I already joined my employer's health insurance, so why am I still billed?

Joining a company plan does not automatically cancel 国民健康保険. You must file a 資格喪失届 at your city or ward office, bringing your new health insurance card or eligibility certificate. The premium is then recalculated through the month before you lost NHI eligibility, and any overpayment is usually refunded. Until you file, the bills continue.

Do I have to pay the big number on the notice right now?

No. The large figure is normally the total for the whole fiscal year. You pay installment by installment: pay the amount printed on each slip by that slip's due date. If you enrolled partway through the year, the amount is spread over the remaining installments.

My income this year is almost nothing, so why is the amount so high?

Premiums are based mainly on last calendar year's income, so this year's situation is not reflected yet. Part of the premium (均等割) is also charged per person regardless of income. Low-income reductions often cannot be applied unless a residence tax declaration has been filed, even with zero income, so ask the 国民健康保険課 to check your case.

What happens to my insurance card if I do not pay?

Non-payment alone does not remove you from NHI, but you will receive reminder notices and late charges may be added. Continued non-payment can mean paying the full cost at the clinic and claiming the insured share back later (特別療養費). Talking to the office before the due date is far better than ignoring the notice.

Insurance / Pension

国民健康保険料納入通知書・納付書: Reading and Paying It

国民健康保険料納入通知書 (notice of National Health Insurance premium) is sent by your city or ward office to tell you how much your household owes in NHI premiums for the fiscal year. Most municipalities send it around June or July. The premium is calculated mainly from last year's income, and the annual total is split into 期 (installments), labelled 第1期, 第2期 and so on. The enclosed 納付書 are the payment slips, one per installment. If your premium is deducted from your pension (特別徴収) or paid by direct debit (口座振替), you may receive only the notice with no slips. This is a routine annual notice, not a demand letter or a penalty.

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Who receives it

It is addressed to the 世帯主 (head of household) of any household enrolled in 国民健康保険. The name on the envelope is the head of household even if only a spouse or child is actually enrolled. If you joined a company health insurance plan, moved to another municipality, or left Japan but never filed the 資格喪失届 (notification that you no longer qualify), bills can keep arriving.

What to do

1Check that the sender is your own city or ward office (国民健康保険課 or 保険年金課) and that the addressee is the head of your household.
2Find the annual total in the 年間保険料額 or 合計 box, then look at the 期別 table below it for the amount and due date of each installment.
3If payment slips are enclosed, tear off one 納付書 at a time and pay it by its due date at a convenience store, bank, post office, or a smartphone payment app your municipality accepts.
4To stop handling slips every time, apply for 口座振替 (direct debit) using the enclosed form or by taking your bank card to the bank or the city office counter.
5If you lost your job or your income dropped and you cannot pay, phone the 国民健康保険課 before the due date passes and ask whether a reduction (軽減・減免) or an installment arrangement is possible.

About the deadline

Each 納付書 has its own 納期限 (payment due date) printed on the face of the slip, usually near the top right or beside the amount. There is not one deadline for the year; there is one per installment. After that date the convenience store barcode usually stops working, and you have to pay at a bank or at the city office counter. Missing the date can lead to a 督促状 (reminder notice), and late charges. Always read the date from the slip in your hand.

If you hold permanent residence

If you hold 永住者 (permanent resident) status, one more thing applies here. The Immigration Services Agency issued a guideline on 1 October 2026 and begins applying it on 1 April 2027. National Health Insurance premiums count as 公租公課 (public taxes and charges) — as do employees' health insurance premiums, National Pension and Employees' Pension premiums, and income, residence and fixed asset tax — and "intentionally not paying 公租公課" is one of the grounds for revoking the status. It applies only where it is "clearly recognised that there is no intention to pay". The agency's own examples are "receiving a demand or a reminder and making no enquiry at all about payment", and repeatedly failing to pay by the dates agreed under an instalment or deferral arrangement. Listed as not applying: "being unable to pay for unavoidable reasons such as illness, disaster or unemployment", and "having shown an intention to pay in response to a reminder, and being on an instalment or deferral arrangement". So if the premium is more than you can pay, do not leave it: ask the National Health Insurance desk about a reduction, an exemption or instalments. And even where a ground does apply, the stated rule is that the Minister of Justice permits a change to another status such as 定住者 (long-term resident) rather than revoking the status outright.

The Immigration Services Agency guideline (Japanese) →

Common misunderstandings

I already joined my employer's health insurance, so why am I still billed?: Joining a company plan does not automatically cancel 国民健康保険. You must file a 資格喪失届 at your city or ward office, bringing your new health insurance card or eligibility certificate. The premium is then recalculated through the month before you lost NHI eligibility, and any overpayment is usually refunded. Until you file, the bills continue.
Do I have to pay the big number on the notice right now?: No. The large figure is normally the total for the whole fiscal year. You pay installment by installment: pay the amount printed on each slip by that slip's due date. If you enrolled partway through the year, the amount is spread over the remaining installments.
My income this year is almost nothing, so why is the amount so high?: Premiums are based mainly on last calendar year's income, so this year's situation is not reflected yet. Part of the premium (均等割) is also charged per person regardless of income. Low-income reductions often cannot be applied unless a residence tax declaration has been filed, even with zero income, so ask the 国民健康保険課 to check your case.
What happens to my insurance card if I do not pay?: Non-payment alone does not remove you from NHI, but you will receive reminder notices and late charges may be added. Continued non-payment can mean paying the full cost at the clinic and claiming the insured share back later (特別療養費). Talking to the office before the due date is far better than ignoring the notice.

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国民健康保険料 納入通知書・納付書: Reading and Paying It