Everyone residing in Japan must be in a health insurance and a pension system — the only question is which pair. Employees get Shakai Hoken deducted from payroll with the employer paying half; everyone else enrolls at city hall in National Health Insurance and National Pension. The 30% copay with a monthly cost cap makes care affordable, students can defer pension legally, and up to five years of pension contributions can be refunded when you leave — but unpaid premiums quietly sabotage visa renewals and permanent residency.
Key facts
- Employees (Shakai Hoken)
- Auto-deducted, employer pays half
- Everyone else
- NHI + National Pension at city hall
- Your share at the clinic
- 30% of cost, with a monthly cap
- National Pension flat premium
- ¥17,510/month (FY2025)
- Leaving Japan
- Lump-sum refund, up to 5 years' worth
Which pair you’re in
Japan runs two parallel pairs and your job decides the pair, not your preference. Company employees get Shakai Hoken: health insurance plus kōsei nenkin pension, deducted from payroll before you see it, employer paying half — better coverage, dependents included, zero paperwork. Everyone else — students, freelancers, gaps between jobs — enrolls at city hall in National Health Insurance (premium based on last year’s income, so newcomers’ first year is cheap) and National Pension (flat ¥17,510 a month in FY2025).
What the card actually buys
The insurance card turns any clinic or hospital in the country into a 30%-copay service with no network restrictions — and the real safety net is the monthly cap: the high-cost benefit limits out-of-pocket costs to roughly ¥80,000–90,000 for a typical income, no matter how large the hospital bill underneath it. Students who can’t spare the pension premium have a clean legal exit — the student deferral — which keeps the record spotless at ¥0.
The money isn’t lost when you leave
Pension contributions follow you out of Japan two ways. The lump-sum withdrawal refunds up to five years of payments if you claim within two years of departure — for a mid-career worker that’s a meaningful six-figure yen sum. Citizens of totalization-agreement countries (Brazil among them) can instead merge Japanese years into their home-country pension. What ruins both options — and quietly torpedoes permanent residency — is a stretch of ignored bills. Pay, or get an exemption approved; the one unrecorded option is pretending the system isn’t there.
Common mistakes & warnings
- Payment records are checked at visa renewal and permanent residency screening — a gap in pension or NHI payments is one of the most common hidden reasons PR applications fail. If you can't pay, file for an exemption at city hall; an approved exemption is a clean record, an ignored bill is not.
- Never treat National Health Insurance as optional in a low-income year — when you eventually enroll, city hall can bill up to two years of back premiums in one letter.
- Students should apply for the student pension deferral (gakusei nōfu tokurei) rather than simply not paying — same ¥0 due now, opposite paper trail.
Frequently asked questions
I'm healthy — can I just skip health insurance?
No. Enrollment is a legal duty attached to residence, not a product you choose. The practical danger is back-billing plus a 100% bill at every clinic visit; the bureaucratic danger is a payment record that undermines renewals and PR.
What happens to my pension money if I leave Japan for good?
File for the lump-sum withdrawal (dattai ichijikin) within two years of leaving — it refunds up to five years of contributions. Citizens of countries with a totalization agreement, including Brazil, can instead count Japanese years toward their home pension.
What if a big hospital bill exceeds what I can pay?
The high-cost medical expense benefit (kōgaku ryōyōhi) caps your monthly out-of-pocket by income bracket — for a typical salary, roughly ¥80,000–90,000 even on a million-yen surgery. Ask the hospital desk for the pre-authorization so you only pay the capped amount.
Official sources
- Japan Pension Service — lump-sum withdrawal and enrollment rules (2026-07-17)
- MHLW — health insurance system overview (2026-07-17)
This page provides general information only and is not legal advice. Immigration rules change; always confirm details with the official sources listed above before making decisions.