Before you start

Ward registration completed
Residence card
Employment details, if enrolling through an employer scheme
My Number

Step-by-step

1
Establish which scheme covers you
Full-time employees are usually enrolled in shakai hoken by their employer, which splits contributions and bundles the pension. Freelancers, part-timers, students and anyone between jobs enrol in National Health Insurance at the ward office. There is no lawful uninsured option.
Via employerWho: YouWeek 1–2
2
Enrol at the ward office if your employer does not
Do it during the same visit as the move-in notification. National Health Insurance premiums are income-based and assessed on last year's income, so your first year is unusually cheap and the second is the real figure.
In personWho: YouWithin 14 days
3
Understand the 30% co-payment and the monthly ceiling
You pay 30% of most treatment at the counter, and above a monthly threshold that scales with income the high-cost medical expense benefit caps what you pay. If you know major treatment is coming, apply for a limit certificate in advance so the cap applies at the counter rather than being reclaimed later.
In personWho: You
4
Look up your hazard map and your designated evacuation site
Kobe publishes ward-level hazard maps covering landslide, flood, tsunami and liquefaction risk. A great deal of the hillside housing sits inside formally designated landslide warning zones, and the reclaimed islands have their own history. Find your nearest designated evacuation site and the route to it before there is a reason to.
OnlineWho: You
5
Register the My Number card as your insurance card
Japan has moved to using the My Number card as the health insurance card. Registering it lets providers see your prescriptions and treatment history with your consent and simplifies claiming the high-cost benefit.
OnlineWho: You
6
Claim the pension lump-sum withdrawal when you leave
Having contributed for at least six months, you can claim back part of your pension after leaving Japan, applied for within two years of departure. It is a substantial sum after a few years and it goes unclaimed constantly.
OnlineWho: YouWithin 2 years of leaving Japan

Documents you’ll need

Residence card
My Number
Health insurance card or registered My Number card
Pension handbook
Jūminhyō residence certificate

Things most newcomers don’t know

A large amount of Kobe's hillside housing sits in a formally designated landslide warning zone.

The city is built onto the flank of the Rokkō range, and Hyōgo has mapped the slopes under the national sediment disaster legislation. Designation does not make a property unsafe, but it changes what happens in heavy rain: evacuation advisories are issued by zone, and if you do not know which zone you are in, the alert on your phone will mean nothing to you. The maps are public, free, and take five minutes.

Source: Hyōgo Prefecture

The high-cost medical expense benefit is what makes a 30% co-payment survivable.

Paying 30% of everything sounds alarming until you learn monthly out-of-pocket costs are capped at a threshold scaling with income. A major operation or a long admission costs a manageable amount rather than a ruinous one. Where treatment is planned, applying for the limit certificate first means the cap is applied at the counter rather than reclaimed months afterwards.

Source: Ministry of Health, Labour and Welfare

National Health Insurance premiums are assessed on last year's income, so year two is the expensive one.

Your first year in Japan is assessed against a Japanese income of zero, which makes premiums minimal and gives a completely misleading impression of what health cover costs. From the second year they are calculated on your actual earnings and rise sharply, in exactly the same way residence tax does and in the same month. Budget for both step changes arriving together in your second June.

Source: City of Kobe

The pension lump-sum withdrawal is real money and departing residents routinely forget it.

Anyone who contributed for at least six months can claim back part of their contributions after leaving Japan, applied for within two years of departure. After three or four years it is a meaningful sum. It needs paperwork sent from abroad plus a Japanese bank account or a tax representative to receive the payment, which is precisely why the groundwork has to be done before you go.

Source: Japan Pension Service

Common mistakes to avoid

Assuming health insurance is optional if you are self-employed — it is not.
Budgeting from a first-year National Health Insurance premium, which is artificially low.
Renting on a Kobe hillside without checking whether it is in a designated landslide warning zone.
Never locating your designated evacuation site in a city with this history.
Leaving Japan without claiming the pension lump-sum withdrawal.

Some of this may be out of date. Spotted something inaccurate? Help us keep it right for the next newcomer.