APPROVED
APPROVED
International Process Guidelines
Sickness
S_BUC_17a – Long-term care – Change of Entitlement to Benefits in kind
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_17a – Long-term care – Change of Entitlement to Benefits in Kind 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
CP.1 What should I do if I receive ‘Information on ' SED S005? 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? 6
BPMN diagram for S_BUC_17a 7
Structured Electronic Documents (SEDs) used in the process 7
Administrative sub-processes 7
Horizontal sub-processes 7
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
05/10/2017
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_17a – Long-term care – Change of Entitlement to Benefits in Kind
Description: 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 concerned person 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 Business Use case enables the institution of the Member State of Residence/Stay to inform the institution of the Competent Member State about any change concerning the benefits in kind granted under its legislation in order to allow the competent institution to adapt the amount of cash benefits if necessary.
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.
Legal Base: The 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 (883/2004)
Implementing Regulation (987/2009)
SED
34
31
S005 - Information on Change of Entitlement to Benefits in Kind – Long term care.
Glossary of relevant terms used in S_BUC_17a:
Term used
Description
Case Owner
In this BUC, the Case Owner is the institution of the place of residence/ stay which sends to the institution of the Competent Member State information concerning any change related to long-term care benefits in kind.
Counterparty
In this BUC, the Counterparty is the institution in the Competent Member State which receives from the institution of the Member State of residence/stay information about any change related to long-term care benefits in kind.
How to start this BUC?
In order to help you understand S_BUC_17a 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 the Member State of Residence/Stay that should inform the institution of the Competent Member State that the amount of benefits in kind communicated has changed, your role will be defined as the Case Owner.
I am the Case Owner. (step CO.1)
If you are the institution of the Competent Member State that needs to be informed about changes concerning benefits in kind granted under its legislation in order to allow to adapt the amount of cash benefits if necessary, 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 where the person is insured. The second step is to identify the relevant institution in this Member State that you need to exchange information with. 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 in this BUC, you can identify the counterparty by checking who sent SED S001 or SED S056 which means that S_BUC 15 or S_BUC 17 already took place between you and the counterparty.
The receiving institution should be the institution which previously sent S001 or SED S056.
Please note that you can also check which institution issued the person’s registration document PD S1, SED S072, 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?
You should fill in 'Information on Change of Entitlement to Benefits in Kind – Long term care' SED S005, by entering all required data:
- The fixed or the open period;
- The information about the amount, currency and frequency of payment.
- The description of the benefits, if necessary.
After filling it in, you can send it to the Counterparty. The Business Use Case ends here.
In some cases it may turn out later that you need to invalidate the SED S005.
Sub-process steps available to the Case Owner at this stage:
I want to invalidate the sent SED (AD_BUC_06).
CP.1 What should I do if I receive ‘Information on ' SED S005?
If you have received an 'Information on Change of Entitlement to Benefits in Kind – Long term care' SED S005 from the Case Owner, first you check if you are responsible to process the received request in accordance with your national procedures.
I am responsible for the business process (CP.2)
I am not responsible for the business process (CP.3)
CP.2 What should I do if I am responsible for the business process?
If you have confirmed that you are responsible for handling this case
you need to review the information and apply to your national case. You do not need to reply anything to the Case Owner.
The Case Owner might also invalidate the information provided on SED S005.
Unless you want to request for additional information or unless you receive any other information from the Case owner, this business use case ends here.
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 previously requested ad-hoc information that I expected, but did not yet receive (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 to handle the received SED but another institution in your country is, you forward the case to the competent Institution in your Member State using the 'Forward Case' sub-process AD_BUC_05. This can be used only once and it interrupts the main process.
If you are not responsible to handle the received SED but you do not know which other institution in your country is the competent one or If you cannot identify the petitioner in your database or there is no insurance record of that person in your country, you can reject SED S005 by using the Administrative process Reject (AD_BUC_09);
Before you forward the case you can ask for any additional information which is required to provide a reply.
Sub-process steps available to the Counterparty at this stage:
I want to forward the case to another Competent Institution in my Member State because I am not or no longer competent to treat it (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 previously requested ad-hoc information that I expected, but did not yet receive (AD_BUC_07).
I want to Reject a received SED (AD_BUC_09)
You can Forward the Case only once, the rest you can perform multiple times.
BPMN diagram for S_BUC_17a
Click here to open the BPMN diagram(s) for S_BUC_17a.
Structured Electronic Documents (SEDs) used in the process
The following SEDs are used in S_BUC_17a:
SED S005 - Information on the End of Incapacity for Work – given by institution of residence/stay;
Administrative sub-processes
The following administrative sub-processes are used in S_BUC_17a:
AD_BUC_05_Subprocess – Forward Case
AD_BUC_06_Subprocess.docx - Invalidate SED
AD_BUC_07_Subprocess – Reminder
AD_BUC_09_Subprocess – Reject SED
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_17a:
H_BUC_01_Subprocess Ad hoc exchange of information