Regulatory Framework

First law:1951.

Current laws:1953 (directive); 1988 and 1994 (directives for women employees); 1998, 1999, 2000, and 2003 (medical insurance directives and pilot rural cooperativemedicare); 2007 (pilot urban resident medical insurance); 2009 (directive on health care reforms); 2010 (social insurance); 2012 (special protection for female employees); 2012 (pilot critical disease insurance for urban and rural residents); 2016 (integrated scheme for rural andnonsalariedurban residents); and 2018 (contribution collection).

Type of program:Social insurance (cash and medical benefits) and mandatory individual account (medical benefits) system.

Note: Since July 2011, existing regional and local social security programs, including pooling arrangements, are being gradually unified under the country's first national law on social insurance. In 2016, the government decided to establish a unified basic health insurance system for both rural andnonsalariedurban residents. The government has also announced a pilot program merging the basic medical insurance for employees and maternity insurance programs.

Coverage

Social insurance (cash benefits):Employed persons in urban areas working in government organizations, enterprises, social groups, and nonprofit organizations.

Voluntary coverage for self-employed persons in most provinces.

Social insurance (Basic medical insurance for employees):Employed persons in urban areas working in government organizations, enterprises, social groups, and nonprofit organizations.

Voluntary coverage for most categories of self-employed persons.

Social insurance and mandatory individual account (Basic medical insurance for rural andnonsalariedurban residents):Rural andnonsalariedurban residents of China not covered by basic medical insurance for employees.

Voluntary coverage for certain categories of self-employed persons, depending on local regulations.

Source of funds

Insured person

Social insurance (cash benefits):None.

Social insurance (Basic medical insurance for rural andnonsalariedurban residents):An average annual flat-rate contribution of at least 220yuan.

Social insurance and mandatory individual account (Basic medical insurance for employees):None to the pooling fund; about 2% of gross earnings to the individual account (local governments may adjust contribution rates based on local conditions).

The minimum monthly earnings used to calculate contributions are 60% of the average monthly local wage in the previous year.

The maximum monthly earnings used to calculate contributions are 300% of the average monthly local wage in the previous year.

Self-employed person

Social insurance (cash benefits):The total cost (actual rates vary depending on the region).

Social insurance (Basic medical insurance for rural andnonsalariedurban residents):An average annual flat-rate contribution of at least 220yuan.

Social insurance and mandatory individual account (Basic medical insurance for employees):About 6% of gross earnings (local government may adjust contribution rates based on local conditions).

The self-employed person's contributions are split between the pooling fund and the individual account in varying proportions based on local conditions. Self-employed persons may pay a lower rate to the pooling fund (without establishing an individual account) or join the basic medical insurance program for urban and rural residents.

Employer

Social insurance (cash benefits):The total cost (sickness benefits); up to 1% of payroll (maternity benefits), depending on local government regulations.

Social insurance (medical insurance for rural andnonsalariedurban residents):None.

Social insurance and mandatory individual account (Basic medical insurance for employees):About 6% of payroll (local government may adjust contribution rates based on local conditions).

70% of the employer's contribution is directed to the pooling fund; 30% to the insured's individual account.

Government

Social insurance (cash benefits):None.

Social insurance (Basic medical insurance for rural andnonsalariedurban residents):An annual matching contribution (combined central and local governments) of 490yuanfor each person. The actual amount of the matching contribution varies by province.

Social insurance and mandatory individual account (Basic medical insurance for employees):None.

Qualifying conditions

Sickness, maternity, and medical benefits:There is no minimum qualifying period.

Cash benefits for insured workers

Sickness benefit (central government guidelines for urban employees, social insurance):60% to 100% (depending on length of service) of the insured's last monthly wage is paid for up to six months each year; thereafter, 40% to 60% until the employee recovers or is assessed with a permanent disability.

Contract workers receive the same benefits as permanent workers.

Maternity benefit (central government guidelines for urban employees, social insurance):100% of the enterprise's average monthly wage for the previous year is paid for 98 to 158 days for the birth of a child, depending on the province, including 15 days before the birth (an additional 15 days for complicated childbirths), 42 days for a miscarriage that takes place after at least four months of pregnancy, and 15 days for a miscarriage that takes place after less than four months of pregnancy.

Some local governments have implemented paternity leave policies.

Medical benefits for insured workers

Basic medical insurance for employees (social insurance and mandatory individual account, central government guidelines):Medical care is provided at accredited hospitals or clinics.

Cost sharing: The pooling fund reimburses the cost of medical benefits up to 600% of the local average annual wage in the previous year. Reimbursement for payments beyond 600% of the local average annual wage must be covered by private insurance or supplemental programs. Medical expenses and private insurance premiums can be drawn from the individual savings account.

Basic medical insurance benefits for rural andnonsalariedurban residents (social insurance):Insured persons are reimbursed annually for medical costs up to 600% of the local average annual income.

Medical benefits for dependents

Basic medical insurance benefits (social insurance and mandatory individual account, central government guidelines):No benefits are provided. The individual account can be inherited.

Medical insurance benefits for rural andnonsalariedurban residents (social insurance):No benefits are provided.

Administrative organization

National Healthcare Security Administration provides general guidance to local governments' medical insurance and sickness and maternity insurance programs and ensures that local regulations follow central government guidelines.

Local government healthcare administration agencies administer medical benefits insurance and sickness and maternity insurance funds.

Local government healthcare security administration agencies contract with accredited clinics and hospitals to provide medical benefits.

National Health Commission provides general guidance to medical care providers.

Local healthcare security administration agencies manage the medical insurance program for employees, the medical insurance program for rural andnonsalariedurban residents, and the cash benefits program.

Last survey reply:1 July 2018

Last ISSA update:1 July 2018

US$1.00 = 6.62yuan.

SOURCE:https://www.issa.int/en/country-details?countryId=CN&regionId=ASI&filtered=false