Interim Measures On The Advance Payment Of Social Insurance Fund

Original Language Title: 社会保险基金先行支付暂行办法

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Read the untranslated law here: http://www.chinalaw.gov.cn/article/fgkd/xfg/gwybmgz/201109/20110900349576.shtml

Interim measures on the advance payment of social insurance fund

    (June 29, 2011 Ministry of human resources and Social Security Department report 15th come into force July 1, 2011) first in order to safeguard the legitimate rights and interests of social insurance of citizens, regulate the advance payment of social insurance fund management, in accordance with the People's Republic of China Law on social insurance (hereinafter referred to as the Social Security Act) and the workers ' compensation insurance Ordinance, these measures are formulated. Article workers or residents participating in the basic medical insurance (hereinafter persons) due to violations resulting in injury to a third person, whose medical expenses should be determined by the third party in accordance with the level of responsibility shall bear.

Over parts of the third party liability of medical costs paid by the basic medical insurance fund in accordance with State regulations.

    In the provisions of the preceding paragraph shall pay the medical costs by a third person, third person fails to pay or of a third person cannot be determined, when medical costs, individuals can join the social insurance agency to apply for advance payment of the basic medical insurance fund and inform its injury reasons and the third party does not pay the bills or of a third person cannot be determined.

    Third, social insurance agencies after receiving individual applications under article, after examination to determine their participation in the basic medical insurance, should be in line with the provisions of the basic medical insurance fund to pay for some medical expenses.

    Fourth personal injury due to acts of infringement of the third party was recognized as work-related injury, third party does not pay employees ' health care costs or of a third person cannot be determined, individuals or their close relatives can be work-related injury certification decisions and related material to apply to the social insurance agency in writing the work injury insurance fund paid in advance and inform the third party does not pay or of a third person cannot be determined.

Article fifth, social insurance agencies to personalized according to article fourth after an application, individuals access to basic medical insurance fund should be reviewed to be paid and their unit to pay industrial injury insurance, and so on, and in accordance with the following situations, respectively:

(A) where the employer has to pay industrial injury insurance fees, and before you found injury with advance payment of the basic medical insurance fund, social insurance agency shall, in accordance with relevant regulations of the work-related injury insurance, industrial injury insurance funds paid in advance beyond the basic medical insurance fund to pay for some medical expenses, and to refund fees paid in advance of the basic medical insurance fund;

(B) where the employer has to pay industrial injury insurance fees, determined that no advance payment for basic medical insurance fund before the injury, work injury insurance fund, the social insurance agency should pay employees ' health care costs; (Three) for personal where employing units not law paid injury insurance fee, and in finds injury zhiqian basic medical insurance fund has first paid of, social insurance handling institutions should in 3 a days within employing units issued written urged told notification, requirements employing units in 5 a days within law paid beyond basic medical insurance fund first paid part of medical costs, and to basic medical insurance fund reimbursement first paid of medical costs.

The employer does not pay the remaining part of the medical costs in the time allotted, work injury insurance fund, the social insurance agency shall be paid in advance;

    (Four) for personal where employing units not law paid injury insurance fee, in finds injury zhiqian basic medical insurance fund no first paid of, social insurance handling institutions should in 3 a days to employing units issued written urged told notification, requirements employing units in 5 a days within law paid all injury medical costs; employing units in provides time within not paid of, social insurance handling institutions should with injury insurance fund first paid.

Sixth employee where the employer fails to pay industrial injury insurance, industrial accident, the employer should take steps to treatment in a timely manner and in accordance with the prescribed standards for treatment of work-related injury insurance items and to pay the costs.

After the workers have been identified for work-related injuries, any of the following circumstances, employees or their close relatives can work-related injury certification decisions and related material to the social insurance agency a written application to pay for work-related injury insurance benefits:

(A) the employer is revoked business license or revocation of registration, filing;

(B) refuse to pay all or part of the costs of the employer;

(C) after arbitration, litigation, the law still cannot get the treatment of work-related injury insurance, issued by the Court to suspend implementation of instruments;

    (D) workers that the employers do not pay for other situations.

    Seventh article social security handling institutions received workers or its near relatives according to sixth article provides proposed of application Hou, should in 3 a days within employing units issued written urged told notification, requirements its in 5 a days within be verified and law paid injury insurance treatment, told its as in provides term within not on time full paid of, injury insurance fund in according to provides first paid Hou, made requirements its reimbursement of right.

    Eighth if an employer does not pay in full and on time in accordance with article seventh, social insurance agency shall, in accordance with the Social Security Act and the provisions of the regulations on industrial injury insurance should pay for work-related injury insurance benefits projects projects to be paid from the work injury insurance fund in.

    Nineth person or his close relatives to pay medical expenses, work injury medical expenses or work-related injury insurance benefits application, social insurance agencies audited do not meet the terms of payment, should be made within 5 working days after receipt of the application would not be paid in advance by a decision, and notify the applicant in writing. Article tenth individual to apply for advance pay, workers ' compensation medical care or treatment of work-related injury insurance shall submit all medical expenses for diagnosis, identification of the original evidence.

Social insurance agencies shall retain all the original evidence, requested the applicant to sign payment credential confirmation by evidence such as the original payment of medical expenses, work injury medical expenses or a work-related injury insurance benefits.

    Individuals due to a third party or employer requesting compensation requires medical, work injury medical expenses or a work-related injury insurance benefits the original evidence, copies can be obtained from the social insurance agency, and a third person or the employer informed promptly of any compensation for the social insurance agency.

Article 11th has been obtained from a third party or employer health care costs, workers ' compensation medical care or treatment of work-related injury insurance, should take the initiative to advance the amount paid shall be borne by the third part or work injury insurance fund to pay for work-related injury insurance benefits return to basic medical insurance fund or the work injury insurance fund, social insurance institutions or recourse against the employer to a third person.

    Individuals refusing to return, the social insurance institution may be paid from future treatment of amounts deducted shall be refunded to or initiate litigation to the people's Court. 12th social insurance agency in accordance with article III of this approach pays or according to article fifth, the second after the provision to pay employees ' health care costs, the Department has identified the third party liability of, according to determine the level of responsibility of the third party should be required by law to repay the amount paid in advance in the appropriate section.

    Third party fails to pay the social insurance agencies shall initiate litigation to the people's Court according to law.

13th, social insurance agencies in accordance with the article fifth third, fourth and sixth, seventh, eighth after the first paid work injury insurance benefits provided, shall order the employer reimbursement in the 10th.

The employer fails to pay the social insurance agency in accordance with section 63rd of the Social Security Act provides to banks and other financial institutions to query their account, apply for a social security administration departments at or above the county level allocated to reimbursement decisions, and notify the employer Bank or other financial institution the amount allocated shall be repaid.

Employer account balances less than the reimbursement, the social insurance institution may require to provide security, sign a deferred payment agreement.

    Employer fails to pay in full and on time and are not guaranteed, social insurance agencies may request the people's Court seizure, attachment, auction the equivalent amount shall be paid at the property, with proceeds from the sale to repay the amounts owed.

    Article 14th social insurance agency recovery work injury insurance benefits to the employer's reasonable expenses and loss of interest on overdue repayment of the employer, shall be borne by the employer.

    15th the employer does not pay according to law of work injury insurance benefits paid by the project, workers can apply for arbitration or litigation.

    Article 16th hide from the third person or the employer obtain medical, work injury medical costs or work-related injury insurance benefits, apply to the social insurance agencies and advance payment from the social insurance fund, in accordance with section 88th of the Social Security Act regulations.

17th employer recourse against the advance payment to the social insurance agency's decision or allocated to the social security administration is dissatisfied with a decision may apply for administrative reconsideration or bring an administrative lawsuit in accordance with law.

    The individual or his or her close relatives no advance payment for social insurance agency is dissatisfied with a decision or not satisfied with the amount to be paid in advance, may apply for administrative reconsideration or bring an administrative suit. 18th article this way come into force July 1, 2011.