National health insurance programs cater to people who do not belong to workplace health insurance programs. Non-Japanese people are required to enter national health insurance programs, if they have made the alien registration, are entitled to stay in Japan for one year or longer and do not belong to workplace insurance programs (except for those who are on the status of “short-term stay.”) Even though people enter Japan with a permit to stay for shorter than one year, if they are later allowed to stay for one year or longer, they must enter into the national health program.
* Note: the following people are exempted from entering the national health insurance program pursuant to the Agreement between Japan and the USA on Social Security implemented on October 1, 2005: people who are covered by a US law designating the US government to bear their medical expenses and certified by the US Social Security Administration that they belong to adequate health insurance programs to prepare for the accrual of costs related to medical services that they could receive in Japan.

Each resident makes the entry procedures at the municipal administrative office where he/she registered as an alien.

After you have completed the entry procedure, you receive your health insurance card. As a card that proves your membership to an insurance program, it must be kept with care. An insurance card bears the holder’s name and address. It must be shown at the reception of a medical institution every time you receive clinical services there. It is advised to carry it when you travel inside Japan. No borrowing, lending, sale or purchase may be made with an insurance card.

When you receive medical care due to sickness or injuries, you pay 30% of the whole medical fees spent for your treatment. However, for insured persons aged 70 or older, whether the contributors or their dependents, the contributors bear either 10% or 30% depending on their income. The contributor bears 20% of the medical fees spent for his/her dependent children up to two years old.

Contributors of national health insurance programs pay insurance contributions by themselves through financial institutions and by other means. They can bring the payment document sent from the municipal administrative office to a financial institution or the municipal administrative office and pay there or use an account transfer at financial institutions. In some cases, collectors visit contributors for the contribution payment.
The amount of insurance contributions differs among municipalities. It is determined every year based on the income level of the contributor’s household and the number of family members. However, non-Japanese contributors in their first year in Japan are charged with the minimum level of the insurance contribution since these people have no income record in Japan. They are charged with different levels of contribution in their second year and afterwards of their residence in Japan. Contributors aged 40 or older and below 65 years pay an amount including the nursing care insurance (see I Other welfare 2-1).
If a contributor defaults in the contribution payment, he/she will return his/her insurance card and instead receives a certificate of the insured status. During his/her holding of the certificate, he/she will have to pay all of the medical fees incurred to him/her (at later times, he/she can claim what is dubbed “medical costs payments” at the municipal administrative office or at his/her workplace.) It is advised to pay the contribution regularly without default. In some cases, the contributor is exempted from the contribution payments when he/she is unable to pay due to a disaster, unemployment, bankruptcy of his/her workplace, etc. In such cases, the contributor is advised to consult staff in charge of national health insurance at the local municipal administrative office.

Once you enter into a national health insurance program, you will not be withdrawn from it automatically. If you have entered into your workplace health insurance program, you should notify this at the national health insurance counter of your local municipal administrative office within 14 days of its occurrence. Likewise a notification within 14 days is also necessary for events including the following: when insured persons have lost their insurance card or have it damaged; birth of a child; change in the head person of the household; death.
Notification is furthermore necessary when contributors have changed their address as a result of moving out from one place and moving into another place. When they move out, they present their insurance card at the local municipal administrative office governing the place they are to move out from and notify the date of moving out. When they have moved into a new place, they notify it at the local municipal administrative office governing their new address within 14 days of their moving in.
When you move out of Japan, you notify it in advance, bringing your insurance card, seal (if you have one), alien registration certificate, airplane ticket, etc.