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16 June 2026
Two systems quietly underpin life in Japan: health insurance and the pension. Both are mandatory for residents, both are sorted at the ward office, and both confuse new arrivals because each comes in two flavours depending on how you work. The good news: enrolment is routine, the healthcare you get is excellent value, and even the pension money isn't necessarily lost if you leave. This guide explains National vs employees' systems, what you pay, how to enrol, the exemptions, and the lump-sum refund.
Employees' Health Insurance (健康保険)
Who's on it: Company employees
How you pay: Deducted from salary; employer shares the cost
National Health Insurance (国民健康保険)
Who's on it: Self-employed, students, others not on a company plan
How you pay: Billed by your municipality, based on income
Employees' Pension (厚生年金)
Who's on it: Company employees
How you pay: Deducted from salary; employer shares the cost
National Pension (国民年金)
Who's on it: Residents 20–59 not on employees' pension
How you pay: Flat monthly contribution
Every resident must be enrolled in a public health-insurance scheme. Which one depends on your work:
If you're a company employee, you're typically on Employees' Health Insurance (健康保険) through your employer, who shares the premium and handles enrolment. Your family can usually be covered as dependents.
If you're self-employed, a student, or otherwise not on a company plan, you enrol in National Health Insurance (国民健康保険, kokumin kenkō hoken) at your ward office, and premiums are based on your income.
Either way, the system covers about 70% of most medical costs — you pay roughly 30% at the clinic or hospital — with caps that protect you from catastrophic bills. For new residents, this is one of the best-value parts of living in Japan.
Japan's pension also splits by work status:
Employees' Pension (厚生年金) — for company employees, deducted from salary with the employer contributing alongside you.
National Pension (国民年金) — residents aged 20–59 who aren't on the employees' pension pay a flat monthly contribution, enrolled at the ward office.
Pension enrolment is mandatory for the eligible age range, regardless of nationality. If you're a student or on a low income, you can apply for exemptions or deferrals rather than skipping payments — ask at the ward office. And crucially for many foreigners: if you leave Japan, you may be able to claim a lump-sum withdrawal payment for some of your contributions (see the FAQ), so the money isn't simply gone.
Both health insurance and pension are handled at the same ward office visit where you register your address — the 14-day registration. If you're an employee, your company usually enrols you in the employees' schemes instead; if not, you enrol in the National schemes yourself at the counter. Bring your residence card and passport, and your coverage and contributions are calculated from your registration date — which is exactly why you shouldn't delay that ward-office visit.
National Health Insurance premiums scale with income (a fresh arrival with low first-year reported income often pays relatively little at first), and the National Pension is a set monthly figure. Together they're a real monthly line item, so build them into your planning from day one — our Budget Calculator includes insurance and pension so your take-home picture is realistic.
Is health insurance mandatory in Japan?
Yes. Every resident must be enrolled in a public health-insurance scheme — Employees' Health Insurance through a company, or National Health Insurance via your municipality if you're self-employed, a student, or otherwise not on a company plan.
How much of my medical costs does insurance cover?
Public health insurance covers about 70% of most treatment costs; you pay roughly 30% at the point of care, with high-cost caps that limit your exposure on large bills.
Do I have to pay into the Japanese pension as a foreigner?
Yes. Pension enrolment is mandatory for residents in the eligible age range (20–59 for the National Pension), regardless of nationality. Employees are on the Employees' Pension; others pay the National Pension.
Can I get my pension money back if I leave Japan?
Often, yes. Foreigners who paid in for a qualifying period may claim a lump-sum withdrawal payment after leaving Japan. The amount is capped and there are rules and deadlines, so check the current conditions with the Japan Pension Service before you depart.
What if I'm a student or can't afford the pension?
Apply for an exemption or deferral at the ward office rather than simply not paying. Students and low-income residents can qualify to reduce or postpone contributions while staying in good standing.
How do I enrol in National Health Insurance?
At the ward office, during the same visit where you register your address. Bring your residence card and passport; premiums are calculated from your registration date, so enrol promptly.
Does my employer handle this for me?
If you're a company employee, usually yes — your employer enrols you in Employees' Health Insurance and the Employees' Pension and deducts contributions from your salary, sharing the cost. If you're not employed by a company, you enrol in the National schemes yourself.
Are my family members covered?
On employer-based insurance, dependents are typically covered. On National Health Insurance, the household enrols together and premiums reflect household income. Either way, every resident needs coverage.
Health insurance and pension look intimidating because each comes in two forms, but for you the action is simple: enrol at the ward office (your employer may do the employee versions for you), pay the income-based or flat contributions, and use the excellent ~70%-covered healthcare. Apply for an exemption if you need one, and remember the pension lump-sum if you ever leave. Build both into your monthly numbers with the Budget Calculator, and slot them into the wider arrival plan with the Path Finder.
Authoritative references: Japan Pension Service (international); Ministry of Health, Labour and Welfare; your local ward/city office for enrolment.
This guide is general information, not financial, tax, or legal advice. Premiums, contribution amounts, exemptions, and the lump-sum withdrawal rules vary and change; verify the current details with the Japan Pension Service, the Ministry of Health, Labour and Welfare, or your ward office.