TsukubaCityInformation
City of Science and Nature

Unless otherwise specified, the information on this page refers to the National Health Insurance Plan (administered by the city) and not the Social Insurance Plan (administered by employers).

There are two kinds of public health insurance available in Japan. Social Insurance (shakai hoken) is for people who have full-time jobs. Social insurance (shakai hoken) is provided by your employer. As of April 1, 2011, 70% of the medical expenses will be covered for the insured employees and their family members. The employee and the employer each pay half of the insurance premium. National health insurance (kokumin kenkou hoken, also known as kokuho) is for people who are not enrolled in social insurance programs through their employer (including students and people who are unemployed).

Foreign nationals who will stay in Japan for over one year and who are not enrolled in other public insurance systems are required to enroll in the National Health Insurance (NHI, kokumin hoken) plan. The insurance premium is calculated according to your total income. A percentage of medical expenses are covered by this insurance. To apply, you need to present your passport and your Alien Registration Certificate at the Health Insurance and Pension Division of City Hall. The best time to apply for this insurance is when you register as a resident of Tsukuba.

If you fail to sign up for national insurance immediately after your arrival in Japan, when you eventually do sign up you will be charged retroactive payments from the time that you arrived. Furthermore, you will have to pay 100% of your medical costs until you do acquire national health insurance coverage. It is within your best interests to sign up for this insurance as soon as possible after your arrival in Japan. Also, notify the National Health Insurance and Pension Division when you move within the city, when your name or household changes, or when you require a new insurance card.

National Health Insurance

If you do not have Social Insurance (shakai hoken), you are required to enroll in the National Health Insurance Plan (kokumin hoken, also known has kokuho). If you are not sure whether you are covered by Social Insurance or not, please ask your employer. National Health Insurance is paid for by contributions from the individual members along with the national, prefectural, and local governments. If you receive medical treatment that is covered by the National Health Insurance Plan, you will have to pay a percentage of the medical fees and the rest will be covered by the plan.

National Health Insurance is made up of two parts - the basic medical contribution and the longterm care contribution. Everyone pays for basic medical coverage and people between 40 and 65 must also pay for long term care insurance.

The head of the household is required to pay the insurance premiums on behalf of the members of the household. If people are living together as room-mates (but are not related), they are considered to be separate households.

How to calculate the national health tax: It is the total amount of Shotoku-wari based on the subscriber's total amount of income in the previous year, Kinto-wari which depends on the number of subscribers, and Byodo-wari, which is imposed on every household. For Kinto-wari and Byodo-wari, if the total income is less than a certain threshold amount, a reduction system of 70%, 50% or 20% tax reduction will be applied.

Tax Rate for Fiscal Year 2011:

National Health Insurance Premium Tax Payment Notice for payment via Account Transfer and Payment Statement
After the amount of annual premium is calculated, a notice on the Premium tax payment will be mailed in the middle of July. There are 9 installments of payment from July until March of the following year.

You can arrange for your payments to be taken directly out of your bank account or postal savings account. Bring your health card and health insurance assessment form, the personal seal (inkan) that you used to open your bank account (not necessary if you used your signature), and your bank book to your bank or post office to set up this convenient service.

Insurance premiums are calculated from the month that one becomes a member. If you join on the last day of a month, you will have to pay the entire premium for that month. The month in which you become a member is based on when you registered as a foreign resident, moved into the city, or withdrew from Worker's Health Insurance. It is not based on when you submit the application.

People who are over 65 also have to pay longterm care insurance premiums. The amount differs according to whether you receive a pension of 180,000 yen per year or less. Please contact the Senior Citizen's Section for more information (029-883-1111). Foreign nationals who will stay in Japan for over one year and who are not enrolled in other public insurance systems are required to enroll in the National Health Insurance (NHI, kokumin hoken) plan. The insurance premium is calculated according to your total income. 70% of medical expenses are covered by this insurance. To apply, you need to present your passport and your Alien Registration Certificate at the National Health Insurance and Pension Division of City Hall.

Please be aware of the following:

• As normal pregnancy and delivery are not considered illnesses, these expenses are not covered by NHI. However, the insured will be paid a lump sum Delivery Fee reimbursement of 420,000 yen after completion of the Birth Registration.
• Dental treatment is covered by the insurance. However, some cases of orthodontic work, fillings and caps may not be covered. For specifics, please consult the dentist beforehand.
• The insurance will pay 50,000 yen for funeral costs of an insured person.
• Medical expenses incurred because of a traffic accident will, in principle, have to be paid by the Motor Vehicle insurer of the party/parties responsible. These expenses will not be covered by NHI. However, after applying, the insured of NHI can get a temporary payment of these expenses from NHI, though the bill will eventually go to the Motor Vehicle insurer.
• You must return your National Health Insurance card to terminate the contract when you leave Tsukuba. If you do not, you will continue to be billed.

Share of Medical Costs Born by Member of National Health Insurance Plan

The share of costs borne by insured members is age-dependent:

• 0 - 2 years of age = 20%
• 3 - 69 years of age = 30%
• 70 - 74 years of age = 10% or 20%

Coverage

The following medical services are eligible for insurance coverage through the National Health Insurance Plan:

1. Medical examinations
2. Medical treatment
3. The administering of medicine and injections
4. Hospitalization and care provided by a nurse
5. Receiving at-home treatment or nursing care

Also:

• Medical treatment administered by a home nurse: When a home nurse visits an insured member under the direction of a physician, a portion of the total cost will be reimbursed.
• Hospital meals: A designated standard amount for meal costs will be borne by the insured member. Amounts which exceed this figure will be covered by the National Health Insurance Program.
• Childbirth Allowances: When an insured member gives birth, a one-time payout of 420,000 yen will be given to the head of the household.
• Bereavement Subsidy: If the insured member passes away, a 50,000 yen subsidy will be paid to cover funeral costs.

The following are not covered.

1. Plastic surgery, orthodontic treatment
2. Normal childbirth and abortions undertaken due to economic reasons
3. Physical health examinations or comprehensive medical examinations (known as ningen dock)
4. Vaccinations/immunizations
5. Administered care that is eligible for Worker's Compensation Insurance
6. Treatment for light body odor or freckles.

Circumstances where insurance coverage is limited.

1. Injuries which are the result of a fight or from intoxication
2. When the insured member ignores instructions given by physicians and insurers
3. Injuries as a result of a crime or intentional act.

Reimbursement of Medical Costs

In the following cases listed below, the insured member will bear the full cost of medical treatment. An application should then be filed at a later date with the National Health Insurance and Pension Division. After a positive review, the portion which exceed the individual's share of payments will be reimbursed.

1. Due to unavoidable circumstances, an insured member receives a medical treatment without presenting his/her health insurance card
2. Bone fractures, sprains, etc. which were treated by a physiotherapist
3. Physician-recognized treatments of acupuncture, moxibustion, massage, etc.
4. Corsettes & other equipment prescribed for medical treatment
5. Cost of raw blood for blood transfusions
6. Medical care, of an "unplanned" nature, such as in the case of an emergency, which is received when traveling abroad

Cancelling National Health Insurance

If you are planning on leaving Tsukuba, please inform the National Health Insurance and Pension Division of the City Hall. You will be asked to submit forms for withdrawing from the National Health Insurance Plan if you:

1. Leave Japan permanently
2. Move to another city
3. Become enrolled in an employer's health insurance plan
4. Your visa (period of stay) has expired.

National Health Insurance Reimbursements for High Medical Bills

If an insured person's total share of payments towards medical treatment in any single month from a single health care provider goes over a prescribed amount, that portion will be reimbursed according to the following schedules. For specific terms & conditions, contact the National Health Insurance and Pension Division.

High Medical Treatment Costs: Designated Policy-holder Contribution Ceilings per Month (For those aged under 70)

High Medical Treatment Costs: Designated Policy-holder Contribution Ceilings per Month (For those aged 70 and above)

Notes

• [1] Household unit income which exceeds 6,000,000 yen after deductions.
• [2] Household unit whose income is exempt from residence tax.
• [3] A household unit whose combined total income is greater or equal to 1,450,000 yen and has family members aged 70 years and above who are enrolled in the National Health Insurance Plan.
• [4] Household unit whose income is exempt from residence tax.
• [5] Household unit whose income is tax-exempt and where all policy holders fail to meet eligibility requirements.
• TC = Total Individual Contribution Costs.

Household Unit Calculation In any single household unit, if individual contribution costs exceed \21,000 on more than 2 or more occasions for any insured household member within a single month, the sum of all contributions within the household will be taken to calculate the individual contribution ceiling amount for that month.

NOTE: (1)Members who receive specialized, high-cost/long-term medical treatments are asked to consult with the National Health & Pension Division directly. (2)Those who appear to qualify for this High Medical Bill Assistance program will have a notice sent to them. Keep this notice to apply for reimbursement.

Traffic Accidents and National Health Insurance

If you are injured in a car accident, you will need to present your National Health Insurance Card for treatment. Always have this on hand. ABSOLUTELY do not accept any payments from the other party involved without first receiving treatment and consulting with health insurance officials. Acceptance of such payments may be construed legally as a settlement of all claims against further reparations. Also, if the accident occurred while on-the-job, or between home and work on one's normal commute, you may be eligible for Worker's Compensation.

Delivery of Health Insurance Cards

Health insurance cards are delivered to residents around the end of March by registered mail. This means that someone must sign for the delivery when the health cards arrive. If no one is at home to receive the delivery, you will get a yellow "advice of delivery" card which will tell you your delivery options. You can either take the card and your identification to the post office and pick up the health card or you can arrange for a second delivery. The following delivery times can be arranged: morning (9-12), afternoon (1-4), evening (5-7), or night (7-9). If you do not want the card delivered, please contact the National Health Insurance and Pension Division in early March. If you did not receive your card in March, please go to the Health Insurance Division (Sakura Branch of City Hall) to pick it up. The head of the household must pick up the card (if not, a letter of proxy must be submitted). Bring your personal stamp and ID.

Long-Term Care Insurance (kaigo hoken)

People between the ages of 40 to 64 and who are covered by a public medical health insurance plan AND all people who are 65 or older must pay long-term care insurance premiums. The long-term care insurance system is supported by payments from the national government (25%), the prefecture (12.5%), the city (12.5%), people between 40 and 64 (30%), and people over 65 (20%). The basic payment is 49,500 yen per year, but the amount is adjusted according to indicators such as income. Payments are made in 6 installments (on the even months) and are either taken directly out of a person's pension (special payment plan), or they are made after receiving notice from the city (regular payment plan). People who are on the regular payment plan can choose to have the money taken directly from their bank account.

Welfare Payments of Medical Expenses

A special welfare service (marufuku) is provided to insured (including NHI and Employee's Health Insurance but excluding optional insurance run by private insurance companies) pregnant women, infants and small chlidren, single parents and their children, and persons with physical or mental disabilities. The city will pay the part of the medical expenses that is not covered by the insurance plan they are on (normally 30% of the medical expenses). Any individual, living in Tsukuba, who is registered with a public health insurance plan, and who meets any one of the following requirements is eligible for this welfare service. However, it is income-tested except for infants and small children under school age category.

Target Groups

• Infants and small children
• Pregnant women with Mother and Child Health Handbooks
• Single mothers and their children (under 18)
• Single fathers and their Children (under 18)
• Persons with severe physical handicaps: Those with handicapped persons' handbooks (class1, class2, and a part of the class3 handicaps); those receiving handicap pensions (class 1 handicapped persons); those whose handicapped persons' handbooks denote that their class of handicap is A.

Bring the following to the City Hall to apply.

• Health insurance card
• Bankbook (post office account books and cash cards are not accepted)
• Personal stamp (you can use your signature instead) Mother and Child Health Handbook (for a pregnant woman)

Bring your ID

In order to conform to new personal information protection laws, the city must confirm your identity before releasing information. When completing procedures at the city hall offices, be sure to bring ID such as your passport, alien registration card, or Japanese license. If you are applying for something on behalf of another person, you may be required to produce a letter of proxy that authorizes you to act on that person's behalf. Please be aware of these conditions and always bring sufficient ID when you visit the city hall. Contact the Citizen Services Division for more information.

Topics: Health
Relevant for: Newcomers, Residents

Please note: While all efforts have been made to offer accurate and up-to-date information on this site, the information is presented as a guideline and is subject to change without notification. Phone numbers, addresses, and/or policies may have changed since this page was created. Please contact the appropriate section of the City Hall for confirmation of information and city policies.