Child Medical Subsidy in Japan: The Iryōshō and How to Use It

The subsidy in four words

Four words cover almost every conversation about the child medical subsidy, at the city office and at the clinic counter. The first is the card itself; the others are what it works with and what it changes.

How the subsidy fits with health insurance

Everyone living in Japan for the longer term joins public health insurance, either through a job or through the city. Insurance pays most of the cost of treatment, and the patient pays a share at the counter: for children before elementary school this is usually 20 percent, and from elementary school 30 percent. The child medical subsidy is a second layer on top: the local government pays all or part of that remaining share.

So the subsidy only works if the child is insured first. A newborn needs to be added to a parent's insurance, or enrolled in the city's national health insurance, before you apply. Since late 2024, new paper insurance cards are no longer issued and the My Number card is used as the insurance card, with a separate document, a shikaku kakuninsho, for those who need one; many cities still issue a paper iryōshō alongside, and some now let the subsidy be read from the My Number card as well.

Applying at the city office

Apply at the children's or family section of your city office, often at the same time as the birth registration or moving-in notice, or soon after, once the child's insurance is sorted. Many cities let you apply online or by post too. The timing matters: in many cities, the subsidy starts from the date of application, or from the birth or moving-in date only if you apply within a set period.

• Your child's health insurance information: the insurance card, eligibility document or the details shown on the parent's My Number insurance.
• The parent's ID, and often the parent's My Number for the income check where one applies.
• Sometimes an income certificate from your previous city if you moved in during the year.
• A bank account in the parent's name, for refunds.
• The city's application form, filled in at the window if needed.

Using the card at the clinic and pharmacy

At reception, hand over or scan the child's insurance and show the iryōshō, every time, or at least at the first visit each month if the clinic says so. The pharmacy needs it too, because medicine is part of the cost. If your city uses the My Number card for the subsidy, the reception staff will tell you whether they can read it there.

Many parents find that the bill becomes zero or a small fixed amount. Keep the receipt anyway: it is the proof you need if you ever claim a refund or a tax deduction for medical costs.

When you still pay, and how refunds work

The subsidy covers medical care that health insurance covers. Things outside insurance are usually not included: voluntary vaccinations, medical certificates and other documents, the extra charge for a private hospital room, and the special fee at large hospitals when you come without a referral letter. Meals during a hospital stay are handled differently from city to city.

You also pay first when the card cannot be used: at a clinic outside your prefecture, on a day you forgot the card, or before the card arrived. In these cases pay the normal insurance share, keep the receipt, and apply to the city for a refund. Cities set a time limit and list the documents, usually the receipt, the card and bank details.

When something changes

The card is tied to your address, the child's insurance and sometimes your income, so tell the city when any of these change. Moving to another city means returning the card and applying again in the new city, where the rules may be different. A change of job usually changes the insurance, so the city needs the new details. Some cities renew cards each year, others when the child reaches a new age band; check the expiry date printed on the card.

Mini dialogue: at the children's section window

Mistakes that cost parents money

• Applying late. In many cities, the subsidy only covers visits from the application date, so apply soon after the birth or move.
• Not keeping receipts. Without them, you cannot claim a refund for a visit when you paid in full.
• Assuming the rules from your last city. A move can change the age limit, the charge and the card.
• Forgetting the pharmacy. The card works there too; show it with the prescription.
• Ignoring the expiry date. An expired card means paying at the counter until the new one arrives.

Rehearse the city office visit

Window Japanese is fast and full of set phrases, so it pays to hear it before the real visit. In AI Sensei, pick Yamada-sensei and ask for the role of a clerk in the children's section of a city office: apply for the subsidy for a newborn, say your insurance is still being processed, and ask when the card arrives. Ask the Sensei to use the polite office style, then read the session report for the words you missed.

Before you go, paste the city's application form headings into Mocchi with /explain, so that terms like shinseisha and hihokensha are clear when you are standing at the counter.