Tokyo, Japan — Foreign residents in Japan who have lived in the country for more than three months and lack health insurance are now legally required to enroll in Japan’s national health insurance (NHI) program, according to a report by The Japan News. The rule, proposed by Japan’s Ministry of Health, Labour and Welfare (MHLW), marks a key step to expand coverage and ensure no foreign residents are excluded from the nation’s social safety net.
Under the new mandate, all foreigners subject to the requirement must pay their NHI premiums in advance. Administered by local governments—including Japan’s 47 prefectures and municipal authorities—the NHI program traditionally covers individuals not eligible for employer-sponsored health insurance, such as the self-employed, unemployed people, and those on non-regular work contracts.
Enrollment Process and Premium Rules
To streamline participation, foreign residents will now be required to join the NHI program immediately after moving to Japan and completing local government registration—a shift from previous policies that allowed for longer enrollment windows. A critical change under the new rule is the requirement to pay a one-time, lump-sum payment covering a full year of insurance premiums, designed to prevent gaps in coverage that could leave residents uninsured.
Once enrolled, participants receive physical payment slips via mail, which they use to settle their premiums. This system aligns with how Japanese citizens and long-term residents have historically managed NHI payments, ensuring consistency across all enrollees.
Foreign Participation in NHI Before the Mandate
Prior to the new rule, foreign residents already made up a small but growing share of the NHI program. In Japan’s 2023 fiscal year (April 2023–March 2024), approximately 970,000 foreigners were enrolled in the NHI—accounting for 4% of all program participants. The MHLW noted that the mandate aims to build on this foundation by closing remaining gaps, particularly for residents who previously delayed or avoided enrollment due to unclear requirements.
Government’s Goal: Universal Coverage for Foreign Residents
The core objective of the mandate is to ensure “every foreign resident in Japan is part of the NHI system,” according to the MHLW. Japan’s national health insurance is a cornerstone of its social welfare model, providing access to affordable medical care—including doctor visits, hospital stays, and prescription medications—with enrollees typically covering 30% of costs out of pocket, while the insurance covers the remaining 70%.
By extending mandatory enrollment to long-term foreign residents without existing coverage, the government seeks to address two key challenges: reducing the risk of uninsured residents facing financial hardship from medical bills, and ensuring the NHI program’s sustainability by expanding its contributor base.
Local government officials have emphasized that support will be available to help foreign residents navigate enrollment, including multilingual guidance on premium calculations and payment procedures.
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