Overview of Sakai City National Health Insurance
For those unfamiliar with Japan’s medical insurance system, please read this overview of Sakai City’s National Health Insurance, including differences from systems in other countries, so that you can understand and use it properly to stay in good health. Detailed explanations of each system are omitted here. For more information, please contact the Health Insurance and Pension Division in the ward where you currently live or previously lived.
1. What is National Health Insurance (NHI)?
In Japan, all residents are required to enroll in a public medical insurance program. National Health Insurance (NHI) is one such public medical insurance program, administered by prefectures and municipalities. It is a mutual support system under which every member contributes money to allow them to receive medical treatment in the event of illness or injury with peace of mind. NHI members can receive medical care at a medical institution with a small co-payment. However, they are obliged to pay insurance premiums.
Foreign nationals must enroll in NHI in any of the following cases. An application needs to be filed to join NHI.
- Persons aged 74 years or younger who are registered as residents of Sakai City
- Persons who live in Sakai City and whose status of residence is “Entertainer,” “Technical Intern Training,” “Dependent,” or “Designated Activities” with a period of stay of 3 months or less, but who are permitted to stay longer than 3 months by an employment agreement, etc.
However, the following cases are excluded.
Persons who are ineligible for NHI
- Persons who are enrolled in employees’ health insurance (including those who are dependents of such persons)
- Persons who are enrolled in the Latter-Stage Elderly Healthcare Insurance System
- Persons who are receiving public assistance
- Persons whose status of residence is “Designated Activities” and whose activities are specified as follows:
(1) Receiving medical treatment
(2) Taking care of persons stated in (1) in daily life
(3) Sightseeing, recreation, or other similar activities
(4) Spouses accompanying persons stated in (3)
If you fall under any of the above after enrolling in NHI, you will lose your eligibility for NHI, so please be sure to promptly submit a notification. If the notification is delayed, you may not be able to receive a refund even if you have overpaid your insurance premiums. After losing your eligibility, you cannot use your National Health Insurance card. If you receive medical care using the NHI card, you must return the medical expenses borne by NHI.
2. Benefits Available
If you present your health insurance card at a medical institution when you are sick or injured, you can receive medical examinations or treatments and be given prescription drugs by paying only part of the medical expenses. The proportion of medical expenses you need to pay at a medical institution is as follows.
From age 0 up to the end of the school year in which the person turns 6*: 20%
* The first March 31 after the person’s 6th birthday. For those born on April 1, the day before their 6th birthday.
From the beginning of the school year in which the person turns 7** up to age 69: 30%
** The first April 1 after the person’s 6th birthday. For those born on April 1, their 6th birthday.
From age 70*** up to 74: 20% or 30% (determined according to income)
*** The first day of the month following the month in which the person turns 70. For those born on the first day of each month, their 70th birthday.
Dental treatment, outpatient treatment, and hospitalization are all covered by the insurance. However, some medical treatments are not covered by the insurance. Please check with the medical institution at the time of your visit to see if the treatment is covered.
In Japan, it is not necessary to register in advance the medical institution you plan to visit in order to be covered by the insurance. Insurance coverage is available regardless of which medical institution you visit in Japan.
There is no deductible (which would require full payment up to a certain amount). You can receive a medical examination at the above co-payment rate from the time of your first visit.
If the monthly medical expenses paid by the same person to the same medical institution exceed the prescribed amount, the excess amount will be reimbursed.
A lump sum payment will be provided when an insured person gives birth or dies.
Medical examinations by NHI
In Sakai City, the following two types of medical examination are conducted at medical institutions designated by the City in order to help NHI members manage their health and prevent disease. Either medical examination can be undertaken once a year, subsidized by Sakai City.
● “Specific health checkup” with no co-payment required (Japanese)
Eligible persons: Those aged between 40 and 74 years
● “Complete physical examination” for which Sakai City subsidizes 70% of the fee (Japanese)
Eligible persons: Those aged between 30 and 74 years. There are requirements for payment of insurance premiums.
Subsidization of medical expenses for children
Sakai City subsidizes part of the medical expenses paid when children up to the age of 18 (up to the first March 31 after the date when they turn 18) who are registered as residents of the City and who are enrolled in a public medical insurance program such as NHI visit a medical institution to seek treatment for illness or injury.
3. Insurance Premiums
Insurance premiums are a valuable source of revenue for the NHI system, in order to pay for the medical expenses of insured persons. Please be sure to pay your insurance premiums by the due date. You are required to pay your insurance premiums even if you do not visit a medical institution. Also, your insurance premiums will not increase, regardless of the number of times you visit a medical institution.
(1) Determination and payment of insurance premiums
The amount to be paid as insurance premiums is determined based on your income from the previous year and other factors. A notification for insurance premiums will be sent in June each year. If you enroll in NHI in the middle of the year or if your insurance premiums are changed, you will be notified as necessary after the amount is decided.
The head of the household is responsible for paying the insurance premiums for all NHI members in the household.
The insurance premiums for one year should be paid in a total of 10 monthly installments from June to March of the following year.
As a general rule, the insurance premiums should be paid by direct debit. The payment due date (direct debit date) is the last day of each month from June to March (the 25th for December, or the next business day if December 25 or the last day of the month falls on a weekend or a holiday). The insurance premiums will be automatically deducted on the debit date. Please ensure prior to the debit date that the account balance is sufficient to cover the amount to be deducted. If you have not completed the direct debit application procedures, please apply at the ward office, bank, or post office.
If you have difficulty paying the insurance premiums due to a disaster or unemployment, please consult with us as soon as possible, as you may be eligible for a premium reduction or exemption.
(2) What happens if you fail to pay by the due date?
- You will be required to pay a delinquent charge.
A reminder or demand letter will be sent to you. If you receive a reminder or a demand letter, please pay your insurance premiums immediately with the enclosed payment form.
If you continue to fail to pay your insurance premiums even after receipt of the reminder, your salary or savings may be subject to seizure. The seized property will be unable to be freely disposed of (for example, you will not be able to withdraw money from your bank account). If payment is still not made after that, the City will collect the seized property to be used to cover the delinquent insurance premiums.
A health insurance card with a shorter validity period will be issued in place of the regular health insurance card. If you continue to fail to pay your insurance premiums thereafter, you must return your health insurance card and will be issued a National Health Insurance Eligibility Certificate instead. Those who are issued an Eligibility Certificate must temporarily pay the full amount of medical expenses when they receive treatment at a medical institution.
4. Inquiries (Japanese only)
Please contact the Health Insurance and Pension Division of the ward office in the ward where you currently live (or the ward where you previously lived if you have moved).
Contact information for the Health Insurance and Pension Division in each ward
For medical examinations, please contact the following.
Type of medical examination
Specific health checkup
Health Service Promotion Division
Complete physical examination
National Health Insurance Division