Japan National Health Insurance for Foreign Residents

If you live in Japan on a residence status for more than three months and you are not covered by an employer's health insurance, you are generally required to join National Health Insurance (国民健康保険, Kokumin Kenkō Hoken), usually shortened to NHI or kokuho. The Immigration Services Agency's living and working guidebook (Chapter 6, Medical Services) states that foreign nationals are obliged to join except in listed cases, such as a stay of less than three months or the "Temporary Visitor" status. You enroll at the municipal office where you are registered, generally within 14 days, pay a premium set by that municipality, and in return pay a fixed share of covered medical costs at the counter: 30% for most people aged 6 to 69.

This is general information, not legal or immigration advice. Premiums, forms and caps change from year to year and differ between municipalities, so confirm your own situation with the NHI counter at your city, ward, town or village office.

Who has to join National Health Insurance in Japan?

Japan's public insurance is compulsory for residents regardless of nationality. The guidebook says all registered residents who are under 75 and are not in Employees' Health Insurance are obliged to enroll in NHI. People who work for a company that must enroll its staff join the workplace scheme (often called shakai hoken) instead, and residents aged 75 or older move to a separate program, the Medical Care System for Elderly in the Latter Stage of Life (後期高齢者医療制度, kōki kōreisha iryō seido). Yokohama's English page describes the NHI group as everyone not signed up for another scheme, which includes self-employed people, those working in agriculture and retirees.

For foreign nationals, the guidebook lists the cases in which NHI does not apply. Anyone outside these cases who is registered as a resident and not in workplace insurance falls under the general rule above:

• the period of stay is less than three months, subject to the exceptions below;
• the status of residence is "Temporary Visitor";
• the status is "Designated Activities" for receiving medical treatment, or for giving everyday assistance to a person receiving that treatment;
• the status is "Designated Activities" for sightseeing, recreation or similar activities;
• the status is "Diplomat", or the person has no valid status of residence;
• the person comes from a country that has a social security agreement with Japan covering health insurance and holds an official certificate showing membership of the home country's system.

A stay shorter than three months does not always rule you out. The guidebook says you can still join if your status is "Entertainer", "Technical Intern Training", "Dependent" or another "Designated Activities" category (other than the medical and sightseeing ones above) and you have a document certifying that your stay will be longer than three months. Municipal pages use the same threshold in plain terms: Yokohama tells non-Japanese residents that they must sign up for health insurance if staying in Japan for more than three months.

What are the key NHI rules and figures at a glance?

The table below puts the enrollment rules, the copay bands, one city's current premium rates and the national high-cost cap side by side, each taken from the official page named in the caption. The premium row is Shinjuku City's rate for fiscal 2026 and is an example only; your own municipality sets its own figures.

Key National Health Insurance rules and figures for foreign residents. Sources: Immigration Services Agency guidebook, Chapter 6; City of Yokohama NHI page (updated March 1, 2026); Shinjuku City NHI pages (premium rates updated April 1, 2026); MHLW high-cost medical expense page (updated July 31, 2026).

Topic	What the official source states	Source
Who must join	Registered residents under 75 not in Employees' Health Insurance; foreign nationals unless a listed exception applies	Immigration Services Agency
Short stays	Stays under three months and "Temporary Visitor" status are excluded; some statuses may join with proof of a stay longer than three months	Immigration Services Agency
Deadline	Notify the ward office NHI section within 14 days	City of Yokohama; Shinjuku City
When coverage starts	From the day you should have enrolled, not the day you file the form	Shinjuku City
Copay, under 6 (preschool)	20%	Immigration Services Agency
Copay, school age to 69	30%	Immigration Services Agency
Copay, 70 to 74	20% (30% at pre-retirement income level)	Immigration Services Agency
Age 75 and over	Separate late-stage elderly system: 10%, or 20% or 30% depending on income	Immigration Services Agency
Premium example (Shinjuku, FY2026)	Medical portion: ¥47,600 per enrolled member plus 7.51% of the assessment base, capped at ¥670,000	Shinjuku City
High-cost cap example (from August 2026)	Under 70, annual income about ¥3.7–5.1 million: about ¥93,000 out of pocket on ¥1,000,000 of treatment in a month	MHLW

How do you enroll at the municipal office?

Enrollment is handled by the NHI section of the office for the municipality where you hold resident registration. Shinjuku City lists moving in "from another city or country" as a reason to enroll, and its English page on NHI enrollment and withdrawal tells residents to complete the procedures within 14 days, adding that the head of the household is responsible for filing the notification. Shinjuku's list of enrollment triggers also includes leaving a workplace health insurance plan and the birth of a child.

The documents depend on your situation. The City of Yokohama's English NHI page (last updated March 1, 2026) asks people moving in from outside the city for a form of personal identification, such as a residence card (在留カード, zairyū kādo), passport, Individual Number (My Number) card or driver's license. If you are joining because you left workplace insurance, it also asks for a document confirming the date your old coverage ended, such as a Certificate of Loss of Health Insurance Eligibility or the eligibility screen in the Myna Portal. Ask your own office for its list before you go.

Filing late does not move your start date. Shinjuku states that eligibility begins not from the day you file but from the day you should have enrolled, so the months between becoming eligible and filing still count as NHI months. Ask the counter how premiums for that earlier period will be billed and how medical bills you paid in full during it are handled.

What you receive has changed in recent years. The Ministry of Health, Labour and Welfare's English guide to the My Number Card as a health insurance certificate (as of July 2025) says the old-style certificate could be used until December 1, 2025 at the latest, while the Health Insurance Eligibility Certificate (資格確認書, shikaku kakuninsho) has been issued from December 2, 2024. Yokohama explains that NHI members without a My Number Card registered for health insurance use are issued a Certificate of Eligibility, which can be shown at a hospital to receive insured treatment; members with a registered card receive a Notice of Eligibility Information instead.

You also have to leave NHI when your situation changes. The guidebook says you must withdraw when you move to a different municipality or join Employees' Health Insurance, and Shinjuku adds leaving Japan to return home. Yokohama warns that if you keep using its NHI certificate after joining workplace insurance, you may be asked to pay back the medical fees the city covered.

How are NHI premiums calculated?

NHI premiums (保険料, hokenryō) are billed by your municipality, and the guidebook sends residents to the municipal office for details. The guidebook says they are calculated per household according to income and the number of household members, and that the head of the household pays. Shinjuku's English premium page explains that the premium has a medical portion, a support portion and a long-term care portion charged only to members aged 40 to 64, and that each portion adds an income-based amount from the previous year to a per-capita amount. It also notes that an income tax report for the whole household is needed for the premium to be calculated correctly, which matters for newcomers with little or no Japanese income history.

To show what the numbers look like, the Shinjuku City premium calculation page (in Japanese, last updated April 1, 2026) lists these rates for fiscal 2026. The annual premium is the sum of all four portions:

• Medical portion: ¥47,600 per enrolled member (均等割, kintōwari) plus 7.51% of the income-based assessment (所得割, shotokuwari), capped at ¥670,000.
• Support portion: ¥17,600 per member plus 2.80%, capped at ¥260,000.
• Long-term care portion (members aged 40 to 64 only): ¥17,800 per member plus 2.43%, capped at ¥170,000.
• Child and childcare support portion, added from fiscal 2026: ¥1,873 per member aged 18 or older plus 0.27%, capped at ¥30,000.

Shinjuku defines the assessment base as total 2025 income minus a basic deduction of ¥430,000 (where total income is ¥24 million or less), treated as zero if negative. It also halves the per-member charge for preschool children automatically. Adding up the per-member charges alone, an adult in Shinjuku who is not aged 40 to 64 and has no assessable income would face ¥67,073 a year before any reduction (¥47,600 + ¥17,600 + ¥1,873 = ¥67,073), and an adult aged 40 to 64, who also pays the long-term care portion, would face ¥84,873 (¥47,600 + ¥17,600 + ¥17,800 + ¥1,873 = ¥84,873). Shinjuku's own fiscal 2026 quick-reference premium table, linked from the same page, prints the same two figures at zero income and states that its amounts are before any reduction of the per-member charge.

Those two figures are a pre-reduction ceiling, not a typical bill. Shinjuku's fiscal 2026 reduction table shows that a household with one NHI member and 2025 income of ¥430,000 or less falls in its largest band, which cuts the per-member charges by 70%. Shinjuku's English page also notes that premiums may be reduced for foreign students and people who have just moved to Japan, and the guidebook says reductions can apply according to income and other circumstances, so the amount you are actually billed may be far lower than the arithmetic above. Shinjuku's reduction table applies to households in which every member is in NHI, and a reduction requires income declarations from all members, including the head of household.

Shinjuku accepts payment by invoice, by direct debit from a financial account, or by deduction from a pension, and it asks residents who have difficulty paying to get in touch with the office rather than let premiums go unpaid. The figures above are Shinjuku's alone; other municipalities set their own rates and caps, so check your own city or ward's page for the current fiscal year.

What does NHI pay for, and what is the 30% copay?

Once your coverage is verified at the clinic or pharmacy, you pay only part of the covered cost (自己負担, jiko futan). The MHLW guide puts it simply: people between 6 and 69 pay 30% of their total medical expenses rather than 100%, and others pay 10%, 20% or 30% according to age and income. The guidebook gives the NHI bands as follows:

• Preschool children under six: 20%.
• School-age children through adults up to 69: 30%.
• Adults aged 70 to 74: 20%, or 30% for those with pre-retirement-level income.

At 75, residents leave NHI for the late-stage elderly system, where the guidebook gives the copay as 10%, rising to 20% for incomes above a certain level and 30% for incomes at a pre-retirement level. Foreign nationals aged 75 or older must join that system on the same terms and exceptions as NHI.

Some costs are paid in full first and partly refunded later. The guidebook lists treatment received after joining NHI but before your certificate arrives, medical devices such as a cast, acupuncture, moxibustion or massage that your doctor deems medically necessary, and medical services received outside Japan. In those cases you pay the whole bill yourself, and once your application is approved you are reimbursed the expenses minus your copay. The guidebook is also blunt about the alternative: if you do not show proof of insurance at the clinic, you cover the full amount of the medical expenses.

How does the high-cost medical expense benefit work?

The high-cost medical expense benefit (高額療養費, kōgaku ryōyōhi) limits how much you pay in a month. The guidebook describes it as covering the amount above a fixed monthly copay limit that varies with age (under 70 or not) and income, and notes that hospital meals and bed costs are not counted. According to the MHLW page on the high-cost medical expense system (updated July 31, 2026), under the rules in force from August 2026 a person under 70 with an annual income of about ¥3.7 million to ¥5.1 million who receives ¥1,000,000 of treatment pays about ¥93,000.

The same page describes two protections for long illnesses. If you reach the cap in three or more months within the most recent 12 months, the limit drops further from the fourth month (多数回該当, tasūkai gaitō). From August 2026 a new annual cap also applies, with the year running from August to the following July, and from August 2027 the income brackets are due to be divided more finely. Because these figures are being revised in stages, check the current table with your municipal office rather than relying on older charts.

You can avoid paying above the cap at the counter in the first place. MHLW says this requires either using a My Number Card registered as your health insurance certificate or obtaining a Limit Application Certificate (限度額適用認定証, gendogaku tekiyō ninteishō) in advance; for NHI members, the municipality handles that application.

What can short-term visitors use, and what can't they?

Tourists and other short-term visitors cannot join NHI. The exclusions in the guidebook cover the "Temporary Visitor" status, stays of less than three months, and the "Designated Activities" categories for sightseeing and recreation and for receiving medical treatment in Japan. Without public insurance there is no 30% or 20% band to fall back on: the MHLW guide describes insured patients paying 30% "rather than 100%", and an uninsured visitor is billed for the full cost of care.

The Japan National Tourism Organization's travel insurance page says medical service in Japan is advanced but treatment can be expensive, and it warns that since 2021 foreigners with unpaid medical expenses in Japan may be restricted or refused entry. It points out that travel insurance is a separate product from any health insurance you hold at home, and that it is possible to buy a policy after arriving in Japan.

If you arrive as a visitor and later change to a residence status of more than three months, none of the official sources cited here addresses that change specifically. The nearest general rule is Yokohama's instruction to notify the ward office "within 14 days of applicability", and Shinjuku likewise asks for procedures to be completed within 14 days of an enrollment trigger. Because statuses and exceptions are detailed, confirm how the rules apply to your status with the Immigration Services Agency or with the NHI counter at your municipal office.