Japan probing abuse of health insurance system by foreign residents

Canada is implementing restrictions on new immigrants for similar reasons. For example, it's much more difficult now for new immigrants to bring in dependents who are elderly, like grandparents, or who have serious medical conditions.

Here's a warning for foreign residents of Japan... if you started paying your monthly health insurance premiums and then find you need to leave the country for an extended period, you better officially notify your city hall first because those premiums will continue to add up while you're gone. We learned the hard way. We left for a few years and didn't realize all the wild health insurance premiums we're adding up. We offered to show our passports to prove that we were out of the country and it didn't matter. Now we have like an extra car payment a month it just gets thrown out the window.

Of course they should be doing this. In a country where theft is extremely low they still lock their doors religiously.... so why wouldn't they build in measures to prevent miss use of the healthcare system.

"...the current insurance system can lead to reverse discrimination against Japanese people," Kobayashi said."

Reverse discrimination?

the insurance system, which was not designed to take into account a time when foreigners would be receiving medical services in the country.

When was it designed, the 1800s?

Tooheysnew

First of all there are many more Asian foreigners than western ones living or coming here to begin with. I’m sure if there were as many western types (since you like to racially divide them) it would be as many rule breakers, or more.

And how many Japanese are working, being paid in cash, off the books with no insurance?

The number of foreigners abusing the system is minuscule but the number of companies abusing the system isn’t.....

So this Chinese gentleman, who lives in China, but is considered a dependent of a Chinese national living in Japan is able to come into the country, receive expensive medical treatment and then return to China, and this is not considered fraud? I would charge the family living in Japan for the costs. I don't want to single out any group, but the gov't has to be very careful with this, or it will invite abuse from all over.

I call bs on that!

What does ‘illegitimately obtaining residential status’ mean?

Does it mean NOT showing proof of residence?

Does it mean NOT showing proof of income?

Does it mean NOT showing proof of taxes paid?

The Chinese gentleman as a resident would be able (legally) to receive healthcare if the son was working and paying tax here-why not?

Maybe, Japan should let people die in the streets?

Actually JeffLee it is now easier for people with health problems to immigrate into Canada... if you search ypu should be able to find am article about that from several months ago... In Canadian news...

Our healthcare system is quite good even though lobbyists in the USA successfully convince many otherwise. I lived in the USA for years and definitely prefer the Canadian system where you won't die in the streets or die of poverty.

With the number of foreigners being roughly 2.5% of the population then whatever abuse there is, is pathetically small.

Many countries have tough, some would say cold-hearted, policies towards immigration and health. For example, New Zealand has refused residency to persons in wheelchairs and others with autism. Entire families have been denied residency because a child was deemed too costly by the NZ government.

Michael Jackson....

I left for one year (after 20-odd years here), informed my local city hall, they said "no problem" we'll sign you off, but be sure to let us know when you get back.... which I did, they then said "but you don't live here any more, you can't get health insurance" (they'd struck me off the register, even though I was still renting my apartment while away, and even though I'd told them I was only visiting overseas).

took me 2 years, and a move from Sapporo to Chiba-ken to get it sorted.... by which time they'd raised the 10% payment (for over 70's) to 20%, lol.

point is, however carefully one handles these things, there's always someone who can stuff it up.... and then, if the solution isn't in the manual.... be prepared for the long, frustrating, haul....

I agree with kurisupsu - the definition of a dependent should be no different for a Japanese or a foreigner who are paying into the national healthcare insurance system.   Surely there also are non-insured Japanese who become registered dependents of an insured person for the purpose of becoming insured.

Lol I tell people that there more Asians in Asia than Westerners so don’t get all uppitty and us vs them about it and people can’t handle it.

Ok how’s this? Since your westerner you are less inclined to crime than Asians being who are you ethnically etc. Happy now?

Wasn't it just yesteryear when Japan, Inc was touting Japan as a medical tourism destination? Well we have our first here, not exactly what the gov't had in mind, but it's part of the dressed rehearsal. Let's see how it all acts out

But there have been a string of incidents whereby foreigners fraudulently obtained resident status, for example, by posing as students studying in Japan.

I didn't know it was that easy to get some resident status. Don't people need proof they study at a school or something? Perhaps they should look deeper into how they obtained resident status.

JT readers - you may be able to get Japanese health insurance even though you are not working. I am what's called a long-term Japan resident. When I had a stroke in 2010 and was out of work I thought I could not be insured. Not so, a kind back office lady at my hospital made a few calls. When I was discharged I visited Meguro Ward Office, filled out the paperwork and viola! got insurance and a 70% refund of my medical bill. I've been a paying participant ever since and thank the Japanese system my hospital and doctors for saving my life.

Kudos to the Japanese government for taking the initiative on this.

Many Japanese go to NZ, Australia, Canada for giving birth, so many that all these nations have a reciprocal agreement that is, as always heavily in Japan's favour. I pay tax and insurance and my medical issues (thankfully none) are now to be investigated by a government official who's medical knowledge is zero and who has to fill a quota that no matter how many scammers the uncover will still be scolded for doing exactly what they were told.

tooheysnewToday 06:56 am

JSTLet’s set this straight - most of these ‘foreigners’ who are rorting the system are asians. Most of the ‘foreigners’ doing crimes in Japan are asians.

Unfortunately, most of us law-abiding tax paying westerners are thrown in this ‘gaijin’ pigeonhole

My family and I are foreigners in Japan. We are Asian, we are residents of this country. We are also law-abiding and we pay our dues to the State. Are we not into this thing you call "gaijin pigeonhole" too?  The correlation between the crimes and the total population of that race/ethnicity's probability to do crime has nothing to do with being 'Western' or Asian. Try population density.

But there have been a string of incidents whereby foreigners fraudulently obtained resident status, for example, by posing as students studying in Japan.

Aren't all these komuin paid to do the fact-checking? I am a bit surprised and somewhat in disbelief such situations are actually possible with all the 'kakunins'.

As for the health insurance for the dependents, it should apply to those actually living in Japan long-term. If someone comes here short-term just to use dependent medical insurance and leave, they or people who helped them should be made to pay the full price when leaving. It could be realized IF multiple disparate social services systems had some connection and data exchange, which as of now isn't there.

"Discriminating against foreigners is out of the question but the current insurance system can lead to reverse discrimination against Japanese people," Kobayashi said.

Out of the question? Dude you just have to live the life of a foreigner here in Japan to understand just how ludicrous you sound. Discriminating against foreigners happens all the time!

These people are going to spoil it for all of us.

Japan is a rich country with high standards of living. It is a privilege to be able to provide excellent quality and exceptional health services and care for foreigners. Long term vision is essential to see the benefits of gratitude in the present and future. The world will only become a better place to live with kindness and compassion towards all.

Why is this article aimed at foreigners when it's the authorities here that are obviously not doing their job properly if people who are NOT eligible are claiming on their medical stuff. It's more to do with a poorly designed and outdated system than opportunistic foreigners. Why always resort to the 'foreign threat' catch-cry!

Reverse discrimination?

Because, apparently it's an 'us vs. them' thing...

It is a privilege to be able to provide excellent quality and exceptional health services and care for foreigners.

The people who are eligible pay dearly for those 'privileges' as you put it.

Japan is a rich country with high standards of living.

Have you ever lived and worked abroad for any extended time?

I find it unbelievable that the Government doesn't make the sponsors or the companies who falsely allow foreigners to register as a resident to be liable for the difference in fake claims.

This will certainly stop companies and local residents from assisting such false claims. It's quite simple and I'm sure acceptable to the community.

it's not a perfect system but it's a system that works

It is a very simple system in my opinion ---- if you are a resident of japan, it is mandatory that you should be in the health insurance system (through your employer or the "public insurance") ---- handled by the city/town/ward or whatever locality you are registered at (your juuminhyo) ---- insurance fees based on your income (or household income) ---- that is why you have to properly update your "juuminihyo" if you are moving somewhere especially abroad.

take note that the word used is "resident" as it doesn't matter which nationality you hold.

if you don't like it, feel free to leave Japan, foreign nationals have that choice, japanese people don't (unlucky)

@MJ. Sorry about your situation. And thanks for updating. Will share as much as I can!!

Great! Finally some action from authorities!

Far from being the envy of the world which many tout it to be, the Japanese health insurance system is riddled with distortions and inequity. Case in point, part timers, who put in just as many hours as full timers, but at three or more workplaces instead of just the one. These people get no health insurance support whatsoever from their employers and must pay through the nose. Needless to say, many go without or engage in subterfuges such as piggybacking on their wife’s coverage. In other families, the Japanese wife and kids are all enrolled very very cheaply because of her negligible earnings, but the foreign husband and main breadwinner, upon whose income they should be paying much higher premiums, has no coverage. Where is the bureaucratic oversight to stamp out such distortions and make the system truly fair?

Action from authorities! That's the best joke ever they are going to pore over their records because they have little to do, wait a while then announce that they have found nothing to substantiate the claims. Summer bonus time.

Oyatoi

If you hold 3 part time jobs or 4 or 1, you can and should still go and apply for social security. It’s not true what you stated.

Just started paying mine after a 3 year battle with city Hall, whereby they overcharged me and my then wife, by 1.75 million yen! They refused to budge even when we had a certified accountant confirm our concerns!

Went to speak with a lawyer and 3 years on, they conceded and acknowledged their mistake! I now have a small back log of payments to make plus private insurance.

The system works but the beaureaucracy is stupidly stupendous!

spell check voila! but i like violas too

If they're so worried about the health care system what is being done about the elderly who use clinics and hospitals as places to meet up with and hang out with their friends? They pay what, 10%? And let's not forget all the housewives who've never personally paid a yen into the system since they stopped working. Once again the Japanese government is targeting foreigners when they should be looking at the locals who take advantage of the system currently in place. Too scared to change the system though because they know the elderly and SAHW would toss them out of power.

In the late 1970's - '80's I worked for seemingly respectable companies JAL, Paramount & Universal Studios.

After after I got older and wiser I learned none paid into insurance, unemployment or pension plans.

Shame on them - if only I knew then what I know now...

I know the problem because I can speak Chinese.

Chinese brokers earn money by refugee application and medical tourism.

RealCDN actually JeffLee is right. Article or not I know people who tried to sponsor their grandparents from the US but because of pre-existing health conditions they would allow them to be sponsored but would not allow them to be covered for Canadian Health Insurance.

Foreigners are foreigners. You should not compare on same level locals and foreigners who can go back anytime home.

My home country is over filled with such false dependents but real ill persons from abroad. So taxes are expanding ever and ever for medical costs. But now taxes are coming from all incomes as socialist mode implies, only way to get closer to a balance system. It works well for me and favorable to one breadwinner family member. No way to become rich in that system without cheat or connections.

Glasses and dental prosthesis to be close to free for all soon (2021) in my country ! So there is a long path to drive to get to high medical standards for Japan when you see so many impaired people with their teeth, poor glasses and bad hearing.

Japan should even do better for what is not just comfort.

The number of foreigners abusing the system is minuscule but the number of companies abusing the system isn’t.....

Based on what knowledge?

Maybe the Chinese guy needed life-saving treatment that he just couldn't get in China. He came here, got the treatment, then he went home after the treatment was completed. And they did pay for the treatment. If something was wrong, it would be up to the hospital and government officials to find out.

Based on what knowledge?

Common knowledge.

Glasses and dental prosthesis to be close to free for all soon (2021) in my country ! So there is a long path to drive to get to high medical standards for Japan when you see so many impaired people with their teeth, poor glasses and bad hearing.

Japan should even do better for what is not just comfort.

The poster tries to give the impression that free healthcare [NHS} in the UK is the walhalla of the healthcare world.

The NHS however is lagging behind to comparable systems in developed nations in many fields. The health state of UK citizens is mediocre compared to the developed nations within the EU.

https://www.kingsfund.org.uk/publications/articles/big-election-questions-nhs-international-comparisons

https://ec.europa.eu/health/sites/health/files/state/docs/chp_uk_english.pdf

thepersoniamnow

”If you hold 3 part time jobs or 4 or 1, you can and should still go and apply for social security. It’s not true what you stated”

Re-read my message. By virtue of being a part timer, one gets zero pension, health, or other social insurance support from one’s employer. Do you dispute this? Is your fall back position to argue that part timers should all become full timers?

The built in unfairness and inequity in the system encourages part timers and their families in particular, to either do without or scam it as per the examples that I gave.

Based on what knowledge?

Common knowledge.

Facts, stats, not the usual kitchen table or barstool wisdom :)

The man was listed as a dependent of the son, thus being entitled to health insurance benefits.

Why was the father listed as a dependent of the son? Seems that's the problem right there. Let's spend a few years of meetings on it

Maybe that Chinese guy was truly a dependant of his son who was dutifully paying into the healthcare insurance system – was registered as such, obtained treatment, and moved back to China. After all, many dependants do not live in Japan forever.

Consider the case of a Japanese student overseas who returns to Japan for treatment, and gets registered as a dependant.  Is this to be considered fraudulent too?

What is the loop hole for resident visa?

@sf2k - parents and grandparents, even siblings and aunts and uncles are frequently listed as, and indeed are - dependants of working aged children/relatives even if they do not share the same residence, but are financially dependant upon the financial breadwinner.

So what exactly did this Chinese cancer patient do wrong?

The rule is simple. To be entitled to Japanese health insurance, you have to be both a family member and a dependent on someone working in Japan. The Chinese man was family member but he was not dependent of his son. He was living in China thus he was not a dependent thus not entitled to health insurance.

And how many Japanese are working, being paid in cash, off the books with no insurance?

Few, since under Japanese law you have to enroll in health insurance. Since your premium is based on your income, there is no excuse not to enroll in health insurance

With the number of foreigners being roughly 2.5% of the population then whatever abuse there is, is pathetically small.”

The issue is not the total number of cases but the proportion of foreigners in Japan  to total number insurance fraud cases that are being committed by foreigners. For example if the number of insurance fraud committed by was foreigners was 2.5%, the government would not be concerned. However, since the government is acting on the issue, it tells me that foreigners are committing issuance fraud out of portion of their numbers. My guess is that 40% of the total insurance fraud cases are being committed by foreigners.

Many Japanese go to NZ, Australia, Canada for giving birth,

I see no logical resaon why a Japanese woman would travel to those countries to give birth. I think you meant Chinese, since Chinese go to those countries to give birth to gain citizenship for their babies and thus themselves.

the case of a Japanese student overseas who returns to Japan for treatment, and gets registered as a dependent. Is this to be considered fraudulent too?

No. Since under Japanese law, a Japanese living overseas is still entitled health insurance. If he is in the US, a Japanese is not allowed to work and he would be dependent on his parents under Japanese law.

I see no logical resaon why a Japanese woman would travel to those countries to give birth.

Well, many who have the cash travel to the US to give birth, because it allows their child to gain citizenship through birth on American soil. BUT that's just the folks who have the money.

he case of a Japanese student overseas who returns to Japan for treatment, and gets registered as a dependent. Is this to be considered fraudulent too?

No. Since under Japanese law, a Japanese living overseas is still entitled health insurance. If he is in the US, a Japanese is not allowed to work and he would be dependent on his parents under Japanese law.

Live and learn.....Yes people on student visa's can and do work in the US.

https://www.hccmis.com/blog/study-abroad/4-ways-to-work-in-the-us-with-a-student-visa/

They can only re-register as a dependent if they are still in school, so no they would not be fraudulent. That is IF they de-registered prior to leaving the country, otherwise they would STILL be under their parents insurance even while they are overseas.

Contrary to what too many people THINK they know, Japanese health insurance will refund medical expenses accrued while overseas when the citizen/student returns to Japan and files the appropriate paperwork. Costs are born, overseas costs that is, first by the payee and refunded upon returning here.

This information is very easy to check on.

I’m confused by the Chinese chaps case. Would the old fella not require residence here to be considered a dependant?

Two things:

1) if foreigners are paying any tax, especially from their labour (ie income tax, payrol), they should be able to get treatment while in the target country.

2) why did the Chinese man need to come to Japan to get care? I know China is state capitalist now, but they still on paper hold Marxist-socialist principles. Does that not entitle all citizens of the PRC to complete free healthcare? If so, is it terrible?

@ Jonathan Prin, Netgrump & others

The UK currently leads the world in universal free healthcare (and has long championed free trade and the movement of people from one part of the world to another for mulifarious purposes).

However, this has started to rankle with the majority of the population and is being seen as unsustainable economically and politically in future. (Hence, in part, "Brexit".)

Japan's ,problems on this front are very small, by comparison with the UK, which has significant "health tourism" (usually free of charge for the medical component) from the African continent, Indian subcontinent and elsewhere.

I regard it all as both a legacy (in terms of all the doctor, nurses and other healthcarerers from Africa & India and elsewhere) and a debt (in terms of all the poor, hungry and sick arriving from Africa, India, and elsewhere) of the relatively long-lived British Empire.

Japan also had its empire - a relatively short-lived one - that at its zenith/nadir (delete one depending on which side of history you are on) included Korea, Manchuria, large parts of China, the Philippines and the lion's share of SE Asia (most of which was 'liberated' from the European imperialists).

Therefore Japan has a similar but smaller legacy (of "guest workers") and debt (to "health tourists") to enjoy.

The real problem is getting the best fit balance right between give and take.

@Robroy

Sanest comment on this thread....

Oita

Learn your rights man.

Yes you don’t get it automatically and you have to apply for a different coverage plan, not Shakai Hokken.

A part timer can also apply for insurance. That is my point. You made it sound like if you are part time you won’t be covered and I don’t want the foreigners on here that don’t know to go off believing that.

As I understand it, through the collusion of government offices in certain districts of Tokyo and companies that want to minimize pension and health care payments for employees, some foreign workers I know of - no Asians here - willingly avoid inclusion in the national pension and health care scheme. They and their companies make sure the threshold of earnings is not met in months used for the scheme’s calculations. Those same companies offer “travelers” insurance to cover medical expenses. In the case of larger medical bills, these delinquents believe they can pay a few years of back payments to get the same medical care scheme members pay for.

Fair? No way. Crack down on this cheating, Mr. Abe. It’s not just Asians.

Well, many who have the cash travel to the US to give birth, because it allows their child to gain citizenship through birth on American soil. BUT that's just the folks who have the money.

You aren’t aware of poor Central Americans making the arduous and dangerous trek to El Norte knowing that children born there will be considered American citizens?

And how many Japanese are working, being paid in cash, off the books with no insurance?

Few, since under Japanese law you have to enroll in health insurance. Since your premium is based on your income, there is no excuse not to enroll in health insurance

Econstats: Do you live in Japan? You don’t know that “the law” and its enforcement are very different things. There are probably as many dodges here as anyway.

You speak of an ideal situation - I’m with you there - but it just doesn’t happen.

They and their companies make sure the threshold of earnings is not met in months used for the scheme’s calculations.

Enrollment in 社会保険 (しゃかいほけん shakai hoken - societal insurance) is not based on salary, it's based on hours worked. Anyone who works 3/4 hours or more of a full time employee must be enrolled in 社会保険 by the company. My old company used to limit us to 29.5 hours/week (keeping us under 30) as a full time worker in our company worked 40 hours. By limiting our hours to 29.5, we didn't cross the threshold, and therefore were responsible for our own insurance. As such, we had to enroll in the 国民健康保険 (こくみんけんこうほけん kokumin kenkou hoken - citizen's health insurance) and pay ourselves. If I recall correctly, the amount we paid as employees did not differ that much from what people on 社会保険 pay, though it doesn't include pension or disability insurance like 社会保険.

theparsnipiamnow

I am well aware of my rights, or rather lack of, thank you.

I don’t know how I can spell it out any more clearly to you, but here goes. I made the point that the system is riddled with distortions and inequity. Case in point, part time workers who put in just as many hours as full timers but are denied the opportunity to work full time in any one place. Instead, they have to farm themselves out to three or four employers, none of whom provide any pension, health insurance or shakai hoken support. Said worker has the option of enrolling in the system but chooses not to precisely because he would end up paying through the nose. Your entire argument is simply a defence of the system’s inherent bias against and unfair treatment of part timers. Rest assured that part timers are only too well aware of this. They show their disdain by either not enrolling at all. Or, scamming the system in one of the ways I adumbrated.

Said worker has the option of enrolling in the system but chooses not to precisely because he would end up paying through the nose.

I don't believe the payments differ to much to the employee whether they are on 社会保険 or 国民健康保険. I'm not sure where the paying out the nose comment is coming from.

Ok ok ok no need to spell it out any more. I think my point stands as does urs.

The PT worker is a horrid thing done by greed here imo, I won’t ever disagree on that. My comment was only ever about whether you could get insurance while being a part time worker. Have a good night!

@ Robroy

Japan also had its empire - a relatively short-lived one - that at its zenith/nadir (delete one depending on which side of history you are on) included Korea, Manchuria, large parts of China, the Philippines and the lion's share of SE Asia (most of which was 'liberated' from the European imperialists).

Therefore Japan has a similar but smaller legacy (of "guest workers") and debt (to "health tourists") to enjoy.

The real problem is getting the best fit balance right between give and take.

Good observation.

What’s a dependent? A few months here, get your medical condition taken care of then go home? Probably went back to a paying job. To claim dependence they should make it a rule that he person being claimed dependent should be so for some length of time, say a year or whatever. A short term vacation here, get checked hen go home is not being a dependent.

It’s good that the Government finally decided to investigate this matter and catch those who have been misusing the system. If people want to stay in a country other then their birth place, it’s only fair to follow the rules of the nation and pay your dues honestly. Some people really abuse the system and these free riders should be taken to task! You can’t have it both ways!

@Strangerland... Excellent detailed comments! Occasionally we don’t see eye to eye on many topics but you are absolutely correct on this one!

@Capt USA ... I’ve heard of some similar stories to the one that you mentioned. There are lots of people who seem to be really abusing the system and should be prosecuted ( sound too harsh but they are breaking the rule ) !

Re-read my message. By virtue of being a part timer, one gets zero pension, health, or other social insurance support from one’s employer. Do you dispute this? Is your fall back position to argue that part timers should all become full timers?

The difference is in one case (full timer) the employer deducts pension and health insurance fees from his salary, and in the other (part-timer) the employee must apply and enroll in the both programs by himself. Health insurance and pension are available for both types of workers.

I could be wrong, but you seem to think pension and health insurance are free for full timers. You are paying for it trust me. Ask any full timer to show you their pay slip and you’ll see proof.

After all, many dependants do not live in Japan forever.

And this raises a very good point.

If the awkward attitudes (and legalities) against foreigners improved, you might find that more of them stay (more than a few years) and continue to support and pay into the system.

@ Makoto Shimizu..... Japan is a rich country with high standards of living. Yes, high standard of living, but, rich, how can Japan be rich but also the have the highest per capita debt in the world. As of this year Japan is $12 Trillion in debt. That is $96,000 for every individual in Japan... in debt. Japan's 2018 GDP is $5.1 Trillion. Debt is often measured versus a country's GDP..... Japan's debt is more than twice its GDP. The USA, which has a National Debt of $21 Trillion has a GDP of the same $21 Trillion. 1 to 1 ratio. The bottom line is.... Japan's healthcare is most likely extremely in the Red, and current taxes absolutely are not covering the bills. Japan will need to increase healthcare premiums vastly if it wants to ever balance its fiscal budget.

I don't believe the payments differ to much to the employee whether they are on 社会保険 or 国民健康保険. I'm not sure where the paying out the nose comment is coming from.

There is a big difference. As a full time, salaried employee the employer pays half of the health insurance fees and the employee the other half. If you are a contract, or part time worker you have to pay the whole lot yourself.

An example: when I was working at the university on a 1 year contract (a flat, monthly payment with no bonus, but no deductions other than income tax) I had to pay Y520000 for one year of 国民健康保険. I was shocked when they sent me the bill. As a full time employee I pay about half of that.

There is a big difference. As a full time, salaried employee the employer pays half of the health insurance fees and the employee the other half. If you are a contract, or part time worker you have to pay the whole lot yourself.

Except that 国民健康保険  does not have the nenkin or disability insurance included, so the payments for end up not differing too much between the two.

I've actually been through that swtichover myself, and I think I actually ended up paying more with 社会保険 after making that switch. It was nearly 15 years ago though, so that's why I'm not sure if things have changed. But I've not heard anything to indicate they have.

@physco.....

While Japan's debt numbers are as you say, there is one thing you are missing when talking about Japan's debt burden in comparison to any other country, who holds Japanese debt?

The "people" of Japan, through the BOJ hold the debt, so while the numbers on the surface are problematic to say the least, it's not likely that Japan will default on it's debt payments, because the money is just going from one pocket into the other.

On the other hand, if Japanese debt was being held by third parties, or other foreign countries, there is no way the IMF or anyone else would let things slide for as long as they have.

Japan needs to tighten it's belts, but Abe and the LDP are loathe to do it while they are in power, so they keep on going through the same cycles of inserting more money into the economy to boost it up.

My spouse had told me that we "had" to get a form of private insurance, when we arrived in Japan. This article is the first to inform me that I MAY apply for the regular National Health Insurance if I wish! It has (for example) the advantage of low-cost health check-ups in each city for insurance holders. (The current private insurance, rather, has refused my request for a change of place so that I might get "Ningen Dock" [Health check]. They insist that all their insured persons must go to their designated place, which is so far away as to be impossible for me to go to when leaving stomach empty not only of food and drink, but of medicine as well. )

For the example given, how was the applicant allowed to have dependents who were not living with him, be part of his insurance cover ? If the answer to that question is fixed, then the problem is partly resolved.