This article is written by a Japanese local.
Even after a foreign employee successfully joins the company and HR completes the enrollment process for Social Insurance (Health Insurance and Employees’ Pension), you cannot immediately relax. From the date of joining, there is typically a time lag of 1 to 3 weeks before the physical plastic “Health Insurance Card (Hokensho)” actually reaches the employee’s hands.
During this “blank period without a card,” it is a frequent occurrence for the employee or their accompanying children to require a sudden hospital visit due to a fever or injury. If they go to the hospital counter without an insurance card, the medical expenses will be charged at “100% (full out-of-pocket cost).” Faced with exorbitant bills, foreign employees often fall into a panic. This article explains objective defense procedures to eliminate the financial risks during this gap period and ensure they receive medical care legally and smoothly.
1. Why Does the “Insurance Card Gap Period” Occur?
[Summary] Due to the physical time required for processing at the Pension Office and postal delivery, a time lag between the date of hire and the arrival of the card is inevitable.
Even if the company submits the “Notification of Acquisition of Qualification” to the Pension Office to coincide with the employee’s start date, the process takes at least one week. This is because it involves physical steps: data entry by the Pension Office, printing the card, mailing it to the company, and handing it to the employee. Especially in April or October, when many new graduates and hires join, waiting nearly three weeks is not uncommon.
The crucial gap here is that “although the legal validity of the health insurance begins on the date of hire, the card proving it is not yet in hand.” Without physical proof, hospital counters will generally refuse to apply the insurance calculation (which reduces the patient’s burden to 30%).
2. Issuing a “Certificate of Qualification” to Prevent 100% Payment
[Summary] If there is a high likelihood of a hospital visit right after joining, having the Pension Office issue a “Certificate of Health Insurance Qualification” is the strongest defense.
In cases where it is highly likely the employee will visit a hospital before the card arrives—such as if they need medication for a chronic condition or are accompanied by small children—HR managers should apply to the Pension Office for a “Certificate of Health Insurance Qualification (Kenko Hoken Hihokensha Shikaku Shomeisho)” simultaneously with the enrollment procedures.
This certificate is an official paper document stating, “The insurance card has not yet been issued, but this person is undoubtedly enrolled in health insurance.” By presenting this at the hospital counter, they can receive medical care at the “30% co-pay” rate from the start, even without the actual card. The application is free, and if requested directly at the Pension Office counter, it is issued on the same day. This is the most effective approach to alleviate the employee’s financial burden and anxiety.
3. “Reimbursement” Procedures If Forced to Pay 100%
[Summary] By filing an “Application for Medical Care Expense Reimbursement” after the card arrives, you can recover the 70% overpaid at the counter.
Even if a sudden nighttime fever prevents the timely issuance of the certificate and the employee is forced to pay “100% of the cost” at the hospital, there is no need to panic. The Japanese health insurance system provides a mechanism called “Medical Care Expenses (Ryoyohi)” to reclaim the difference later.
- Step 1: Always Obtain the Necessary Documents at the Hospital
Instruct the employee that when paying 100% at the counter, they must request and strictly keep two documents: the “Receipt (Ryoshusho)” and the “Statement of Medical Details (Rezept).” Without these, the refund process cannot proceed. - Step 2: Negotiate a Refund at the Hospital if Within the Same Month
If the insurance card arrives “within the same calendar month,” they can take the card and the receipt back to the hospital counter. In many cases, the hospital will recalculate the bill and refund the 70% difference in cash on the spot. - Step 3: Apply to the Insurance Association if the Month Has Changed
If the month of the medical visit and the month the card arrives are different, or if the hospital refuses an over-the-counter refund, submit the “Application for Medical Care Expense Reimbursement” along with the receipt to the health insurance association (e.g., Japan Health Insurance Association / Kyokai Kenpo). After screening, the 70% difference will be deposited into the designated bank account (this takes about 1 to 2 months).
4. Practical Q&A (Strictly Prohibited Actions)
[Summary] Answers questions regarding the severe trouble of “Return of Unjust Enrichment” caused by presenting an invalidated previous insurance card.
Q. While waiting for the company insurance card, can the employee continue to use the “National Health Insurance Card” made at the city office at the hospital?
A. Absolutely not. The moment the date of hire (the acquisition date of corporate Social Insurance) arrives, the National Health Insurance legally loses its validity. If they present an invalid National Health Insurance card to pay only 30%, the municipal office will later send a stern notice demanding the immediate return of the 70% wrongfully waived using an invalid card (Demand for Return of Unjust Enrichment), forcing a lump-sum repayment. From the date of hire onward, the correct procedure is to never use the old card, pay the full amount, and seek reimbursement through the company’s insurance later.
Q. Is there a deadline for filing the reimbursement (Medical Care Expense) application?
A. The deadline is “two years” from the day after the medical expenses were paid. After two years, the statute of limitations expires, and the right to receive a refund is lost. Because foreign employees often leave this undone due to not knowing how to fill out the forms, it is highly recommended that HR managers establish a system to support them with the application documentation.
Conclusion: Prevent Gap Period Panics Through “Prior Communication”
The situation where an insurance card is “unusable from tomorrow” or “not in hand” causes extreme stress for employees concerned about their health. HR managers should clearly document and share during the onboarding orientation that “it takes two weeks for the card to arrive” and “the mechanism for out-of-pocket payment and reimbursement if illness occurs during that time,” thereby eliminating unnecessary panic during the setup of their living infrastructure.