[QuestionI’m a company employee. Is it compulsory to enroll in Employee Health Insurance?

[Answer]
Yes, if you are eligible, you are required to join one. Irrespective of nationality, gender, or  wage level, those working for a “covered establishment” defined below are to be enrolled in Employee Health Insurance (EHI).
There are two kinds of establishments that are covered by EHI.
1.      Establishment with compulsory coverage
　・Sole proprietor that hires five employees or more on a regular basis (excluding 　 　　　establishments in agriculture, forestry, fishery, and service industry)
　・ Public or private corporation that hires employees on a regular basis
2. Establishment with voluntary coverage
Establishments not qualified for the above 1 but approved by Social Insurance office to be covered by EHI and pension scheme.
Those who are employed by establishments covered by the EHI scheme are essentially insured but following workers are excluded even if they are employed by a workplace covered by the scheme;
1. A worker covered by other public insurances (*)including mutual aid association insurance and seamen’s insurance.
2. A day laborer who is employed part time for less than one month
3. A worker who is employed for a period of two months or less
4. A worker who is to be employed by temporary establishments whose place of business is not fixed
5. A seasonal worker employed for a period of four months or less
6. A worker who is to be employed by temporary establishments for period of six months or less.
Part timers who put in hours more than three quarters of the regular full-time workers are eligible for the system. Foreign workers employed full time by an establishment covered by EHI are also insured.
* Japanese public insurance falls into four broad categories: Employee Health insurance intended for private sector employees, National Health Insurance administered by the municipalities, Medical Aid System for the Elderly and other insurance (mutual aid association insurance for public service employees, Seamen’s Insurance for public service employees, etc.).

[Question]I’m on a temporary visitor’s visa. Am I eligible for National Health Insurance?

[Answer]

Since you are a temporary visitor with a permitted period of stay in Japan less than one　year, you do not meet the requirements to enroll in the National Health Insurance (NHI). Therefore to cope with medical emergencies during your stay in Japan, it would be advisable to purchase some kind of private travel insurance before coming to Japan. 

According to the National Health Insurance Law, people who are not eligible to enroll in NHI include;
1. Those who are covered by other public health insurance programs
2. Those who are receiving public assistance from Welfare Program
3. Non-Japanese nationals (Article 1 Section 2 Enforcement Regulations to National Health Insurance)
・Those who are staying in Japan without resident status
・Those who are only permitted to stay in Japan for less than one year 
・Those who have not completed Alien Registration
・Those who come from a country with which Japan signed a bilateral Social Security Agreement that covers medical insurance and who are insured by public health insurance back home.

 Although people on “Diplomacy” and “Official” statuses are excluded from the obligation of Alien Registration, those staying with “Official” status are covered by the NHI if their period of residence is one year or longer.

[Question]My monthly premium for National Health Insurance is so high that I have difficulty paying it off. What will happen if the premiums go unpaid for some time?

[Answer]

The National Health Insurance is based on the philosophy of mutual support among subscribers and is principally financed by premiums (tax) paid by its contributors. Therefore, if there is a shortage of fund due to premium payment delinquency, the national health insurance scheme cannot function properly as a contingency mutual support system because it cannot cover the cost of medical treatment. According to the National Health Insurance Law, if you fall behind in paying due premiums without justifiable reasons, the following procedures can be enforced;

1. If you have failed to pay the premium for one year or longer past the deadline of payment, the administrator of the plan can demand you return your NHI certificate. In return, you will be issued an insured person’s qualification certificate. By showing the certificate you have to pay the full amount first at a medical institution and then get reimbursed later at your city office for what the NHI covers for the amount you have already paid.  
2. When your delinquency period extends over one and a half years, the NHI administrator can totally or partially suspend paying various benefits from the NHI. 
3. When your delinquency period extends longer than one and a half years, benefits from the NHI will be appropriated for payment of the outstanding premiums.

Other than the above consequences, the administrator of the plan can garnish your assets.If you are unable to pay the premiums, you are advised to consult with officials in charge of NHI at your city office as soon as possible.

(Premium/tax)

The formula used to calculate the National Health Insurance premium varies depending on municipalities. In principle, there are two methods for calculation: “means-proportional rate” which is based on the total amount of income and assets of an insured household, and “fixed-benefit rate” which is based on the fixed portion of an insured household. If your city calculates NHI premium based on previous year’s income, you may find it difficult to pay the premium when your income drops sharply from the previous year. You can apply for exemption/reduction of the premium or deferment of the payment at your city office under certain circumstances including:
1. in case your houses or office buildings are damaged by disaster
2. in case you’ve lost your job due to sickness, injury or other reasons
3. in case your income has decreased due to retirement, dismissal or other reasons

If your income drops drastically, please submit proof to that effect at the NHI section of your city office to ask if you are qualified for exemption/reduction of premium payment.

[Question]I’m a long term resident in Japan. I became ill during a short stay in my country. Does my National Health Insurance cover the medical expenses overseas?

[Answer]

In principle, yes. Under the NHI overseas medical reimbursement system that started in January 2001, you can claim benefits for overseas medical treatment from NHI once you return to Japan. However, the system is not applicable in the following situations:

1) the kind of treatment that is not covered by the National Health Insurance when received in Japan
2) in case an insured goes aboard with an aim to receive medical treatment there

You need to have a re-entry permit before going abroad since you need to have a continued residence in Japan to be applicable for reimbursement. And the benefits are provided only when your overseas stay does not extend a longer period of time. For application, you will need a detailed account of treatment you received abroad and itemized receipts (with Japanese translation thereof), your NHI certificate, seal and the family head's bankbook. There is a similar program in the Employee Health Insurance that provides reimbursement benefits for overseas medical treatment.