| UPDATE – March 2010 |
| Japan Today reported that in March the ambiguous Japanese immigration policy that seemed to force foreigners to join the National Health Care system —Guideline No. 8— has been officially deleted (See original Japanese version here). The article also goes on to say, “Although Immigration will encourage enrolment in Japan’s social system by distributing brochures, individual offices and officers are ‘forbidden’ to pressure anyone to join. In fact, the new guidelines state clearly that enrolment in the social system will in no way be tied to visa renewal.” |
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The Japanese government will tell you it’s the law to buy into the Japanese Health Insurance system but this is a lie. Health Insurance, like most laws in Japan involve a big grey zone. A more accurate statement by the Japanese government would be, “Pretty please join our super expensive medical coverage but if you don’t, we can’t force you to.” There is no way penalty for not joining the system and as long as you’re a fine outstanding citizen it won’t effect your VISA or Permanent Residence application in any way.
In the summer of 2009 the Japanese government made a surprise announcement that getting your new VISA would require you enrol into the Japanese Health system. It was later clarified by the government that the new “no health insurance, no visa” law in fact wasn’t a law at all but just a guideline with no legal standing. In other words you can’t be denied a VISA for the sole reason of not having Insurance. This doesn’t mean that Japanese government officials won’t tell you that you, “have” to enrol into the government Health system but the best way to brush them off is to just say you have private insurance whether you do or you don’t.
Now that doesn’t mean you shouldn’t have health coverage in Japan. There are many private companies (Interglobal and IMG are some of the bigger ones) that offer good private health coverage for relatively cheap rates. Interglobal offers a silver plan that covers you 100% in Japan and all over the world ( except the US ) for around $1000 a year. Here is a more detailed breakdown of insurance companies although its a little dated being from 2002.
Joining the system
Now if you want to join the system for whatever reason the first question is why?? There is no legal reason. If you do join the government plan the Japanese system will only cover 70% of your medical bills while taking a large chunk of your pay check every month while the private plans listed above will cover you for 100% of hospital bill for a fraction of the cost. Also if you’ve been in Japan for longer than a year you will have to pay a Health penalty for the time you’ve stayed in Japan. Depending on your city government this could mean anywhere from 5 years to 2 years back payment in one lump sum. The monthly payments are based on your city taxes but the average worker is going to pay around 20,000 a month into the health system. So if you have to pay 3 years back payments thats 600,000 YEN (About $6000) and you can’t deduct any payments you’ve been making to private insurance.
Now if you still want to join first you need to decide which of the Japanese plans will fit your needs:
Break down of Japanese Health system
In Japan there are two major health plans in Japan (There are six other very specific minor plans )
1. Employee health insurance (kenkou hoken, 健康保険)
2. National health insurance (kokumin kenkou hoken, 国民健康保険)
Like the name implies the Employee plan is supposed to be taken care of by your company and the National plan is for independent workers or employees an employer doesn’t want to cover.
Employee health insurance (kenkou hoken, 健康保険)
If you are a foreigner in Japan your company will most likely either not tell you about the Employee plan or do everything in their power to keep you off it as they are by law supposed to pay 50% of the cost of the monthly payment. But it is not just foreigners who are kept off the company’s health coverage plan; Japanese companies are increasingly kicking their employees off or not adding new employees to their company plan as a way to increase profits. Millions of Japanese are left uninsured even though the law requires Japanese companies to cover them.
Under the Employee health insurance if you get sick you will apply for the following:
-70% of all medical costs
– 60% of salary from lost days (beginning from the third day absent from work due to injury or sickness)
– High-cost medical expenses cannot exceed 80,100 yen/month
– 0% interest loans are available to cover excessive costs
National health insurance (kokumin kenkou hoken, 国民健康保険)
This is the plan you will most likely join. If you fall sick you can receive the following benefits:
-70% of all medical costs
– High-cost medical expenses cannot exceed around 100,000 yen/month
– 0% interest loans are available to cover excessive costs
Top up coverage
As both of the above only cover 70% of the costs it is worth while to look into a TOP UP plan to cover the remaining 30%. AFLAC and Intergobal both offer good coverage for around 25,000YEN.
Calculating Japanese Health care costs
The formula for paying into the medical system varies a little from city government to city government but for this example we’ll use the Shinagawa forumla:
(Family members in your house x 31,200) + (Family’s total city tax x .80) = A
(Family members in your house x 8,700) + (Family’s total city tax x .23) = B
Then add A + B to get the total amount for the year (The medical system monthly payments start in June and end in May)
So if you have one person in your household and your annual city tax payment was 150,000YEN then it would like this:
(1 x 31,200) + (150,000 x .80) = A
(1 x 8,700) + (150,000 x .23) = B
A + B = 194400 YEN (or 16,200YEN monthly payments)
Cost Break down
In the table below are three options for 100% medical coverage based on making enough money to get a 150,000 city tax bill.
| Name of coverage plan | Monthly cost |
| Employee health insurance 1 | 8,100 2 + 2000 TOP UP3 = 11,100 YEN |
| National health insurance 1 | 16,200 + 2000 TOP UP3 = 18,200 YEN |
| Interglobal private insurance | US$83 = 7200 YEN4 |
1- In the Japanese system the amount you pay will go up according to how much you make where as health coverage outside the Japanese Health program, like with a private insurer, will stay the same.
2- Employee pays half of medical premium cost
3- Based on cheapest TOP UP plan provided by Interglobal
4- Yen dollar conversion based on Dec 2009 rates for the Interglobal silver plan which offers $1000 yearly premium for 100% coverage
Which is best for you?
So as you can see if you’re getting around 150,000YEN annual city tax bill the Japanese health system is almost twice the price of private insurance. However, 150,000 YEN city tax bill isn’t very much; probably the average Eikawa job. Any decent job in Japan will pay more which means you’ll have to pay more city taxes which in turn means a higher city tax bill and higher Japanese Health Insurance premiums. Now you can reduce the amount you pay in city taxes by following some tax advice from GaijinTax.com and that will in turn reduce your monthly medical payments. Even with the tax advice though if you make a lot you’ll pay a lot.
One more thing to think when making your decision is that the private insurance is a flat fee no matter how much you make BUT as you get older the private insurance premiums will steadily go up until it reaches the point where its cheaper to pay into the Japanese Health System.
For other “How to … in Japan” guides, try these:
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| How to become big in Japan | How to cycle in Japan | How to survive getting arrested in Japan | Making Friends in Japan | How not to be a hostess |
Gaijinass 
I stumbled onto your article and wanted to thank you, as it’s very informative. Do you happen to know of any link in English to these plans?
I ask because I’m actually looking to see if my employee health insurance has some sort of optional travel insurance plan. I can’t use a private company, because I’m actually traveling back to my home country (US), and travel insurance won’t cover me because I have a US passport. I’m in a conundrum. I know you probably can’t answer this question, but if you could let me know where to start looking, I’d appreciate it!
Look at the city website of the city or ku you are working in. They should have an English site that will have general information and explain how to enroll in the Employee system.
Here is a website that provides more information:
http://www.sia.go.jp/e/ehi.html
If you go from Employee Health Insurance to NHI, are you still responsible for back-pay before joining NHI?
Depends if you’re in the same ku (city district). If you are then yes. If you’ve moved to a different ku then you its like starting fresh.
This seems really strange because I have had insurance the entire time. It’s just that my employer pays half of it (or whatever the percentage is). It’s not like I have been uninsured. Seems like paying double to me.
Oh sounds like you’re going from the Japanese Employer health care insurance to NHI. If that’s the case you shouldn’t have to pay back payments.
Also wondering…when I marry my Japanese boyfriend, will I be required to join his (jieitai) plan?
No you can stay in the NHI but its worth looking into whether joining his plan is cheaper
That’s right..Japanese employer insurance to NHI. Thanks for the info!
I have been told that the local city hall can take my car or possesions if I do not pay for National Health Insurance under the self employed plan. As it reads above I work part time at a few schools so have to pay it myself with no help from any employer. Is this true they can take my possesions and sell them,the same as if I did not pay income tax.
If you’ve already joined the system and after making a few payments you fall behind then yes, they have the power to seize your belonging or garnish your wages. If you haven’t joined the health system yet then no because you won’t owe them any money because you haven’t joined.
Hi, thanks for the advice, it was not what I wanted to hear, but at least it is correct. I was put into this system although I stated clearly that I did not want to pay since I have private insurance which covers 100% of my very few health costs. I paid under duress and later took some advice that i did not have to pay and there was nothing they could do about it. It appears as you say that only applies if I did not make a first payment then stop. The problem for me now is that i stopped paying for 2 years and now they want 2 years back payments plus the current year’s payments which is next impossible for me to pay,so I have a big problem with a very stubborn and by the rule book type of city hall officer who is becoming very threatening about taking my car etc.Looking at the above comment, if I moved to another Ku I could at least only have to pay the arrears and could avoid new payments, is this true?
Hi again, where can I see a full version of the actual law applying to payment and collection precedures applicable to National Health Insurance payments? In Japanese or English.
http://law.e-gov.go.jp/htmldata/S33/S33HO192.html
Hi,
To enroll in NHI, is there any medical checkup or health screening needed to be performed?
If so, what tests do they perform?
No tests just go to city hall and sign up, but I wouldn’t do that for the reasons outlined in the article. However, private insurance policies usually have a one year no pre-conditions clause.
Thanks so much for your article. This morning, 2 chaps came to our door-step to demand that hubby (sole bread-winner) pay the amount owing about ¥700,000 (for 10 months).
Hubby said that when he first registered himself and the family for NHI, he did it under duress and ignorance at City Hall. Without any bi-lingual help, he just did what he was told. About a year ago, he realised that they were withdrawing ¥68,000 per month without informing him of the increase. We then formally stopped them from withdrawing the said amount from his bank account. We also expressed our intention to go private. Yet, they continue to send the monthly slips for payment.
Today, hubby informed them his income has been halved yet they still demanded that payment, mentioning a penalty will be imposed against his salary. Can they do that legally?
Since July, we have been paying full medical costs to show that we are not interested in being part of NHI.
Please advise us what is the next best action.
(NB I thought there was a ‘ceiling’ amount that NHI can charge.)
There is a ceiling for medical costs that you have to pay when you get sick. The ceiling for monthly payments is higher than 68,000 YEN.
I’m afraid there is little chance that you will be able to get out of the NHI system, once you’re in, you are in for life.
You will probably be forced to pay the 700,000 YEN that you owe, although I’m surprised they came to your door. If you go to city hall they can set up a payment plan and get the debt collectors off your back. Paying full medical costs won’t help either but you might be able to get a refund when you show that you were still on NHI when you were paying the full amount.
The monthly payments won’t go down until next year when the payments are adjusted for your husbands income. However the money you are paying now will be deducted from any future taxes that you pay. So next year your tax bill will be a lot less which means that your health insurance premiums will be less (the amount of your monthly premiums is based on amount you pay to city taxes) .
Officially the only way you can get out of NHI is to leave the country.
Unofficially you can try and move to another city (ku in Japanese) either by actually moving or registraring at a friends house. Then show that you are on private insurance at the new ku but depending on the technology of the ku it might not work if your ku and the new ku’s database are connected.
Also one way I’ve heard could work is the Angry Gaijin. The angry Gaijin approach is where you go and yell and scream your outrage at city hall which will open up two possibilities:
A) Embarrassed and anxious to get you out as soon as possible they reduce the amount you have to pay.
or
B) They want to make an example of the annoying Gaijin and start seizure proceedings against your assets.
Thanks so much for your prompt response.
So, even when hubby joins up with a private insurer say next week whilst still living in the same city, he is still require to back pay dued premiums? Will deductions be thus adjusted?
What puzzled me as well is that both parents’ coverage ends next month whilst the kids are due to expire in January 2011? Yet the NHI dept says that the invoices will continue to be sent. What’s the story with that?
Even when your husband joins a private insurance plan you will still be in the NHI and they will still expect you to pay your past and future monthly premiums. You can go down to city hall and beg them to get out out of the system but its extremely unlikely that they will let you; 95% chance you be forced to remain in the NHI and pay premiums based on what he made last year.
It’s not until next June after you file your taxes that the premiums will be adjusted to his new financial situation.
As for any kids, depending on your ku sometimes Children under 18 have free health care if their parents are part of the Japanese system which means they are on a different schedule.
Sandy,
What is happening to you is the way the law really works. At some point in 2009, your husband’s salary must have been really high. So the ku gets the income information and assesses the rate based off that. If it’s 68,000 yen a payment (10 payments), it must mean your husband was making 8 million at least.
Even though his salary went down, they base it off the prior year. When 2011 comes around, they would base it off 2010.
You cannot really, legally “go private”. What these expats have done is delude themselves into thinking that since Japan hasn’t bothered to enforce its laws against non-enrollees, you can simply disenroll. You can’t do this legally.
By the way, you know that your National Health insurance payments are deductible against your National tax? That means the government should be crediting you 25%-35% of the cost.
Good luck, but if you think some website that someone set up out there out there exempts you from paying what, yes, very much looks like a tax, I think you’re just asking for trouble down the road if you stay here.
Sandy, what happened to your hubby also happened to me. I left work early February 2008 and was almost away for the rest of that year. Needless to say, my “shakai hoken” also ended the day I left my job.
Mid 2009 when I decided to take care of my pending “nenkin” premiums so I went to the city office to tell them that I missed some payments because I was out of work since 2008, and asked for advise.
After signing some documents, I realized I was also signed up for the NHI! Then right there the guy told me that I owe them like 650,000yen. That was only for 2008! (There’s another for 2009.) What I fail to comprehend is, why do I have to pay that 650,000yen? It’s the middle 2009 and I should pay that amount, for year 2008, which in any way will never be used for its purpose? That’s illogical, nonsense!
If it was for 2009, at least the current year I went there, then I would understand. But 2008? Technically, I was not even in their database yet that time and I never used any insurance that year and even the following year.
Now that I’m back in the work force again with “shakai hoken,” it is making me more mad to think about NHI.
I read in another forum that they can only ask for the last 2 or 3 years back. However, the source is not mentioned so I am not sure of its reliability.
However, I had a similar experience before. When I moved to Setagaya-ku. I went to the city hall to enlist and I told them that I haven’t paid the last 2-3 years (I was a student then) of insurance premium, they simply said okay. No back payments! No questions asked. It’s simply like starting anew.
I am still trying to do research on the source of that “past 2-3years only” and for the meantime, I am giving it a rest and resume my “fight” next year.
This is actually the rule. They base the NHI on the last year’s income, and I got caught in that rule during 2009. My bill was a fortune.
I think the logic behind it is that the ward office doesn’t know what the current year’s income is. But this could easily be solved by having a rule that lets you establish current year’s income–that’s what the U.S. does with Medicare surcharge as well as student loans.
Evetything is set up as if you are a male salaryman worker who will be in one program for 40 years. Anyone else gets these special zingers.
That said, I am still in favor of doing it the right way. You get a deduction for the hoken payments, and in the long run it should all balance out.
Gosh, hubby will definitely put on “Angry Gaijin” now!
So, sir/madam are you also the brains behind GaijinTax,com?
No, but that site does work. Lowering health premiums is all about lowering your tax rate and that’s what Gaijintax.com is all about.
Oh and tell us how it works out.
Also, if we choose to leave Japan, does it mean that the overdued amount will be written off and we will not be permitted to return here ?
In the past (depending on your ku, probably now) the Japanese just write off any debt owed by foreigners who leave the country. But more and more kus are starting to digitize and talk to other city kus.
It’s only a matter of time before immigration will have a national database that will check if you owe any money when you exit/enter the country but that ability to the best of knowledge doesn’t exist yet.
yosomono, your input is much appreciated. Whatever the outcome, yours truly will be back with an up-date, unless ‘they’ are going to take the computer as well.
I recently moved back to Japan after 3 years travel/work throughout Asia. During that 3 years I was covered by my employers health care. I have just moved back to Japan and don’t have any cover at the moment. I want to get onto a plan ASAP.
I married a Japanese national this year, and we have just bought a place so we are looking at being here for a while. We are also looking at have children in the next year. My wife is currently working and is covered by her companies health care (she is also planning on using that companies maternity leave when the time comes).
I am self employed and work mostly from home, so I don’t have any health care provided. We have looked into me joining her healthcare cover, but her company has informed her this isn’t possible. It will cover our (future) children however.
With that in mind I am not sure what is best for me. I have avoided the National Health Care system like a plague the whole time I have been here – only heard horror stories about it. However with moving back full time and planning to start a family I was wondering if I should bite the bullet and finally join?
It would seem to me it would be best for me to stay in private health care (I have been looking at what health care fund would be good for me and I am leaning towards Healthcare international, but would like suggestions on this too) and let my wife and then children be covered by the National system. However I am not sure if this is an option or not.
I would like to hear from any other foreigners who are in a similar situation and any advice would be greatly appreciated.
I am not certain you are prohibited from joining your spouse’s company plan.
I can be classed as a dependent, but only if I earn less that 1,300,000 a year. I earn more than that, so I can’t join her plan.
I would still continue with NHI before I ever did a private plan.
Can you outline why Hoofin? I am still up in the air about what I should do, but leaning towards NHI. Any advice/personal experience would be greatly appreciated.
I know everyone looks at this differently, but to me, people should look at what might happen in the near future, and not what they have been able to get away with in the past.
In about 2 years, a new Alien Registration system is going to be put in place, where someone in the central government will be tracking who is, and is not, enrolled in health care and pension. This makes it more likely that people will be hit with an arrearage if they aren’t in the NHI.
The second reason is that the Japanese government is in the process of reforming the pension and health care system. This will probably mean a complete revision to shakai hoken. When that comes about, I am not certain that the government will say that everyone starts new. They may be looking for money in arrears, at least on the health care side.
Some people say “risk it” and go without enrolling. I think that risk is riskier than it used to be. It’s a taxi meter running, where you might be able to jump out of the cab or not.
I’ve spent over five years in Japan, and enrolled in the NHI at the start. Sure, I ended up paying considerable money for health care that I didn’t “use”–especially when I was doing well in jobs. But had I been the one to have the heart attack or the accident, the system would be there for me.
I believe that if there is a right way to do things, and you can manage to do it, it’s the best way to go. I realize many people were hookwinked into not enrolling, and that in some cases with places like GABA or the dispatch ALT companies, they barely pay enough to survive in Japan. I know, then, people do what they gotta do. But again, if you can do things the right way, I would go with that way.
You’re assuming that the Japanese will in the future require foreigners to have health insurance. As it stands now and as this article even says in the first paragraph the Japanese government has stated that: “Although Immigration will encourage enrolment in Japan’s social system by distributing brochures, individual offices and officers are ‘forbidden’ to pressure anyone to join. In fact, the new guidelines state clearly that enrolment in the social system will in no way be tied to visa renewal.”
I doubt this will ever change if Japan required all foreigners to join the health care system Japan would be shunned by foreign workers. And I don’t mean English Teachers no body cares about them. I mean bank executives, CEOs etc. If they joined the health care system it would be for life that means they would have to A) pay huge amounts of money relevant to their pay cheque B) Every time they leave the country and come back they would have to all the back payments for when they weren’t in the country. There is no way these foreigners who (actually have a voice would be forced to join the system)
inChofu,
I think you have that last part wrong. You may not know that payments in the NHI or into a health insurance part of Shakai Hoken are capped at a certain level. I think, after-tax, the amount is something like 570,000 yen a year.
All those expat CEO’s and the like top out at a certain amount, and then they do not pay any extra on the money above that.
When times weren’t as lean for me, I was in that boat. My payments only went up to a certain amount of my IBM salary. So I definitely know that that is right.
570,000 is still about $US 500 a month which I’m sure they could get a much better private policy for that amount of money, one that covers 100% of the cost.
But you’re still ignoring that every time the foreigner leaves the country they have to keep making their Japanese health insurance payments. So if they have to go to Belgium or China for six months even though they’ll have a totally separate insurance policy for each country they still have to keep paying into the Japanese system for life even when they aren’t there. I’ll agree with the Japanese government when they say Japanese officials are forbidden to force foreigners to join the system and that having health insurance IS NOT TIED to the VISA application!
I think those are the same far-fetched examples that the Free Choicers down in Osaka were sending up on the internet last winter.
When someone leaves the United States on business for six months, their private policy is NOT going to pick up overseas charges. Medicare won’t either.
A private “travel” policy for an expat resident in Japan will not cover 100% of costs for $500 a month. They will cap it at some low figure, and try to push the so-called insured into the National system.
Of course you can always tell them you are leaving the country for good – my wife was advised to do this by the nice lady at the ward office. We “moved” overseas for 6 months and then “returned” to Japan. Not sure how many times you can do it, but it is a good way around the system.
This was the maneuver that was being highlighted via an internet website connected to the same server that supported HealthOne’s Japan side business. I pointed this out last December, and the website quickly disappeared.
http://hoofin.wordpress.com/2009/12/13/ron-kesslers-freechoice-jp-tied-to-website-telling-foreigners-tricks-to-get-out-of-nhi/
There will always be people trying to cheat a government, whether Japan in 2010 or anywhere, anytime. I am not sure it makes it right. Are you?
If you are going to start talking ethics regarding government you should do it elsewhere. How many pensions did the Japanese government “lose”? Ethical. Very “right” of them. Lets keep it on topic, the ins and outs of the National health insurance system.
Well the Japanese Lady at the Japanese Ward office told my Japanese wife that was the best thing to do.
She only did what the government official told her to do. I think that Japanese people are much better at thinking their way around things than they are given credit for:)
health plans may be expensive but it is really very necessary to get one for yourself :-,
expensive is understandable, but signing up in mid-2009 and paying for year 2008? that’s absurd! i never heard of anyone going back in time to get sick and make use of that health insurance plan.
by the way, when i said 2008, it’s the amount calculated based in year 2007.
it would make more sense if they billed me from year 2009 (calculated based in year 2008) because that’s the year i, actually was fooled into signing with nhi.
It is supposed to be based on the prior year. So if you signed up in December 2010 (this month), they would look at your 2009 tax information (where the residence tax is also calculated off of).
If you went in in early 2009, they might have reached back to 2007. But at some point, it should have been 2008. (I actually was in the same situation.)
Deshou?! They said that I didn’t have health insurance back in 2008 so then my membership should start from 2008. What? It’s already mid-2009, why should the membership start in the past? And then I was told that I should pay the premiums for 2008. My heavens, that’s the most irrational thing I’ve ever heard.
See? This is the thing.
The rule is that any month you are a resident in Japan, you are supposed to be covered under either NHI or the Shakai system. There are maybe one or two other possible Japan-based ones.
You’re really not allowed to go bare, and you’re not allowed to substitute a gap policy like travel insurance.
Because of weak enforcement, people find this out too late. Then, they get hit for a huge bill, especially if they were making big money. The bill is a deduction to taxes, but it still hurts.
The trouble, as I have seen it, comes from these people who say, “fly under the radar.” Since they have so far been successful (i.e. successful in the past), they think that that is a legitimate approach.
it is a billed-in-arrears system. There’s no easy way around that. You can have Year X money and pay shakai hoken, and then the next year be in Kokumin Kenko Hoken and still be billed based off Year X. Japan makes the rules, and that’s the rule they have.
It’s tough on foreigners because we’re discriminated against when it comes to permanent employment.
It’s tough if you join the system. But as shown by Japan decreeing that foreigners don’t have to join the system then as long you are responsible and have private health insurance you avoid all the drama that comes with joining NHI.
No, that wasn’t what happened. Ron Kessler’s group made a big stink about Guideline 8 in the visa renewals. So the Ministry of Justice deleted Guideline 8 and put other wording about “encourage to join” in another part of the guideline.
The Health, Labor and Welfare Ministry oversees the health insurance system. Their regulations, based on Japanese national statute, say that everyone is supposed to be IN.
The requirement has always been there. Since it’s weakly enforced, the ability to skirt it has apparently always been there, too. I think the poster’s upset had to do with the fact that when they left Shakai, the got hit with a bill.
All the people currently dodging it are going to get hit with a big bill when the new Zairyu cards come out.
Can you please post a link to something from the Health, Labor and Welfare Ministry containing the the regulations you are referring to?
You’re interpreting the law the way a Western Person would. In the west the law is black and white. A judge in a case might say while I agree with the defendant the law forces me to send him to jail/pay a fine/ rule against him. While in Japan the law is giant grey zone where the laws are mere guidelines and the judge, or in this case the ministry, can bend the law to their will to give rulings, enforce laws, etc.
The laws and regulations revolving around health care have been created so that there is a grey zone for foreigners. The Japanese will never make all foreigners join the system as it would devastate the rich expat workers who work temporarily in Japan working in Japan for a year or two leave and then return for another year. The fact that the Ministry of Justice confirmed that having health care will not affect your VISA status confirms that the Japanese don’t want to change the status quo.
Sure. The link is within this comment on my blog from March:
http://hoofin.wordpress.com/2010/03/08/new-japanese-basic-resident-registration-zairyu-card-to-require-health-and-pension-information/#comment-378
“Ken44” and I went on about that very question over two comment boards (mine and Debito Arudou’s.) So, as I keep saying, it’s not that there’s no requirement. It’s that the requirement is weakly enforced.
The fly-under-the-radar gang keep saying to avoid, but what I am saying is that once the Zairyu card comes out, there’s going to be an official record (a blank space) saying that so-and-so isn’t enrolled in health insurance.
Also, I refer you to the same link I provided, as Comment 5 above back in June.
https://gaijinass.wordpress.com/2009/11/28/how-to-navigate-the-japanese-health-system/comment-page-1/#comment-631
Yosomono, it has nothing to do with Western concepts. All I am saying is that there is statute that says everyone must be in by virtue of residing in Japan. For Japanese, the enrollment is automatic through the BRR (basic resident registration). Foreigners have to sign up. People don’t. Enforcement is weak. But based on what the one poster said, there is at least some enforcement. So that should be the grain of salt people take from this.
By the way, now that American Medicare tax will apply to more income of high U.S. earners, who are taxed on income earned abroad, it is much more likely that these people will join NHI so that they are not subject to Medicare tax at all. I think they’d rather pay a (Japan) tax deductible 730,000 a year than pay a (U.S. nondeductible) 2.9% Medicare tax on $300,000, plus on any unearned income in their investment accounts.
That’s exactly my point Japanese law has nothing to do with western concepts. The fact that one Ministry tells government employees that it forbidden to discuss or even to try and convince foreigners to sign up for the Health Insurance while the another government agency says that its the law to sign up shows that it’s a grey zone. A grey zone that purposely exists so that foreigners can exist in Japan without joining the health system.
I don’t think it’s deliberate. I think it exists because of apathy, and as a chance to did the foreigner on something if they have to.
We are maybe saying the same thing about a shade of gray. But still, the people who go around saying people don’t have to enroll are simply wrong.
If you want to join the NHI be my guest but I`ve elected not to. Hoofin`s just pissed because he`s being forced to pay and others aren`t.
I`ve seen this nasty fight at work where some gaijins are paying anywhere from 40,000-60,000 yen a month towards their NHI and others aren`t enrolled. Needless to say this can cause resentment in the staff room.
No, no. I willingly paid it–that’s the rule. I had to pay a big number last year, but it was tax deductible. In the first year (2005), my premiums were based on 0 yen Japan income (2004). So it evened out.
This is a “taxes affect relative prices” problem. The people who skirt are actually driving down the wages of those who do not. That’s the unfairness.
If you get hurt in Japan, particularly outside of Tokyo just leave. You would be better served swimming, yes swimming, through Fukushima’s radioactive water all the way to Hawaii or Australia.
I still bear the scars from their malpractice. My treatment did not even improve to the level of 5th rate prison doctor until American guest lecturer MDs started leaning on the local medical bureaucracy.
I had to re-set my dislocated jaw Lethal Weapon style because none of their doctors thought anything was wrong even though my jaw had moved nearly a centimeter out of socket to my left. Yes, it really was hanging that far off socket like in a cheesey low budget wire-works film.
My bandages began growing mold over open wounds so using a knife and tweezers I dug out all the wadding and bandaging under my cast. To top it off my wrists never properly healed because resting them under a green tinted light bulb for a half hour three times a week, while still in cast, is not an effective rehabilitative therapy.
To top it all off I had to end up negotiating and haggling over the bill
If you think I just had bad luck… HA! One friend spent a week in patient for tonsillitis.
Another friend got a broken leg on a Friday night and there were no full-time doctors at any of the nearby hospitals till Monday. Of course, his flight home to France was scheduled for Sunday and there was nobody to sign off on the paper work to let him fly.
A classmate whose arm got busted after being hit by a car had a similarly delayed recovery process. I used to have more, but after a decade I’ve blocked most of it out.
The horror stories have a real place. I know a woman that was told if she had her first child via “c-section”, all her subsequent kids would have to be brought into the world this way. Amazingly inept.
I was ‘strongly encouraged’ to join NHI 18 months ago and my family’s premiums have recently gone through the roof. I understand how everything is calculated (based on last years tax) however, given that I am only planning on being in Japan for another 8 months, having to pay JPY68,000 every month prior to leaving is going to really hurt.
I went to the Ward Office and they told me there was no way out, but did give me a form (I don’t know the name of the form as there is too much Kanji on it) which I could fill out and bring back which would state when I was leaving the city (and therefore not paying for NHI any longer). If I was to submit this form now (effectively saying that I was ‘leaving the city’), and then sign up for Private Health cover, would this likely impact my visa or anything else for the next 8 months?
I’ll have to check to make sure but I’m pretty sure you have to show proof that you’re leaving i.e. Plane ticket, Cruise pass, etc
But be sure to fill in that form when you really go otherwise they’ll keep charging even though you’ve left. That would not make a nice surprise when you return to Japan on vacation and have a giant bill.
Great overview. Do you have any plans to update this article or is there anything new we should be aware of?
Interessting thoughts