S_BUC_24 - Aggregation of Periods - Insurance Risk Type : Sickness, Paternity and Maternity

EESSI Business Use CaseEESSI Business Use Case&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&& EESSI Business Use Case EESSI Business Use Case APPROVEDAPPROVED APPROVED APPROVED S_BUC_24Aggregation of Periods - Insurance Risk Type: Sickness, Paternity and Maternity S_BUC_24Aggregation of Periods - Insurance Risk Type: Sickness, Paternity and Maternity S_BUC_24 Aggregation of Periods - Insurance Risk Type: Sickness, Paternity and Maternity S_BUC_24 Aggregation of Periods - Insurance Risk Type: Sickness, Paternity and Maternity Table of Contents Table of Contents 2 Document Control Information Settings Value Document Title: Business Use Case S_BUC_24 - Aggregation of Periods - Insurance Risk Type : Sickness, Paternity and Maternity 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: Public Date: 08/08/2018 Document history: The Document Author is authorized 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 13/10/2015 Carine Molle First draft of the document v0.2 11/12/2015 Carine Molle Updated based on comments and remarks received from Ad Hoc Group Members Section 4.1: RUP Table Representation Branch 2 is added (H_BUC_01) available for Case Owner Branch 3 is added (Forward) for Counterparty Section 4.4: RUP UC Diagram Representation updated Section 5.1 Case Owner BPMN diagram updated Section 5.2 Counterparty BPMN diagram updated Document has been updated in order to be in line with presentation and content as proposed for the approval by the Administrative Commission Section 2.1: last sentence is removed Section 2.2 minor updates Section 4.2: Request – Reply SEDs added Section 4.3: Attachments allowed added Section 4.5: SED and Sub-process versioning added Section 5.4: Main scenario is removed Section 6.1 is removed while replaced by section 4.5 v0.2.1 15/01/2016 Carine Molle Document has been updated with remarks / questions and feedbacks received from Germany and Belgium. Minor changes which do not impact the process itself have been implemented through the document.

Section 4.1: RUP Table Representation Step 2: Reference to "Residence Member State(s)" is removed see comment from Belgium in section 6.1 Step 3: "and" has been added at the end of each sentence Step 6: details have been added for the periods Special rule: Aggregation periods type benefits in cash or benefits in kind is removed Section 5.3 Called sub-processes Identify participants diagram has been changed Version number of the document has been changed to be in line with the convention M.m.p where:

• M = Major version (e.g. Approved by AC)

• m = Minor version (e.g. changes in the process)

• p = Patch version (e.g. wording…any changes without any impact on the process itself) v0.2.2 09/02/2016 Carine Molle Comments received from Germany have been implemented Section 2.1 is renamed Section 3 Actors and Roles Description for Case Owner is updated Section 4 RUP Table Representation Description is updated SR0 is updated v0.3.0 22/06/2016 Valérie Banchereau Alignment to the standard description and layout of the BUC. v0.4.0 17/08/2016 Carine Molle Comments received from AC have been implemented. v0.99.0 21/09/2016 Carine Molle Candidate for AC approval. Remaining AC comments will be discussed during the AHG meeting the 4th October 2016. More details related to these comments can be found in section 6.1 of this document v0.99.1 17/11/2016 Carine Molle Last comments received from Germany and agreed by AHG members have been accepted in the document. As agreed by AHG members "Reminder" has been added for Case Owner and Counterparty. Section 4.1 has been updated (Branch 4 and 5 added) Section 4.4 has been updated (Reminder is added) Section 4.5 SED and Sub-process Versioning (Reminder is added) Submitted for AC 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 with the version of the diagram

• removed Use Case diagram v1.0.2 08/02/2018 Joël Fiora Section 4.1: as requested by the AHG, removed the references to the fields or sections of the SEDs. Section 4.1 : replace 'Flow' by 'Case' v4.1.0 08/08/2018 Eric Briffoz

• Section 4.4: merged 2 tables (for SED & for Subprocesses) into 1 Artefact table.

• Version adaptations to release 4.1.0

1 Introduction

1.1 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.

1.2 Scope

This document is limited to the external view of the Sickness´ sector process concerning the Aggregations of Periods – Insurance Risk Type: Sickness, Paternity and Maternity. The different elements like use case description, business actors, and business process as well as supporting UML diagrams and BPMN models pertaining to the Aggregations of Periods – Insurance Risk Type: Sickness, Paternity and Maternity.

1.3 Definitions, Acronyms and Abbreviations

Please see the EESSI Project Glossary here.

1.4 References

# Description EC Regulation 883/2004 Regulation EC No 883- 2004.pdf EC Regulation 987/2009 Regulation EC No 987-2009.pdf UML 2.x http://www.omg.org/spec/UML/ BPMN 2.0 http://www.omg.org/spec/BPMN/index.htm UML 2.0 In Action Henriette Baumann, Patrick Grassle & Philippe Baumann, 2005, ISBN 1904811558 RUP@EC standard 5.0 http://www.cc.cec/RUPatEC_Standard/ RUP op maat http://www.rupopmaat.nl/

1.5 Overview

Chapter 1 introduces the external view on the business system under review and lists the elements of this specification. Chapter 2 introduces the Aggregations of Periods – Insurance Risk Type: Sickness, Paternity and Maternity 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 Aggregations of Periods – Insurance Risk Type: Sickness, Paternity and Maternity business process. Chapter 4 describes in detail the Aggregations of Periods – Insurance Risk Type: Sickness, Paternity and Maternity business process based on the RUP use case template, as well as the relationship to other use cases. Chapter 5 describes the Aggregations of Periods – Insurance Risk Type: Sickness, Paternity and Maternity business process using business process modelling notation (BPMN). 2. Description

2.1 Business Scenario

As the regulation dictates (Art. 6 of 883/04 and Art. 12 of 987/09), the Competent Institution of a Member State should take into account periods of insurance, employment, self-employment or residence completed under the legislation of any other Member States as though they were periods completed under the legislation it applies. In this particular case, the Competent Institution of a Member State shall contact the institutions of Member States to whose legislation the person concerned has also been subject in order to determine all the periods completed under their legislation. In accordance with the new regulations, information about relevant periods of insurance, employment, self-employment or residence can only be requested by the Competent Institution. There is no portable document which could be issued directly to the person concerned.

2.2 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 (883/04) Implementing Reg (987/09) 12(1) S040 S041 Table 1: SED – Legal base relationship matrix 3. 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 Competent Institution of a Member State where the person is insured. The Case Owner contacts the institution of another Member State to determine all the periods completed under its legislation. Counterparty In this BUC the Counterparty is the Institution of another Member State whose legislation the insured person has also been subject to. Table 2: Actors & Roles 4. Use Case

4.1 RUP Table Representation

Use Case ID: S_BUC_24 Use Case Name: Aggregations of Periods – Insurance Risk Type : Sickness, Paternity and Maternity Created By: Carine Molle Last Updated By: Carine Molle Date Created: 13/10/2015 Last Revision Date: 25/112016 Actors: Case Owner Counterparty Description: This case aims at exchanging information needed for the aggregation of periods of insurance, employment, self-employment or residence completed under the legislation of another Member State other than the Competent Member State. In this particular case, the Competent Institution of a Member State shall contact the institution of a Member State to whose legislation the person concerned has also been subject in order to determine all the periods completed under its legislation. The periods completed in another Member State should be taken into account in the Competent Member State as though they were completed under its legislation. This case concerns only one insurance risk type at a time (i.e. sickness, maternity or paternity) and one Member State at a time. Trigger: The Competent Institution whose legislation makes the acquisition, retention, duration or recovery of the right to sickness, maternity and equivalent paternity benefits conditional upon the completion of periods, needs a confirmation of relevant periods that the person concerned claims to have completed under the legislation of another Member State. Preconditions: The insured person claims to have completed periods of insurance, employment, self-employment or residence under the legislation of (a) Member State(s) other than the Competent Member State. These periods should be taken into account as though they were completed under the legislation of the Competent Member State. Post Conditions: The Competent Member State is informed that the person concerned did not complete any periods or, that the person concerned completed the requested periods under legislation of (a) Member State(s) other than the Competent one. If the insured person has completed the requested periods, they can be aggregated. Main Scenario: Identify Participants 1. The Case Owner (Competent Member State's Institution) identifies the Member State(s) where the person has completed periods of insurance, employment, self-employment or residence;

2. The Case Owner then identifies the correct institution (Counterparty). There will be only one Counterparty. The Case Owner and the Counterparty are herein collectively referred to as the Participants. Process to Request for Insurance Periods : Sickness, Maternity or Paternity 3. The Case Owner fills in the Request for Periods – Insurance Risk Type : Sickness and Maternity (S040) by entering the required information; S040 is filled-in for one type of benefits, one category of benefits, one insured person, one Member State and one institution. The Case Owner will possibly execute this case multiple times to request all completed periods in different Member States for each type of benefits and by category for an insured person. This way of working promotes smooth communication and clearly defines the scope of responsibility of the institutions involved; 4. The Case Owner sends the S040 to the Counterparty. Process for the Reply to Request for Periods : Sickness, Paternity and Maternity 5. The Counterparty receives the S040; 6. The Counterparty fills in the Reply to Request for Periods – Insurance Risk Type: Sickness, Paternity and Maternity (S041) to inform the Competent Institution that the person concerned did not complete any periods under its legislation or to confirm the requested periods completed by the insured person under its legislation. The information provided in the Section 4 is linked to periods that strictly correspond to the nature (benefits in kind or in cash) and to the type (sickness, maternity or paternity benefits) requested in the S040. 7. The Counterparty sends the S041 to the Case Owner; 8. The Case Owner receives the S041; 9. This use case ends here. Alternative Scenarios: The Following Branches determine the use of Horizontally Defined Processes within this Business Process Branch 1:. between [step 5] and [step 6], in case of ambiguities, the Counterparty may optionally choose to request AdHoc Information from the Case Owner 1. The Counterparty executes business use case H_BUC_01 – Adhoc Exchange of Info; 2. [This Branch] Ends. Branch 2:. After [step 8] the Case Owner may optionally choose to request AdHoc Information from the Counterparty 1. The Case Owner executes business use case H_BUC_01 – Adhoc Exchange of Info; 2. [This Branch] Ends.

The Following Branches determine the use of Administrative Defined Sub-Processes within this Business Process Branch 3:. At [step 5] the Counterparty may optionally choose to Forward this Business Process to another Competent Institution within its MS who assumes responsibility for handling it 1. The participant executes business use AD_BUC_05 – Forward Case; 2. [This Branch] Ends. Branch 1:. After Branch 1 [step 1] Counterparty may optionally choose to send a reminder in order to receive the answer to Ad Hoc Information expected and not yet received. 1. The Counterparty executes business use case AD_BUC_07_ -_Reminder; 2. [This Branch] Ends Branch 2:. At any step after [step 4] Case Owner may optionally choose to send a reminder in order to receive Information expected and not yet received. 1. The Case Owner executes business use case AD_BUC_07_ -_Reminder; 2. [This Branch] Ends Exceptions : None Includes: See diagram at part 4.4 Special Requirements: SR0: General Rule The case can concern only one person. The case can concern, only one

• Other Member State than the Competent Member State;

• Categories of benefits : sickness, maternity or paternity Each case can be handled by separate institutions. SR1: Rules about the invoking of Branches: Horizontals [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:

4.2 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) S040 S041

4.3 Attachments Allowed

The following table specifies whether attachments are permitted to be included when sending a SED type. SED Attachments S040 Allowed S041 Allowed

4.4 Artefacts used

The following table specifies the artefacts that are used in this Business Use Case. Artefact name Artefact type S040 SED S041 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 5. Business Processes This chapter describes the Business Use Case the Aggregations of Periods – Insurance Risk Type: Sickness, Paternity and Maternity using BPMN 2.0.

5.1 Case Owner and Counterparty

Figure 2: depicts the use case end-to-end, from a high level, using the BPMN 2.0 collaboration diagram

5.2 Sub Processes

Not applicable. 6. Appendices

6.1 Issues

# Issue date Description Replies Action/Resolution Close date 11/12/2015 Forward option Should be available as agreed at the beginning of the process Document is updated 16/12/2015 11/12/2015 H_BUC_01 should be added for the Case Owner Comment received from CZ: It should be possible to start the horizontal process or sub process anytime throughout the whole BUC by every party. This allows counterparty to inform about its incompetence for proceeding of SED, or about probably more suitable institution. No other admin messages are needed. H_BUC_01 should be added for the Case Owner Document is updated 16/12/2015 11/12/2015 What about reject option? We do not support this option, because this “rejection” SED in fact provides nothing more than horizontal information. H001 can serve the same purpose. No action required 11/12/2015 15/01/2016 Section 4.1 – step 1 Reference to "Residence Member State(s)" is removed. Comment received from Belgium Not necessarily: e.g. if insured person was a frontier worker and lives in FR but worked in LU, then a request for information on the insurance periods should be sent to LU and not FR. Proposal: delete “Residence Member State)” 15/01/2016 Section 4.1 – Step 3 Comment received from Belgium : Title of SED S040 should be modified by adding reference to parternity, cf. texts of the Regulations and box 4.2 of SED S040. Proposal: title of SED S040 to be adapted by adding reference to Paternity 21/09/2016 AD_BUC_06_Subprocess – Invalidate SED should be added for the case owner - if the S040 was sent by mistake it have to be possible to invalidate such message. If there is no such option, the case is pending and stays active. This AD_BUC_06 should be used only before the reply on S041 is received. Because after that there is no point of invalidation. AHG members suggest adding an additional refusal code in the S041. If this additional refusal code is part of the SED, Admin BUC "Reject" is not needed anymore. No change in the document 25/11/2016 21/09/2016 title (and all places it is mentioned) Please change into: Aggregation of Periods - Insurance Risk Type : Sickness, Maternity/ Paternity - in accordance to Article 3 of BR we have sickness benefits, maternity benefits and equivalent paternity benefits AHG members agreed on the suggestion. The title of the BUC has been changed in the document. 25/11/2016 21/09/2016

/ 4.1 / Alternative scenarios If it is true that Reminder field will be deleted from the SED H001, then the AD_BUC_07_Subprocess – Reminder should be added both to allow the Case Owner to send a reminder after S040 and the Counterparty to send a reminder after H001 (request for ad hoc info). If it is not true, we have some doubts towards the fact that 2 types of exchange of information has been put together in branch 1, ie. ad hoc exchange of information and reminder using the same H_BUC_01. It is worth to note that reminder has its own dedicated AD BUC. During the AHG meeting in November, AHG members agreed to introduce the Admin sub-process "Reminder" in all the "Request - Answer" BUCs and in BUCs in which H_BUC_01 is used "Reminder" is added for Case Owner and Counterparty 25/11/2016 21/09/2016 Please, add AD_BUC_09_Subprocess – Reject SED for situations when the SED S040 is sent to a wrong institution which cannot forward it within the MS (the AHG proposes to use H001 instead which is a longer one to be filled in) AHG members suggest handling this remark when reviewing the SED. They will foresee in the SED a similar function that the "Reject". No change in the document 25/11/2016 21/09/2016 Please consider to add AD_BUC_10_Subprocess – Update SED at least for Case Owner after sending S040. The possibility to update S040 should be limited by the receipt of a reply on S041. AHG members suggest starting a new case instead of updating the SED previously sent. No change in the document 25/11/2016 21/09/2016 Page 11/Par. 3/line 14 of par. 3 Please consider: Instead of sending (executing) this BUC multiple times, improvement may be done by making this SED (S040) multilateral, ie. A clerk prepares only 1 SED but sends it to several MSs. Replies should be received only by the sender of S040. There is no need to have multilateral BUCs. In principle, the Case Owner contacts the previous Member State. It is only if the period is not covered, that the Member State just before will be contacted. No change in the document 25/11/2016 25/11/2016 BPMN diagrams will be updated. "Reminder" will be added for Case Owner and Counterparty Scheduled for update.