Travel insurance for Japan: what hospitals ask for and what to check

Most travel insurance pages for Japan tell you the country is safe and the hospitals are excellent. Both can be true, and neither tells you what happens at the reception desk or what to look for in a policy. This guide uses the Japan National Tourism Organization's guide for visitors who feel ill as its source for how hospitals handle foreign visitors, and then turns that into a checklist for reading any policy. No policy is ranked here, because the details that matter are in each policy's own wording, and policies change.

This page is not medical or legal advice. Your policy document is the only thing that says what you are covered for, and the hospital is the only one that can tell you what it needs from you on the day. For the wider picture, see the travel insurance guides.

JNTO's guide sets out a simple sequence for a visit: reception, a medical information sheet, the examination and treatment, payment, and then a pharmacy if you receive a prescription. At reception you are asked how you will pay, and JNTO suggests you ask for a general estimate of the treatment cost. It also publishes a printable personal-information sheet and a sheet for pointing to symptoms, which help when language is a barrier.

The detail that surprises visitors is payment. JNTO says payment by credit card is accepted only at major hospitals, and that clinics generally accept cash only. It adds that medicine is charged separately at the pharmacy. If you have overseas travel insurance with a cashless payment service, JNTO says you do not need to pay on the spot, but if you do not, you may be charged the full amount, and the cashless conditions vary by insurance company. Cashless payment, in JNTO's words, is a system where the bill goes to the insurance company or its assistance company instead of to you.

JNTO also warns that foreign visitors who fail to pay their medical expenses may be denied entry into Japan in the future, which is one more reason to arrange cover and a payment method before you need care.

Read the policy document, not the landing page, and check it against how Japan's system works. These are the lines that matter most:

• Medical limit and repatriation. JNTO's guide gives two examples of how fast costs can rise: a bicycle collision with surgery, a 19-day hospital stay, an attending physician and a flight home, at 7.5 million yen, and a heart attack with surgery, a 45-day stay and a flight home, at 10 million yen, citing Tokio Marine International Assistance. Use these as a sense of scale when you read a limit, and check that the limit covers a serious admission and transport home.

• Cashless payment. Whether the assistance company can arrange it for a Japanese hospital, for which kinds of care, and what you must do first. Some insurers only do it for admissions, and some require you to call before treatment.

• A 24-hour assistance line with English support, and ideally someone who can contact the hospital in Japanese. Save the number offline.

• Hiking and altitude. Many policies cover walking only up to a stated altitude. Mount Fuji's summit is 3,776 m, according to the Official Web Site for Mt. Fuji Climbing, which can be above a policy's hiking limit. If you plan to climb, read the altitude clause before you buy.

• Winter sports. Skiing and snowboarding in Hokkaido or Nagano are often a paid extra, and off-piste skiing may be excluded.

• Natural disasters. Japan has earthquakes and typhoons. Check how the policy treats trip disruption from both, and whether it pays for extra nights if trains stop.

• Pre-existing conditions. Declare them, even ones you think are minor, or a related claim can be refused.

• Pregnancy. JNTO notes that travel insurance does not cover perinatal medical care, which could make it expensive, so read the exclusions closely.

• Cancellation and baggage. These are separate sections in many policies. Cancellation cover is often an add-on, so check whether it is in the base price.

The comparison table on this page lists the main types of cover, not named providers. A single-trip medical and travel policy suits most visitors on one trip. An annual multi-trip policy suits people who leave the country several times a year, but check the maximum days per trip against your longest journey and declare conditions at renewal as well as at purchase. A medical-only policy is a floor for a short trip by a healthy traveler who can carry a large bill on a card for a few weeks, and it may be pay first and claim later.

Credit card cover is a back-up, not a plan, unless the limits are high. Read the card's policy document for the medical limit, the assistance number and the conditions. JNTO's guide also notes that insurance can be bought online after you enter Japan, with coverage and cashless negotiation features, so it is not too late if you arrive without cover. Buying before you fly is still safer, because cancellation cover usually applies only to events after you buy.

A city and rail trip, such as the 10-day loop, puts the weight on the medical limit, repatriation and a working assistance line, because the main risk is an unexpected illness or fall, not a mountain. Add cancellation cover if your flights and hotels are prepaid and hard to change.

A hiking trip, such as the Kumano Kodo or a Fuji climb, puts the weight on the activity and altitude wording, and on whether the policy covers evacuation from remote ground. Read how the policy defines hiking, trekking and mountaineering, because the same walk can sit in different categories. A winter trip to a ski area adds the winter sports clause and equipment cover. A long stay of several weeks adds the maximum trip length, and travelers over a certain age should check age limits and whether the medical limit falls with age. Families should check whether children are covered under a parent's policy at no extra cost, and whether the assistance line can help with pediatric care.

Ask the insurer, or read in the policy wording, whether it will arrange cashless payment at a Japanese hospital, and for which kinds of care. Ask what you must do before treatment, whether you can call from abroad and at what hours. Ask what the policy needs for a claim, and how long claims typically take to be paid. Ask whether there is an excess, a deductible or a co-payment, and whether the medical limit is per person or per trip. If the answers are not in the wording, treat that as a sign to look at another policy.

The first mistake is reading only the summary page, where the altitude cap, the exclusions and the claim steps are missing. The second is assuming a card cover that applies only if you paid for the trip with that card. The third is arriving without the assistance number saved offline. The fourth is buying a policy that treats a hiking day like a walk in the park: on Fuji, the Kumano Kodo or a long mountain route, check the altitude and activity wording first. The fifth is waiting until you are at the hospital to call the assistance line, when cashless payment is far easier to arrange before treatment.

In an emergency, call 119 for an ambulance or fire, and 110 for the police. JNTO notes that you cannot choose which hospital an ambulance takes you to, and that depending on your condition you may be treated without being questioned, so filling out the medical information sheet in advance is important. For something less urgent, call your insurer's assistance line first, then use JNTO's guide for visitors who feel ill, which includes a search of medical institutions by area, language and department.

The Japan Visitor Hotline, run by JNTO, is a 24-hour multilingual call center at 050-3816-2787. JNTO says it answers visitors' questions directly and, as a general rule, does not provide three-way interpretation or make reservations on a visitor's behalf. JNTO's guide also explains that some institutions are designated as base medical institutions for foreign patients and that a JMIP mark shows a third-party certification of services for foreign patients.

Before you leave the hospital or clinic, ask for an itemized receipt and, if they can provide one, a diagnosis letter or medical certificate in English. Ask at the first visit, not the last, and ask whether it carries a fee. Keep every receipt, including pharmacy ones, and the prescription.

If you already have cover that includes overseas medical costs at a high limit, with a 24-hour assistance line, you may not need to buy another policy. That can come from an employer, a premium credit card or an annual policy you forgot you had. Check it against the questions in this guide: does it cover Japan, does the assistance company arrange cashless payment, and what is excluded.

Residents of Japan enrolled in the national health insurance system are in a different position, since the system covers part of their costs at Japanese hospitals. Travel insurance can still help with cancellation and other items, but the hospital desk will treat them as insured patients.

Check the medical limit against JNTO's examples. Confirm that the assistance company arranges cashless payment in Japan. Read the altitude and activity clauses against your plans. Check how the policy treats natural disasters and pre-existing conditions. Save the assistance number offline. Carry some cash for clinics, and a card with a high limit for larger hospitals. Pair this with a plan for staying connected and keep a list of the emergency numbers in your phone.