Country guide — Asia-Pacific
Expat insurance and health insurance in Japan
In short
In Japan, affiliation with health insurance does not depend on visa type: it is in principle mandatory for any foreign resident holding a residence status of 3 months or more who has registered an address, whatever the purpose of the stay (working holiday visa once settled, student, employee, retiree). Affiliation with Kenko Hoken (via the employer, for employees) or Kokumin Kenko Hoken (national insurance, run by the municipality, all other cases), covering about 70% of costs. Failing to register within 14 days of registering an address exposes you to a retroactive contribution demand and can complicate residence permit renewal.
Key figures
- 13,125 French nationals registered with the consular register in 2025 (12,652 in 2024, +3.74%).
- Life expectancy at birth: 84.04 years in 2024 — among the highest levels in the world.
- Health spending per capita: US$3,638.19 in 2023.
Local healthcare system
A universal, mandatory health insurance system with two schemes: Kenko Hoken (employees, contribution shared between employer and employee, automatically covers dependants) and Kokumin Kenko Hoken (municipal scheme for self-employed people, students, working holiday visa holders without formal employment, retirees — contribution calculated on the previous year's income, minimum ≈20,000-30,000 JPY/year for a new arrival with no prior Japanese income).
Both schemes cover ≈70% of costs, with a monthly cap based on income. Unlike Thailand: this cover applies whatever the status (public or private) of the facility, including clinics serving an international clientele.
Legal and visa obligations
- General requirement: any foreigner with a residence status of ≥3 months, having registered their address (juminhyo), must affiliate within 14 days. Exempted: tourist stays <90 days and secondment covered by the bilateral agreement.
- France-Japan working holiday visa: no proof of insurance required for the visa itself, but affiliation is mandatory once settled — see our working holiday visa insurance.
- Student: status ≥3 months → mandatory NHI affiliation, often at a reduced rate (see student insurance abroad).
- Seconded employee: may, subject to conditions and for up to 5 years, remain affiliated with the French scheme (including health) via a secondment certificate.
- Failure to affiliate: retroactive contributions demanded back to the eligibility date (not the registration date), which can complicate residence permit renewal. The National Health Insurance Act (国民健康保険法, art. 127) allows each municipality to set an administrative fine (過料) by ordinance of up to 100,000 JPY for failing to declare affiliation or making a false declaration — a penalty rarely applied in practice, the most frequent real risk remaining the retroactive contribution demand.
Cost of some medical procedures
Orders of magnitude from specialised sources, not official fee schedules.
| Procedure | Public sector | Private sector |
|---|---|---|
| GP consultation (with affiliation) | 1,000 to 3,000 JPY (≈€6-17) | 5,000 to 10,000 JPY without affiliation (≈€28-56) |
| Specialist consultation | ≈5,000 to 10,000 JPY with affiliation (30% co-payment + free-choice fee at a large hospital) | 10,000 to 20,000 JPY+ without affiliation |
| Emergency care | ≈1,000 to 15,000 JPY depending on severity (30% co-payment) | 20,000 to 50,000 JPY+ without affiliation |
| Night in hospital (shared room) | 30% co-payment; monthly out-of-pocket cap ≈35,000-252,600 JPY depending on income (meal/linen fees not covered) | ≈30,000-50,000 JPY/day without affiliation (≈€167-278) |
| X-ray / MRI / blood test | 30% co-payment if medically prescribed (not reimbursed for a convenience screening such as ningen dock) | ≈15,000 to 50,000 JPY depending on the test without affiliation (e.g. knee MRI ≈50,000 JPY) |
| Ambulance (life-threatening emergency, no. 119) | Free (public service) | Free (public service) |
Social security agreements with France
France-Japan social security agreement signed 25 February 2005, in force since 1 June 2007. It coordinates only disability, old-age and survivor benefits — no cover for healthcare in Japan under French rights.
- For a retiree or ordinary resident: CLEISS recommends voluntary affiliation with the CFE or private insurance.
- In the case of secondment: a French employer may, subject to conditions and for up to 5 years, keep an employee affiliated with the French scheme (including health) via a secondment certificate obtained before departure.
- Outside covered secondment, any French resident remains subject to the Japanese affiliation requirement.
Which insurance for my profile
General matrix — does not recommend any specific product or insurer.
| Profile | Regulatory constraint | Points of attention |
|---|---|---|
| Working holiday visa | No proof of insurance for the visa; mandatory NHI affiliation once settled | The Japanese scheme does not cover medical repatriation |
| Student | Status ≥3 months → mandatory NHI affiliation | Also check the host institution's own requirements |
| Seconded employee | Possible to remain on the French scheme (including health) for up to 5 years via a secondment certificate | Check the certificate is actually obtained before departure |
| Employee on a local contract | Mandatory affiliation with the employer's Kenko Hoken | Automatic cover for dependants |
| Retiree | No health cover via the CLEISS agreement; mandatory NHI affiliation | Consider CFE and/or private insurance, especially for repatriation |
Hospitals and care network
- St. Luke's International Hospital (Tokyo, Tsukiji) — 539 beds, 24/7 emergency care, English-speaking staff, serving the international community since 1902.
- Tokyo Medical and Surgical Clinic (Tokyo) — Western-trained doctors, 7-day service, support with visa/travel procedures.
- Yodogawa Christian Hospital (Osaka) — dedicated international patient service, reference for the Kansai foreign community.
Practical steps
- Working holiday visa application: free application, in person, 18-30 years old, valid 12 months, quota of ≈1,800 places/year, funds required (€3,100 + return ticket, or €4,500 without a ticket).
- Health insurance affiliation: within 14 days of registering your address (juminhyo) at the municipal office.
- Seconded employee: request the secondment certificate before departure from your French fund, via the employer.
- Recommended registration with the roll of French nationals living abroad (Tokyo or Kyoto) beyond 6 months.
- Voluntary CFE affiliation recommended by CLEISS, particularly for retirees not covered by secondment.
Frequently asked questions
Is health insurance mandatory for all French nationals moving to Japan?
Yes, in almost all cases: any resident with a residence status of 3 months or more must affiliate, with Kenko Hoken or Kokumin Kenko Hoken depending on their status.
Does the France-Japan CLEISS agreement cover my healthcare costs in Japan?
No, for an ordinary resident or a retiree: it only coordinates pensions. Only a seconded employee holding a certificate can remain affiliated with the French scheme (including health), for a limited period.
Does the Japan working holiday visa require proof of insurance to obtain the visa?
No, it's not a mandatory part of the application. Affiliation becomes mandatory once settled, and supplementary private cover remains recommended for repatriation.
What does mandatory Japanese health insurance cover?
About 70% of medical costs, with a monthly cap based on income. Medical repatriation is not covered.
Can I get treatment at a clinic serving an international clientele with mandatory Japanese insurance?
Yes: unlike some other countries, mandatory affiliation applies whatever the status of the facility consulted.
Moving to Japan? Get a quote
Written by Expavy
Sources
- CLEISS — France-Japan social security agreements
- CLEISS — Retirement in Japan, health cover
- France Diplomatie — Japan, Health
- pvtistes.net — The working holiday visa in Japan
- World Bank — Life expectancy, Japan
- France Diplomatie — Register of French nationals abroad (carte-registre, 2025 data)
- e-Gov / hourei.net — National Health Insurance Act (国民健康保険法), art. 127
- E-Housing — Cost of health insurance and care in Japan (2025)
- Japan Dev — Going to the ER in Japan