EESSI Business Use Case
EESSI Business Use Case
S_BUC_17
Long-Term Care Cash Benefits - Information on Payment
S_BUC_17
Long-Term Care Cash Benefits - Information on Payment
Table of Contents
1. Introduction 6
1.1. Purpose 6
1.2. Scope 6
1.3. Definitions, Acronyms and Abbreviations 6
1.4. References 7
1.5. Overview 7
2. Description 8
2.1. Business Scenario 8
2.2. Legal Base 8
3. Actors & Roles 9
4. Use Case 10
4.1. RUP Table Representation 10
4.2. Request – Reply SEDS 13
4.3. Attachments Allowed 13
4.4. Artefacts used 14
5. Business Processes 15
5.1. Case Owner and Counterparty 15
5.2. Sub Processes 16
6. Appendices 17
6.1. Issues 17
Document Control Information
Settings
Value
Document Title:
Business Use Case
S_BUC_17 - Long-Term Care Cash Benefits - Information on Payment
Project Title:
EESSI (Electronic Exchange of Social Security Information) Project
Document Author:
European Commission, DG EMPL F5
System Owner:
European Commission, DG EMPL D2
Doc. Version:
v4.1.0
Sensitivity:
Internal
Date
09/08/2018
Document history:
The Document Author is authorised to make the following types of changes to the document without requiring that the document be re- approved:
Editorial, formatting, and spelling
Clarification
To request a change to this document, contact the Document Author or Owner.
Revision
Date
Created by
Short Description of Changes
v0.1.0
07/03/2016
Valérie Banchereau
First draft of the document
v0.1.10
07/06/2016
Valérie Banchereau
Document updated based on remarks received from Germany.
Comments from Germany added.
Section 2.2 – Legal Base, Art. 28 removed from table, following Germany's advice ' Should be deleted on the SED as this specific information is described in Article 31 (2)'
Section 4.1-RUP Table description: '
Details added in the Description
Post Condition' description has been changed from 'The Competent Member State receives from the institution of the Member State of Residence/Stay the confirmation whether it provides benefits in kind or not for the concerned person . ' to Germany proposal ' The competent Member State decides whether the provision on prevention of overlapping of long-term care benefits under Art. 34 Regulation (EC) 883/04 applies in that case or not.'
One of the "Remarks"
Section 4.1 – RUP Table: 'Description' adapted:
'In case of a long-term incapacity due to a sickness in a Member State of residence / stay other than the competent Member State, the concerned person receives long-term care cash benefits from the Member State of residence / stay. ' replaced by ' A person receiving long-term care cash benefits from the competent Member State resides or stays in another Member State.'
'Remarks' section, initially under Special
Requirements in section 4.1 RUP Table Description is moved after Step
5 of Main Scenario 'SR' section, moved under RUP Section 5, at
Germany's request.
v0.2.0
28/06/2016
Valérie Banchereau
Alignment to the standard description and layout of the BUC.
Requests from Germany implemented: see Section 6.1, issues 6 and 7.
v0.3.0
08/11/2016
Carine Molle
Remarks and last comments received from Germany have been accepted in the document.
Comments received from AC have been implemented in the document.
As suggested "Reminder" has been added for the Counterparty and Case Owner.
Section 4.1 has been updated (Branch 3 and 4 added)
Section 4.4 has been updated (Reminder is added)
Section 4.5 SED and Sub-process Versioning (Reminder is added)
v0.99.0
25/11/2016
Carine Molle
Submitted for approval
v1.0.0
15/12/2016
Heidi Warson
AC Approved Version
v1.0.1
03/07/2017
Joël Fiora
-Included BPMN picture in section 5
- removed Use Case diagram
v4.1.0
09/08/2018
Madalina Alecsandrescu
- Section 4.4 merged 2 tables (for SED & for Subprocesses) into 1 BUC Artefact table."
- Version adaptations to release 4.1.0.
Introduction
Purpose
The purpose of this document is to construct an external view of the 'EESSI business system' as described in EC Regulations 883/2004 and 987/2009. The ‘EESSI Business System’ describes the business and expected business processes without consideration as to which part(s) may be realised by an IT System (i.e. the proposed EESSI IT System).
The external view comprises of models and descriptions of business use cases, the services of a business system offered to business actors: customers, business partners, or other business systems.
A business use case is described from an actor's perspective; it describes the interaction between an actor and the business system, meaning it describes the behaviours of the business system that the actor utilises. The Business Use Case includes Use Case Diagrams and Business Process Models.
Use case diagrams show actors, business use cases, and their relationships. Use case diagrams do not describe procedures. Alternative scenarios also remain hidden. These diagrams give a good overview of the behaviours of the EESSI business system which will direct and govern part of the expected behaviours and functionality delivered by the EESSI IT System.
Scope
This document is limited to the external view of the Sickness´ sector process Long-Term Care Cash Benefits – Information on Payment.
The different elements like use case description, business actors, and business process as well as supporting UML diagrams and BPMN models pertaining to Long-Term Care Cash Benefits – Information on Payment.
Definitions, Acronyms and Abbreviations
Please see the EESSI Project Glossary here.
References
#
Description
1
EC Regulation 883/2004
Regulation EC No 883- 2004.pdf
2
EC Regulation 987/2009
Regulation EC No 987-2009.pdf
3
UML 2.x
http://www.omg.org/spec/UML/
4
BPMN 2.0
http://www.omg.org/spec/BPMN/index.htm
5
UML 2.0 In Action
Henriette Baumann, Patrick Grassle & Philippe Baumann, 2005, ISBN 1904811558
6
RUP@EC standard 5.0
http://www.cc.cec/RUPatEC_Standard/
7
RUP op maat
http://www.rupopmaat.nl/
Overview
Chapter 1 introduces the external view on the business system under review and lists the elements of this specification.
Chapter 2 introduces the Long-Term Care Cash Benefits – Information on Payment business process. This chapter gives a short and detailed description as well as a reference to the business process´ legal base.
Chapter 3 lists the actors involved in the Long-Term Care Cash Benefits – Information on Payment business process.
Chapter 4 describes in detail the Long-Term Care Cash Benefits – Information on Payment business process based on the RUP use case template, as well as the relationship to other use cases.
Chapter 5 describes the Long-Term Care Cash Benefits – Information on Payment business process using business process modelling notation
(BPMN).
Description
Business Scenario
An insured person residing or staying in a Member State other than the competent Member State may be entitled to long-term care cash benefits provided by the competent institution in accordance with the legislation it applies.
If in the same time, the person concerned receives long-term care benefits in kind for the same purpose from the Member State of residence or stay, the general provision on prevention of overlapping of benefits shall be applicable.
This particular case implements the clause on the reduction of the amount of cash benefits by the amount of the benefits in kind provided by the institution of the State of residence or stay.
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.
It is irrelevant whether this benefit in kind would have led to a reduction of cash benefits according to the legislation of the state of residence or stay.
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.
SED
basic Reg.(883/2004)
implementing Reg.(987/2009)
34
31(2)
31(3)
S001
S003
Table 1: SED – Legal base relationship matrix
Actors & Roles
This chapter captures details of the actors which are important to understand the different types of system users. An actor is anyone or anything that exchanges data with the business system. An actor can be a user, external hardware or another system.
The overarching description of each actor described in this Business Use Case can be found in the Glossary. Below you will find a short description which provides further clarity of this actor within the context of this Business Use Case.
Actor name
Description
Case Owner
In this BUC, the Case Owner is the institution in the Competent Member State which provides the institution in the place of residence / stay with information regarding entitlement to long-term care benefits in cash for the concerned person.
Counterparty
In this BUC, the Counterparty is the institution in the Member State of Residence/Stay which receives the information on long-term care cash benefits from the Competent Member State.
The Counterparty informs the competent Member State if it provides benefits in kind or not for the person concerned.
Table 2: Actors & Roles
Use Case
RUP Table Representation
Use Case ID:
S_BUC_17
Use Case Name:
Long-Term Care Cash Benefits – Information on Payment
Created By:
Valérie Banchereau
Last Updated By:
Carine Molle
Date Created:
07/03/2016
Last Revision Date:
08/11/2016
Actors:
Case Owner
Counterparty
Description:
A person receiving long-term care cash benefits from the competent Member State resides or stays in another Member State. If in the same time, the person concerned receives long-term care benefits in kind for the same purpose from the Member State of residence or stay, the general provision on prevention of overlapping of benefits shall be applicable.
This particular case implements the clause on the reduction of the amount of cash benefits by the amount of the benefits in kind provided by the institution of the place of residence or stay.
This particular case allows the Competent Member State to send to the institution of the Member State of Residence/Stay information about payment of long-term care benefits in cash and to receive from the Member State of residence/stay information about entitlement to benefits in kind for the concerned person.
It might be that the long-term care benefits in kind are provided by another institution than the institution that received the entitlement document (e.g. SED S072, PD S1). In case of ambiguities, the message has to be sent to the institution which also received (or already confirmed) the registration SED S072.
It is not applicable if the Member State of residence or stay is not included in the list referred to in article 34(2) of the Basic Regulation.
Trigger:
An insured person residing or staying in a Member State whose legislation provides for long-term care benefits in kind is entitled to long-term care benefits in cash under the legislation of the competent Member State.
Preconditions:
The insured person resides or stays outside the Competent Member State. The insured person is entitled to long-term care cash benefits according to the legislation of the competent Member State.
The legislation of the Member State of Residence/Stay provides for long-term care benefits in kind.
Post conditions:
The competent Member State decides whether the provision on prevention of overlapping of long-term care benefits under Art. 34 Regulation (EC) 883/04 applies in that case or not.
Main Scenario:
Identify Participants
The Case Owner identifies the Member State of Residence/Stay to be informed about the payment of long-term care cash benefits;
The Case Owner then identifies the correct institution in the Member State of Residence/Stay. There will be only one counterparty. The Case Owner and the Counterparty are herein collectively referred to as the Participants.
Send Information of Payment for long-term care cash benefits
The Case Owner fills in the "Information on payment of cash benefits – long-term care" SED (S001) by entering all required data;
The Case Owner sends the "Information on payment of cash benefits – long term care" SED (S001) to the Counterparty;
The Counterparty receives the "Information on payment of cash benefits – long term care" SED (S001);
REMARKS: in case of ambiguities, SED S001 has to be sent to the institution which also received (or already confirmed) the registration SED S072.
Send Entitlement to Benefits in Kind for Long-term care cash benefits
The Counterparty fills in the "Entitlement to Benefits in Kind – Long- term care" SED (S003);
Invoices of the long-term care provider or the notice that has been given to the person concerned can be attached to the SED;
The Counterparty sends the "Entitlement to Benefits in Kind – Long-term care" SED (S003) to the Case Owner;
The Case Owner receives the SED S003;
This use case ends here.
REMARKS: It is up to the competent institution to decide which benefits in kind have to be taken into account for the reduction of cash benefits.
Alternative Scenarios:
Following Branches Determine the use of Horizontal Processes within this Business Process
After [step 5] the Counterparty may optionally choose to request Ad Hoc Information from Case Owner.
The Counterparty executes business use case H_BUC_01 – Ad Hoc Exchange of Info;
[This Branch] Ends.
After [step 8] the Case Owner may optionally choose to request Ad Hoc Information from the Counterparty.
The Case Owner executes business use case H_BUC_01 – Ad Hoc Exchange of Info;
[This Branch] Ends.
Following Branches Determine the use of Administrative Processes
within this Business Process
Between [step 5] and [step 6], the Counterparty may optionally choose to Forward this Business Process to another Competent Institution within its Member State who assumes responsibility for handing it
The Counterparty executes business use case AD_BUC_05 – Forward Case;
[This Branch] Ends.
After [step 5] Counterparty may optionally choose to send a reminder in order to receive the answer to Ad Hoc Information expected and not yet received.
The Counterparty executes business use case AD_BUC_07 – Reminder;
[This Branch] Ends.
After [step 8] Case Owner may optionally choose to send a reminder in order to receive the answer to Ad Hoc Information expected and not yet received.
The Case Owner executes business use case AD_BUC_07 – Reminder;
[This Branch] Ends.
Exceptions:
None
Includes:
See diagram at part 4.4
Special Requirements:
SR0 : General Rule
As the information is individualised the case can concern only one person.
SR1: Rules about the invoking of Branches:
Horizontal
[Branch 1] – May be invoked more than once
[Branch 2] – May be invoked more than once
Administrative
[Branch 3] – May be invoked once only when the first SED is received by Counterparty and before sending the answer.
[Branch 4] – May be invoked more than once.
[Branch 5] – May be invoked more than once.
Assumptions:
Notes and Issues:
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)
S001
S003
Attachments Allowed
The following table specifies whether attachments are permitted to be included when sending a SED type.
SED
Attachments
S001
Allowed
S003
Allowed
Artefacts used
The following table specifies the artefacts that are used in this Business Use Case.
Artefact name
Artefact type
S001
SED
S003
SED
H_BUC_01_Subprocess
BUC
AD_BUC_05_Subprocess – Forward Case
BUC
AD_BUC_07_Subprocess – Reminder
BUC
AD_BUC_11_Subprocess – Business Exception
BUC
AD_BUC_12_Subprocess – Change of Participant
BUC
Business Processes
This chapter describes the Business Use Case Long-Term Care Cash Benefits – Information on Payment using BPMN 2.0.
Case Owner and Counterparty
Figure 2: depicts the use case end-to-end for the Case Owner and Counterparty, from a high level, using the BPMN 2.0 collaboration diagram
Sub Processes
Not applicable.
Appendices
Issues
#
Issue date
Description
Solution
Close date
1
07/03/2016
SED S001 & S003 mention article 28 of Regulation (EC) 987/2009. This article is not mentioned in the Guidelines.
Comment from Germany: 'it should be deleted from SED'
Article 28 will be suppressed from SEDs S001 and S003 in version 4 of the SED (see JIRA ticket EESSIDRY-1428)
2
07/03/2016
Remark on SED S001 (p. 73 of Guidelines): in case of ambiguities, this SED has to be sent to the institution which also receives (or already confirmed) the registration SED S072 or PD S1.
What does it mean?
Comment from Germany: Especially in France the institution that provides benefits in kind in case of long-term care is not the institution that confirms the registration of a person with S073. The latter one is CPAM which provides benefits in kind in case of sickness.
07/06/2016
3
29/04/2016
Section 5.1 – Identify Participants' diagram, comment from Germany: 'Select competent institution as Participant” seems to be incorrect. It should be “Select institution of place of residence or stay as participant”.
This diagram is a general diagram which is used within all the BUCs. This means that the terminology used is the general one.
So "Select Competent Institution as Participant" should be read as "Select institution of place of residence or stay as participant"
07/06/2016
4
29/04/2016
Comments from Germany: ' From my point of view AD_BUC_11 requires that competent institutions as well as AP provider work with a kind of BUC-state control engine.
I doubt whether this is in line with our general approach.
How can we manage that this issue will be discussed and solved?'
There is a difference between the implementation and the rules. It should probably be controlled at the national level application, but the rules, if implemented on national level, should be described somewhere. This document captures this kind of requirements and behaviour.
07/06/2016
5
28/06/2016
Conversion of the BPMN to split between Case Owner and Counterparty.
Scheduled for update.
6
23/08/2016
Germany proposes to make section 4.2 of SED S003 repeatable in order to share information about several sorts of payments. In many cases in the area of long-term care, payments are made ad-hoc or as lump sum, but there are also monthly payments… LTC- SEDs should be able to adapt to this variety.
This will be handled in V4 of the SED (JIRA ticket EESSIDRY-1427)
7
23/08/2016
Section 4.2 should be made mandatory in case section 4.1 'Entitlement or not'="The person concerned is entitled to benefits in kind – long term care".
This will be handled in V4 of the SED (JIRA ticket EESSIDRY-1427)
8
08/11/2016
"Reminder" Admin BUC should be added in the BPMN diagram for Case Owner and Counterparty.
Scheduled for update.