Is Japanese National Health Insurance compulsory?
The quick answer is – well like everything in Japan there is no quick answer.
The Japanese authorities will do everything they can to get you into their scheme because they have an ever growing problem with obligations to a healthy non income producing aged society of pensioners.
The NHI is not so bad is it? Well let’s see. Because you can’t just pay for the Health Insurance part of the NHI you also have to pay for the pension fund that keeps the ageing population flush with social security payments. The rough amount per employee is about 8% so how much is that? A typical office clerk earning 250,000Ұ/month will be paying 20,000Ұ per month or $199 US. When they visit the doctor or hospital they will also pay a minimum of 20% and up to 30% of the bill. When you are young you do not go to the doctor so often so this may not be such a big deal, but if you are getting a little long in the tooth the frequency may increase and this becomes a relevant part of the calculations. The actual Medical Insurance part of the bill is not as much as the pension part.
Insurance is compulsory but what are the types of acceptable insurance?
- Japanese National Health Insurance – NHI.
- Social Health Insurance/Employees’ Health Insurance – SHI
- International Travel Insurance – for example Protexplan .
As much as the Japanese bang on about how you are obliged to use their system is not enforceable by law for foreigners to pay for Japanese Medical Insurance or Pension. If you pay your ward taxes then you can just neglect to pay the others. The pension part of the contributions is partly refundable, you will receive the last three years of your contributions if you leave Japan permanently. If you ever want to get into the NHI anytime after the two week registration grace period you will have to pay some retrospective payments, depending on your municipality, the back payments can be from 2 years to the original date that you were supposed to start paying. People that have managed to stay out of the system just stay away from that counter when they register their new address at the local ward office.
So you are a foreigner living in the land of the rising sun, you pay your dues. You go on a trip somewhere and get sick, will the Japanese system pay for your hospital visit in another country, will it pay for you to fly home to your home country, will it pay for you to fly back to Japan? No it wont!
The fact is for a foreigner living away from their home country NHI/SHI only does part of the job, not only are you paying for a doomed pension system that even if you get back three years of contributions you loose out on any growth that might have otherwise been achieved but you are being enrolled in a health care program that limits you to only Japan. The chances are that if you are an expat you travel and will need cover no matter where life takes you.
If you have private medical insurance you will be covered in Japan and the rest of the world (according to your selection) and the chances are it will cost you a lot less.
Stay tuned for our next article on how to stay of the system, with actual situations.
written by JC