This article is written by a Japanese local.
When foreign expats arrive in Japan and join a company, there is usually a time lag (a blank period) of one to several weeks before their physical “Health Insurance Card” (Hokensho) is delivered. If you experience a sudden fever or injury and need to visit a hospital during this gap, you will be billed for highly expensive medical costs at the reception counter.
As a rule, Japanese medical institutions cannot apply health insurance coverage without the presentation of a physical insurance card. However, if you understand the rules of Japan’s medical infrastructure, even if you temporarily pay the full amount out-of-pocket, you can receive a refund (reimbursement) later through an objective administrative procedure. This article explains the practical steps to prevent medical cost troubles while uninsured and to properly recover your expenses.
1. The “Blank Period” and the Principle of 100% Out-of-Pocket Payment
[Summary] If you visit a doctor without your insurance card in hand, you are legally obligated to temporarily pay the “full amount (100%)” of the medical expenses, which can easily amount to tens of thousands of yen in cash.
If you are enrolled in Japan’s public health insurance system, your out-of-pocket payment at the counter is reduced to just a “30% co-pay.” However, even if your enrollment paperwork is being processed, if you cannot present the original physical insurance card (or MyNumber insurance card) on the day of your visit, the medical institution cannot verify your insurance status.
Therefore, as a temporary measure, the day’s medical costs will be billed as “100% (full) out-of-pocket payment.” You must be prepared for the objective fact that even a simple consultation for a cold and a prescription can result in an expensive cash payment of 10,000 to 20,000 JPY or more.
2. Objective Conditions for Utilizing the Post-Fact Refund System (Ryoyohi-barai)
[Summary] By presenting your insurance card and objective proof documents at a later date, you can execute the “Ryoyohi-barai” (Medical Expense Refund) procedure to get 70% of the advanced payment refunded.
Even if you pay the full 100% at the counter, as long as you legally met the qualifications for health insurance (e.g., your employment had started) on the day of the consultation, you can recover the “70% portion that insurance was supposed to cover” by completing procedures at a later date. Under the Japanese system, this is called “Ryoyohi-barai” (Medical Care Expense Payment).
For example, if you paid the full 10,000 JPY at the hospital, completing this procedure later will result in 7,000 JPY being deposited into your designated bank account. This is the greatest defensive system within Japan to ensure you do not suffer a permanent financial loss from high medical bills.
3. Defensive Procedure: Two Documents You Must Keep
[Summary] To receive a refund, the physical retention and submission of the “Original Receipt” and the “Medical Details Statement” issued on the day of your visit are absolute requirements.
The absolute practical condition for successfully claiming your medical expense refund is the retention of the documents issued by the medical institution. If you lack either of the following two items, you will not receive any refund at all.
- Receipt (Ryoshusho): The original receipt acting as objective evidence that you paid the medical expenses. Copies are not accepted.
- Medical Details Statement (Shinryo Meisaisho): A document detailing the exact tests and treatments performed, calculated in medical points.
Clearly tell the receptionist: “I am currently waiting for my health insurance card to be issued. Please make sure to give me the Receipt and the Medical Details Statement so I can process a refund later.” Receive them and store them safely in a clear folder so they are not lost.
4. Practical Q&A (Overseas Insurance and Claim Destinations)
[Summary] Direct billing with overseas travel insurance is generally not accepted at Japanese clinics. Refunds are processed at the “hospital counter” if within the same month, or via your “insurance association or city hall” if requested in a subsequent month.
Q. Can my overseas medical insurance or credit card travel insurance pay the hospital directly?
A. Basically, no. Small Japanese clinics and hospitals do not have direct billing networks with overseas insurance companies. Therefore, you must execute the practical procedure of temporarily advancing the full amount in Japanese Yen (cash) at the counter, and later sending the claim documents yourself to your Japanese health insurance association or your home country’s insurance provider.
Q. Where do I go to process the refund?
A. If your insurance card arrives “within the exact same calendar month” you visited the hospital, in most cases, simply bringing your insurance card and the original receipt back to the hospital’s reception desk will allow them to refund the difference (70%) in cash on the spot. However, if the calendar rolls over into the “next month,” the hospital can no longer process the refund. You must switch to the procedure of mailing a designated application form to your “Enrolled Health Insurance Association” (via your company’s HR) or the “City Hall” (for National Health Insurance).
Conclusion: Prioritize Proper Medical Care and Securing Documents Over Fear of Bills
Enduring illness and letting your condition worsen because you think, “I can’t go to the hospital because I don’t have my insurance card yet and I’m afraid of the full cost,” is the biggest infrastructure risk that can undermine your life in Japan. Even during the waiting period for your card, temporary out-of-pocket expenses are covered by the legal relief measure of post-fact refunds (Ryoyohi-barai). Do not hesitate to visit a medical facility; simply prioritize the objective defensive procedure of securing the “Receipt and Medical Statement” indispensable for your refund.