上海市外来从业人员综合保险暂行办法
上海市人民政府令第123号

　　第一条　（目的）为了保障外来从业人员的合法权益，规范单位用工行为，维护本市劳动力市场秩序，根据本市实际，制订本办法。

　　第二条　（含义）本办法所称的外来从业人员综合保险（以下简称综合保险），包括工伤（或者意外伤害）、住院医疗和老年补贴等三项保险待遇。

　　本办法所称外来从业人员，是指符合本市就业条件，在本市务工、经商但不具有本市常住户籍的外省、自治区、直辖市的人员。

　　第三条　（适用范围）本市行政区域内，经批准使用外来从业人员的国家机关、社会团体、企业（包括外地施工企业）、事业单位、民办非企业单位、个体经济组织（以下统称用人单位）及其使用的外来从业人员和无单位的外来从业人员，适用本办法。

　　下列外来从业人员不适用本办法：

　　（一）从事家政服务的人员；

　　（二）从事农业劳动的人员；

　　（三）按照《引进人才实行〈上海市居住证〉制度暂行规定》引进的人员。

　　第四条　（管理部门）市劳动和社会保障局是本市综合保险的行政主管部门，负责综合保险的统一管理。劳动保障行政部门所属的外来人员就业管理机构，负责综合保险的具体管理工作。

　　市公安、建设、财政、工商、卫生等部门按照各自职责，协同做好综合保险管理工作。

　　第五条　（缴费主体）用人单位和无单位的外来从业人员依照本办法规定，缴纳综合保险费。

　　第六条　（登记手续）用人单位应当自本办法施行之日起30日内，到外来人员就业管理机构办理综合保险登记手续。初次使用外来从业人员或者初次进入本市施工的用人单位，应当在获得批准使用外来从业人员之日起30日内，办理综合保险登记手续。

　　无单位的外来从业人员，应当在申领《上海市外来人员就业证》之日起5个工作日内，到外来人员就业管理机构办理综合保险登记手续。

　　综合保险的具体登记事项，由市劳动和社会保障局另行规定。

　　第七条　（注销与变更）用人单位依法终止或者迁出本市，或者综合保险登记事项发生变更的，应当自有关情形发生之日起30日内，到原办理登记机构办理注销或者变更登记手续。

　　无单位的外来从业人员不在本市从业或者综合保险登记事项发生变更的，应当及时到原办理登记机构办理注销或者变更登记手续。

　　第八条　（缴费期限）用人单位和无单位的外来从业人员应当自办理综合保险登记手续当月起，向市外来人员就业管理机构缴纳综合保险费。综合保险费的缴纳以三个月为一个周期，每次应当缴纳三个月的综合保险费。

　　第九条　（缴费基数和比例）用人单位缴纳综合保险费的基数，为其使用外来从业人员的总人数乘以上年度全市职工月平均工资的60％。无单位的外来从业人员缴纳综合保险费的基数，为上年度全市职工月平均工资的60％。

　　用人单位和无单位的外来从业人员按照缴费基数12.5％的比例，缴纳综合保险费。其中，外地施工企业的缴费比例为7.5％。

　　第十条　（综合保险费的列支渠道）用人单位缴纳的综合保险费，按照财政部门规定的渠道列支。

　　第十一条　（基金使用）本市建立综合保险基金。综合保险基金主要用于综合保险待遇的支付及运营费。

　　综合保险基金不敷使用时，可以调整缴费比例。缴费比例的调整由市劳动和社会保障局提出，报市政府批准后执行。

　　第十二条　（基金管理）综合保险基金实行集中管理、单位立户、专款专用，任何部门、单位和个人不得转借、挪用、侵占。

　　综合保险基金依法接受财政、审计、监察等部门的监督。

　　第十三条　（享受待遇）依照本办法规定履行缴费义务的，按下列规定享受综合保险待遇：

　　（一）用人单位使用的外来从业人员，享受工伤、住院医疗和老年补贴三项待遇；

　　（二）无单位的外来从业人员，享受意外伤害、住院医疗和老年补贴三项待遇；

　　（三）外地施工企业的外来从业人员，享受工伤、住院医疗两项待遇。

　　第十四条　（工伤或意外伤害保险待遇）用人单位使用的外来从业人员、无单位的外来从业人员在参加综合保险期间发生工伤事故（或者意外伤害）、患职业病的，经有关部门作出认定和劳动能力鉴定后，参照本市规定的工伤待遇标准，享受工伤（或者意外伤害）保险待遇。工伤（或者意外伤害）保险金一次性支付。

　　第十五条　（住院医疗待遇）外来从业人员在参加综合保险期间因患病或者非因工负伤住院的，住院发生的医疗费用在起付标准以下的部分，由外来从业人员自负；起付标准以上的部分，由综合保险基金承担80％，外来从业人员承担20％。住院医疗费用的起付标准为上年度全市职工年平均工资的10％。

　　用人单位和无单位的外来从业人员缴费满三个月的，享受住院医疗待遇的最高额，为上年度全市职工年平均工资；连续缴费满六个月的，享受住院医疗待遇的最高额，为上年度全市职工年平均工资的2倍；连续缴费满九个月的，享受住院医疗待遇的最高额，为上年度全市职工年平均工资的3倍；连续缴费满一年以上的，享受住院医疗待遇的最高额，为上年度全市职工年平均工资的4倍。

　　第十六条　（老年补贴待遇）用人单位和无单位的外来从业人员连续缴费满一年的，外来从业人员可以获得一份老年补贴凭证，其额度为本人实际缴费基数的5％。

　　外来从业人员在男年满60周岁、女年满50周岁时，可以凭老年补贴凭证一次性兑现老年补贴。

　　第十七条　（办理综合保险待遇的手续）符合本办法第十四条、第十五条、第十六条规定条件的外来从业人员，可以凭本人身份证、《上海市外来人员就业证》、老年补贴凭证以及相关证明材料，办理享受工伤（或者意外伤害）、住院医疗或者老年补贴待遇的手续。

　　第十八条　（综合保险金的支付）综合保险金由外来人员就业管理机构支付。

　　综合保险金也可以根据国家和本市的有关规定，并按照本办法规定的标准，委托保险公司支付和运作。

　　第十九条　（监督检查）劳动保障行政部门所属的劳动监察机构负责对综合保险费的缴纳情况进行监督检查。

　　对未按规定缴纳综合保险费的用人单位和无单位的外来从业人员，劳动保障行政部门应当责令其限期补缴；逾期仍不缴纳的，从欠缴之日起，按日加收2‰的滞纳金。对逾期拒不缴纳综合保险费、滞纳金的，劳动保障行政部门可以申请人民法院依法强制征缴。

　　在补缴综合保险费之前，外来从业人员因工伤（或者意外伤害）、住院发生的费用，由用人单位按照本办法规定的标准承担或者由无单位的外来从业人员个人承担。

　　第二十条　（举报）任何组织和个人对有关综合保险费征缴的违法行为，有权向劳动保障行政部门举报。劳动保障行政部门对举报应当及时调查，按照规定处理，并为举报人保密。

　　第二十一条　（争议处理）外来从业人员与用人单位因缴纳综合保险费发生争议的，可以向劳务纠纷调解委员会申请调解，也可以直接向劳动争议仲裁委员会申请仲裁。对裁决不服的，可以依法向人民法院提起诉讼。

　　第二十二条　（实施细则）本办法的实施细则，由市劳动和社会保障局制定。

　　第二十三条　（实施日期）本办法自2002年9月1日起施行。

　　2002年7月22日

Interim¹ Procedures of Shanghai Municipality on The Comprehensive Insurance for Out-of-town Employees（Promulgated on July 22, 2002 by Decree No. 123 of the Shanghai Municipal People''s Government）

　　Article 1 （Purpose）In order to ensure the legitimate² rights and benefits of out-of-town employees, normalize the act of employment of the units, and safeguard the order of labor³ market in this Municipality, these Procedures are formulated⁴ with full consideration to the actual circumstances of this Municipality.

　　Article 2 （Definition）The comprehensive insurance for out-of-town employees mentioned in these Procedures （hereinafter referred to as the comprehensive insurance） refers to the three insurance benefits with industrial injuries （or unexpected injuries）, hospital treatment, and old-age allowance included.The out-of-town employees refer to the personnel from other provinces, autonomous⁵ regions and municipalities directly under the Central Government without the permanent Shanghai residence registration⁶ who do physical labor or commercial business in this Municipality and meet the employment requirements of this Municipality.

　　Article 3 （Scope of Application）These Procedures apply to the state organs, mass organizations, enterprises （including out-of-town construction enterprises）, institutions, private institutions, individual economic organizations with the approval of employing out-of-town employees in the administrative⁷ area of this Municipality （hereinafter referred to as the employer-units）, and the out-of-town employees they employ and the out-of-town employees not affiliated⁸ with any unit.These Procedures do not apply to the following out-of-town employees:1. The persons doing household service;2. The persons doing agricultural work; and3. The talents introduced according to the "Interim Provisions on the Implementation⁹ of the System of ''Residence Permit of Shanghai Municipality'' to Introduced Talented Personnel".

　　Article 4 （Administrative Department）The Municipal Labor and Social Security Bureau is the competent administrative department of the municipal comprehensive insurance in charge of the unified¹⁰ administration of the comprehensive insurance. The administrative agency in charge of the employment of out-of-town employees under the labor and social security administrative department shall be responsible for the specific administrative work.The municipal departments of public security, construction, finance, industry and commerce, public health and sanitation¹¹ shall coordinate¹² in doing a good job of the administration of the comprehensive insurance according to their respective duties.

　　Article 5 （Subject of Payment of Premium¹³）The employer-units and the out-of-town employees not affiliated with any unit shall pay the comprehensive insurance premium according to the provisions of these Procedures.

　　Article 6 （Registration Procedures）The employer-units shall, within 30 days upon the implementation of these Procedures, go through the registration procedures of the comprehensive insurance with the administrative agency in charge of the employment of the out-of-town employees. The employer-units that employ out-of-town employees for the first time or the employer-units that enter the construction market of the Municipality for the first time shall, within 30 days upon the reception of the approval of employing out-of-town employees, go through the registration procedures of the comprehensive insurance.The out-of-town employees not affiliated with any unit shall, within 5 working days upon reception of the "Work Permit for Out-of-town Employees in Shanghai Municipality", go through the registration procedures of the comprehensive insurance with the administrative agency in charge of the employment of out-of-town employees.The specific registration items of the comprehensive insurance shall be separately formulated by the Municipal Labor and Social Security Bureau.

　　Article 7 （Cancellation¹⁴ and Alteration¹⁵）When a employer-unit that winds up or moves out of this Municipality according to law, or there is an alteration of the registration items of the comprehensive insurance, it shall, within 30 days upon the occurrence of such situations, go through the cancellation or alteration registration procedures with the original registration organizations.When the out-of-town employees not affiliated with any unit no longer work in this Municipality, or there is an alteration of their registration items of the comprehensive insurance, they shall go through the cancellation or alteration registration procedures with the original registration organizations.

　　Article 8 （Time Limit for Payment of Premium）The employer-units and the out-of-town employees not affiliated with any unit shall, within the same month upon the completion of the registration procedures of comprehensive insurance, pay the comprehensive insurance premium to the Municipal Administrative Organization of the Employment of Out-of-town Employees. The cycle period of payment of the comprehensive insurance premium shall be 3 months. The payer shall each time pay 3 months'' comprehensive insurance premium.

　　Article 9 （Payment Base and Rate）The employers-unit's base of payment of comprehensive insurance premium shall be 60% of the sum total of the total number of the out-of-town employees they employ multiply by the average monthly salary and wage of the last year of all the staff members and workers of this Municipality. The base of payment of comprehensive insurance premium for the out-of-town employees not affiliated with any unit shall be 60% of the average monthly salary and wage of the last year of all the staff members and workers of this Municipality.The employer-unit and the out-of-town employees not affiliated with any unit shall pay the rate of 12.5% of the payment base as the comprehensive insurance premium. Among them, the payment rate for out-of-town construction enterprises shall be 7.5%.

　　Article 10 （The Channel of Arrangement and Payment of Comprehensive Insurance Premium）The comprehensive insurance premium paid by the employer-units shall be arranged and paid through the channel stipulated¹⁶ by the finance department.

　　Article 11 （Use of the Fund）This Municipality shall establish a Comprehensive Insurance Fund. The Comprehensive Insurance Fund shall be used chiefly for the payment of comprehensive insurance benefits and the operation fee.In case of insufficiency of the Comprehensive Insurance Fund, the rate of payment of premium may be adjusted. The adjustment of the rate of payment of premium shall be proposed by the Municipal Labor and Social Security Bureau, and be implemented¹⁷ after being approved by the Municipal Government.

　　Article 12 （Management of the Fund）The Comprehensive Insurance Fund shall practice centralized management, open separate bank account, and be earmarked for its specific purpose only. No departments, units, or individual persons shall relend, misappropriate, or embezzle¹⁸ the money.The Comprehensive Insurance Fund shall accept the supervision¹⁹ of the finance, auditing²⁰ and supervisory departments in accordance with law.

　　Article 13 （Benefits Enjoyed）Anyone who has performed the obligation of premium payment according to the provisions of these Procedures shall enjoy benefits of the comprehensive insurance according to the following provisions:1. The out-of-town employees used by the employer-units shall enjoy three benefits, including industrial injuries, hospital treatment and old-age allowance;2. The out-of-town employees not affiliated with any unit shall enjoy three benefits, including unexpected injuries, hospital treatment and old-age allowance; and3. The out-of-town employees used by the out-of-town construction enterprises shall enjoy two benefits, including industrial injuries and hospital treatment.

　　Article 14 （Insurance Benefits for Industrial or unexpected Injuries）In case that the out-of-town employees used by the employer-units, and the out-of-town employees not affiliated with any unit suffer industrial injury （or unexpected injury）, or industrial disease during the valid²¹ period of the comprehensive insurance, they shall, after being affirmed and have the appraisal²² of the sufferer's labor ability issued by the relevant department, enjoy insurance benefits for industrial injury （or unexpected injury） taking the standard of industrial injury benefits set by this Municipality as reference. The insurance for industrial injury （or unexpected injury） shall be paid to the sufferer in a lump sum.

　　Article 15 （Insurance Benefits for Hospital Treatment）In case that the out-of-town employees are hospitalized for illness or non-industrial injury during the period of validity of the comprehensive insurance, the portion of the payment for medical treatment in hospital below the starting payment standard shall be born by the sufferer; for the portion above the starting payment standard, the comprehensive insurance shall bear 80%, and the out-of-town employees shall bear 20%. The starting payment standard for medical treatment in hospital shall be 10% of the average annual salary and wage of the last year of the staff members and workers of this Municipality.In case that the employer-units or the out-of-town employees not affiliated with any unit have paid the insurance premium for three months, the maximum benefit for the medical treatment in hospital to be enjoyed shall be as much as the average annual salary and wage of all staff members and workers of this Municipality of the last year. In case of a continuous payment of premium for six months, the maximum benefit for medical treatment in hospital to be enjoyed shall be two times as much as the average annual salary and wage of the staff members and workers of this Municipality of the last year. In case of a continuous payment of premium of nine months, the maximum benefit for the medical treatment in hospital to be enjoyed shall be three time as much as the average annual salary and wage of the staff members and workers of this Municipality of the last year. In case of a continuous payment of premium of more than one year, the maximum benefit for medical treatment in hospital to be enjoyed shall be four times as much as the average annual salary and wage of the staff members and workers of the last year of this Municipality.

　　Article 16 （Benefit for Old-age Allowance）In case that the employer-units or the out-of-town employees not affiliated with any unit have continuously paid the insurance premium for one year, the out-of-town employees may obtain a certificate for old-age allowance, and its specific amount shall be 5% of the payment base actually paid by the employee.The out-of-town employees may, at the age of 60 for male and at the age of 50 for female, cash the old-age allowance in a lump sum with the certificate for old-age allowance.

　　Article 17 （Going Through the Procedures for Comprehensive Insurance Benefits）The out-of-town employees who have satisfied the conditions provided in Article 14, Article 15 and Article 16 of these Procedures may, with his/her Personal ID, "Work Permit for Out-of-town Employees of Shanghai Municipality", Certificate for Old-age Allowance and other relevant certifying²³ materials, go through the procedures for enjoying benefits for industrial injuries （or unexpected injuries）, hospital treatment or old-age allowance.

　　Article 18 （Payment of the Comprehensive Insurance Compensation）The comprehensive insurance compensation shall be paid by the administrative organization in charge of the out-of-town employment of the employees.The comprehensive insurance compensation may, according to the relevant provisions of the State and this Municipality, and according to the standard provided in these Procedures, be entrusted²⁴ to insurance companies for payment and operation.

　　Article19 （Supervision and Inspection）The labor supervisory organization under the labor security administrative department shall be responsible for the supervision over and inspect of the payment of the comprehensive insurance premium.The labor security administrative department shall order the employer-units and the out-of-town employees not affiliated with any unit who do not pay the comprehensive insurance premium according to the provisions, to make the payment within a time limit. If they still do not pay when the payment is overdue²⁵, they shall pay an overdue fine of 2‰ each day. Those who refuse neither to pay the comprehensive insurance premium when it is overdue nor the overdue fine, the labor security administrative department may apply to the People'' Court for enforcement of paying the premium.Before the make-up of the payment of the comprehensive insurance premium, the employer-units or the out-of-town employees not affiliated with any unit shall bear themselves the expense for industrial injuries （or unexpected injuries） and hospital treatment.

　　Article 20 （Report against Wrongful Acts）Any organization or individual person has the right to report against the wrongful acts related to the payment of the comprehensive insurance premium to the labor security administrative department. The labor security administrative department shall timely investigate the case upon receiving the report, deal with the case according to provisions of laws, and keep it confidential²⁶ for the reporter.

　　Article 21 （Settlement of Dispute）In case of a dispute over the payment of the comprehensive insurance premium with the employer-unit, the out-of-town employees may apply to the mediation²⁷ committee of labor disputes for mediation, or may directly apply to the arbitration²⁸ committee of labor disputes for arbitration. In case that the award is not accepted, either party may bring a lawsuit²⁹ in the People''s Court according to law.

　　Article 22 （Implementation Bylaws）The implementation bylaws of these Procedures shall be formulated by the Municipal Labor and Social Security Bureau.

　　Article 23 （Effective Date）These Procedures shall become effective on September 1, 2002.

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