Social Health Insurance Plan

The Social health insurance plan is one of the major plans of the Japanese public medical insurance. It is generally assumed as more favorable for the insureds than anothoer plan. The major benefits is to enable the insureds to visit a doctor or to buy designated medicine by paying only 30% og the medical expenses. This is common to another plan, but the Social health insurance plan provides a little wider viariety of servicies to the insureds.

There are 2 types of insurers for this plan. One is The Social Health Insurance Unions(Kenko Hoken Kumiai 健康保険組合) and the other is the Health Insurance Association of Japan(Zenkoku Kenko Hoken Kyokai 全国健康保険協会). The former are established mainly by big groups of private companies. The latter is a public body, affiliated by the Minstry of Health, Labour and Welfare. The insurance plan run by it is called "KYOKAI KENPO 協会けんぽ". It is usually not a major concern for the insureds which type of the insurers cover them. There are very few and minor differences by the types of the insurers.

The Social Health Insurance Plan covers regular workers at applicable offices. Non-regular workers at certain large companies has become qualified as the insureds. The insureds join the Social health insurance plan via their employers. Therefore, when an insured quits his/her job at the working place, he/she is supposed to be excluded from the Social health insurance plan and be enrolled in the National Healrh Insurance plan. But, in this case, he/she can claim to remain insured for 2 more years after leaving the company, by an appropriate applicatin within 20 days from the date of leaving the company. This special treatment is called as "voluntary continuing enrollment". A considerable number of people, who regard the Social health insurance plan as more favorable than another, submit the claim.

Certain dependents of the insureds are also coverd by the Social Health insurance plan. The qualified dependents are exempt from paying premiums. This is a large advantage of this plan for the insureds and their families. Regarding this point, the requirements for people living abroad to be qualified as the eligible dependents has become very strict since April 2020. This revision causes a disadvantage for foreign people coming to work in Japan. Only those who obviously have a domicile in Japan, such as students staying abroad to study for several months, are contiuniously covered.

〔In Japanese〕

社会保険は、日本の公的医療保険の一種です。一般に、社会保険は、国民健康保険よりも加入者に有利であると考えられています。 その中核的なメリットは病院にかかったり、薬を買ったりする際の医療費の負担が3割で済むことです。 これ自体は国民健康保険と同様ですが、社会保険には、この他に、いくらか幅広い給付を備えたものとなっているのです。

社会保険制度の保険者には、健康保険組合と全国健康保険協会との2種類があります。健康保険組合は主に民間の大企業グループが結成したもので、全国健康保険協会は公的機関です。 全国健康保険協会によって運用されている保険制度を「協会けんぽ」と呼んでいます。 しかし、通常の場合、どちらの保険者の下で社会保険に加入しているかは、その加入者にとって重大な関心事ではありません。加入者にとって、ほとんど相違はないからです。



Enrollment Procedures

The procedures for the enrollment in the Social Health Insurance plan shall be conducted by the employers. Most companies have to join the Social Health Insurance plan with a few exceptions. The eligible companies are required to properly judge whether their employees are qualified as the insureds of the plan, and whether the dependents of the insureds are accepted as the qualified dependents. Depending on the judgment, the companies have to take enrollement procedures on behalf of the employers accordingly. The individual insureds do not have to do any painful work for it. What they have to do is only to fill out some documents following instructions by the employers.

Notwithstanding the mandatory procedures mentioned above, some employers omit them by accident or intentionally. In some cases, the employers are simply not experienced in such desk works. But, there are more serious cases. To have their employees join in this plan raises a large financial burden on the employer, as I tell in the following chapter. Therefore, there are comapnies which yield to temptation to ignore the obligation. Maybe, I guess it is difficult for you, as an employee, to change your employer's mind.

〔In Japanese〕


ところで、先述した加入手続きの規定があるにも関わらず、故意あるいは過失によって、必要な加入手続きを行わない雇い主もいます。単に、雇い主がこのような事務作業に慣れていない場合もありますが、より深刻な場合もあります。 次章で述べる通り、一般的に、従業員を社会保険に加入させることは、その雇い主にとって大きな経済的な負担となります。このため、小さな会社において、この負担を免れたいとの誘惑に駆られることは、必ずしも珍しいことではないのです。 しかし、一従業員である貴方にとって、雇い主の考えを改めさせることは難しいかもしれません。

Insurance Premiums

The premiums of the Social Health Insurance plan is calculated solely based on your salaries and bonuses, while the premiums of the National Health Insurance plan are calculated variously on different kinds of calculation elements. This is one of the most important differences between these 2 plans.

And the Social Health Insurance premiums are borne by the employers to the half. So, generally speaking, the burden on the insureds are less than that on the National Health Insurance plan insureds, even when the both get earnings at the same level. In other words, the employers are made to bear the burden, which is never light especially for small companies. This is the reason why some employers try to escape this plan.

Concretely speaking, the insurance premiums of this plan are decided according to the calculation table prepared by the insurer. The premiums amount can vary by the insurers, but only very little. If you are insured by the Health Insurance Association of Japan, living in Tokyo, the premium rate after March 2021 is 9.84%. The half of it, 4.92%, is borne by the individual insureds. The another half is borne by the employers. The premiums are settled monthly. The premiums for a month shall be deducted from the monthly salary paid in the next monthl and paid at the end of the month by the employers to the insurer's offices.

〔In Japanese〕


そして、社会保険の保険料は、その雇い主によって半額が負担されます。このため、一般的に社会保険制度の加入者個々人の負担は、同程度の所得水準にある国民健康保険の加入者に比べ小さくなります。 逆に言えば、雇い主がその負担をしているわけです。この負担は、特に小規模企業において、決して軽いものではありません。 このことから、社会保険制度への加入を嫌う雇い主がでてくるわけです。

具体的には、社会保険の保険料額は、その保険者によって策定された料率表に従って算定されます。保険者によって保険料に差がでることがありますが、その差は僅かです。 東京に住む、協会けんぽの加入者の場合には、2021年3月以降の保険料率は9.84%となっています。この半分の4.92%が被保険者個々人によって負担され、残余の半分は雇い主が負担します。保険料は月単位で納付されます。ある月分の保険料はその翌月の給与から天引きされ、その月末に雇い主から保険者に納付されることになっています。