Forgot to Pay Japan NHI? Here’s What Happens
According to Japan's Health Insurance Act and National Health Insurance Act, foreigners who hold a residence card (zairyu card) and are staying in Japan for more than 3 months are legally required to be part of the national healthcare system.
Since the enrollment is mandatory, failing to pay will result in consequences.
In this article, we will explain what happens when you forget to pay your National Health Insurance in Japan and how to resolve & avoid late payments.
Note: This article provides information for residents enrolled in Japan’s National Health Insurance system (Kokumin Kenkō Hoken). If you are enrolled in employee health insurance (Shakai Hoken), payment rules are handled through your employer and are different.
Forgot to pay your National Health Insurance in Japan – what should you do first?
If you forgot to pay your National Health Insurance (Kokumin Kenkō Hoken) in Japan, you should contact your local city or ward office and request a reissued payment slip or pay at the counter.
Missing one payment does not immediately cancel your insurance coverage. However, continued non-payment may lead to penalties and restriction of benefits.
Japan's National Healthcare system
In Japan, it is mandatory to take part in the national healthcare.
The national healthcare system in Japan consists of the Employee Health Insurance (Shakai Hoken) and National Health Insurance (Kokumin Kenkou Hoken).
If you are a full-time employee at a Japanese company, you are already covered by the employee health insurance (Shakai Hoken) provided by the company.
However, if you are not (e.g., student, self-employed, freelancer, unemployed, etc. ), you are legally required to follow the necessary procedures to enroll in National Health Insurance (Kokumin Kenkou Hoken).
How National Health Insurance premiums are determined
The insurance premium each household pays is calculated based on several factors such as income from the previous year (January - December), age, household size, and the local government's rate.
Since calculating the exact amount can be complicated, many local governments provide quick estimation and simulators.
If you are wondering about the total amount and breakdown of your National Health Insurance premiums, it is recommended to check your local government's website.
Coverage of National Health Insurance
When you receive treatment in the case of illnesses or injuries, you have to present your National Health Insurance card for the insurance benefits.
For those under 70 years old, 70% of the medical expenses are covered by National Health Insurance, and they have to pay 30% of the total medical bill.
For those over 75 years old, 90% of the medical expenses are covered, and they have to pay 10%. However, if this person earns income equivalent to that of average working adults, he or she has to pay 30% of the total medical bill.
80% of the medical expenses are covered for those under 6 years old (before elementary school), and their parents need to pay 20% of the total medical bill.
Normally, you pay an amount according to your self-pay percentage (10%-30%) at the medical institution counter.
The High-Cost Medical Care Expense System (Kogaku Iryo-hi Seido) is a system where, if your monthly medical expenses are high, the amount that exceeds a certain self-pay limit will be reimbursed. The person who wishes to use this system must apply at the counter of their local government office.
What happens when you miss your due date
According to guidance published by the Ministry of Health, Labour and Welfare, municipalities are responsible for collecting National Health Insurance premiums and handling overdue payments, reminders, and benefit restrictions.
Since enrollment in National Health Insurance is mandatory for those who are not part of the Employee Health Insurance, it has similar characteristics to tax. As long as the person is registered as a resident in the city or town, whether a Japanese or a foreigner, the person is obligated to pay the National Health Insurance premiums every month.
If you fail to pay the insurance premiums by the deadline, there will be consequences.
If you continue to fail payments: Reminder & notification by phone, letters, and visits. A late fee will be added.
If you don't pay for less than a year: The NHI card will be switched to a "short-term insurance card" with a validity period of six months or so.
If you don't pay for more than a year: The card will be switched to a "qualification certificate," which, in this case, requires you to pay 100% of the medical expenses at the counter and then apply for deduction.
If you don't pay for more than 1.5 years: All or part of the health insurance benefits will be suspended, meaning that you have to pay the full amount yourself and will no longer be able to receive the benefits of National Health Insurance.
Eventually, if you continue not to pay for the National Health Insurance, your assets will be seized (including salary, life insurance, deposits, savings, real estate, etc.).
Additionally, from 40 years old, it is also required to pay for the nursing care insurance premiums. There are penalties for these if you fail to pay by the deadline.
Note: The monthly deadline is the last day of each month. If the last day of the month is a bank holiday, the following business day becomes the due date. For December, usually the due date is the first business day of the following year.
If you forgot to pay your NHI bill and already paid 100% at the hospital
If you missed your National Health Insurance (NHI) payment and had to pay the full medical cost at a hospital or clinic, you may still be able to receive a reimbursement later.
If you were enrolled in National Health Insurance at the time of treatment, you can apply for a refund of the insured portion of the medical fee at your local city or ward office.
In general, you will need to submit:
the original medical receipts
a completed reimbursement (refund) application form
your bank account details
your National Health Insurance information
After your application is reviewed, the portion normally covered by National Health Insurance (for example, 70% for most people under 70 years old) will be transferred to your bank account.
Please note that reimbursement procedures, required documents, and processing time may vary by municipality. It is recommended to contact your local city or ward office as soon as possible after receiving treatment.
Missing a payment does not automatically mean you permanently lose your insurance benefits. In many cases, benefits can still be applied retroactively once your payment status is corrected.
How to pay for National Health Insurance premiums
There are multiple ways to make a payment.
Bank transfer (auto pay): Apply at your local city office by submitting the bank transfer request form
Payment slip: Bring the payment slip to the bank, financial institutions, post office, local city office, and convenience store
Cashless payments: Scan the payment slip's barcode and pay with a payment app (e.g., PayPay, dPay, etc.)
Credit card: Scan the payment slip's QR code with the payment system "Mobile Register" and pay with a credit card (may or may not be possible depending on your credit card)
Deduction from pension: For some households with family members aged from 65 to 75, the insurance premiums can be paid by deduction from pensions
Insurance premium reduction for special cases
If you cannot pay the insurance premiums due to unavoidable or special circumstances, do not hesitate to contact and consult with your local government office.
There are payment reductions and special consideration for those who are in unavoidable circumstances.
Here are the cases where you are eligible for a reduction or an exemption:
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Reduction and exemptions in the event of a natural disaster or financial hardship
Households that have suffered from a natural disaster (floods, fires, earthquakes, etc.)
Households that have experienced a significant decrease in income due to retirement, business closure, illness, death, etc., and are recognized as being in financial difficulty
The details of insurance premium reduction vary depending on the local government, so consult with them as soon as possible when it is financially difficult to pay the insurance premiums.
Prevention tips for overdue payments
If you are in a financially difficult situation due to disasters or unavoidable reasons, reach out to the local city hall for a reduction or an exemption.
If you tend to forget to pay the monthly insurance premiums because you are busy, you can apply for a bank transfer monthly auto payment at your local city hall.
However, if you do not have a Japanese bank account, using reminder tools and bill-payment services will help you avoid missing the deadline.
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Frequently asked questions
Here are some of the frequently asked questions about National Health Insurance premiums in Japan.
Q: What happens if I forget to pay for National Health Insurance in Japan?
If you have a residence card (zairyu card), are staying for more than 3 months in Japan, and are not working for a company full-time, you are legally required to enroll in the National Health Insurance. If you fail to pay by the deadline, there will be reminder notices by phone, letters, and visits. Also, the late fee will be added. Eventually, your National Health Insurance will be suspended, and your assets will be seized.
Q: Can I pay for National Health Insurance at a convenience store?
Yes. You can bring your NHI payment slip to the convenience store cash register and pay. However, you cannot pay at a convenience store if the payment due date has passed. Also, if the payment slip doesn't have the convenience store barcode or the payment amount exceeds ¥300,000, you cannot pay at the convenience store.
Q: I received a notification about unpaid National Health Insurance. What should I do first?
If you receive a notification for unpaid National Health Insurance premiums, contact your local city or ward office immediately and confirm the outstanding amount. You can usually pay using a reissued payment slip or at the municipal counter. Responding quickly to a notification helps prevent additional penalties and further administrative procedures.
Q: Can I still use my health insurance after receiving a late payment notification?
In most cases, receiving a late payment notification does not immediately cancel your National Health Insurance coverage. However, continued non-payment after repeated notifications may lead to restricted benefits or replacement of your insurance card. It is strongly recommended to make inquiries with your local city or ward office to confirm your current coverage status.
Q: Where should I make inquiries if I forgot to pay my health insurance in Japan?
All inquiries about unpaid National Health Insurance premiums should be made to the National Health Insurance section at your local city or ward office. They can confirm your payment history, issue new payment slips, and advise you on available payment options or reductions.
Q: Will missing one payment affect my visa or residence status in Japan?
Missing a single National Health Insurance payment does not directly affect your residence status. However, repeated non-payment and ignoring official notifications may lead to serious administrative consequences, including enforced collection procedures.
Q: I forgot to pay and left Japan temporarily. Will I still receive notifications?
Yes. Notifications for unpaid National Health Insurance premiums are usually sent to your registered address in Japan. If you are outside Japan and cannot receive mail, it is important to make inquiries with your municipality to avoid missing important notices and deadlines.
Q: Can I set up a payment plan if I do not have enough money to pay at once?
If you are experiencing financial difficulty and do not have enough money to pay the full amount at once, you may be able to request an installment payment plan. You must contact your local city or ward office and submit the necessary application. Availability of payment plans varies by municipality.
In closing
It is legally required for every resident, regardless of their nationality, to be part of the national health care program in Japan.
If you work for a Japanese company full-time, you are automatically covered by the Employee Health Insurance. However, if not, you must enroll in National Health Insurance.
There will be serious consequences, and eventually seizure of assets, if you fail to pay by the deadline and are in arrears.
To avoid potential problems, it is important to inquire with your local government office, choose the best payment method that suits you, and seek additional help.
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