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National Health Insurance (NHI)
Public health insurance in Japan is broadly divided into health insurance for employed persons and National Health Insurance (NHI)/Medical Insurance for Elderly, operated by municipal (city, special city, town or village) governments. Anyone who is domiciled in Japan must enroll in a health insurance program. Once enrolled in a program, withdrawal is not permitted while the person is eligible for NHI.
Joining NHI
[Inquiries]Qualification Section , National Health Insurance Division(Phone 03-3463-1781)
Shibuya City manages the NHI program for people who own their own businesses and other local residents.
Anyone to whom the following conditions apply must enroll in NHI even if he/she is a member of a private medical insurance plan:
Anyone who is 74 years old or younger and registered as a foreign resident in Shibuya; who has a status of resident other than “diplomat” or “temporary visitor”; and whose period of stay is for one year or longer. (This excludes those who are members of the health insurance plan at their place of employment and their family members; tourists and those with a short-term stay of one year or less; and diplomats.)
The obligation to pay NHI fees is incurred once enrolled in the NHI program. Each member is issued an NHI certificate and this certificate must be presented when receiving treatment at a medical facility.
Items required for enrollment procedures:
- Certificate of alien registration
- If you have discontinued your enrollment in another health insurance plan, a certificate proving loss of insured status
- If you have been a resident for less than one year, documentation (student or employee ID) that certifies that your period of stay will be one year or more.
The following people are not required to enroll in NHI:
- Anyone who is enrolled in a health insurance program at his/her place of employment or through a family member who belongs to such a program
- Anyone who receives public assistance
Notification is required when...
[Inquiries]Qualification Section , National Health Insurance Division(Phone 03-3463-1781)
The head of the household should bring his/her certificate of alien registration and NHI certificate to the National Health Insurance Division and complete the required procedures within 14 days if any of the following apply:
- A change of address within Shibuya
- The head of the household or the NHI member’s name has changed
- When a child is born
- If the NHI certificate has been lost or is so soiled that it can no longer be used
* When a person moves out of Shibuya or leaves Japan, the NHI certificate becomes invalid on the day after the departure date, and must be returned. If the certificate is used after that date any medical fees incurred will have to be repaid in full. The NHI certificate should also be returned upon enrollment in an employees’ health insurance plan, when a person begins to receive public assistance, or if a member dies.
How NHI fees are calculated
[Inquiries]Qualification Section , National Health Insurance Division(Phone 03-3463-1781)
NHI fees are calculated on a per household basis and the head of the household is the person who
incurs the obligation to pay the fees.
People who join the NHI program part-way through the year pay fees from the month of enrollment,
while people who withdraw pay their fees up until the month prior to withdrawal.
Paying NHI fees
[Inquiries]Collection Section , National Health Insurance Division(Phone 03-3463-1784)
The following methods can be used to pay your NHI fees, due at the end of specified months.
- Paying with NHI invoices
NHI invoices are sent once a year in June for 10 installments. If you have recently enrolled, the invoices will be sent after enrollment procedures are completed. The fees can be paid at banks in the metropolitan area; at Japan Post Banks in Tokyo, Yamanashi Prefecture, or Kanto area; at the City Office, Branch Offices; or at Convenience stores designated on the back of the invoices. - Paying through automatic bank transfer
If you have an account at a bank or other financial institution, automatic debits can be used to pay NHI fees.
Summary of benefits
[Inquiries]Benefits Section , National Health Insurance Division(Phone 03-3463-1782)
When you show your NHI certificate when you receive treatment at a hospital or medical clinic, you will only have to pay a certain percentage of the cost. The remainder is paid by NHI.
People between 70 and 74 years old must show their Elderly Recipient Certificate together with their NHI certificate.
Personally-borne percentage
- Preschoolers (before entrance to compulsory education) 20%
- 6 (after starting compulsory education) to 69 years old 30%
- 70 to 74 years old 20% or 30% (actively working level earner)
*However, those with 20% will be 10% until March 2012
Medical care fees
If you receive medical treatment without submitting your certificate due to an emergency or other unavoidable reason, or if you use equipment that your physician authorizes as necessary, such as surgical corsets, then you can apply for a reimbursement for a designated portion of the amount you paid.
Excess medical fees
When the fees paid by an NHI member to a medical facility exceed a designated amount a refund application is sent to the concerned member. The excess medical fees are later refunded. In addition, the amount a member pays for costs incurred during hospitalization can be reduced by applying in advance to Shibuya City.
Other benefits
- A ¥420,000 childbirth fee is provided per child after the birth. Alternatively, Shibuya City can pay the childbirth fee (maximum ¥420,000) directly to the medical care facility, if the consent of the facility has been obtained.
- When an NHI member dies a ¥70,000 funeral fee subsidy is provided to the person who makes the funeral arrangements.
Medical expenses not covered by NHI
Health checkups, cosmetic surgery, orthodontic treatments, normal childbirth, abortions for economic reasons,
and vaccinations deemed voluntary are not covered by NHI.
When injured by a third party
When an NHI member has been injured in an accident or has become ill due to the actions of a third party the medical costs should, as a rule, be paid in their entirety by the person at fault, but it is also possible to receive treatment through the NHI program. When NHI is used in this type of instance it is mandatory to file a report.