Japan Health Insurance & Pension for Foreigners — Premiums, Coverage & Lump-Sum Withdrawal

What to Check First

A planned three-month trip is different from the residence status and period of stay on your residence documents. Check employer insurance, NHI and pension coverage separately.

Prepare your residence status and period, the date you established your address, employment start date, and current insurance and pension coverage. Confirm which documents you need, then submit the relevant notifications.

Employer Insurance and NHI Procedures

The route into Japan’s health insurance and pension system depends on your employment and other eligibility conditions. Enrollment may still require a procedure with your employer or municipality.

Track 1: Shakai Hoken (社会保険) — for company employees

If you meet the eligibility requirements for your employer’s health insurance and Employees’ Pension, your employer handles enrollment. If you previously had NHI, also check the municipal NHI withdrawal procedure after joining employer insurance.

The ¥88,000 monthly wage requirement for short-time workers was removed on October 1, 2026. Other eligibility conditions include working at an applicable establishment, scheduled hours of at least 20 per week, and not being a student. Voluntary establishment coverage, actual working conditions and special minimum-wage reduction cases also affect eligibility; check with your employer or a Pension Office.

Track 2: National Health Insurance (国民健康保険) + National Pension (国民年金) — check municipal and pension eligibility

If you are not eligible for employer health insurance or dependent coverage under it, check your National Health Insurance (NHI, or “kokuho” 国保) eligibility with your municipality. Foreign nationals generally qualify with a period of stay exceeding three months, among other conditions, but short-stay visitors are excluded. Exceptions apply to some residence statuses with a period of stay of three months or less and proof of an expected longer stay. Register according to your municipality’s conditions, such as Meguro City’s enrollment guide. Check National Pension procedures separately.

Category I National Pension members are generally residents of Japan aged 20–59 who are not Category II or III members. Register at your municipality’s National Pension counter within 14 days of becoming eligible for Category I. Employees’ Pension members use their employer; eligible dependent spouses use their spouse’s employer. Exclusions for certain residence statuses and social security agreements can apply, so do not transfer the NHI three-month rule to pension coverage.

Which health insurance applies depends on factors such as eligibility through your employer and your residence status. If you qualify for employer health insurance but enrollment is not progressing, consult your employer or a Pension Office, and explain your current insurance situation to your municipality too.

Enrolling in National Health Insurance — It’s Not Automatic

NHI enrollment requires a registration separate from resident registration. If you are eligible, check the process at your municipality’s NHI counter.

How to enroll:

1. Before visiting, check eligibility, required documents and language support with your municipality’s National Health Insurance counter (国民健康保険窓口 / Kokumin Kenko Hoken madoguchi)
2. Gather the documents required for your enrollment reason, such as your residence card (在留カード / zairyuu kaado) and evidence of loss of employer coverage, then visit the counter
3. Fill out the enrollment form (加入届 / kanyuu todoke)
4. Ask the counter when your eligibility information will be reflected in your My Number health insurance card, or how and when a Certificate of Qualification will be issued

The municipal notification deadline is 14 days from the date you become eligible. Check the eligibility date for your reason for enrolling. 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.

For a medical visit, use your My Number card registered for health insurance or a Certificate of Qualification (資格確認書 / shikaku kakuninsho). MHLW guidance explains that, for the time being, people without a My Number health insurance card receive a Certificate of Qualification free of charge without applying. Ask your insurer how and when it will be issued.

How Much Do Premiums Cost?

Shakai Hoken (company employees)

Employees’ Pension contributions are calculated using standard monthly remuneration, standard bonuses and the contribution rate, with employer and employee sharing them equally. Health insurance rates vary by insurer and other conditions. Check the health insurance, pension and any long-term care insurance entries separately on your payslip, and ask your employer for your own amounts.

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 Shinjuku ward’s current-year calculation guide gives the local rates.

NHI uses previous-year income, so higher income after arrival can raise the next fiscal year’s premiums. The first year is not necessarily inexpensive. Even if you have no income, check income declarations and reduction procedures with your municipality, and check the year and amount on your payment notice.

How to Check Your Premiums (NHI + National Pension)

NHI premiums depend on the fiscal year, municipality, previous year’s income, and household composition. Shinjuku ward publishes rates and premium estimate tables by fiscal year. A child and child-rearing support contribution was added for FY2026, so do not use an earlier year’s table to estimate current premiums.

If you cannot use Shinjuku’s estimate tables, contact the ward’s relevant office with documents showing your previous year’s income. If you live elsewhere, use your own municipality’s table. Employer health insurance and Employees’ Pension Insurance use a different calculation: ask your employer instead of multiplying an NHI estimate by a fixed percentage.

NHI Calculation Example: A Single 30-Year-Old in Shinjuku

This arithmetic example uses Shinjuku’s FY2026 rates, assuming one NHI member aged 30, an assessment income base of ¥1 million, and full-year coverage. This does not mean salary revenue of ¥1 million. The assessment base is the previous year’s total income and other applicable income, less the specified basic deduction.

This is before reductions, exemptions and rounding rules, not an actual payment notice. For coverage starting or ending during the year, ask your municipality to confirm the chargeable months and final adjustment. If you have overseas income, ask how it is treated, converted and documented. The annual amount divided by 12 is not necessarily the amount on each payment slip.

National Pension

The ¥17,920 amount applies to Category I and voluntary members. It does not mean every Employees’ Pension member must pay this amount on top of their workplace contributions. If you receive a payment slip, check its months and your coverage category; ask a Pension Office about any apparent overlap with employer enrollment.

For Category I and voluntary National Pension members, the contribution is ¥17,920 per month in FY2026. If payment is difficult, check exemption and deferral eligibility. There are four exemption amounts—full, three-quarters, half and one-quarter—and a separate payment-deferral scheme. Income, age and other conditions are assessed; students have a separate special-payment scheme.

Short Stays and Preparing to Leave Japan

If you are a Category I National Pension member with three months requiring full contributions in FY2026, the calculation is ¥17,920 per month × 3 = ¥53,760. This is an example of contributions you pay, not a refund. Estimate NHI coverage months and premiums separately.

If you have no previous qualifying periods and only three qualifying months of National Pension from this stay, you do not meet the six-month requirement for a lump-sum withdrawal. Check your contribution record instead of budgeting for a refund simply because your stay is short.

Before departure, ask your municipality about NHI withdrawal and required documents and how to pay or settle any remaining balance. Separately ask a Pension Office about address and coverage-category procedures, future benefits and lump-sum withdrawal. If you have employer coverage, also confirm your employment end date and coverage loss date with your employer.

Your Pension Isn’t Wasted

If you expect to leave Japan, check what happens to your pension contributions before deciding they have no future value. A lump-sum withdrawal and social security agreements have different conditions and consequences.

Lump-Sum Withdrawal Payment (脱退一時金)

Check Japan Pension Service’s lump-sum withdrawal guidance for your pension category and claim deadline. Requirements include not being a Japanese national, no longer being covered by a Japanese public pension, and having no address in Japan.

National Pension requires at least six qualifying contribution months, while Employees’ Pension requires at least six months of insured coverage. You must not have met the qualifying period for an old-age pension or ever have been entitled to a disability pension or other specified pension benefit. The deadline is generally two years after your last loss of insured status; if you still had an address in Japan that day, it is two years after the first subsequent date on which you no longer had a Japanese address. Confirm with a Pension Office rather than simply counting from your flight date.

Examples of Lump-Sum Withdrawal Amounts

The following are selected official National Pension amounts when the last contribution month is April 2026–March 2027. Qualifying months exclude unpaid months; partially exempt contribution periods are weighted under the specified rules.

Different final contribution years and Employees’ Pension require different calculations. Employees’ Pension uses factors such as average standard remuneration, so your current monthly salary alone cannot establish the payment. Confirm your contribution record and amount with a Pension Office before claiming.

After a lump-sum withdrawal, all pension coverage periods before the claim cease to count. Check the consequences, including combining periods under a social security agreement, before deciding to claim.

Social Security Agreements (社会保障協定)

Check Japan’s social security agreements currently in force, including Germany, the United States, France, Canada, Australia, South Korea, China, and Italy.

These agreements serve two purposes:

1. Preventing dual enrollment: If your posting period and country-specific conditions qualify, dual coverage can be avoided; check procedures such as obtaining a certificate of coverage
2. 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 Japan Pension Service’s agreement list for your country and the agreement’s scope.

If You Cannot Pay, and Residence Screening

An MHLW notice describes preparations to start sharing municipal NHI collection information with the Immigration Services Agency in June 2027 for residence screening. This concerns NHI data sharing; it does not establish automatic refusal of every renewal or status change for everyone with unpaid NHI or pension contributions. Check the Immigration Services Agency’s procedure guidance for the documents and requirements relevant to your own residence status.

Separate from that data-sharing start date, payment of public health insurance and pension contributions is already considered in permanent residence applications. Check the supporting documents required for your type of application.

If payment is difficult, contact your insurer or a Pension Office promptly rather than leaving payment notices unanswered.

• National Pension: Ask a Pension Office or your municipal counter whether you qualify to apply for exemption or payment deferral
• National Health Insurance: Ask your municipality about payment consultation, including whether reductions or payment by installments are available

Submitting an application does not mean it has been approved. Check the result, the period covered, and any amount you must continue to pay.

Using Insurance at the Hospital

Your share of covered care varies by age, income and other factors; the standard share is 30% from the start of compulsory schooling through age 69. If your share is 30% and covered care costs ¥10,000, you pay ¥3,000 at reception. Booking fees and treatment outside insurance coverage are separate.

At the reception desk:

Receptionist: “マイナ保険証または資格確認書はお持ちですか” (Maina hokenshō mata wa shikaku kakuninsho wa omochi desu ka / “Do you have a My Number health insurance card or a Certificate of Qualification?”) You: For a My Number health insurance card, verify your identity using the card reader. For a Certificate of Qualification, present it at reception.

If you are enrolled but your eligibility cannot be confirmed at the visit, explain the situation at reception and ask which documents can be used and how to pay. If you pay the full amount, ask the medical facility and your insurer about settling the bill or applying for medical expense reimbursement. The amount also depends on your copayment share. 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)

If your share of covered medical care becomes high, you may qualify for the High-Cost Medical Care System. For care from August 2026, monthly limits were revised and an annual limit was introduced, covering August through the following July. The division into more detailed income bands is scheduled separately for August 2027. Limits vary by age, income, treatment month and other factors, so check MHLW’s revision guidance and ask your insurer which category applies to you. Extra room charges, meals and certain other costs are excluded.

Before a planned hospitalization or surgery, ask the medical facility and your insurer whether they can confirm your limit through your My Number health insurance card or whether you need a Limit Application Certificate (限度額適用認定証 / gendogaku tekiyō ninteishō). This helps you anticipate the amount due at the counter.

When Things Go Wrong

Alternatives

Can I just get private health insurance?

Private insurance can provide supplementary cover. Check your public-insurance eligibility through your employer and municipality. Do not omit required public-insurance enrollment simply because you hold a private policy.

Can my home country’s insurance cover me?

Direct billing and reimbursement conditions depend on your policy and provider. Use JNTO’s medical-care guidance and ask your insurer and medical facility about covered treatment, payment methods and required documents. Holding overseas insurance and qualifying for Japan’s public insurance are separate questions.

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 confirming insurance eligibility at reception
• 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
• Daycare and Kindergarten in Tokyo for Foreigners — If you have young children, you can also check childcare enrollment procedures

References:

• Japan Pension Service: National Pension contributions
• Japan Pension Service: lump-sum withdrawal system
• Japan Pension Service: Social Security Agreements
• Shinjuku City: National Health Insurance calculation
• Japan Pension Service: removal of the short-time wage requirement
• MHLW: notice concerning sharing NHI collection information
• Ministry of Health, Labour and Welfare “Social Security Agreements for Workers Abroad”
• Ministry of Health, Labour and Welfare “High-Cost Medical Care System”
• Japan Pension Service “Premium Exemption System”