Before you start

Residence permit and work permit
Employment contract, which is what triggers social insurance enrolment
Employer's private medical insurance details, if provided
A Chinese mobile number, since hospital appointment systems are app-based

Step-by-step

1
Confirm your employer has enrolled you in social insurance
The 2011 Interim Measures make enrolment compulsory for foreign employees nationally, covering pension, medical, work injury, unemployment and maternity. Shanghai's earlier voluntary arrangement lapsed on 15 August 2021 and the national position applies. Check your payslip shows the deductions rather than assuming.
Via employerWho: Your employerMonth 1
2
Check whether a totalisation agreement exempts you
China has bilateral social security agreements with a number of countries — Germany, South Korea, Japan, Canada, Switzerland, the Netherlands, Spain, Denmark, Finland and others — under which posted workers can be exempted from some contributions with a certificate of coverage from home. The scope differs agreement by agreement, so check yours specifically rather than assuming it covers everything.
Via employerWho: You
3
Read the employer's private policy before you need it
Most foreign employees in Shanghai are also given private cover, and the material question is whether it admits you to the international wings and private hospitals or only reimburses public treatment. Also check the maternity, dental and evacuation terms — these are where policies differ most.
Via employerWho: You
4
Learn the ordinary hospital route as well as the international one
Chinese hospital outpatient works by registration: you take a number for a department, see a doctor briefly, and are sent for tests and pharmacy in the same building. It is fast and inexpensive but conducted in Mandarin. Knowing how to do it means you are not stranded when the international clinic is closed.
In personWho: You
5
Use the hospital apps and mini-programs
Appointments at major Shanghai hospitals are made through WeChat mini-programs or the hospital's own app, often days ahead, and popular specialists' slots go quickly. Walking in without an appointment usually means a long wait or no slot at all.
Mobile appWho: You
6
Know where the 24-hour international emergency care is
Identify the nearest emergency department that will treat you in English before you need it, and note that ambulance dispatch on 120 goes to the nearest appropriate public hospital, not to your preferred one.
In personWho: You

Documents you’ll need

Passport and residence permit
Social insurance card, once issued
Private insurance card and policy number
Employment contract
Vaccination and medical history, translated if possible

Things most newcomers don’t know

Shanghai's voluntary social insurance regime for foreigners ended in August 2021, and this is a genuine city-level difference.

National rules have made enrolment compulsory for foreign employees since 2011, but Shanghai ran a local notice letting foreign employees and their employers treat it as optional. That notice expired on 15 August 2021 and was not renewed, so full five-fund enrolment is the position here now. Guides written before 2021 — and there are many — still say otherwise. Enforcement across China remains uneven city by city, which is exactly why the local position matters more than the national one.

Source: Shanghai Human Resources and Social Security Bureau

A totalisation agreement can exempt you from part of the contribution, and nobody will volunteer it.

China has bilateral social security agreements with over a dozen countries. Where one applies, a posted worker with a certificate of coverage from their home scheme can be exempted from specified Chinese contributions — most commonly pension and unemployment. The exemptions differ by agreement and none of them covers everything. Your employer's payroll team will not raise it unless you do, and the certificate has to come from your home country's social security body.

Source: Ministry of Human Resources and Social Security

The international wing and the ordinary department are often the same doctors.

Huashan, Ruijin, Zhongshan and several other major Shanghai hospitals run international or VIP outpatient services in the same building, with the same senior physicians, but with appointments, English-language support, shorter waits and prices several times higher. If you are paying yourself rather than through insurance, the ordinary department with a Mandarin-speaking friend gets you to the same clinician for a fraction of the cost.

Source: community-reported

The pension you contribute to is partly refundable when you leave, but only if you start the process properly.

Foreign employees who leave China permanently can generally apply to withdraw the individual portion of their pension account, and the employer's contribution is not refunded. The application needs your social insurance records, your bank details and evidence that you are leaving, and it is materially easier to assemble while you still have a Chinese bank account and a local HR team. People who leave first and think about it later frequently never recover it.

Source: Ministry of Human Resources and Social Security

Common mistakes to avoid

Assuming Shanghai still runs the pre-2021 voluntary social insurance arrangement.
Not checking whether your country's totalisation agreement exempts part of the contribution.
Discovering only at the hospital desk that your private policy does not cover the international wing.
Walking into a major hospital without an app appointment.
Leaving China without starting the pension refund while you still have a local account.

Some of this may be out of date. Spotted something inaccurate? Help us keep it right for the next newcomer.