Under Article 4 of the Agreement, in conjunction with Article 2.1(b) of the Agreement, a worker who is exempt from Japanese social security coverage will be excluded not only from the Japanese retirement, survivors and disability insurance programs, but also from the Japanese national health insurance programs.
During the negotiation of the Agreement, the Japanese social security authorities expressed concern that some U.S.-based workers in Japan who are excluded from Japanese health insurance contributions and benefits as a result of the Agreement might be left without any health insurance protection and not have the financial means to use national health insurance facilities on a reimbursable basis. In order to help avoid this situation, Article 4.3 provides that such workers and their employers will only be exempt from contributions to the Japanese health insurance programs if the worker's employer, or the worker in the case of a self-employed person, attests to the fact that the worker and any family members who accompany the worker have private health insurance coverage.