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Introduction to National Health Insurance
(国民健康保険とは)

[April 1, 2016]

All residents of Japan, including foreign nationals, are required to enroll in a health insurance system, so that they can easily receive medical services in case of illness or injury.

Company employees are enrolled in their company’s health insurance plan, while those not covered by an employee health insurance plan are covered by the National Health Insurance Program.

People who are required to join the National Health Insurance Program
(国民健康保険の加入対象となる方)

Foreign residents in Osaka City who fall under either of the following categories are required to join the National Health Insurance Program of Osaka City.
  1. Foreign nationals who have registered as residents of Osaka City with permission to stay in Japan for three months or more
  2. Foreign nationals who live in Osaka City with permission to stay in Japan for three months or less, but who expect to stay in Japan for longer than three months (e.g. foreign nationals with the status of residence of “Entertainer” who have been originally permitted to stay in Japan for three months or less but who expect to stay for longer than three months as stipulated in their contract with their promoter or other means)

Note: While resident registration is not required for foreign nationals whose status of residence is “Official,” they have to join the National Health Insurance Program if they expect to stay in Japan for longer than three months.

People who cannot join the National Health Insurance Program
(国民健康保険の加入対象とならない人)

The following persons cannot be enrolled in the National Health Insurance Program: company employees who are enrolled in their company’s health insurance plan; those whose visa status is “short stay” or “diplomat”; those whose visa status is approved for “activity to receive medical care etc.” and those who care such people, out of “designated activities”; those whose activity is “Sightseeing, recreation, or other similar activities” and their spouses and those whose status of residence has not been qualified; and those who fall under the following categories.

  1. Individuals enrolled in the Medical Care System for the Elderly Aged 75 and Over
  2. Recipients of benefits under the Public Assistance Act
  3. Individuals proved to be covered by proper health insurance by social insurance-related agencies of the United States of America, the Kingdom of Belgium, the French Republic, the Kingdom of the Netherlands, the Czech Republic, the Swiss Confederation and Hungary.
  4. Children who are given protection under the Child Welfare Act and who have no one to support them, along with other persons with special reasons prescribed by the Ministry of Health, Labour and Welfare

Main benefits available to the insured (excluding those covered by the Medical Care System for the Elderly Aged 75 and Over)
(主な保険の給付(後期高齢者医療制度の対象となる方を除きます。))

When you receive medical treatment for illness or injury at a medical institution, please be sure to always bring your health insurance certificate with you. Those aged 70 years or older should bring the 高齢受給者証 (Korei Jukyushasho or Recipient Card for Seniors), in addition to the health insurance certificate.

Co-payment rates: your share of medical expenses to be paid to hospital

  • Individuals aged up to six years old: 20% (For children aged six years old, the co-payment rate of 20% is applied until March 31 immediately following the day when they reach six years of age.)
  • Individuals aged between six and sixty-nine years old: 30% (For children aged six years old, the co-payment rate of 30% is applied after April 1 immediately following the day when they reach six years of age.)
  • Individuals aged 70 years or older: The rate shown in the 高齢受給者証 (Korei Jukyushasho or Recipient Card for Seniors), which is 20% (10%)* or 30% (for those who earn as much as active workers) of total medical expenses

(Note)
For those who were born before April 2, 1944, the co-payment rate shall be 10% as provided in the special measures by the government.

Cases not covered by health insurance (保険が適用されない場合)

In principle, the following cases are not covered by health insurance:

  • Treatments and drugs not covered by health insurance, additional fees for special accommodations during hospitalization, and additional fees for special dental materials
  • Normal pregnancy and delivery
  • Health check-ups, inoculations, and vaccinations
  • Cosmetic surgery
  • Orthodontic treatment

Medical expenses (療養費)

If you received medical treatment without your health insurance certificate for unavoidable reasons (e.g. you became acutely ill, were injured at home or abroad, or involved in a medical emergency) and paid the entire medical costs yourself, you may apply for reimbursement at the department in charge of health insurance and pension programs at your local ward office. The following are necessary for application: your health insurance certificate; your personal seal; a bank passbook in the name of head of your household (or a document showing the account number); a statement that describes the nature of the treatment given; and the receipt.

When you received medical treatment at a foreign medical institution during traveling abroad, you can apply for the reimbursement for the medical expenses you have paid, by submitting, in addition to the abovementioned documents, the receipt you have paid to the foreign medical institution, the medical expense bill describing the contents of treatments, and your passport.

* If such a bill is written in foreign language, its Japanese translation shall be attached (together with the name and address of the translator).
* The reimbursement system for medical expenses paid abroad applies only to a short stay in foreign country, but not a long stay.

Medical expenses overpayment (高額医療費)

If the medical expenses you paid to medical institutions within one calendar month exceed the prescribed amount, you may apply for reimbursement for the balance at the department in charge of health insurance and pension programs at your local ward office. The following are necessary for application: your health insurance certificate; your personal seal; a bank passbook in the name of head of your household (or a document showing the account number); and the receipts.

Medical and nursing care overpayment (高額介護合算医療費)

In the case of a household receiving both "medical" and "nursing care" services, if the household’s total expenses paid within a one-year period (from August 1 to July 31) exceed the prescribed amount, you may apply for reimbursement for the balance at the department in charge of health insurance and pension programs at your local ward office. The following are necessary for application: your health insurance certificate; your personal seal; a bank passbook in the name of the head of your household (or a document showing the account number); and the receipts.

Lump Sum Birth Allowance (出産育児一時金)

When you gave birth to a child at more than 12 weeks gestation (including stillbirth or miscarriage), you can apply for the lump sum birth allowance at the group in charge of health insurance and pension programs at your local ward office. Osaka City can otherwise pay such an allowance directly to the medical institution on behalf of you (excluding a foreign country’s medical institution). If you wish to use this direct payment system, please enquire a medical institution where you are expecting to give birth.

The following is necessary for application: your health insurance certificate; your personal seal; a certificate that you gave birth at more than 12 weeks gestation (including stillbirth or miscarriage); a written agreement issued by the medical institution that agrees to receive the direct payment of the allowance on behalf of you; a document showing the amount of the allowance that the medical institution is to receive; and a bank passbook in the name of head of your household that shows the account number. When you gave birth in a foreign country, you have to submit the certificate that you gave birth there and your passport. If such a document is written in foreign language, you have to submit its Japanese translation. This system allows for a woman who is domiciled in Japan and gave birth during a short stay abroad.

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Social Welfare Bureau, Osaka City Hall, 1-3-20 Nakanoshima, Kita-ku, Osaka, 530-8201
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