When an employee is off sick — how much sickness allowance is paid, and for how long

In short: When an employee cannot work because of a non-work illness or injury and no wages are paid, health insurance pays sickness allowance (Health Insurance Act, Article 99). It starts on the fourth day after a waiting period of three consecutive days, and the daily amount is, in principle, the average of the standard monthly remuneration over the 12 months before the start date ÷ 30 × two-thirds. Since the amendment effective January 1, 2022 (Reiwa 4), the payment period is a total of one year and six months from the day payment begins (Article 99, paragraph 4). Where the cause is a work or commuting accident, the benefit comes from workers' accident insurance, not health insurance. This page sets out the requirements, the waiting period and amount, the totalled payment period, adjustment with paid leave/retirement/workers' accident insurance/disability pension, and what the employer must certify and do.

When an employee is going to be off for a long time with an injury or a private illness, the first thing the person in charge wants to grasp is health-insurance sickness allowance. This page is for HR and general-affairs staff and managers at small and medium-sized companies, and sets out the amount, the period and the employer's role, from the viewpoint of a shakai hoken roumushi's labour management. Where judgement is involved — such as whether it is workers' accident insurance or health insurance, or what to do if it is refused — checking with the Labor Standards Inspection Office or a qualified professional is the premise.

When is sickness allowance paid (the four requirements)?

The Japan Health Insurance Association (Kyokai Kenpo) states that it is paid when all four of the following are met (Health Insurance Act, Article 99; referenced September 2026).

Requirement	Content
① Non-work cause	Treatment for a non-work illness or injury (a work or commuting accident is for workers' accident insurance)
② Unable to work	Unable to work because of that treatment
③ Four or more days	Off work for four or more days, including three consecutive days
④ No wages paid	No wages paid for the period off (if paid but less than the allowance, the difference is paid)

The point is that it must be "non-work." An injury or illness caused by work (a work accident) or an injury while commuting (a commuting accident) is a benefit from workers' accident insurance, and health-insurance sickness allowance is not paid. Because whether the cause is work (work-relatedness) is decided by the Labor Standards Inspection Office, check with the office or a shakai hoken roumushi if in doubt. Treatment need not be in hospital; recuperation at home can also qualify. For labour handling of leave and return to work when someone is off for a long time, see also How to handle leave and return to work for mental ill-health.

How do you count the three-day waiting period, and how is the amount calculated?

First you count the three-day "waiting period," and payment then starts on the fourth day.

Item	Content
Waiting period	Three consecutive days. These three may include paid leave and public holidays (weekends, etc.)
Start of payment	From the fourth day after the waiting period is complete
Daily amount	Average of the standard monthly remuneration over the 12 months before the start date ÷ 30 × two-thirds
If under 12 months	Use the lower of "the average of the standard monthly remuneration over that period" and "the amount set by Kyokai Kenpo"

The waiting period needs "three consecutive days." A pattern of a day off, then work, then off again does not complete it. The three waiting days may be counted to include public holidays such as weekends and paid leave.

For the amount, you divide by 30 the average of the standard monthly remuneration over the 12 months before the start date, and two-thirds of that is the daily amount. Where the enrolment period is under 12 months, use the lower of ① the average of the standard monthly remuneration over that period and ② the amount set by Kyokai Kenpo (for a start date on or after April 1, 2025, 320,000 yen; the figure is revised; referenced September 2026). For how the standard monthly remuneration is fixed and revised, see The difference between the base-calculation notice and the monthly-change notice.

How long at most is the payment period (the 2022 totalling)?

The payment period changed with the amendment effective January 1, 2022 (Reiwa 4).

Timing	How the payment period is counted
After the amendment (current)	A total of one year and six months from the day payment begins (Health Insurance Act, Article 99, paragraph 4)
Before the amendment	One year and six months from the day payment begins (a continuous period on the calendar)

Before the amendment, once one year and six months had passed on the calendar from the start of payment, it was cut off there even if there was a period in between where the person returned to work and payment stopped. After the amendment, you can receive it until the days actually paid total one year and six months. A period in between where no payment was made pushes back the period available by that number of days (an amendment to Article 99 of the Health Insurance Act by the Act partially amending the Health Insurance Act and others to build an all-generations social-security system, Act No. 66 of 2021; referenced September 2026).

This totalling applies to sickness allowance whose payment start date is on or after July 2, 2020 (Reiwa 2). That said, fine points — such as the treatment where a person becomes able to work and reports back, then again becomes unable to work for the same illness — need confirmation with the insurer (Kyokai Kenpo or a health-insurance society).

How is it adjusted with paid leave, retirement, workers' accident insurance, and disability pension?

Sickness allowance is adjusted for the part that overlaps with other benefits or remuneration.

Counterpart	Content of adjustment
Wages (remuneration)	Not paid while remuneration can be received; if remuneration is less than the allowance, the difference is paid (Health Insurance Act, Article 108, paragraph 1)
Disability employees' pension / disability grant	Adjusted where receivable for the same illness (in principle the pension takes priority and the difference is adjusted; Article 108)
Old-age retirement pension benefit	Adjusted where a person receiving continued benefit after loss of status can receive an old-age retirement pension (same Article)
Maternity allowance	For the same period the maternity allowance takes priority and the difference is adjusted (same Article)
Workers' accident leave (compensation) benefit	A work or commuting accident is for workers' accident insurance, and sickness allowance is not paid for the same cause

Even after retirement, a person who was continuously an insured person for one year or more up to the day before loss of status, and who is receiving (or is in a state able to receive) sickness allowance at the time of loss, can continue to receive it after retirement (continued benefit after loss of status; Health Insurance Act, Article 104). However, there is adjustment where, for instance, an old-age retirement pension can be received after retirement. Because the split between workers' accident insurance and health insurance involves judging work-relatedness, see also Reporting private illness and the workers' accident procedure together with the workers' accident procedure. Where a disability remains, a shakai hoken roumushi helps with the disability-pension claim.

What must the employer certify and do?

Sickness allowance is claimed by the person (the insured), but there is a part the company carries.

What to do	Content
Employer certification	Fill in the field on the application where the employer certifies the work situation and the wage-payment situation
Arranging the wage ledger and attendance record	Keep the attendance and wage records so completion of the waiting period and non-payment of wages can be confirmed
Handling social-insurance premiums	While on leave, insured status for health insurance and employees' pension in principle continues; decide how to collect the employee's share of premiums
Guidance	Guide the person on the timing of the claim and the attached documents (the field for the treating doctor's opinion, etc.)

For the company, the points least likely to trip you up are writing the employer certification accurately, and deciding in advance how to collect the employee's share of social-insurance premiums during leave (since it cannot be deducted from wages, e.g. by bank transfer). This office helps arrange the employer certification, the social-insurance procedures on leave and return, and the leave-of-absence provisions in the work rules. The initial consultation is free. For how fees are thought about, see the fee schedule; the questions we are asked most often are on the FAQ page.

Where judgement of law is involved — such as what to do if refused, or whether leave or dismissal for a private illness is possible — we guide you to an attorney. This office does not accept referral fees.

Frequently asked questions

Q. May I count paid leave or weekends in the three-day waiting period?
A. Yes. The waiting period is "three consecutive days," and these three may be counted to include paid leave and public holidays such as weekends. But they must be consecutive; a pattern of a day off, then work, then off again does not complete it.

Q. What does a totalled payment period of one year and six months mean?
A. With the amendment effective January 1, 2022, you can receive it until the days actually paid, counted from the day payment begins, total one year and six months. Even if there is a period in between where you return to work and payment stops, the period available is pushed back by that number of days. Before the amendment it was cut off at one year and six months on the calendar (applies where the start date is on or after July 2, 2020; referenced September 2026).

Q. If we pay even part of the wages, is no sickness allowance paid?
A. In principle it is not paid while remuneration can be received, but where the remuneration paid is less than the sickness allowance, the difference is paid (Health Insurance Act, Article 108, paragraph 1). Whether it is paid in full or as the difference depends on the amount of wages paid.

Q. Is sickness allowance cut off on retirement?
A. Not necessarily. A person who was continuously an insured person for one year or more up to the day before loss of status, and who is receiving (or able to receive) sickness allowance at retirement, can continue to receive it after retirement (Health Insurance Act, Article 104). However, there is adjustment where, for instance, an old-age retirement pension can be received.

Sources for this article

• Health Insurance Act (Act No. 70 of 1922), Article 99 (sickness allowance = paid from the day on which three days have elapsed, counted from the day the person became unable to serve their duties owing to treatment; the daily amount is two-thirds of one-thirtieth of the average of the standard monthly remuneration over the 12 continuous months before the start date; paragraph 4 = a total of one year and six months from the day payment begins) / confirmed against the e-Gov law text (referenced September 2026)
• Health Insurance Act, Article 108 (adjustment with remuneration, disability employees' pension, disability grant, old-age retirement pension benefit, and maternity allowance) and Article 104 (continued benefit after loss of status = a person who was continuously an insured person for one year or more up to the day before loss of status) / confirmed against the e-Gov law text (referenced September 2026)
• The totalling of the payment period is an amendment to Article 99 of the Health Insurance Act by the Act partially amending the Health Insurance Act and others to build an all-generations social-security system (Act No. 66 of 2021), effective January 1, 2022 (Reiwa 4), applying where the payment start date is on or after July 2, 2020 (Reiwa 2) / confirmed against the Ministry of Health, Labour and Welfare Q&A and the Japan Health Insurance Association's guidance (referenced September 2026)
• The four requirements, how the three-day waiting period is counted, and the amount where the enrolment period is under 12 months (the amount set by Kyokai Kenpo; for a start date on or after April 1, 2025, 320,000 yen; the figure is revised) confirmed against the Japan Health Insurance Association (Kyokai Kenpo) "sickness allowance" guidance (referenced September 2026)
• A work or commuting accident is covered by the leave (compensation) benefit under the Workers' Accident Compensation Insurance Act, and health-insurance sickness allowance is not paid (work-relatedness is determined by the Labor Standards Inspection Office)

This article does not go so far as to decide whom you should consult. Support for the sickness-allowance claim, arranging the employer certification, social-insurance procedures on leave and return, and the disability-pension claim are the work of a shakai hoken roumushi. Because the split between workers' accident insurance and health insurance involves judging work-relatedness, confirmation with the Labor Standards Inspection Office is the premise; what to do if refused and whether leave or dismissal for a private illness is possible are the work of an attorney, and tax filing is the work of a tax accountant. This office does not accept referral fees. The cost of consulting 四葉社会保険労務士事務所 is set out in the fee schedule, and the questions we are asked most often are on the FAQ page.

This article is general information. Judgments that fit your particular circumstances are made by a qualified professional after a meeting. Written by Joji Uramatsu (Shakai Hoken Roumushi (Certified Social Insurance and Labor Consultant), Gyoseishoshi (Certified Administrative Procedures Legal Specialist), Registered Real Estate Transaction Specialist).