Two public schemes, and nobody opts out

Japan’s Ministry of Health, Labour and Welfare describes a universal system in which every resident must enrol in public health insurance. Most people reach it through one of two doors. Employees’ Health Insurance, known as kenko hoken or shakai hoken, covers people working at companies, and the employer handles the enrolment. National Health Insurance, kokumin kenko hoken, is run by each municipality and covers everyone else, including the self-employed, students and foreign residents staying longer than three months, who sign up at their local office.

Whichever scheme applies, a patient who shows an insurance card or a My Number Card usually pays 30% of the treatment bill and the scheme pays the remainder. A high-cost medical expense benefit refunds a month’s spending above a set ceiling, so a long hospital stay does not leave a household carrying the whole bill.

When a company in Japan has to enrol its staff

The Japan Pension Service sets out who must be covered. Every corporation, plus certain businesses with five or more workers, falls under Employees’ Health Insurance and Employees’ Pension Insurance together, and regular employees and officers are enrolled in both. The employer files the enrolment with the Japan Pension Service within five days of the start date.

Part-time staff are included once they work at least three-quarters of a regular worker’s hours. Below that line, a part-timer still joins when they work 20 or more hours a week, expect at least two months of work, are not a student and work at a covered workplace. Since October 2024 a covered workplace means a corporation with more than 50 workers, or a smaller one that opts in by agreement, and that size threshold has been coming down in stages.

How the premium is shared

Employer and employee share the premium as the law sets out, and the Tokyo Metropolitan Government describes the health premium as split equally, with the employee’s half taken from pay. There is no single national rate. It turns on the insurer, either the Japan Health Insurance Association (Kyokai Kenpo) or a company health insurance society, and on the prefecture, and it is reset every year.

Accounting and expat guides add that from age 40 a second charge appears: long-term care insurance, kaigo hoken, collected with the health premium and shared with the employer. Financially dependent family members who live in Japan can be covered under the employee’s own insurance, which matters when a hire relocates with a spouse or children.

What the public plan leaves to private cover

The Tokyo Metropolitan Government lists items public insurance does not pay for: a private single room in hospital, cosmetic dental work such as orthodontics, health checkups, vaccinations, and a normal pregnancy and childbirth. Public cover also stops at the border, because it pays for treatment in Japan.

Private medical insurance in Japan is optional and sits on top of the public plan. Broker and expat guides describe policies that help with the 30% co-payment or pay a cash amount for each hospital stay, and international plans that add care outside Japan for staff who travel or visit family overseas. How Japan taxes an employer-paid private policy is worth raising with a local adviser before it goes into a benefits package.

Why an international plan can only add to Japanese cover

Because enrolment is compulsory for residents, an international plan cannot stand in for Employees’ Health Insurance or National Health Insurance. The narrow exception is a national of a country that has a social security agreement with Japan, who in some cases need not join National Health Insurance and should ask the municipal office.

Japan also controls who can sell cover to people living there. Law-firm guides to the Insurance Business Act explain that the Financial Services Agency licenses insurers, that a foreign insurer generally needs a licensed branch in Japan, and that an unlicensed foreign insurer may not conclude contracts with residents outside narrow exceptions. Overseas brokers that solicit business in Japan come under the Act’s registration rules as well. So whether a given international plan can be offered to someone living in Japan is a question for the insurer to answer before any benefit is built around it.

Employer of record, contractor or your own entity

EOR provider guides say a US employer without a Japanese company usually hires through an employer of record, and they describe the arrangement like this: the EOR becomes the legal employer, runs payroll and tax withholding, and enrols the employee in Employees’ Health Insurance and pension from the first day. Your company then decides what to add on top.

A genuine independent contractor is not enrolled by the client. They join National Health Insurance at their municipal office, and the premium follows the previous year’s income and household. The ministry warns that a long run of unpaid premiums can count against a foreign resident renewing a period of stay or changing residence status, so a contractor setup leaves real obligations with the worker. Injuries at work are separate again, handled by Workers’ Accident Compensation Insurance rather than health insurance.

A hire in Japan can also change your US policies. Our page on insurance changes for remote teams covers employment practices liability and cyber. We can request those lines from insurers for you, and the insurer decides after reviewing the business.

Requesting an introduction for a Japan hire

Through the quote form on this page, tell us where in Japan your people live, how many you employ there, whether they come through an employer of record or your own entity, and whether a spouse or children need cover. From there, we can introduce you to a benefits partner focused on health coverage for people working outside the US.

The partner and the insurer settle who qualifies, which plans fit alongside the Japanese scheme and what they cost. We stay your contact for the business insurance side of the hire.

A few useful answers

Common questions

Can an employee in Japan rely on an international health plan instead of the Japanese scheme?

No. Every resident must belong to Employees’ Health Insurance or National Health Insurance, so an international plan works as an addition. Private and international plans may add items the public plan leaves out, such as care abroad, and the insurer decides what a given plan includes.

Who enrols a remote employee hired through an employer of record in Japan?

The employer of record, as the legal employer, files the enrolment for Employees’ Health Insurance and pension. The Japan Pension Service gives employers five days from the start date to file it.

Does Japanese health insurance cover the employee’s family?

Financially dependent family members who live in Japan can be covered under the employee’s Employees’ Health Insurance. Ask the benefits partner how relatives living elsewhere would fit under an international plan.

Do part-time employees in Japan get health insurance through work?

They do once they work at least three-quarters of a regular worker’s hours. Below that, a part-timer working 20 or more hours a week at a covered workplace, expecting at least two months of work and not a student, is enrolled too.

Is a work injury in Japan a health insurance claim?

No. Injuries at work fall under Workers’ Accident Compensation Insurance, a separate scheme from health insurance.

International Health Insurance for Remote Employees in Japan