Access Healthcare in Japan Without an ID or Insurance Card | MyKyoten

Are philosophically opposed to government database linkage (yes, these people exist)

The catch is: Most city hall clerks don't know how to issue these certificates anymore because the demand dropped to near-zero. You'll need to specifically ask for it, and you might get pushback.

Step 1: Go to your city hall's health insurance counter This is the kokumin kenkō hoken (国民健康保険) desk if you're on National Health Insurance, or your employer's HR department if you're on company insurance (社会保険, shakai hoken).

Step 2: Say the magic words Tell them: "My Number kādo o tsukawanai node, shikaku kakuninsho o hakkō shite kudasai" (マイナンバーカードを使わないので、資格確認書を発行してください) - "I'm not using the My Number card, so please issue a Certificate of Eligibility."

The clerk will probably look confused. Some will ask "Why?" Just repeat: "Shikaku kakuninsho o onegaishimasu" (資格確認書をお願いします). You don't owe them an explanation-it's your legal right.

Step 3: Fill out a request form They'll hand you a form asking for your name, address, date of birth, and insurance number (保険者番号). If you don't know your insurance number, it's on any old medical receipt or the notification letter you got when you enrolled. Bring that.

Step 4: Wait 1-2 weeks Unlike the instant activation of the Residence Card (在留カード) system, the paper certificate has to be printed and mailed to you. Some wards hand it to you on the spot, but most mail it within 5-10 business days. If you need medical care urgently, this delay is a problem.

When you arrive at the clinic or hospital, hand the receptionist your Certificate of Eligibility instead of your Residence Card (在留カード). It's a folded piece of paper (about A5 size) with your name, insurance number, and a validity period printed on it.

The vibe: The receptionist will pause, sometimes for a full 10 seconds, because they're used to scanning QR codes, not processing paper. They might call over a supervisor. Stay calm. Point to the insurance number on the certificate and say "Kore de daijōbu desu" (これで大丈夫です) - "This is fine."

They'll manually input your insurance info into their system. This adds 3-5 minutes to check-in, but it works. You'll pay the same 30% co-pay as everyone else (70% covered by insurance). The certificate doesn't change your coverage-it just proves you're enrolled.

[WARNING BOX] The Certificate of Eligibility has an expiration date (usually 1 year from issue). If it expires and you show up at the doctor, they'll charge you 100% of the bill upfront, then you'll have to file for a 70% reimbursement later at city hall. This is a bureaucratic nightmare. Set a phone reminder 2 weeks before expiration to renew.

Honestly, some small clinics (especially ones run by elderly doctors with outdated systems) will flat-out refuse the paper certificate. They'll say "My Number kādo ga nai to dame desu" (マイナンバーカードがないとダメです) - "We need the My Number card."

This is technically illegal-they're required by law to accept the Certificate of Eligibility-but arguing with a 70-year-old doctor who doesn't know the 2026 regulations is a losing battle. If this happens:

Ask for the clinic manager or head nurse. Sometimes the doctor is wrong and the admin staff knows better.

Show them the certificate's insurance number. Say "Hokensha bangō ga koko ni arimasu" (保険者番号がここにあります) - "The insurance number is right here."

If they still refuse, leave and find a bigger hospital. University hospitals and chain clinics (like Seikei-kai or Tokushukai) are more up-to-date and will accept it without fuss.

Reality check: "The government pushed the My Number health insurance link so hard that they accidentally trained an entire generation of medical receptionists to forget the paper system exists."

What If I'm on Company Health Insurance Instead of National?

If you work for a company, you're on shakai hoken (社会保険), not kokumin kenkō hoken. The Certificate of Eligibility system still applies, but you request it from your employer's HR department, not city hall.

The process is the same: Tell HR you're not linking your insurance to My Number and need the paper certificate. They'll submit a form to the insurance union (健康保険組合), which will mail you the certificate. Takes 1-2 weeks.

Some HR departments will push back harder than city hall because they want everyone on the digital system for administrative ease. Stand your ground. It's legal.

Here's the money-saver: The Certificate of Eligibility is free to issue. No ¥300 fee like the juminhyo, no ¥1,600 fee like replacing a lost Residence Card (在留カード).

But here's the trap: If you lose the certificate, some insurers charge a ¥500-1,000 reissue fee. This varies by ward and company insurance plan. So: Keep it in a plastic sleeve in your wallet, or take a photo of it and store the image in a password-protected folder on your phone.

Also: Don't laminate it. Some people do this thinking it'll preserve the paper, but laminated certificates sometimes get rejected at hospitals because staff think they're fake.

Use the old card while it still works (saves you the hassle of getting the certificate)

In November 2026, request the Certificate of Eligibility from city hall before the grace period ends

Don't assume the old card will work indefinitely-one day you'll show up and they'll reject it

✅ Certificate of Eligibility (the paper document)

✅ Residence Card (在留カード) (as backup ID, even if not using it for insurance)

✅ Cash (¥5,000-10,000, some clinics still don't take cards)

✅ A photo of your certificate on your phone (in case you forget the physical copy)

2026 Reality Check: The Paper Certificate Still Exists (Barely)

Lost their card and are waiting for a replacement

How to Actually Get the Certificate (The Human Version)

My Number kādo o tsukawanai node, shikaku kakuninsho o hakkō shite kudasai

The Catch: Not All Clinics Will Accept It

The government pushed the My Number health insurance link so hard that they accidentally trained an entire generation of medical receptionists to forget the paper system exists.

The Frugal Mindset: The Certificate Is Free (Unlike Replacements)

Edge Case: What If I'm Transitioning From the Old Pink Card?

If you still have one of the old pink health insurance cards (issued before March 2026), it's technically invalid as of April 2026, but some clinics are still accepting them during the grace period (until December 2026).

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資格確認書 (Certificate of Eligibility) sample

Document reference - 資格確認書 (Certificate of Eligibility) sample

What can I use instead of a health insurance card in Japan?

You can use a Certificate of Eligibility, known in Japanese as shikaku kakuninsho. This is a paper document issued by your city hall or employer's HR department that proves your enrollment in the national health insurance system.

How do I get a Certificate of Eligibility for health insurance in Japan?

Go to the health insurance counter at your local city hall and request the shikaku kakuninsho. Tell them you are not using the My Number card. Processing typically takes 5 to 10 business days and some wards issue it on the spot.

Will Japanese clinics accept a Certificate of Eligibility?

Most clinics are legally required to accept it. However some smaller or older clinics may be unfamiliar with the document. If a clinic refuses, ask for the manager or go to a larger hospital which will be more up to date with the 2026 regulations.

What happened to the old pink health insurance card in Japan?

The old pink paper health insurance cards were officially phased out in 2026. The government now expects residents to use the My Number card or residence card for insurance verification at clinics. The Certificate of Eligibility is the alternative for those who opt out.

Does the Certificate of Eligibility expire?

Yes. It is typically valid for one year from the date of issue. If it expires before you renew it and you visit a clinic, you may be charged full price upfront and need to claim a 70 percent reimbursement afterward at city hall.