The Japan Times ran a couple of articles last week on the coming changes in health insurance for foreigners in Japan.
As you are probably already aware, starting next April, you will have to show proof of enrollment in shakai hoken (SH) or kokumin kenko hoken (KKH) when you apply to renew your visa. Jenny Uechi reminds us of the law:
If you are working for a company in Japan, chances are that you are (or need to be) enrolled in shakai hoken, in which you pay half of your health insurance premiums and your company pays the rest. There isn't much ambiguity about shakai hoken: If a company employs more than five people, and an employee is working more than 20 hours a week for a period longer than 2 months, the company is obligated to submit paperwork for an employee's health insurance and pension to the Social Insurance Agency within five days of hiring. With shakai hoken comes the kosei nenkin, or pension plan; the two are a set, and enrollment is mandatory whether you plan to retire in Japan or not.
Meanwhile, people who are unemployed, self-employed, employed by a small firm or retired should be enrolled in kokumin kenko hoken (national health insurance). People paying into this system have to sign up on their own for kokumin nenkin (the national pension) at their city ward office.
Unfortunately a lot of English instructors are unaware of the law and find themselves in a position like "Patrick Johnson:"
Patrick Johnson (not his real name), an assistant language teacher, has recently had to fork out over ¥700,000 in back payments for the last two years he has been living in Japan without national health insurance. He has just paid his final monthly installment of ¥75,000, he explains with a tired sigh of relief. He used to pay for private insurance, but has left the scheme now he is covered by kokumin kenko hoken.
Johnson, who works for a large corporation with far more than five employees, is well aware that he should technically be enrolled in shakai hoken, where his company pays 50 percent of his premiums. But because his contract states that he only works 29.5 hours — well over the 20-hour limit but .5 of an hour below the limit that usually triggers a government crackdown — the company can instead oblige him to sign up for the other option, where he has to bear 100 percent of the cost.
"You know how the system works," he says wearily, as though hour-fudging is a given in Japan's language-teaching industry.
Johnson reflects on his experience with more resignation than rage. Last year, he says, the city started sending letters asking him to pay health insurance. Since he already had private coverage through his company, he did not think much of it, but started panicking when the city approached his company asking for his bank information. Then one day it happened — he saw ¥50,000 had vanished from his bank account
His experience is typical of most instructors. They are generally unaware that their employers should be enrolling them in an insurance scheme and are surprised to learn that they owe up to two years in back payments when they finally do get properly enrolled. This is also one of the reasons why many would like to avoid SH or KKH--they are expensive.
Which brings me to Ronald Kessler's Zeit Gist column in which he argues that foreigners in Japan have special healthcare needs and that for vital reasons of communication, level of service, and repatriation of remains, foreigners should be able to presumably opt out of SH or KKH and choose their own plans.
There are a few problems with Mr. Kessler's argument, however. First, enrollment in SH and KKH is mandated by law, and, lke taxes, you can't choose to not pay. He also forgets to mention that if foreigners do need extra coverage, they can get it from one of Japan's private insurance companies. This is in fact what many Japanese do to cover the gap between SH or KKH should they be hospitalized for an extended period of time. Moreover, he fails to provide any specifics as to what other health insurance plans make them preferable to Japan's public ones. What are the cheaper and more comprehensive health insurance plans? Are they universally accepted across Japan?
One point I agree with him on is that it is curious that Immigration, not the Social Insurance Agency, will effectively be enforcing enrollment. This shifts the burden of enrollment on the instructors, not their employers.
If the government wants to enforce enrollment in this odd manner, then that's there prerogative. Personally, I don't see this an issue of choice insomuch as it is a labour issue. As has been mentioned on LJ before, employers play fast and loose with working hours, drawing up 29.5 hour work weeks so they can avoid having to enroll their instructors in a health plan even if their instructors are physically at school on a full-time basis.
Instead of putting the burden on instructors to enroll, the Social Insurance Agency should be cracking down on the schools who shirk their legal obligations.
One thing is for sure, there will be more than a few instructors who are hit for back payments when they are ultimately forced to enroll. There may even be a few who are unable to renew their visas.
It's time for instructors to be prepared. If your visa is up for renewal next spring, make sure you have some money set aside in case you are have to make back payments. While costly, you can negotiate with local governments and set up a payment schedule that fits your budget or even get your payments reduced.
It's also time to start making some noise about your working conditions. Even "Patrick Johnson" knew his employer was gaming the system yet he turned a blind eye. Don't let your employer rob you of your right to healthcare in Japan. For all its warts and deficiencies, SH and KKH cover you, no questions asked. The choice involved here is not which plan is better for foreigners in Japan, but choosing to stand up to your employer and demanding your right to healthcare coverage.