Japan Health Insurance & Pension (NHI, Nenkin)
Understand National Health Insurance and the pension system in Japan — enrollment, costs and what you must pay.
Insurance & Pension
Health insurance and pension are mandatory for all residents in Japan
Mandatory for all residents staying 3+ months. Non-enrollment can result in back-payments and visa complications.
Your health insurance card is now your My Number Card (Myna Hokensho)
Japan stopped issuing the old health insurance card in December 2024, and the last ones expired by December 2025. Register your My Number Card as your insurance card and show it at the clinic. No card yet? Your insurer automatically sends a Certificate of Eligibility (shikaku kakuninsho) so you can still be treated.
Read the full My Number Card guide →
Last verified
Which System Applies to You?
Shakai Hoken (Employees' Insurance)
Employee Health Insurance + Pension
Company employees (full-time or part-time 20h+/week)
~10% of salary (split 50/50 with employer)
Your employer handles everything
Health insurance + pension (Kousei Nenkin) bundled together
Health Insurance Card from employer
Kokumin Kenko Hoken (National Health Insurance)
National Health Insurance
Self-employed, freelancers, students, unemployed, WHM
¥20,000–80,000/month (based on previous year income — often low in year 1)
City Hall within 14 days of residence registration
Health insurance only — pension (Kokumin Nenkin) enrolled separately
NHI Card from City Hall
What Does Insurance Cover?
70% covered by insurance — you pay 30%
Monthly cap on out-of-pocket costs (¥36,900–270,300 depending on income, raised on 1 August 2026)
Doctor visits, hospital, surgery, prescriptions, basic dental, mental health, maternity (¥500,000 birth lump sum)
Cosmetic procedures, orthodontics, private hospital rooms, unapproved treatments
Find Your Insurance System
Not sure which system applies to you?
What is your employment status?
Employed by a company
Self-employed / Freelance
Student
Unemployed / Job seeking
Dependent of a worker
How many hours per week do you work?
20 hours or more per week
Less than 20 hours per week
Does your spouse/parent have Shakai Hoken through their employer?
Yes
No / I don't know
You are covered by Shakai Hoken
Your employer will enroll you. Health insurance + pension are bundled. Cost is split 50/50.
You need National Health Insurance (NHI)
Enroll at your City Hall within 14 days. Pension (Kokumin Nenkin) must be enrolled separately.
You may qualify as a dependent
If your annual income is under ¥1.3M, you can be covered under your family member's Shakai Hoken at no extra cost.
Since the primary worker doesn't have Shakai Hoken, enroll in NHI at City Hall.
Retake quiz
Pension (Nenkin)
Pension enrollment is mandatory for all residents aged 20–59, separate from health insurance.
Kousei Nenkin (Employees' Pension)
For employees — 18.3% of salary split 50/50 with employer. Includes Kokumin Nenkin automatically.
Kokumin Nenkin (National Pension)
For everyone else — fixed ¥17,920/month. Students can apply for exemption.
Lump-Sum Withdrawal (Dattai Ichijikin)
Foreigners leaving Japan permanently can claim a partial refund of pension contributions (up to 5 years). Apply within 2 years of departure.
If You Need Medical Care
Bring your Health Insurance Card (or My Number Card) to any clinic or hospital
You pay 30% at the counter — insurance covers the rest
For emergencies, call 119 (ambulance is free)
If monthly costs exceed the cap, apply for High-Cost Medical Expense refund at your insurer
Official Sources
Information verified against official sources. Regulations may change — always confirm with official sources for critical decisions.
Ministry of Health, Labour and Welfare
Health insurance system overview
Japan Pension Service
Pension enrollment and lump-sum withdrawal
Japan Pension Service (English)
English guide for foreign residents
Immigration Services Agency
Foreign residents life support portal
MHLW — High-Cost Medical Expense Benefit (高額療養費)
Monthly and annual out-of-pocket ceilings, reformed August 2026
High-Cost Medical Expense Benefit (高額療養費)
New ceilings in force since 1 August 2026
Whatever your treatment costs, what you actually pay in a month is capped. Your insurer refunds anything above the ceiling — and since 1 August 2026 the monthly ceilings are higher and there is also a yearly ceiling. Figures below are for people under 70.
Annual income
Monthly ceiling
Until July 2026
Yearly ceiling
About ¥11.6M and above
About ¥7.7M – ¥11.6M
About ¥3.7M – ¥7.7M
Up to about ¥3.7M
Exempt from residence tax
The yearly ceiling is new. Your monthly out-of-pocket amounts add up over the year; once the total reaches the yearly ceiling for your bracket, your insurer refunds everything above it.
From the 4th month with a high-cost claim within 12 months, the ceiling drops again (多数回該当): ¥140,100, ¥93,000, ¥44,400 or ¥24,600 depending on your bracket.
A second step lands on 1 August 2027: the income brackets are split much more finely, and households under about ¥2M get a 25% cut on the repeat-month ceiling.
Read the official MHLW page
Public health insurance for self-employed/unemployed residents. Premium based on income.
Mandatory pension scheme — even foreigners must enroll. ¥17,920/month in 2026.