Sickness Allowance (Shobyo-Teate-Kin)

Sickness Allowance Japan pays insured employees about two-thirds of daily pay when a non-work illness or injury keeps them from work.¹² The first three days go unpaid, then the benefit can run for up to 1.5 years in total while the absence lasts.

Confirm current details with official sources

Procedures, fees, and requirements can change. Confirm current details at Kyokai Kenpo. This article is general information, not medical advice; for the work-incapacity certification consult a licensed healthcare provider, and for eligibility or filing questions consult a labor and social security attorney or your insurer branch.

Overview

The 傷病手当金 (shōbyō teate kin, "sickness allowance") protects the living costs of an insured worker and family during sick leave.¹ It is available only to people insured under Employees Health Insurance, not to National Health Insurance members and not to dependents on someone else's policy.²

Payment replaces roughly two-thirds of the daily standard pay, after a 3-day wait, for up to 1.5 years counted from the start date.¹² The claim moves through three hands: the insured person, the attending physician, and the employer, before it reaches the insurer branch or society.²³

Who Can Receive It

All four statutory tests must hold at the same time.¹² Miss one and the claim fails, even if the illness itself is serious.

The four eligibility tests

First, the absence must be for recuperation from a non-work illness or injury.¹ Treatment paid out of pocket still counts when a physician certifies the incapacity, and recuperation at home counts on the same terms.¹

Second, the person must be unable to perform their own job.¹² The call rests on the attending physician's opinion weighed against the actual duties and working conditions, not on a generic diagnosis alone.¹²

Third, the absence must run 4 or more days including 3 consecutive waiting days.¹² Payment starts on day 4 of continued incapacity.

Fourth, no salary may be paid for the leave period.¹ When partial salary below the allowance amount is paid for absent days, the insurer pays only the shortfall.¹²

Work-related and commuting injuries sit outside this benefit and go to workers compensation instead.¹² Procedures that are not treated as illness, such as cosmetic surgery, are also excluded.¹²

Why National Health Insurance members are excluded

National Health Insurance has no income-replacement equivalent to this benefit.¹² The 国民健康保険 (kokumin kenkō hoken, "National Health Insurance") covers medical costs for the self-employed, the unemployed, students, and new arrivals between jobs, but it does not pay sick-leave income.¹

The same exclusion applies to time spent as a voluntary-continuation insured person after resignation.¹ That status keeps medical coverage alive but cannot start a new sickness-allowance claim.¹

Check your card operator before assuming the branch route

Kyokai Kenpo members file with their Kyokai Kenpo branch, while Health Insurance Society members file with their own society. The benefit rules match, but the mailbox does not.¹³

Benefit Amount and Duration

The daily amount tracks salary through the 標準報酬月額 (hyōjun hōshū gekkaku, "standard monthly remuneration").¹ The rule itself is stable; the yen inputs move with pay and with the published all-insured average.

The two-thirds daily formula

Divide the 12-month average standard remuneration before the start date by 30, then multiply by two-thirds.¹² The benefit page works an example from a 170,000-yen average to about 5,670 yen per 30th, giving 3,780 yen per day (as of 2026-09-07; confirm current figures with Kyokai Kenpo).¹

When pre-start history is shorter than 12 months, the calculation uses the lower of the available continuous-month average or the published all-insured-person average.¹² That fallback average is 320,000 yen for starts on or after 2025-04-01 (as of 2026-09-07) and 300,000 yen for starts on or before 2025-03-31 (as of 2026-09-07).¹²

Item	Amount	As of	Notes
Daily rate rule	12-month average / 30 x 2/3	2026-09-0712	Core formula, salary-linked
Short-history fallback, starts from 2025-04-01	320,000 yen average	2026-09-0712	Use lower of the two fallbacks
Short-history fallback, starts up to 2025-03-31	300,000 yen average	2026-09-0712	Older-start cohort only

The table inputs reflect the published averages (as of 2026-09-07).¹² Partial salary for absent days offsets the result, so only the gap between salary and the allowance is paid.¹²

The 1.5-year cumulative clock

Payment runs for a total of 1 year and 6 months counted from the start date.¹² The clock totals eligible days; it does not require 1.5 unbroken years of leave.

The span looks like this:

Once a person is judged work-capable again, later recurrence does not reopen post-resignation continuation.¹

The 3-Day Waiting Period

The 3 consecutive waiting days, or 待期 (taiki, "waiting period"), start on the first day off for recuperation.¹² Day 4 onward of continued incapacity is payable.

Paid leave, weekends, and public holidays all count toward the wait, regardless of whether salary was paid on those days.¹ When incapacity begins mid-workday from a non-work cause, that day counts as waiting day 1.¹

Two days off followed by a workday does not complete the wait.¹ The 3 days must be consecutive days off, as shown below.

Do not break the three-day run with a workday

A single workday inside the first three days restarts the wait from zero. Schedule the absence as a continuous block until the wait completes.¹

How to Apply

One form carries three certifications. The insured person, the employer, and the attending physician each complete their own section, then the packet goes to the insurer.²³

Who fills in which section

The insured person enters the basic claim details, the employer certifies salary payment for the claimed period, and the physician gives the work-incapacity opinion.²³ Kyokai Kenpo publishes hand-written and input versions plus a worked entry example.³

Do not attach payroll ledgers or attendance-record copies.³ Kyokai Kenpo asks applicants to skip those extras to keep review efficient.³

Where and when to submit

Kyokai Kenpo members submit to their enrolled branch by mail or through electronic application.¹³ Electronic filing is recommended and lets applicants check processing status from a phone or PC (as of 2026-09-07; confirm current figures with Kyokai Kenpo).³

File in 1-month units aligned to each salary cutoff, because the employer must certify pay for each claimed month.² Society members use the same monthly rhythm but send the packet to their own society, not a Kyokai Kenpo branch.¹³

The filing flow looks like this:

After You Apply

Approval does not end the paperwork. Most claims repeat monthly until recovery or the 1.5-year total runs out.

Payment timing and repeat claims

When review finds payment possible, Kyokai Kenpo pays within 10 business days of receipt (as of 2026-09-07; confirm current figures with Kyokai Kenpo).³ In practice the first payment often lands 1–2 months after leave starts because each month needs employer certification first (as of 2026-09-07).²³

Later months repeat the same cycle: close the pay period, get the employer section certified, and file again.² Each leave day carries its own 2-year claim deadline running from the next day, so late filing loses the oldest days first.³

File each cutoff month instead of batching the whole leave

Monthly filing keeps the employer certification fresh and starts the payment clock sooner. Waiting until recovery to file once risks expired days at the back end.²³

Overlaps and post-resignation continuation

When maternity allowance and sickness allowance overlap, maternity allowance is paid first.² If its daily amount is lower, the gap can be claimed as sickness allowance.²

Leavers can carry the benefit past resignation only on narrow terms. The person needs 1 or more continuous years as an insured person before the day before disqualification, excluding voluntary-continuation, mutual-aid, and NHI periods, plus current receipt or eligibility on the disqualification date.¹²

Working on the retirement date breaks that continuation path.² Old-age pension receipt during post-resignation continuation also suspends the benefit except for any excess over 1/360 of the annual pension amount.²

Good to know

Mental-health leave uses the same form and the same tests

Mental-health conditions clear the same four tests through the same physician-certification flow as physical conditions.¹ Home recuperation counts when the physician certifies that the person's own duties cannot be performed.¹ Practitioner summaries describe post-2020 extended mental-health leave as a major use pattern, but the Kyokai Kenpo pages fetched here publish the coverage mechanics without a disease-share breakdown, so this article states the pattern without a percentage.¹

Paid leave and allowances can shrink the payment instead of blocking it

Salary for absent days offsets the allowance rather than voiding the claim.¹² Fixed allowances paid regardless of attendance, such as commuting, dependent, and housing allowances, plus in-kind meals or housing, count as paid remuneration for absent days.² Overtime for days actually worked and one-off condolence money do not enter the offset.²

The 2-year claim deadline runs per leave day

Each sick-leave day expires 2 years after itself, counted from the next day.³ A claim filed 6 months after leave starts is still timely for recent days but may already have lost nothing; a claim filed 2.5 years later has lost the earliest months even if the form is perfect.³

Society members file with their society, not a Kyokai Kenpo branch

The published branch address list is for Kyokai Kenpo members only.¹³ Employees of large firms with their own Health Insurance Society send the same tripartite form to the society's counter and follow its cutoff calendar.¹³

See also

• How Japan's Universal-Coverage System Works
• Who Enrolls in National Health Insurance
• What NHI Covers and What's Excluded
• NHI Enrollment at the Ward Office
• Maternity and Childbirth Allowances
• Continuation After Resignation: Nin-i Keizoku

References

Footnotes

1. 全国健康保険協会 (Kyokai Kenpo). 「病気やケガで会社を休んだとき (傷病手当金)」. https://www.kyoukaikenpo.or.jp/benefit/injury_and_sickness_allowance/ ↩ ↩² ↩³ ↩⁴ ↩⁵ ↩⁶ ↩⁷ ↩⁸ ↩⁹ ↩¹⁰ ↩¹¹ ↩¹² ↩¹³ ↩¹⁴ ↩¹⁵ ↩¹⁶ ↩¹⁷ ↩¹⁸ ↩¹⁹ ↩²⁰ ↩²¹ ↩²² ↩²³ ↩²⁴ ↩²⁵ ↩²⁶ ↩²⁷ ↩²⁸ ↩²⁹ ↩³⁰ ↩³¹ ↩³² ↩³³ ↩³⁴ ↩³⁵ ↩³⁶ ↩³⁷ ↩³⁸ ↩³⁹ ↩⁴⁰ ↩⁴¹ ↩⁴² ↩⁴³ ↩⁴⁴

2. 全国健康保険協会 (Kyokai Kenpo). 「よくあるご質問: 病気やケガで会社を休んだとき (傷病手当金)」. https://www.kyoukaikenpo.or.jp/faq/benefit/002 ↩ ↩² ↩³ ↩⁴ ↩⁵ ↩⁶ ↩⁷ ↩⁸ ↩⁹ ↩¹⁰ ↩¹¹ ↩¹² ↩¹³ ↩¹⁴ ↩¹⁵ ↩¹⁶ ↩¹⁷ ↩¹⁸ ↩¹⁹ ↩²⁰ ↩²¹ ↩²² ↩²³ ↩²⁴ ↩²⁵ ↩²⁶ ↩²⁷ ↩²⁸ ↩²⁹ ↩³⁰ ↩³¹ ↩³² ↩³³ ↩³⁴ ↩³⁵ ↩³⁶

3. 全国健康保険協会 (Kyokai Kenpo). 「健康保険傷病手当金支給申請書」. https://www.kyoukaikenpo.or.jp/application_form/benefit/001 ↩ ↩² ↩³ ↩⁴ ↩⁵ ↩⁶ ↩⁷ ↩⁸ ↩⁹ ↩¹⁰ ↩¹¹ ↩¹² ↩¹³ ↩¹⁴ ↩¹⁵ ↩¹⁶ ↩¹⁷ ↩¹⁸