When you become unable to work due to illness, injury, or a mental health condition such as depression, employees and public servants have a powerful safety net called the "injury-and-illness allowance" (sickness benefit). Health insurance pays roughly two-thirds of your salary for a combined total of 1 year and 6 months, tax-free. "Taking time off does not mean zero income." This article summarizes what you should know before taking leave: how the benefit is calculated, the 3-day waiting-period rule, and the conditions for continuing to receive it even after you leave your job.
1. Benefit amount: the average of your standard monthly remuneration over the most recent 12 months ÷ 30 × 2/3 (daily amount). At a monthly salary of ¥300,000, that is about ¥6,667 a day = about ¥200,000 a month.
2. Period: a combined total of 1 year and 6 months from the start of payment (the 2022 revision made it a "cumulative total," so periods during which you return to work are not counted)[Ministry of Health, Labour and Welfare (in Japanese)].
3. Conditions: you are unable to work due to a non-occupational illness or injury / from the 4th day after taking 3 consecutive days off (the 3-day waiting period includes weekends and paid leave) / no salary is paid during that time (or it is less than the allowance).
4. Mental illnesses such as depression and adjustment disorder are also covered (among the most common by actual number of payments).
5. You can continue receiving it even after leaving your job: if you have been an insured person for 1 year or more up to your last day of employment and are receiving it (or meet the requirements) at the time of leaving, you can receive the remaining period even after quitting.
6. Tax-free, with no tax return required. In a year when your income drops, you may also become eligible for the spousal deduction.
How much do you receive? (Formula and examples)
- Monthly salary (standard monthly remuneration) ¥300,000 → about ¥6,667 a day → about ¥200,000 a month
- Monthly salary ¥450,000 → ¥10,000 a day → about ¥300,000 a month
- If you have been enrolled for less than 12 months, the calculation uses the lower of "your own average" or "the average of all members of your insurance plan (around ¥300,000 for Kyokai Kenpo)"
* What is paid covers "days when you are unable to work and receive no salary." If your company pays part of your salary, the difference is paid. Depending on your health insurance society, supplementary benefits may bring it above 2/3.
Because it is tax-free, this amount is essentially your take-home pay as is. However, during leave you must still pay social insurance premiums (health insurance and employees' pension) and residence tax, so expect your actual disposable amount to be "the allowance minus a few tens of thousands of yen per month" (unlike maternity/childcare leave, injury-and-illness leave does not exempt you from premiums).
The conditions for receiving it and the "3-day waiting period" rule
- Non-occupational illness or injury is covered (occupational or commuting accidents are covered by workers' accident compensation insurance's leave allowance = about 80% of salary).
- After taking 3 consecutive days off work (the waiting period), payment begins from the 4th day. Because the 3-day waiting period counts weekends, holidays, and paid leave, if you take "Friday, Saturday, Sunday" off you become eligible from Monday.
- A doctor's opinion of "inability to work" is required (the application form has a certification section for the attending medical provider). Mental illnesses such as depression, adjustment disorder, and autonomic nervous system disorder are also covered if a doctor certifies inability to work.
- To apply, submit the "Injury-and-Illness Allowance Payment Application Form" (completed by you + the doctor's certification + the company's certification) to your insurer. In practice, it is customary to apply in segments of every 1 to 2 months.
Do you lose it if you leave your job? (Conditions for continued benefits)
"My leave of absence has run out and I'm resigning... my income will stop." This is where continued benefits after loss of eligibility come into play. If you meet both of the following, you can receive the remaining portion of the combined 1 year and 6 months even after leaving.
- You were continuously an insured person under health insurance for 1 year or more up to your last day of employment
- At the time you leave, you are receiving the injury-and-illness allowance or are in a state where you could receive it (unable to work)
If, "because it's your last day," you go in to work on your final day of employment to say goodbye or clear out your desk, as a rule the operation treats that day as one on which you were not unable to work, and you lose the right to continued benefits. Keep resting on your last day too. Also, continued benefits end at the point you "recover to a state where you can work," and you cannot receive them at the same time as unemployment benefits (which are for people able to job-hunt). The correct order is: after the injury-and-illness allowance ends, go to Hello Work to lift the extension of the benefit-receiving period and move to unemployment benefits.
Money matters during leave (check these too)
- Residence tax: because it is based on the previous year's income, the full amount is due even during leave. If you cannot pay it via your company, switch to ordinary collection (How residence tax works).
- Medical expenses: if treatment costs mount up, combine it with the high-cost medical expense benefit (a monthly cap). For psychiatric outpatient care, Services and Supports for Persons with Disabilities medical care (10% co-payment) is also available.
- If you are not cured within 1 year and 6 months: consider transitioning to a disability pension (from grade 3 of the employees' disability pension). Because certifying the date of your first medical visit becomes important, keep your consultation records.
- Taxes after returning to work: because the injury-and-illness allowance is tax-free, in a year when your income drops you can optimize your household's taxes with the medical expense deduction and the spousal deduction.
- The National Health Insurance for the self-employed and freelancers has no injury-and-illness allowance (it is an optional benefit). The risk of being unable to work is an area to protect yourself against with private income-protection insurance, the Small Enterprise Mutual Aid, and the like.
FAQ
How much do you receive from the injury-and-illness allowance?
The daily amount is the average of your standard monthly remuneration over the most recent 12 months ÷ 30 × 2/3. As a guide, a monthly salary of ¥300,000 gives about ¥200,000 a month, and ¥450,000 gives about ¥300,000 a month; because it is tax-free, it is essentially your take-home pay. However, during leave you must still pay social insurance premiums and residence tax.
Can I receive it for depression?
Yes. If it is a non-occupational illness or injury that a doctor certifies as making you unable to work, mental illnesses such as depression and adjustment disorder are covered, and mental illnesses are among the most common by actual number of payments. Because the application form has a doctor's certification section, consult your attending physician.
Can I keep receiving it after leaving my job?
If you had a continuous insured period of 1 year or more up to your last day of employment and are receiving it (or are unable to work and could receive it) at the time you leave, you can receive the remainder of the combined 1 year and 6 months even after leaving. Note that, as a rule, you lose the right if you go in to work on your last day.
Is the injury-and-illness allowance taxed? What about being a dependent?
It is tax-free: no income tax or residence tax applies, and no tax return is required. It is also not counted as income in the tax dependent determination. However, in the health insurance dependent-eligibility determination (¥1.3 million), many insurers do treat it as income, so if you are joining a family member's dependents, check with your insurer.
Data sources
- Payment requirements, benefit amount (2/3), and the cumulative-total handling of the payment period for the injury-and-illness allowance: Ministry of Health, Labour and Welfare, Social Security Council Health Insurance Committee material "On the Injury-and-Illness Allowance" (in Japanese)
- Application procedures and continued benefits: Japan Health Insurance Association (Kyokai Kenpo) (in Japanese) "When you take time off work due to illness or injury"
* Supplementary benefits of health insurance societies and payment practices vary by insurer. This article is general information; for whether a specific payment applies, please confirm with the insurer you belong to.