China Launches Pilot Program to Integrate Maternity Insurance with Employee Basic Medical Insurance in 12 Cities

Recently, the General Office of the State Council issued the “Notice on the Pilot Program for the Merger and Implementation of Maternity Insurance and Basic Medical Insurance for Employees,” which was published on the website of the Ministry of Human Resources and Social Security on February 4 with a detailed interpretation. The notice requires pilot regions and relevant departments to strengthen organizational leadership and earnestly implement the program.

China’s maternity insurance system was established in the early years of the People’s Republic of China. The Regulations on Labor Insurance of the People’s Republic of China, adopted in 1951, specified that the beneficiaries of maternity insurance were “female workers and female staff members.” In 1955, female employees of government agencies were also included within the scope of coverage. The Regulations on Labor Insurance set forth details such as the coverage scope of maternity insurance, benefit ratios, maternity leave and maternity allowances, maternity subsidies, parties responsible for payment of medical services, and wages during maternity leave. In the 1960s,In the 1970s, with the discontinuation of the pooled social insurance system, maternity insurance shifted from state-level pooling to enterprise-based insurance.

In the early 1990s, during the transition from a planned economy to a market economy, reforms of the maternity insurance system lagged behind, failing to keep pace with the reforms of medical insurance and old-age pension systems across various regions. In December 1994, the Ministry of Labor issued the Interim Measures for Maternity Insurance for Enterprise Employees, establishing a unified national framework for the pooling of maternity insurance funds. In 2010 and 2012, the state promulgated the Social Insurance Law of the People's Republic of China and the Special Provisions on Labor Protection for Female Employees, respectively, further standardizing maternity insurance policies.

While advancing the employee maternity insurance system, the state has introduced relevant policies to address maternity medical benefits for non-employed women. These policies stipulate that maternity medical expenses for urban non-employed women are covered by the Basic Medical Insurance for Urban Residents, while those for rural women are addressed through the New Rural Cooperative Medical Scheme (NRCMS) and national childbirth subsidy programs. Currently, national maternity security policies basically cover all women of childbearing age in both urban and rural areas.

In the transition from enterprise-based insurance to social insurance, maternity insurance faces several challenges, including an excessively low level of pooled coverage. Multiple survey reports from organizations such as the All-China Federation of Trade Unions, as well as from individuals, indicate that inadequate implementation of maternity insurance remains quite prevalent in China. Some enterprises have discontinued maternity insurance coverage, and maternity insurance benefits are often not paid in full.

However, by the end of 2016, China’s maternity insurance scheme covered 184 million participants. Current fund revenue amounted to RMB 51.9 billion, expenditures totaled RMB 52.7 billion, and the cumulative balance stood at RMB 67.6 billion. Nationwide, 8.08 million person-times received maternity insurance benefits. Years of practical experience have demonstrated that the maternity insurance system has operated steadily, continuing to play a significant role in safeguarding women’s equal employment rights, balancing employer burdens, and ensuring the basic livelihood and health of working women during childbirth.

A relevant official from the Ministry of Human Resources and Social Security explained that the purpose of this pilot program for the combined implementation is to strengthen the mutual aid capacity of the funds, enhance overall management efficiency, and reduce operational costs by integrating the funds and management resources of the two insurance schemes. This does not involve a simple merger of the two insurance systems at the institutional level, nor does it entail any adjustments to maternity insurance benefit policies; rather, it is a merger at the level of management and operation.

Compared with medical insurance, maternity insurance has distinct functions and coverage policies. As a type of social insurance, it remains necessary to retain it for the following reasons: First, maternity insurance serves the unique function of safeguarding women’s equal employment rights and providing labor protection for female employees. Second, it reflects employer liability, as individuals are not required to pay maternity insurance premiums. Third, regarding benefits, eligible medical expenses are reimbursed on an actual-cost basis, and maternity allowances are provided (accounting for more than 60% of fund expenditures, primarily to balance the burden on employers). These policies are clearly stipulated in the Social Insurance Law and the Law on the Protection of Women’s Rights and Interests.

The pilot program was launched by the end of June 2017, with a duration of approximately one year. Through this initial pilot, we aim to explore an institutional framework and operational mechanism that aligns with China’s level of economic development, optimizes insurance management resources, and facilitates the integrated implementation of the two insurance schemes.

This timeMerger of Two Insurance PlansThe pilot program is being implemented in 12 cities: Handan City (Hebei Province), Jinzhong City (Shanxi Province), Shenyang City (Liaoning Province), Taizhou City (Jiangsu Province), Hefei City (Anhui Province), Weihai City (Shandong Province), Zhengzhou City (Henan Province), Yueyang City (Hunan Province), Zhuhai City (Guangdong Province), Chongqing Municipality, Neijiang City (Sichuan Province), and Kunming City (Yunnan Province). Regions not included in the pilot program are prohibited from independently launching pilot initiatives.

The pilot program clarifies five key points, summarized as “four unifications and one unchanged element.”

First, unify enrollment registration. In-service employees participating in the Employee Basic Medical Insurance shall simultaneously enroll in maternity insurance. A relevant official from the Ministry of Human Resources and Social Security stated that unifying enrollment registration helps further expand the coverage of maternity insurance to more occupational groups and leverages the law of large numbers inherent in social insurance.

Second, unify the collection and management of funds. The maternity insurance fund is merged into the employee basic medical insurance fund for unified collection. During the pilot period, the new contribution rate for employers’ employee basic medical insurance may be determined based on the sum of the contribution rates for maternity insurance and employee basic medical insurance, with individuals exempt from paying maternity insurance premiums. This approach helps improve collection efficiency, expand the scope of mutual aid within the fund, and does not increase the contribution burden on employers. Meanwhile, clearly defined expenditure items for maternity benefits ensure that female employees receive their entitled maternity insurance benefits and lay the foundation for further improving maternity insurance benefit policies.

Third, unify the management of medical services. Following the merger and joint implementation of the two insurance schemes, a unified system for managing designated medical services shall be implemented. When medical insurance agencies enter into relevant medical service agreements with designated medical institutions, they shall incorporate requirements and indicators related to maternity medical services into the agreement terms, and leverage agreement-based management to strengthen oversight of maternity medical services. The drug catalogs for Employee Basic Medical Insurance, Work-Related Injury Insurance, and Maternity Insurance, as well as the scope of diagnostic and therapeutic items and medical service facilities covered under Basic Medical Insurance, shall be applied. In principle, maternity medical expenses shall be settled directly between medical insurance agencies and designated medical institutions.

Fourth, unify administration and information services to provide employees with more convenient and efficient services. Following the merger of the two insurance schemes, administrative management shall be unified, and operational procedures standardized. The administration of maternity insurance shall be uniformly handled by the agencies responsible for administering basic medical insurance for employees, with operational expenses included in the fiscal budget at the corresponding level.

“One Unchanged” refers to the fact that maternity insurance benefits for employees remain unchanged during the maternity period. Maternity insurance benefits include maternity medical expenses and maternity allowances as stipulated in the Social Insurance Law of the People’s Republic of China, with the required funds disbursed from the employee basic medical insurance fund. The payment period for maternity allowances shall be implemented in accordance with the maternity leave duration prescribed by laws and regulations such as the Special Provisions on Labor Protection for Female Employees. The consolidation of the two insurance schemes will not lead to a reduction in maternity insurance benefits for insured employees; moreover, with the enhanced pooling capacity of the fund, it will help better safeguard the benefits of insured individuals.

Article 64, Paragraph 1 of the Social Insurance Law stipulates that “social insurance funds include the basic old-age insurance fund, the basic medical insurance fund, the work-related injury insurance fund, the unemployment insurance fund, and the maternity insurance fund. Separate accounts shall be established for each type of social insurance fund, with separate accounting conducted in accordance with the unified national accounting system.” Article 66 provides that “social insurance fund budgets shall be established according to the level of pooling, and social insurance fund budgets shall be prepared separately by social insurance item.”

The Pilot Program proposed “merging the maternity insurance fund into the employee basic medical insurance fund,” which involved a departure from the aforementioned provisions of the Social Insurance Law. To this end, the State Council submitted a request to the Standing Committee of the National People’s Congress (NPCSC) for authorization to temporarily adjust the implementation of relevant legal provisions during the pilot period. On December 25, 2016, the 25th Session of the Standing Committee of the 12th National People’s Congress reviewed and approved the Decision on Authorizing the State Council to Temporarily Adjust the Application of Relevant Provisions of the Social Insurance Law of the People’s Republic of China in the Administrative Areas of 12 Pilot Cities Including Handan, Hebei Province. This fully demonstrates that the pilot program strictly adhered to the requirements of law-based administration.