□ Reporter Wen Lijuan
□ Trainee reporter of this newspaper Wang Yuxiang
At the beginning of this year, 44-year-old Guo Yongfang was admitted to the hospital. She is from Handan, Hebei Province, and came to Beijing in 2022 to work as a delivery person. After a heavy snowfall in mid-December 2025, she felt discomfort in her waist when delivering orders. At first, she thought it was an old problem, so she put on a baby warmer and continued running on the road every day. It wasn't until the pain in her waist became unbearable and her right leg became numb that she went to the hospital for treatment. The diagnosis and treatment resulted in a lumbar disc herniation compressing the nerves, requiring hospitalization for surgery.
She was treated in the hospital for half a month, and the surgery cost a total of more than 48,000 yuan. To Guo Yongfang's surprise, the employee's medical insurance reimbursed more than 30,000 yuan, while he only borne more than 10,000 yuan. She made another calculation: without this medical insurance, she would have to go back to her hometown for surgery, and the reimbursement rate would not be that high, and the cost would be more.
This guarantee comes from a formal labor contract signed by Guo Yongfang as a full-time rider in July 2025 with JD.com - the platform paid five insurances and one housing fund for her.
The results of the ninth national workforce situation survey show that the number of workers in my country’s new employment form has reached 84 million. For many people in this group, Guo Yongfang’s experience is becoming a promising future. On September 8, 2026, seven departments including the National Medical Security Administration jointly issued the "Notice on Carrying out Special Actions to Improve the Quality of Basic Medical Insurance for Flexible Employment Personnel, Migrant Workers, and People with New Employment Forms" (hereinafter referred to as the "Notice"). It will take about three years to continue to increase the number of flexible employment personnel and others participating in basic medical insurance, especially the number of employees participating in employee medical insurance. It is understood that this is the first special action at the national level to promote this group to participate in employee medical insurance.
But how to ‘get’ this benefit? How can it be sustained for a long time? With questions in mind, reporters from the "Rule of Law Daily" launched an investigative interview.
It's all a matter of calculation.
The "2025 National Medical Security Development Statistical Bulletin" shows that in 2025, the fund payment ratio within the employee medical insurance hospitalization expense catalog will be 84.1%, and the fund payment proportion within the resident medical insurance hospitalization expense catalog will be 66%. For most people with flexible employment who could only participate in residents' medical insurance in the past, the difference from "resident" to "employee" is more than a dozen percentage points.
Reporters recently interviewed dozens of takeaway riders, online ride-hailing drivers, and domestic service workers in Beijing, Hunan, Heilongjiang and other places and found that when they see a doctor, they always make an account first - how much money they spend on a medical visit depends on how many orders they have to make and receive before they can earn back. Some riders reported to reporters that although the commercial accident insurance they participated in could cover work-related injuries, it did not cover chronic diseases and outpatient needs.
When a reporter asked, ‘Would you be willing to get employee medical insurance in exchange for a few more orders each month?’, most of the interviewees answered: ‘Of course. The burden of personal expenses is reduced. If you get sick, you are more willing to go to the hospital, and you no longer have to "carry for minor illnesses and postpone major ones." ’
Li Yan, a 37-year-old full-time rider on JD.com, calculated an account for reporters: In August this year, he went to a community hospital after catching a cold. The registration fee was 20 yuan. He only paid 1 yuan from his personal account, and the remaining 19 yuan was paid by the medical insurance fund. He spent 7.78 yuan to buy medicine, and he was cured after taking the medicine for two days as directed by the doctor. Before joining JD.com in March 2025, he paid for medical treatment and medicine at his own expense in Beijing. The New Rural Cooperative Medical System (New Rural Cooperative Medical Care) he spent 400 yuan a year in his hometown did not go through the registration process for cross-provincial medical treatment. Direct online settlement was not possible in Beijing, and it was difficult to use it for daily outpatient services and medicine purchase.
During the interview, the question that many interviewees were most concerned about was: How much does it cost each month to participate in employee medical insurance?
The reporter learned that in Hefei, Anhui, a delivery rider who participates in employee medical insurance needs to pay 275 yuan per month; after the platform shares 50%, the rider only needs to pay 138 yuan per month, totaling 1,656 yuan a year. As a pilot city for the long-term insurance participation mechanism, Hefei will also provide a monthly subsidy of no less than 40 yuan per person to the new number of workers with new employment forms in platform companies participating in employee medical insurance during the pilot period.
According to Li Haiming, associate professor at the School of Law of Central University of Finance and Economics, the significance of this policy is to better implement Article 23, Paragraph 2 of the Social Insurance Law, which states that "self-employed individuals, part-time employees who have not participated in the basic medical insurance for employees in the employer, and other flexible employment personnel can participate in the basic medical insurance for employees, and individuals must pay basic medical insurance premiums in accordance with national regulations." It responds to the actual needs of some flexible employment personnel for higher-level medical security, and gradually explores and improves the medical insurance policies and systems for flexible employment personnel and other groups.
Take multiple measures to solve the insurance problem
In order to solve the problem of difficulty in participating in medical insurance for flexible employment and other groups of employees, the "Notice" proposes four measures: to facilitate participation, and to promote the elimination of household registration restrictions on place of employment and permanent residence in megacities. To facilitate transfer, explore ways to convert the payment period of continuous participation in resident medical insurance into the period of local employee medical insurance. Convenient payment, implement monthly payment, and explore quarterly, half-year, and full-year prepayment. It is convenient to use, promotes the integrated service of "flexible employment and insurance participation", and promotes the mutual use of personal accounts across provinces.
The "Notice" clarifies that employees with flexible employment should pay monthly to participate in employee medical insurance, and various localities can explore prepayment on a quarterly, half-year, or full-year basis based on actual conditions. The employee medical insurance payment period is allowed to be accumulated on a monthly basis, and every 12 months is counted as one year.
‘For practitioners in the new employment form, they may only work a job for a few months, stop for a month or two and then change to another one, and the scattered payment time can be saved. ’ Li Haiming said.
How can the platform help? The "Notice" clearly states that platform companies are encouraged to adopt "individual payment + platform subsidy" for employees with new employment forms who receive stable orders to participate in employee medical insurance, and pay social insurance and other payment methods according to the unit employee model. This will be gradually institutionalized when conditions are mature.
Li Yan told reporters that his monthly payment for his personal medical insurance account is 148.4 yuan, and the platform pays nearly 3,000 yuan for his five insurances and one housing fund.
‘What to do if we change cities’ is also planned. The "Notice" proposes that when the medical insurance relationship is transferred and continued, the payment years will be calculated cumulatively; provinces with conditions can explore converting the years of continuous participation in resident medical insurance into employee medical insurance years; employee medical insurance retirement benefits will no longer be tied to monthly pensions.
Li Yan has the most direct experience. Starting from April 2025, he will have Beijing social security for the first time after working as a food delivery seller in Beijing for 10 years. He said: "When I signed the labor contract, I was told that I would have to pay social security. After living in Beijing for so many years, I felt like I had truly integrated into the city of Beijing." ’
Those who are willing to participate in insurance are not only those who have already received insurance. Li Shuang (pseudonym), a part-time worker who signed a contract with a domestic service platform, said that the platform has not yet mentioned participating in employee medical insurance, but she has been looking forward to paying for it and would rather pay some money herself because "this way medical treatment will be guaranteed."
There are also people who agree with this guarantee, but are still weighing it in their hearts. Liu Sheng (pseudonym), an online ride-hailing driver in Beijing, has a heavy family burden. He admits that "if he participates in employee medical insurance, his salary will be better after retirement." However, the money he gets every month is also difficult for him to part with.
We must really do "good things" well
Experts interviewed pointed out that this is the first time at the national level that a special action has been carried out for groups such as flexible employment personnel to participate in employee medical insurance. The joint document issued by seven departments including the National Medical Insurance Administration is itself a signal of ‘policy integration’ and ‘department linkage’.
But to really do good things well, the experts interviewed believe that there are still several problems that need to be solved.
The first is the risk of insurance suspension. Riders have fluctuating incomes and job turnover, and are most afraid of interruptions in payment. The "Notice" has responded through "monthly accumulation" and clearly set a reasonable waiting period for benefits to facilitate timely renewal after the insurance is terminated. Li Haiming believes that whether the medical insurance fund is sustainable depends on the balance between individuals, platforms, and government finances, "and it will not be all personal contributions by flexible employees."
The second is the sustainability of platform subsidies. Guo Zheng, a member of the "Rule of Law Daily" lawyer expert database and senior partner of Beijing Tianchi Juntai Law Firm, reminded that the current legal nature of platform subsidies is a 'conditional unilateral promise' and is not a legal obligation; the "Notice" states that platforms are "encouraged" to carry out relevant subsidies and "gradually institutionalized when conditions are mature." He suggested that regulatory authorities could require platforms to report subsidy rules and publicize the change procedures, clarify the quantitative standards for "stable order acceptance", and allow "encouragement" to have predictable binding force.
The third is the dilemma of "multiple platforms for receiving orders, but no platform is responsible". For riders who ride on multiple platforms at the same time, which platform should pay? Guo Zheng believes that in the future, "payment by order and automatic deduction by the platform" can be explored in the future, and the payment unit can be refined from "monthly" to "order". This can also be learned from the experience of the occupational injury protection pilot program - the total number of people insured in the 17 pilot provinces has exceeded 27 million, and the pilot program is being further expanded to the entire country.
The fourth is the willingness to participate in insurance itself. A person in charge of the platform admitted frankly that some riders still have insufficient understanding of participating in employee medical insurance, and their willingness to participate is still low. Experts interviewed believe that the three-year timetable of the special action must not only solve the question of 'how to pay', but also answer the question of 'why to pay'.
The arrival of policies will ultimately fall on people. Guo Yongfang said that if she feels unwell in the future, she will go to a community hospital or hospital to see a doctor, and the registration fee will basically be covered. ‘Employee medical insurance has given me a sense of security, my life is protected, and I feel more at ease. ’
From an in-hospital operation to an employee medical insurance that comes to the account every month, changes are happening for ‘Guo Yongfang and the others’. And this may be just the beginning.
