[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"article:kenkou-hoken":3},{"meta":4,"markdown":81},{"type":5,"articleId":6,"slug":7,"title":8,"titleEn":9,"category":10,"summary":11,"publishedAt":12,"image":13,"vocabulary":14},"article","living-kenkou-hoken","kenkou-hoken","健康保険の入門 — 国保と社保の違い","Introduction to Health Insurance — National Health Insurance vs Employees' Health Insurance","living-in-japan","Comprehensive comparison of Japan's two main public health insurance schemes: 健康保険 \u002F 社保 (Employees' Health Insurance for company employees, premium calculated from 標準報酬月額, employer pays 50%) vs 国民健康保険 \u002F 国保 (for self-employed, retirees, and unemployed, premium based on previous-year income and number of household members, fully self-paid). Coverage is uniformly 70% paid by insurance \u002F 30% out-of-pocket (under-6 and over-70 may differ). The 高額療養費制度 caps monthly out-of-pocket cost (~80,100 yen + 1% over threshold for general earners). Dependents (扶養) can be added under 社保 (income under 1.3M yen) but 国保 has no dependent concept — every household member pays. Switching procedures within 14 days when changing jobs.\n","2026-04-27T00:00:00Z","https:\u002F\u002Fimages.yamiyomi.com\u002Fliving-kenkou-hoken.png",[15,20,25,29,33,37,41,45,49,53,57,61,65,69,73,77],{"word":16,"reading":17,"meaning":18,"level":19},"健康保険","けんこうほけん","health insurance (employees')","N2",{"word":21,"reading":22,"meaning":23,"level":24},"国民健康保険","こくみんけんこうほけん","National Health Insurance","N1",{"word":26,"reading":27,"meaning":28,"level":19},"社会保険","しゃかいほけん","social insurance",{"word":30,"reading":31,"meaning":32,"level":24},"標準報酬月額","ひょうじゅんほうしゅうげつがく","standard monthly remuneration",{"word":34,"reading":35,"meaning":36,"level":19},"保険料","ほけんりょう","insurance premium",{"word":38,"reading":39,"meaning":40,"level":24},"自己負担","じこふたん","out-of-pocket payment",{"word":42,"reading":43,"meaning":44,"level":24},"高額療養費制度","こうがくりょうようひせいど","high-cost medical expense system",{"word":46,"reading":47,"meaning":48,"level":24},"扶養","ふよう","dependent support",{"word":50,"reading":51,"meaning":52,"level":24},"被扶養者","ひふようしゃ","dependent (insurance)",{"word":54,"reading":55,"meaning":56,"level":24},"被保険者","ひほけんしゃ","insured person",{"word":58,"reading":59,"meaning":60,"level":24},"給付","きゅうふ","benefit, payment",{"word":62,"reading":63,"meaning":64,"level":19},"加入","かにゅう","enrollment",{"word":66,"reading":67,"meaning":68,"level":24},"脱退","だったい","withdrawal, leaving",{"word":70,"reading":71,"meaning":72,"level":24},"任意継続","にんいけいぞく","voluntary continuation",{"word":74,"reading":75,"meaning":76,"level":24},"協会けんぽ","きょうかいけんぽ","Japan Health Insurance Association (kyokai kenpo)",{"word":78,"reading":79,"meaning":80,"level":24},"組合健保","くみあいけんぽ","corporate union health insurance","\n::para\n[日本]{にほん:Japan:N5}は「[国民]{こくみん:nation-wide:N3}[皆]{かい:all:N3}[保険]{ほけん:insurance:N1}」の[制度]{せいど:system:N3}を[採用]{さいよう:adopting:N2}しており、[原則]{げんそく:in principle:N2}としてすべての[居住者]{きょじゅうしゃ:resident:N3}が[何らか]{なんらか:some kind of:N5}の[公的]{こうてき:public:N4}[医療]{いりょう:medical:N2}[保険]{ほけん:insurance:N1}に[加入]{かにゅう:to enroll:N3}する[義務]{ぎむ:obligation:N1}があります。[主な]{おもな:main:N4}[制度]{せいど:system:N3}は[2]{に:two}つあり、[一]{いち:one:N5}つは[会社員]{かいしゃいん:company employees:N4}とその[家族]{かぞく:family:N4}が[加入]{かにゅう:to enroll:N3}する「[健康]{けんこう:health:N1}[保険]{ほけん:insurance:N1}（[社保]{しゃほ:social insurance:N1}）」、もう[一]{いち:one:N5}つは[自営業者]{じえいぎょうしゃ:self-employed:N2}・[無職]{むしょく:unemployed:N3}・[退職者]{たいしょくしゃ:retiree:N3}などが[加入]{かにゅう:to enroll:N3}する「[国民]{こくみん:national:N3}[健康]{けんこう:health:N1}[保険]{ほけん:insurance:N1}（[国保]{こくほ:NHI:N1}）」です。\n\n#en\nJapan adopts a \"universal health coverage\" system, in which in principle all residents are obligated to enroll in some form of public medical insurance. There are two main schemes: \"Employees' Health Insurance\" (shaho) for company employees and their families, and \"National Health Insurance\" (kokuho) for the self-employed, unemployed, and retirees.\n::\n\n::heading\n[社保]{しゃほ:employees' insurance:N1}（[健康]{けんこう:health:N1}[保険]{ほけん:insurance:N1}）の[基本]{きほん:basics:N1}\n#en\nBasics of Shaho (Employees' Health Insurance)\n::\n\n::para\n[健康]{けんこう:health:N1}[保険]{ほけん:insurance:N1}（[社保]{しゃほ:employees' insurance:N1}）は、[原則]{げんそく:in principle:N2}として[週]{しゅう:per week:N4}30[時間]{じかん:hours:N5}[以上]{いじょう:or more:N4}[勤務]{きんむ:to work:N3}する[正社員]{せいしゃいん:regular employee:N4}や、[一定]{いってい:certain:N3}[条件]{じょうけん:conditions:N1}を[満たす]{みたす:to satisfy:N3}[短時間]{たんじかん:short-time:N2}[労働者]{ろうどうしゃ:worker:N3}（[週]{しゅう:per week:N4}20[時間]{じかん:hours:N5}[以上]{いじょう:or more:N4}・[月額]{げつがく:monthly:N2}[賃金]{ちんぎん:wage:N1}88,000[円]{えん:yen:N5}[以上]{いじょう:or more:N4}・[従業員]{じゅうぎょういん:employees:N1}51[人]{にん:people:N5}[以上]{いじょう:or more:N4}の[企業]{きぎょう:company:N1}など）が[加入]{かにゅう:to enroll:N3}します。[運営]{うんえい:operation:N2}[主体]{しゅたい:body:N4}は2[種類]{しゅるい:types:N3}：[中小]{ちゅうしょう:small and medium:N5}[企業]{きぎょう:enterprise:N1}を[中心]{ちゅうしん:centered:N4}とした「[全国]{ぜんこく:nationwide:N3}[健康]{けんこう:health:N1}[保険]{ほけん:insurance:N1}[協会]{きょうかい:association:N2}（[協会]{きょうかい:association:N2}けんぽ）」と、[大]{だい:large:N5}[企業]{きぎょう:enterprise:N1}が[独自]{どくじ:own:N1}に[設立]{せつりつ:to establish:N2}する「[健康]{けんこう:health:N1}[保険]{ほけん:insurance:N1}[組合]{くみあい:union:N3}（[組合]{くみあい:union:N3}[健保]{けんぽ:health insurance:N1}）」です。\n\n#en\nEmployees' Health Insurance (shaho) generally covers regular employees working 30+ hours a week, plus part-time workers meeting certain conditions (20+ hours weekly, monthly wage of 88,000 yen or more, employer with 51+ employees). There are two operating bodies: Japan Health Insurance Association (Kyokai Kenpo), which mainly covers SMEs, and corporate union health insurance (Kumiai Kenpo), independently established by large corporations.\n::\n\n::para\n[保険料]{ほけんりょう:insurance premium:N1}は「[標準]{ひょうじゅん:standard:N1}[報酬]{ほうしゅう:remuneration:N1}[月額]{げつがく:monthly amount:N2}」（[毎月]{まいつき:monthly:N5}の[給与]{きゅうよ:salary:N3}を50[等級]{とうきゅう:grades:N1}に[区分]{くぶん:dividing:N2}した[額]{がく:amount:N2}）に[保険料]{ほけんりょう:premium:N1}[率]{りつ:rate:N1}（[協会]{きょうかい:association:N2}けんぽは[都道府県]{とどうふけん:prefecture:N2}ごとに[異なり]{ことなり:different:N1}、[全国]{ぜんこく:nationwide:N3}[平均]{へいきん:average:N2}10%[前後]{ぜんご:approximately:N5}）を[掛けて]{かけて:multiplied by:N3}[算出]{さんしゅつ:calculated:N2}され、[労使]{ろうし:labor and management:N3}が[折半]{せっぱん:to split in half:N3}します。つまり[従業員]{じゅうぎょういん:employee:N1}は[実際]{じっさい:actual:N3}の[保険料]{ほけんりょう:premium:N1}の[半分]{はんぶん:half:N5}（[約]{やく:approximately:N3}5%）のみを[負担]{ふたん:to bear:N2}します。[賞与]{しょうよ:bonus:N2}（ボーナス）からも「[標準]{ひょうじゅん:standard:N1}[賞与]{しょうよ:bonus:N2}[額]{がく:amount:N2}」をベースに[保険料]{ほけんりょう:premium:N1}が[徴収]{ちょうしゅう:collected:N1}されます。\n\n#en\nPremiums are calculated by multiplying the \"standard monthly remuneration\" (the monthly salary divided into 50 grade brackets) by the premium rate (Kyokai Kenpo rates differ by prefecture, averaging around 10% nationally) and split evenly between employer and employee. Thus the employee bears only half (around 5%) of the actual premium. Premiums are also collected from bonuses based on the \"standard bonus amount.\"\n::\n\n::callout\n[社保]{しゃほ:employees' insurance:N1}の[要点]{ようてん:key points:N3}：[標準]{ひょうじゅん:standard:N1}[報酬]{ほうしゅう:remuneration:N1}[月額]{げつがく:monthly amount:N2}×[料率]{りょうりつ:rate:N1}≒10%。[労使]{ろうし:employer-employee:N3}[折半]{せっぱん:50\u002F50 split:N3}＝[本人]{ほんにん:the person:N5}[負担]{ふたん:burden:N2}は[約]{やく:approximately:N3}5%。40[歳]{さい:years old:N3}[以上]{いじょう:or more:N4}は[介護]{かいご:long-term care:N1}[保険料]{ほけんりょう:premium:N1}（[約]{やく:approximately:N3}1.6%）も[上乗せ]{うわのせ:added on top:N3}。\n\n#en\nShaho key points: Standard monthly remuneration × rate ≈ 10%. 50\u002F50 employer-employee split = personal burden is about 5%. From age 40, long-term care insurance premium (approx. 1.6%) is added on top.\n::\n\n::heading\n[国保]{こくほ:NHI:N1}（[国民]{こくみん:national:N3}[健康]{けんこう:health:N1}[保険]{ほけん:insurance:N1}）の[基本]{きほん:basics:N1}\n#en\nBasics of Kokuho (National Health Insurance)\n::\n\n::para\n[国民]{こくみん:national:N3}[健康]{けんこう:health:N1}[保険]{ほけん:insurance:N1}（[国保]{こくほ:NHI:N1}）は、[市町村]{しちょうそん:municipality:N2}（および[都道府県]{とどうふけん:prefecture:N2}）が[運営]{うんえい:operate:N2}する[制度]{せいど:system:N3}で、[社保]{しゃほ:employees' insurance:N1}に[加入]{かにゅう:enroll:N3}していない[人]{ひと:person:N5}が[対象]{たいしょう:target:N2}です。[具体的]{ぐたいてき:specifically:N3}には[個人]{こじん:individual:N2}[事業主]{じぎょうぬし:business owner:N4}・フリーランス・[農業]{のうぎょう:agriculture:N2}[従事者]{じゅうじしゃ:engaged in:N1}・[退職]{たいしょく:retired:N3}[者]{しゃ:person:N4}（[任意]{にんい:voluntary:N3}[継続]{けいぞく:continuation:N1}を[利用]{りよう:use:N3}しない[場合]{ばあい:case:N3}）・[無職]{むしょく:unemployed:N3}の[人]{ひと:person:N5}・[非正規]{ひせいき:non-regular:N3}[雇用]{こよう:employment:N2}で[社保]{しゃほ:employees' insurance:N1}の[加入]{かにゅう:enrollment:N3}[要件]{ようけん:requirements:N3}を[満たさ]{みたさ:satisfy:N3}ない[人]{ひと:person:N5}などです。\n\n#en\nNational Health Insurance (kokuho) is operated by municipalities (and prefectures) and covers people not enrolled in employees' insurance. Specifically, this includes sole proprietors, freelancers, agricultural workers, retirees (when not using voluntary continuation), the unemployed, and non-regular workers who do not meet the requirements for shaho enrollment.\n::\n\n::para\n[国保]{こくほ:NHI:N1}の[保険料]{ほけんりょう:premium:N1}は、[前年]{ぜんねん:previous year:N5}の[所得]{しょとく:income:N3}と[世帯]{せたい:household:N2}の[加入]{かにゅう:enrolled:N3}[人数]{にんずう:number of people:N3}に[基づき]{もとづき:based on:N1}、[市町村]{しちょうそん:municipality:N2}ごとに[計算]{けいさん:calculated:N2}されます。[一般]{いっぱん:typically:N2}には①[所得割]{しょとくわり:income-based portion:N3}、②[均等割]{きんとうわり:per-person portion:N2}、[市町村]{しちょうそん:municipality:N2}によっては③[平等割]{びょうどうわり:per-household portion:N3}・④[資産割]{しさんわり:asset-based portion:N3}を[組み合わせて]{くみあわせて:combining:N3}[算出]{さんしゅつ:calculated:N2}されます。[年間]{ねんかん:annual:N5}[上限]{じょうげん:cap:N3}は[医療]{いりょう:medical:N2}[分]{ぶん:portion:N5}・[後期]{こうき:later-stage:N3}[高齢]{こうれい:elderly:N2}[支援]{しえん:support:N1}[分]{ぶん:portion:N5}・[介護]{かいご:long-term care:N1}[分]{ぶん:portion:N5}を[合計]{ごうけい:totaled:N3}して[年]{ねん:year:N5}102[万]{まん:ten thousand:N5}[円]{えん:yen:N5}[程度]{ていど:approximately:N3}（[年度]{ねんど:fiscal year:N4}・[市町村]{しちょうそん:municipality:N2}により[変動]{へんどう:varies:N3}）。[全額]{ぜんがく:full amount:N2}が[本人]{ほんにん:the person:N5}[負担]{ふたん:burden:N2}（[折半]{せっぱん:50\u002F50 split:N3}なし）となるため、[同等]{どうとう:equivalent:N3}の[年収]{ねんしゅう:annual income:N3}でも[社保]{しゃほ:employees' insurance:N1}より[割高]{わりだか:relatively expensive:N3}に[感じ]{かんじ:to feel:N3}られることが[多い]{おおい:common:N4}です。\n\n#en\nKokuho premiums are calculated by each municipality based on the previous year's income and the number of enrolled household members. Typically the calculation combines (1) an income-based portion, (2) a per-person portion, and depending on the municipality (3) a per-household portion and (4) an asset-based portion. The annual cap, totaling medical \u002F later-stage elderly support \u002F long-term care portions, is approximately 1.02 million yen (varies by year and municipality). Since the entire amount is paid by the individual (no 50\u002F50 split), it often feels relatively expensive compared to shaho at equivalent income levels.\n::\n\n::callout\n[社保]{しゃほ:employees' insurance:N1} vs [国保]{こくほ:NHI:N1} 比較：[社保]{しゃほ:employees' insurance:N1}＝[標準]{ひょうじゅん:standard:N1}[報酬]{ほうしゅう:remuneration:N1}[月額]{げつがく:monthly:N2}ベース・[労使]{ろうし:employer-employee:N3}[折半]{せっぱん:50\u002F50:N3}・[扶養]{ふよう:dependent:N1}OK。[国保]{こくほ:NHI:N1}＝[前年]{ぜんねん:previous year:N5}[所得]{しょとく:income:N3}+[世帯]{せたい:household:N2}[人数]{にんずう:size:N3}ベース・[全額]{ぜんがく:full amount:N2}[自己]{じこ:self:N1}[負担]{ふたん:burden:N2}・[扶養]{ふよう:dependent:N1}[概念]{がいねん:concept:N1}なし（[全員]{ぜんいん:everyone:N3}が[被保険者]{ひほけんしゃ:insured:N1}）。\n\n#en\nShaho vs Kokuho comparison: Shaho = standard monthly remuneration basis, 50\u002F50 employer-employee split, dependents OK. Kokuho = previous year income + household size basis, fully self-paid, no dependent concept (every member is an insured person).\n::\n\n::heading\n[医療費]{いりょうひ:medical expenses:N2}の[自己]{じこ:self:N1}[負担]{ふたん:burden:N2}[割合]{わりあい:percentage:N3}と[給付]{きゅうふ:benefits:N3}\n#en\nOut-of-Pocket Burden Percentage and Benefits\n::\n\n::para\n[公的]{こうてき:public:N4}[医療]{いりょう:medical:N2}[保険]{ほけん:insurance:N1}の[給付]{きゅうふ:benefit:N3}は[原則]{げんそく:as a rule:N2}として、[医療費]{いりょうひ:medical cost:N2}の70%を[保険]{ほけん:insurance:N1}が[負担]{ふたん:cover:N2}し、[残り]{のこり:remaining:N3}30%を[患者]{かんじゃ:patient:N2}が[窓口]{まどぐち:counter:N3}で[支払い]{しはらい:to pay:N3}ます。これは[社保]{しゃほ:employees' insurance:N1}・[国保]{こくほ:NHI:N1}とも[共通]{きょうつう:same:N3}です。ただし[年齢]{ねんれい:age:N2}により[次]{つぎ:following:N3}のように[異なり]{ことなり:differs:N1}ます。[未]{み:un-:N3}[就学]{しゅうがく:school enrollment:N1}[児]{じ:child:N2}（6[歳]{さい:years old:N3}に[達する]{たっする:reaching:N3}[年度]{ねんど:fiscal year:N4}の[年度末]{ねんどまつ:year-end:N3}まで）は[自己]{じこ:self:N1}[負担]{ふたん:burden:N2}20%。70[歳]{さい:years old:N3}〜74[歳]{さい:years old:N3}は[原則]{げんそく:as a rule:N2}20%（[現役]{げんえき:active:N3}[並み]{なみ:equivalent:N2}[所得者]{しょとくしゃ:earner:N3}は30%）。75[歳]{さい:years old:N3}[以上]{いじょう:or more:N4}は[後期]{こうき:later-stage:N3}[高齢者]{こうれいしゃ:elderly:N2}[医療]{いりょう:medical:N2}[制度]{せいど:system:N3}に[移行]{いこう:transitioning:N2}し[原則]{げんそく:as a rule:N2}10%（[一定]{いってい:certain:N3}[所得]{しょとく:income:N3}[以上]{いじょう:or more:N4}は20%・[現役]{げんえき:active:N3}[並み]{なみ:equivalent:N2}[所得者]{しょとくしゃ:earner:N3}は30%）。\n\n#en\nPublic medical insurance benefits in principle cover 70% of medical costs, with the patient paying the remaining 30% at the counter. This is the same for shaho and kokuho. However, age-based differences apply as follows. Pre-school children (until the end of the fiscal year in which they turn 6) bear 20%. Ages 70-74 in principle 20% (active-equivalent earners pay 30%). Age 75 and over transitions to the late-stage elderly medical system, in principle paying 10% (those at certain income levels pay 20%, active-equivalent earners pay 30%).\n::\n\n::heading\n[高額]{こうがく:high-cost:N2}[療養費]{りょうようひ:medical treatment expense:N1}[制度]{せいど:system:N3}\n#en\nHigh-Cost Medical Expense System\n::\n\n::para\n1ヶ[月]{かげつ:month:N5}（[月]{つき:month:N5}の[初日]{しょにち:first day:N3}から[末日]{まつじつ:last day:N3}まで）の[医療費]{いりょうひ:medical expense:N2}[自己]{じこ:self:N1}[負担]{ふたん:burden:N2}[額]{がく:amount:N2}が[一定]{いってい:certain:N3}の[上限]{じょうげん:cap:N3}を[超えた]{こえた:exceeded:N2}[場合]{ばあい:case:N3}、その[超過]{ちょうか:excess:N2}[分]{ぶん:portion:N5}が[後日]{ごじつ:later:N5}[還付]{かんぷ:refunded:N1}される[制度]{せいど:system:N3}が[高額]{こうがく:high-cost:N2}[療養費]{りょうようひ:medical treatment expense:N1}[制度]{せいど:system:N3}です。70[歳]{さい:years old:N3}[未満]{みまん:under:N3}・[一般]{いっぱん:general:N2}[所得]{しょとく:income:N3}[区分]{くぶん:bracket:N2}（[年収]{ねんしゅう:annual income:N3}[約]{やく:approximately:N3}370[万]{まん:ten thousand:N5}〜770[万]{まん:ten thousand:N5}[円]{えん:yen:N5}）の[人]{ひと:person:N5}の[計算式]{けいさんしき:calculation formula:N2}は「80,100[円]{えん:yen:N5} + （[総]{そう:total:N2}[医療費]{いりょうひ:medical expense:N2} − 267,000[円]{えん:yen:N5}）×1%」です。[例えば]{たとえば:for example:N3}、[総]{そう:total:N2}[医療費]{いりょうひ:medical expense:N2}が100[万]{まん:ten thousand:N5}[円]{えん:yen:N5}（[窓口]{まどぐち:counter:N3}[負担]{ふたん:payment:N2}30[万]{まん:ten thousand:N5}[円]{えん:yen:N5}）の[場合]{ばあい:case:N3}、[自己]{じこ:self:N1}[負担]{ふたん:burden:N2}[上限]{じょうげん:cap:N3}は[約]{やく:approximately:N3}87,430[円]{えん:yen:N5}となり、[差額]{さがく:difference:N2}[約]{やく:approximately:N3}21[万]{まん:ten thousand:N5}[円]{えん:yen:N5}が[還付]{かんぷ:refunded:N1}されます。\n\n#en\nThe high-cost medical expense system refunds the excess portion when monthly out-of-pocket medical costs (from the first to the last day of the month) exceed a certain cap. For people under 70 in the general income bracket (annual income approx. 3.7M to 7.7M yen), the formula is: \"80,100 yen + (total medical cost - 267,000 yen) × 1%.\" For example, if total medical costs are 1 million yen (counter payment 300,000 yen), the out-of-pocket cap is approximately 87,430 yen, and the difference of approximately 210,000 yen is refunded.\n::\n\n::para\n[事前]{じぜん:in advance:N4}に[加入]{かにゅう:enrolled:N3}している[健康]{けんこう:health:N1}[保険]{ほけん:insurance:N1}（[協会]{きょうかい:association:N2}けんぽ・[組合]{くみあい:union:N3}[健保]{けんぽ:health insurance:N1}・[市町村]{しちょうそん:municipality:N2}）に「[限度]{げんど:limit:N3}[額]{がく:amount:N2}[適用]{てきよう:applied:N3}[認定証]{にんていしょう:certificate:N1}」を[申請]{しんせい:to apply:N1}しておけば、[医療]{いりょう:medical:N2}[機関]{きかん:institution:N3}の[窓口]{まどぐち:counter:N3}で[最初]{さいしょ:from the start:N3}から[自己]{じこ:self:N1}[負担]{ふたん:burden:N2}[上限]{じょうげん:cap:N3}[額]{がく:amount:N2}までの[支払い]{しはらい:payment:N3}で[済み]{すみ:to suffice:N3}ます。[特に]{とくに:especially:N4}[入院]{にゅういん:hospitalization:N4}や[高額]{こうがく:expensive:N2}な[治療]{ちりょう:treatment:N2}を[受ける]{うける:to receive:N3}[際]{さい:occasion:N3}に[非常]{ひじょう:extremely:N3}に[重要]{じゅうよう:important:N3}な[制度]{せいど:system:N3}です。\n\n#en\nBy applying in advance for the \"Limit Amount Application Certificate\" from your health insurance (Kyokai Kenpo, Kumiai Kenpo, or municipality), you can pay only up to the out-of-pocket cap amount at the medical institution's counter from the start. This is an extremely important system, especially when hospitalized or receiving expensive treatment.\n::\n\n::callout\n[高額]{こうがく:high-cost:N2}[療養費]{りょうようひ:medical treatment expense:N1}＝1ヶ[月]{かげつ:month:N5}の[自己]{じこ:self:N1}[負担]{ふたん:burden:N2}に[上限]{じょうげん:cap:N3}。[一般]{いっぱん:general:N2}[所得]{しょとく:income:N3}[区分]{くぶん:bracket:N2}は[約]{やく:approximately:N3}80,100[円]{えん:yen:N5} + （[総]{そう:total:N2}[医療費]{いりょうひ:medical:N2}−267,000[円]{えん:yen:N5}）×1%。「[限度]{げんど:limit:N3}[額]{がく:amount:N2}[適用]{てきよう:applied:N3}[認定証]{にんていしょう:certificate:N1}」を[事前]{じぜん:in advance:N4}[取得]{しゅとく:obtain:N3}すれば[窓口]{まどぐち:counter:N3}[支払い]{しはらい:payment:N3}を[抑え]{おさえ:to limit:N1}られる。\n\n#en\nHigh-cost medical expense system = caps monthly out-of-pocket cost. General income bracket cap is approx. 80,100 yen + (total medical cost - 267,000 yen) × 1%. Obtaining the \"Limit Amount Application Certificate\" in advance keeps counter payments within the cap.\n::\n\n::heading\n[扶養]{ふよう:dependent:N1}（[被]{ひ:insured:N2}[扶養者]{ふようしゃ:dependent:N1}）[制度]{せいど:system:N3}\n#en\nDependent (Hifuyousha) System\n::\n\n::para\n[社保]{しゃほ:employees' insurance:N1}には「[被]{ひ:insured:N2}[扶養者]{ふようしゃ:dependent:N1}」[制度]{せいど:system:N3}があり、[一定]{いってい:certain:N3}の[要件]{ようけん:requirements:N3}を[満たす]{みたす:to satisfy:N3}[家族]{かぞく:family:N4}は[追加]{ついか:additional:N3}[保険料]{ほけんりょう:premium:N1}なしで[同じ]{おなじ:same:N4}[保険]{ほけん:insurance:N1}に[加入]{かにゅう:enrolled:N3}できます。[主]{しゅ:main:N4}な[要件]{ようけん:requirements:N3}は、①[年間]{ねんかん:annual:N5}[収入]{しゅうにゅう:income:N3}130[万]{まん:ten thousand:N5}[円]{えん:yen:N5}[未満]{みまん:under:N3}（60[歳]{さい:years old:N3}[以上]{いじょう:or more:N4}または[障害者]{しょうがいしゃ:disabled person:N1}は180[万]{まん:ten thousand:N5}[円]{えん:yen:N5}[未満]{みまん:under:N3}）、②[被保険者]{ひほけんしゃ:insured person:N1}（[本人]{ほんにん:the person:N5}）の[年間]{ねんかん:annual:N5}[収入]{しゅうにゅう:income:N3}の[2分の]{にぶんの:half of:N5}1[未満]{みまん:less than:N3}（[同居]{どうきょ:cohabiting:N3}[要件]{ようけん:requirement:N3}に[応じて]{おうじて:depending on:N1}[異なる]{ことなる:differs:N1}）です。[配偶者]{はいぐうしゃ:spouse:N3}・[子]{こ:child:N5}・[父母]{ふぼ:parents:N5}・[孫]{まご:grandchildren:N2}・[兄弟姉妹]{きょうだいしまい:siblings:N4}などが[対象]{たいしょう:eligible:N2}です。\n\n#en\nShaho has a \"dependent\" (hifuyousha) system, allowing family members meeting certain requirements to enroll in the same insurance without additional premiums. Main requirements: (1) annual income under 1.3 million yen (under 1.8 million yen for those 60+ or disabled), (2) less than half of the insured person's annual income (depending on cohabitation requirements). Eligible relatives include spouse, children, parents, grandchildren, and siblings.\n::\n\n::para\n[一方]{いっぽう:on the other hand:N4}、[国保]{こくほ:NHI:N1}には「[扶養]{ふよう:dependent:N1}」の[概念]{がいねん:concept:N1}が[存在]{そんざい:exist:N3}しません。[世帯]{せたい:household:N2}[全員]{ぜんいん:everyone:N3}がそれぞれ[被保険者]{ひほけんしゃ:insured person:N1}となり、[各人]{かくじん:each person:N2}の[所得]{しょとく:income:N3}に[応じた]{おうじた:according to:N1}[保険料]{ほけんりょう:premium:N1}（[均等割]{きんとうわり:per-person portion:N2}を[含む]{ふくむ:including:N2}）が[算出]{さんしゅつ:calculated:N2}され、[世帯]{せたい:household:N2}[主]{ぬし:head:N4}が[一括]{いっかつ:in bulk:N1}[納付]{のうふ:to pay:N1}します。[家族]{かぞく:family members:N4}が[多い]{おおい:many:N4}と[均等割]{きんとうわり:per-person portion:N2}が[積み重なり]{つみかさなり:accumulate:N3}、[割高]{わりだか:relatively expensive:N3}になりがちです。\n\n#en\nOn the other hand, kokuho has no \"dependent\" concept. Every household member is an insured person, and premiums (including a per-person portion) are calculated by each person's income, with the household head paying in bulk. With many family members, the per-person portions accumulate, tending to make it relatively expensive.\n::\n\n::heading\n[転職]{てんしょく:job change:N3}・[退職]{たいしょく:retirement:N3}[時]{じ:occasion:N5}の[切り替え]{きりかえ:switching:N2}\n#en\nSwitching When Changing Jobs or Retiring\n::\n\n::para\n[退職]{たいしょく:retirement:N3}・[転職]{てんしょく:job change:N3}の[際]{さい:occasion:N3}は[資格]{しかく:eligibility:N3}[喪失]{そうしつ:loss:N1}から14[日]{にち:days:N5}[以内]{いない:within:N3}に[次]{つぎ:next:N3}の[手続き]{てつづき:procedure:N3}を[行う]{おこなう:to perform:N5}[必要]{ひつよう:necessary:N3}があります。[選択肢]{せんたくし:options:N1}は3つ：①[転職先]{てんしょくさき:new employer:N3}の[社保]{しゃほ:employees' insurance:N1}に[加入]{かにゅう:enroll:N3}（[空白]{くうはく:gap:N4}[期間]{きかん:period:N3}なしの[転職]{てんしょく:job change:N3}が[理想]{りそう:ideal:N3}）、②[任意]{にんい:voluntary:N3}[継続]{けいぞく:continuation:N1}[被保険者]{ひほけんしゃ:insured person:N1}[制度]{せいど:system:N3}：[退職]{たいしょく:retirement:N3}[前]{まえ:before:N5}に2ヶ[月]{かげつ:months:N5}[以上]{いじょう:or more:N4}[加入]{かにゅう:enrolled:N3}していた[人]{ひと:person:N5}は[最長]{さいちょう:up to:N3}2[年間]{ねんかん:years:N5}[同じ]{おなじ:same:N4}[健康]{けんこう:health:N1}[保険]{ほけん:insurance:N1}を[継続]{けいぞく:to continue:N1}できる（ただし[保険料]{ほけんりょう:premium:N1}は[全額]{ぜんがく:full amount:N2}[本人]{ほんにん:the person:N5}[負担]{ふたん:burden:N2}）、③[国保]{こくほ:NHI:N1}に[加入]{かにゅう:enroll:N3}（[市町村]{しちょうそん:municipality:N2}[役所]{やくしょ:office:N3}に[退職]{たいしょく:retirement:N3}を[証明]{しょうめい:proving:N1}する[書類]{しょるい:documents:N3}を[持参]{じさん:bring:N3}）。\n\n#en\nWhen retiring or changing jobs, you must complete the next procedure within 14 days of losing eligibility. There are 3 options: (1) enroll in the new employer's shaho (job changes without a gap are ideal), (2) Voluntary Continuation Insured Person system: those enrolled for 2+ months before retirement can continue the same health insurance for up to 2 years (but premiums become fully self-paid), (3) enroll in kokuho (bring documents proving retirement to the municipal office).\n::\n\n::callout\n[切り替え]{きりかえ:switching:N2}の[要点]{ようてん:key points:N3}：[退職]{たいしょく:retirement:N3}[後]{ご:after:N5}14[日]{にち:days:N5}[以内]{いない:within:N3}に[手続き]{てつづき:procedure:N3}。[任意]{にんい:voluntary:N3}[継続]{けいぞく:continuation:N1}は[最長]{さいちょう:max:N3}2[年]{ねん:years:N5}・[全額]{ぜんがく:full amount:N2}[自己]{じこ:self:N1}[負担]{ふたん:burden:N2}（[折半]{せっぱん:50\u002F50:N3}なし）。[国保]{こくほ:NHI:N1}は[退職]{たいしょく:retirement:N3}[前]{ぜん:before:N5}の[所得]{しょとく:income:N3}が[反映]{はんえい:reflected:N3}されるため[初年度]{しょねんど:first year:N3}は[高額]{こうがく:high:N2}になりやすい。\n\n#en\nSwitching key points: complete procedures within 14 days of retirement. Voluntary continuation is max 2 years with fully self-paid premiums (no 50\u002F50 split). Kokuho reflects pre-retirement income, so the first year tends to be expensive.\n::\n\n::callout\n[総]{そう:overall:N2}まとめ：①[国民]{こくみん:nation-wide:N3}[皆]{かい:all:N3}[保険]{ほけん:insurance:N1}＝[全員]{ぜんいん:everyone:N3}[加入]{かにゅう:enrolled:N3}[義務]{ぎむ:obligation:N1}、②[社保]{しゃほ:employees' insurance:N1}＝[会社員]{かいしゃいん:employee:N4}・[標準]{ひょうじゅん:standard:N1}[報酬]{ほうしゅう:remuneration:N1}[月額]{げつがく:monthly:N2}×10%・[折半]{せっぱん:50\u002F50:N3}・[扶養]{ふよう:dependent:N1}OK、③[国保]{こくほ:NHI:N1}＝[自営]{じえい:self-employed:N2}・[無職]{むしょく:unemployed:N3}・[前年]{ぜんねん:previous year:N5}[所得]{しょとく:income:N3}+[人数]{にんずう:headcount:N3}・[全額]{ぜんがく:full amount:N2}[自己]{じこ:self:N1}[負担]{ふたん:burden:N2}・[扶養]{ふよう:dependent:N1}なし、④[窓口]{まどぐち:counter:N3}[負担]{ふたん:burden:N2}は[原則]{げんそく:in principle:N2}30%（[未]{み:un-:N3}[就学]{しゅうがく:school enrollment:N1}[児]{じ:child:N2}・70[歳]{さい:years old:N3}[以上]{いじょう:or more:N4}は[軽減]{けいげん:reduced:N2}）、⑤[高額]{こうがく:high-cost:N2}[療養費]{りょうようひ:medical treatment expense:N1}＝[月]{つき:month:N5}[80,100]{はちまんいっぴゃく:approx. 80,100}[円]{えん:yen:N5}+1%[超過]{ちょうか:excess:N2}が[一般]{いっぱん:general:N2}の[上限]{じょうげん:cap:N3}、⑥[退職]{たいしょく:retirement:N3}[後]{ご:after:N5}は14[日]{にち:days:N5}[以内]{いない:within:N3}に[切り替え]{きりかえ:switch:N2}（[任意]{にんい:voluntary:N3}[継続]{けいぞく:continuation:N1}か[国保]{こくほ:NHI:N1}）。\n\n#en\nSummary: (1) universal coverage = everyone obligated to enroll, (2) shaho = company employees, standard monthly remuneration × 10%, 50\u002F50 split, dependents OK, (3) kokuho = self-employed and unemployed, previous year income + household size, fully self-paid, no dependents, (4) counter burden in principle 30% (reduced for pre-school children and those 70+), (5) high-cost medical = approx. 80,100 yen + 1% excess as general bracket cap, (6) post-retirement, switch within 14 days (voluntary continuation or kokuho).\n::\n"]