"Questions and Answers on the Five Social Insurances and One Housing Fund

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Question: What is the five social insurances and one housing fund? Answer: “Five social insurances and one housing fund” refers to five types of insurance, including pension insurance, medical insurance, unemployment insurance, work-related injury insurance, and maternity insurance ； “\"One gold\" refers to the housing provident fund. Among them, pension insurance, medical insurance, and unemployment insurance are covered by contributions made both by employers and employees, while work-related injury insurance and maternity insurance are entirely borne by the employers. Individuals do not need to pay. It should be noted here that the “five social insurances” are mandatory, whereas the “one fund” is not mandatory. Question: What are the contribution rates for the \"five social insurances and one housing fund\"? Answer: The current contribution rate for pension insurance in Beijing is 20% for employers (of which 17% goes into the pooled fund and 3% goes into the individual account), and 8% for individuals (with all of it going into the individual account) ； Health insurance contribution rate: 10% by the employer, 2% + 3 yuan by the individual. Unemployment insurance contribution rate: 1.5% by the employer, 0.5% by the employee ； Work-related injury insurance determines its injury coverage rate based on the industry category to which the employer belongs ； Birth insurance contribution rate: 0.8% by the employer, with no contribution from the individual. Housing fund contribution rate: Choose the housing fund contribution rate based on the actual situation of the enterprise. But in principle, the maximum contribution amount shall not exceed 10% of 300% of the average wage of employees in Beijing. A pooled fund refers to the mechanism needed for coordination during the transition of the pension insurance system from a **unit-based system to a **social system, in order to address issues such as uneven economic development and an aging population. (1) Establish a social pooling fund primarily through corporate contributions ； (2) Establish individual accounts primarily through contributions from employees and enterprises ； (3)**Cover the administrative costs of the pension insurance fund. This semi-fund system that combines social pooling with individual accounts is conducive to addressing China’s aging population crisis, gradually dispersing the transition costs from the old system to the new one, and progressively shifting from an enterprise-based pension system to an individual-based pension system. The contribution amounts for the four social insurances and one housing fund vary from region to region, with the base amount being determined based on the total salary. Some companies provide a basic salary along with various subsidies when making payments, but other companies only offer the basic salary when making deductions, which is in violation of the law. The specific ratio should be consulted with the local labor department. The withdrawal of benefits related to pension insurance, unemployment insurance, and health insurance is allowed only under statutory conditions, and these benefits are issued by the authorities responsible for registration. For example, to receive pension benefits, one must reach the legal age; similarly, there are certain conditions for receiving unemployment benefits – such as obtaining a certificate of unemployment from the local street office where one’s residence is registered, along with a job search certificate, which means that one must still be willing to look for work after becoming unemployed in order to qualify for these benefits. If you don’t want to work after losing your job, then you won’t be able to receive insurance benefits. Additionally, pension and unemployment benefits cannot be received simultaneously. Question: Is insurance provided during the trial period? Answer: Insurance should also be available during the probation period, as it is an integral part of the contract term and is not separate from it. So insurance should also be purchased during the trial period. Furthermore, it is a legal obligation for companies to provide insurance for their employees; this does not depend on the employees’ wishes or willingness. Even if employees state that they do not need insurance, it is still required, and commercial insurance cannot replace social insurance. Benefits under the pension insurance. Those who have paid into the pension insurance for 15 years or more and have reached the legal retirement age are eligible to receive pension benefits: 1. They can receive the basic pension, calculated in accordance with relevant regulations, on a monthly basis until their death. The formula for calculating the basic pension is as follows: Basic pension = Basic pension component + Pension from individual account + Transitional pension = Monthly average wage of all employees in the city in the year before retirement × 20% (15% if the contribution period is less than 15 years) + Total amount in the individual account divided by 120 + Indexed monthly average contribution wage × Contribution period up to the end of 1997 × 1.4%. 2. Death benefits. (1) Funeral expenses (2) One-time compensation payment (3) A subsidy for members of the immediate family who meet the criteria for support, paid on a monthly basis until such time as those family members pass away. Note: Pension insurance contributions should be made continuously as much as possible. According to relevant regulations, whenever an enterprise or the insured person stops paying the basic pension insurance premiums (except for those who are receiving unemployment benefits or those who are exempt from payment per relevant rules), and the insured person meets the **specified conditions for receiving a pension, the base amount for calculating the basic pension is determined by taking into account the cumulative period of interrupted payments, with each full 12 months counted as one year of interruption; periods shorter than 12 months are not taken into account. For example, if you retire in 2020, your basic pension would normally be calculated as 20% of the average social wage in 2019. However, if your pension insurance payments were interrupted for 30 months before retirement, which is equivalent to 2.5 years, but it is counted as 2 years, then your basic pension would be calculated as 20% of the average social wage in 2017. Question: What benefits are available to those who are enrolled in medical insurance? Answer: 1. Medical expenses for outpatient and emergency care. The portion of medical expenses that fall within the scope covered by basic medical insurance and exceed 2,000 yuan during an employee’s working year (from January 1 to December 31) ； 2. Settlement ratio. During the contract period, 50% of the amount exceeding 2,000 yuan for dispatched personnel will be reimbursed, with the individual bearing 50% of the cost ； The maximum amount reimbursable for outpatient and emergency treatments for dispatched workers within a single year is 20,000 yuan. 3. Insured persons should properly keep the outpatient medical documents obtained from designated hospitals (including receipts for amounts below a certain threshold, prescription forms, etc.) as proof for reimbursement of medical expenses ； 　 4. Outpatient treatment for three types of special diseases: When insured persons require outpatient treatment for radiotherapy and chemotherapy due to malignant tumors, or for kidney dialysis or the use of immunosuppressive drugs after kidney transplantation, the designated secondary or tertiary hospitals where they receive treatment must issue a “Disease Diagnosis Certificate”. Additionally, they need to fill out the “Beijing Medical Insurance Special Disease Application and Approval Form”, which is then submitted to the district medical insurance center for approval and record-keeping. Outpatient treatment and medication pickup for these three special diseases are only permitted at the designated hospitals approved for such care; it is not possible to purchase them at designated retail pharmacies. Medical expenses that fall within the scope specified for special outpatient conditions will be settled on a basis similar to that of inpatient care. 5. Inpatient care ● Admission deposit: For insured individuals who meet the criteria for inpatient treatment, the hospital charges a certain deposit upon admission; the amount of this deposit is determined by the hospital based on the severity of the condition. If the employer of the dispatched employee and the employee themselves fail to pay the medical insurance premiums on time and in full, the hospital deposit must be paid in full by the dispatched employee personally. ●Settlement cycle: For insured persons undergoing hospital treatment, each 90 days constitutes a settlement cycle; if the stay is within 90 days, each hospitalization counts as one settlement cycle. ●For patients with malignant tumors undergoing outpatient radiotherapy and chemotherapy, those on renal dialysis or taking immunosuppressive drugs after kidney transplantation, as well as patients with mental illnesses who require long-term hospitalization, the medical expenses are settled on a cycle of 360 days. ●For medical expenses incurred by insured persons receiving treatment in home beds at designated community health service centers (stations), the settlement period is 90 days. ●Upon discharge or the completion of a phase of treatment, the assigned employee must first settle with the hospital any costs that are to be borne by them personally. As for the medical expenses that should be covered by the basic medical insurance fund and the large-amount medical mutual assistance fund, the hospital will submit them to the medical insurance authority for review and settlement. ●For insured persons undergoing hospital treatment, the settlement of medical expenses that fall within the scope covered by basic health insurance involves setting a deductible and a maximum payment limit for the basic health insurance fund. ●The deductible is 1,300 yuan for the first hospitalization, and 650 yuan for subsequent hospitalizations; the maximum payment limit is 50,000 yuan ； Mutual assistance for high medical expenses exceeding the maximum payment limit (excluding amounts below the deductible and the portion to be borne by the dispatched employee personally). 70% of the cost is covered by funding, while the 30% is borne by the dispatched personnel themselves. A maximum of 100,000 yuan can be paid within one year. The settlement standard for hospital expenses involves a segmented calculation and cumulative payment method, based on the hospital’s grade and the amount of expenses, within a single settlement period. (When the various ratios are adjusted, the new standards shall apply.) Note: Medical insurance does not cover accidents that are not work-related! Question: Will participating in unemployment insurance entitle one to benefits? Answer: After contributing to unemployment insurance for over a year and the records being returned to the local community office. Unemployment insurance benefits can be received on the street. 1. Unemployment insurance benefits: These refer to the basic living expenses paid by the unemployment insurance authorities to eligible unemployed individuals in accordance with regulations, and they represent the main form of unemployment insurance benefits. Unemployment insurance benefits are governed by relevant documents in Beijing. 2. Medical assistance during unemployment benefits receipt: refers to the subsidy paid for medical expenses incurred by unemployed persons while receiving unemployment benefits. Complied in accordance with relevant policies and regulations of Beijing. 3. The funeral subsidy for unemployed persons who die during the period of receiving unemployment benefits, as well as the pensions for their dependent spouses and immediate family members, shall be handled in accordance with relevant regulations. Question: What benefits are available under work-related injury insurance? Answer: In the event of an accident during the contract period, it is necessary to request a written explanation from the company, which must be stamped with the company’s official seal. An application for work-related injury recognition should be submitted as soon as possible (preferably within three working days), and the following documents must be provided. 1. Initial treatment diagnosis certificate or hospital medical record. 2. Certificate of occupational disease diagnosis (one original and one copy). 3. For traffic accidents, an accident ruling issued by the traffic police department or a certificate of the traffic accident from the relevant transportation authority is required. 4. Copy of ID card. 5. The original labor contract valid during its term. Question: What benefits are available under maternity insurance? Answer: Expenses related to childbirth can be reimbursed. The scope of reimbursement includes maternity allowances, maternity medical expenses, medical expenses for family planning surgeries, **and other birth-related expenses specified by the local authorities. 　 The maternity allowance is calculated by taking the employee’s contribution base for the month of childbirth, dividing it by 30, and then multiplying the result by the number of days of maternity leave. The maternity allowance is equivalent to the female employee’s salary during her maternity leave; if this amount is lower than her actual salary, the difference shall be covered by the employer. 　 Medical expenses related to childbirth include medical examination fees, delivery costs, surgical fees, hospitalization costs, and medication costs incurred by female employees due to pregnancy and childbirth. Medical expenses for family planning procedures include those incurred by employees due to family planning. Currently, one is required to have paid into health insurance for 20 years and pension insurance for 15 years in order to be eligible to receive a pension and enjoy medical coverage after retirement.