JPN-Journal.com Health Insurance for Foreigners Working in Japan.

What is Employees' Health Insurance?

Overview

Employees' Health Insurance is a workplace-based health insurance system that provides insurance coverage for employees and their dependent family members in the event of sickness, injury, and death arising outside the scope of work, and childbirth.

There are two types of employees' health insurance: Government-managed and Society-managed. Society-managed health insurance is a system originating from the Government-managed health insurnace but each society is free to manage its own health insurance programs with its own benefits and contributions within limits imposed by law. Our introduction here is limited to the Government-managed health insurance.

Insurer of Employee's Health Insurance is the Japanese government, specifically the Ministry of Health, Labour, and Welfare. Day-to-day operations are administered by Social Insurance Offices with jurisdiction over addresses of business enterprises.


Enrollment

Because Employees' Health Insurance is a workplace-based health insurance system, the business enterprise itself must first be registered with the Social Insurance Office with jurisdiction over its business location before employees can enroll.

The following business enterprises are required to register by law:

(1) Non-incorporated businesses with more than five employees, and
(2) Incorporated businesses.

Liaison offices of corporations are treated as non-incorporate businesses. Therefore, employees at these business enterprises are automatically enrolled in the Employees' Health Insurance from the first day of employment. However, (a) employees insured under another participating office and (b) employees hired for a period of less than 2 months are excluded.

Also, part-time employees whose work days and work hours exceed 3/4 those of regular employees in the same workplace are required to be covered by health insurance.

Most legitimate businesses register in the system from day one of their operation. New employees need not worry about the registration status of employers.

Employer's human resource or administrative department is often responsible for collecting from you information necessary to complete your Health Insurance Enrollment Application and filing with the Social Insurance Office. Application must be filed within five days from the date of hire.


Coverage of Your Family

Your family members may apply for health insurance coverage if they are (1) your first, second, or third-degree family members or relatives and (2) you provide substantial financial support.

Substantial support is deemed if your dependant (a) lives with you and has income of less than JPY 1,300,000 and less than half of your annual income or (b) does not live with you and has income of less than JPY 1,300,000 and less than the total financial support amount provided by you.

For dependants 60 years or older or with disability, the income threshold is JPY 1,800,000.

Family members other than your spouse, children, parents, grandparents, great grandparents, and younger siblings, must be living with you to receive health insurance coverage.

When your dependants become eligible for or disqualifies from health insurance coverage, your employer must complete and file an Application for Change in Dependant's Coverage with the Social Insurance Office within five days from the date of change.

Addition of family members under your coverage does not increase your health insurance premium.


Insurance Premium Rate

Your health insurance premiums are shared equally by you and your employer. Your share of premium is deducted from your paycheck and your employer makes a matching contribution.

Required contribution amount is calculated as = Standard Monthly Remuneration* x Contribution rate**

* Standard Monthly Remuneration serves as the basis for calculating the benefits and insurance contributions for Employees' Health Insurance and Employees' Pension Insurance. Your total monthly compensation is matched against the prescribed remuneration table (below) to determine your "Standard Monthly Remuneration" which includes payments such as salary, wage, and any allowance you receive from your employer in return for your service.

** Contribution rate for the Government-managed Health Insurance is 82/1000. If you are aged 40 or over but under 65, contribution rate is 94.3/1000 including contribution for Long-term Care Insurance.

2008 Standard Remuneration Table


Coverage after Resignation or Termination

You may be eligible for voluntary health insurance coverage even after resignation or termination from work if you have at least two consecutive months of Employees' Health Insurance coverage immediately prior to your resignation or termination.

To opt for voluntary health insurance coverage, you must complete and submit an Application for Voluntary and Continuous Coverage to the Social Insurance Office within 20 days from the day of resignation or termination. Timeliness is extremely strict for application for voluntary health insurance coverage. Social Insurance Office will not accept late application without good cause such as major earthquakes and other natural disasters or act of God.

Under the voluntary health insurance coverage you are insured for up to two years. There is no extension or renewal.

While your employer made a matching contribution of your health insurance premium during your employment (and therefore you were only paying half the full amount), under voluntary health insurance coverage you're former employer has no obligation to contribute to your health insurance coverage. As a result, you are responsible for the full premium (and therefore you will be paying double what you used to pay).

If you fail to pay your first premium by the date specified by the Social Insurance Office without good cause, your application for voluntary health insurance coverage may be considered invalid.

Generally, premium payment is due on the 10th day of each month. If you fail to pay your monthly premiums by the specified date without good cause, your voluntary coverage is subject to termination on the day following the payment date.

It is therefore advisable to opt for lump-sum advance payment of premiums for either six months or for one year. Discounts are offered for advance lump-sum payment of premiums.


What is National Health Insurance?

Overview

National Health Insurance provides health insurance coverage for self-employed workers, individual contractors, and other Japanese citizens and legal residents who do not qualify for Employees' Health Insurance and their dependents in the event of sickness, injury, and death arising outside the scope of work, and childbirth.

Unlike Employees' Health Insurance, National Health Insurance is run independently by each municipal government. Therefore, Setagaya Ward of Tokyo and Tama City of Tokyo, despite being in the same prefecture, are managed separately. Insurer is each municipal government with jurisdiction over each individual's residential address. Day-to-day operations are administered by a designated division within the offices of municipal governments.


Enrollment

All individuals not enrolled in Employees' Health Insurance are required by law to enroll in National Health Insurance. These individuals include, but are not limited to:

(a) self-employed individuals and his/her dependent,
(b) retired individuals and his/her dependents, and
(c) foreign students studying in Japan.


Insurance Premium

Unlike Employees' Health Insurance, insurance premium for National Health Insurance is not based on a simple rate and table. Because each municipal government manages and administers its own National Health Insurance system, each municipal government has its own way of calculating insurance premiums. In the case of Setagaya Ward of Tokyo, insurance premium is calculated as follows:

(Inhabitant tax amount x 1.24) + (JPY 35,100 x number of household members enrolled) [ceiling: JPY 530,000]

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Employees' Health Insurance Benefits

- Medical Care Benefits
- Medical Care Expenses
- Meal Service Benefits
- Transportation Expenses
- High-cost Medical Care Benefits
- Sickness/Injury Allowance
- Maternity Allowance
- Midwifery Allowance
- Funeral Expenses


Medical Care Benefits

When you or your dependants become sick or is injured outside the scope of work, you or your dependant can receive medical treatment under the health insurance system by presenting an Employees' Health Insurance Certificate Card (Card) at any participating medical institution. By presenting the Card your co-payment will be 30% of actual medical cost.

Co-payment is 20% of actual medical cost for children under the age of 3. Co-payment is 10% of actual medical cost for elderly person aged 70 and older. However, co-payment is 30% of actual medical cost for high income elderly person.


Medical Care Expenses

When you or your dependants become sick or is injured outside the scope of work and receive medical treatment at non-participating medical institutions for good cause, you can receive reimbursement for a portion of actual medical expenses paid.

You need to complete and file an Application for Medical Care Expenses together with receipts of itemized medical expenses paid with the Social Insurance Office to claim your benefit. Claims must be submitted within two years from the next day of paying actual medical expenses.


Meal Service Benefits

When you or your dependants is hospitalized in participating medical institution, you can receive meal services by paying a standard amount to the medical institution. Standard amount per day is set at JPY 260 per meal. Insured person falling under low-income household is eligible to apply for a lower rate.


Transportation Expenses

When you or your dependants is immobilized due to sickness or injury and pay expenses for transportation to participating medical institution, you can receive reimbursement for a portion of actual transportation expenses paid provided such expenses were reasonable and appropriate.

Benefit amount is calculated based on the cost of most economic route and/or method of transportation.

You need to complete and file an Application for Transportation Expenses together with a doctor's note and receipts of transportation expenses paid with the Social Insurance Office to claim your benefit. Claims must be submitted within two years from the next day of paying actual transportation expenses.


High-Cost Medical Care

When you or your dependants' co-payments exceed a statutory amount, you are eligible to apply for reimbursement for amounts exceeding the statutory amount. Statutory amounts differ depending on your income.

When co-payments paid to a participating medical institution for you or your dependants in the same month exceed the statutory amount shown in table below, you are eligible to apply for reimbursement for the excess amount (Case 1).

When you or your dependants have received reimbursement for three months within a calendar year, specified amount over which excess co-payment can be reimbursed is adjusted as shown in table below (Case 2).

When two or more members of your household have paid more than JPY 21,000 of co-payments each, the total co-payments less the sum of statutory amount for each individual, in both Case 1 and 2, will be reimbursed.