KYB CHINA(2023年7月21日国务院第11次常务会议通过 2023年8月16日中华人民共和国国务院令第765号公布 自2023年12月1日起施行)
(Adopted at the 11th Executive Meeting of the State Council on July 21, 2023, promulgated by Order No. 765 of the State Council of the People's Republic of China on August 16, 2023, and effective as of December 1, 2023)
总 则
General Provisions
为了规范社会保险经办，优化社会保险服务，保障社会保险基金安全，维护用人单位和个人的合法权益，促进社会公平，根据《中华人民共和国社会保险法》，制定本条例。
These Regulations are formulated in accordance with the Social Insurance Law of the People's Republic of China to standardize social insurance administration, optimize social insurance services, ensure the security of social insurance funds, protect the legitimate rights and interests of employers and individuals, and promote social equity.
经办基本养老保险、基本医疗保险、工伤保险、失业保险、生育保险等国家规定的社会保险，适用本条例。
These Regulations apply to the administration of basic old-age insurance, basic medical insurance, work-related injury insurance, unemployment insurance, maternity insurance, and other social insurances prescribed by the state.
社会保险经办工作坚持中国共产党的领导，坚持以人民为中心，遵循合法、便民、及时、公开、安全的原则。
Social insurance administration work shall adhere to the leadership of the Communist Party of China, adhere to a people-centered approach, and follow the principles of legality, convenience, timeliness, openness, and security.
国务院人力资源社会保障行政部门主管全国基本养老保险、工伤保险、失业保险等社会保险经办工作。国务院医疗保障行政部门主管全国基本医疗保险、生育保险等社会保险经办工作。
The human resources and social security administrative department of the State Council shall be in charge of the administration of basic old-age insurance, work-related injury insurance, unemployment insurance, and other social insurances nationwide. The medical security administrative department of the State Council shall be in charge of the administration of basic medical insurance, maternity insurance, and other social insurances nationwide.
县级以上地方人民政府人力资源社会保障行政部门按照统筹层次主管基本养老保险、工伤保险、失业保险等社会保险经办工作。县级以上地方人民政府医疗保障行政部门按照统筹层次主管基本医疗保险、生育保险等社会保险经办工作。
The human resources and social security administrative departments of local people's governments at or above the county level shall, in accordance with the level of overall planning, be in charge of the administration of basic old-age insurance, work-related injury insurance, unemployment insurance, and other social insurances. The medical security administrative departments of local people's governments at or above the county level shall, in accordance with the level of overall planning, be in charge of the administration of basic medical insurance, maternity insurance, and other social insurances.
国务院人力资源社会保障行政部门、医疗保障行政部门以及其他有关部门按照各自职责，密切配合、相互协作，共同做好社会保险经办工作。
The human resources and social security administrative department, the medical security administrative department, and other relevant departments of the State Council shall, in accordance with their respective responsibilities, closely cooperate and collaborate with each other to jointly carry out social insurance administration work.
县级以上地方人民政府应当加强对本行政区域社会保险经办工作的领导，加强社会保险经办能力建设，为社会保险经办工作提供保障。
Local people's governments at or above the county level shall strengthen leadership over social insurance administration within their administrative regions, enhance the capacity building for social insurance administration, and provide guarantees for social insurance administration work.
社会保险登记和关系转移
Social Insurance Registration and Relationship Transfer
用人单位在登记管理机关办理登记时同步办理社会保险登记。
When an employer registers with the registration authority, it shall simultaneously complete social insurance registration.
个人申请办理社会保险登记，以公民身份号码作为社会保障号码，取得社会保障卡和医保电子凭证。社会保险经办机构应当自收到申请之日起10个工作日内办理完毕。
An individual applying for social insurance registration shall use their citizen identity number as the social security number and obtain a social security card and a medical insurance electronicvoucher. The social insurance agency shall complete the processing within 10 working days from the date of receiving the application.
社会保障卡是个人参加基本养老保险、基本医疗保险、工伤保险、失业保险、生育保险等社会保险和享受各项社会保险待遇的凭证，包括实体社会保障卡和电子社会保障卡。
The social security card is the credential for an individual to participate in basic old-age insurance, basic medical insurance, work-related injury insurance, unemployment insurance, maternity insurance, and other social insurances, and to enjoy various social insurance benefits. It includes both physical and electronic social security cards.
医保电子凭证是个人参加基本医疗保险、生育保险等社会保险和享受基本医疗保险、生育保险等社会保险待遇的凭证。
The medical insurance electronicvoucher is the credential for an individual to participate in basic medical insurance, maternity insurance, and other social insurances, and to enjoy basic medical insurance, maternity insurance, and other social insurance benefits.
登记管理机关应当将用人单位设立、变更、注销登记的信息与社会保险经办机构共享，公安、民政、卫生健康、司法行政等部门应当将个人的出生、死亡以及户口登记、迁移、注销等信息与社会保险经办机构共享。
The registration authority shall share information on the establishment, modification, and cancellation of employers with the social insurance agency. Public security, civil affairs, health, judicial administration, and other departments shall share information on individuals' birth, death, household registration, migration, and cancellation with the social insurance agency.
用人单位的性质、银行账户、用工等参保信息发生变化，以及个人参保信息发生变化的，用人单位和个人应当及时告知社会保险经办机构。社会保险经办机构应当对用人单位和个人提供的参保信息与共享信息进行比对核实。
When an employer's registration information such as nature, bank account, or employment changes, or when an individual's registration information changes, the employer or individual shall promptly inform the social insurance agency. The social insurance agency shall compare and verify the registration information provided by the employer or individual with the shared information.
用人单位和个人申请变更、注销社会保险登记，社会保险经办机构应当自收到申请之日起10个工作日内办理完毕。用人单位注销社会保险登记的，应当先结清欠缴的社会保险费、滞纳金、罚款。
When an employer or individual applies to modify or cancel social insurance registration, the social insurance agency shall complete the processing within 10 working days from the date of receiving the application. When an employer cancels social insurance registration, it shall first settle any outstanding social insurance premiums, late fees, and fines.
社会保险经办机构应当及时、完整、准确记录下列信息：
The social insurance agency shall promptly, completely, and accurately record the following information:
(一)社会保险登记情况；
(1) Social insurance registration status;
(二)社会保险费缴纳情况；
(2) Social insurance premium payment status;
(三)社会保险待遇享受情况；
(3) Social insurance benefit entitlement status;
(四)个人账户情况；
(4) Individual account status;
(五)与社会保险经办相关的其他情况。
(5) Other circumstances related to social insurance administration.
参加职工基本养老保险的个人跨统筹地区就业，其职工基本养老保险关系随同转移。
An individual participating in basic pension insurance for employees who works across coordinated regions shall have their basic pension insurance relationship transferred accordingly.
参加职工基本养老保险的个人在机关事业单位与企业等不同性质用人单位之间流动就业，其职工基本养老保险关系随同转移。
An individual participating in basic pension insurance for employees who moves between employers of different natures, such as between government agencies and public institutions and enterprises, shall have their basic pension insurance relationship transferred accordingly.
参加城乡居民基本养老保险且未享受待遇的个人跨统筹地区迁移户籍，其城乡居民基本养老保险关系可以随同转移。
An individual participating in basic pension insurance for urban and rural residents who has not yet received benefits and moves their household registration across coordinated regions may have their basic pension insurance relationship transferred accordingly.
参加职工基本医疗保险的个人跨统筹地区就业，其职工基本医疗保险关系随同转移。
An individual participating in basic medical insurance for employees who works across coordinated regions shall have their basic medical insurance relationship transferred accordingly.
参加城乡居民基本医疗保险的个人跨统筹地区迁移户籍或者变动经常居住地，其城乡居民基本医疗保险关系可以按照规定随同转移。
An individual participating in basic medical insurance for urban and rural residents who moves their household registration or changes their habitual residence across coordinated regions may have their basic medical insurance relationship transferred in accordance with regulations.
职工基本医疗保险与城乡居民基本医疗保险之间的关系转移，按照规定执行。
The transfer between basic medical insurance for employees and basic medical insurance for urban and rural residents shall be carried out in accordance with regulations.
参加失业保险的个人跨统筹地区就业，其失业保险关系随同转移。
An individual participating in unemployment insurance who works across coordinated regions shall have their unemployment insurance relationship transferred accordingly.
参加工伤保险、生育保险的个人跨统筹地区就业，在新就业地参加工伤保险、生育保险。
Individuals covered by work-related injury insurance and maternity insurance who work across coordinated regions shall participate in work-related injury insurance and maternity insurance at the new place of employment.
用人单位和个人办理社会保险关系转移接续手续的，社会保险经办机构应当在规定时限内办理完毕，并将结果告知用人单位和个人，或者提供办理情况查询服务。
When employers and individuals go through the procedures for transferring social insurance relationships, the social insurance agency shall complete the procedures within the prescribed time limit and inform the employer and individual of the result, or provide inquiry services regarding the processing status.
军事机关和社会保险经办机构，按照各自职责办理军人保险与社会保险关系转移接续手续。
Military authorities and social insurance agencies shall, in accordance with their respective responsibilities, handle the procedures for transferring military insurance and social insurance relationships.
社会保险经办机构应当为军人保险与社会保险关系转移接续手续办理优先提供服务。
Social insurance agencies shall provide priority services for the transfer of military insurance and social insurance relationships.
社会保险待遇核定和支付
Verification and Payment of Social Insurance Benefits
用人单位和个人应当按照国家规定，向社会保险经办机构提出领取基本养老金的申请。社会保险经办机构应当自收到申请之日起20个工作日内办理完毕。
Employers and individuals shall, in accordance with state regulations, apply to the social insurance agency for receiving basic pension. The social insurance agency shall complete the processing within 20 working days from the date of receiving the application.
参加职工基本养老保险的个人死亡或者失业人员在领取失业保险金期间死亡，其遗属可以依法向社会保险经办机构申领丧葬补助金和抚恤金。社会保险经办机构应当及时核实有关情况，按照规定核定并发放丧葬补助金和抚恤金。
If an individual covered by basic pension insurance for employees dies, or if an unemployed person dies while receiving unemployment insurance benefits, their survivors may apply to the social insurance agency for funeral subsidies and pensions in accordance with the law. The social insurance agency shall promptly verify the relevant information, and determine and disburse the funeral subsidies and pensions in accordance with regulations.
个人医疗费用、生育医疗费用中应当由基本医疗保险(含生育保险)基金支付的部分，由社会保险经办机构审核后与医疗机构、药品经营单位直接结算。
The portion of individual medical expenses and maternity medical expenses that should be paid by the basic medical insurance (including maternity insurance) fund shall be directly settled by the social insurance agency with medical institutions and pharmaceutical business units after review.
因特殊情况个人申请手工报销，应当向社会保险经办机构提供医疗机构、药品经营单位的收费票据、费用清单、诊断证明、病历资料。社会保险经办机构应当对收费票据、费用清单、诊断证明、病历资料进行审核，并自收到申请之日起30个工作日内办理完毕。
If an individual applies for manual reimbursement due to special circumstances, they shall provide the social insurance agency with the charging receipts, expense lists, diagnosis certificates, and medical records from medical institutions and pharmaceutical business units. The social insurance agency shall review the charging receipts, expense lists, diagnosis certificates, and medical records, and complete the processing within 30 working days from the date of receiving the application.
参加生育保险的个人申领生育津贴，应当向社会保险经办机构提供病历资料。社会保险经办机构应当对病历资料进行审核，并自收到申请之日起10个工作日内办理完毕。
An individual covered by maternity insurance who applies for maternity allowance 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 receiving the application.
工伤职工及其用人单位依法申请劳动能力鉴定、辅助器具配置确认、停工留薪期延长确认、工伤旧伤复发确认，应当向社会保险经办机构提供诊断证明、病历资料。
Workers with work-related injuries and their employers, when applying for labor ability appraisal, confirmation of assistive device configuration, confirmation of extension of paid leave for medical treatment, or confirmation of recurrence of old work-related injuries, shall provide diagnostic certificates and medical records to the social insurance agency.
个人治疗工伤的医疗费用、康复费用、安装配置辅助器具费用中应当由工伤保险基金支付的部分，由社会保险经办机构审核后与医疗机构、辅助器具配置机构直接结算。
The portion of medical expenses, rehabilitation expenses, and expenses for installation and configuration of assistive devices for the treatment of work-related injuries that should be paid from the work-related injury insurance fund shall be directly settled by the social insurance agency after review with the medical institution and assistive device configuration institution.
因特殊情况用人单位或者个人申请手工报销，应当向社会保险经办机构提供医疗机构、辅助器具配置机构的收费票据、费用清单、诊断证明、病历资料。社会保险经办机构应当对收费票据、费用清单、诊断证明、病历资料进行审核，并自收到申请之日起20个工作日内办理完毕。
If, due to special circumstances, the employer or individual applies for manual reimbursement, they shall provide the charging receipts, expense lists, diagnostic certificates, and medical records from the medical institution and assistive device configuration institution to the social insurance agency. The social insurance agency shall review the charging receipts, expense lists, diagnostic certificates, and medical records, and complete the processing within 20 working days from the date of receiving the application.
人力资源社会保障行政部门、医疗保障行政部门应当按照各自职责建立健全异地就医医疗费用结算制度。社会保险经办机构应当做好异地就医医疗费用结算工作。
The human resources and social security administrative department and the medical security administrative department shall, in accordance with their respective responsibilities, establish and improve the settlement system for medical expenses incurred in different places. The social insurance agency shall properly handle the settlement of medical expenses incurred in different places.
个人申领失业保险金，社会保险经办机构应当自收到申请之日起10个工作日内办理完毕。
When an individual applies for unemployment insurance benefits, the social insurance agency shall complete the processing within 10 working days from the date of receiving the application.
个人在领取失业保险金期间，社会保险经办机构应当从失业保险基金中支付其应当缴纳的基本医疗保险(含生育保险)费。
During the period when an individual is receiving unemployment insurance benefits, the social insurance agency shall pay from the unemployment insurance fund the basic medical insurance (including maternity insurance) premiums that the individual should pay.
个人申领职业培训等补贴，应当提供职业资格证书或者职业技能等级证书。社会保险经办机构应当对职业资格证书或者职业技能等级证书进行审核，并自收到申请之日起10个工作日内办理完毕。
When an individual applies for subsidies such as vocational training subsidies, they shall provide a vocational qualification certificate or a vocational skill level certificate. The social insurance agency shall review the vocational qualification certificate or vocational skill level certificate and complete the processing within 10 working days from the date of receiving the application.
个人出现国家规定的停止享受社会保险待遇的情形，用人单位、待遇享受人员或者其亲属应当自相关情形发生之日起20个工作日内告知社会保险经办机构。社会保险经办机构核实后应当停止发放相应的社会保险待遇。
If an individual experiences circumstances stipulated by the state that result in the cessation of social insurance benefits, the employer, the benefit recipient, or their relatives shall inform the social insurance agency within 20 working days from the date of occurrence of the relevant circumstances. After verification, the social insurance agency shall stop paying the corresponding social insurance benefits.
社会保险经办机构应当通过信息比对、自助认证等方式，核验社会保险待遇享受资格。通过信息比对、自助认证等方式无法确认社会保险待遇享受资格的，社会保险经办机构可以委托用人单位或者第三方机构进行核实。
The social insurance agency shall verify the eligibility for social insurance benefits through methods such as information comparison and self-service authentication. If the eligibility for social insurance benefits cannot be confirmed through information comparison, self-service authentication, or other methods, the social insurance agency may entrust the employer or a third-party institution to conduct verification.
对涉嫌丧失社会保险待遇享受资格后继续享受待遇的，社会保险经办机构应当调查核实。经调查确认不符合社会保险待遇享受资格的，停止发放待遇。
For those suspected of continuing to receive benefits after losing eligibility for social insurance benefits, the social insurance agency shall investigate and verify. If the investigation confirms that they are not eligible for social insurance benefits, the payment of benefits shall be stopped.
社会保险经办服务和管理
Social Insurance Handling Services and Management
社会保险经办机构应当依托社会保险公共服务平台、医疗保障信息平台等实现跨部门、跨统筹地区社会保险经办。
Social insurance handling agencies shall rely on social insurance public service platforms, medical insurance information platforms, etc., to achieve cross-departmental and cross-pool-region social insurance handling.
社会保险经办机构应当推动社会保险经办事项与相关政务服务事项协同办理。社会保险经办窗口应当进驻政务服务中心，为用人单位和个人提供一站式服务。
Social insurance handling agencies shall promote the coordinated handling of social insurance matters with related government service matters. Social insurance handling windows shall be stationed in government service centers to provide one-stop services for employers and individuals.
人力资源社会保障行政部门、医疗保障行政部门应当强化社会保险经办服务能力，实现省、市、县、乡镇(街道)、村(社区)全覆盖。
The human resources and social security administrative departments and the medical security administrative departments shall strengthen the capacity of social insurance handling services to achieve full coverage at the provincial, municipal, county, township (street), and village (community) levels.
用人单位和个人办理社会保险事务，可以通过政府网站、移动终端、自助终端等服务渠道办理，也可以到社会保险经办窗口现场办理。
Employers and individuals handling social insurance matters may do so through government websites, mobile terminals, self-service terminals, and other service channels, or they may go to social insurance handling windows for on-site processing.
社会保险经办机构应当加强无障碍环境建设，提供无障碍信息交流，完善无障碍服务设施设备，采用授权代办、上门服务等方式，为老年人、残疾人等特殊群体提供便利。
Social insurance handling agencies shall strengthen the construction of barrier-free environments, provide barrier-free information exchange, improve barrier-free service facilities and equipment, and adopt methods such as authorized agency and door-to-door services to provide convenience for special groups such as the elderly and disabled.
用人单位和个人办理社会保险事务，社会保险经办机构要求其提供身份证件以外的其他证明材料的，应当有法律、法规和国务院决定依据。
When employers and individuals handle social insurance matters, if the social insurance handling agency requires them to provide supporting materials other than identity documents, there shall be a basis in laws, regulations, and State Council decisions.
社会保险经办机构免费向用人单位和个人提供查询核对社会保险缴费和享受社会保险待遇记录、社会保险咨询等相关服务。
Social insurance handling agencies shall provide free services to employers and individuals, including querying and verifying social insurance contribution and benefit records, social insurance consultation, and other related services.
社会保险经办机构应当根据经办工作需要，与符合条件的机构协商签订服务协议，规范社会保险服务行为。人力资源社会保障行政部门、医疗保障行政部门应当加强对服务协议订立、履行等情况的监督。
Social insurance handling agencies shall, based on the needs of handling work, negotiate and sign service agreements with qualified institutions to regulate social insurance service behavior. The human resources and social security administrative departments and the medical security administrative departments shall strengthen supervision over the conclusion and performance of service agreements.
医疗保障行政部门所属的社会保险经办机构应当改进基金支付和结算服务，加强服务协议管理，建立健全集体协商谈判机制。
Social insurance handling agencies affiliated with the medical security administrative departments shall improve fund payment and settlement services, strengthen service agreement management, and establish and improve collective negotiation mechanisms.
社会保险经办机构应当妥善保管社会保险经办信息，确保信息完整、准确和安全。
Social insurance agencies shall properly maintain social insurance administration information, ensuring the information is complete, accurate, and secure.
社会保险经办机构应当建立健全业务、财务、安全和风险管理等内部控制制度。
Social insurance agencies shall establish and improve internal control systems for operations, finance, security, and risk management.
社会保险经办机构应当定期对内部控制制度的制定、执行情况进行检查、评估，对发现的问题进行整改。
Social insurance agencies shall periodically inspect and evaluate the establishment and implementation of internal control systems, and rectify any issues found.
社会保险经办机构应当明确岗位权责，对重点业务、高风险业务分级审核。
Social insurance agencies shall define job responsibilities and authorities, and conduct tiered review for key and high-risk operations.
社会保险经办机构应当加强信息系统应用管理，健全信息核验机制，记录业务经办过程。
Social insurance agencies shall strengthen the management of information system applications, improve information verification mechanisms, and record the process of business operations.
社会保险经办机构具体编制下一年度社会保险基金预算草案，报本级人力资源社会保障行政部门、医疗保障行政部门审核汇总。社会保险基金收入预算草案由社会保险经办机构会同社会保险费征收机构具体编制。
Social insurance agencies shall specifically prepare the draft budget for the next year's social insurance fund, and submit it to the human resources and social security administrative department and the medical security administrative department at the same level for review and consolidation. The draft revenue budget of the social insurance fund shall be specifically prepared by the social insurance agency jointly with the social insurance premium collection agency.
社会保险经办机构设立社会保险基金支出户，用于接受财政专户拨入基金、支付基金支出款项、上解上级经办机构基金、下拨下级经办机构基金等。
Social insurance agencies shall establish a social insurance fund expenditure account for receiving funds transferred from the fiscal special account, paying fund expenditure amounts, remitting funds to higher-level agencies, and allocating funds to lower-level agencies.
社会保险经办机构应当按照国家统一的会计制度对社会保险基金进行会计核算、对账。
Social insurance agencies shall conduct accounting and reconciliation of social insurance funds in accordance with the unified national accounting system.
社会保险经办机构应当核查下列事项：
Social insurance agencies shall verify the following matters:
(一)社会保险登记和待遇享受等情况；
(1) Social insurance registration and benefit entitlement status, among others.
(二)社会保险服务机构履行服务协议、执行费用结算项目和标准情况；
(2) The performance of service agreements by social insurance service institutions and the implementation of expense settlement items and standards;
(三)法律、法规规定的其他事项。
(3) Other matters stipulated by laws and regulations.
社会保险经办机构发现社会保险服务机构违反服务协议的，可以督促其履行服务协议，按照服务协议约定暂停或者不予拨付费用、追回违规费用、中止相关责任人员或者所在部门涉及社会保险基金使用的社会保险服务，直至解除服务协议；社会保险服务机构及其相关责任人员有权进行陈述、申辩。
If a social insurance agency discovers that a social insurance service institution violates a service agreement, it may urge the institution to perform the agreement, suspend or withhold payment of expenses, recover improperly paid expenses, suspend the social insurance services involving the use of social insurance funds by the responsible personnel or their department, or even terminate the service agreement; the social insurance service institution and its responsible personnel have the right to make statements and defenses.
社会保险经办机构发现用人单位、个人、社会保险服务机构违反社会保险法律、法规、规章的，应当责令改正。对拒不改正或者依法应当由人力资源社会保障行政部门、医疗保障行政部门处理的，及时移交人力资源社会保障行政部门、医疗保障行政部门处理。
If a social insurance agency discovers that an employer, individual, or social insurance service institution violates social insurance laws, regulations, or rules, it shall order rectification. If the party refuses to rectify or if the matter should be handled by the human resources and social security administrative department or the medical security administrative department according to law, the matter shall be promptly transferred to the relevant department for handling.
国务院人力资源社会保障行政部门、医疗保障行政部门会同有关部门建立社会保险信用管理制度，明确社会保险领域严重失信主体名单认定标准。
The human resources and social security administrative department and the medical security administrative department of the State Council, together with relevant departments, shall establish a social insurance credit management system and specify the criteria for determining the list of seriously dishonest entities in the social insurance field.
社会保险经办机构应当如实记录用人单位、个人和社会保险服务机构及其工作人员违反社会保险法律、法规行为等失信行为。
Social insurance agencies shall truthfully record dishonest acts such as violations of social insurance laws and regulations by employers, individuals, and social insurance service institutions and their staff.
个人多享受社会保险待遇的，由社会保险经办机构责令退回；难以一次性退回的，可以签订还款协议分期退回，也可以从其后续享受的社会保险待遇或者个人账户余额中抵扣。
If an individual receives excessive social insurance benefits, the social insurance agency shall order the return of the excess; if it is difficult to return the full amount at once, a repayment agreement may be signed for installment repayment, or the amount may be deducted from subsequent social insurance benefits or the individual's personal account balance.
社会保险经办监督
Supervision of Social Insurance Administration
人力资源社会保障行政部门、医疗保障行政部门按照各自职责对社会保险经办机构下列事项进行监督检查：
The human resources and social security administrative department and the medical security administrative department shall, according to their respective responsibilities, supervise and inspect the following matters of social insurance agencies:
(一)社会保险法律、法规、规章执行情况；
(1) Implementation of social insurance laws, regulations, and rules;
(二)社会保险登记、待遇支付等经办情况；
(2) The handling of social insurance registration, benefit payment, etc.;
(三)社会保险基金管理情况；
(3) The management of social insurance funds;
(四)与社会保险服务机构签订服务协议和服务协议履行情况；
(4) The signing and performance of service agreements with social insurance service providers;
(五)法律、法规规定的其他事项。
(5) Other matters stipulated by laws and regulations.
财政部门、审计机关按照各自职责，依法对社会保险经办机构的相关工作实施监督。
The financial department and audit authority shall, in accordance with their respective duties, supervise the relevant work of social insurance agencies according to law.
人力资源社会保障行政部门、医疗保障行政部门应当按照各自职责加强对社会保险服务机构、用人单位和个人遵守社会保险法律、法规、规章情况的监督检查。社会保险服务机构、用人单位和个人应当配合，如实提供与社会保险有关的资料，不得拒绝检查或者谎报、瞒报。
The human resources and social security administrative department and the medical security administrative department shall, in accordance with their respective duties, strengthen the supervision and inspection of social insurance service providers, employers, and individuals regarding their compliance with social insurance laws, regulations, and rules. Social insurance service providers, employers, and individuals shall cooperate, truthfully provide materials related to social insurance, and shall not refuse inspection or make false reports or conceal information.
人力资源社会保障行政部门、医疗保障行政部门发现社会保险服务机构、用人单位违反社会保险法律、法规、规章的，应当按照各自职责提出处理意见，督促整改，并可以约谈相关负责人。
If the human resources and social security administrative department or the medical security administrative department finds that a social insurance service provider or employer violates social insurance laws, regulations, or rules, it shall, in accordance with its respective duties, propose handling opinions, urge rectification, and may interview the relevant responsible persons.
人力资源社会保障行政部门、医疗保障行政部门、社会保险经办机构及其工作人员依法保护用人单位和个人的信息，不得以任何形式泄露。
The human resources and social security administrative department, the medical security administrative department, social insurance agencies, and their staff shall protect the information of employers and individuals according to law and shall not disclose it in any form.
人力资源社会保障行政部门、医疗保障行政部门应当畅通监督渠道，鼓励和支持社会各方面对社会保险经办进行监督。
The human resources and social security administrative department and the medical security administrative department shall smooth the supervision channels, encourage and support all sectors of society to supervise the handling of social insurance.
社会保险经办机构应当定期向社会公布参加社会保险情况以及社会保险基金的收入、支出、结余和收益情况，听取用人单位和个人的意见建议，接受社会监督。
Social insurance agencies shall regularly disclose to the public the participation in social insurance and the income, expenditure, balance, and earnings of social insurance funds, listen to the opinions and suggestions of employers and individuals, and accept social supervision.
工会、企业代表组织应当及时反映用人单位和个人对社会保险经办的意见建议。
Trade unions and enterprise representative organizations shall promptly reflect the opinions and suggestions of employers and individuals regarding social insurance administration.
任何组织和个人有权对违反社会保险法律、法规、规章的行为进行举报、投诉。
Any organization or individual has the right to report or complain about acts that violate social insurance laws, regulations, or rules.
人力资源社会保障行政部门、医疗保障行政部门对收到的有关社会保险的举报、投诉，应当依法进行处理。
The human resources and social security administrative department and the medical security administrative department shall handle received reports and complaints concerning social insurance in accordance with the law.
用人单位和个人认为社会保险经办机构在社会保险经办工作中侵害其社会保险权益的，可以依法申请行政复议或者提起行政诉讼。
If an employer or individual believes that a social insurance agency has infringed upon their social insurance rights and interests in the course of social insurance administration, they may apply for administrative reconsideration or initiate administrative litigation in accordance with the law.
法律责任
Legal Liability
社会保险经办机构及其工作人员有下列行为之一的，由人力资源社会保障行政部门、医疗保障行政部门按照各自职责责令改正；给社会保险基金、用人单位或者个人造成损失的，依法承担赔偿责任；对负有责任的领导人员和直接责任人员依法给予处分：
If a social insurance agency or its staff commits any of the following acts, the human resources and social security administrative department or the medical security administrative department shall, within their respective responsibilities, order correction; if losses are caused to the social insurance fund, employer, or individual, they shall bear compensation liability in accordance with the law; and the responsible leaders and directly responsible personnel shall be given sanctions in accordance with the law:
(一)未履行社会保险法定职责的；
(1) Failing to perform statutory social insurance duties;
(二)违反规定要求提供证明材料的；
(2) Requiring the provision of certification materials in violation of regulations;
(三)克扣或者拒不按时支付社会保险待遇的；
(3) Withholding or refusing to pay social insurance benefits on time;
(四)丢失或者篡改缴费记录、享受社会保险待遇记录等社会保险数据、个人权益记录的；
(4) Losing or tampering with social insurance data such as contribution records, records of enjoyment of social insurance benefits, and personal rights records.
(五)违反社会保险经办内部控制制度的。
(5) Violating the internal control system of social insurance administration.
人力资源社会保障行政部门、医疗保障行政部门、社会保险经办机构及其工作人员泄露用人单位和个人信息的，对负有责任的领导人员和直接责任人员依法给予处分；给用人单位或者个人造成损失的，依法承担赔偿责任。
If human resources and social security administrative departments, medical security administrative departments, social insurance administration agencies, or their staff disclose the personal information of employers or individuals, the responsible leaders and directly responsible personnel shall be given sanctions according to law; if losses are caused to employers or individuals, they shall bear compensation liability according to law.
以欺诈、伪造证明材料或者其他手段骗取社会保险基金支出的，由人力资源社会保障行政部门、医疗保障行政部门按照各自职责责令退回，处骗取金额2倍以上5倍以下的罚款；属于定点医药机构的，责令其暂停相关责任部门6个月以上1年以下涉及社会保险基金使用的社会保险服务，直至由社会保险经办机构解除服务协议；属于其他社会保险服务机构的，由社会保险经办机构解除服务协议。对负有责任的领导人员和直接责任人员，有执业资格的，由有关主管部门依法吊销其执业资格。
If social insurance fund expenditures are obtained by fraud, forgedcertification materials, or other means, the human resources and social security administrative department or the medical security administrative department shall, according to their respective responsibilities, order the return of the funds and impose a fine of not less than 2 times but not more than 5 times the amount defrauded; if the violator is a designated medical or pharmaceutical institution, it shall be ordered to suspend the relevant responsible department's social insurance services involving the use of social insurance funds for a period of not less than 6 months but not more than 1 year, until the social insurance administration agency terminates the service agreement; if the violator is another social insurance service institution, the social insurance administration agency shall terminate the service agreement. For responsible leaders and directly responsible personnel who have professional qualifications, the relevant competent authorities shall revoke their professional qualifications according to law.
隐匿、转移、侵占、挪用社会保险基金或者违规投资运营的，由人力资源社会保障行政部门、医疗保障行政部门、财政部门、审计机关按照各自职责责令追回；有违法所得的，没收违法所得；对负有责任的领导人员和直接责任人员依法给予处分。
If social insurance funds are concealed, transferred, embezzled, misappropriated, or invested in violation of regulations, the human resources and social security administrative department, the medical security administrative department, the financial department, or the audit authority shall, according to their respective responsibilities, order the recovery of the funds; if there are illegal gains, the illegal gains shall be confiscated; the responsible leaders and directly responsible personnel shall be given sanctions according to law.
社会保险服务机构拒绝人力资源社会保障行政部门、医疗保障行政部门监督检查或者谎报、瞒报有关情况的，由人力资源社会保障行政部门、医疗保障行政部门按照各自职责责令改正，并可以约谈有关负责人；拒不改正的，处1万元以上5万元以下的罚款。
If a social insurance service institution refuses to accept supervision and inspection by the human resources and social security administrative department or the medical security administrative department, or makes false reports or conceals relevant information, the human resources and social security administrative department or the medical security administrative department shall, according to their respective responsibilities, order correction and may interview the responsible person; if correction is refused, a fine of not less than 10,000 yuan but not more than 50,000 yuan shall be imposed.
公职人员在社会保险经办工作中滥用职权、玩忽职守、徇私舞弊的，依法给予处分。
If public officials abuse their power, neglect their duties, or engage in malpractice for personal gain in social insurance administration, they shall be given sanctions according to law.
违反本条例规定，构成违反治安管理行为的，依法给予治安管理处罚；构成犯罪的，依法追究刑事责任。
If a violation of these regulations constitutes a violation of public security administration, public security administration penalties shall be imposed according to law; if a crime is constituted, criminal liability shall be pursued according to law.
附 则
Supplementary Provisions
本条例所称社会保险经办机构，是指人力资源社会保障行政部门所属的经办基本养老保险、工伤保险、失业保险等社会保险的机构和医疗保障行政部门所属的经办基本医疗保险、生育保险等社会保险的机构。
For the purposes of these regulations, 'social insurance administration agencies' refer to the agencies under the human resources and social security administrative departments that administer basic old-age insurance, work-related injury insurance, unemployment insurance, and other social insurances, and the agencies under the medical security administrative departments that administer basic medical insurance, maternity insurance, and other social insurances.
本条例所称社会保险服务机构，是指与社会保险经办机构签订服务协议，提供社会保险服务的医疗机构、药品经营单位、辅助器具配置机构、失业保险委托培训机构等机构。
For the purposes of these regulations, 'social insurance service institutions' refer to medical institutions, pharmaceutical business units, assistive device configuration institutions, unemployment insurance entrusted training institutions, and other institutions that have signed service agreements with social insurance administration agencies to provide social insurance services.
社会保障卡加载金融功能，有条件的地方可以扩大社会保障卡的应用范围，提升民生服务效能。医保电子凭证可以根据需要，加载相关服务功能。
Social security cards are loaded with financial functions, and where conditions permit, the application scope of social security cards may be expanded to enhance the effectiveness of livelihood services. Medical insurance electronicvoucher may, as needed, be loaded with relevant service functions.
本条例自2023年12月1日起施行。
These Regulations shall come into force as of December 1, 2023.