NHI yea or hell naw

[nawlinsgurl]

A lot of post here about getting out of NHI but not so many about joining...I have to decide soon and my school offers koumein hoken (i think) not shakai hoken...anyways no idea what's the difference.
But seems like once you join NHI, you are in FOR LIFE---unless you want to lie about moving and other ish.
Anyone happy in NHI or should I run like hell from the health plan?

[Sterling]

A lot of post here about getting out of NHI but not so many about joining...I have to decide soon and my school offers koumein hoken (i think) not shakai hoken...anyways no idea what's the difference.
But seems like once you join NHI, you are in FOR LIFE---unless you want to lie about moving and other ish.
Anyone happy in NHI or should I run like hell from the health plan?

Here is a decent summary of reasons:

http://www.medexplan.com/japan.html

---

Reasons not to Join Japanese National Health (JNH):


1. It does not provide good cover outside of Japan, and the pension portion is confiscated if you leave before contributing for 25 years.
2. The JNH system only covers 70% of your hospital bill, MedExPlan covers 100%.
3. It does not provide the extra benefits that expat policies have like medical evacuation, compassionate travel, home nursing etc.
4. Clinics catering to foreigners with American and British doctors in Tokyo do not accept JNH.
5. Most foreigners prefer not to be treated in a Japanese hospital, given the choice. The average hospital stay in Japan is 34 days while in Europe it is 7, and in the US it is 5 days. (statistics: American Chamber of Commerce Journal article) If you are really sick or need elective surgery, private insurance enables your return home or to a country where they speak your language and hospitals are up to European and US standards of treatment.
6. Medical malpractice: In Japan it seems to be common from reading newspaper reports. You do not have much hope of success in litigation, or of getting a good settlement even if you win. The Japanese legal system does not have juries, the courts proceed glacially, and there is often discrimination against foreigners. If you would be satisfied with an apology, they express regret a lot here as long as they don't have to pay and nobody loses their job or actually has to takes responsibility for incompetence.



Reasons to Join Japanese National Health:

1. If you have a big family, i.e. 4 or more children, JNH can sometimes be cheaper than private expatriate insurance depending on your income.
2. If you join you can get into the unemployment insurance & pension system.
3. If you have pre-existing conditions or chronic diseases like diabetes that may require expensive maintenance, and or flare up seriously from time to time, JNH will cover them. Private insurers like MedExPlan will not if they are pre-existing conditions.

---

The issue of "priciness" is relative to how much money you are making. As the premiums are based on previous year's taxable income in Japan, they function as a tax up to a point .... the annual premiums are capped at something like Y560,000 per annum. So, for someone making say Y8 million in taxable income who gets hit with the highest premium, it probably sucks. Not so for the dude making Y30,000,000 per year in taxable income. He pays exactly the same. A clear example of a 'tax' that squeezes middle-income earners.

As indicated in the link, if you have a previous existing condition, then you definitely will want NHI as most private plans may reject your application. In that case, even the max premium of Y560,000 per year with a 30% co-pay no longer sounds unreasonable.

Another reason to consider NHI is that for most people they are more likely to go in for preventative treatment - and that plays a role in nipping more serious medical problems in the bud. For the people who like the idea of only shelling out $500 - $1,000 per year for a bare bones 'only in the case of emergency' private healthcare plan - that might serve you alright as long as you are healthy, but as you get older, a lot of people find their luck running out as minor issues develop. It's called "aging"...




FYI I am in a position now to get back on NHI - without it appears incurring a two-year premium payment penalty. My reason for doing so (haven't decided yet) would be:

1. The maximum Y560,000 annual premium isn't out of the financial ballpark for me.

2. I'm experiencing some minor chronic injuries that would be covered under the NHI. Even with the 30% co-pay, I reckon I could make it worth it.

3. I am not sure if this is accurate but should I ever consider getting a mortgage in Japan, I heard one of the conditions would be that I am covered by NHI ... (can anyone confirm this?)

[Hijinx]

Try explaining to a J-wife that you're not going to go on the NHI.

[Sterling]

Try explaining to a J-wife that you're not going to go on the NHI.

I'm not married so I'm not 100% certain I understand ...

Is the NHI sacred to them or something?

[tomd]

Your school does not "offer" kokumin hoken - it is the default option offered by your city office if you are not offered shakai hoken by your company.

(This is provided you are staying in Japan for more than 1 year, otherwise you would not be eligible to join either).

The issue not already mentioned is that it is, as I understand it, the law to have health insurance under one or other of the above. Foreign/expat/third party schemes are not recognized as such.

(While there are cases where foreigners have managed to successfully quit NHI after arguing that they have an expat plan, this is certainly not the rule and as I understand it the city offices are becoming increasingly strict about this).

As you say, there may well be issues with regard getting mortgages etc as, as far as japanese law is concerned, you have no health insurance under expat plans.

-T

[nawlinsgurl]

Thanks for the info!

[happiness]

Try explaining to a J-wife that you're not going to go on the NHI.

Why? I think such wife must be very Japanized and rooted to their culture even though she has foreign husband.
My wife has both NHI and with me private one. I have only private. She understands me very well as she benefits too by not seeing often J doctors, but have this opportunity to visit foreign clinics in Tokyo and get reimbursed 100% very quick.

[koufun]

one more benefit of having Japanese Health Insurance is that you are not restricted to going to hospitals and clinics only in the area you live in.. anyone can go to the any hospital or clinic including the top hospitals such as Keio with a JHI health insurance card, although it may cost an extra thousand yen or two if you don't have a letter of referral from another doctor..

[happiness]

one more benefit of having Japanese Health Insurance is that you are not restricted to going to hospitals and clinics only in the area you live in.. anyone can go to the any hospital or clinic including the top hospitals such as Keio with a JHI health insurance card, although it may cost an extra thousand yen or two if you don't have a letter of referral from another doctor..

What are you talking about? I`ve been on private for very long time and had no restrictions at all. There may be insurers with such deal but not the one I`m with. I go to any hospital I feel is good either in japan or overseas. For instance I started treatment in Europe but my holiday were over and couldn`t finish treatment over there. Upon return to Japan I continued treatment in foreign clinic here (don`t except JNHI) When everything was over I collected all invoices from home and Japan, ONLY one Claim Form filled in in Europe and sent to underwriter. My money was in my bank account here 2 weeks later.
I could go to Japanese clinic or hospital but I don@t like it. I write this in case you think only foreign clinics are OK to continue treatment.

[Sterling]

What are you talking about? I`ve been on private for very long time and had no restrictions at all. There may be insurers with such deal but not the one I`m with. I go to any hospital I feel is good either in japan or overseas. For instance I started treatment in Europe but my holiday were over and couldn`t finish treatment over there. Upon return to Japan I continued treatment in foreign clinic here (don`t except JNHI) When everything was over I collected all invoices from home and Japan, ONLY one Claim Form filled in in Europe and sent to underwriter. My money was in my bank account here 2 weeks later.
I could go to Japanese clinic or hospital but I don@t like it. I write this in case you think only foreign clinics are OK to continue treatment.

Do you mind sharing which private health plan you are using?

[happiness]

Do you mind sharing which private health plan you are using?

I hope I won`t be banned for sharing this info here. It is not too cheap, but it is always worth to take a look and compare with others.
www.mpih-jp.com

[koufun]

Why? I think such wife must be very Japanized and rooted to their culture even though she has foreign husband.

Interesting concept: a Japanese wife clinging on to being very 'Japanized' in the country called Japan where she was born, and having been well rooted in the culture where she grew and flourished... even though life has blessed her with a foreign husband... From this concept I guess some Japanese ladies may not see what a gem such a foreign husband is... (:

[happiness]

Interesting concept: a Japanese wife clinging on to being very 'Japanized' in the country called Japan where she was born, and having been well rooted in the culture where she grew and flourished... even though life has blessed her with a foreign husband... From this concept I guess some Japanese ladies may not see what a gem such a foreign husband is... (:

Thanks for bringing this up. After I read my post over again, I realized that this was interesting concept indeed. The word "Japanized" towards Japanese was kind of unsuitable. Anyway, let`s leave this as it is, otherwise it will go far behind the basic question in this thread. I think all opinions are very valuable and let`s not make this look like a "fight" because of religion or political view. Let`s enjoy and be happy with whatever people got. I have private insurance, someone have JNHI and that`s OK What people do here is giving their own opinions and share experience with many providers on this market. There will be always good and bad or I`d rather say inappropriate company.
Cheers

[JerseyBoy]

FYI I am in a position now to get back on NHI - without it appears incurring a two-year premium payment penalty.

How come you get hit with a 2-year premium payment?

[Sterling]

How come you get hit with a 2-year premium payment?

If you have not been on a proper Japanese corporate health insurance plan(those offshore private programs don't count), you are expected to enroll in NHI. If you suddenly want to sign up, what I have generally heard is that most ward offices will demand you pay two year's worth of premiums. The maximum possible amount (depending on how much you earn) would be Y560,000 per year ... or Y1,120,000 for two years.

[JerseyBoy]

If you have not been on a proper Japanese corporate health insurance plan(those offshore private programs don't count), you are expected to enroll in NHI. If you suddenly want to sign up, what I have generally heard is that most ward offices will demand you pay two year's worth of premiums. The maximum possible amount (depending on how much you earn) would be Y560,000 per year ... or Y1,120,000 for two years.

That sounds like a highway robbery. If that is true, you are paying for the health premium for which you are not getting any benefit. Is the premium a lump sum payment? Or, is it going to a monthly installment?

[Sterling]

That sounds like a highway robbery. If that is true, you are paying for the health premium for which you are not getting any benefit. Is the premium a lump sum payment? Or, is it going to a monthly installment?

Not certain as I have not done it myself. My understanding is that they request a lump sum payment for the outstanding premiums but as many have indicated, if you ask nicely, they will often let you break it down into smaller payments.

[happiness]

Guys, you`re right. This is why I will never come back to JNHI. I pay for my private about 150,000yen a year and as I mentioned above, I`m very happy with that.
My advise for all of you who is planning to be only on private, please really think about it. Sometimes premiums goes up (they certainly do) and then you may think going back to JNHI will makes everything cheaper. In most cases what you get is bill for up to 2 years premiums back and in second year another big increase due to your income. What do you think, which one would be cheaper ?

[tomd]

If that is true, you are paying for the health premium for which you are not getting any benefit.

Japan essentially has a socialized health system by law.
Therefore everyone is supposed to be a member of either NHI or shakai hoken, which are essentially the same except for the way in which premiums are collected (and their calculation). Therefore health insurance is effectively part of the tax burden, and everyone is supposed to pay.

In practice, the system is quite non-punitive for people who fly below the radar and do not join - you are unlikely to have baliffs knocking at your door. On the other hand, if people were able to just join and leave on a whim, they would only join at the time they acquire some serious illness that requires long term treatment. Since NHI is necessarily inclusive of preexisting and chronic conditions etc, the system would not be viable if that could occur.

Therefore if you want to join they allow you to do so but backdate the premiums for (part of) the time you should have been contributing but were not. Given that non-joiners are essentially evading part of their tax burden, that sounds fair enough to me.
The efficiencies (or otherwise) of the system are debatable and have been here in the past, but the basic premise is reasonable.

-T

[originaloli]

I think this comes down to ideology. Being European, I am happy to pay for a national health service. I think most North American posters are getting confused. This is not an alternative health plan option, it is the law. Like many laws in Japan it is not enforced heavily. By rights you should be locked up in prison for not paying NHI, just as you would for not paying taxes. Feel fortunate that you can evade it so easily.

Please think long and hard though about the weak and ill in society. I certainly never minded paying extra in England to benefit the people down the road who weren't as fortunate. That's England too, where we don't really look after people too well compared to northern Europe. Scandanavia has it right, in my opinion. I personally think it is immoral to avoid what is both a legal necessity and a social obligation in Japan.

[Sterling]

I think this comes down to ideology. Being European, I am happy to pay for a national health service. I think most North American posters are getting confused. This is not an alternative health plan option, it is the law. Like many laws in Japan it is not enforced heavily. By rights you should be locked up in prison for not paying NHI, just as you would for not paying taxes. Feel fortunate that you can evade it so easily.

Please think long and hard though about the weak and ill in society. I certainly never minded paying extra in England to benefit the people down the road who weren't as fortunate. That's England too, where we don't really look after people too well compared to northern Europe. Scandanavia has it right, in my opinion. I personally think it is immoral to avoid what is both a legal necessity and a social obligation in Japan.

Do you pay NHK?

NHK fees are similar. However, I've always refused to enter into an agreement with NHK - as required by the Broadcast Law - and haven't paid a dime in fees. And, before one argues it is a quintessential gaijin folly, so do a significant percentage of true yeller Japanese...

[PanicInducingGaijin]

Do you pay NHK?

NHK fees are similar. However, I've always refused to enter into an agreement with NHK - as required by the Broadcast Law - and haven't paid a dime in fees. And, before one argues it is a quintessential gaijin folly, so do a significant percentage of true yeller Japanese...

I've never paid the NHK man, but I still agree with originaloli about contributing to the country's healthcare system. I'm not sure I would go so far as to say it's "immoral" not to pay into it, but it would be in the interest of society if everyone were to contribute.

And I'm an American, FWIW.

[originaloli]

I don't actually pay NHI at the moment. I've only just got here and my working visa hasn't come through yet. Therefore I can't join. Though I will, just as I will pay my (stupidly low) taxes when I work. As I neither watch TV or access the NHK website, I won't pay them any money.

If you honestly think one can compare a welfare service to television then I doubt we will agree and there is little point discussing it, especially not through the limited medium of forums. I'm happy to agree to disagree. I'm unlikely to change your mind so I'd rather we could simply live in peace.

I realise this is not a nationality issue. It rarely is - there are people everywhere who want to find a way out of paying things. I usually think it's greed, although to be fair I am sure many people are genuinely on the breadline. The reference to Americans was simply that there is essentially no welfare in America and thus the concept is often more startling to them. That is certainly the case in Europe.

I also don't care much for calling our host country's folk 'true yeller'. I will assume it was made in jest.

[Sterling]

I don't actually pay NHI at the moment. I've only just got here and my working visa hasn't come through yet. Therefore I can't join. Though I will, just as I will pay my (stupidly low) taxes when I work. As I neither watch TV or access the NHK website, I won't pay them any money.

If you honestly think one can compare a welfare service to television then I doubt we will agree and there is little point discussing it, especially not through the limited medium of forums. I'm happy to agree to disagree. I'm unlikely to change your mind so I'd rather we could simply live in peace.

I realise this is not a nationality issue. It rarely is - there are people everywhere who want to find a way out of paying things. I usually think it's greed, although to be fair I am sure many people are genuinely on the breadline. The reference to Americans was simply that there is essentially no welfare in America and thus the concept is often more startling to them. That is certainly the case in Europe.

I also don't care much for calling our host country's folk 'true yeller'. I will assume it was made in jest.

Actually, abiding by the Broadcast Law does not depend on whether you watch NHK or not. Simply having the means to receive their broadcast technically obligates you to enter in a contract with them:

Article 32 of the Broadcast Law
Any person who has installed receiving equipment capable of receiving the broadcasting provided by NHK shall conclude a contract with NHK with regard to the reception of its broadcasting. However, this shall not apply to those who have installed receiving equipment not intended for the reception of broadcasting, or receiving equipment solely for the reception of radio broadcasting or multiplex broadcasting (broadcasting of voice and other sound transmissions not coming under television broadcasting and multiplex broadcasting classifications).

And while I do agree with your point about the silliness about equating medical services with public access television, the annoying NHK man in my former neighborhood would probably beg to differ with us on that point. Annoying NHK Man would probably argue that in the event of a natural disaster, the emergency broadcasts by NHK would provide an essential lifeline to survivors. He obviously has great faith in the survivability of my 50" flat screen TV.

Back to healthcare insurance. With the ever increasing aging population, it is clear that there is a pressure to extract premiums from healthy 30-somethings in order to fund the needs of seniors in this country. The system encourages abuse with many seniors feeling comfortable about making daily unnecessary visits to the GP so that they can socialize with their friends.

Even the Prime Minister of this country, Taro Aso, understands this problem. On November 20th at a meeting of the Council on Fiscal and Economic Policy, he correctly indicated "Why do I have to pay for medical expenses for old people (who become sick) because they drink and eat all the time and do nothing?". He further continued with "At school reunions for 67- and 68-year-olds, I see worn-out people who go to the doctor all the time. They were very active when they were students, but now their medical expenses (which the government must shoulder) are much more than mine. It's because I take a walk every morning and do other things. I pay more taxes than they do."

Despite having to apologize for his comments later on, I believe Prime Minister Aso only did so to appease the politically-correct crowd.

[originaloli]

No one likes Aso. He's a fool and a dangerous one at that. I certainly don't know how much faith I put in his opinion.

As for NHK - an interesting point. Do they provide radio services? I'll bet they get used in earthquake situations. Still, that's the responsibility of government. I have no means to receive television, as I said. Nor do I want to at any point soon. People keep telling me it'll improve my Japanese but I find that can be better done by interacting face-to-face with people. You might be interested to know that I paid the license fee in the UK despite not having a TV for the past five years. Three big reasons for this. First, the BBC is (cliche alert) a wonderful institution and is only that way because it is funded largely by the people. Second, I use the BBC website as my go-to place on the internet. Thirdly, this is peanuts. Hundred and thirty odd quid over a whole year.

On NHI contributions, as I said before, it isn't about what one gets out of it. It's that it's there. For me, for you, for all of us. I understand that it's not a proper welfare system but it's a damn state better than nothing. What do I care that I'm paying some extra to help support my fellow humans? So what? Unless I'm wrong it's on a scale (which may well be unfair at certain points) so I doubt anyone's suffering. Sure, some people might be a little less comfortable, but that doesn't invalidate the principal.

Furthermore, if you really are worried about getting squeezed as a healthy thirty-something supporting these elderly folk, bear in mind you'll be supported by me in turn. As will I be by the next generation. Ok, I'll concede this much - I don't hold out much hope for either of us, looking around at a world bespoiled by self-interest and greed. Just look at xmas for a truly horrific example of how fun gets hi-jacked by profiteers.

We're starting to ruin the thread possibly and I feel a soapbox beneath my feet so I should stop boring you all. Still, it's genuinely pleasant to express one's views without torrents of badly worded or pointless abuse being the response. Thank you.

[Sterling]

I re-read Aso's comments and realized that he is a bit of a dolt. As I indicated in a previous post, the NHI premiums behave as a progressive tax to a certain point. After one reaches the maximum level of Y560,000 per year, it is capped and becomes regressive. So a silverspoonin' multi-millionaire like Aso pays the same as some over-worked 40-something sarariman drone who is making say, Y9 million in annual taxable income.

Although I am American, I have lived in other countries where socialized medicine is the norm. It is a strange but nice feeling to know you don't have to double-check your coverage - the insurance equivalent of driving through South Central Los Angeles at night. The US is a great place if you've always been lucky enough to have been a member of a first-tier health insurance program. Cyndi Lauper was right - "money changes everything". However, I really would not want to change places with a fellow American suffering under some anally-retentive HMO - or worse still, nothing at all. For those at the bottom of the socio-economic ladder however, there is always Medicare.

Kind of getting back to topic ... the premiums for NHI are based on one's previous year's income in Japan. For any newly-arrived gaijin like originaloli, the first year will be a breeze. The trick is to plan ahead and realize the next year will NOT be as kind. The local residence tax (10% of taxable income) plus the NHI will kick in the second year - and create an unpleasant financial shock to anyone who is not prepared.

If you are itching to get off, it can be done. However, really make certain you aren't just reacting to the initial sticker shock of the second or third year. If you find later that you have any sort of long-term condition that requires regular treatment - and is a condition that would cause you to be denied by most private plans as a 'pre-existing condition' - even with the 30% co-pay, you may wish you had stayed on the Japanese socialized medical plan...

[Sterling]

For anyone who believes it's just us gaijin ... 1 out of five households in Japan are delinquent in their NHI premiums...

21% of households fail to pay national health care insurance premiums (Kyodo)

2009 01 16

TOKYO ―

The welfare ministry said Friday that 20.9% of households involved in the national health care insurance system failed to pay insurance premiums as of June 1, 2008, the worst figure ever.

While self-employed and jobless people take out national health care insurance, the Ministry of Health, Labor and Welfare said the increase in premiums has made it difficult for people to pay.

[Phin]

Hi all,

I'm new here and actually joined to post a thread with the title of "Private vs. NHI" so I'm pleased to have found this before I did so!

I am teaching (Interac, don't go there - have read enough on that subject!) and starting work in March. They have recommended InterGlobal (it's ok to mention companies here, right?) however it's obviously reasonably pricey so I thought I'd check out NHI. Despite NHI being half the cost, I am erring towards private purely for the repatriation costs and cover when I am traveling.

My question is this - I plan to stay in Japan as long as I can. At any point will not having signed up to NHI negatively affect me? For example, unemployment benefits (I think I could only get these after a year anyhow), mortgage (as someone above mentioned), tax when it is recalculated next year (I am guessing this will be the case) etc. etc. What about with visa renewals - I assume they won't think you're a "bad citizen" and boot you out?!!

Any advice would be appreciated - trying to take the sensible long-term route on all this.

Thanks very much!

Phin

[bitteradjunct]

Any advice would be appreciated - trying to take the sensible long-term route on all this
Phin

If you are thinking long term (or even if you aren't) have a look at the fine print of your medical coverage. A lot of it is really meant to be used as one off health coverage for travellers; not people working long term. For example, a friend elected to take the company plan over the national plan. He ended up hurting his back falling off his bicycle. After the third trip to the doctor the insurance company cut him off and wouldn't pay for any more care and certainly wouldn't pay for the operation the doctor thought he needed.

[Phin]

Thanks BA. I am in the process of getting quotes and I will be sure to review the fine print of all of them. I will have to do this with the help of my dad I think, as frankly I find the whole thing as baffling as Japanese laws It's quite a tricky decision, all things considered, although the repatriation costs would be a major pull of going private - if one of my family fell critically ill it is nice to think that they would cover the cost of a flight home...