APPROVED
APPROVED
International Process Guidelines
Sickness
S_BUC_01 – Entitlement - Residence outside competent Member State without PD
Date: 11/09/2018
Version of guidelines document: v4.1.0
Based on: S_BUC_01 version 4.1.0
Common Data Model version 4.1.0
TABLE OF CONTENTS
S_BUC_01 – Entitlement - Residence outside competent Member State without PD 4
How to start this BUC? 5
What is my role in the social security exchange of information I have to
complete? 5
CO.1 Who do I need to exchange information with? 5
CO.2 How do I identify the correct institution to exchange information with? 5
CO.3 How do I proceed after having identified the Counterparty? 6
CO.4 How do I proceed after having received the ‘Entitlement document - Residence’ SED S072 from the Counterparty? 6
CO.5 How do I proceed when I have received the ‘Dispute of date’ SED S050? 6
CO.6 How do I end the process after having received the ‘Entitlement document - Residence’ SED S072 which states a lack of entitlement? 7
CP.1 What should I do if I have received the ‘Request for entitlement document - Residence’ SED S071? 7
CP.2 How do I express a dispute concerning the registration date indicated in the ‘Information of registration - Residence’ SED S073 after I have received the SED S073 from the Case Owner? 7
BPMN diagram for S_BUC_01 8
Structured Electronic Documents (SEDs) used in the process 8
Administrative sub-processes 8
Horizontal sub-processes 8
Document history:
Revision
Date
Created by
Short Description of Changes
V0.1
07/04/2017
Secretariat
First draft of the document submitted for review to the Sickness Ad Hoc group
V0.2
09/05/2017
Secretariat
Implement changes and updates following the AHG comments. Version submitted for AC review.
V0.99
15/06/2017
Secretariat
Version submitted for AC approval.
V1.0
13/07/2017
Secretariat
AC approved version
With minor formatting and clarification corrections
V4.1.0
11/09/2018
Secretariat
Performed patch changes to reference the new CDM version 4.1.0
S_BUC_01 – Entitlement - Residence outside competent Member State without PD
Description: As the regulation dictates (Art. 24 of Regulation 987/09 and Art. 17, 22, 25 and 26 of Regulation 883/04) the insured person and/or members of his/her family shall register with the institution of the place of residence. Their right to health benefits in kind in the Member State of residence shall be certified by a document issued by the Institution from the competent Member State upon request of the insured person or upon request of the institution of the place of residence.
The case described hereafter models the process that leads to the registration of an entitlement to the health benefits in kind of the insured person and/or members of the person's family in the Member State of residence in case of a person without entitlement document. This process is started by the Competent Institution in the Member State of residence.
Legal Base: This Business Use Case document's legal base is described in the following Regulations
Basic Regulation (EC) No 883/2004
Implementing Regulation (EC) No 987/2009
The following matrix specifies the SEDs that are used in this Business Use Case and documents the articles that provide the legal basis for each SED.
Basic Regulation No 883/2004
Implementing Regulation No 987/2009
SED
17
22
24
25
26
24
S071 Request for Entitlement Document - Residence
S072 Entitlement Document - Residence
S073 Information of Registration - Residence
S050 Dispute of Date
Request – Reply SEDs
The following table specifies the SEDs that have a logical pairing to one another, usually this is known as a request-reply pair.
REQUEST SED
REPLY SED(s)
S071 Request for Entitlement Document - Residence
S072 Entitlement Document – Residence
S050 Dispute of Date
S073 Information of Registration - Residence
Glossary of relevant terms used in S_BUC_01:
Term used
Description
Case Owner
In this BUC the Case Owner is the institution of the place of residence of the insured person who claims the rights to health benefits in kind.
Counterparty
In this BUC the Counterparty is the Competent Institution of a Member State where the person is insured.
Claimant
In this BUC the claimant is the insured person resident outside the competent Member State who claims the health benefits in kind.
How to start this BUC?
In order to help you understand S_BUC_01 we have created a set of questions that will guide you through the main scenario of the process as well as possible sub-scenarios or options available at each step along the way. Ask yourself each question and click on one of the hyperlinks that will guide you to the answer. You will notice that in some of the steps, where it is allowed to use the additional horizontal and administrative sub-processes, they will be listed under the step description.
What is my role in the social security exchange of information I have to complete?
If you are the Institution of a Member State where the person in question currently resides that requests for an entitlement document from the Competent Institution in another Member State (Counterparty) where the person(s) has acquired the rights for health benefits in kind, your role will be defined as the Case Owner.
I am the Case Owner. (step CO.1)
If you are the Competent Institution that receives a ‘Request for entitlement document - residence’ SED S071 from an Institution of another Member State in order to enquire information about the rights for health benefits of the person in question your role will be defined as the Counterparty.
I am the Counterparty. (step CP.1)
CO.1 Who do I need to exchange
information with?
As the Case Owner, your first step in any new request for information will be to identify the responsible Member State that you need to exchange information with. The second step is to identify the relevant institution in this Member State that is responsible for the information you require. In this Business Use Case, the institution can be chosen only among the institutions responsible for health insurance. This activity will define the Counterparty you will be working with in the gathering of information. There can only be one Counterparty in this Business Use Case.
I need to identify the Counterparty. (step CO.2)
I have identified the Counterparty I need to contact.(step CO.3)
CO.2 How do I identify the correct institution to exchange information with?
In order to determine the relevant Competent Institution from another Member State you will need to consult the Institution Repository (IR). The IR provides an electronic record of all current and previous Competent Institutions and Liaison Bodies that have been responsible for the cross border coordination of social security information for each of the relevant Member States.
Please note that the Liaison Body should be chosen only if it is impossible to identify the correct Competent Institution in the respective Member State or if the case is handled by the Liaison Body.
To access the IR please use the following link.
I have now identified the Competent Institution from the Member State
I need to contact. (step CO.3)
CO.3 How do I proceed after having identified the Counterparty?
Fill out the ‘Request for entitlement document - residence’ SED S071 by entering the period for which an entitlement document is requested and the probable status of the person. Afterwards, you send the SED S071 to the identified Counterparty.
Please note that the SED S071 always concerns only a single person. If you need entitlement documents for several people, you will need to execute the Business Use Case several times. If you are issuing the S071 for a family member, you have to fill in the data of a main insured person in section 4 of the S071.
The Counterparty will then fill in the ‘Entitlement document - residence’ SED S072 by entering either the validity period for the entitlement or the reason for refusal (if the entitlement is not granted) and send it to you.
I have received SED S072 from the Counterparty and I want to continue the process. (step CO.4)
I have received SED S072 and I want to end the process due to the lack of entitlement confirmed by the Counterparty.(step CO.6)
CO.4 How do I proceed after having received the ‘Entitlement document - Residence’ SED
S072 from the Counterparty?
After you have received SED S072 from the Counterparty you need to fill in the ‘Information of Registration - Residence’ SED S073 entering the agreed period of the registration or the reason for refusal of the Counterparty’s proposal and send the SED S073 to the Counterparty. If the registration concerns a family member, you have to fill in the data of a main insured person in section 4 of the S073. When the Counterparty receives the SED S073 and does not dispute your indicated information on the period of registration, the Business Use Case ends here.
I have received a ‘Dispute of date’ SED S050 from the Counterparty after I have sent the S073 to the Counterparty.(step CO.5)
Sub-process steps available to the Case Owner at this stage:
I want to request ad-hoc Information from the Counterparty (H_BUC_01).
I want to remind a Counterparty of a SED or information that it needs to send to me (AD_BUC_07).
CO.5 How do I proceed when I have received the ‘Dispute of date’ SED S050?
After you have received the SED S050, where the Counterparty expresses a dispute concerning the registration date indicated in the ‘Information of Registration - Residence’ SED S073, you need to fill out the SED S073 entering the new data of the registration or the original data and send it to the Counterparty. You might need to repeat this process multiple times in case of ongoing disagreement.
After you and the Counterparty have agreed on the information of the period of registration in SED S073, you may close the case.
Sub-process steps available to the Case Owner at this stage:
I want to request ad-hoc information from the Counterparty (H_BUC_01).
I want to remind a Counterparty of a SED or information that it needs to send to me (AD_BUC_07).
CO.6 How do I end the process after having received the ‘Entitlement document - Residence’ SED S072 which states a lack of entitlement?
If the Counterparty confirmed the lack of entitlement, the international Business Use Case ends here. You will have to inform the claimant according to your national procedures.
Sub-process steps available to the Case Owner at this stage:
I want to request ad-hoc information from the Counterparty (H_BUC_01).
I want to remind a Counterparty of a SED or information that it needs to send to me (AD_BUC_07).
CP.1 What should I do if I have received the
‘Request for entitlement document - Residence’ SED S071?
If you have received a SED S071 from the Case Owner, please verify if you are competent to treat this particular case.
If you are competent to treat the case you need to fill in an ‘Entitlement document - Residence’ SED S072 by entering either the validity period for it or the reason for refusal (if the entitlement is not granted) into section 8. If you are issuing the entitlement document for a family member, please indicate the data of a main insured in section 4 of the S072. Please remember to indicate the address of residence of a person for whom you are issuing the S072. Then, send SED S072 to the Case Owner.
If you are not the competent institution for this cases you may forward S071 to another competent institution in your Member State by using AD_BUC_05 or reply on S072 with information that entitlement is not granted and the reason is a lack of competence.
The Case Owner will fill in the ‘Information of registration - Residence’ SED S073 entering the agreed period of the registration or reason for refusal of your proposal and will send SED S073 back to you.
If you have received SED S073, please check whether you agree with the registration date indicated in SED S073. If this is the case, the Business Use Case ends here.
I want to express a dispute concerning the registration date indicated in the S073 after I have received the S073 from the Case Owner. (step CP.2)
Sub-process steps available to the Counterparty at this stage:
I want to forward the case to another Competent Institution in my Member State (AD_BUC_05).
I want to request ad-hoc Information from the Case Owner (H_BUC_01).
I want to remind the Case Owner of a SED or information it needs to send me (AD_BUC_07).
CP.2 How do I express a dispute concerning the registration date indicated in the ‘Information of registration - Residence’ SED S073 after I have received the SED S073 from the Case Owner?
In order to express a dispute concerning the registration date indicated in the SED S073 after having received it from the Case Owner, you need to fill in a ‘Dispute of Date’ SED S050 and send it to the Case Owner.
The Case Owner must reply with another SED S073, therefore you might need to repeat this step several times in case of ongoing disagreement. BUC ends when you agree with the received S073.
Sub-process steps available to the Counterparty at this stage:
I want to request ad-hoc Information from the Case Owner (H_BUC_01).
I want to remind the Case Owner of a SED or information it needs to send me (AD_BUC_07).
BPMN diagram for S_BUC_01
Click here to open the BPMN diagram(s) for S_BUC_01.
Structured Electronic Documents (SEDs) used in the process
The following SEDs are used in S_BUC_01:
SED S071 – Request for entitlement document - Residence
SED S072 – Entitlement document - Residence
SED S073 – Information of registration - Residence
SED S050 – Dispute of date
Administrative sub-processes
The following administrative sub-processes are used in S_BUC_01:
AD_BUC_05_Subprocess – Forward Case
AD_BUC_07_Subprocess - Reminder
The following sub-processes are used for the handling of exceptional business scenarios that arise due to the exchange of social security information in an electronic environment and can be used at any point in the process:
AD_BUC_11_Subprocess – Business Exception
AD_BUC_12_Subprocess – Change of Participant
Horizontal sub-processes
The following horizontal sub-process is used in S_BUC_01:
H_BUC_01_Subprocess – Ad-hoc Exchange of Information