Part of our Healthcare for Families in Tokyo guide. Last reviewed: October 2026.
Healthcare is one of the areas where Tokyo is genuinely more generous to families than the national default — but the extra benefit isn’t automatic. You have to know it exists and apply for it. This guide covers who has to enroll in health insurance, what you pay, how Tokyo’s child medical subsidy works, and what to do on your first ward-office visit.
Who has to enroll
Anyone living in Japan on a visa of three months or longer who is registered as a resident must be covered by public health insurance. There are two main routes:
- Employees’ Health Insurance (shakai hoken): if a parent is employed by a Japanese company or a foreign company’s Japanese entity, the family is usually covered through the employer. A spouse and children who are financially dependent can generally be added as dependents, typically without a separate premium.
- National Health Insurance (Kokumin Kenko Hoken, NHI): for everyone else — self-employed people, freelancers, students, and families whose employer doesn’t provide Japanese health insurance. You enroll at your ward office.
There’s no opt-out for a family living in Tokyo long-term. If you need NHI, enroll at the ward office within 14 days, alongside your address registration. Enrolling late doesn’t save money: premiums are generally charged back to the date you became eligible.
What NHI costs
NHI premiums are set by each ward and are based mainly on the household’s income in the previous calendar year, plus a per-person amount. In your first year, if you have no Japanese income on record, premiums are often low. They usually rise substantially once your Japanese income is assessed the following year. Ask the ward about reductions if your income is low, and use the ward’s premium estimate if one is published.
Adults aged 20 to 59 who aren’t enrolled in a pension through work are also generally required to join the National Pension at the same time. Ask about both at the same counter visit.
What standard coverage looks like
- Co-payment: under Japan’s public health insurance, patients generally pay 30% of medical costs. Children before compulsory school age pay 20%.
- High-cost medical care benefit: if your out-of-pocket costs in a single month exceed an income-based limit, the excess is refunded (or capped up front with the right certificate). This protects you from very large bills for hospital stays.
- Childbirth: public health insurance pays a childbirth lump-sum allowance to help with delivery costs, which are otherwise not covered as routine medical care.
Where Tokyo goes further: the child medical subsidy
On top of insurance, Tokyo’s municipalities run a child medical expense subsidy that covers the co-payment for children’s insured medical care. In Tokyo’s 23 wards, it covers children until the end of the March after they turn 18, with no income limit. It comes as a separate certificate, issued by age:
- Maru-nyū (乳) — infants and preschool children
- Maru-ko (子) — elementary and junior high school age
- Maru-ao (青) — high school age
The certificate is not issued automatically with your insurance card. You apply at the ward office, usually at the same visit where you register your address and enroll in insurance. Show it at the clinic together with the child’s insurance card. Some details — such as small per-visit charges for high-school-age children in some municipalities outside the 23 wards — vary by area.
What’s not covered: things outside insured care, such as hospital meal charges, private-room fees, document fees, and non-insured treatments or vaccinations.
Using the certificate outside your ward
If you see a doctor somewhere the certificate isn’t accepted (for example, outside Tokyo), you typically pay the normal co-payment and then claim a refund from your ward with the receipt. Keep receipts and the medical statement from the clinic.
Finding a pediatrician who speaks your language
English-speaking pediatric care exists in Tokyo but isn’t the default outside the most international neighborhoods. Clinics in and around Minato have the highest concentration of English-speaking doctors who also accept National Health Insurance. Ward offices in international-heavy areas also maintain windows for foreign residents, which are a good first stop if you’re not sure where to start.
Free checkups and vaccinations
Wards provide free routine infant health checkups at set ages and free routine (“statutory”) vaccinations. After registration, the ward usually sends vouchers or a booklet. If you arrive with a baby or young child, ask the ward’s health center how to enter your child into the local schedule, and bring vaccination records from home.
A practical first-visit checklist
- Register your address at the ward office (within 14 days of moving in)
- Enroll in National Health Insurance, or confirm employer coverage, at the same visit
- Ask for the child medical subsidy certificate — it will not be offered automatically
- Join the National Pension if required
- Ask the health center about checkups and vaccinations for young children
- Ask the foreign-resident window (where available) for a list of English-speaking pediatric clinics near you
The most common mistake newly arrived families make isn’t the insurance itself — it’s not knowing to ask for the child subsidy certificate. Put it on your list for the first visit.
FAQ
Does private international health insurance replace NHI?
No. If you’re a registered resident, you’re still required to join Japanese public health insurance. Some families keep private insurance as well for care abroad or private hospitals.
We have employer insurance. Do we still need the child subsidy certificate?
Yes. The subsidy covers the co-payment regardless of whether the child is on NHI or employer insurance. Apply for it at the ward office either way.
Are vaccinations covered by insurance?
Routine vaccinations on Japan’s statutory schedule are free through the ward. Optional vaccines (and some travel vaccines) are paid out of pocket.
Sources and official information
- Ministry of Health, Labour and Welfare — Annual Health, Labour and Welfare Report (English, PDF) — co-payment rates
- Inagi City (Tokyo) — Medical expense assistance for infants, children and high school students (English) — an example of how Tokyo municipalities run the maru-nyū, maru-ko and maru-ao subsidies
- Japan Pension Service — official website
This guide is general information, not medical or insurance advice. See our editorial policy.
