Employees’ Health Insurance in Japan, Explained (2026)
Wondering if your new business is obligated to cover health insurance for your employees? Here’s what every business owner ought to know about employees’ health insurance 健康保険 = kenkou hoken in Japan.
In principle, all residents and citizens of Japan must enroll in the public health insurance system.
While this article focuses on employees’ health insurance in Japan, there are 4 additional types of insurance that business owners must be aware of:
Workers' Accident Compensation Insurance 労災保険（労働者災害補償保険）= rousai hoken
Employment Insurance 雇用保険 = koyou hoken
Employees’ Pension Insurance 厚生年金保険 = kou sei nenkin hoken
Nursing Care Insurance 介護保険 = kaigo hoken
Note: Workers' Accident Compensation Insurance and Employment Insurance are often referred to as 労働保険 = roudou hoken "labor insurance." And Employees’ Pension Insurance, Employees’ Health Insurance, and Nursing Care Insurance are referred together as 社会保険 = shakai hoken “social insurance.”
Health insurance in Japan: How the system works
Japan has a universal public health insurance system that all residents—both Japanese nationals and foreign residents—are legally required to enroll in. The system ensures access to medical care at a standardized cost, regardless of income level or nationality.
Japanese health insurance is broadly divided into two main categories:
Employees’ Health Insurance (健康保険 / Kenkō Hoken) Applies to full-time and qualifying part-time employees working for companies in Japan. Premiums are shared equally between the employer and the employee and are deducted directly from the employee’s salary.
The National Health Insurance (国民健康保険 / Kokumin Kenkō Hoken) Applies to individuals who are not covered by Employees’ Health Insurance, including freelancers, self-employed individuals, students, retirees, and those who are unemployed. Enrollment and premium payments are handled through the local city or ward office.
Under both systems, the public insurer typically covers approximately 70% of approved medical costs, with the remaining 30% paid by the patient at the point of care.
The insurer pays the remaining 70% behind the scenes. This can be Kyokai Kenpo, a company health insurance union, or a city office, depending on the plan.
Employees’ Health Insurance vs National Health Insurance in Japan
In Japan, the public health insurance system is divided into two main categories. Understanding the differences between Employees’ Health Insurance (健康保険) and the National Health Insurance (国民健康保険) is essential for both employers and residents, as enrollment depends on employment status.
Category |
Employees’ Health Insurance (健康保険) |
The National Health Insurance (国民健康保険) |
Who enrolls |
Full-time and qualifying part-time employees |
Freelancers, self-employed individuals, students, retirees, unemployed residents |
Enrollment handled by |
Employer |
Individual (via city or ward office) |
Premium paid by |
Employer and employee (split evenly) |
Individual |
Premium calculation |
Based on standard monthly salary |
Based on household income, age, and municipality |
Payment method |
Automatically deducted from salary |
Paid directly to local government |
Dependent coverage |
Yes (dependents covered without additional premium) |
No (each household member pays separately) |
Medical cost coverage |
Approx. 70% covered by public insurance |
Approx. 70% covered by public insurance |
Switching required when employment status changes |
Yes |
Yes |
Note: International students in Japan must also register for national health insurance. This happens at the local city office soon after arrival. Many students pay around 2,000 yen a month in their first year. The exact amount depends on the city and can be reduced further if income is low.
If an individual becomes employed by a company that provides Employees’ Health Insurance, they must switch from the National Health Insurance to Employees’ Health Insurance. They also have an option to continue their old plan through voluntary continuation.
To do so, individuals must apply for voluntary continuation within 20 days of leaving their job. This option lasts up to 2 years and they will need to pay the full premium themselves.
Employees’ health insurance at a glance
The beginnings of Japan’s healthcare system was influenced by social systems in Denmark, Sweden, and Germany.
According to Japan Health Policy Now (JHPN), “The concept of the Health Insurance Act itself dates back to the 1890s, when Minister of Home Affairs Shinpei Goto started discussions within the government after recently returning to Japan from a study trip to Germany.”
Upon Goto’s return, other factors took precedence, and it wasn’t until 1938 that the foundations of Japan’s current National Health Insurance system were enacted.
Today, employees’ health insurance premiums are split evenly between employers and employees, with the employees’ portion taken directly out of their paycheck.
If/when an employee requires medical attention, the government subsidizes the cost of approx. 70 percent of medical bills, the remaining 30 percent of which is paid by the employee.
How copay rates change with age
The standard copay is 30% of medical costs for most working adults. This rate is not fixed for everyone.
Children under 6 pay 20%
Adults 70 to 74 pay 20%, or 30% if they have high income
Adults 75 and older pay 10%, or 30% if they have high income
At age 75, employees move to a separate program. This is called the Late-Stage Medical Care System for the Elderly.
Premiums under this program are based on the person's own income. A flat per-person charge is added on top.
Who administers your employees' health insurance?
Most small and medium businesses use the Japan Health Insurance Association, known as Kyokai Kenpo. This covers company staff and their dependents.
Large companies often set up their own health insurance union instead. This is called a kenpo kumiai.
If your business does not have its own union, you will use Kyokai Kenpo. Rates differ by prefecture, so check your local rate each year.
How to determine if your business must cover employees’ health insurance
Business establishments that are obliged to pay for employees’ social insurance (which includes employees’ health insurance) are referred to as 強制適用事業所 = kyousei tekiyou jigyou sho, compulsory business establishments, which have the following applicability guidelines:
Businesses of national, local public bodies and corporations
Business establishments that employ more than 5 people. Workers who work at the place are enrolled (even for part-time workers, if the working hours per day or week and the prescribed number of working days per month are three-quarters or more of normal workers). Applicable to the following industries: a. Manufacturing; b. Civil Engineering; Construction; c. Mining; d. Electricity, Gas; e. Transportation; f. Janitorial, Commercial Cleaning; g. Merchandizing; h. Finance, Insurance; i. Storage, Rental; j. Intermediary, Brokerage; k. Collecting, Guidance, Advertising; l. Education, Research; m. Medical, Health; n. Communication, News
Coming in October 2029: more industries join this list. Agriculture, food service, hotels, and hair and beauty businesses with 5 or more staff will also become mandatory.
For all other businesses that do not fall under the aforementioned criteria, employee enrollment is voluntary and is referred to as 任意適用事業所 = ninni tekiyou jigyousho, voluntary application establishments. Further explanation on these two category types can be found here.
How to determine if your employees are eligible for employees’ health insurance
Even if your business is mandated to cover employees’ health insurance, employees themselves have eligibility requirements as well.
Current employee eligibility rules
Right now, part-time employees must meet all of these rules to join Employees' Health Insurance.
You work 20 hours or more each week
You earn 88,000 yen or more per month
Your job is expected to last 2 months or more
You are not a student
Your company has 51 or more employees
These rules apply today. They are about to change in a big way.
Note: This 51-employee threshold is different from the 5-employee rule above. It only applies to shorter-hour part-time workers, not your regular staff.
What changes in October 2026
Japan will remove the wage rule in October 2026. This rule is known as the "106 man yen wall."
After this date, the 88,000 yen income test no longer applies. If you work 20 hours or more each week, you will need to join shakai hoken.
This applies no matter how much you earn. Company size still matters for now, but that rule will keep shrinking too. By 2035, every company must enroll eligible part-time staff, regardless of size.
What this means for employers: more part-time and arubaito staff will qualify starting October 2026. Review your staff now, and check who will newly qualify.
The 29.5-hour practice, and why it is ending
Some employers, especially language schools, have long scheduled staff just under 30 hours a week. This is often called the 29.5-hour practice.
The goal was to avoid the old "three-quarters of full-time hours" enrollment rule. Employees on these contracts often paid for their own health insurance instead.
This practice is losing its effect. After October 2026, working 20 hours or more a week can trigger enrollment on its own.
Business owners using reduced hours to avoid enrollment should review contracts now. The wage threshold that once made this workable is being removed.
Additionally, keep in mind the Japan Pension Service states, “If you are a part-time worker, you must be covered if your weekly work hours and monthly workdays are three-fourths or more of those for regular workers in the same workplace. If your work hours and workdays are less than that, you still must be covered if your condition applies to the following 5: (1) your weekly work hours are 20 hours or more, (2) your employment is expected to be one year or longer, (3) your monthly wage is 88,000 yen or more, (4) you are not a student, and (5) you are employed by a “specific covered workplace.”
Note: This quote describes the rules before the October 2026 change.
How much will it cost to enroll in employees’ health insurance?
Health premiums for employees’ health insurance roughly follow this calculation: standard monthly salary x insurance premium rate = health insurance premium.
*Standard monthly salary
Employees’ standard monthly wage also includes “position allowance, weighting allowance, dependent family allowance, commuting allowance, housing allowance, overtime allowance, and any cash or items given as payment for labor. Furthermore, bonuses paid 4 or more times per year also count as part of the standard monthly salary,” according to the Japan Health Insurance Association (JHIA, also known as Kyokai Kenpo) site.
Note: Calculating the standard monthly salary is complex and can be confusing. When monthly salary increases or decreases (such as, when an employee takes maternity leave or childcare leave), causing the salary amount to move into a different grade or level, then the health insurance premium must be recalculated. Please refer to this freee.jp article (Japanese) for further details.
*The insurance premium rate
The insurance premium rate differs from prefecture to prefecture and is updated yearly. To find out the health insurance premium rate for the prefecture in which your business operates, refer to this page (Japanese) on the JHIA site.
For 2026, Tokyo's health insurance rate is 9.85%. Rates change every year, so always check the current rate for your prefecture.
Here is a simple example based on this rate.
Standard monthly salary (350,000 yen) x insurance premium rate (9.85%) = health insurance premium, split evenly between employer and employee.
A new child and childcare support levy also started in April 2026. This adds a small extra cost on top of your health insurance premium. Check the JHIA site for the exact current rate.
(*split evenly between employer and employee)
The High-Cost Medical Expense benefit
If an employee's medical bills are high in one month, this benefit limits what they pay. This applies to employees' health insurance and national health insurance alike.
For a typical earner, the cap is around 80,100 yen. A small extra charge applies above 267,000 yen in costs that month.
Lower income employees pay a flat 57,600 yen cap instead. Your employees can apply for a certificate in advance to use this cap directly at the hospital.
How to enroll in employees’ health insurance
Businesses that are compulsorily mandated to enroll in employees’ health insurance should submit the designated applications to the Japan Pension Service within 5 days of establishment.
The following applications must be submitted either by mail or at a Japan Pension Service window or electronically (e-submissions are mandatory for large companies). Employees’ health insurance application forms are accessible here (Japanese). Note: These documents are the same application forms to apply for employees' pension insurance because if you are applying for employees' health insurance, you will also be required to apply for employees' pension insurance as well (this applies to enterprises that voluntarily enroll employees in social insurance).
Notification of New Application for Health Insurance and Employee's Pension 健康保険・厚生年金保険新規適用届 kenkouhoken・kouseinenkin hoken shinki tekiyou todoke (See here for a tentative translation of this form provided by Japan Pension Service)
Notification of the Acquisition of Eligibility 被保険者資格取得届 hihokensha shikaku shutoku todoke (See here for a tentative translation of this form provided by Japan Pension Service)
Notification of eligible dependents 被扶養者（異動）届（国民年金第3号被保険者関係届）hifuyousha (idou) todoke (kokumin nenkin dai 3 gou hihokensha kankeitodoke) (See here for a tentative translation of this form provided by Japan Pension Service)
Application of Registering Bank Account for Insurance Fee Payments 保険料口座振替納付（変更）申出書 hokenryou kouzafurikae noufu (henkou) moushidesho
Keep in mind, each time you hire a new employee who is eligible for employees’ health insurance, you must also submit Notification of New Application for Health Insurance and Employee's Pension「健康保険・厚生年金保険被保険者資格取得届」within 5 days of the hiring date to the Japan Pension Service Office.
Regarding employees’ health insurance coverage of dependents, the Japan Pension Service provides an English-language explanation of the dependents eligible to be covered in this article (Section: “Coverage of Your Dependents”).
Image: Japan Pension Service
When does your coverage actually start?
Your employees' health insurance coverage starts on your first day of employment. It does not start when your insurance card arrives.
Insurance cards often take one to two weeks to arrive. During this gap, you are still covered.
If you need medical care before your card arrives, you have options.
Ask your employer for a certificate of insurance eligibility
Pay the full cost and apply for reimbursement later
Contact the hospital in advance to confirm your coverage
Your employer handles the enrollment paperwork. You do not need to enroll yourself.
Frequently asked questions
How does the healthcare system in Japan work?
Japan runs on a universal public health insurance program. All residents have access to medical care under this system.
Patients can visit approved healthcare providers anywhere in Japan. Most working adults pay 30% of medical costs, and public health insurance covers the rest.
This rate is lower for some age groups. Children under 6 and adults 70 to 74 pay 20%, and adults 75 and older pay 10%.
Is health insurance mandatory in Japan?
Yes. In Japan, you need to be enrolled in a public health insurance program if you are a resident, regardless of nationality. This requirement applies to both Japanese nationals and foreign residents living in Japan for three months or longer.
Do foreigners need health insurance in Japan?
Yes. Foreign residents in Japan are legally required to enroll in either national health insurance or employees’ health insurance, depending on their employment status. Private insurance alone does not replace Japan’s public health insurance requirement.
How do I use my health insurance at a hospital or clinic in Japan?
After enrolling in a public health insurance program, you will receive a health insurance card. Presenting this card at hospitals, clinics, and other healthcare providers allows you to receive medical care at the insured rate, typically paying only 30% of medical costs at the time of treatment.
What happens if I do not enroll in health insurance in Japan?
Failing to enroll in Japan’s health insurance system can result in back payments, penalties, and full responsibility for medical costs if treatment is needed. In some cases, non-enrollment can also affect visa renewals or residency procedures.
Are all healthcare providers covered under Japan’s health insurance system?
Most hospitals, clinics, and medical institutions in Japan are registered providers under the public healthcare system. This allows insured patients to receive standardized medical care nationwide, regardless of location.
Does Japan’s health insurance cover dependents?
Yes, but coverage depends on the type of health insurance. Under employees’ health insurance, eligible dependents can be covered without additional premiums. Under national health insurance, each household member must enroll individually and pay their own premiums.
Does Japan’s health insurance cover mental health care?
Yes. Mental health is covered under Japan’s public health insurance system. Services such as psychiatric consultations, counseling provided at medical institutions, and prescribed psychiatric medications are generally included when treatment is deemed medically necessary.
What medical care is covered by Japan’s health insurance?
Japan’s health insurance covers the cost of a wide range of services, including doctor visits, hospitalization, surgery, prescription medications, and diagnostic tests. Services not considered medically necessary—such as cosmetic procedures—are generally not covered.
What happens at the hospital if I forget my insurance card?
If you visit a hospital without your insurance card, you will be required to pay the full medical cost upfront. Once you present your insurance card later, you can usually apply for a partial reimbursement through your insurer.
How are hospital bills calculated under Japan’s health insurance system?
Hospital bills follow standardized national fee schedules across Japan. This keeps costs consistent, no matter which hospital you visit.
Most patients pay 30% of the total cost. Insurance covers the rest.
Your age can lower this rate. Children under 6 and adults 70 to 74 pay 20%, and adults 75 and older pay 10%.
Can I switch health insurance programs if my job status changes?
Yes. If your employment status changes, you are required to switch to the appropriate health insurance program—moving from the national health insurance to employees’ health insurance or vice versa. This ensures continuous coverage within Japan’s healthcare system.
How long does health insurance coverage remain valid?
Insurance plans remain valid as long as you are properly enrolled and paying premiums. If your employment or residency status changes, you must update your insurance enrollment to avoid gaps in coverage.
Do I need additional private insurance in Japan?
Public health insurance provides comprehensive coverage for most medical needs. Some residents choose supplemental private insurance, such as hospitalization riders or income-protection plans, but these are optional and do not replace Japan’s public system.
Will the 106 man yen wall affect my shakai hoken enrollment?
Yes, starting October 2026. Japan is removing the 88,000 yen monthly wage rule for shakai hoken. After this date, working 20 hours or more each week is enough to qualify. This applies to part-time and arubaito staff too.
Does my health insurance coverage start before my card arrives?
Yes. Your coverage starts on your first day of employment, not when your card arrives. Cards can take one to two weeks to arrive. Ask your employer for a certificate of eligibility if you need care sooner.
Closing thoughts
Employees’ health insurance is just one type of insurance that certain businesses are compulsorily obligated to enroll in.
You may recall, 社会保険 = shakai hoken “social insurance” collectively refers to Employees’ Pension Insurance, Employees’ Health Insurance, and Nursing Care Insurance.
Stay tuned for upcoming articles that cover the remaining insurance types for employees that business owners should be aware of.
Please note: If your business is mandated to enroll employees in health insurance but you fail to do so, this can lead to penalties that may include up to six months of imprisonment or paying a 500,000 yen fine.
For further rules and regulations regarding hiring workers and the various insurance plans to enroll in, refer to this page (Japanese) by the Ministry of Health, Labour and Welfare (MHLW).
Related articles
Employees’ Pension Insurance in Japan, What Business Owners Should Know
Japan’s Pension Refund for Foreigners [Step-by-Step How to Withdraw]
Workers' Accident Insurance in Japan, What Business Owners Should Know
Unemployment Insurance in Japan, What Business Owners Should Know
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