Healthcare Reimbursement in Japan: Employee, Seconded Worker, Self-Employed, Working Holiday, Student, Retiree, Tourist

The ISA guidebook for living and working in Japan reminds us that enrolment in public health insurance concerns all residents, whatever their nationality. The Japanese schemes cover 70% of costs for most insured people aged 6 to 69 (30% borne by the patient), 80% before age six and from 70 to 74, and 90% from age 75 for most insured people. Your situation determines the applicable scheme and its cost. The reimbursement guide explains the general logic, and the page on the Japanese healthcare system presents each scheme.

An employee hired locally, full-time or part-time depending on working time and company size, is enrolled in Kenko Hoken. The employer and employee each pay half of the contribution, and dependants are covered without contributing. The patient pays 30% of costs. On top come a monthly cap on out-of-pocket costs, a sickness allowance paid from the fourth day of absence, a maternity leave allowance and the childbirth lump sum (ISA).

During the first weeks, as long as the card has not been received, the employee advances the full costs and claims reimbursement of the covered share.

The France-Japan social security convention of 25 February 2005, in force since 1 June 2007, coordinates the disability, old-age and survivors risks. It provides for the totalisation of insurance periods, with each State paying its share of pension. It also sets the secondment rule: for an initial assignment of 5 years at most, an employee sent by a French employer remains enrolled in the French scheme, including for sickness, and care received in Japan is covered without additional contributions (CLEISS). The secondment certificate is requested before departure from the competent French body, online through the Urssaf (the French social security contributions collector) employer account for the general scheme; an exceptional extension can be requested if the assignment exceeds 5 years.

On the Japanese side, the ISA guidebook exempts from national insurance people from a country that has concluded with Japan an agreement including health insurance and who hold the official certificate of their home scheme. See the glossary: seconded employee and bilateral social security agreement. The CLEISS (the French liaison centre for international social security) also describes how a self-employed person established in France who provides a service in Japan can stay in the French scheme, under conditions.

National insurance concerns residents under 75 who do not fall under Kenko Hoken. It applies to the self-employed person based in Japan, to the student, whose status is not among the exceptions, and to the working holiday visa holder: the ISA guidebook excludes only the specified activities of medical care and tourism-leisure, so the 12-month stay requires enrolment, to be requested at the city office with the residence card.

The contribution is calculated per household according to income and the number of people, with possible reductions depending on income, to be requested at the city office. The patient pays 30% and benefits from the monthly cap. The self-employed person also contributes to the national pension, at a flat amount (category I). For the student and the working holiday visa holder, see the pages on student insurance abroad and working holiday visa insurance.

Spouse: the dependant of a Kenko Hoken employee is covered without a health contribution and falls under category III of the national pension. The spouse of an NHI holder is insured as part of the household. A spouse holding the “Dependent” status can enrol even for a stay announced as under three months, on proof of a longer stay. See the expat family guide.

Retiree: the CLEISS indicates that the 2005 convention opens no right to reimbursement of care received in Japan on the basis of the French pension. The resident retiree enrols in Kokumin Kenko Hoken until 75, then in the system for the elderly; they can top this up through voluntary enrolment in the CFE or through private insurance. See retiring in Japan and the guide to retiring abroad.

CFE member: only the certificate provided for by a social security agreement exempts you from national insurance (ISA). Voluntary enrolment in the CFE falls under a different framework: it serves as a top-up, including for the costs that the Japanese scheme leaves to the patient.

First-euro insurance: international health insurance reimburses from the first euro and also covers evacuation and repatriation, but mandatory Japanese enrolment applies to every non-exempt resident; the two add up, with private insurance covering the 30% left to the patient depending on the contract (see first euro and expat health insurance).

Tourist: the temporary visitor and the stay of under three months remain outside the public schemes. France Diplomatie reminds us that the embassy never covers healthcare costs and that insurance covering care and repatriation is essential (see long-stay travel insurance).

Return to France: before leaving, report your departure to the city office. Care received outside Japan can give rise to reimbursement by the Japanese scheme, after advancing the costs and less the co-payment. A foreigner who has left after at least six months of contributions and less than ten years of insurance can claim a lump-sum withdrawal of their pension within two years, calculated on 60 months at most. See returning to France and insurance for returning to France.

• Consultation: 30% borne by the patient in both schemes. A large hospital may charge at least 7,000 yen for a first consultation without a referral letter (Ministry of Health, Labour and Welfare, MHLW).
• Hospitalisation: same co-payment, limited by the monthly cap (for example 85,800 yen plus 1% beyond 286,000 yen of costs for an annual income of 3.7 to 7.7 million yen); meals and bed are left out of the calculation (ISA, MHLW).
• Medicines: prescriptions are collected at the pharmacy, and medicines are part of the covered costs; drugstores sell non-prescription products (ISA).
• Dental: dentistry is one of the system’s specialties; implants are outside insurance (MHLW).
• Optical: ophthalmology is one of the specialties; glasses, like hearing aids, are outside insurance (MHLW).
• Maternity: normal delivery is outside the care benefit, but gives the right to the childbirth lump sum of 500,000 yen (488,000 yen outside the obstetric compensation scheme or before 22 weeks), paid directly to the establishment; a caesarean delivery is covered as care (Japan Health Insurance Association).