Health cover counts in a founder’s permit review in Japan and Germany

In Japan, a company is a compulsory workplace for employees’ health insurance even when only its owner works there, and under a health ministry notice a director it pays for running it is insured through it, not through municipal National Health Insurance.

Immigration officials check the company’s enrolment and payment when a Business Manager status is renewed. In Germany, the self-employed are generally outside compulsory statutory insurance, and a residence permit as a rule requires adequate health cover.

The two systems side by side

Japan: a company of one is a covered workplace

Under the National Health Insurance Act, everyone with an address in Japan is in the National Health Insurance (NHI) that prefectures run with their municipalities, with exceptions that include people insured under the employees’ scheme and their dependants.

Shinjuku City in Tokyo says a foreign resident under 75 with a resident record and a status of more than three months must join unless covered at work or otherwise exempt.

The Japan Pension Service says every corporate place of business, including one where only the owner works, is a compulsory workplace for both employees’ pension and health insurance.

Under a Ministry of Health, Labour and Welfare notice of 18 March 2026, amended in September to make its handling clearer, company officers, representative directors included, who receive pay from the company in return for their work are insured as people it employs; the test is whether the work is, in substance, regular participation in management and whether the pay is made regularly for it.

Shinjuku lists people working at or managing a corporation, and their dependants, among those who cannot join NHI.

This means a Business Manager holder who runs a company and draws a salary from it is insured through the company’s employees’ scheme, with qualifying family members as dependants, not through municipal NHI.

NHI remains the scheme for a sole proprietor: the Immigration Services Agency asks a sole proprietor with no duty to join employees’ insurance to explain why the business is not a compulsory workplace and to show the proprietor’s own NHI enrolment.

What it costs in Japan

NHI premiums are set by each municipality on household income. In Shinjuku, for fiscal 2026, the premium has four parts, each a flat amount per member plus a share of the household’s assessment base, the sum of each member’s 2025 total income less a ¥430,000 basic deduction (for total income up to ¥24 million).

The four parts are medical care, ¥47,600 a member plus 7.51%; support for the late-stage elderly scheme, ¥17,600 plus 2.80%; long-term care, for members aged 40 to 64 only, ¥17,800 plus 2.43%; and a new child-support part, ¥1,873 for each member aged 18 or over plus 0.27%.

National ceilings cap the four parts at a total of ¥1.13 million a year for a household. From fiscal 2026, municipalities that choose to may require new arrivals to prepay their first year’s premium.

For a company enrolled with the Japan Health Insurance Association (Kyokai Kenpo) in Tokyo, the general premium rate is 9.85% from March 2026, with a long-term care rate of 1.62% for members aged 40 to 64 and, from April 2026, a child-support rate of 0.23%.

In both schemes, patients pay 30% of treatment costs from school age until the month they turn 70, and 20% before compulsory schooling, up to a monthly ceiling.

After the Prime Minister put a planned August 2025 increase on hold on 7 March 2025, the ceilings were revised in line with medical-cost growth from 1 August 2026, the health ministry says, and an annual cap was added; a second stage follows in August 2027.

For patients under 70 with income of about ¥3.7 million to ¥7.7 million, the ceiling is now ¥85,800 a month plus 1% of costs above ¥286,000 (previously ¥80,100 plus 1%), and ¥530,000 a year; from about ¥11.6 million, it is ¥270,300 plus 1% above ¥901,000, and ¥1.68 million a year.

Japan: the renewal check now, and the one planned for 2027

Since the Business Manager rules changed on 16 October 2025, the Immigration Services Agency checks at each renewal whether the business has enrolled in health insurance and employees’ pension and paid the premiums, alongside labour insurance and the taxes it owes.

Asked whether renewal can be refused when the business and its taxes are in order, the agency’s FAQ says problems with social-insurance enrolment or payment count against the applicant and that there are cases in which renewal is not granted.

People who already held the status will not be refused before 16 October 2028 solely because they miss the new business criteria, though the agency weighs the business and the prospect of meeting them; the agency states no comparable transition for its checks on public dues. This indicates that insurance problems get no such grace.

The ¥30 million Business Manager threshold is covered in a separate article.

The next step reaches every foreign resident in NHI. On 23 January 2026 the government decided that, from June 2027, the agency should be able to check NHI payment electronically for all residence statuses, and that using the data in landing and residence reviews would be considered.

Under a health ministry plan, municipalities would supply five years of payment data monthly, viewed with the applicant’s consent; an applicant in arrears would have to pay, or pledge to pay in instalments, and present a certificate, without which an extension would in principle not be granted.

The planned exchange would therefore cover any months a founder or family members spent in NHI within those five years.

Systems were still being built in July 2026, and a September 2026 draft agency plan adds national pension payment data. None of this is in force yet; under a voluntary arrangement the Cabinet Secretariat described in 2025, 68 municipalities as of June 2025 passed uncollectable NHI arrears more than a year overdue to immigration offices for residence reviews.

Germany: insurance is compulsory, the statutory scheme is not

Every person resident in Germany must take out and keep health insurance with an insurer licensed in Germany, covering at least outpatient and inpatient treatment with deductibles of no more than €5,000 a year, under section 193 of the Insurance Contract Act; members of statutory insurance are exempt, and applying more than a month after the duty arises costs a premium surcharge.

People whose main occupation is self-employment are not compulsorily insured as employees under section 5 of Book V of the Social Code.

The same section’s catch-all for residents with no other cover excludes them, and reaches nationals of countries outside the European Union, the European Economic Area and Switzerland only if they hold a permit valid for more than twelve months that carried no duty to secure their livelihood.

Under section 5(1) of the Residence Act, discussed below, a residence title as a rule requires a secured livelihood. This indicates that a self-employment permit under section 21 of that Act carries that duty.

Voluntary membership under section 9 depends mainly on prior statutory membership, at least 24 months in the five years before leaving compulsory insurance or 12 months without a break immediately before; another route, a first job in Germany paid above €77,400 a year in 2026, is for employees.

Read together, these rules indicate that a founder arriving without German insurance history normally insures privately.

For comparison, statutory members in 2026 pay 14.6% of contributory income, or 14.0% without sick-pay entitlement, plus an add-on set by each fund that averages 2.9%. Long-term care insurance adds 3.6%, or 4.2% for childless members over 23.

Contributions are charged on income up to €69,750 a year. No official figure for private premiums was found.

Germany: what the immigration office accepts

A residence title as a rule requires a secured livelihood, under section 5(1) of the Residence Act, and section 2(3) counts livelihood as secured only if it includes adequate health insurance without recourse to public funds. Section 21 itself does not mention health insurance; the requirement comes through these general rules.

The federal administrative regulation on the Act, dated 2009, says statutory membership is always adequate without further checks, that private cover needs a thorough case-by-case check, and that proof of long-term care insurance may be demanded in section 21 cases.

Frankfurt and Berlin, the two immigration offices examined, spell this out. Frankfurt requires private cover to match statutory insurance in kind and scope, without extensive exclusions, cost caps or clauses ending cover at a given age, on giving up the activity, on a change of residence purpose or on loss of legal status.

It treats the private basic tariff as always adequate, requires the insurer’s written confirmation under section 257(2a) of Book V of the Social Code, says travel insurance that sufficed for entry is not enough, and issues no residence permit without proof.

Berlin’s page for the self-employment permit asks for statutory or comparable private cover in Germany and says foreign health insurance is generally not sufficient. The section 21 self-employment permit is covered in a separate article.

Private insurance has a later consequence. Under section 6(3a), a person who becomes compulsorily insured after turning 55 stays exempt if not statutorily insured in the previous five years and, for at least half that time, exempt, released from the duty or self-employed.

This means a founder privately insured past 55 would generally not return to the statutory scheme by taking a job.

What this article has not established

In Japan, it was not established whether a director drawing no salary, or a token one, is insured through the company, or what pay the employees’ scheme rates apply to and how the premium is split between company and director.

Nor was it established how a newcomer’s first NHI premium is assessed without Japanese income in the previous year, or what will count as arrears if the planned 2027 data exchange starts.

In Germany, no federal regulation on the point newer than 2009 was found, and what private insurance costs was not established. The Vietnamese side was not established.

The same question for the United States, Canada and Australia will be covered in a separate article; residence status and healthcare in Portugal, Dubai and Singapore were compared in an August article.