Japan’s first health insurance

History Japan’s first health insurance system was introduced in 1922. It took effect in 1927 to cover laborers and in 1938 was extended to cover farmers also.   The system originated from labor unions representing workers in dangerous industries, and over time was gradually extended so that currently all Japanese citizens and residents should be covered.  The current NHI system, which is managed by local municipal governments, was introduced in 1961. The information in this article relates to Minato Ward in Tokyo, and NHI conditions in other municipalities may differ. Joining NHI   People are required to join NHI within two weeks of becoming eligible. 

This is required if a person moves to the municipality from another municipality or overseas and isn’t covered by Employees' Health Insurance, withdraws from Employees' Health Insurance (for example, due to job loss), stops receiving public assistance, or is born (and not covered under parents Employees Health Insurance).  

Those who do not register when they become eligible and register later, can be charged for up to two years of back payments. A person applies to their local ward office or city office, which issues them with a NHI card, and invoices for the NHI premiums. The insured person then pays the premiums, and is now covered.

How the National Health Insurance works.

When the insured person uses a medical facility that accepts NHI, they will only need to pay part of the cost. The medical facility will then send invoices for the remaining amount to the National Health Insurance Federation, which reviews and pays the medical facility. After this, the NHIF reports on the invoices to the municipal office, which reimburses the NHIF Withdrawing from NHI  There are several different grounds for withdrawing from NHI.

 As NHI is managed by local municipalities, if an insured person moves to another municipality, they must withdraw from their current municipality’s NHI and enter the NHI of their new area. If the insured person is not a Japanese citizen and leaves Japan without intention of returning, or without re-entry permission they must settle their premium in advance. NHI members also withdraw if they join Employees' Health Insurance, start receiving public assistance, or pass away.

Insurance Premiums  There are three types of NHI premiums. The head of household is responsible for payment, even if they are not a NHI member. The rate at which the premiums are calculated is based on the Resident's tax (住民税 juuminzei) amount charged by the local municipal government. This is in turn based on income earned by that member during the previous calendar year. Resident’s tax is determined in June, and notifications are sent in July. Because of this, the yearly NHI premium is divided into 10 installments.  Category 1 - The basic premium (for regular NHI members.) Calculated by multiplying the total residents tax paid by all NHI members in the household by 0.80. This is the income levy.

Then multiplying the number of insured household members by 31,200. This is the per capita levy. These two levies added together are the annual premium that must be paid. The maximum possible is 500,000 per year. Category 2 - The premium for supporting the elderly (for people older than 75.) Calculated by multiplying the total residents tax paid by all NHI members in the household by 0.23. This is the income levy. Then multiplying the number of insured household members by 8,700. This is the per capita levy. These two levies added together are the annual premium that must be paid. The maximum possible is 130,000 per year. Category 3 - For nursing care (for people in long-term care) Calculated by multiplying the total residents tax paid by all category 2 NHI members in the household by 0.11. This is the income levy. Then multiplying the number of category 2 household members by 12,000. This is the per capita levy. These two levies added together are the annual premium that must be paid. The maximum possible is 100,000 per year.