Japan
Japan Clinics that direct bill ProtExPlan: Tokyo: 1. Akasaka International Clinic 2. The King Clinic
3. The Shane Clinic
2-33-5 Higashi Azabu
Minato-ku, Tokyo
Tel: +81-3-5549-9983
Fax: +81-3-5549-9984
Information on Japan and the Japanese National Health System:
The Shane Clinic
Dr. Fred Shane has been in Japan for decades and is a retired US Army Medical Corps Colonel, originally from Texas. Patients have told us is the and nicest old gentleman you'd ever want to meet, he treated the author and we agree. The clinic is a 5-minute walk from Azabu Juban subway station on both the Oedo and Nanboku lines.
The King Clinic
Dr. Leo King has treated many patients and those that have reported back have said he is excellent. The office is beside the Tokyo landmark Condomania store on the same corner at the intersection of Omotesando and Meiji Dori in Harajuku. The closest station is JR Harajuku on the Yamanote line or the co-located Meiji Jingumae subway station on the Chiyoda subway line.
Dr. Doug Berger - American Board Certified Psychiatrist in Tokyo
We've known Doug for many years as a medical insurance client and a hiking partner. Don't hesitate to call him if you need to talk something over.
www.japanpsychiatrist.com
www.megurocounseling.com
The Japanese National Health (JNH) System:
The JNH system can be both municipally administered and by your employer in a company scheme. The premiums cover both the national pension scheme and health insurance. For the pension portion you need to contribute for 25 years to qualify. If you leave Japan early, the maximum refund is the last 3 years thus forfeiting additional contributions. As for the Health insurance portion, the scheme only covers 70% of your hospital bill, and only in Japan. The premiums are like a tax because they are a percentage of your income, about 8.5%. That means if you make $100,000 a year, you are paying the maximum, which is a cap of about $5,000 annually. ProtExPlan would charge an average of $1,000 a year for most clients in Japan. Most expats in their first year find the monthly JNH premiums reasonable because they are based on prior annual income. Since you did not have any income in Japan, you get charged the minimum base rate of about $20 monthly. Most people are rudely shocked when they get their assessment at the end of the first year, when it goes to a minimum of about $220 monthly! The other nasty surprise is that there is no legal way out of JNH once you are enrolled. So be smart and don't enroll in the first place.
Reasons not to Join Japanese National Health (JNH):
1. It does not provide good cover outside of Japan, and the pension portion is confiscated if you leave before contributing for 25 years.
2. The JNH system only covers 70% of your hospital bill, ProtExPlan covers 100%.
3. It does not provide the extra benefits that expat policies have like medical evacuation, compassionate travel, home nursing etc.
4. Clinics catering to foreigners with American and British doctors in Tokyo do not accept JNH.
5. Most foreigners prefer not to be treated in a Japanese hospital, given the choice. The average hospital stay in Japan is 34 days while in Europe it is 7, and in the US it is 5 days. (statistics: American Chamber of Commerce Journal article) If you are really sick or need elective surgery, private insurance enables your return home or to a country where they speak your language and hospitals are up to European and US standards of treatment.
6. Medical malpractice: In Japan it seems to be common from reading newspaper reports. You do not have much hope of success in litigation, or of getting a good settlement even if you win. The Japanese legal system does not have juries, the courts proceed glacially, and there is often discrimination against foreigners. If you would be satisfied with an apology, they express regret a lot here as long as they don't have to pay and nobody loses their job or actually has to takes responsibility for incompetence.
Reasons to Join Japanese National Health:
1. If you have a big family, i.e. 4 or more children, JNH can sometimes be cheaper than private expatriate insurance depending on your income.
2. If you join you can get into the unemployment insurance & pension system.
3. If you have pre-existing conditions or chronic diseases like diabetes that may require expensive maintenance, and or flare up seriously from time to time, JNH will cover them. Private insurers like ProtExPlan will not if they are pre-existing conditions.
How to get out of the Japanese National Health system:
1. Move from one ward or municipality (ku) to another. You must deregister at the old ward and reregister your address and foreign resident ID card in the new ward. The place in the ward office or city hall where you register your address is a different office and bureaucracy than the health insurance office. Simply do not reregister at that health insurance office in the new ward and you are out of the system. You must return to the old ward office and inform them you have moved in order to cut the ties.
2. If you do not want to move, or cannot move, do the same as in 1. by establishing a correspondence address in another ward, and move on paper. Many people do this using a friend's address.
3. If you are a member of a company plan and are leaving, then you can leave JNH because they expect you to go dutifully to your ward office and join the individual plan. Just don't go down to the ward office and join, and you are out of the system! Don't feel bad, 30% of Japanese citizens are delinquent. The above assumes your are not hired by another firm that forces you on their plan and are entering contract employment, or are joining a firm that is owned by understanding foreigners.
There is no way a ward can force you to join JNH, but if you do, it can be a big problem to leave. So never join in the first place unless you can avoid it. It is important to cut JNH properly because the unpaid premiums will keep accruing like a tax bill, and will not go away unless you sever the ties properly. There are no negative consequences for being out of the JNH system as long as you have private insurance that pays your medical bills. If there ever is a problem, they will ask you to pay back premiums, and if they ask you to do this you can avoid this by showing proof of private cover like your ProtExPlan policy certificate, or a letter from us.
Inconsistency in Japanese National Health membership policy:
Everybody is supposed to be a member of JNH, yet there is a 30% delinquency rate and legally resident Brazilian factory workers in Aichi prefecture and other places who want to join are barred. JNH is a bad deal for foreign residents in Japan, so you shouldn't feel guilty about avoiding it and saving thousands of dollars per year. Another recent issue was the government's incompetent loss of 30 million citizens records of payment history into the plan. Do you think they've learned to back up data yet?? Do you think if you were a foreigner in Japan and paid into the system for decades that you've get any action if they lost your records??
The USA - Japan Totalization Treaty effective mid 2005:
Many American residents of Japan have waited a long time for this during the 20 year negotiation period, but they will be disappointed. Above it was mentioned that the qualification period of the Japanese national pension system is 25 years, the qualification period for US Social Security is only 10 years. The totalization treaty allows time spent in either country by "detached workers" to count towards qualification time. So for example, if a US citizen is transferred by his employer on a temporary basis for up to 5 years, he will be able to totalize time spent in Japan and add this towards the 10 year qualification period back for US Social Security benefits. The treaty eliminates dual payments by companies into the respective government pension systems.
Employers of Americans certified as a "detached workers" had to apply to the IRS before they were transferred for an official certificate. This exempts the employer from paying into the Japanese National Health and Pension system and allows you to have private medical insurance and get time credit for Social Security. The "detached worker" status is only valid for a 5 year period, and is only for temporary workers employed by a US employer. You do not qualify if you have been transferred permanently or indefinitely, or if the US employer hired you in Japan, or if you are employed by a Japanese firm. If you are not a "detached worker" you will still have all but 3 years of your pension payments confiscated upon leaving by the Japanese government. Germany, the UK and South Korea have also similar Social Security totalization agreements.
Consumer Warning about Insurance Plans to avoid in Japan:
1. Viva Vida & Xpat Membership Clubs
This is a dubious form of "insurance" that seems to be allowed in Japan by virtue of it being a membership club and is caveat emptor completely unregulated. The club is owned by one man who is president for life and there is no underwriter. You have no way of knowing what the financial health of Viva Vida or Xpat is since there is no financial transparency and members have limited rights. The maximum payable for a claim is about $18,000 which is woefully inadequate. Viva Vida is primarily aimed at Brazilians living in Japan. Xpat is a related offshoot of Viva Vida launched by a Nepali travel agent in Osaka. He seems to be an agent of Viva Vida that has just re-branded this farce in order to sell the same thing to Westerners. It is very expensive at about $500 per year for the extremely limited benefits and no underwriter. Japan is the only country where we've actually seen a snake oil salesman pitching a crowd and doing brisk business with eager buyers. Would you buy snake oil?
2. MedOne / HealthOne
Our Nepali travel agent from Osaka above is quite the entrepreneur and has launched his own medical insurance plans under various names. All you need to know to avoid them is that he underwrites them himself. There's no financial transparency, and no guarantee. What if there's an earthquake in Japan that wipes him out? Do you think he's going to have the ability to pay the claims??
3. Adapt Health Plan
This plan was created by people that were fired from other legitimate international medical insurers. There is no underwriter and they have failed to pay hospital claims for things like motorcycle accidents because they alleged the driver was speeding. How they could possibly know that, we don't know. Once again, there is no underwriter and all of that nonsense about trustees in New Zealand and medical savings accounts is exactly that. What happens if there is an earthquake in Japan? Well that would be "an act of God" or a "force majuere" or the savings account would be drained, or they'd invent another reason not to pay.
Disclaimer:
The information about Japan is meant to be helpful and is to the best of our experience and knowledge and provided as a courtesy. If you find any inaccuracies or disagree, then we invite your comments, and will amend this information accordingly.