How to Register for National Health Insurance in Japan

If you’re planning to live in Japan long-term—whether as a student, remote worker, or entrepreneur—one of the first things you’ll need to take care of is registering for National Health Insurance (NHI). Japan’s healthcare system is efficient, affordable, and accessible, but only if you’re properly enrolled.

In this guide, we’ll walk you through everything you need to know about how to register for National Health Insurance in Japan, who is eligible, what documents you’ll need, what to expect in terms of costs, and how to use your insurance once you have it.

1. Understanding the Japanese Health Insurance System

Japan’s health insurance system consists of two main types:

• Employee’s Health Insurance (Shakai Hoken / 健康保険)
  For full-time workers employed by companies.

• National Health Insurance (Kokumin Kenkō Hoken / 国民健康保険)
  For students, freelancers, part-time workers, unemployed residents, and those who are self-employed.

If you don’t qualify for the Employee’s Health Insurance, you are legally required to enroll in National Health Insurance—regardless of your nationality.

2. Who Needs to Register?

You must register for National Health Insurance if:

• You’ve been issued a Residence Card.

• You are living in Japan for more than 3 months.

• You are not enrolled in an employer-sponsored health insurance program.

• You are a freelancer, business owner, student, or someone between jobs.

Even if you are on a working visa but not covered through a company, you must register for NHI.

Note: Short-term visitors on tourist visas are not eligible for NHI.

3. Where and When to Register

You must register at the city or ward office where you reside. This must be done within 14 days of:

• Moving to Japan

• Changing your address within Japan

• Losing coverage under a previous employer’s plan

Municipal Office Example

If you live in Shibuya, you’ll go to the Shibuya City Office (Shibuya Kuyakusho). If you’re in Osaka, visit your ward’s local office. Each municipality has slightly different procedures, but the core requirements are consistent.

4. Documents You’ll Need

To register, bring the following:

• Passport

• Residence Card (在留カード / Zairyū kādo)

• My Number (マイナンバー) Notification or Card

• Certificate of Residence (住民票 / Jūminhyō)
  (Usually obtained during your residence registration process at the ward office)

• Previous health insurance card, if switching from another provider

If you are a student:

• Student ID or proof of enrollment

If you’re self-employed:

• Declaration of income (prior year’s tax documents if available)

5. Step-by-Step Registration Process

Step 1: Go to Your Local Ward Office

Visit the National Health Insurance section (国民健康保険課) of your ward or city office. There’s usually an English-speaking staff or translation service available.

Step 2: Fill Out the Registration Form

You’ll be asked to fill out a registration form. This form will ask for:

• Your name and address

• Date of arrival in Japan

• Residency status

• Family members (if applicable)

Step 3: Show Your Documents

Present your Residence Card, My Number, and passport. If you’re switching from a different plan, show proof of cancellation or loss of previous coverage.

Step 4: Receive Your Health Insurance Card

If everything is in order, you’ll receive a National Health Insurance card (保険証 / Hokenshō). This card allows you to access healthcare services at subsidized rates.

6. Cost of National Health Insurance

The cost of NHI is based on your income from the previous year. If it’s your first year in Japan, your income is considered zero, and your premiums are significantly reduced or waived in many cases.

Estimated Monthly Premiums:

Your exact premium will be mailed to you with a payment slip or can be auto-deducted from your bank account.

Tip: If you’re earning little or nothing in your first year, apply for premium reduction (減免 / Genmen) or exemption at the time of registration.

7. How to Pay for NHI

You can pay your NHI premiums in several ways:

• Convenience stores (e.g., 7-Eleven, FamilyMart)

• ATM bank transfers

• Direct debit (automatic withdrawal)

• At the ward office payment counter

Premiums are typically billed every month or quarterly. Be sure to pay on time to avoid penalties and maintain active coverage.

8. What Does NHI Cover?

Once you’re registered, you only pay 30% of the medical costs. The remaining 70% is covered by the government.

Covered Services:

• Doctor visits

• Hospital treatment

• Surgery

• Dental treatment

• Maternity care

• Prescription drugs

Not Covered:

• Cosmetic surgery

• Preventive care (like vaccinations unless mandatory)

• Most alternative medicine

• Some overseas treatments

You can also apply for High-Cost Medical Expense Reimbursement (高額療養費制度) if you face a serious illness and your share of payment exceeds a certain threshold.

9. Additional Benefits

Maternity Support

Pregnant women can receive prenatal check-ups and birth-related benefits. Some cities offer cash grants or birth allowances to help with delivery costs.

Child Healthcare

Many municipalities offer free or discounted medical care for children up to age 15. You need to apply separately for a Child Medical Certificate (乳幼児医療証).

Health Checkups

Annual health checkups are often subsidized or free, especially for people over 40 years old. Ask your ward office or local clinic about these programs.

10. Cancelling or Changing Your Insurance

If your situation changes, you must notify the ward office:

• If you leave Japan permanently

• If you enroll in employer-sponsored insurance

• If you move to a different municipality

Failure to notify could result in being billed for months of premiums you were no longer supposed to pay.

To cancel NHI:

• Bring your health insurance card

• Show proof of new coverage or departure

• Submit the withdrawal form

11. Penalties for Not Registering

Even if you don’t use medical services, you are legally obligated to enroll and pay NHI premiums. Avoiding registration can result in:

• Backdated premium charges

• Fines or delayed access to services

• Visa renewal issues

If you’ve missed the deadline, register immediately—some penalties may be reduced if you explain your circumstances.

12. Using Your Health Insurance Card

Always carry your health insurance card when:

• Visiting a hospital or clinic

• Filling prescriptions

• Getting dental care

Show your card at reception. The staff will charge you 30% of the bill, and the remaining 70% is settled through the insurance.

13. What If You Have Private Insurance?

Many expats also buy private insurance for extra coverage, such as:

• English-speaking clinics

• Private rooms

• Overseas travel coverage

But this does not exempt you from NHI enrollment. You must still join the national system unless you are a diplomat, short-term visitor, or have specific exemptions granted.

14. Special Notes for Students

If you’re a student on a Student Visa, you must:

• Register for NHI within 14 days

• Provide proof of enrollment

• Pay reduced premiums (often ¥1,000 – ¥2,000 per month)

Some universities handle the paperwork for you during orientation, but always double-check with your local ward office.

15. NHI vs. Shakai Hoken: What’s the Difference?

If you start working full-time for a company, your employer is required by law to switch you to Employee’s Insurance, and you must cancel your NHI.

Conclusion: Take Action Early

Registering for National Health Insurance is not only a legal obligation, but also a smart move to protect yourself from unexpected medical expenses. Japan’s healthcare system is among the best in the world—affordable, efficient, and high-quality—and NHI gives you full access to it.

Whether you’re planning a long-term stay as a student, a freelancer setting up shop in Tokyo or Osaka, or simply taking a gap year in Japan, don’t delay—head to your local ward office and get enrolled.

Final Tips

• Use Google Translate or bring a Japanese friend if your Japanese is limited.

• Ask about premium reduction options if you have low or no income.

• Store your insurance card in your wallet at all times.

• Always notify the ward office if your address or work situation changes.

Need help navigating life in Japan? Check out our full [Tokyo Relocation Guide] or [Japan Startup Guide] for more expat-friendly advice.