Health insurance and pension in Japan: National Health Insurance, employee insurance and the lump-sum withdrawal

Rules, fees and services change often. Last checked: 7 November 2026. Always confirm with the official sources below or with your city office before you act.

Japan has public health insurance and a public pension for everyone who lives here, Japanese or not. You do not choose whether to join: the law decides which scheme you are in. This guide explains the two health schemes, what you pay at the clinic, how pension works, and how to get pension money back when you leave.

Two kinds of health insurance

• Employee health insurance (健康保険, kenkō hoken): for regular employees of companies that must provide it. Part-time workers can also be covered, depending on their hours, pay and the size of the company. Your employer enrols you. Your dependent family members can be covered without paying their own premium.
• National Health Insurance (国民健康保険, kokumin kenkō hoken): for registered residents under 75 who are not in employee insurance, for example students, self-employed people and people between jobs. You join at the city or ward office. Most foreign residents staying more than three months must join. Visitors and a few other statuses are excluded.

Who pays the premium

In employee insurance, the employer and the employee each pay half of the premium. It is taken from your salary. In National Health Insurance, the premium is calculated per household from income and the number of members. The head of the household pays it, usually with payment slips sent by the city. If your income is low, ask the city office about a reduction.

Join on time. Shinjuku City, for example, says coverage starts from the day you should have joined, not the day you visit the office. So a late application can mean a bill for the past months.

What you pay at the clinic: the 30% co-payment

With public insurance you pay only part of the bill at the hospital, clinic or pharmacy:

• Children under 6 (before school age): 20%
• From school age to 69: 30%
• Ages 70 to 74: 20% (30% for people with income at working-age level)

High-cost medical care. If your co-payments in one month go over a limit set by your age and income, the extra is paid back (meals and beds in hospital are not included). If you are off work sick for more than three days in a row, employee insurance can pay a sickness allowance from the fourth day.

Showing your insurance at the clinic

The old health insurance cards expired on 1 December 2025. For a while, clinics still accepted an expired card if the patient brought it by mistake, but MHLW ended that on 31 July 2026. Now, at a hospital, clinic or pharmacy, you show one of these:

• your My Number Card registered for health insurance use (マイナ保険証, maina hokenshō). You can register it at the card reader at the clinic. Since 19 September 2025, clinics and pharmacies with the right equipment also accept a smartphone with the My Number Card added. Or:
• an eligibility certificate (資格確認書, shikaku kakuninsho). Your insurer sends it free, without an application, to people who have not registered a My Number Card for health insurance.

Watch the expiry date of your My Number Card’s electronic certificate. If it expires, the card still works as a health insurance card for 3 months, but renew it at the city office quickly. If you cannot show proof of insurance yet (for example just after joining), you may pay the full cost and claim back everything except your share later. MHLW has a leaflet about using the My Number Card at clinics in 15 languages.

Pension: who joins which system

Registered residents aged 20 to 59 must join the public pension:

• Employees’ Pension Insurance (厚生年金, kōsei nenkin): company employees. The employer enrols you, and the premium is split between you and the employer and taken from your salary.
• National Pension (国民年金, kokumin nenkin), Category I: students, self-employed people and others. You join at the city office and pay a flat premium of ¥17,920 a month in FY2026.
• Category III: dependent spouses of employees. The spouse’s employer handles the paperwork, and there is no separate premium.

You can get an old-age pension from age 65 if you have at least 10 years in the system. Pension also covers disability and survivors, so unpaid months can cost you more than money later.

Students: the Special Payment Exception

Students can apply to postpone National Pension payments while they study (学生納付特例, gakusei nōfu tokurei). It depends on your own income in the previous year, not your family’s. Most students at universities, junior colleges and vocational schools with courses of one year or longer qualify. Apply at the National Pension counter of your city office, by post, online, or at your school if it is authorised to handle the application. Postponed months count toward the 10 years needed for a pension, but they do not raise its amount unless you pay them later. Apply on time: if you are disabled by an accident or illness before you apply, you may not receive a disability pension.

Leaving Japan: the lump-sum withdrawal payment

If you leave Japan, you may claim part of your pension premiums back (脱退一時金, dattai ichijikin). You qualify if all of these are true:

• You do not have Japanese nationality.
• You paid at least 6 months of National Pension, or were in Employees’ Pension for at least 6 months.
• You no longer have an address in Japan.
• You have never been eligible for a Japanese pension, which means under 10 years in total.

The deadline is 2 years from the date you no longer had an address in Japan.

1. Before you leave, file your moving-out notification (転出届) at the city office. If you leave with a re-entry permit without filing it, you cannot claim until the permit expires.
2. Download the claim form in your language from the Japan Pension Service. Forms exist in 14 languages, including English, Nepali, Vietnamese, Indonesian and Filipino.
3. Attach a copy of your passport (name, date of birth, nationality, signature and status pages), proof of your bank account (bank name, branch, branch address, account number and your name as holder) and a document showing your Basic Pension Number.
4. Send it by post after your moving-out date, or hand it in after the moving-out notification. If you filed the moving-out notification, you do not need to prove separately that you left.

How much? National Pension: for someone whose last premium was paid between April 2026 and March 2027, 6 months gives ¥53,760 and 60 months or more gives ¥537,600 (the maximum). Employees’ Pension: your average monthly pay in the system multiplied by a rate that depends on months enrolled. Only up to 60 months are counted (36 months if all your periods were before April 2021).

Tax. 20.42% income tax is withheld from the Employees’ Pension part (not from the National Pension part). You can get it back by filing a special tax return through a tax agent in Japan. Name the agent at the tax office before you leave. See our tax guide.

Think before you claim. After the payment, all your Japanese pension periods before it are cancelled, even months over 60. If you might come back to Japan, for example from Specified Skilled Worker (i) to (ii), or on a path to permanent residence, those years could count toward a future pension. The Japan Pension Service suggests claiming after each stay if you come to Japan several times.

Social security agreements

Japan has agreements with some countries that let you add up pension periods in both countries. As of March 2026, these include India and the Philippines. Bangladesh, Nepal, Viet Nam and Indonesia are not on that Japan Pension Service list. If you are from a partner country and your combined periods reach 10 years, you cannot claim the lump sum. You can receive a pension from each country instead.

Common mistakes

• Not joining National Health Insurance because “I am healthy”. Coverage starts from the day you should have joined, and a late start can mean back premiums.
• Leaving pension bills unpaid without applying for the student exception or a low-income exemption. Unpaid months can mean no disability pension.
• Leaving Japan without the moving-out notification, then being unable to claim the lump sum.
• Missing the 2-year deadline after leaving.
• Claiming the lump sum when you plan to come back to Japan for many more years.

Before your first clinic visit, our question words lesson helps with forms that ask what, where and when.