For foreign residents living in Japan, enrolling in health insurance is essential for living with peace of mind.
However, because “Employee Health Insurance” and “National Health Insurance” have similar names, many people are unsure of the differences between them or which one they should enroll in. There are differences in enrollment requirements, premiums, and dependent coverage between the insurance provided by your employer and the insurance administered by your municipality.
In this article, we’ll clearly compare the differences between Employee Health Insurance and National Health Insurance and provide a detailed explanation—including insights from an administrative scrivener—on which option foreign residents should choose.
目次
- What Is Employee Health Insurance?
- What Is National Health Insurance?
- Main Differences Between Employee Health Insurance and National Health Insurance
- Which System Do Foreigners Choose?
- Points to Note from the Perspective of Administrative Scriveners and Certified Social Insurance and Labor Consultants
- Summary
What Is Employee Health Insurance?
Employee Health Insurance is a public health insurance system that employees of corporations or workplaces meeting certain criteria enroll in through their employer. Under this system, the company and the employee each bear half of the premium.
Corporations and other legal entities, as well as sole proprietorships with five or more regular employees engaged in certain types of business, are subject to mandatory enrollment; therefore, employees of such establishments must enroll if they meet the requirements regarding working hours and other criteria.
A key feature of this system is that when seeking medical treatment for illness or injury, the out-of-pocket cost is generally 30% of the total medical expenses, and participants are eligible for various benefits, such as the High-Cost Medical Care Support System, sickness allowance, and maternity allowance.
Additionally, family members who meet certain conditions can be registered as dependents and use the Employees’ Health Insurance just like the insured person.
Even foreign nationals who work for a Japanese company in a capacity that makes them eligible for social insurance must enroll in the Employee Health Insurance system, just like Japanese nationals.
What Is National Health Insurance?
National Health Insurance is a public health insurance system for self-employed individuals and those working at businesses not covered by Employee Health Insurance. Enrollment procedures are handled at the municipal office in your area of residence.
As with Employee Health Insurance, the out-of-pocket cost for medical expenses is generally 30%, but benefits typically available to company employees—such as sickness allowance and maternity allowance—are generally not provided.
Furthermore, since each family member is considered a separate policyholder, it is not possible to enroll as a dependent, as is the case with Employee Health Insurance. Another major difference is that premiums are calculated individually for each person.
As a general rule, foreign nationals who have resided legally in Japan for more than three months and are not enrolled in Employee Health Insurance are also eligible to enroll in National Health Insurance.
Main Differences Between Employee Health Insurance and National Health Insurance
Although both systems are public health insurance programs, there are differences in how one enrolls, how premiums are calculated, and the benefits provided.
The most significant difference is eligibility. Employee Health Insurance is for people employed by companies or other eligible employers, while National Health Insurance is for everyone else.
There are also differences in premiums. Under Employee Health Insurance, premiums are split equally between the employer and the employee based on salary, whereas under National Health Insurance, municipalities calculate premiums based on the previous year’s income.
Furthermore, Employee Health Insurance includes a dependent coverage system, whereas National Health Insurance does not; therefore, every family member must be enrolled as an individual policyholder, which is another important point to note.
Which System Do Foreigners Choose?
Foreigners are not free to choose between Employee Health Insurance and National Health Insurance. Which system they enroll in depends on their employer and employment status.
For example, if you are hired as a full-time employee by a Japanese company, you will enroll in Employee Health Insurance if the company is a covered workplace under the social insurance system. On the other hand, international students attending Japanese language schools or universities, people working at businesses that are not covered workplaces, and self-employed individuals enroll in National Health Insurance.
If you leave your job, you will enroll in National Health Insurance if you were previously enrolled in Employee Health Insurance.
Since the system you are enrolled in may change as described above, it is important not to forget to complete the necessary procedures. If there is a period during which you are uninsured, you may be billed retroactively for insurance premiums.
Points to Note from the Perspective of Administrative Scriveners and Certified Social Insurance and Labor Consultants
Foreign nationals’ status of residence is closely linked to the social insurance system. In particular, for foreign nationals coming to Japan on a work visa, it is important to confirm that their employer has properly enrolled them in the Employees’ Health Insurance program.
Additionally, when lifestyle changes occur—such as changing jobs, leaving employment, or switching to a spouse visa—it may become necessary to switch from Employees’ Health Insurance to National Health Insurance, or vice versa.
Administrative scriveners are experts in residence status, while certified social insurance and labor consultants are experts in social insurance. When these two professionals work together, they can provide general explanations of the relationship between residence status and the social insurance system, as well as guidance on the necessary administrative procedures.
Summary
Both Employee Health Insurance and National Health Insurance are part of Japan’s public health insurance system, but there are significant differences in eligibility, premiums, benefits, and the dependent coverage system.
Foreign nationals cannot freely choose between the two; enrollment is determined based on factors such as employment status and residence status.
Since your enrollment status may change due to starting a new job, changing jobs, or retiring, it is important to complete the necessary procedures by the deadline. By correctly understanding the system, you can live in Japan with peace of mind and be properly prepared in the event of illness or injury.
If you have any questions or concerns about the procedures, we recommend consulting a specialist, such as an administrative scrivener, to receive advice tailored to your specific situation.