both provide equivalent fundamental coverage.

Who is enrolled by employers

Employers are required to enroll in shakai hoken and extend coverage to their employees if they meet the applicable size and hours thresholds. The threshold for full-time employees has always included any employee working 30 or more hours per week at any size company. Reforms in 2022 and 2024 have progressively lowered the hours threshold for part-time workers at mid-sized and larger companies, so part-time foreign residents should confirm their status with their employer’s HR department.

Self-employed workers and those working for companies below the threshold are not eligible for shakai hoken and must enroll in NHI.

How enrollment works

Your employer handles the paperwork to enroll you in the relevant scheme. You do not go to a municipal office for this — the employer submits forms to the Japan Pension Service (日本年金機構) on your behalf. You receive an insurance card (健康保険被保険者証, kenkō hoken hihokensha shō) shortly after enrollment, which serves the same function as the NHI card: present it at medical appointments to activate the 70% insurance coverage.

Premium deductions appear on your salary slip (給与明細, kyūyo meisai) as 健康保険料 (kenkō hokenryō). Your employer deducts your share each month and remits the combined employer-employee premium to the insurance fund.

Dependent coverage

Shakai hoken is notable for allowing dependents — spouses and children who are primarily supported by the insured employee — to be enrolled on the same policy with no additional premium. This is a significant advantage over NHI, where each household member generates additional premium charges.

To enroll a dependent, submit the health insurance dependent enrollment form (被扶養者届, hifuyōsha todoke) through your employer. The insurer will verify the dependent’s income (the standard threshold is annual income below ¥1.3 million). Approved dependents receive their own insurance cards and receive the same 70% coverage as the primary insured.

When you lose employment

Shakai hoken coverage terminates on the last day of employment. If you leave a job — whether voluntarily, through redundancy, or contract expiry — you must address your health insurance within 14 days. Two options are available.

Option 1: Enroll in NHI. Go to your local municipal office with your residence card, residence registration, and documentation of your previous shakai hoken (such as the withdrawal certificate your employer will issue). NHI premiums are based on the previous year’s income, so premiums in the year you leave employment may be substantial.

Option 2: Voluntary continued insurance (nin’i keizoku). You may continue your previous shakai hoken for up to two years after leaving employment, but you bear the full premium — both your prior portion and the employer’s portion. Apply within 20 days of losing coverage through your previous insurance fund. This is sometimes advantageous if your prior income was modest and Kyōkai Kenpo premiums are lower than the NHI rate your municipality would calculate.

Last reviewed: September 2026