APPROVED
APPROVED
International Process Guidelines
Sickness
S_BUC_15 – Long Term Care Cash Benefits - Application
Date: 11/09/2018
Version of guidelines document: v4.1.0
Based on: S_BUC_14a version 4.1.0
Common Data Model version: 4.1.0
TABLE OF CONTENTS
S_BUC_15 – Long Term Care Cash Benefits - Application 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 transmit information to? 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? 5
CO.4 How do I proceed after I have received ' Reply to Notification of Application for Cash Benefits – Long Term Care' - SED S057? 6
CP.1 What should I do if I have received the ‘Notification of Application for Cash Benefits – Long Term Care’ SED S056? 6
CP.2 What should I do if I am responsible for the business process? 6
CP.3 What should I do if I am not responsible for the business process? 7
BPMN diagram for S_BUC_15 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
17/07/2017
Secretariat
First draft of the document submitted for review to the Sickness Ad Hoc
group
V0.2
31/08/2017
Secretariat
Comments received from AHG integrated.
Version submitted for AC review.
V0.99
10/10/2017
Secretariat
Implemented changes and updates following the AC comments. Version submitted for AC approval.
V1.0
11/12/2017
Secretariat
AC approved version.
V4.1.0
11/09/2018
Secretariat
Performed patch changes to reference the new CDM version 4.1.0
S_BUC_15 – Long Term Care Cash Benefits - Application
Description:
This BUC allows an Institution of place of residence to be notified by corresponding Competent Institution about insured person's application for long-term care cash benefits.
The notification is optional and the decision of doing it belongs to the Competent Institution, with the purpose of preventing overlapping of benefits. It is not applicable if the Member State of residence or stay did not declare any long-term care benefits in kind in the list referred in article 34(2) of the Basic Regulation.
If notification is sent, then the Institution of place of residence must reply information on: if the long-term care benefits in kind are provided or not; if provided, then further details on the amount, currency, frequency and benefits in kind themselves are required.
The BUC is individualized, meaning the case concerns only one person.
Legal Base - is captured in the following:
Basic Regulation (EC) No. 883/2004;
Implementing Regulation (EC) No. 987/2009.
The matrix specifies the articles providing the legal basis for the SEDs used in this BUC:
SED
Basic Regulation (883/04)
Implementing Regulation (987/09)
21
34
28
31
S056 Notification of Application for Cash Benefits – Long Term Care
S057 Reply to Notification of Application for Cash Benefits – Long Term Care
Request – Reply SEDs:
REQUEST SED
REPLY SED(s)
S056 Notification of Application for Cash Benefits – Long Term Care
S057 Reply to Notification of Application for Cash Benefits – Long Term Care
Glossary of relevant terms used in the BUC:
Term used
Description
Case Owner
In this BUC, the Case Owner is the institution in the competent Member State which informs the institution of the place of residence or stay about an application for long-term care benefits in cash.
Counterparty
In this BUC, the Counterparty is the institution in the Member State of Residence/Stay which receives the information about an application for long-term care benefits in cash from the Competent Member State for the concerned person.
The Counterparty will inform the Case Owner if it provides or not long term care benefits in kind to the person concerned.
How to start this BUC?
In order to help you understand the BUC 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 represent the Competent Institution that received the claim for the long-term care cash benefits from an insured person that resides or stays in a Member State other than the Competent Member State, then your role will be defined as the Case Owner in this BUC.
I am the Case Owner. (step CO.1)
If you represent the institution that has received a notification concerning an application for getting long-term care cash benefits (SED S056 Notification of Application for Cash Benefits – Long Term Care), then your role will be defined as the Counterparty.
I am the Counterparty. (step CP.1)
CO.1 Who do I need to transmit information to?
As the Case Owner, your first step in any new exchange of 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 need to exchange. 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. There can be only one Counterparty.
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.
Please note that you can determine the relevant Institution in the country of residence you will need to check which institution confirmed registration of the insured person via SED S073, E 106, E 121, E109 or
E 120
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?
Once you determined the correct Counterparty institution, you prepare the notification by filling the SED S056 'Notification of Application for Cash Benefits – Long Term Care’ and making sure you enter all the required information.
You start the BUC for each case for which you have to send a notification on the application for long-term care benefits in cash.
Then you send the SED (including any attachments if necessary) to the Counterparty.
You expect to receive the corresponding reply in SED S057 ‘Reply to Notification of Application for Cash Benefits – Long Term Care’ from the Counterparty that you process (along with any provided attachments).
How do I proceed after I have received ' Reply to Notification of Application for Cash Benefits – Long Term Care' - SED S057? (Step CO.4 How do I proceed after I have received ' Reply to Notification of Application for Cash Benefits – Long Term Care' - SED S057?)
Sub-process steps available to the Case Owner at this stage:
After receiving the SED S057, you may, depending on the case:
Ask a Counterparty of a SED ad-hoc information (H_BUC_01), or;
Remind a Counterparty of a SED or information that it needs to send to me (AD_BUC_07).
CO.4 How do I proceed after I have received ' Reply to Notification of Application for Cash Benefits – Long Term Care' - SED S057?
After you have received SED S057 from the Counterparty, you are informed on the fact that the insured person or any of his/her family members receive long-term care benefits in kind (plus related details) or not at all.
This information may impact the amount of the long-term care cash benefits provided to the insured person.
Unless you need additional information, the use case ends here, the use case ends here.
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 send reminder in order to receive Information expected and not yet received (AD_BUC_07).
CP.1 What should I do if I have received the ‘Notification of Application for Cash Benefits – Long Term Care’ SED S056?
You have received a request SED S056 ‘Notification of Application for
Cash Benefits – Long Term Care’ from the Case Owner which you need to process.
First, you check if you are responsible for the business process in accordance with your national procedures.
I am responsible for the business process. (step CP.2)
I am not responsible for the business process.(step CP.3)
CP.2 What should I do if I am responsible for the business process?
If you have received a request SED S056 ‘Notification of Application for Cash Benefits – Long Term Care’ from and you are responsible for the business process.
You have to fill in the reply SED S057 ‘Reply to Notification of Application for Cash Benefits – Long Term Care’, making sure you enter all the information required by the Competent Institution SED S056.
Then you send the SED (including any attachments if necessary) to the Counterparty.
The business use case ends here.
Sub-process steps available to the Counterparty at this stage:
I want to request ad-hoc information (H_BUC_01).
I want to send reminder in order to receive Information expected and not yet received (AD_BUC_07).
CP.3 What should I do if I am not responsible for the business process?
You have two options:
If you are not responsible for the reply but another institution in your country is, you can forward the case to the competent Institution in your Member State using the forward the case to the competent Institution in your Member State using the 'Forward Case' sub-process AD_BUC_05. This sub-process can be used only once
If your Member State was chosen incorrectly as a recipient of S056 or the forward is not possible, you can inform the Case Owner using ad- hoc information (H_BUC_01)
The business use case ends here.
BPMN diagram for S_BUC_15
Click here to open the BPMN diagram(s) for this BUC.
Structured Electronic Documents (SEDs) used in the process
The following SEDs are used in this BUC:
S056 Notification of Application for Cash Benefits – Long Term Care
S057 Reply to Notification of Application for Cash Benefits – Long Term Care
Administrative sub-processes
The following administrative sub-processes are used in this BUC:
AD_BUC_05_Subprocess – Forward Case
AD_BUC_07_Subprocess – Send 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 this BUC:
H_BUC_01_Subprocess – Ad-hoc Exchange of Information