Q&A on National Health Insurance（国民健康保険に関するQ&A）

Q&A on National Health Insurance Eligibility, Premiums, and Benefits（国民健康保険の資格・保険税・給付に関するQ&A）

Below are the main Q&As regarding National Health Insurance eligibility, National Health Insurance tax (premiums), and NHI benefits.

Please bring the Certificate of Loss of Eligibility (Withdrawal Certificate) for health insurance and pension issued at the time of your resignation.

If you do not have documents such as the Certificate of Loss of Eligibility or your separation notice, or if you have already submitted those documents elsewhere, please contact the National Health Insurance & Pension Division.

Regarding the amount of National Health Insurance tax (premium), please refer to the ‘How National Health Insurance Tax Is Calculated (Japanese version)’ section, or contact the National Health Insurance & Pension Division for an estimate.

When making an inquiry, please prepare documents showing the previous year’s income of the head of household and all persons who will enroll in National Health Insurance (such as a copy of your final tax return or your withholding tax slip). 

Under Japan’s universal health insurance system, everyone must be enrolled in some form of health insurance. You must complete the necessary procedures to avoid any uninsured period.

If enrollment is delayed, you will be required to enroll retroactively from the date your previous insurance coverage ended. You cannot choose not to enroll simply because you do not visit hospitals. Please either enroll as a dependent under a family member’s health insurance or complete the procedures to join National Health Insurance.

The longer you delay enrollment in National Health Insurance, the further back premiums will be charged retroactively, which may result in a large lump-sum payment.

When you enroll in another health insurance plan due to employment, you must complete the withdrawal procedure from National Health Insurance, including for any dependents.

If you have already completed the withdrawal procedure but still receive a tax notice, it may be for another family member. Even if the head of household joins company insurance, if at least one family member remains enrolled in National Health Insurance, the tax notice will still be sent to the head of household.

Additionally, even if you withdrew before the tax determination date, if you were enrolled in National Health Insurance at any point during the fiscal year, premiums will be assessed for that period.

In addition to filing a moving-out notification for your residence record, you must separately complete the National Health Insurance withdrawal procedure.

Premiums are charged based on the insurance you were enrolled in at the end of each month. Therefore, you must pay National Health Insurance premiums through the month before you moved out.

Please note: National Health Insurance withdrawal due to moving out cannot be processed during the Thursday extended service hours or Sunday holiday service at the Citizens’ Affairs Division.

If your annual income is less than 1.3 million yen (or less than 1.8 million yen if aged 60 or older or disabled), and you mainly rely on the income of the employee enrolled in workplace insurance, you may qualify as a dependent.

Eligibility criteria differ depending on the insurer, so please check with the workplace.

You can apply for reissuance. Please bring photo ID (such as a My Number Card or driver’s license) and the necessary documents to the National Health Insurance & Pension Division or a branch office. Online application is also available.Reissued certificates will be marked ‘Reissued.’

If reissuance is processed, the previously issued certificate will be publicly declared invalid on the bulletin board at Higashihiroshima City Office. If you later find the old certificate, please return it promptly. (In case of theft, report it to the police.)

The National Health Insurance premium consists of:

• Basic portion
• Late-stage elderly support portion
• Long-term care portion (for ages 40–64 only)

Each portion is calculated as:
Income-based amount + Per-capita amount + Per-household amount

• Income-based amount: Based on previous year’s total income
• Per-capita amount: Fixed amount × number of insured persons
• Per-household amount: Fixed amount per household

See ‘How National Health Insurance Tax Is Calculated (Japanese version)’ for details.

NHI premiums cover April through the following March (12 months), divided into 8 payment installments. The number of installments does not correspond to the number of months enrolled.

Therefore, even after completing withdrawal procedures, you may still need to make payments. If you enrolled mid-year, you may have fewer installments or may be required to pay in a lump sum, but the calculation method remains the same.

Premiums are calculated based on income from January to December of the previous year.

If your household situation has not changed and income is similar, possible reasons include:

• Income was not declared
• Your income exceeded the threshold for premium reduction
• You turned 40 and the long-term care portion was added

There is a reduction system for low-income households. However, if income is not declared, reductions cannot be applied. Anyone aged 18 or older as of January 1 must file an income declaration, even if they have no income.

Mail may have been returned to the City Office. Please contact the office. If it was not returned, you will be guided through the reissuance process.

If the certificate’s expiration date is the day after your residence period expires, bring the following to extend it:

1. NHI Certificate of Eligibility Confirmation
2. Updated residence card
3. Passport (if your status of residence is ‘Designated Activities’)

The annual tax decision notice and payment slips (covering April through March of the following year) are sent to the head of household around mid-July each year.

You may use it for up to three months after expiration as a grace period. After three months, it cannot be used.

Please renew your card or digital certificate before the grace period ends. If renewal is not completed, a Certificate of Eligibility Confirmation will be sent before the three-month period expires.

After three months, registration for use as a My Number health insurance card will be canceled. To continue using it, you must renew the card/digital certificate and re-register.

Yes. If you received medical treatment without proof of insurance due to unavoidable reasons, you may apply for reimbursement of medical expenses.

See: ‘Benefits Available Under National Health Insurance’ (Japanese version).

Self-pay per meal:

• General (others): 510 yen
• Resident tax-exempt households / Low-income 2 (age 70+):
  ・Up to 90 days hospitalization: 240 yen
  ・Over 90 days in past 12 months (advance application required): 190 yen
• Low-income 1 (age 70+): 110 yen

Tax-exempt and low-income households may need a ‘Certificate of Maximum Amount Application and Standard Copayment Reduction.’
※ Usually not required if the My Number Card is usable as insurance at the medical institution.

Yes. If approved upon application, the amount exceeding the limit will be reimbursed as High-Cost Medical Expense benefits.

See: ‘When Medical Expenses Are High’ (Japanese version).

Self-pay percentages:

• Age 0 to pre-elementary school: 20%
• Elementary school age to under 70: 30%
• Age 70 and over: 20% (30% for those with income comparable to the working population)

If deemed medically necessary by a physician, you may apply for reimbursement of the amount excluding your co-payment portion.

See: ‘Benefits Available Under National Health Insurance’ (Japanese version).

National Health Insurance and Pension Division(Kokuho-nenkin-ka, 国保年金課) : 082-420-0933
Location: 1F Main building