What is the advance payment of social insurance fund?

Interim Measures for Advance Payment of Social Insurance Funds

Article 1 These Measures are formulated in accordance with the Social Insurance Law of People's Republic of China (PRC) (hereinafter referred to as the "Social Insurance Law") and the Regulations on Industrial Injury Insurance in order to safeguard the legitimate rights and interests of citizens to participate in social insurance and standardize the advance management of social insurance funds.

Article 2 If employees or residents (hereinafter referred to as individuals) participating in the basic medical insurance are injured or injured due to the tort of a third party, the medical expenses shall be borne by the third party according to the determined responsibilities. Medical expenses exceeding the liability of third parties shall be paid by the basic medical insurance fund in accordance with state regulations.

The medical expenses specified in the preceding paragraph shall be paid by the third party. If the third party fails to pay or cannot identify the third party, when the medical expenses are settled, the individual may apply in writing to the social insurance agency of the insured place for the basic medical insurance fund to pay in advance, and inform the injured reason and the situation that the third party fails to pay the medical expenses or cannot identify the third party.

Article 3 After receiving an application submitted by an individual in accordance with the provisions of Article 2, the social insurance agency shall, upon examination and verification, confirm that the individual participates in the basic medical insurance, and pay the corresponding medical expenses in advance in accordance with the provisions on coordinating the payment of the regional basic medical insurance fund.

Article 4 If an individual is identified as a work-related injury due to the infringement of a third person, and the third person fails to pay the medical expenses for the work-related injury or cannot identify the third person, the individual or his close relatives may apply to the social insurance agency in writing for the work-related injury insurance fund to pay in advance with the work-related injury identification decision and relevant materials, and inform the third person that the third person has not paid or cannot identify the third person.

Article 5 After receiving an application submitted by an individual in accordance with the provisions of Article 4, the social insurance agency shall examine the work-related injury insurance premium paid by the individual basic medical insurance fund and the unit, and deal with it respectively according to the following circumstances:

(1) If the employer where the individual is located has paid the work-related injury insurance premium according to law before the work-related injury is recognized, and the basic medical insurance fund has paid in advance, the social insurance agency will use the work-related injury insurance fund to pay the medical expenses that exceed the part paid in advance by the basic medical insurance fund in accordance with the relevant provisions of the work-related injury insurance, and will refund the expenses paid in advance to the basic medical insurance fund;

(two) for the employer where the individual is located has paid the work-related injury insurance premium according to law, and the basic medical insurance fund has not been paid in advance before the work-related injury identification, the social insurance agency shall use the work-related injury insurance fund to pay the work-related injury medical expenses in advance;

(3) If the employer where the individual is located fails to pay the work-related injury insurance premium according to law, and the basic medical insurance fund has paid in advance before the work-related injury is recognized, the social insurance agency shall issue a written reminder notice to the employer within three working days, requiring the employer to pay the medical expenses other than the part paid in advance by the basic medical insurance fund according to law within five working days, and repay the medical expenses paid in advance to the basic medical insurance fund. If the employer fails to pay the remaining medical expenses within the specified time, the social insurance agency shall pay in advance with the industrial injury insurance fund;

(4) If the employer where the individual is located fails to pay the work-related injury insurance premium and the basic medical insurance fund fails to pay in advance before the work-related injury is recognized, the social insurance agency shall issue a written reminder notice to the employer within three working days, requiring the employer to pay all the work-related injury medical expenses according to law within five working days; If the employer fails to pay within the specified time, the social insurance agency shall pay in advance with the industrial injury insurance fund.

Article 6 Where an employee's employer fails to pay work-related injury insurance premiums in accordance with the law, and an industrial accident occurs, the employer shall take measures for timely treatment and pay the fees according to the prescribed work-related injury insurance treatment items and standards.

After an employee is identified as a work-related injury, under any of the following circumstances, the employee or his close relatives may apply in writing to the social insurance agency for advance payment of work-related injury insurance benefits with the determination of work-related injury and related materials:

(1) The business license of the employing unit is revoked or the registration is cancelled according to law;

(two) the employer refuses to pay all or part of the expenses;

(three) after arbitration and litigation in accordance with the law, the court still cannot obtain the treatment of work-related injury insurance, and the court issues a document to suspend the execution;

(4) Other circumstances in which the employee thinks that the employer does not pay.

Article 7 After receiving the application submitted by employees or their close relatives in accordance with the provisions of Article 6, the social insurance agency shall send a written reminder to the employer within three working days, requiring it to verify and pay the industrial injury insurance benefits according to law within five working days, and inform it that if it fails to pay in full and on time within the prescribed time limit, the industrial injury insurance fund will obtain the right of recovery after paying in advance according to the provisions.

Article 8 If the employer fails to pay the fees in full and on time in accordance with the provisions of Article 7, the social insurance agency shall pay the items that should be paid by the industrial injury insurance fund in advance in accordance with the provisions of the Social Insurance Law and the Regulations on Industrial Injury Insurance.

Article 9 If an individual or his close relatives apply for advance payment of medical expenses, work-related injury medical expenses or work-related injury insurance benefits, and the social insurance agency fails to meet the conditions for advance payment after examination, it shall make a decision not to advance payment within 5 working days after receiving the application, and notify the applicant in writing.

Article 10 Where an individual applies to pay medical expenses, work-related injury medical expenses or work-related injury insurance benefits in advance, he shall submit all original bills and other evidence of medical diagnosis and appraisal expenses. The social insurance agency shall keep all the original bills and other evidence, require the applicant to sign the advance voucher for confirmation, and advance the medical expenses, work-related injury medical expenses or work-related injury insurance benefits with the original bills and other evidence.

If an individual requests a third person or an employer to compensate for the original bill of medical expenses, work-related injury medical expenses or work-related injury insurance benefits, he may request a copy from the social insurance agency and promptly inform the social insurance agency that the third person or the employer will compensate.

Article 11 Where an individual obtains medical expenses, work-related injury medical expenses or work-related injury insurance benefits from a third person or an employer, he shall voluntarily return the part paid in advance by the third person or the work-related injury insurance benefits paid in advance by the work-related injury insurance fund to the basic medical insurance fund or the work-related injury insurance fund, and the social insurance agency shall not recover from the third person or the employer.

If the individual refuses to return, the social insurance agency may deduct the amount that should be returned from the relevant benefits paid later, or bring a lawsuit to the people's court.

Article 12 After the social insurance agency has paid the medical expenses in advance according to the provisions of Article 3 of these Measures or paid the medical expenses for work-related injuries in advance according to the provisions of Items 1 and 2 of Article 5, if the relevant department determines the liability of the third party, it shall require the third party to repay the corresponding part of the amount paid in advance according to the determined liability. If the third party fails to repay within the time limit, the social insurance agency shall bring a lawsuit to the people's court according to law.

Thirteenth social insurance agencies in accordance with the provisions of Article 5, Item 3, Item 4, Article 6, Article 7 and Article 8 of these measures, after paying the treatment of work-related injury insurance in advance, it shall order the employer to repay it within 10 days.

If the employer fails to repay within the time limit, the social insurance agency may, in accordance with the provisions of Article 63 of the Social Insurance Law, inquire about its deposit accounts in banks and other financial institutions, apply to the social insurance administrative department at or above the county level for deciding to allocate the amount to be repaid, and notify the employer's banks or other financial institutions in writing to allocate the amount to be repaid.

If the balance of the employer's account is less than the amount to be repaid, the social insurance agency may require it to provide a guarantee and sign a deferred repayment agreement.

If the employer fails to repay in full and on time and fails to provide guarantee, the social insurance agency may apply to the people's court to seal up, detain or auction the property whose value is equivalent to the amount to be repaid, so as to pay off the owed amount with the proceeds from the auction.

Fourteenth social insurance agencies to recover the reasonable expenses of work-related injury insurance benefits from the employer and the interest loss of the employer's overdue repayment shall be borne by the employer.

Fifteenth if the employer fails to pay the work-related injury insurance benefits that should be paid by it according to law, the employees may apply for arbitration or bring a lawsuit according to law.

Article 16 Where an individual conceals medical expenses, work-related injury medical expenses or work-related injury insurance benefits obtained from a third person or an employer and applies to the social insurance agency for advance payment from the social insurance fund, it shall be handled in accordance with the provisions of Article 88 of the Social Insurance Law.

Article 17 If an employer refuses to accept the recovery decision made by the social insurance agency or the allocation decision made by the social insurance administrative department, it may apply for administrative reconsideration or bring an administrative lawsuit according to law.

Individuals or their close relatives who are dissatisfied with the refusal to advance or the amount of advance made by social insurance agencies may apply for administrative reconsideration or bring an administrative lawsuit according to law.

Article 18 These Measures shall come into force as of July 20 1 and 1.