Insurance & costs
Sick leave and the statutory medical period for foreign employees in China
Map lawful foreign employment, medical evidence, employer leave, sick pay, the medical period, return to work and immigration as separate records.
A foreign employee's illness absence in China is not one document or one department. The treating institution keeps and maintains the official clinical record and may issue medical proof. The employee notifies the employer and submits the required evidence. The employer records sick leave under the contract, collective agreement and lawfully adopted rules. Payroll applies the controlling local sick-pay rule. A separate ledger tracks the statutory medical period. Return to work compares current functional information with the actual job, while any work permit, residence permit, passport, social-insurance or overseas assignment deadline continues through its own process. This guide uses current national rules to organise that file for a lawfully employed foreign national. It does not promise that a particular person has a labor relationship, approve leave, calculate city pay, extend immigration status, diagnose illness or provide legal advice.
Use this as a practical starting point
Provider procedures can change, so confirm time-sensitive details with the hospital, insurer or service. A licensed professional must make clinical decisions for an individual patient.
At a glance
Key points
- Current judicial rules directly recognise specified lawful foreigner-China-employer labor relationships, but physical presence or payment alone does not settle status.
- The foreign-employment rules place work time, rest, leave, labor safety and health and social insurance under state provisions for a foreigner within their scope.
- An overseas assignment, China payroll, work permit, residence permit and labor relationship may point to different entities and must be reconciled.
- For urgent symptoms, call 120 or obtain emergency care before trying to complete an employer or immigration form.
- A provider document, the employee's sick-leave request, employer approval, payroll treatment and the statutory medical period are separate records with different owners.
- Foreign nationality does not create a special nationwide sick-pay percentage; the controlling city rule and any more favourable employment term still govern the calculation.
- A possible work injury or occupational disease needs its own recognition route and should not disappear inside an ordinary illness file.
- Return-to-work restrictions should describe function against the actual role while medical and health information remains limited to a necessary purpose.
- Medical-period protection affects specified termination routes, but it is not absolute immunity and does not itself extend an immigration document.
- A bilingual chronology should preserve the Chinese originals, identify translations and show who made each administrative decision.
Identify the legally relevant foreign-employment arrangement
Start with the relationship that actually exists, not the label on a mobility spreadsheet. Record the China employer's registered Chinese name, any overseas employer, domestic branch or representative office, payroll provider, client site and day-to-day manager. Obtain the labor contract or assignment letter, work permit or permanent-residence evidence, residence document, current passport and social-insurance record. The 2025 Supreme People's Court interpretation identifies permanent residence, a work permit plus lawful stay or residence, and other completed national procedures as circumstances supporting recognition of a labor relationship with a China employer. That direct rule is safer than assuming nationality either creates or removes labor protection.
A business visitor, contractor, freelancer, overseas remote worker or person performing work outside required authorisation may present a different issue. Do not promise the medical-period framework applies merely because the person receives money or has been in China for months. Ask which entity hired, directs, pays, evaluates, can discipline, holds the work permit and registered social insurance. If those facts conflict, preserve them and obtain qualified advice. The sick-leave file can still document clinical care and notices without prematurely writing a legal conclusion about employment status.
Reconcile work permit, residence and social-insurance records
Create a status table with the work-permit holder, employing entity, permitted occupation and location, residence-document expiry, passport number, social-security number, five-insurance registration, payroll entity and responsible service authority. The 2024 foreign social-insurance revision uses current work-permit and residence terminology and generally requires the responsible employer or domestic work unit to register the qualifying foreign employee within thirty days after the employment document is processed. A social-security agreement may change specified branches only where the nationality, certificate, branch and validity period actually fit.
Absence does not automatically freeze an expiry date or authorise work outside the permit scope. Ask HR and the employee to review deadlines before a long treatment period, record the official inquiry and avoid sending unsupported medical detail. If an application requires the employee's attendance and illness makes that difficult, ask the responsible immigration or work-authorisation authority about an authorised alternative. Do not use a clinician's note as a promise of approval. Keep any immigration outcome separate from the employer sick-leave and statutory medical-period ledgers.
Control cross-border sharing of employee health information
A multinational may have local HR, a regional mobility team, overseas headquarters, payroll, an insurer and an assistance company. List which recipient needs which field and why. Local HR may need the absence dates and a valid certificate; payroll may need the approved leave category and pay inputs; a safety manager may need functional restrictions; immigration counsel may need only enough information to explain inability to attend. The fact that a recipient is within the corporate group does not make the whole clinical record minimum necessary.
Use a secure approved channel, mask identity numbers where possible, restrict onward sharing and document retention. If information will leave China, verify the current cross-border lawful basis and compliance route rather than assuming an employment-management purpose removes all obligations. Give the employee a clear explanation of the recipients and purpose. A bilingual summary can reduce disclosure, but it should be a faithful translation or authorised administrative summary, not a rewritten diagnosis. Preserve the source document and translation relationship.
Maintain a bilingual foreign-employee absence file
Use one index in English and Chinese for the provider visit, diagnosis certificate or 病假证明, employee 病假申请, employer leave approval, 病假工资 or 疾病救济费 calculation, 医疗期 ledger, any 复工 or work-restriction record, work permit and residence deadlines, social-insurance inquiries and labor-dispute documents. Record who translated each item and whether the translation is informal, employer-prepared or certified. Do not replace the Chinese original, alter dates or add a legal conclusion attributed to the clinician.
At each review point, ask what changed in each layer. A new certificate may extend the clinical rest recommendation but does not automatically extend employer approval, the medical period or immigration documents. A return-to-work recommendation may change the absence record but not resolve a pay dispute. A social-insurance update may correct identity data without proving employment status. This disciplined bilingual index gives the employee, HR and any adviser the same chronology while keeping decisions with the institution authorised to make them.
Put urgent care and the first employer notice in the right order
When symptoms may be life-threatening, the practical first step is emergency treatment, not a leave portal. Call 120 when an ambulance is needed or use the nearest appropriate emergency department. A colleague or family member can send a short factual notice to the employer stating that the employee is receiving care, cannot complete the ordinary process and will provide evidence when reasonably possible. Preserve the time of the clinical encounter and the time of that notice. Do not delay treatment while waiting for an insurer, manager, work-permit agent or overseas headquarters to approve it.
After the immediate risk is controlled, reconstruct the administrative timeline without changing clinical dates. Record who contacted the employer, what channel was used, which documents were unavailable at the time and when the employee became able to respond. Emergency care does not automatically approve sick leave, establish a work injury, set sick-leave pay or start an immigration extension. Those later questions belong to the employer, payroll, responsible authority or another qualified institution. This guide is administrative information, not clinical advice or legal advice.
Use a ten-layer map for a cross-border illness case
Label ten distinct layers: clinical care; provider-issued medical certificate; employee sick-leave request; employer absence record; sick-leave wage or illness relief; statutory medical period; possible work-injury or occupational-disease handling; return-to-work evidence; employment decision or labor dispute; and immigration plus work-authorisation administration. Give every layer a responsible owner, source document, date range, current status and correction route. The same PDF may be relevant to several layers, but one person's action should not be presented as another institution's decision.
This map is especially useful where local HR, a global mobility team and an overseas employer use different systems. Ask each team to update only the field it owns. A hospital can support a diagnosis and rest recommendation; it does not approve employer leave. Payroll can explain a wage calculation; payment is not proof that the medical-period ledger is correct. A work-permit service agent can report a filing deadline; that advice is not a return-to-work assessment. Keeping the layers distinct lets an error be corrected without contaminating the rest of the record.
Connect provider evidence to the employer's actual leave rule
Obtain the employer's communicated policy or contractual process for notice, document format, authorised recipient, translation, original-document custody, extension and appeal. Then compare the medical document with that process. The issuing physician should have personally examined or investigated the patient, act within the registered scope and use the institution's controlled form, signature and seal. Check the foreign employee's passport name, alternate name order, visit date, issue date, rest period and document number before submission. A discrepancy should be corrected by the institution, never edited by the employee.
Ask HR to record a defined result such as received, pending verification, accepted for stated dates, partly accepted or rejected with reasons. A diagnosis certificate does not automatically become employer approval, but an employer also should not rely on an unpublished after-the-fact demand. If authenticity is questioned, identify the precise issue and use a proportionate verification route. Medical information remains sensitive personal information; a certificate or limited extract may be enough, and submission should not be treated as permission to obtain an unrelated complete clinical history.
Calculate foreign-employee sick pay under the controlling local rule
There is no separate national sick-pay rate merely because the worker holds a foreign passport. The national implementation opinion supplies a floor during the prescribed medical period: sick-leave wage or disease relief may fall below the local minimum wage but not below eighty percent of that minimum. The city or province may define the calculation base, service band, daily treatment and other inputs. A labor contract, collective agreement or lawfully adopted employer rule may provide a more favourable result. Ask payroll to identify each source and its effective date.
Build a worksheet showing the approved absence dates, local rule, base wage or normal working time wage if the local text uses that concept, rate, divisor, gross result, local-minimum-wage comparison, lawful deductions and payment date. Do not import a formula from the employee's home country or another Chinese city. Keep the worksheet apart from the medical-period ledger: a paid day does not automatically prove the protection clock was counted correctly, and a medical-period day does not necessarily identify the payroll unit used by the local wage rule.
Track the national medical period without treating diagnosis as entitlement
The statutory medical period is a job-protection period for treatment and rest after illness or non-work injury. It is not an annual bank of paid sick days. The matrix uses total actual working years and years with the current employer: under ten total years gives three months when current-employer service is under five and six months when it is at least five; at least ten total years maps current-employer bands to six, nine, twelve, eighteen or twenty-four months. Prior overseas employment may raise evidence questions, so document what service is relied on rather than assuming every foreign record will be treated identically.
Each entitlement accumulates inside a corresponding observation window: three months in six, six in twelve, nine in fifteen, twelve in eighteen, eighteen in twenty-four and twenty-four in thirty. The ledger should identify the first sick-rest day, every later interval, public holidays and rest days inside supported rest, actual return dates and unresolved gaps. A new certificate does not automatically reset the window. Special-disease extension language also requires current local and responsible-authority verification; a serious diagnosis alone is not a promised twenty-four-month result.
Screen work causation before ordinary sick leave becomes the only file
Ask early whether an accident occurred during work, symptoms followed a work exposure or a statutory occupational disease may be involved. Preserve incident reports, witness details, exposure information and the earliest clinical history while ordinary sick-leave administration continues. Under the work-injury regulation, an employer's recognition application is generally due within thirty days, while the worker, close relative or trade union generally has a one-year route if the employer does not apply. Missing that distinction can damage a claim even when the employee has a genuine medical certificate.
Work-injury recognition, occupational-disease diagnosis, suspension-of-work-with-pay and labor-capacity assessment are not interchangeable with the non-work medical period. A normal outpatient diagnosis does not establish occupational disease, and employer approval of sick leave does not recognise a work injury. A foreign employee should also verify social-insurance participation and any treaty treatment without assuming coverage decides causation. Use the responsible authority and qualified clinical or legal professionals for a contested classification.
Plan return to work around the authorised job and current function
Before the employee returns, compare current clinical recommendations with the permitted job, actual workplace and essential duties. Describe hours, travel, lifting, driving, machinery, night work, exposure and concentration demands. Ask for functional limits and a review date rather than broad access to diagnoses. A treating clinician provides clinical evidence; the employer still decides how a restriction can be accommodated operationally. A general discharge note does not automatically certify fitness for every safety-sensitive task.
If a temporary arrangement changes duties, location or schedule, check whether it remains within work-permit and residence conditions and whether any government filing or amendment is needed. Record the arrangement's start, end, pay treatment, reporting line and review. Do not disguise a permanent transfer as an informal recovery plan. If the employee cannot perform the original role after the medical period, genuine alternative work and any later employment decision form a separate legal stage.
Audit protection, contract expiry and dispute readiness
Article 42 restricts termination under Article 40 or Article 41 while the employee remains within the prescribed medical period, and Article 45 generally extends fixed-term contract expiry until the protected circumstance ends. That protection is not absolute and does not bar every other statutory ground. An employer should reconcile the medical-period ledger, employer leave record, pay file, contract term and communicated rules before taking action. Foreign status does not remove these checks, and illness does not automatically renew the work permit or residence permit.
After the period, Article 40 requires more than the passing of a date: the employee must be unable to perform the original work and unable to perform other work arranged by the employer. If those conditions are established, thirty days' written notice or one additional month's wage and economic compensation may be relevant, with trade-union procedure where applicable. Preserve translations, delivery receipts and wage calculations for a labor dispute. This page cannot predict an individual outcome; obtain qualified advice for a contemplated termination.
Avoidable problems
Common mistakes
- Assuming a foreign passport excludes a lawfully employed worker from national leave and medical-period rules.
- Assuming an overseas contract means there can be no China labor relationship or domestic work-unit responsibility.
- Treating illness as an automatic work-permit, residence-permit or assignment extension.
- Sending a complete medical chart to overseas HR when a certificate and dates would meet the purpose.
- Using a work permit as conclusive proof that every payroll, leave and medical-period decision is correct.
- Applying the employee's home-country sick-pay formula instead of the current Chinese local wage rule.
- Merging provider rest dates, employer approved dates and medical-period accumulation into one unexplained timeline.
- Waiting for an employer response before seeking urgent treatment for a potentially serious condition.
- Ignoring a possible work exposure because HR has already coded the absence as ordinary sick leave.
- Moving an employee into a different role without checking functional safety and work-authorisation consequences.
- Treating Article 42 as a promise that no statutory termination ground can ever apply during illness.
- Letting translations replace or silently alter the original Chinese medical and employment documents.
Common questions
Frequently asked questions
Do the national rules apply to every foreigner doing work in China?
No automatic conclusion should be made. The current judicial rule identifies lawful-status circumstances supporting a labor relationship with a China employer. Visitors, contractors and unauthorised arrangements require separate analysis.
Does a social-security agreement remove sick-leave rights?
No broad inference follows. Agreements are branch- and certificate-specific. Verify the exact contribution branch and period; employer leave, sick pay and the medical-period framework remain separate questions.
Should a foreign employee call HR before going to an emergency department?
Clinical safety takes priority. Use 120 or emergency care when needed, send a brief notice as soon as reasonably possible and document why the ordinary submission route could not be followed immediately.
Can overseas service be counted automatically as total actual working years?
Do not assume either inclusion or exclusion. Preserve contracts, separation records and other service evidence, identify the rule being applied and seek responsible-authority or qualified legal guidance if the result changes the medical-period tier.
Which entity should receive the medical certificate in a multinational group?
Use the authorised channel of the entity managing the relevant China employment record. Regional or overseas teams should receive only the minimum information needed for a defined role, with cross-border compliance checked separately.
Is foreign-employee sick pay always eighty percent of salary?
No. The national eighty-percent rule is a floor tied to the applicable local minimum wage during the medical period. A current local rule and any more favourable contract or collective term supply the full calculation.
Does a new diagnosis certificate reset the statutory medical period?
Not automatically. The employer should maintain an accumulation ledger under the applicable entitlement and observation window, preserving the relationship between each certificate, approved absence and actual return.
Can an ordinary sick note establish a work injury or occupational disease?
No. It can preserve clinical evidence, but recognition and occupational-disease diagnosis have separate statutory routes, evidence requirements, responsible institutions and deadlines.
May a recovering employee change duties while remaining on the same work permit?
That depends on the authorised employer, occupation, location and current administration. Check the official work-authorisation route before promising that a temporary or alternative role needs no filing.
Can a fixed-term China contract simply expire during the medical period?
Article 45 generally extends expiry until the protected circumstance ends. The exact ledger, contract, work-authorisation dates and any later route should be reviewed together rather than backdating an end.
Evidence
Sources consulted for this guide
National rules are separated from city and provider examples. Access dates show when a source was collected; source pages and procedures can change afterward.