When spring approaches next year, many foreigners in Japan could be in for a rude awakening: From April 1, all those who apply to extend their visa in Japan will be asked to show proof of enrollment in one or other of Japan’s main national health systems, the shakai hoken (social health insurance and pension) or kokumin kenko hoken (national health insurance).
When that time comes, it won’t help to present details of your own private health plan, or to argue about the inefficiencies of the system for foreigners. Japan has had a mandatory universal health care system in place since 1961, meaning that any resident over 20 must be enrolled, whether employed or unemployed, Japanese or non-Japanese.
If you are working for a company in Japan, chances are that you are (or need to be) enrolled in shakai hoken, in which you pay half of your health insurance premiums and your company pays the rest. There isn’t much ambiguity about shakai hoken: If a company employs more than five people, and an employee is working more than 30 hours a week for a period longer than 2 months, the company is obligated to submit paperwork for an employee’s health insurance and pension to the Social Insurance Agency within five days of hiring. With shakai hoken comes the kosei nenkin, or pension plan; the two are a set, and enrollment is mandatory whether you plan to retire in Japan or not.
Meanwhile, people who are unemployed, self-employed, employed by a small firm or retired should be enrolled in kokumin kenko hoken (national health insurance). People paying into this system have to sign up on their own for kokumin nenkin (the national pension) at their city ward office.
On the positive side, the new guidelines will at least force the issue into the open so that there are fewer people … blindsided by back payments, says Yujiro Hiraga, president of [Zenkoku Ippan Tokyo General Union’s predecessor] the National Union of General Workers, Tokyo Nambu. “I think it will be a good source of pressure for employers to enroll their staff.” But, he adds, “The negative effect is that it might encourage more secrecy among people and companies without it.”
He notes that the number of employers who enroll their staff in insurance is shrinking with the economic downturn, and that things could get worse: A labor ministry survey last year found that over 100,000 companies had not enrolled their staff in shakai hoken as of March 2008.