Regulations on the Administration of Social Insurance

Regulations on Social Insurance Management the People's Republic of China Decree No. 765 of the State Council

Decree of the State Council of the People's Republic of China

No. 765

The Regulation on the Handling of Social Insurance, which was adopted at the 11th executive meeting of the State Council on July 21, 2023, is hereby promulgated and shall come into force on December 1, 2023.

Premier Li Qiang

16 August 2023

Regulations on the Administration of Social Insurance

Chapter I General Provisions

Article 1 In order to regulate the handling of social insurance, optimize social insurance services, ensure the safety of social insurance funds, safeguard the legitimate rights and interests of employers and individuals, and promote social equity, these regulations are formulated in accordance with the Social Insurance Law of the the People's Republic of China.

Article 2 These Regulations shall apply to the handling of basic old-age insurance, basic medical insurance, work-related injury insurance, unemployment insurance, maternity insurance and other social insurances prescribed by the State.

Article 3 The handling of social insurance shall adhere to the leadership of the Communist Party of China, adhere to the people as the center, and follow the principles of legality, convenience, timeliness, openness and safety.

Article 4 The administrative department of human resources and social security under the State Council shall be in charge of the handling of social insurance such as basic old-age insurance, work-related injury insurance and unemployment insurance nationwide. The administrative department of medical security under the State Council is in charge of the handling of social insurance such as basic medical insurance and maternity insurance nationwide.

The human resources and social security administrative departments of the local people's governments at or above the county level shall be in charge of the handling of social insurance such as basic old-age insurance, work-related injury insurance and unemployment insurance in accordance with the overall planning level. The medical security administrative departments of the local people's governments at or above the county level shall be in charge of the handling of social insurance such as basic medical insurance and maternity insurance in accordance with the overall planning level.

Article 5 The administrative department of human resources and social security, the administrative department of medical security and other relevant departments of the State Council shall, in accordance with their respective duties, closely cooperate and cooperate with each other to jointly do a good job in the handling of social insurance.

The local people's government at or above the county level shall strengthen the leadership of the social insurance handling work in its administrative area, strengthen the capacity building of social insurance handling, and provide guarantee for the social insurance handling work.

Chapter II Social Insurance Registration and Relation Transfer

Article 6 The employing unit shall handle the registration of social insurance at the same time when the registration administration organ handles the registration.

Individuals apply for social insurance registration, use the citizen identification number as the social security number, and obtain the social security card and medical insurance electronic certificate. The social insurance agency shall complete the application within 10 working days from the date of receipt of the application.

Article 7 The social security card is a certificate for individuals to participate in basic old-age insurance, basic medical insurance, work-related injury insurance, unemployment insurance, maternity insurance and other social insurance and enjoy various social insurance benefits, including physical social security cards and electronic social security cards.

Medical insurance electronic certificate is a certificate for individuals to participate in basic medical insurance, maternity insurance and other social insurance and enjoy basic medical insurance, maternity insurance and other social insurance benefits.

Article 8 The registration management agency shall share the information on the establishment, change, and cancellation of registration of the employer with the social insurance agency, and the public security, civil affairs, health, judicial administration and other departments shall register the birth, death, and household registration, migration, Information such as cancellation is shared with social insurance agencies.

Article 9 If the nature of the employer, bank account, employment and other insurance information changes, as well as personal insurance information changes, the employer and individual shall promptly notify the social insurance agency. The social insurance agency shall compare and verify the insured information provided by the employing units and individuals with the shared information.

Article 10 If an employing unit or individual applies for changing or canceling the social insurance registration, the social insurance agency shall complete the application within 10 working days from the date of receipt of the application. If the employer cancels the social insurance registration, it shall first settle the outstanding social insurance premiums, late fees and fines.

Article 11 A social insurance agency shall record the following information in a timely, complete and accurate manner:

(I) social insurance registration;

(II) the payment of social insurance premiums;

Enjoyment of (III) social insurance benefits;

(IV) personal accounts;

(V) other circumstances related to the handling of social insurance.

Article 12 If an individual who participates in the basic old-age insurance for employees is employed across the overall planning area, the basic old-age insurance relationship of the employees shall be transferred along with it.

Individuals who participate in the basic old-age insurance for employees move between institutions and enterprises and other employers of different natures, and their basic old-age insurance relations for employees are transferred along with them.

Individuals who participate in the basic old-age insurance for urban and rural residents and do not enjoy the benefits move their household registration across the overall planning area, and their basic old-age insurance relationship for urban and rural residents can be transferred along with them.

Article 13 If an individual who participates in the basic medical insurance for employees is employed across the overall planning area, the basic medical insurance relationship for employees shall be transferred along with it.

If individuals who participate in the basic medical insurance for urban and rural residents move their household registration or change their habitual residence across the overall planning area, their basic medical insurance relationship for urban and rural residents can be transferred along with them in accordance with the regulations.

The transfer of the relationship between the basic medical insurance for employees and the basic medical insurance for urban and rural residents shall be carried out in accordance with the provisions.

Article 14 Where an individual participating in unemployment insurance is employed across an overall planning area, his unemployment insurance relationship shall be transferred along with it.

Article 15 Individuals who participate in work-related injury insurance and maternity insurance are employed across the overall planning area, and participate in work-related injury insurance and maternity insurance in the new place of employment.

Article 16 Where an employing unit or individual goes through the formalities for the transfer and continuation of social insurance relations, the social insurance agency shall complete the formalities within the prescribed time limit, inform the employing unit or individual of the results, or provide inquiry services for the handling of the situation.

Article 17 Military organs and social insurance agencies shall, in accordance with their respective duties, handle the procedures for the transfer and continuation of the relationship between military insurance and social insurance.

Social insurance agencies shall give priority to providing services for the transfer and continuation of military insurance and social insurance relations.

Chapter III Verification and Payment of Social Insurance Benefits

Article 18 Employers and individuals shall, in accordance with the provisions of the State, apply to social insurance agencies for receiving basic pensions. The social insurance agency shall complete the application within 20 working days from the date of receipt of the application.

Article 19 If an individual who participates in the basic old-age insurance for employees dies or an unemployed person dies during the period of receiving unemployment insurance benefits, his or her survivors may apply to the social insurance agency for funeral subsidies and pensions in accordance with the law. The social insurance agency shall verify the relevant situation in a timely manner, verify and issue funeral subsidies and pensions in accordance with the provisions.

Article 20 The part of personal medical expenses and maternity medical expenses that should be paid by the basic medical insurance (including maternity insurance) fund shall be directly settled with medical institutions and drug dealers after being reviewed by the social insurance agency.

If an individual applies for manual reimbursement due to special circumstances, he shall provide the social insurance agency with the fee bills, expense lists, diagnosis certificates, and medical records of medical institutions and drug dealers. The social insurance agency shall review the fee bills, expense lists, diagnosis certificates, and medical records, and complete the processing within 30 working days from the date of receipt of the application.

To apply for maternity allowance, an individual participating in maternity insurance shall provide medical records to the social insurance agency. The social insurance agency shall review the medical records and complete the processing within 10 working days from the date of receipt of the application.

Article 21 Workers with work-related injuries and their employing units shall provide diagnosis certificates and medical records to social insurance agencies when they apply for the appraisal of labor ability, the confirmation of the allocation of assistive devices, the confirmation of the extension of the period of suspension of work and the confirmation of the recurrence of old injuries.

Article 22 The part of the medical expenses, rehabilitation expenses and the cost of installing and configuring assistive devices for the treatment of work-related injuries that should be paid by the work-related injury insurance fund shall be settled directly with the medical institution and the assistive device allocation institution after examination and approval by the social insurance agency.

If an employer or individual applies for manual reimbursement due to special circumstances, it shall provide the social insurance agency with the fee bills, expense lists, diagnosis certificates, and medical records of medical institutions and assistive device allocation institutions. The social insurance agency shall review the fee bills, expense lists, diagnosis certificates, and medical records, and complete the processing within 20 working days from the date of receipt of the application.

Article 23 The administrative department of human resources and social security and the administrative department of medical security shall establish and improve the settlement system of medical expenses for medical treatment in different places in accordance with their respective duties. Social insurance agencies shall do a good job in the settlement of medical expenses for medical treatment in different places.

Article 24 When an individual applies for unemployment insurance benefits, the social insurance agency shall complete the application within 10 working days from the date of receipt of the application.

During the period when an individual receives unemployment insurance benefits, the social insurance agency shall pay the basic medical insurance (including maternity insurance) that he should pay from the unemployment insurance fund.

Individuals applying for vocational training and other subsidies shall provide vocational qualification certificates or vocational skill grade certificates. The social insurance agency shall examine the vocational qualification certificate or vocational skill level certificate, and complete the process within 10 working days from the date of receipt of the application.

Article 25 If an individual ceases to enjoy social insurance benefits as stipulated by the state, the employer, the person enjoying the benefits or his relatives shall notify the social insurance agency within 20 working days from the date of occurrence of the relevant situation. The social insurance agency shall stop issuing corresponding social insurance benefits after verification.

Article 26 Social insurance agencies shall verify their qualifications for social insurance benefits through information comparison, self-help certification, etc. If the qualification for social insurance benefits cannot be confirmed through information comparison, self-service authentication, etc., the social insurance agency may entrust the employer or a third-party agency to verify.

The social insurance agency shall investigate and verify the suspected loss of social insurance benefits after continuing to enjoy the benefits. If it is confirmed through investigation that it is not eligible for social insurance benefits, the payment of benefits shall be stopped.

Chapter IV Social Insurance Agency Services and Management

Article 27 Social insurance agencies shall rely on social insurance public service platforms, medical security information platforms, etc. to achieve cross-departmental and cross-regional social insurance agencies.

Article 28 Social insurance agencies shall promote the coordination of social insurance handling matters and related government service matters. The social insurance handling window shall be stationed in the government service center to provide one-stop service for employers and individuals.

The administrative departments of human resources and social security and the administrative departments of medical security shall strengthen the ability of social insurance handling services to achieve full coverage of provinces, cities, counties, townships (streets) and villages (communities).

Article 29 Employers and individuals may handle social insurance affairs through service channels such as government websites, mobile terminals, and self-service terminals, or at the social insurance handling window.

Article 30 social insurance agencies shall strengthen the construction of barrier free environment, provide barrier free information exchange, improve barrier free service facilities and equipment, and provide convenience for the elderly, the disabled and other special groups by means of authorized agency and door-to-door service.

Article 31 Where an employing unit or individual handles social insurance affairs, and the social insurance agency requires it to provide other certification materials other than identity documents, it shall have the basis of laws, regulations and the decision of the State Council.

Article 32 Social insurance agencies provide employers and individuals with free of charge to inquire and check social insurance payment and enjoy social insurance treatment records, social insurance consultation and other related services.

Article 33 Social insurance agencies shall, in accordance with the needs of the handling work, negotiate and sign service agreements with qualified agencies to regulate social insurance services. The administrative department of human resources and social security and the administrative department of medical security shall strengthen the supervision of the conclusion and performance of service agreements.

Article 34 The social insurance agency under the medical security administrative department shall improve fund payment and settlement services, strengthen the management of service agreements, and establish and improve the collective negotiation mechanism.

Article 35 Social insurance agencies shall properly keep the information of social insurance agencies and ensure the integrity, accuracy and safety of the information.

Article 36 Social insurance agencies shall establish and improve internal control systems for business, finance, safety and risk management.

The social insurance agency shall regularly inspect and evaluate the formulation and implementation of the internal control system, and rectify the problems found.

Article 37 The social insurance agency shall clarify the powers and responsibilities of the post and examine the key business and high-risk business at different levels.

Article 38 Social insurance agencies shall strengthen the application and management of information systems, improve the information verification mechanism, and record the business handling process.

Article 39 The social insurance agency shall specifically prepare the draft budget of the social insurance fund for the next year and submit it to the human resources and social security administrative department at the same level and the medical security administrative department for review and summary. The draft budget for the income of the social insurance fund shall be specifically prepared by the social insurance agency in conjunction with the social insurance premium collection agency.

Article 40 Social insurance agencies shall set up social insurance fund expenditure accounts, which shall be used to receive funds allocated by special financial accounts, to pay for fund expenditures, to release funds from higher-level agencies, and to allocate funds from lower-level agencies.

Article 41 Social insurance agencies shall conduct accounting and reconciliation of social insurance funds in accordance with the unified accounting system of the State.

Article 42 A social insurance agency shall verify the following matters:

(I) social insurance registration and entitlement;

(II) the performance of service agreements, cost settlement items and standards by social insurance service institutions;

Other matters stipulated by (III) laws and regulations.

Article 43: If a social insurance agency discovers that a social insurance service agency violates a service agreement, it may urge it to perform the service agreement, suspend or refuse to allocate fees, recover illegal fees, and suspend relevant responsible persons or departments in accordance with the service agreement. Social insurance services involving the use of social insurance funds until the service agreement is terminated; social insurance service agencies and their related responsible personnel have the right to make statements and defenses.

Article 44 If a social insurance agency finds that an employing unit, individual or social insurance service institution violates social insurance laws, regulations and rules, it shall order it to make corrections. Those who refuse to make corrections or should be dealt with by the human resources and social security administrative department or the medical security administrative department in accordance with the law shall be promptly transferred to the human resources and social security administrative department and the medical security administrative department for handling.

Article 45 the administrative department of human resources and social security and the administrative department of medical security under the State Council shall, in conjunction with the relevant departments, establish a social insurance credit management system and clarify the criteria for identifying the list of subjects with serious breach of trust in the field of social insurance.

Social insurance agencies shall truthfully record the acts of employers, individuals, social insurance service institutions and their staff in violation of social insurance laws and regulations.

Article 46 If an individual enjoys more social insurance benefits, the social insurance agency shall order the return; if it is difficult to return it at one time, it may sign a repayment agreement to return it in installments, or it may be deducted from the social insurance benefits or personal account balance it enjoys subsequently.

Chapter V Supervision of Social Insurance Management

Article 47 the administrative departments of human resources and social security and the administrative departments of medical security shall, in accordance with their respective duties, supervise and inspect the following matters of social insurance agencies:

Implementation of (I) social insurance laws, regulations and rules;

(II) social insurance registration, treatment payment and other handling conditions;

Management of (III) social insurance funds;

(IV) the service agreement signed with the social insurance service institution and the performance of the service agreement;

Other matters stipulated by (V) laws and regulations.

Financial departments and audit institutions shall, in accordance with their respective duties, supervise the relevant work of social insurance agencies in accordance with the law.

Article 48 The administrative departments of human resources and social security and the administrative departments of medical security shall, in accordance with their respective duties, strengthen the supervision and inspection of the compliance of social insurance service institutions, employers and individuals with social insurance laws, regulations and rules. Social insurance service institutions, employers and individuals shall cooperate, truthfully provide information related to social insurance, and shall not refuse to check or make false reports or conceal reports.

If the administrative department of human resources and social security and the administrative department of medical security find that social insurance service institutions and employers violate social insurance laws, regulations and rules, they shall put forward handling opinions in accordance with their respective duties, supervise rectification and reform, and may interview the relevant responsible persons.

Article 49: Human resources and social security administrative departments, medical security administrative departments, social insurance agencies and their staff shall protect the information of employers and individuals in accordance with the law, and shall not disclose it in any form.

Article 50 the administrative departments of human resources and social security and the administrative departments of medical security shall smooth the channels of supervision, encourage and support all parties in the society to supervise the handling of social insurance.

Social insurance agencies shall regularly announce to the public the situation of participating in social insurance and the income, expenditure, balance and income of social insurance funds, listen to the opinions and suggestions of employers and individuals, and accept social supervision.

Trade unions and enterprise representative organizations shall promptly reflect the opinions and suggestions of employers and individuals on social insurance agencies.

Article 51 Any organization or individual shall have the right to report and complain about any violation of laws, regulations and rules on social insurance.

The administrative departments of human resources and social security and the administrative departments of medical security shall handle the reports and complaints about social insurance received according to law.

Article 52 Where an employing unit or individual considers that a social insurance agency has infringed upon its social insurance rights and interests in the course of social insurance handling, it may apply for administrative reconsideration or bring an administrative lawsuit in accordance with the law.

Chapter VI Legal Liability

Article 53: If a social insurance agency and its staff commit one of the following acts, the human resources and social security administrative department and the medical security administrative department shall order corrections in accordance with their respective duties; cause losses to the social insurance fund, the employer or the individual If it is responsible, it shall be liable for compensation according to law; the responsible leaders and directly responsible persons shall be punished according to law:

The (I) fails to perform the statutory duties of social insurance;

The (II) violates the provisions to require the provision of supporting materials;

(III) withholding or refusing to pay social insurance benefits on time;

(IV) loss or falsification of payment records, records of social insurance benefits and other social insurance data, personal rights and interests records;

(V) violates the internal control system of the social insurance agency.

Article 54: Where human resources and social security administrative departments, medical security administrative departments, social insurance agencies and their staff disclose employer and personal information, the responsible leaders and directly responsible persons shall be punished according to law; If the employer or individual causes losses, it shall be liable for compensation according to law.

Article 55: Where a social insurance fund expenditure is defrauded by fraud, forged certification materials or other means, the human resources and social security administrative department and the medical security administrative department shall order it to return in accordance with their respective duties, and impose a fine of 2 to 5 times the amount defrauded; If it belongs to a designated medical institution, it shall be ordered to suspend the social insurance services involving the use of social insurance funds by the relevant responsible department for more than 6 months and 1 year, until the social insurance agency rescinds the service agreement; if it belongs to other social insurance service agencies, the social insurance agency rescinds the service agreement. For the responsible leaders and directly responsible personnel who have the qualifications to practice, the relevant competent departments shall revoke their qualifications according to law.

Article 56 whoever conceals, transfers, misappropriates or misappropriates social insurance funds or invests and operates in violation of regulations shall be ordered to recover them by the administrative departments of human resources and social security, the administrative departments of medical security, the financial departments and the auditing organs in accordance with their respective duties; if there are illegal gains, the illegal gains shall be confiscated; and the responsible leaders and persons directly responsible shall be punished according to law.

Article 57 if a social insurance service institution refuses the supervision and inspection of the administrative department of human resources and social security or the administrative department of medical security, or falsely reports or conceals the relevant information, the administrative department of human resources and social security and the administrative department of medical security shall order it to make corrections in accordance with their respective duties, and may interview the relevant responsible person; if it refuses to make corrections, it shall be fined not less than 10000 yuan but not more than 50000 yuan.

Article 58 Public officials who abuse their powers, neglect their duties, or engage in malpractices for personal gains in the work of social insurance agencies shall be punished according to law.

Article 59 Anyone who violates the provisions of these Regulations and constitutes a violation of public security management shall be punished according to law; if a crime is constituted, criminal responsibility shall be investigated according to law.

Chapter VII Supplementary Provisions

Article 60 the term "social insurance agencies" as mentioned in these regulations refers to the institutions that handle basic old-age insurance, industrial injury insurance, unemployment insurance and other social insurance under the administrative department of human resources and social security, and the institutions that handle basic medical insurance, maternity insurance and other social insurance under the administrative department of medical security.

Article 61 The term "social insurance service institutions" as mentioned in these Regulations refers to medical institutions, pharmaceutical trading units, assistive device allocation institutions, unemployment insurance entrusted training institutions and other institutions that have signed service agreements with social insurance agencies to provide social insurance services.

Article 62: Social security cards are loaded with financial functions. Where conditions permit, the scope of application of social security cards can be expanded to improve the efficiency of people's livelihood services. The medical insurance electronic certificate can load relevant service functions according to needs.

Article 63 These Regulations shall enter into force on December 1, 2023.