Basic medical insurance within the five insurances

China’s statutory health cover is basic medical insurance, one of the five social insurances under the Social Insurance Law, next to pension, work-injury, unemployment and maternity cover. People in a job join the employee version through their employer. Residents with no workplace cover join a separate urban and rural residents’ scheme where they live.

A national healthcare security agency oversees the system, and a provincial government report put membership at about 1.33 billion people at the end of 2025. Hong Kong, Macau and Taiwan each run their own systems, so everything here concerns the mainland only.

Foreign employees and the 2011 interim measures

Interim measures from the labour ministry took effect on 15 October 2011 and pulled foreign workers into the system. A foreign national lawfully employed in China by a registered Chinese employer, whether a company, a public institution, a social group or a law or accounting firm, must join all five insurances, and the employer and employee each pay a share. The rule also reaches a foreigner whom an overseas company sends to its branch or representative office in China; the local unit and the worker then pay.

The clock starts early. The employer must register the foreign employee for social insurance within 30 days of the employment permit being processed, after which the social insurance agency issues a social security number and card. Where the worker’s home country has signed a social insurance agreement with China, that agreement governs how they take part.

Why there is no single national rate

Contribution bases and rates are fixed locally. The employer registers with the social insurance bureau in the city where the employee works, so the cost in Shenzhen will not match Shanghai or Beijing. As one example, Shenzhen’s 2025 medical insurance regulation sets its main employee tier at 8% of the contribution base, 6% from the employer and 2% from the employee, and a lower tier is being folded into it. Treat that as a single city’s 2025 figure and check the current figure for your employee’s city before you budget.

Law-firm guidance on Chinese employment also points to a housing provident fund, the “one fund” employers pay into beside the five insurances, so payroll costs run wider than health cover alone.

Family members and city enrolment rules

Each city sets its own rules on whether relatives can join. Beijing’s government says the spouse and minor children of a holder of a Type A foreigner’s work permit, and people with a Beijing-issued permanent resident ID card, may join the residents’ basic medical insurance at their community service centre when they have no other basic cover. Shanghai lets the spouse and children of overseas talent holding a master residence permit enter its resident scheme. Enrolment there usually opens in early November with cover from the following month, and late applicants face a three-month wait.

Smaller cities write their own rules too. In Yiwu, in Zhejiang province, foreigners with residence permits of at least two years can join basic medical insurance as flexible workers.

Extra cover on top of the mandatory scheme

For anyone employed in China, an international plan is not a substitute for employee basic medical insurance. The mandatory cover stays in place, and whatever the company adds rests above it.

Insurance business is tightly held. China’s Insurance Law lets only insurers set up under it, with regulator approval, carry on commercial insurance, and requires organisations in China that need domestic insurance to buy it from insurers in China. Law-firm commentary says it is still unsettled whether a foreign insurer’s global master policy can validly reach a group’s Chinese subsidiaries. Whether any plan arranged from outside China can cover one employee there is for the insurer to confirm.

The tax rules favour one local category. Accounting-firm tax alerts describe “tax-advantaged” commercial health insurance products whose premiums can be deducted from wage income within set limits, which employers may buy for staff, and a 2023 change widened the eligible products to include long-term care and disease cover.

Hiring without a Chinese entity

Law-firm guidance warns that a worker carrying on business activities in China for a company with no Chinese company, branch or representative office risks an “illegal office” finding and a permanent establishment exposure for tax. Companies without an entity often turn to an outsourcing or labour-dispatch provider, which signs the employment contract and handles salary, social insurance and individual income tax.

That route has edges. The same guidance notes that global employment outsourcing is not a concept Chinese law recognises, and that it resembles statutory labour dispatch, which, in law-firm guidance from 2022, is confined to temporary, supporting or substitute roles and capped at 10% of a client’s workforce (check the current figure). How far those limits apply to foreign clients is unclear, and sales and marketing staff carry the most risk. Because the structure decides who enrols your employee and how a benefit is taxed, check with a local adviser before you settle on one.

Requesting a benefits introduction

If you want to look at an extra layer of cover, fill in the quote form on this page. Tell us which city your employee works in, how many people you have in mainland China, and whether they are employed by your own entity, a branch or an outsourcing provider. We can then put you in touch with a benefits partner that works on health cover for international and remote teams. The partner and the insurer settle eligibility, plan design and pricing, and Mithril1 remains your contact for business insurance.

A few useful answers

Common questions

Do foreign employees in China have to join basic medical insurance?

Yes, when a registered Chinese employer lawfully employs them. Under the measures in force from 15 October 2011 they join all five social insurances, basic medical insurance among them, and the employer registers them within 30 days of the employment permit being processed.

What does an employer contribute toward health insurance in China?

Each city sets its own rate. Shenzhen’s 2025 regulation, for example, sets the main tier at 8% of the contribution base with 6% from the employer. Other cities differ, so check the current figure with the local bureau.

Can an international health plan replace Chinese social insurance?

No. For someone employed in China it can only sit on top of the mandatory cover, and whether a given plan can cover a person there is for the insurer to confirm.

Can an employee’s family join the local scheme?

In some cities. Beijing and Shanghai let certain spouses and children of foreign professionals join residents’ basic medical insurance, with rules and enrolment windows that vary by city.

How does an outsourcing or EOR arrangement work in China?

Law-firm guidance from 2022 describes it as close to labour dispatch, which is limited to temporary, supporting or substitute roles and to 10% of a client’s workforce; check the current figure. How those limits apply to foreign clients is unclear.

International Health Insurance for Remote Employees in China