A Complete Guide to National Health Insurance for International Students in Japan

1. Enroll in National Health Insurance (NHI) upon arrival

All students on a "Study" visa (3+ months) must join Japan's National Health Insurance program. Do this immediately after you move into your address. Complete your Resident Registration (住民登録) at the city hall or ward office and at the same time apply for NHI. In practice:

• When: Within 14 days of establishing your address in Japan. Often you register your address and NHI together.
• Where: Visit your local City Hall or Ward Office's National Health Insurance section (国民健康保険課).
• What to bring: Passport, Residence Card (在留カード), and student ID or enrollment certificate. (Some offices also ask for your My Number card.) You will fill out forms and then receive your health insurance card (or qualification certificate until the My Number card system is in place).

Back-pay warning: If you delay, you may be billed retroactively for missed months. Always enroll promptly.

Updating info: If you change address, name or household, report it within 14 days – surrender the old card and get a new one. When you leave Japan (graduation, end of study), return the card and cancel your enrollment before departure.

Action Tip: When you enroll, submit an income report/reduction form. Students with little or no income can often cut insurance premiums dramatically (see Section 3 below).

2. What NHI covers (and what it doesn't)

Japan's National Health Insurance covers most illness- and injury-related medical costs. When you see a doctor or fill a prescription, the insurance system pays 70% of the eligible costs and you need to pay the remaining 30%. (Children under 6 and adults 70–74 pay only 20%.) In practical terms:

• Covered: Doctor visits, hospital stays, surgeries, prescription drugs and standard treatments. Basic dental care is also included (though cosmetic or specialized dental work is usually excluded).
• Co-pay: Typically pay 30% of bills (20% for young children or ages 70–74). For example, a ¥10,000 clinic visit costs you ¥3,000 at time of service. The NHI fund pays the rest.
• High-Cost Care: If your bills in a month exceed a threshold, you can apply for a high-cost medical care reimbursement (高額療養費) to get back the excess.
• Childbirth Benefit: NHI does not pay for normal delivery costs, but there is a lump-sum childbirth subsidy (~¥420,000) for insured persons who give birth. (This is separate from the day-to-day coverage.)
• Not covered by the National Health Insurance: Elective and cosmetic procedures, routine vaccinations, normal pregnancy/delivery costs (medical treatment itself), some dental treatments (e.g. braces), vision/hearing aids, etc. Travel/overseas medical expenses and most non-Japanese care are also not covered by default.
• Insurance for Students: Because NHI leaves a 30% co-pay, many schools offer (or recommend) insurance for students pursuing education to cover that gap. These are voluntary plans (often called "student comprehensive insurance" or travel insurance for students) which pay the remaining 30% of medical costs and also cover other risks (accidents, liability, repatriation, etc.). For example, one Japanese language school offers a "Student Insurance" for about ¥10,000/yr that fully covers the 30% copay and adds extra benefits. In short, NHI pays ~70%, and a student insurance policy can pay the remaining ~30% for covered services. See Section 4 below for more on private plans.

3. Insurance premium costs and examples

NHI insurance premiums (保険料) are charged per household based on income, household size and composition. Each city/ward calculates them slightly differently, but they typically include a per-person charge (均等割) and per-household charge (平等割) plus an income-based tax (所得割). Students with little or no income usually pay very low premiums. For example:

• Tokyo (Chofu City) – A low-income international student typically pays about ¥12,000 per year (~¥1,000/month) after reductions. (Without reductions, base fees in Tokyo can be ~¥30,000–40,000/yr.)
• Tokyo (City average) – One guide notes "about ¥1,500 per month" for a student, reflecting discounted rates.
• Nagasaki City – Nagasaki University reports roughly ¥15,300 per year (~¥1,275/month) if your income is under ¥100,000.
• Osaka City (FY2025) – For reference, Osaka's rates are ¥33,574 per household + ¥34,424 per person per year. (A single student household with zero income could be assessed ~¥68,000/yr before reductions.)
• Fukuoka City (FY2025) – Fukuoka's rates are ¥18,863 per household + ¥19,980 per person per year (~¥38,843 for a single-person household).

In practice, students get big reductions. After filing income declarations, most students pay only a few thousand yen per year. (For example, if you earn nothing, Tokyo and other cities often reduce ~70–90% of the fees.)

Tips to reduce insurance premiums

• File the reduction form: When enrolling, declare your (low) income. Many cities have a "reduction application" that slashes your NHI bill. E.g. Tokyo's Chofu City allows a "簡易減額申請" so a zero-income student pays only ~¥10k/yr instead of ¥30k. Students should submit income reports so they qualify for reductions.
• Automatic discounts: Some cities automatically apply 70%/50%/20% discounts to the per-capita and per-household charges for very low-income households. You usually don't need a separate application for those beyond your initial filing.
• University aid: Check if your school offers subsidies. For example, some universities subsidize ¥5,000/yr of student NHI premiums. Ask your international affairs office or student support.
• Pay on time: Many municipalities allow you to pay yearly or bi-monthly installments. Avoid penalties by paying on schedule.
  

4. Insurance for Students (Private) – filling coverage gaps

Private insurance for students pursuing education plans are optional but highly recommended. These plans typically supplement NHI in two ways:

• Covering the 30% co-pay: Plans like personal accident insurance for students pay the 30% NHI copay for eligible medical expenses. In effect, you pay 0% out of pocket for covered medical treatment (since NHI covered 70% and the plan covers the rest).
• Additional coverage: They also insure things NHI doesn't, such as accidents off-campus, personal liability (e.g. if you accidentally injure someone or damage property), and emergency repatriation (costs if you or your family must travel for your care). Some plans even cover limited dental or loss of personal belongings.

Example: Some Japanese school plans (¥10,000/yr) cover 100% of typical medical bills: e.g. for a ¥10,000 treatment, NHI pays ¥7,000 and the insurance pays the remaining ¥3,000. It also provides ¥30 million liability insurance and other benefits. Many language schools and universities bundle a similar insurance with tuition or offer it at enrollment.

A comparison is shown below:

Insurance Type & Coverage (% of medical cost)	Notes
National Health Insurance ~70% (standard)	You need to pay 30% at the hospital (20% for young children/age 70–74). Covers illness/injury but not cosmetic or normal childbirth.
Student/Travel Insurance Remainder (~30% of medical cost)	Covers the NHI copay and often extra expenses (accident, liability, rescue). Example plans fully cover remaining costs, making net out-of-pocket ~0.

5. Checklist & Tips

• Documents to carry: Always have your NHI insurance card (or qualification certificate) on you in Japan. Present it at every clinic or pharmacy; otherwise you must pay 100%. After Dec 2024, the My Number card can serve as your insurance card (otherwise you'll get a paper "資格確認書" to use). Keep your Residence Card and passport handy for address updates.
• Regularly report income: Each year, you may need to declare income for NHI premium recalculation. Watch for forms mailed by June and return them promptly to keep reduced rates.
• Co-pays at visit: Remember to pay your 30% share when receiving care. If you have student insurance, submit claims as needed to recover that 30%.
• Emergency care: In an emergency, go to any hospital; show your insurance. If treatment occurs outside your city or abroad temporarily, keep all paperwork – you may claim reimbursements later. Still, consider a travel insurance policy for overseas trips.
• Stay informed: Check your city's official website (often in English) for NHI details. Local ward office sites have guides in multiple languages for international students in Japan.
• Leaving Japan: Before you graduate or go home, visit the municipal office to cancel NHI (保険証返納). Make sure all insurance premiums are paid up to the date you leave. This avoids surprise bills later.

By following these steps and tips, exchange students can confidently handle the health insurance system in Japan – ensuring both compliance and affordable access to medical care while studying in Japan.