Japanese Health Insurance and Pension for Foreign Workers — Shakai Hoken Explained for SSW and Other Visa Holders

Once you start working in Japan, your salary slip will start showing big deductions for shakai hoken — Japan's combined social insurance system, mainly health insurance and employees' pension. For most full-time foreign workers including SSW (Specified Skilled Worker), engineers, intra-company transferees and technical interns, enrollment is mandatory by law, not optional.

This guide explains how Japan's shakai hoken works in plain English: who is enrolled, what each part does, how much you pay, what you get in return, how to add dependents (family) abroad or in Japan, what happens when you change jobs or leave Japan, and how to claim the pension lump-sum withdrawal when you go home.

What Is Shakai Hoken?

Shakai hoken is Japan's social insurance system. For full-time employees of qualified employers, it bundles five components, but as a worker you mainly see and pay for:

• Health insurance — covers most of your medical costs.
• Employees' pension — pays a pension when you retire, plus disability and survivor benefits.
• Long-term care insurance — only for people aged 40 and over; pays for elderly care in Japan.
• Employment insurance — pays unemployment benefits if you lose your job.
• Workers' accident insurance — covers work-related injuries; fully paid by the employer, not deducted from your salary.

Who Is Enrolled — and Who Isn't

Enrollment in employer-based shakai hoken (health insurance + employees' pension) is mandatory if your employer is a covered business and you work as a regular full-time employee. The standard rule for part-time workers is enrollment when you work 20 or more hours per week AND are expected to be employed for 2 months or more, in companies that meet the size requirement (which has been broadened over recent years).

Specifically:

• SSW (Specified Skilled Worker) — almost always enrolled, because SSW jobs are full-time direct employment by qualifying employers.
• Engineer / Specialist in Humanities / International Services — enrolled at any normal Japanese employer.
• Intra-company transferee — enrolled.
• Highly Skilled Professional — enrolled.
• Technical intern — enrolled.
• Spouse working part-time — enrolled if hours and other conditions are met; otherwise covered as a dependent.
• Self-employed / freelance / very small employers — not in employer shakai hoken; instead enrolled in National Health Insurance and National Pension through the local municipal office.

In general, foreign residents in Japan who are subject to the Japanese public health insurance and pension systems must enroll in the applicable scheme. Non-enrollment or unpaid premiums can negatively affect future visa renewals and permanent residence applications, depending on the case.

Health Insurance (Kenkou Hoken)

With your shakai hoken health insurance card, you pay only 30% of medical costs at most clinics, hospitals and dentists in Japan, with the insurance covering the other 70%. Children under elementary school age and adults aged 70+ have lower copays.

Major features:

• You can use almost any clinic or hospital in Japan, no referrals required for most visits.
• Prescription medicine bought at a pharmacy with a doctor's prescription is also subject to the same 30% copay structure.
• High-cost medical care: if your monthly medical bill exceeds an income-based cap, the excess is reimbursed (or, if you obtain a "limit application certificate" in advance, you don't have to pay it up front).
• Maternity covered with a flat-rate childbirth lump-sum currently around ¥500,000 per birth.
• Sickness allowance pays approximately two-thirds of your standard daily wage if you cannot work due to non-work-related illness or injury. There is a 3-day waiting period; the allowance is paid from the 4th day onward. Since the January 2022 amendment, the maximum total duration is a cumulative 1 year 6 months (not consecutive) — periods you return to work do not count toward the total.

Employees' Pension (Kousei Nenkin)

Kousei nenkin is the second-tier pension for employees. It includes the basic pension plus an additional employment-based component proportional to your salary.

Three main types of benefits:

• Old-age pension: paid from age 65 (currently). To qualify for the basic component you need 10 years (120 months) of total combined coverage in Japan's public pension. Foreigners can use a social security agreement with their home country to combine coverage periods (see below).
• Disability pension: paid if you become disabled while enrolled.
• Survivor pension: paid to qualifying family members if you die while enrolled.

Social security agreements with your home country

Japan has bilateral social security agreements in effect with 24 countries as of December 1, 2025: Germany, the UK, Korea, the United States, Belgium, France, Canada, Australia, the Netherlands, Czech Republic, Spain, Ireland, Brazil, Switzerland, Hungary, India, Luxembourg, the Philippines, Slovakia, China, Finland, Sweden, Italy, and Austria. (Note: the agreements with the UK, Korea, China, and Italy cover only avoidance of double premium payment, not combining of coverage periods for pension qualification.) These agreements:

• Depending on the agreement country, may allow combining coverage periods from Japan and your home country to qualify for either pension (totalization). Some agreements (UK, Korea, China, Italy) cover only the elimination of double premium payment and do not allow totalization.
• Avoid double payment of pension premiums for short-term workers temporarily sent between countries.

Vietnam, Indonesia, Myanmar, Nepal, Cambodia, Mongolia, Sri Lanka, and Bangladesh do not currently have a social security agreement with Japan in effect. (Note: Japan and Vietnam started government-level negotiations on a social security agreement in July 2025; an agreement is under discussion but not yet in force.) Workers from these countries who don't reach 10 years of contributions can claim the pension lump-sum withdrawal when leaving Japan instead.

How Much You Pay — Premium Calculation

Shakai hoken premiums are calculated from your standard monthly remuneration, which is set by your employer based on your base pay plus regular allowances. Bonuses are also subject to premiums separately.

Approximate rates (2026):

So your worker share is roughly 14–16% of your standard remuneration, with the same amount paid by your employer on your behalf. On a salary of ¥200,000/month, your monthly shakai hoken deduction is typically around ¥28,000–¥32,000.

What You Get — Benefits Overview

Adding Dependents (Family)

Your spouse, children and certain other family members can be added to your shakai hoken health insurance as dependents at no additional health-insurance premium. Dependents enjoy the same 30% copay as you do.

To qualify as a dependent, the family member must:

• Be related to you within the legally defined scope (spouse, children, parents, grandparents, siblings, etc., with rules on whether they live with you).
• Be financially supported mainly by you.
• Have annual income below the threshold (currently ¥1.3 million; or ¥1.8 million for those aged 60+ or with certain disabilities).

For dependents residing outside Japan, additional documentation is now required (proof of relationship and proof of remittances/financial support). Some narrow exceptions exist for students, spouses living abroad temporarily for the worker's job, and minor children. Check with your employer's HR or your insurance society for the latest rules.

For pension, dependents have a separate concept: a non-working spouse can be enrolled as a Category 3 insured person in the National Pension system at no extra premium, but this is generally available only for spouses residing in Japan.

If Your Employer Doesn't Enroll You: National Health Insurance & National Pension

If you are not eligible for employer shakai hoken (e.g., you're self-employed, work for a very small employer, or your hours are below the threshold), you must enroll in:

• National Health Insurance — through your local municipal office.
• National Pension — flat-rate monthly premium of ¥17,920 in FY 2026 (April 2026 – March 2027), per Japan Pension Service. The premium is reviewed annually.

National Health Insurance premiums are calculated based on your previous year's income plus a per-person component. They can feel high for new arrivals because the household base assessment uses prior-year data; many municipalities offer reductions for low-income or new-resident cases — ask at the ward office.

Coverage and benefits are similar to employer health insurance (30% copay, high-cost medical care, etc.), but there is no sickness allowance and no maternity leave allowance, and pension benefits are limited to the basic National Pension level (no employment-based top-up).

When You Change Jobs

If you switch from one full-time employer to another with no gap, your shakai hoken simply transfers:

1. Your old employer files a loss of qualification notice.
2. Your new employer files an acquisition of qualification notice.
3. You return your old health insurance card and receive a new one within a few weeks.

If there is a gap between jobs (you've quit but haven't started the new job), you have several options:

• Continued enrollment in your former employer's health insurance for up to 2 years — you pay both halves yourself, but you keep the same plan.
• National Health Insurance + National Pension via your local ward office for the gap period.
• Become your spouse's dependent if your spouse is enrolled in shakai hoken and your income meets the dependent threshold.

When You Leave Japan — Pension Lump-Sum Withdrawal

If you have paid into Japanese pension for at least 6 months and you leave Japan permanently without qualifying for a Japanese pension (and your home country does not have a totalization agreement that lets you combine your years), you can claim a pension lump-sum withdrawal.

Key points:

• Must apply within 2 years of leaving Japan.
• Amount is calculated based on your average standard remuneration and the number of months you contributed. The maximum number of months counted in the calculation is currently 60 (5 years), provided your final coverage month was on or after April 2021. (The government has decided to raise this cap from 5 years to 8 years (96 months) in line with the Ikusei Shuro program; implementation date to be announced.)
• 20.42% income tax (and reconstruction surtax) is withheld at source from the Employees' Pension portion of the lump sum; the National Pension portion is not subject to withholding. You can recover all or part of the withheld tax by appointing a tax representative in Japan before leaving and filing an application for refund under the "selective taxation as retirement income" procedure within 5 years of receipt.
• If you were enrolled in National Pension as a Category 1 insured person, a separate National Pension lump-sum withdrawal may also be available under the same requirements. (Note: National Health Insurance does not have a lump-sum withdrawal system — only pension does.)

For detailed steps, see our separate guide on the pension lump-sum withdrawal system.

Common Issues and Fixes

Issue: "My employer says they don't do shakai hoken"

Fix: If you are a full-time employee at a covered business, this is illegal. Talk to the Japan Pension Service or your local Pension Office, or contact a labor consultation hotline (see our separate guide). The employer can be ordered to enroll you retroactively.

Issue: "My salary deduction looks higher than expected"

Fix: Standard monthly remuneration is set in April–June each year and applied from September. If you got a raise or worked many overtime hours then, your premiums for the rest of the year will be based on that higher figure. Ask HR for the standard remuneration sheet.

Issue: "I don't have a My Number yet but the employer wants to enroll me in shakai hoken"

Fix: You can usually still be enrolled. Once you register your address at the ward office, your My Number will be assigned automatically. Provide it to HR as soon as you have it.

Issue: "Can I add my parents living overseas as health-insurance dependents?"

Fix: Sometimes, but the rules tightened a few years ago. You'll need to prove the family relationship and prove ongoing financial support (typically by remittance records). Check with your insurance society for the current document checklist.

Frequently Asked Questions

Summary

Shakai hoken is a big chunk of your monthly deductions, but it's also one of the most valuable parts of working in Japan: cheap and high-quality healthcare for you and your family, real protection if you get sick or injured, and pension contributions that either become a Japanese pension or come back as a lump sum when you leave. Understanding how it works helps you plan your finances, protect your visa status, and make smart decisions about staying in Japan long-term or returning home.