Setting Up Your NHI as a Foreigner in Japan

So, you’ve made the leap to Japan—whether for work, study, or some grand adventure. Now, among the many bureaucratic hurdles you’ll need to clear, signing up for National Health Insurance (NHI) is one of the most important. It’s not the most thrilling part of your journey, but trust me, you don’t want to find yourself in a doctor’s office without it. Medical bills without insurance? That’s a level of suffering no amount of konbini comfort food can fix.

Let’s break it down, step by step.

---

1. Do You Need to Enroll in NHI?

If you’re a resident of Japan (i.e., staying for more than three months), then yes—unless you’re already covered by your employer’s Shakai Hoken (社会保険, Social Insurance).

Here’s how it works:

• If you’re a full-time employee at a company that offers Shakai Hoken, congratulations! You don’t need NHI, as you’re already covered.
• If you’re a part-time worker, freelancer, student, or unemployed, you’ll need to sign up for NHI at your local city or ward office.

👉 Pro tip: Some smaller companies don’t provide Shakai Hoken even if you work full-time (though they’re legally required to in most cases). If your employer tells you they don’t offer it, double-check whether you should actually be enrolled before defaulting to NHI.

---

2. How to Sign Up for NHI

Now, onto the fun part—dealing with bureaucracy. Here’s what you need to do:

Step 1: Go to Your Local Ward/City Office

You need to register at the municipal office of the city or ward where you live. Bring:
✅ Your Residence Card (在留カード, Zairyū Kādo)
✅ Your My Number Card (or the notification letter if you don’t have the card yet)
✅ Your Passport (not always required, but it’s good to have)
✅ A document showing your address (if you just moved in, your Jūminhyō (住民票, Resident Certificate) might be necessary)

Step 2: Fill Out the Application

At the counter, say:
🗣️ “Kokumin Kenkō Hoken ni Kannyū Shitai desu” (I’d like to enroll in National Health Insurance).
You’ll be handed a form to fill out—basic stuff like your name, address, and resident status.

Step 3: Receive Your NHI Card

You’ll either get your health insurance card on the spot or be told it will be mailed to you in a few days. This little card is your golden ticket to 70% off medical expenses at hospitals and clinics.

---

3. How Much Does NHI Cost?

Here’s the part that stings a little. NHI premiums are based on your previous year’s income, so:

• If you just moved to Japan and have no prior income here, you’ll pay the minimum amount (typically around ¥2,000–¥4,000 per month).
• If you had a job last year in Japan, your premiums will be calculated based on that income. Expect something between ¥10,000–¥30,000 per month, depending on how much you earned.

👉 Pro tip: If you find your premium too high, ask about the reduction program (減免, Genmen). If you’re a low-income earner, student, or recently unemployed, you might be eligible for a discount.

---

4. Using Your NHI: What’s Covered?

Your NHI covers 70% of most medical expenses, meaning you only pay 30% out-of-pocket. Here’s what’s included:
✅ Doctor visits (including specialists)
✅ Hospital stays
✅ Emergency care
✅ Surgeries
✅ Prescriptions
✅ Some dental care
✅ Basic maternity services

Not covered? Fancy procedures like LASIK, cosmetic treatments, and some dental work (like orthodontics).

---

5. What Happens If You Don’t Enroll?

If you’re required to sign up for NHI and you don’t, Japan’s bureaucracy will find you. You’ll be expected to pay back premiums from the date your residency started—yes, even if you never used the insurance. So don’t try to dodge it!

---

6. What If You Leave Japan?

Before heading off to your next adventure, you must cancel your NHI at the ward office. If you don’t, premiums will keep stacking up, and that’s a headache you don’t want.

👉 Pro tip: If you overpaid premiums, you might get a refund—so check before you go.

---

Final Thoughts

Setting up NHI is one of those things you just have to get through when living in Japan. The process is relatively simple, and the peace of mind is 100% worth it. Japan’s healthcare system is excellent, and with your NHI card, you won’t have to worry about medical expenses wrecking your budget.

Got questions or stuck on something? Drop me a comment, and I’ll help you through it. Happy (and insured) living in Japan! 🇯🇵💙