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EESSI Business Use Case

S_BUC_15

Long Term Care Cash Benefits- Application

S_BUC_15

Long Term Care Cash Benefits- Application

Table of Contents

Table of Contents 2

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_15 - Long Term Care Cash Benefits- Application

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:

V1.0.2

Sensitivity:

Internal

Date:

09/02/2018

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

03/03/2016

Valérie Banchereau

First draft of the document

V0.1.1

07/06/2016

Valérie Banchereau

Comments received from Germany have been accepted. Comments from Germany added.

Section 4.1 : RUP Table Description

Post Conditions has been changed

Section 6.1: Issues has been completed with the remarks and comments received 'Post Conditions' description changed: 'The Competent Member State receives information from the Member State of residence / stay if it provides or not long-term care benefits in kind for the concerned person concerned'. Germany proposes

'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”.'

V0.2.0

27/06/2016

Valérie Banchereau

Alignment to the standard description and layout of the BUC.

Section 2.1: first sentence of Business Scenario description adapted to be aligned with S_BUC_17 and S_BUC_17a.

Section 4.1:

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.

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

30/06/2017

Joël Fiora

-Included BPMN picture in section 5

-Correction in the horizontal sub-process in section 4.5

- removed Use Case diagram

V1.0.2

09/02/2018

Joël Fiora

- Section 4.1: as requested by the AHG, removed the references to the fields or sections of the SEDs.

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

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 - Application. 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 Benefit – Application.

Definitions, Acronyms and Abbreviations

Please see the EESSI Project Glossary here.

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/

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 - Application 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 - Application business process.

Chapter 4 describes in detail Long Term Care Cash Benefits - Application business process based on the RUP use case template, as well as the relationship to other use cases.

Chapter 5 describes Long Term Care Cash Benefits – Application 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 allows the competent Member State to inform the Member State of residence or stay about an application for long-term care benefits in cash for the person concerned.

The Member State of residence or stay informs the competent Member State if he provides long-term care benefits in kind or not for the insured person as it is described in article 34(2) of the Basic Regulation.

This case is optional and is only relevant if the legislation of the Member State of residence or stay provides long-term care benefits in kind.

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 Reg.(883/2004)

Implementing Reg.(987/2009)

SED

S056

S057

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 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 he provides or not long term care benefits in kind to the person concerned.

Table 2: Actors & Roles

Use Case

RUP Table Representation

Use Case ID:

S_BUC_15

Use Case Name:

Long Term Care Cash Benefits - Application

Created By:

Valérie Banchereau

Last Updated By:

Carine Molle

Date Created:

01/03/2016

Last Revision Date:

08/11/2016

Actors:

Case Owner

Counterparty

Description:

A person applies for long-term care benefits in cash from the competent

Member State whereas he/she resides or stays in another Member State. If the person concerned already 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 may become applicable.

This particular case allows the competent Member State to inform the Member State of residence or stay about an application for long-term care benefits in cash of the person concerned.

The Member State of residence or stay informs the competent Member State if he provides long-term care benefits in kind within the meaning of article 34(2) of the Basic Regulation to the insured person.

This case is optional and is only relevant if the legislation of the Member State of residence or stay provides long-term care benefits in kind.

Trigger:

An insured person residing or staying in a Member State whose legislation provides for long-term care benefits in kind applies for 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 applies for 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 application for 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 Notification of Application for Cash Benefits – Long term Care

The Case Owner fills in the "Notification of Application for Cash Benefits – Long Term Care" SED (S056) by entering all required data;

The Case Owner sends the "Notification of Application for Cash Benefits – Long Term Care" SED (S056) to the Counterparty;

The Counterparty receives the "Notification of Application for Cash Benefits – Long Term Care" SED (S056).

Reply to the notification of application for Cash Benefits – Long term care

The Counterparty fills in the "Reply to notification of application for Cash Benefits – Long Term Care" SED (S057);

The Counterparty sends the "Reply to notification of application for Cash Benefits – Long Term Care" SED (S057) to the Case Owner;

The Case Owner receives the S057;

This Use case ends here.

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 the 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 .

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 request 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)

S056

S057

Attachments Allowed

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

SED

Attachments

S056

Allowed

S057

Allowed

Artefacts used

The following table specifies the version of the SED that are used in this Business Use Case.

Artefact name

Artefact type

S056

SED

S057

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 - Application 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

28/04/2016

Section 4.1 -RUP table Representation: Section 5.2 has to be completed if the option "The person concerned is entitled to benefits in kind – long term care" has been selected in the section 5.1; Comments from GE:

This sentence is right.

But SED S057 does not reflect this obligation yet. Section 5.2 should become mandatory if the MS of residence / stay confirms under Section

5.1 that the person receives benefits in kind according to its legislation.

We need to start working on secondary compulsory fields in all SEDs'.

This will be handled in V4 version of SED S057 (Jira ticket EESSIDRY-1429)

28/04/2016

Section 4.1 RUP Table Description

Special Requirements section - Comment from Germany (BO) - From my point of view SR require that participants 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

28/04/2016

Section 4.5 - SED and Sub-process Versioning, 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?'

07/06/2016

28/04/2016

Section 5.2 Called Sub Processes

Identify Participants

Comment received 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

27/06/2016

Conversion of the BPMN to split between Case Owner and Counterparty.

Scheduled for update.

23/08/2016

Section 5.2 of RUP table: Germany proposes that section 5.2 of SED S057 could be 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 version of SED S057 (Jira ticket EESSIDRY-1429)

08/11/2016

"Reminder" to be added in the BPMN diagram for Case Owner and Counterparty

Scheduled for update.