This article was written by the NIPPON VISA & LIFE editorial team based on information from public organizations such as the national government and local governments. Rules and fees may differ depending on the city, ward, town or village where you live.
In Japan, people who are not covered by their company’s health insurance join the National Health Insurance (kokumin kenko hoken, also called “kokuho”) of the city, ward, town or village where they live. Both when you join and when you leave, you must notify the municipal office counter within 14 days. This article explains, situation by situation, when you need to join or leave and what to bring.
The Short Answer: How to Join and Leave National Health Insurance
- People under 75 who are registered as residents in Japan and are not covered by a company’s or other health insurance join National Health Insurance
- When you join or leave, notify the National Health Insurance counter of the municipality where you live within 14 days
- In principle, the notification is made by the head of household (the representative of the household)
- A procedure to leave is needed when you join your company’s health insurance, when you move to another municipality, and when you leave Japan and no longer have an address in Japan
- Premiums are set for each household. They may be reduced when your income is low or when you lost your job because you were dismissed, among other cases
An overview of the procedures at the municipal office is available in Procedures at the Municipal Office After Arriving in Japan: The Basics of the Moving-in Notification, My Number, National Health Insurance, National Pension and Resident Tax. For how to see a doctor, see When You Get Sick or Injured in Japan: The Basics of Hospitals, Ambulances, Medicine, Medical Insurance and Where to Get Help.
(Sources: Immigration Services Agency (ISA) “Guidebook on Living and Working” Chapter 6, 2-2 National Health Insurance, Ministry of Health, Labour and Welfare “Joining and Leaving National Health Insurance”)
There Are 2 Types of Public Medical Insurance in Japan
Everyone who lives in Japan, regardless of nationality, is supposed to join public medical insurance. There are mainly the following 2 types.
| Type | Who joins | Who handles the procedure |
|---|---|---|
| Health Insurance (company insurance) | People who work at a company that must provide health insurance (regular employees, part-time and arubaito workers who meet the conditions, etc.) and their family members (dependents) | The company |
| National Health Insurance | People who are not covered by the Health Insurance above (self-employed people, people who are not working, international students, arubaito workers who do not meet the conditions for company insurance, etc.) | You (the head of household), at the municipal office |
People covered by their company’s health insurance and their dependents (family members supported under the company insurance) do not join National Health Insurance. If you are not sure which one applies to you, first ask your workplace, “Am I enrolled in health insurance?”
(Sources: Immigration Services Agency (ISA) “Guidebook on Living and Working” Chapter 6 Medical Insurance, 2-1 Health Insurance, National Health Insurance Act Articles 5 and 6)
Who Joins and Who Does Not Join National Health Insurance
Who Joins
People under 75 who are registered as residents and are not covered by a company’s or other health insurance. Foreign nationals also need to join National Health Insurance unless they fall under “Who Does Not Join” below.
Who Does Not Join (Foreign Nationals)
- People whose period of stay is 3 months or less (see below for exceptions)
- People with the status of residence “Temporary Visitor” (短期滞在)
- People with the status of residence “Designated Activities” (特定活動) who engage in “activities to receive medical treatment,” “activities to take care of that person’s daily life,” or “sightseeing, recreation or other similar activities”
- People with the status of residence “Diplomat” (外交)
- People with no status of residence
- People from countries that have concluded a social security agreement with Japan that covers medical insurance, and who have received a “Certificate of Coverage” (a certificate showing they are enrolled in their home country’s insurance) from their home country’s government
Even if your period of stay is 3 months or less, you can join if your status of residence is “Entertainer” (興行), “Technical Intern Training” (技能実習), “Dependent” (家族滞在) or “Designated Activities” (excluding the medical treatment, care, sightseeing and similar activities above), and you are recognized, based on documents, as staying in Japan for more than 3 months.
People aged 75 or older join the “Medical Care System for the Elderly in the Latter Stage of Life” instead of National Health Insurance.
(Sources: Immigration Services Agency (ISA) “Guidebook on Living and Working” Chapter 6, 2-2 (1) and 2-3)
Procedures for Joining and Leaving
Deadline and Where to Go
- When you join or leave, notify within 14 days
- Notify the National Health Insurance counter of the municipality where you live. The name of the counter, such as “Insurance and Pension Division” (hoken nenkin ka) or “National Health Insurance and Pension Division” (kokuho nenkin ka), differs by municipality
- Under the law, the notification is to be made by the head of household. Write your My Number (Individual Number) on the notification form
National Health Insurance coverage starts not from the day you notify, but from the day you came to have an address or the day you lost your company health insurance coverage, and so on. Example: Yokohama City explains that premiums are charged not from the month you notify but from the month you joined National Health Insurance (left your previous insurance), and that if your notification is late, you will have to pay retroactively. Notify within 14 days of the relevant day.
(Sources: Ministry of Health, Labour and Welfare “Joining and Leaving National Health Insurance”, National Health Insurance Act Articles 7 to 9, Ordinance for Enforcement of the National Health Insurance Act Articles 2, 3, 11 and 13, Yokohama City “National Health Insurance Premiums”)
When You Need to Join
| Situation | What to do |
|---|---|
| You came to Japan and your address has been decided (and you do not join company health insurance) | Complete the procedure to join National Health Insurance together with the moving-in notification (resident registration) |
| You quit your job and lost your company health insurance | Complete the procedure to join National Health Insurance (also for your family if they were dependents under the company insurance) |
| You moved in from another municipality | Complete the procedure to join in the new municipality |
| A child was born | Complete the procedure to enroll the child in National Health Insurance |
The moving-in notification must be made within 14 days after your address is decided. For details, see The Moving-in Notification and the Resident Record: Notify Your Municipality Within 14 Days After Your Address in Japan Is Decided (What to Bring, the Process and When You Move).
When You Need to Leave
| Situation | What to do |
|---|---|
| You joined company health insurance, for example by getting a job | Complete the procedure to leave National Health Insurance. Bring something that shows you joined the company insurance |
| You move to another municipality | Complete the procedure to leave in your current municipality, and the procedure to join in the new municipality |
| You leave Japan and no longer have an address in Japan | Complete the procedure to leave National Health Insurance together with the moving-out notification |
After you join company health insurance, you can no longer use your National Health Insurance eligibility certificate (shikaku kakuninsho, a document showing your insurance coverage).
(Sources: Immigration Services Agency (ISA) “Guidebook on Living and Working” Chapter 6, 2-2 (2), National Health Insurance Act Articles 6, 8 and 9, Yokohama City “Joining and Leaving National Health Insurance”)
Examples of What to Bring (Example: Yokohama City)
What to bring differs by municipality. Here, as an example, we introduce Yokohama City’s guidance.
| Situation | What to bring (Yokohama City) |
|---|---|
| Leaving workplace health insurance and joining National Health Insurance | Something that shows the date you lost coverage (a health insurance loss of eligibility certificate, your My Number Card and the coverage screen on Mynaportal, etc.), and identification documents |
| Moving in from outside the city | Identification documents |
| A child was born | Maternal and Child Health Handbook, and identification documents of the person who comes to the counter |
| Joining workplace health insurance and leaving National Health Insurance | Something that shows the date you obtained coverage (eligibility certificate, notice of eligibility information, health insurance acquisition of eligibility certificate, the coverage screen on Mynaportal, etc.), and the National Health Insurance eligibility certificate you have been using |
| Moving out of the city | The National Health Insurance eligibility certificate you have been using |
Yokohama City explains that if you use your National Health Insurance eligibility certificate or similar after losing coverage, you may be billed for the medical costs paid by the city.
You can find what to bring in your municipality by searching its website with words such as “(name of your municipality) 国民健康保険 加入” (National Health Insurance join) or “国民健康保険 脱退” (National Health Insurance leave).
(Sources: Yokohama City “Joining and Leaving National Health Insurance”)
Health Insurance When You Quit Your Job
When you quit your job, you lose your company health insurance coverage. You will choose one of the following.
- Join National Health Insurance: Complete the procedure within 14 days at the municipality where you live
- Continue your company health insurance (voluntary continuation): If you had been continuously covered by your company health insurance for 2 months or more before quitting, you can continue to be covered by applying within 20 days of the day you lost coverage. Apply to the health insurance you were enrolled in (Japan Health Insurance Association (Kyokai Kenpo) or a health insurance society)
- Become a dependent under a family member’s company health insurance: Complete the procedure through your family member’s workplace
Which option is best (how much the premiums will be) differs from person to person. Ask the National Health Insurance counter of your municipality or the health insurance you were enrolled in.
(Sources: Health Insurance Act Article 3, Paragraph 4 and Article 37, Ministry of Health, Labour and Welfare “Joining and Leaving National Health Insurance”)
How Premiums Work
- Premiums are calculated for each household and are based on the income and number of members enrolled, among other factors
- The head of household pays the premiums
- The calculation method and payment schedule are set by each municipality’s ordinance. Check the amount in the notice sent by your municipality
(Sources: Immigration Services Agency (ISA) “Guidebook on Living and Working” Chapter 6, 2-2 (3), Ministry of Health, Labour and Welfare “National Health Insurance Premiums and Taxes”)
When Premiums May Be Reduced
| Situation | Details |
|---|---|
| Household income is low | For households with income below the standard, part of the premium (the per-capita and per-household portions) is reduced by 70%, 50% or 20% |
| You have a child who has not yet entered elementary school | 50% of the child’s per-capita premium is reduced |
| You quit your job due to bankruptcy, dismissal, non-renewal of contract, etc. | For people who became an “eligible recipient for specific reasons” (tokutei jukyu shikakusha) or “person who left a job for specified reasons” (tokutei riyu rishokusha) under employment insurance, premiums are calculated by treating the previous year’s employment income as 30/100, from the time they lost their job until the end of the following fiscal year |
| Payment is difficult due to special circumstances such as a disaster | Premiums may be reduced, or payment may be postponed |
The reductions for low-income households, children who have not yet entered elementary school, and people who quit their jobs are systems based on national rules. On the other hand, how premiums are calculated and paid, and how reductions and exemptions are handled in cases such as disasters, differ by municipality. Check with your municipality’s counter about the procedure for receiving the reduction for people who quit their jobs. If you think you cannot pay the premiums, consult the National Health Insurance counter of your municipality before the payment deadline.
The procedures when you cannot pay National Pension premiums are summarized in When You Cannot Pay National Pension Premiums: How to Apply for Exemption or Payment Postponement (Income Standards, Where to Apply, What to Bring and Making Up Payments).
(Sources: Ministry of Health, Labour and Welfare “National Health Insurance Premiums and Taxes”)
What National Health Insurance Covers
| Benefit | Details |
|---|---|
| Out-of-pocket share of medical costs | What you pay at a hospital or pharmacy is 20% for children under 6 (before entering elementary school), 30% for people under 70, and 20% for people aged 70 to 74 (30% for people with income comparable to working people) |
| Medical expenses reimbursement (ryoyohi) | For example, if just after joining you have not yet registered your My Number insurance card and do not have an eligibility certificate, you first pay the full amount, and if your application is approved, the amount above your out-of-pocket share is refunded |
| High-cost medical expense benefit | When the medical costs you pay in 1 month exceed a certain amount, the excess is refunded |
| Lump-sum childbirth allowance | Money is paid when an enrolled person gives birth |
When your medical costs are high, see When Your Medical Costs Are High in Japan: How the High-Cost Medical Expense Benefit Works, Guideline Upper Limits and How to Apply (Including the Revisions from August 2026).
(Sources: Immigration Services Agency (ISA) “Guidebook on Living and Working” Chapter 6, 2-2 (4))
When You Have Trouble: Frequently Asked Questions
Can I go to a hospital before completing the procedure to join?
You can go to a hospital. However, if you have not yet registered your My Number insurance card and do not have an eligibility certificate with you, you may have to pay the full medical cost first. If you later apply to your municipality and it is approved, the amount above your out-of-pocket share is refunded as “medical expenses reimbursement” (ryoyohi).
I joined company insurance but have not completed the procedure to leave National Health Insurance
Your National Health Insurance coverage ends on the day you join company health insurance, but you (the head of household) must make the notification to leave yourself. As soon as you notice, notify your municipal office counter.
What should I do when I return to my home country?
When you leave Japan and no longer have an address in Japan, submit a moving-out notification to your municipality and complete the procedure to leave National Health Insurance. Check with your municipal office counter how to pay your last premiums.
I do not understand Japanese well
In addition to the municipal office counter, the international exchange association in your area or similar organizations may offer consultations in foreign languages.
(Sources: Immigration Services Agency (ISA) “Guidebook on Living and Working” Chapter 6, 1-2 and 2-2, National Health Insurance Act Articles 8 and 9)
Primary Sources Referenced in Writing This Article
- Immigration Services Agency (ISA) “Guidebook on Living and Working” (Chapter 6 Medical Care)
- Ministry of Health, Labour and Welfare “Joining and Leaving National Health Insurance”
- Ministry of Health, Labour and Welfare “National Health Insurance Premiums and Taxes”
- e-Gov Laws and Regulations Search “National Health Insurance Act”
- e-Gov Laws and Regulations Search “Ordinance for Enforcement of the National Health Insurance Act”
- e-Gov Laws and Regulations Search “Health Insurance Act”
- Yokohama City “Joining and Leaving National Health Insurance”
- Yokohama City “National Health Insurance Premiums”
This article is a translation of the original Japanese version.
