National Health Insurance and the National Pension in Japan: Enrollment, Cost, and the Refund When You Leave

Sora— research-based comparisons

Published: September 2, 2026

Most newcomers assume health insurance and a pension are things you sign up for, like a private plan back home. In Japan that’s backwards: once you’re on the resident register, National Health Insurance and the National Pension become your default coverage automatically — the paperwork that follows is about registering an address, not opting in.

Do foreign residents get to choose whether they’re insured?

No. If you’re on the resident register and not otherwise covered, enrollment is automatic. Article 5 of the National Health Insurance Act (Act No. 192 of 1958) states it plainly (author’s translation):

Any person who has an address within the area of a prefecture shall be the insured person of the National Health Insurance operated jointly by that prefecture and the municipalities within it.

That’s the entire mechanism — no application, no eligibility interview, no waiting period tied to nationality. Article 6 exempts a short list, most importantly anyone already covered as an employee or dependent under a company plan. Its eleventh category defers to a ministry regulation, where the exceptions foreign residents actually meet live: medical treatment, tourists 18 or older staying one year or less on a sightseeing-related status, and their accompanying spouse.

The National Pension works the same way:

All residents of Japan between age 20 and 60, regardless of nationality, must enroll.

A person who moves to Japan starts in Category I automatically, staying there until an employer or spouse’s coverage moves them into Category II or III. The same narrow exception applies: medical-stay and long-stay sightseeing visas aren’t subject to pension coverage.

How much is the National Pension in fiscal 2026?

A flat ¥17,920 a month, published by the Japan Pension Service and last updated 1 April 2026 — the same figure for every Category I insured person, regardless of income.

If that’s a stretch, there are three exemption levels:

Students use a separate route: the Special Payment System for Students defers payment rather than reducing it, and approval lasts one year, renewed annually. A deferred month still counts as a “valid period” — a disability or death during that stretch can still trigger the disability or survivor’s basic pension — but it doesn’t raise your eventual old-age pension unless you pay it back later, which you can do for up to ten years.

Why isn’t there a single monthly cost for National Health Insurance?

Because the law only fixes the shape of the bill, not the price — the rate is set by whichever municipality you live in. Article 29-7 of the Enforcement Order lays out four levies added together: a basic (medical) levy, a late-elder-support levy, a nursing-care levy for households with a member aged 40–64, and a child-rearing support levy added from fiscal 2026 (more below).

For each of those four, a municipality picks one of three formulas:

A flat “NHI costs ¥X a month” figure on an English forum is never a national rule — it’s one municipality’s ordinance, one bracket, one fiscal year. The order does fix a ceiling on each levy, regardless of income:

The order caps each of the four separately; it doesn’t publish a combined household ceiling, so don’t add these into a headline number — that isn’t what the statute says.

What is the new child-rearing support money from April 2026?

Starting with the April 2026 premium, National Health Insurance (and employer health insurance) gained a fourth funding stream: a levy for Japan’s child and family support program. The Children and Families Agency describes two mechanisms:

• Employer health insurance: a nationally set 0.23% of your standard monthly remuneration for fiscal 2026, split with your employer paying half — roughly 0.115% from your own pay, applying from the April 2026 premium, deducted starting May 2026.
• National Health Insurance: the rate is set by your own municipality’s ordinance based on household and individual income, so it varies by city — check with yours for the exact collection date.

This deliberately doesn’t put a yen figure on how much any household’s bill rises — the agency’s own estimate tables are unverified by this article — so check the agency’s page (Japanese-language; no English version confirmed as of 13 August 2026) for a household-specific figure.

How do you actually apply, and who gets billed?

You don’t, not for the insurance itself. Enrollment follows automatically from registering your address at your municipal office; what you file is the residency paperwork, not an insurance application.

That registration also produces the insured-person status. Worth knowing: under Article 76, the premium is billed to the head of household.

That counter is often Japanese-only — our guide to starting Japanese from scratch as an adult resident covers what to expect. The resident-record copy this registration produces also matters beyond health insurance: it’s the same document behind Japan’s tightened rules for converting a foreign driver’s license.

What is the Lump-sum Withdrawal Payment, and who can claim it?

A partial refund of pension contributions, paid to non-Japanese nationals who leave without ever qualifying for a Japanese pension — its official name is the Lump-sum Withdrawal Payment, not the “pension refund” people search for. The Japan Pension Service sets four conditions, and a claimant must meet all of them:

1. You do not have Japanese nationality.
2. Your National Pension contribution-paid period, or your Employees’ Pension Insurance enrollment period, is six months or more.
3. You do not have an address in Japan.
4. You were never eligible to receive a pension, including a disability allowance.

A deadline catches people out: the claim must be filed within two years of the date you stopped having an address in Japan — not two years from when you left the country, which isn’t always the same day.

The two filings you must make before you leave

Two administrative steps decide whether the payment above is straightforward or stuck — both before you board a flight home.

File the Moving-out Notification. The Japan Pension Service’s own guidance describes what happens either way:

If you submit a Moving-out Notification to the municipality, you can claim [the payment] after leaving Japan with a re-entry permit or deemed re-entry permit. However, suppose you have not submitted the Moving-out Notification. In that case, you are considered as an insured person in the National Pension; that’s why you cannot claim [the payment] until your re-entry permit expires.

Skip it, and the system still treats you as insured, blocking the claim until an unused re-entry permit runs out.

File the Tax Agent notification, before you leave. This matters only if your payment includes Employees’ Pension Insurance, since that portion is taxed at the source (more below). To get it back, you file through a Tax Agent for Income Tax — the “Notification of Tax Agent for Income Tax/Consumption Tax” must be submitted before you return home, not after. There’s no special qualification for the Tax Agent beyond having an address or place of residence in Japan — a friend, a former coworker, or a professional will do.

Moving the payment back out of Japan afterward runs through the ordinary rules for sending money abroad.

The 120-month wall and the 60-month cap

Two separate limits shape how much of a Lump-sum Withdrawal Payment you can collect, pulling in opposite directions.

• The 120-month (10-year) wall. If your total “eligibility period” reaches 120 months — including any period totalized under a social security agreement — you can no longer claim the payment at all, since that period qualifies you for Japan’s ordinary Old-age Pension instead.
• Claiming forfeits everything before it. A successful claim, at any point, forfeits every period of Japanese coverage before it. You can’t bank the years and also take the lump sum.
• The 60-month (5-year) cap on the payment. Since April 2021 the maximum months used to calculate it rose from 36 to 60.
• Extra months past 60 don’t buy more. Someone enrolled 61 months or longer is paid as if enrolled for exactly 60 — and all their months before the claim, not just the ones past 60, are invalid. The Japan Pension Service’s own example: enroll 90 months, claim, and you receive the 60-month amount while all 90 months are gone.

Together, the rules reward leaving early and cleanly, not cashing out after staying enrolled as long as possible.

How much is the payment in FY2026?

For the National Pension (Category I), the amount depends only on months paid — not income. For a last contribution-paid month between April 2026 and March 2027:

This resets every fiscal year — 2025’s 60-month tier was a lower ¥525,300, 2024’s lower still. Check the year matching your own last paid month, not the year you’re reading this.

Employees’ Pension Insurance has no flat table. The Japan Pension Service publishes a payment rate for each enrollment length — already calculated from the insurance premium rate, so you multiply it directly by your average standard remuneration during the insured period — for a final enrolled month of April 2021 or later:

Five years of Employees’ Pension enrollment works out to roughly 5.5 months of your average standard remuneration — before tax. A non-resident’s payment has income tax withheld at source, at 20.42%, refundable by filing the “Tax Return for Refund Due to Taxation on Retirement Income at the Taxpayer’s Option” — exactly why the Tax Agent notification has to be filed before you leave. The National Pension portion has no tax withheld at source at all.

Before it lands anywhere, opening the Japanese account it’s paid into is its own hurdle — our guide to opening a bank account as a foreign resident covers what that takes.

Does a social security agreement with your home country change any of this?

Sometimes. As of Austria’s agreement entering force on 1 December 2025, Japan has agreements with 24 countries: Germany, the UK, South Korea, the US, Belgium, France, Canada, Australia, the Netherlands, Czech Republic, Spain, Ireland, Brazil, Switzerland, Hungary, India, Luxembourg, the Philippines, Slovak Republic, China, Finland, Sweden, Italy, and Austria.

But “an agreement exists” doesn’t mean your years abroad and in Japan add together. Four of those 24 — the UK, South Korea, China, and Italy — only eliminate double contributions, so you aren’t charged into two systems at once; they exclude totalization entirely. The other 20 do combine periods for eligibility. The Lump-sum Withdrawal Payment PDF cites that same 20-country figure as of March 2026 for this reason — not a contradiction, just a narrower count than all 24 agreement countries.

Where totalization applies, it interacts with the limits above: pushing your combined eligibility period to 120 months blocks the payment outright, since you’d qualify for an ordinary pension instead, and claiming the lump sum before that point forfeits the Japanese period for good. The real question isn’t “can I get a refund” but whether banking the years is worth more than taking the payment now — a choice that runs only one way.

FAQ

Do foreign residents in Japan have to enroll in National Health Insurance? Yes, unless already covered through an employer’s health insurance. Article 5 of the Act makes anyone with a registered address in the relevant prefecture an insured person automatically, with no opt-in. Exceptions: a medical-treatment stay, or a sightseeing-related status for one year or less, plus an accompanying spouse.

How much does National Health Insurance cost per month in Japan? There’s no single figure. The law fixes four levy categories and a statutory annual cap on each, but the rate applied to your income is set by your municipality’s own ordinance. A flat monthly number quoted for “foreigners in Japan” is describing one municipality’s rate, not a national one.

How do I apply for National Health Insurance in Japan? You don’t submit a separate application. Coverage follows automatically once you’re on the resident register at your municipal office. Premiums are billed to the head of household under Article 76.

What is the Lump-sum Withdrawal Payment, and how does it differ from a “pension refund”? Lump-sum Withdrawal Payment is the Japan Pension Service’s own name; “pension refund” is just a search term. It pays back part of what a non-Japanese national contributed, provided they had six or more months of coverage, no longer have an address in Japan, and were never eligible for a pension.

Can I get my National Pension back after I leave Japan? Only within limits. At 120 months of total eligibility you can’t claim at all, since you’d qualify for an ordinary pension instead — and below that, a claim is capped at the 60-month rate and forfeits every prior period of coverage.

What to remember

Enrollment isn’t the decision point — residency makes that choice the moment you register an address. What’s yours to decide comes later: an exemption or deferral if ¥17,920 is a stretch, and, if leaving for good, whether to bank your years toward a future pension or take the Lump-sum Withdrawal Payment and give them up.

Get the paperwork order right on the way out: file the Moving-out Notification and, if it applies, the Tax Agent notification before you leave, not after, and claim within two years of losing your Japanese address. Miss the two-year deadline and you can no longer claim at all. Miss a filing instead, and the payment gets harder to collect, not impossible — blocked until your re-entry permit expires, or missing the tax refund you were owed.

Everything above reflects what the National Health Insurance Act, its Enforcement Order, the Japan Pension Service and the Children and Families Agency had published as of 13 August 2026. Contribution amounts change every fiscal year, so check the Japan Pension Service’s own pages before relying on a figure here.

Sources: National Health Insurance Act, Act No. 192 of 1958 (e-Gov, Japanese), National Health Insurance Act Enforcement Order, Cabinet Order No. 362 of 1958 (e-Gov, Japanese), National Health Insurance Act Enforcement Regulation (e-Gov, Japanese), Japan Pension Service: National Pension enrollment (English), Japan Pension Service: National Pension Contributions (English), Japan Pension Service: Lump-sum Withdrawal Payments (English), Japan Pension Service: Lump-sum Withdrawal Payment claim form and guidance (PDF, English/Japanese), Japan Pension Service: Status of Agreements in Force (English), Children and Families Agency: about the child-rearing support money system (Japanese) (all accessed 13 August 2026).