Health Insurance

[chibaka]

Hello girls and boys, new member here. Not new in bizzaroland however.
Question about the shitty office health insurance. When I came here first I had company insurance, then when cirkumstances changed I joined my wife's company plan. I know, I know, sound like a bum..
Anyway, after more than a few conversations and a few claims... I want to think about the Japanese system, so is there a rough guide on how much it will hurt my wallet? I've never paid this insurance, nor the dreaded already bankrupt pension....

So how much? Good idea? Bad idea? pros and cons?

Thanks in advance

[Russell]

Welcome here!

A couple of decades ago I read that as long as you are not in, you are free to join any foreign health insurance. Once you were in the national health insurance, though, you couldn't get out.

I don't know whether that changed in the mean time; some others here may be able to tell you. In the worst case you may have to pay back-charges once you decide to eventually join, even if you were insured with some foreign company before.

Whether it is a merit to be in the national system depends also on your health. One member here (Taro Toporific) is said to stay in Japan because he cannot afford to join the US health insurance. If you are healthy, it may not be so economic to join. I guess it also depends on how long you plan to stay here in Japan.

[chibaka]

Thanks for the reply, all insurance to date has been Japanese company plans, so I wouldn't think there would be any back claims.
Haven't considered the foreign insurance plans, I imagine lots of tooth sucking should I present that card when seeking treatment, especially living in the inaka... still get stared at for the crime of wearing a different face here, being double the average size doesn't help.

As a Brit, I'll never criticize the NHS again

[Samurai_Jerk]

Thanks for the reply, all insurance to date has been Japanese company plans, so I wouldn't think there would be any back claims.
Haven't considered the foreign insurance plans, I imagine lots of tooth sucking should I present that card when seeking treatment, especially living in the inaka... still get stared at for the crime of wearing a different face here, being double the average size doesn't help.

As a Brit, I'll never criticize the NHS again

If you're talking about the company plans that are required by law for full-time employees, the benefits won't change if you join Japanese NHS (kokumin hoken) so there's no advantage. The disadvantage is that you'll have to pay the whole premium yourself. Besides, if you're on one of those plans, you're already in the national system.

[Taro Toporific]

Question about the shitty office health insurance. When I came here first I had company insurance, then when cirkumstances changed I joined my wife's company plan....
Anyway, after more than a few conversations and a few claims... I want to think about the Japanese system, so is there a rough guide on how much it will hurt my wallet?

Gomi-Girl uses/used foreign health insurance and she seems to have saved a lot of money.

Let's say you are 30 years old, Japanese health will cost at least 40,000 yen/m in the higher income brackets and I assume that a foreign health insurance will be only 25,000-32,000 yen. Back in when I was in my 30s with a job at Hitachi in a decent pay range, Japanese health only cost me 33,000-36,000yen/m because the company paid part of the amount. I me this seems a bargain compared to upcoming Obamacare estimate of basic health at $270 to $550/m for the best coverage. (Obamacare still a long way from functioning.)

However, using Japanese Health Insurance will make claims much easier to collect on than a foreign health insurance plan. As you have learned with foreign insurance, you pay 100% of the costs and wait-for-Godot to maybe collect reimbursement (denied claims happen more often since foreign insurance companies know they can screw you around). Japanese Health cannot "deny" claims, they just pay (and sort out medical fraud on their own and not very well).

Whether it is a merit to be in the national system depends also on your health. One member here (Taro Toporific) is said to stay in Japan because he cannot afford to join the US health insurance. If you are healthy, it may not be so economic to join. I guess it also depends on how long you plan to stay here in Japan.

Yep, I have lived in health insurance exile since 1980.
As paraplegic in the USA I was denied almost all claims under the "prexisting conditions" loophole, and my monthly premium was well over $1,800/m (178,551 yen per month!). In comparison for me, Japanese health insurance is almost free and because I am handicapped there's no deductible---I walk out of the doctors and the pharmacists without having to pay one yen.

[Coligny]

Also, i don't remember kids paying much of anything for healthcare...

[chibaka]

Thanks for the insights, enlightening. I'll check out more next time I have the displeasure of meeting the city office drones.

[wangta]

Question about the shitty office health insurance. When I came here first I had company insurance, then when cirkumstances changed I joined my wife's company plan....
Anyway, after more than a few conversations and a few claims... I want to think about the Japanese system, so is there a rough guide on how much it will hurt my wallet?

Gomi-Girl uses/used foreign health insurance and she seems to have saved a lot of money.
Yep, I have lived in health insurance exile since 1980.
As paraplegic in the USA I was denied almost all claims under the "prexisting conditions" loophole, and my monthly premium was well over $1,800/m (178,551 yen per month!). In comparison for me, Japanese health insurance is almost free and because I am handicapped there's no deductible---I walk out of the doctors and the pharmacists without having to pay one yen.

So Taro, you are in a wheelchair? Good on you for having the skills and savvy to be in Japan then if it's so damned tough to be in that position in the US.
I haven't signed up for the national health insurance yet despite being in Japan for about 3 months. I did have it before when I lived elsewhere in this island nation but that was some time ago. I haven't got a summons yet from the city hall tho I went there to show them my new alien card given to me when I arrived in Japan.
I don't have any desire to pay the around 25,000 yen per month I paid after the first year when I was in Japan first time for health insurance that I didn't use for 5 plus yrs. Not once. And the system doesn't give you any kind of discount or money back if you never use your health insurance. That sucks deeply.
I also believe if you venture down to city hall to sign up for the NHI then they will tack on the Pension as well. I am talking about Kokuminkenkohoken. I believe it is now compulsory to join both together.
Before anybody slags me off for not wanting to pay the pension, I should point out that when I was in Japan the first time I was told I had a choice and so didn't pay it.
Can anybody tell me what is the likelihood of City Hall telling me to come in and sign up for both? I had to go there with my boss first time back but fortunately I had left my passport behind and they said come back another day.

[Samurai_Jerk]

Before anybody slags me off for not wanting to pay the pension, I should point out that when I was in Japan the first time I was told I had a choice and so didn't pay it.
Can anybody tell me what is the likelihood of City Hall telling me to come in and sign up for both? I had to go there with my boss first time back but fortunately I had left my passport behind and they said come back another day.

Who ever told you that you didn't have to join was either mistaken or lying. It's compulsory. A lot of employers, especially in the eikaiwa industry, do (or at least used to) lie about that because they don't want to pay their half which they're legally required to do.

There is strong likelihood you'll get something in the mail someday telling you you need to sign up. If you don't, they could go after your bank account though I don't think that happens very often. There was also some talk about making it a requirement to be enrolled for visa renewals and status changes.

[canman]

Chibaka, how long have you been in Japan will decide how much you have to,pay in back payments. When I first came to Japan 20 years ago my company informed us that they provided us with health insurance, so I didn't think anything of it. Although it was a pain in the ass going to the hospital, paying cash and then getting reimbursed. Also the dirty looks I would get when the staff at the hospital would ask for my "hokensho" made me feel a bit like an outcast. Anyway, when I left the company and decided to join the national insurance system I went to the city hall and asked to join. They looked up my file and said," oh you've been here 7 years but you never joined, why" I told them that my company provided insurance, but I was told that I was supposed to join the Japanese system regardless.
Then they looked at my salary and informed me that I had to pay ¥400 000 in back payments. I got up and walked, and thanks to GG, joined Global health, and used them for a few years. But even that became troublesome after 9/11, getting reimbursed through your credit cards.In a strange twist, I needed up getting sick and spending two weeks in the hospital, the bill came to a little over ¥400 000, and in a real stroke of luck, my student being our member of parliament got one,of her supporters who worked in the accounting department of the hospital make it look like Imhad paid the cash as a back payment, when in fact it was the insurance company.
Since then I have been a member of the national health service, but I still have my own private pension, I haven't joined the national system. But the bastards got my email, and I get email telling me to join monthly!

[wangta]

Who ever told you that you didn't have to join was either mistaken or lying. It's compulsory. A lot of employers, especially in the eikaiwa industry, do (or at least used to) lie about that because they don't want to pay their half which they're legally required to do.

There is strong likelihood you'll get something in the mail someday telling you you need to sign up. If you don't, they could go after your bank account though I don't think that happens very often. There was also some talk about making it a requirement to be enrolled for visa renewals and status changes.

Sorry, I didn't make it clear who told me - it was my first city hall. Honest. I was in Japan first time around quite some time ago when nenkin was not attached to the national health insurance with no exceptions. I was given the choice to join or not join the pension system and I didn't.

My boss wasn't pulling a swifty - they were with me when we were talking to the official and they definitely weren't saying any bullshit. The city hall official at the desk definitely said I could opt in but it wasn't compulsory. Same at many other places at that time. It depended on your prefecture.

Some yrs later when I left Japan, I hadn't paid the health insurance per month for some time. I think I was 6mths in arrears. I suppose they could bail me up for it now but I don't know if they backcharge you for missing 'self employed' hoken payments.

I did not use the J health system once my entire time in Japan, and so was not one of those gaijin who let payments slip but still use their healthcare booklet when they go to the doctor. I still think the lack of some kind of refund or discounted payments for those who never use the system but pay a monthly payment of around 25,000 yen over a number of yrs is not the way to do things.

And I do understand that healthcare is very expensive in some other countries but I honestly paid less than that in my home country for private coverage - and if I'd gotten really sick the way one of my family members did and had major surgery when I was living back at home I would have owed less than 300 bucks for the surgery and time spent recuperating there including in a private room with all meals and everything else provided. The J national health insurance isn't that good for the payments from those on a very ordinary income.

[gaijinpunch]

Pros: No re-imbursement system or mystery charges when you're on J-NHS.
Con: You cannot (simply) remove yourself and switch. They will back-charge you effective when your visa took effect. This can be painful.

If your'e going to live here for X amount of time and you know you won't need international insurance, then NHS is probably not a bad thing. If you might need coverage abroad at any time while you live in Japan, not being on NHS is going to make your life a whole lot easier.

As paraplegic in the USA I was denied almost all claims under the "prexisting conditions" loophole,

Will Obama-care fix that?

[chibaka]

Chibaka, how long have you been in Japan will decide how much you have to,pay in back payments.

I have always been in a company plan (which I understand somehow includes national health), either my own or my wifes, so why on earth would I need to back pay for some other policy? I have been covered with Japanese insurance from day one.

I still think the lack of some kind of refund or discounted payments for those who never use the system

If you drive a car and don't crash, do you ask for your insurance contributions back? Insurance is what it is, to cover your ass in case of unfortnate circumstances.

IF I consider the national system, the only sitution I can foresee in which I would want to get out again, is joining a company plan (need a new job), or leaving Japan

[canman]

I have always been in a company plan (which I understand somehow includes national health), either my own or my wifes, so why on earth would I need to back pay for some other policy? I have been covered with Japanese insurance from day one.
I could be wrong, but you are thinking that if you were covered by your wive's plan, then you didn't have to pay.
If you were working and earning a salary, then you are expected to pay. If you were sitting at home, or working without reporting it, then that is a different story.
Also at first you told us you had company insurance, are you sure it was national health insurance? Or was it private insurance?Again, if it was not national health insurance the gov't doesn't care, they will make you pay back what you should have for at least two years!

[chibaka]

So let me get this straight, hypothetical situation:
Salaryman joins a company and with it gets an insurance card, covers all health (minus of course the 30%). Salaryman after 20 years for whatever reason leaves the company and is unemployed. He tries to join the national scheme and is asked to pay back twenty years?

Even in this fucked up country I can't believe thats the case. As far as I'm aware, you have either national scheme or company scheme. Company scheme if I recall correctly, is somehow linked with national, someone may corrrect this if it is wrong.

I worked XX years and had company insurance. I was made unemployed, so as my earnings became below a certain threshold, my wife was was able to add me on to her plan, an addition for which she pays. My earnings will be over the acceptable threshold, therefore I should consider alternatives. Never in the time here have I had anything free, either I paid, or she did.

Back payment is a complete non starter as far I as am aware. Last time I asked, the only condition shitty office had was, if I join, it would be calculated at the PREVIOUS YEARS salary, which was the year I left the company and took a payout. Fuck that, it was huge.....

[Samurai_Jerk]

Sorry, I didn't make it clear who told me - it was my first city hall. Honest. I was in Japan first time around quite some time ago when nenkin was not attached to the national health insurance with no exceptions. I was given the choice to join or not join the pension system and I didn't.

Regardless of who told, they were wrong. A lot of the city offices in the past didn't know the rules themselves and told people it was optional or even refused to let them join. However, the central government doesn't care about that.

I still think the lack of some kind of refund or discounted payments for those who never use the system but pay a monthly payment of around 25,000 yen over a number of yrs is not the way to do things.

[Samurai_Jerk]

So let me get this straight, hypothetical situation:
Salaryman joins a company and with it gets an insurance card, covers all health (minus of course the 30%). Salaryman after 20 years for whatever reason leaves the company and is unemployed. He tries to join the national scheme and is asked to pay back twenty years?

No one is saying that. What people are saying is that if you're on private insurance that's not part of the system you may be asked to make back payments. If you're using company insurance that's part of the system, you won't be. You haven't been very clear about which you're on.

[chibaka]

You haven't been very clear about which you're on.

No idea, do large (read huge) multinational companies avoid the national insurance contributions and potentially leave employees in the shit?

I'm assuming not, although I will ask the wife before I take the plunge obviously. For the purposes of this investigation I will assume the national system requirements have been fulfilled.

[canman]

Please read the end of my last post. I said up to two years prior. I'm not trying to bust your balls or anything, just telling you what I experienced.
I think you really need to find out what kind of insurance you had before. If you had a blue or pink colored paper card, with your name, address(as the hokensho is also one of the main forms of ID in Japan) then you were probably enrolled in the national system. It should also state your birthdate, and when you came to Japan, as well as an expiration date.

[chibaka]

Right, well the first card is long gone, and my memory cells are fading. However the card I have now, which is identical to my wifes (I think, she's not here at the mo) has my name, date of birth, and her company name as they issued it. Never get questioned when I present it anywhere.

Still can't see that she or I would be liable for backpayment, should we ever join the national plan, but then sometimes I have to remind myself where I live, and that normal logic just doesn't cut it

[Samurai_Jerk]

Right, well the first card is long gone, and my memory cells are fading. However the card I have now, which is identical to my wifes (I think, she's not here at the mo) has my name, date of birth, and her company name as they issued it. Never get questioned when I present it anywhere.

Still can't see that she or I would be liable for backpayment, should we ever join the national plan, but then sometimes I have to remind myself where I live, and that normal logic just doesn't cut it

If you have a plastic card that's been issued by the company that you just present at the hospital every time you go and are automatically covered and only have to pay the 30% difference, you're are in the system.

[canman]

Chibaka, are you working right now? If you aren't then you could be covered by your wife's insurance. Just as a wife would be covered by her husband's insurance if she was a stay at home Mom. I think where it might get murky, is that if you decide to get a job, or then apply for your own insurance, they might look at you as being the main bread winner and expect you to pay in arrears.
One other question, if your wife has insurance, and you are covered by it, and have had no problems, why are you thinking of joining for yourself. You said it sounds like you are a bum, but what about all the wives out there that use their husband's insurance.
If you are covered, I would forget about trying to join yourself!

[chibaka]

If you have a plastic card that's been issued by the company that you just present at the hospital every time you go and are automatically covered and only have to pay the 30% difference, you're are in the system.

Thank you Samurai, thats exactly what happens, so I'm in

I think where it might get murky, is that if you decide to get a job.

Yes I do work, and fortunately my earnings are somehow always at a level where I can be included in my wifes policy
The reason for my question is simply if either of our situations change, I maybe forced into it.

And as this is Japan, with all the tooth sucking and arse scratching that accompanies the simplest of tasks, forewarned is forearmed.

I appreciate your comments

[wangta]

Sorry, I didn't make it clear who told me - it was my first city hall. Honest. I was in Japan first time around quite some time ago when nenkin was not attached to the national health insurance with no exceptions. I was given the choice to join or not join the pension system and I didn't.

Regardless of who told, they were wrong. A lot of the city offices in the past didn't know the rules themselves and told people it was optional or even refused to let them join. However, the central government doesn't care about that.

I still think the lack of some kind of refund or discounted payments for those who never use the system but pay a monthly payment of around 25,000 yen over a number of yrs is not the way to do things.

I'm not trying to be smart with you - the evidence points to now gaijin are being sucked into the Govt's embracing of retrospective payments and penalties for actions that up to about 2005 or so were fine. I know you've been here for a fairly lengthy time but I can tell you that the pension part of kokuminkenkohoken was voluntary in many prefectures in the year 2,000 and for some time until relatively recently.

Yes, it may have been a case of a rule not being enforced but the fact is, in different prefectures many ward offices gave the gaijin the option of joining or not. I am sure that was because shakai hoken was different - the employer paid half. It was seen by my old city hall as the gaijin's choice because we were not getting any subsidy from their employer even though we were working full time as Engrish teachers. Ward offices knew the game of underplaying the the teachers' hours was going on with kokuminkenkohoken.

The foreigners MUST pay the pension rule has been presented as the only option Japan wide over the last few years. I have friends who left Japan 5 yrs ago and they were in the same boat - they were given the option to join or not some years before and when they checked with their ward offices again it was the same answer, no, on kokuminkenkohoken you have a choice. Shakai hoken you don"t as you are getting subsidised by your employer.

The numbers of Japanese refusing to join or pay into the system andof course the fact that the J govt like every other govt in the world has wasted untold billions on crap and perks for politicians and their cronies/interest groups is why we are now being forced to pay. The retrospectivity is not a previous practice re gaijin generally - only with the health insurance did you have to do the back pay if you stopped paying. As for the idea that if you NEVER use your health coverage in 5 plus years after paying a total of around 300,000 yen per year for 5 yrs and it's laughable to ask for a certain level of discount or whatever - that's the way some private funds operate in a no. of countries and it's not laughable.

Your premiums go down just as they would in reverse go up if you are a smoker or have some pre existing conditions. Or you receive some special service for free or at a discounted price. In Korea my national health contributions stayed at the same level over some years because like in Japan, I never once used the system.

[Samurai_Jerk]

Sorry, I didn't make it clear who told me - it was my first city hall. Honest. I was in Japan first time around quite some time ago when nenkin was not attached to the national health insurance with no exceptions. I was given the choice to join or not join the pension system and I didn't.

Regardless of who told, they were wrong. A lot of the city offices in the past didn't know the rules themselves and told people it was optional or even refused to let them join. However, the central government doesn't care about that.

I still think the lack of some kind of refund or discounted payments for those who never use the system but pay a monthly payment of around 25,000 yen over a number of yrs is not the way to do things.

I'm not trying to be smart with you - the evidence points to now gaijin are being sucked into the Govt's embracing of retrospective payments and penalties for actions that up to about 2005 or so were fine. I know you've been here for a fairly lengthy time but I can tell you that the pension part of kokuminkenkohoken was voluntary in many prefectures in the year 2,000 and for some time until relatively recently.

Yes, it may have been a case of a rule not being enforced but the fact is, in different prefectures many ward offices gave the gaijin the option of joining or not. I am sure that was because shakai hoken was different - the employer paid half. It was seen by my old city hall as the gaijin's choice because we were not getting any subsidy from their employer even though we were working full time as Engrish teachers. Ward offices knew the game of underplaying the the teachers' hours was going on with kokuminkenkohoken.

The foreigners MUST pay the pension rule has been presented as the only option Japan wide over the last few years. I have friends who left Japan 5 yrs ago and they were in the same boat - they were given the option to join or not some years before and when they checked with their ward offices again it was the same answer, no, on kokuminkenkohoken you have a choice. Shakai hoken you don"t as you are getting subsidised by your employer.

The numbers of Japanese refusing to join or pay into the system andof course the fact that the J govt like every other govt in the world has wasted untold billions on crap and perks for politicians and their cronies/interest groups is why we are now being forced to pay. The retrospectivity is not a previous practice re gaijin generally - only with the health insurance did you have to do the back pay if you stopped paying.

You seem to be trying to disagree with me even though I'm not disagreeing with you.

As for the idea that if you NEVER use your health coverage in 5 plus years after paying a total of around 300,000 yen per year for 5 yrs and it's laughable to ask for a certain level of discount or whatever - that's the way some private funds operate in a no. of countries and it's not laughable.

Your premiums go down just as they would in reverse go up if you are a smoker or have some pre existing conditions. Or you receive some special service for free or at a discounted price. In Korea my national health contributions stayed at the same level over some years because like in Japan, I never once used the system.

The system is what is. Other people's non compliance or government waste isn't an excuse. If you don't like it, don't live here.

[wangta]

The point of my relating the background to ward offices allowing gaijins in the past not to pay the pension component of the kokuminkenkohoken is that it was not even a solid rule until relatively recently. It was at the discretion of different ward offices in different prefectures - the whole retrospectivity now is simply a cash cow. Yes, we have to pay it now by what is being enforced at this present time and has been for the last few years at least.

Oh please, the old 'If you don't like it, go home, don't live here'............... I know I am a new poster but I've been a lurker for a while and I don't recall people telling you that when you gripe about something which you and everybody inevitably does at some time on a forum.

And you missed the point - irrespective of whether Japan does it or not, some other countries do have health insurance that acknowledges you when you don't use the system and gives you something back whether it be premiums that are reduced for the next year or stay the same even while those who use the system's regularly are rising. Pointing this out to you to let you know the idea is not laughable as you indicated is hardly equivalent to 'I shouldn't live in Japan'.

[Samurai_Jerk]

The point of my relating the background to ward offices allowing gaijins in the past not to pay the pension component of the kokuminkenkohoken is that it was not even a solid rule until relatively recently. It was at the discretion of different ward offices in different prefectures - the whole retrospectivity now is simply a cash cow. Yes, we have to pay it now by what is being enforced at this present time and has been for the last few years at least.

Oh please, the old 'If you don't like it, go home, don't live here'............... I know I am a new poster but I've been a lurker for a while and I don't recall people telling you that when you gripe about something which you and everybody inevitably does at some time on a forum.

And you missed the point - irrespective of whether Japan does it or not, some other countries do have health insurance that acknowledges you when you don't use the system and gives you something back whether it be premiums that are reduced for the next year or stay the same even while those who use the system's regularly are rising. Pointing this out to you to let you know the idea is not laughable as you indicated is hardly equivalent to 'I shouldn't live in Japan'.

I don't mind people bitching. I do mind people avoiding their legal obligation to pay taxes, social security, or NHI which you seem to want to do.

[Russell]

Well, if you don't use the system in Japan, the 30% bill you pay yourself is 0, so in that sense you get some kind of "discount"...

[wangta]

I don't mind people bitching. I do mind people avoiding their legal obligation to pay taxes, social security, or NHI which you seem to want to do.

Well, you wouldn't want to 'mind people bitching' as you do some of it yourself in these forums.

Actually when I came to Japan the first time around I didn't actually have to pay kokuminkenkohoken, either. I was given the option at my city hall of presenting to them evidence of enrolment in a private health insurance fund from my home country or joining the NHI. I joined the NHI as I was living in Japan.

Just because you've never heard of that doesn't mean it didn't happen, just like the choice to opt out of kokumin nenkin as a gaijin some time ago. I still dispute your statements that the pension has always been compulsory for gaijin - given the choice as some of us were in different prefectures says it all as schemes that are compulsory give no opt out choices.

I personally never objected to people doing what they felt was best for them re the health insurance and pension systems in Japan. As somebody who was part of the large contingent of Eikaiwa teachers who were working much longer hours than listed on our contracts so our employers could avoid paying shakai hoken, I understood and still understand why gaijin here object to being classed as 'self employed' so employers can avoid their obligations re the health insurance and the pension.

And yes, as somebody who never used the health system in either Japan or Korea I certainly didn't look forward to paying the large fees in Japan and the less costly fees in Korea. And I never went and got a prescription or subsidised medical treatment when my NHI was in arrears unlike some other people both gaijin and Japanese who take their card and do just that when they aren't keeping up payments.

Russell - true. Not having to use health insurance is a good thing. And I see nothing wrong with not wanting to enrol in it again in Japan as the pension will come attached regardless of the fact that I am going to have to do so. Seems Samurai is a case of 'You know you've been in Japan too long when you tell people if they don't like something...etc etc'

[gaijinpunch]

If you got your private health care offered by a Japanese company, you are most likely not going to have to back pay to the start of your visa. You are definitely going to have to back pay from the day your old company insurance became ineffective. If we want to make sure all of our i's and t's are dotted properly, technically you're supposed to have joined NHS within 2 weeks of your insurance not working. To boot, they say they may not pay for procedures that happen during this lapse (above 2 weeks).

The word they use for any acceptable insurance other than NHS is  公的な保険. If it's provided within Japan, you are most likely safe as a kitten (for the time you were covered). If it's international, you have to get a proof of insurance statement which is issued by the government... not the insurance provider.