Announce the Regulations on Social Insurance Handling, and Li Qiang signs the State Council Order

Release time:Apr 16, 2024 03:26 AM

Premier Li Qiang recently signed a State Council order, announcing the Regulations on the Handling of Social Insurance, which will come into effect on December 1, 2023.

The handling of social insurance is the "last mile" of the social insurance system, which concerns whether the people can conveniently enjoy social insurance benefits. The Party Central Committee and the State Council attach great importance to this. The Social Insurance Law formulated in 2010 has established a special chapter to regulate the handling of social insurance. With the development and changes of the economy and society, there are some new problems and situations in the handling of social insurance, which need to be refined and improved from a legal system perspective.

The Regulations consist of 7 chapters and 63 articles, which mainly stipulate the following content: firstly, closely follow the Social Insurance Law and clarify the scope of regulation adjustment. This regulation applies to the handling of social insurance such as basic pension insurance, basic medical insurance, work-related injury insurance, unemployment insurance, maternity insurance, and other national regulations. The second is to clarify the responsibilities of the handling agency and strengthen service management supervision. The social insurance agency is required to handle the registration and transfer of social insurance relationships, record and keep information on social insurance handling, and timely verify and pay social insurance benefits. Require agencies to standardize social insurance services and management, and clarify the specific content and requirements for social insurance supervision. The third is to reduce the number of proof materials and clarify the processing time limit. Strengthen the sharing of information between relevant departments and handling agencies, clarify the relevant proof materials for enjoying social insurance benefits, shorten the time limit for social insurance handling, clarify the transfer and continuation procedures of social insurance relationships, establish and improve the settlement system for medical expenses in other places, require handling agencies to strengthen the construction of accessible environments, and provide convenience for the elderly, disabled, and others. The fourth is to improve management systems and strengthen supervision measures. Require the handling agency to negotiate and sign service agreements with eligible institutions to standardize social insurance services. Establish a social insurance credit management system. Require the competent department to supervise and inspect the handling institutions, social insurance service institutions, etc; The financial department and audit agency shall implement supervision in accordance with the law. Require the competent department to facilitate supervision channels and the handling agency to publicly disclose relevant information. The fifth is to clarify legal responsibilities and severely punish illegal and criminal acts. Corresponding legal responsibilities have been established for illegal activities such as defrauding social insurance fund expenditures, concealing, transferring, misappropriating, or illegally investing and operating social insurance funds.

Regulations on the Handling of Social Insurance

general provisions

Article 1: In order to standardize 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, this regulation is formulated in accordance with the Social Insurance Law of the People's Republic of China.

Article 2: These Regulations shall apply to the handling of social insurances stipulated by the state, such as basic pension insurance, basic medical insurance, work-related injury insurance, unemployment insurance, maternity insurance, etc.

Article 3 The handling of social insurance shall adhere to the leadership of the CPC, the people as the center, and 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 responsible for the handling of social insurance such as basic pension insurance, work-related injury insurance, and unemployment insurance nationwide. The administrative department of medical security under the State Council is responsible for handling social insurance such as basic medical insurance and maternity insurance nationwide.

The human resources and social security administrative departments of local people's governments at or above the county level shall be responsible for the handling of social insurance such as basic pension insurance, work-related injury insurance, and unemployment insurance at the overall planning level. The medical security administrative department of the local people's government at or above the county level shall be responsible for the handling of social insurance such as basic medical insurance and maternity insurance at the overall planning level.

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

Local people's governments at or above the county level shall strengthen their leadership over the handling of social insurance in their respective administrative regions, enhance the construction of social insurance handling capabilities, and provide guarantees for the handling of social insurance.

Chapter 2 Social Insurance Registration and Relationship Transfer

Article 6: Employers shall simultaneously handle social insurance registration with the registration management authority.

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

Article 7: Social security cards are vouchers for individuals to participate in basic pension insurance, basic medical insurance, work-related injury insurance, unemployment insurance, maternity insurance, and enjoy various social insurance benefits, including physical social security cards and electronic social security cards.

The electronic medical insurance certificate is a certificate for individuals to participate in social insurance such as basic medical insurance and maternity insurance, and enjoy social insurance benefits such as basic medical insurance and maternity insurance.

Article 8: The registration management authority shall share the information on the establishment, change, and cancellation of the employer's registration with the social insurance agency. The departments of public security, civil affairs, health, and judicial administration shall share the information on an individual's birth, death, household registration, migration, and cancellation with the social insurance agency.

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 inform the social insurance agency. Social insurance agencies should compare and verify the insured information and shared information provided by employers and individuals.

Article 10: Employers and individuals who apply for changes or cancellations of social insurance registration shall complete the application within 10 working days from the date of receipt by the social insurance agency. If an employer cancels its social insurance registration, it shall first settle the outstanding social insurance premiums, late fees, and fines.

Article 11 Social insurance agencies shall timely, completely, and accurately record the following information:

Social insurance registration status;

Payment status of social insurance premiums;

Enjoyment of social insurance benefits;

Personal account information;

Other situations related to social insurance handling.

Article 12: Individuals who participate in the basic old-age insurance for employees and engage in cross regional employment shall have their basic old-age insurance relationship transferred accordingly.

Individuals who participate in the basic pension insurance for employees are employed in different types of employers such as government agencies and enterprises, and their basic pension insurance relationship is transferred accordingly.

The basic pension insurance relationship of urban and rural residents can be transferred with the transfer of registered residence of individuals who participate in the basic pension insurance for urban and rural residents and do not enjoy benefits across the coordinated areas.

Article 13: Individuals who participate in the basic medical insurance for employees and engage in cross regional employment shall have their basic medical insurance relationship transferred accordingly.

If an individual who has participated in the basic medical insurance for urban and rural residents moves his or her registered residence or changes his or her habitual residence across the coordinated areas, his or her basic medical insurance relationship for urban and rural residents can be transferred with him or her according to the regulations.

The relationship between employee basic medical insurance and urban and rural resident basic medical insurance shall be transferred in accordance with regulations.

Article 14: Individuals who participate in unemployment insurance and engage in cross regional employment shall have their unemployment insurance relationship transferred accordingly.

Article 15: Individuals who participate in work-related injury insurance and maternity insurance for cross regional employment shall participate in work-related injury insurance and maternity insurance in their new employment areas.

Article 16: If an employer or individual applies for the transfer and continuation of social insurance relationships, the social insurance agency shall complete the procedures within the prescribed time limit and inform the employer and individual of the results, or provide inquiry services on the application status.

Article 17 Military organs and social insurance agencies shall handle the procedures for transferring and continuing the relationship between military insurance and social insurance in accordance with their respective responsibilities.

Social insurance agencies should provide priority services for the transfer and continuation of military insurance and social insurance relationships.

Chapter 3 Verification and Payment of Social Insurance Benefits

Article 18 Employers and individuals shall, in accordance with national regulations, apply to social insurance agencies to receive basic pension benefits. The social insurance agency shall complete the application within 20 working days from the date of receipt.

Article 19: If an individual who participates in the basic pension insurance for employees dies or an unemployed person dies during the period of receiving unemployment insurance benefits, their family members may apply for funeral subsidies and pensions from the social insurance agency in accordance with the law. The social insurance agency shall promptly verify the relevant situation, verify and distribute funeral subsidies and pensions in accordance with regulations.

Article 20: The portion of personal medical expenses and maternity medical expenses that should be paid by the basic medical insurance fund shall be directly settled with medical institutions and drug operating units after being reviewed by the social insurance agency.

Due to special circumstances, individuals who apply for manual reimbursement should provide the social insurance agency with the fee receipts, expense lists, diagnostic certificates, and medical records of medical institutions and drug trading units. The social insurance agency shall review the fee bills, fee lists, diagnostic certificates, and medical records, and complete the application within 30 working days from the date of receipt.

Individuals who participate in maternity insurance and apply for maternity allowances should provide medical record information to the social insurance agency. The social insurance agency shall review the medical records and complete the application within 10 working days from the date of receipt.

Article 21: Workers with work-related injuries and their employing units who apply for labor capacity appraisal, confirmation of auxiliary equipment configuration, confirmation of extension of work stoppage leave period, and confirmation of recurrence of old work-related injuries in accordance with the law shall provide diagnostic certificates and medical records to the social insurance agency.

Article 22: The portion of the medical expenses, rehabilitation expenses, and installation and configuration of auxiliary equipment for personal treatment of work-related injuries that should be paid by the work-related injury insurance fund shall be directly settled with medical institutions and auxiliary equipment configuration institutions after being reviewed by the social insurance agency.

Employers or individuals who apply for manual reimbursement due to special circumstances shall provide the social insurance agency with the fee receipts, expense lists, diagnostic certificates, and medical records of medical institutions and auxiliary equipment configuration institutions. The social insurance agency shall review the fee bills, fee lists, diagnostic certificates, and medical records, and complete the application within 20 working days from the date of receipt.

Article 23: The administrative departments of human resources and social security, as well as the administrative departments of medical security, shall establish and improve the settlement system of medical expenses for medical treatment in other places in accordance with their respective responsibilities. Social insurance agencies should do a good job in settling medical expenses for medical treatment in other 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.

During the period of receiving unemployment insurance benefits, the social insurance agency shall pay the basic medical insurance premiums that individuals should pay from the unemployment insurance fund.

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

Article 25: In the event that an individual ceases to enjoy social insurance benefits as stipulated by the state, the employer, the beneficiary or their relatives shall notify the social insurance agency within 20 working days from the date of the relevant situation. After verification, the social insurance agency shall stop issuing corresponding social insurance benefits.

Article 26 Social insurance agencies shall verify the eligibility for enjoying social insurance benefits through information comparison, self-service authentication, and other methods. If it is impossible to confirm the eligibility for social insurance benefits through information comparison, self-service authentication, etc., the social insurance agency may entrust the employer or a third-party organization to verify.

For those who are suspected of losing their eligibility for social insurance benefits and continuing to enjoy them, the social insurance agency shall investigate and verify. If it is confirmed through investigation that the eligibility for social insurance benefits is not met, the benefits will be suspended.

Chapter 4 Social Insurance Handling 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 handling.

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

The administrative departments of human resources and social security, as well as medical security, should strengthen their ability to handle social insurance services and achieve full coverage at the provincial, municipal, county, township, and village levels.

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

Article 30 Social insurance agencies shall strengthen the construction of accessible environments, provide accessible information exchange, improve accessible service facilities and equipment, and use authorized agency and door-to-door services to provide convenience for special groups such as the elderly and disabled.

Article 31: When employers and individuals handle social insurance affairs, if the social insurance agency requires them to provide proof materials other than their identity documents, they shall have the basis of laws, regulations, and decisions of the State Council.

Article 32: Social insurance agencies shall provide free services to employers and individuals, such as checking and verifying records of social insurance payments and benefits, and providing social insurance consultation.

Article 33: Social insurance agencies shall negotiate and sign service agreements with eligible institutions according to the needs of their handling work, and regulate social insurance service behavior. The administrative departments of human resources and social security, as well as medical security, should strengthen supervision over the signing and performance of service agreements.

Article 34: Social insurance agencies affiliated with medical security administrative departments shall improve fund payment and settlement services, strengthen service agreement management, and establish and improve collective negotiation mechanisms.

Article 35 Social insurance agencies shall properly safeguard social insurance handling information, ensuring its completeness, accuracy, and security.

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

Social insurance agencies should regularly inspect and evaluate the formulation and implementation of internal control systems, and rectify any problems found.

Article 37: Social insurance agencies shall clarify their job responsibilities and conduct graded audits on key and high-risk businesses.

Article 38 Social insurance agencies shall strengthen the management of information system applications, improve information verification mechanisms, and record the process of business handling.

Article 39: The social insurance agency shall prepare a specific draft budget for the next year's social insurance fund, and submit it to the local human resources and social security administrative department 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 fee collection agency.

Article 40: Social insurance agencies shall establish a social insurance fund expenditure account, which shall be used to receive funds transferred from financial special accounts, pay fund expenditure funds, transfer funds from higher-level agencies, and 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 national accounting system.

Article 42: Social insurance agencies shall verify the following matters:

Registration of social insurance and enjoyment of benefits;

Performance of service agreements, execution of cost settlement items and standards by social insurance service institutions;

Other matters stipulated by laws and regulations.

Article 43: If the social insurance agency discovers that the social insurance service institution has violated the service agreement, it may supervise and urge it to fulfill the service agreement, suspend or refuse to disburse fees, recover illegal fees, suspend social insurance services related to the use of social insurance funds by relevant responsible personnel or departments in accordance with the service agreement, until the service agreement is terminated; Social insurance service institutions and their related responsible personnel have the right to make statements and defend themselves.

Article 44 If a social insurance agency discovers that an employer, individual, or social insurance service institution has violated social insurance laws, regulations, or rules, it shall order it to make corrections. For those who refuse to make corrections or should be handled by the human resources and social security administrative department or medical security administrative department in accordance with the law, they shall be promptly transferred to the human resources and social security administrative department or medical security administrative department for processing.

Article 45: The human resources and social security administrative departments and medical security administrative departments of the State Council, in conjunction with relevant departments, shall establish a social insurance credit management system and clarify the criteria for identifying the list of seriously untrustworthy entities in the field of social insurance.

The social insurance agency shall truthfully record the dishonest behavior 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 them to return the benefits; For those that are difficult to return in one go, a repayment agreement can be signed for installment repayment, or they can be deducted from their subsequent social insurance benefits or personal account balance.

Chapter 5 Supervision of Social Insurance Handling

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

Implementation of social insurance laws, regulations, and rules;

The handling of social insurance registration, benefits payment, and other related matters;

Management of social insurance funds;

Signing service agreements and performance of service agreements with social insurance service institutions;

Other matters stipulated by laws and regulations.

The financial department and audit agency shall, in accordance with their respective responsibilities, supervise the relevant work of social insurance agencies in accordance with the law.

Article 48: Human resources and social security administrative departments, as well as medical security administrative departments, shall strengthen supervision and inspection of social insurance service institutions, employers, and individuals in compliance with social insurance laws, regulations, and rules in accordance with their respective responsibilities. Social insurance service institutions, employers, and individuals shall cooperate and truthfully provide information related to social insurance, and shall not refuse to inspect or falsely report or conceal information.

If the administrative departments of human resources and social security, as well as medical security, discover that social insurance service institutions or employers have violated social insurance laws, regulations, and rules, they shall propose handling opinions according to their respective responsibilities, supervise rectification, and may interview relevant responsible persons.

Article 49: The administrative departments of human resources and social security, medical security, 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, as well as medical security, shall establish smooth channels for supervision and encourage and support all sectors of society to supervise the handling of social insurance.

Social insurance agencies shall regularly disclose their participation in social insurance and the income, expenditure, balance, and income of social insurance funds to the society, listen to the opinions and suggestions of employers and individuals, and accept social supervision.

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

Article 51: Any organization or individual has the right to report or complain about violations of social insurance laws, regulations, and rules.

The administrative departments of human resources and social security, as well as medical security, shall handle reports and complaints related to social insurance in accordance with the law.

Article 52 If an employer or individual believes that a social insurance agency has infringed upon their social insurance rights and interests in the process of handling social insurance, they may apply for administrative reconsideration or file an administrative lawsuit in accordance with the law.

Chapter 6 Legal Liability

Article 53: If a social insurance agency or its staff commits any of the following behaviors, the human resources and social security administrative department and the medical security administrative department shall order them to make corrections according to their respective responsibilities; Those who cause losses to social insurance funds, employers or individuals shall bear compensation liability in accordance with the law; Punish responsible leaders and directly responsible personnel in accordance with the law:

Failure to fulfill legal responsibilities for social insurance;

Violating regulations by providing proof materials;

Those who withhold or refuse to pay social insurance benefits on time;

Losing or tampering with payment records, records of enjoying social insurance benefits, and other social insurance data, as well as personal rights and interests records;

Violating the internal control system of social insurance handling.

Article 54: If the administrative departments of human resources and social security, medical security, social insurance agencies, and their staff leak information of employers and individuals, the responsible leaders and directly responsible personnel shall be punished in accordance with the law; If it causes losses to the employer or individual, it shall be liable for compensation in accordance with the law.

Article 55: If a person fraudulently obtains social insurance fund expenditures through fraud, forgery of proof materials, or other means, the administrative department of human resources and social security, and the administrative department of medical security shall, in accordance with their respective responsibilities, order them to return the funds and impose a fine of not less than twice but not more than five times the amount fraudulently obtained; Those belonging to designated medical institutions shall be ordered to suspend social insurance services related to the use of social insurance funds by relevant responsible departments for more than 6 months but less than 1 year, until the service agreement is terminated by the social insurance agency; If it belongs to other social insurance service institutions, the social insurance agency shall terminate the service agreement. For responsible leaders and directly responsible personnel who have professional qualifications, their professional qualifications shall be revoked by the relevant competent department in accordance with the law.

Article 56: Those who conceal, transfer, embezzle, or misappropriate social insurance funds or engage in illegal investment and operation shall be ordered by the administrative departments of human resources and social security, medical security, finance, and auditing to recover them in accordance with their respective responsibilities; If there are illegal gains, the illegal gains shall be confiscated; Punish responsible leaders and directly responsible personnel in accordance with the law.

Article 57: If a social insurance service institution refuses the supervision and inspection of the human resources and social security administrative department or the medical security administrative department, or falsely reports or conceals relevant information, the human resources and social security administrative department or the medical security administrative department shall order it to make corrections according to their respective responsibilities, and may interview the relevant person in charge; Those who refuse to make corrections shall be fined between 10000 yuan and 50000 yuan.

Article 58: Public officials who abuse their power, neglect their duties, or engage in favoritism and fraud in the handling of social insurance shall be punished in accordance with the law.

Article 59: Those who violate the provisions of these Regulations and constitute violations of public security management shall be punished for public security management in accordance with the law; If a crime is constituted, criminal responsibility shall be pursued in accordance with the law.

Chapter 7 Supplementary Provisions

Article 60 The social insurance agency referred to in these Regulations refers to the institutions that handle basic pension insurance, work-related injury insurance, unemployment insurance and other social insurance under the jurisdiction of the human resources and social security administrative department, as well as the institutions that handle basic medical insurance, maternity insurance and other social insurance under the jurisdiction of the medical security administrative department.

Article 61: The social insurance service institutions referred to in these Regulations refer to medical institutions, drug trading units, auxiliary equipment configuration institutions, unemployment insurance commissioned training institutions, and other institutions that sign service agreements with social insurance agencies and provide social insurance services.

Article 62: Social security cards shall be equipped with financial functions. If conditions permit, the application scope of social security cards may be expanded to improve the efficiency of people's livelihood services. Medical insurance electronic vouchers can load relevant service functions as needed.

Article 63: These regulations shall come into effect on December 1, 2023.

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