Before you start

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

Step-by-step

1
Work out which scheme you belong to
Full-time employees are usually enrolled in shakai hoken by their employer, which splits contributions and bundles the pension. Everyone else — freelancers, part-timers, students, anyone between jobs — enrols in National Health Insurance at the ward office. There is no third option of being uninsured.
Via employerWho: YouWeek 1–2
2
Enrol at the ward office if your employer does not
Do it during the same visit as your 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 not.
In personWho: YouWithin 14 days
3
Understand the 30% co-payment and the monthly ceiling
You pay 30% of most treatment at the counter. Above a monthly threshold scaling with income, the high-cost medical expense benefit caps what you pay. If you know a major treatment is coming, apply for a limit certificate in advance so the cap applies at the counter rather than being reclaimed months later.
In personWho: You
4
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 prescription and treatment history with your consent and simplifies claiming the high-cost benefit.
OnlineWho: You
5
Find a clinic within walking distance, and check its winter hours
Japanese clinics run roughly 9–12 and 16–19 with a long midday break, and in Sapporo a clinic three subway stops away is a different proposition in February than in July. Register somewhere you can reach on foot in snow. Sapporo's ward-level holiday and night-time emergency clinics cover the gaps.
In personWho: You
6
Claim the pension lump-sum withdrawal when you leave
If you 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 forgotten 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

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 that scales with income. A major operation or a long admission costs a manageable amount rather than a ruinous one. If a significant treatment is planned, apply for the limit certificate first so the cap is applied at the counter instead of being refunded months later.

Source: Ministry of Health, Labour and Welfare

Hokkaido has almost no cedar pollen and a great deal of birch pollen instead.

Japan's notorious sugi season barely exists here, which is why hay fever sufferers move north with relief — and then develop a white birch allergy in May instead. Birch pollen cross-reacts with apples, cherries, peaches and soy, producing oral allergy syndrome: an itching mouth after raw fruit that people mistake for something else entirely. If raw apple starts to bother you in your second Hokkaido spring, that is what is happening.

Source: community-reported

Falls on ice are a genuine seasonal injury category, not a joke.

Sapporo's freeze-thaw cycle polishes pavements into what locals call tsuru-tsuru road surface, and the city fire service transports people with wrist, hip and head injuries from falls throughout the winter — enough that Sapporo runs an annual public campaign teaching how to walk on it. Small strides, feet flat, hands out of pockets, and boots with actual winter soles rather than fashion treads.

Source: City of Sapporo

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 requires paperwork sent from abroad plus a Japanese bank account or a tax representative to receive it, which is exactly 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.
Registering with a clinic you cannot reach on foot once the pavements ice over.
Leaving Japan without claiming the pension lump-sum withdrawal.
Not applying for a limit certificate before a planned major treatment.

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