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2026-10-04Health

🏥 Kokuho Rules Revision: Public Comment Open

Announced Sept 5, 2026; comments close Oct 4 at 23:59 — draft ordinance amending National Health Insurance, elderly medical care and nursing care rules (MHLW)

What is happening?

On September 5, 2026, Japan's Ministry of Health, Labour and Welfare (MHLW) opened a public comment procedure on a draft ministerial ordinance titled "Ordinance Partially Amending the Enforcement Regulations of the National Health Insurance Act and Related Regulations." This is a formal procedure under the Administrative Procedure Act. Comments are accepted from 00:00 on September 5, 2026 until 23:59 on October 4, 2026. The case number is 495260179 and the responsible office is the Health Insurance Bureau's Division for the Elderly at MHLW. The draft is issued under three enabling provisions: Article 29-4-4(3) of the National Health Insurance Act Enforcement Order (Cabinet Order No. 362 of 1958), Article 16(8) and Article 16-4(2) of the Enforcement Order of the Act on Assurance of Medical Care for Elderly People (Cabinet Order No. 318 of 2007), and Article 22-3(10) of the Long-Term Care Insurance Act Enforcement Order (Cabinet Order No. 412 of 1998). As the word "related regulations" in the title indicates, the amendment spans three public insurance systems: National Health Insurance, the medical care system for people aged 75 and over, and long-term care insurance. In Japan, rules become more detailed in the order of act → cabinet order → ministerial ordinance, and ministerial ordinances set practical rules such as application forms and notification procedures. The specific content is set out in the "draft ordinance" and "outline" PDFs on the e-Gov case page. Because the comment period is still open, the content is not final and no enforcement date has been announced.

👥 Who is affected?

  • Foreign residents enrolled in municipal National Health Insurance because they are not covered by an employer's health insurance (students, self-employed, freelancers)
  • Foreign residents aged 40 and over who pay long-term care insurance premiums together with medical insurance premiums
  • People aged 75 and over enrolled in the medical care system for the elderly, and their families or supporters
  • Anyone who wants to submit an opinion on the draft (accepted until 23:59 on October 4, 2026)

🌏 Impact on foreign residents

Foreign residents registered in Japan who are not covered by an employer's health insurance enrol in municipal National Health Insurance. This applies to students, the self-employed, freelancers and people between jobs, and those aged 40 and over also pay long-term care premiums. The three systems covered by this draft are therefore directly tied to daily life for foreign residents. However, this is still only the comment stage. The content is not fixed and no enforcement date has been announced. Nothing about your insurance card or premium payments changes right now, so if you see a definitive-sounding claim on social media, check the e-Gov case page and MHLW announcements first. Actual procedures will change only after the ordinance is promulgated and enforced and your municipality issues guidance.

💡 Points to keep in mind

1Comments are accepted from 00:00 on September 5, 2026 to 23:59 on October 4, 2026. Submissions after the deadline are not accepted.
2e-Gov asks you to read the full "comment submission guidelines (including where to submit)" and the "draft ordinance" before commenting.
3The case number is 495260179; you can find it in the e-Gov public comment case list.
4How and where to submit is stated in the "comment submission guidelines" PDF — open that file first.
5For materials and enquiries: MHLW Health Insurance Bureau, Division for the Elderly (1-2-2 Kasumigaseki, Chiyoda-ku, Tokyo 100-8916; tel. 03-5253-1111, ext. 3199).
6Because the comment period is open, nothing is final and no enforcement date has been published — you do not need to change any procedure now.
7Once the rules are finalised, confirm the actual procedures and premiums at the National Health Insurance / long-term care insurance desk of the municipality where you are registered.

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