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Japan Health Insurance & Pension for Foreigners — Premiums, Coverage & Lump-Sum Withdrawal
Shakai Hoken vs. National Health Insurance, monthly premium estimates, how to claim lump-sum withdrawal when leaving, and the 2027 visa renewal change.
Two Tracks: Company Employee vs. Everyone Else
Japan’s health insurance and pension system splits into two tracks based on your employment status. You don’t choose — it’s determined automatically.
Track 1: Shakai Hoken (社会保険) — for company employees
If you’re employed by a company, health insurance and Employee’s Pension are bundled together. Premiums are deducted from your salary, split 50/50 between you and your employer. Your company handles all the paperwork — you don’t need to visit the ward office.
Since October 2024, part-time workers who clock 20+ hours per week and earn ¥88,000+ per month are also covered under Shakai Hoken.
Track 2: National Health Insurance (国民健康保険) + National Pension (国民年金) — for everyone else
Freelancers, self-employed, unemployed, students — anyone not enrolled in company insurance must join National Health Insurance (NHI, commonly called “kokuho” 国保) and National Pension through their local ward office. This requires you to go register in person as part of your ward office moving procedures.
Which track you’re on isn’t a choice — it follows from your employment. If your employer isn’t enrolling you in Shakai Hoken despite meeting the requirements, you’ll need to register for NHI + National Pension yourself.
Enrolling in National Health Insurance — It’s Not Automatic
Unlike Shakai Hoken, NHI doesn’t kick in by itself. Registering your address at the ward office does not automatically enroll you in health insurance. You have to file a separate application.
How to enroll:
- Go to the National Health Insurance counter (国民健康保険窓口 / Kokumin Kenko Hoken madoguchi) at your local ward office (区役所 / kuyakusho) or city hall
- Bring your residence card (在留カード / zairyuu kaado) and passport
- Fill out the enrollment form (加入届 / kanyuu todoke)
- Your insurance credential is issued on the spot
The deadline is 14 days from the date you become eligible — typically 14 days after moving in or leaving a company. If you miss the deadline, you can still enroll, but premiums are charged retroactively from the eligibility date. “I didn’t register, so I don’t owe anything” is not how it works.
Since December 2024, traditional paper insurance cards (保険証) are no longer issued for new enrollees. Japan has transitioned to using My Number Cards (マイナンバーカード) as proof of insurance. If you don’t have a My Number Card, you’ll receive a “Qualification Confirmation Document” (資格確認書 / shikaku kakuninsho) instead.
How Much Do Premiums Cost?
Shakai Hoken (company employees)
Premiums are a percentage of your salary, split evenly with your employer. For the Japan Health Insurance Association (協会けんぽ / Kyokai Kenpo), the health insurance rate is roughly 10% (your share: ~5%). Add Employee’s Pension at ~18.3% (your share: ~9.15%).
For an employee earning ¥300,000/month, total deductions for social insurance come to roughly ¥43,000.
National Health Insurance (NHI)
NHI premiums vary by municipality but generally combine two components: an “income-based portion” (所得割 / shotokuwari) calculated from your previous year’s income, and a “per-capita portion” (均等割 / kintouwari) — a flat amount per insured person.
The calculation method is detailed on the Ministry of Health, Labour and Welfare website.
The year-two shock: In your first year in Japan, you likely had zero Japanese income the previous year, so your premiums are low — often just the per-capita portion. In year two, premiums jump because they’re now based on your first year’s actual earnings. This surprises many foreigners.
If your income is low, the per-capita portion can be reduced by 70%, 50%, or 20% through an automatic discount system.
Premium Simulation by Annual Income (NHI + National Pension)
To give you a concrete idea, here’s a rough estimate for a single person under 40 living in Shinjuku ward. National Pension is a flat ¥17,510/month nationwide (FY2025). NHI figures are approximate, based on Shinjuku ward’s premium rates (FY2024).
| Annual income (salary) | NHI (annual, approx.) | National Pension (annual) | Total (monthly equiv.) |
|---|---|---|---|
| ¥2,000,000 | ~¥90,000 | ¥210,120 | ~¥25,000/month |
| ¥3,000,000 | ~¥170,000 | ¥210,120 | ~¥32,000/month |
| ¥4,000,000 | ~¥270,000 | ¥210,120 | ~¥40,000/month |
| ¥5,000,000 | ~¥370,000 | ¥210,120 | ~¥48,000/month |
NHI premiums shown are the income-based portion plus per-capita portion. Long-term care insurance (for ages 40+) is not included. Having dependents increases the per-capita portion. Rates differ by municipality, so check your ward’s website for exact figures.
For Shakai Hoken (company employees), your out-of-pocket amount is roughly 60–70% of the figures above — the employer covers the rest.
National Pension
National Pension premiums are the same nationwide: ¥17,510 per month for FY2025. This is a flat rate regardless of income. If you can’t afford it, exemption and deferral programs are available — full exemption, 3/4 exemption, half exemption, 1/4 exemption, and payment deferral. There’s also a special provision for students.
Your Pension Isn’t Wasted
“Why pay into a pension I’ll never collect?” — this is a common reaction among foreigners. But Japan’s pension system has provisions specifically for people who leave.
Lump-Sum Withdrawal Payment (脱退一時金)
After leaving Japan, you can claim back a portion of your pension contributions as a lump-sum payment.
Eligibility requirements:
- At least 6 months of pension enrollment
- No longer residing in Japan (you’ve left the country)
- Not eligible for a pension (less than 10 years of enrollment)
- Apply within 2 years of departure
Calculation cap: Currently, the maximum calculation is based on 60 months (5 years) of contributions. Even if you paid for 6 or more years, only 5 years are counted. A 2025 legal amendment will raise this cap to 8 years (96 months), with implementation expected within 4 years of the law’s promulgation.
Lump-Sum Withdrawal Payment Simulation
For National Pension contributors, the lump-sum withdrawal is a fixed amount based on the number of months enrolled (approximate figures based on FY2025 calculation standards).
| Enrollment period | Payout (approx.) |
|---|---|
| 6–11 months | ~¥50,000 |
| 12–17 months | ~¥100,000 |
| 24–29 months | ~¥200,000 |
| 36–41 months | ~¥300,000 |
| 60 months (current cap) | ~¥500,000 |
For Employee’s Pension (Shakai Hoken) contributors, the amount depends on your salary and months enrolled, so it varies widely. As a rough guide, someone earning ¥300,000/month who was enrolled for 3 years can expect approximately ¥500,000–¥600,000.
The trade-off: Claiming the lump-sum withdrawal permanently erases your pension record for that period. If your home country has a social security agreement with Japan, this means you lose the ability to combine enrollment periods between countries — which could affect pension eligibility in your home country.
Social Security Agreements (社会保障協定)
Japan has social security agreements with 23 countries, including Germany, the United States, France, Canada, Australia, South Korea, China, and Italy.
These agreements serve two purposes:
- Preventing dual enrollment: If you’re posted to Japan for 5 years or less, you can remain enrolled only in your home country’s pension system
- Combining enrollment periods: Pension enrollment periods in both countries can be added together to meet eligibility requirements
However, agreements with the UK, South Korea, China, and Italy only cover dual-enrollment prevention — they do not allow combining periods. Check the Ministry of Health, Labour and Welfare page to see if your country is included.
June 2027: Unpaid Premiums Will Block Visa Renewal
Starting June 2027, foreigners who fail to pay National Health Insurance or National Pension premiums — and ignore official demands for payment — will generally be denied visa renewals and status changes. If you’re navigating Japan’s employment system, understanding this change is particularly important. During FY2026, system upgrades will link municipal premium payment records to the Immigration Services Agency database.
Until now, unpaid premiums didn’t directly affect standard visa renewals (permanent residence applications were already subject to this check, but regular status renewals were not). After the change, payment status will be verified for all visa renewals and status changes.
What to do if you can’t pay:
The issue isn’t falling behind on payments — it’s ignoring collection notices. If your income is low and you genuinely can’t afford premiums, don’t ignore the problem. Take action:
- National Pension: Apply for exemption or deferral (免除申請 / menjo shinsei) at your ward office
- National Health Insurance: Visit the ward office counter to discuss installment payments (分割納付 / bunkatsu noufu) or premium reduction (減免 / genmen)
Periods covered by an exemption are not counted as “delinquent.” Filing the paperwork versus doing nothing makes a significant difference.
Using Insurance at the Hospital
Japan’s health insurance covers 70% of medical costs. If a treatment costs ¥10,000, you pay ¥3,000 at the window. The insurance covers the remaining ¥7,000.
At the reception desk:
Receptionist: “保険証をお願いします” (Hokenshou o onegai shimasu / “Your insurance card, please”) You: Present your My Number Card (or Qualification Confirmation Document) → Place card on the reader → Identity verification → Check-in complete
If you visit a hospital without any insurance credential, you’ll pay 100% upfront and apply for the 70% reimbursement from your insurer afterwards. For help finding a clinic, see our guide on how to find a clinic in Tokyo.
High-Cost Medical Care System (高額療養費制度)
When monthly medical expenses are high, there’s a cap on your out-of-pocket costs. For people under 70 with a standard income, the monthly cap is approximately ¥80,100. Anything above that is reimbursed later.
If you have a planned hospitalization or surgery, you can obtain a “Limit Application Certificate” (限度額適用認定証 / gendogaku tekiyou ninteishou) from your insurer in advance. This limits your hospital bill to the cap amount at the time of payment, so you don’t need to pay more and wait for reimbursement.
When Things Go Wrong
| Situation | What to do |
|---|---|
| Company won’t enroll you in Shakai Hoken | Contact the Pension Office (年金事務所 / nenkin jimusho). If you meet the requirements, they’ll instruct your employer to comply |
| Missed the 14-day enrollment deadline | You can still enroll late, but premiums are charged retroactively from the eligibility date |
| Can’t afford premiums | Visit the ward office to apply for exemption, reduction, or installment payments. Ignoring it risks visa renewal problems |
| No My Number Card | The ward office can issue a “Qualification Confirmation Document” (資格確認書) |
| Gap between jobs | You need to enroll in NHI within 14 days of your last day at your previous employer |
| Worried about language | The Japan Pension Service offers pamphlets in 15 languages. Some ward offices have multilingual counters |
Alternatives
Can I just get private health insurance?
You can purchase private health insurance as supplementary coverage on top of Japan’s public system. But private insurance alone does not exempt you from the public insurance obligation. After June 2027, not being enrolled in public insurance could directly impact your visa renewal.
Can my home country’s insurance cover me?
Most overseas travel insurance or expat insurance from your home country cannot be used directly at Japanese medical facilities. You’d need to pay 100% upfront and file claims after returning home. Regardless, if you’re registered as a resident in Japan, the obligation to enroll in NHI remains.
Related Articles
- Ward Office Procedures After Moving — Where you enroll in National Health Insurance after moving
- How to Find a Clinic in Tokyo — Finding a hospital or clinic and using your insurance card
- How Payments Work in Japan — PayPay, credit cards, Suica, and what to carry
- How to Find an Apartment in Tokyo — Upfront costs and the rental process
References:
- Japan Pension Service “National Pension System Overview” https://www.nenkin.go.jp/international/japanese-system/nationalpension/nationalpension.html (Accessed: 2026-02-17)
- Japan Pension Service “Lump-sum Withdrawal Payment” https://www.nenkin.go.jp/international/japanese-system/withdrawalpayment/payment.html (Accessed: 2026-02-17)
- Japan Pension Service “Social Security Agreements” https://www.nenkin.go.jp/service/shaho-kyotei/shaho.html (Accessed: 2026-02-17)
- Ministry of Health, Labour and Welfare “National Health Insurance Premium Calculation” https://www.mhlw.go.jp/stf/newpage_21517.html (Accessed: 2026-02-17)
- Ministry of Health, Labour and Welfare “Social Security Agreements for Workers Abroad” https://www.mhlw.go.jp/stf/seisakunitsuite/bunya/nenkin/nenkin/shakaihoshou.html (Accessed: 2026-02-17)
- Ministry of Health, Labour and Welfare “High-Cost Medical Care System” https://www.mhlw.go.jp/content/000333280.pdf (Accessed: 2026-02-17)
- Japan Pension Service “Premium Exemption System” https://www.nenkin.go.jp/service/kokunen/menjo/20150428.html (Accessed: 2026-02-17)
* This article was translated from the original Japanese with the help of machine translation. Some expressions may not read naturally.
