China Expands Medical Insurance Access for Flexible Workers

China’s National Healthcare Security Administration (NHSA) announced a series of measures on September 4 to expand employee medical insurance coverage for flexible employment workers, targeting an estimated 200 million gig economy workers, freelancers, and migrant laborers who have historically faced barriers to accessing comprehensive healthcare protection. The announcement came during a State Council Information Office press conference under the “Starting the 15th Five-Year Plan” series, as Xinhua News reported.

Policy Context

The new measures build on a rapid policy evolution in China’s medical insurance system. Just one week before the announcement, the Standing Committee of the National People’s Congress passed the Medical Insurance Law on August 28, marking the first dedicated legislation for medical insurance in the country’s history. The law, which takes effect January 1, 2027, explicitly encourages flexible workers to participate in employee basic medical insurance, according to the NHSA website.

China operates a two-tier medical insurance system: Urban Employee Basic Medical Insurance, which offers higher reimbursement rates of approximately 80 percent for hospitalization within policy scope, and Urban-Rural Resident Basic Medical Insurance, which provides roughly 70 percent coverage. Flexible workers have often been relegated to the lower-tier resident insurance due to household registration (hukou) restrictions, irregular income patterns, and frequent job changes.

Key Measures Announced

NHSA Deputy Director Huang Huabo outlined four areas of reform at the press conference, as detailed in the China News Service report.

Removing registration barriers: The NHSA will continue pushing megacities to fully eliminate hukou restrictions for employment-based and residence-based medical insurance participation. Local governments are also being encouraged to include flexible workers in maternity insurance coverage, allowing delivery workers, ride-hailing drivers, and freelancers to access maternity benefits.

Accumulating contribution years: For migrant workers who participate in employee medical insurance seasonally or periodically, contribution years can now be accumulated on a monthly basis. Scattered contribution periods will all count toward employee insurance contribution years, enabling workers who reach legal retirement age with sufficient contributions to enjoy retirement medical benefits.

Flexible payment options: Workers will have monthly payment options, with exploration of quarterly, semi-annual, and annual prepayment models. Platform companies are encouraged to adopt appropriate payment methods for eligible employees. Contribution bases can reference local employee basic pension insurance bases, subject to fund balance requirements.

Improved services: The NHSA will streamline online and offline business channels, implement “one-stop service for flexible employment insurance participation,” and promote cross-province sharing of personal accounts for spouses, children, parents, and other close relatives.

Growing Participation

The scale of flexible workers joining employee medical insurance has been expanding steadily. According to NHSA data cited by Phoenix News, 69.82 million flexible workers and others participated in employee medical insurance nationally in 2025, a year-on-year increase of 5.54 percent. This represents growth of more than 20 million since the start of the 14th Five-Year Plan period. Total basic medical insurance participation reached 1.331 billion in 2025, maintaining a coverage rate of 95 percent.

The announcement follows a July 9 press conference at which the NHSA first signaled plans for a special action to expand flexible worker coverage. The agency confirmed then that 2025 data showed 69.82 million flexible workers in employee medical insurance, and noted that efforts were underway to push megacities to remove participation restrictions.

Remaining Challenges

While most megacities have now relaxed hukou restrictions for flexible worker participation, some—particularly Beijing—continue to maintain barriers, as Southern Metropolis Daily has reported. Workers affected by such restrictions have been forced to enroll in insurance in their hometowns or places of household registration, complicating access to medical services and reimbursement.

The conversion ratio between resident and employee insurance contribution years will need careful calibration to maintain fund sustainability, and implementation will vary by region as local governments adapt the national framework to their circumstances.

What to Watch

The NHSA has issued a joint action notice with the Ministry of Finance, Ministry of Transport, Ministry of Commerce, State Taxation Administration, State Post Bureau, and All-China Federation of Trade Unions—six departments in total—targeting flexible employment workers. As the Medical Insurance Law takes effect in 2027 and the 15th Five-Year Plan period unfolds, the pace of local implementation and the extent to which remaining megacity restrictions are lifted will be key indicators of how quickly China’s flexible workforce gains access to comprehensive medical protection.

The push reflects a broader trend of state-led expansion of contributory social insurance to China’s growing gig and flexible workforce, rather than creating separate systems for these workers. With platform companies increasingly engaged in facilitating participation, the coming months will reveal how effectively these measures translate into tangible coverage gains for millions of workers across the country.