Every resident of Japan must have public health insurance. Employees get it through their employer; everyone else joins the national health insurance run by their municipality. Patients usually pay 30% of the cost of treatment, with a monthly ceiling on out-of-pocket costs for high bills.
Employers belong to one of two kinds of insurer. The Japan Health Insurance Association, known as Kyokai Kenpo, covers most small and mid-sized companies, with a rate set by prefecture. For fiscal 2026 the Tokyo rate is 9.85% of standard monthly remuneration, effective from March 2026 pay. Large companies and industry groups often run their own health insurance societies, which can set lower rates and offer extra benefits. Employees aged 40 to 64 also pay long-term care insurance, at 1.62% in Kyokai Kenpo for fiscal 2026. From April 2026 a new child and child-rearing support levy of 0.23% is collected alongside.
Standard monthly remuneration is capped at 1.39 million yen, and bonuses count up to 5.73 million yen a year. The insurance also pays a sickness allowance of about two thirds of pay for up to 18 months when an employee is off work for a non-work illness or injury, and maternity and childbirth benefits. Dependants with low income are covered at no extra cost.
What it means for a foreign employer
- Your subsidiary will usually join Kyokai Kenpo. Joining an industry health insurance society can be cheaper, but entry depends on the society's rules.
- Senior candidates may lose benefits. People leaving large Japanese companies may be giving up a generous society with low rates, health checks and resort facilities. They notice.
- Dependants are included. A spouse and children with low income are covered without additional contributions.
- Long-term sick leave has a safety net. The sickness allowance means unpaid sick leave is less harsh than it looks, which affects how you design sick-pay policies.
Sources
- Health Insurance Act, Articles 40, 45, 99 and 160.
- Japan Health Insurance Association, fiscal 2026 rates by prefecture and child and child-rearing support levy.