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 third option.
Via employerWho: YouWeek 1–2
2
Enrol at the ward office if your employer does not
Do it in the same visit as the move-in notification. National Health Insurance premiums are income-based and assessed on last year's income, so the 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 scaling 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 instead of being reclaimed later.
In personWho: You
4
Book Aichi's medical interpretation service before an appointment, not during one
Aichi operates a prefecture-wide medical interpretation system covering participating hospitals in Portuguese, Spanish, Chinese, English and other languages, by advance arrangement. It exists because of the region's foreign workforce and it is genuinely good — but it is booked ahead through the hospital, not summoned on the day.
In personWho: 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 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 is routinely left unclaimed.
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

Aichi runs its own medical interpretation system, and it is one of the best reasons to be ill here rather than elsewhere.

The prefecture funds trained medical interpreters across a network of participating hospitals in Portuguese, Spanish, Chinese, English and other languages, built up because Aichi's manufacturing workforce has included large foreign communities for over thirty years. Most Japanese prefectures offer nothing comparable at this scale. It must be arranged through the hospital in advance, so the time to find out how it works is before you need it.

Source: Aichi Prefecture

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

Paying 30% of everything sounds alarming until you learn monthly out-of-pocket costs are capped at a threshold that scales with income. A major operation or a long admission costs a manageable sum 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 refunded months later.

Source: Ministry of Health, Labour and Welfare

Nagoya's summer is a medical problem, not a complaint about the weather.

The city sits in the Nōbi basin where heat pools, and it regularly runs hotter than Tokyo or Osaka, pushing past 40°C in bad years. Aichi consistently records among the highest numbers of heat-illness ambulance transports of any prefecture. Air conditioning is not a luxury in a Nagoya flat, and the standard advice — salt, fluids, and staying indoors between eleven and four in August — is given seriously here.

Source: Ministry of Health, Labour and Welfare

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 in the Aichi manufacturing sector it is a meaningful amount. It needs paperwork sent from abroad plus a Japanese bank account or a tax representative to receive the payment, which is why the groundwork must be laid 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.
Turning up at a hospital expecting an interpreter on the day rather than booking one in advance.
Treating a Nagoya August as survivable without air conditioning.
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.