S_BUC_07 - Scheduled Treatment - Information on Coverage of Specific Benefit in Kind | Lexipedia

EESSI Business Use Case

Annex Nr.13 to the note AC 370/16rev

Approved

S_BUC_07 - Scheduled Treatment - Information on Coverage of Specific Benefit in Kind

Table of Contents

Table of Contents 2

1. Introduction 7

1.1. Purpose 7

1.2. Scope 7

1.3. Definitions, Acronyms and Abbreviations 7

1.4. Overview 8

2. Description 9

2.1. Business Scenario 9

2.2. Legal Base 9

3. Actors & Roles 10

4. Use Case 11

4.1. RUP Table Representation 11

4.2. Request – Reply SEDs 13

4.3. Attachments Allowed 13

4.4. Artefacts used 13

5. Business Processes 15

5.1. Main Process 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_07 - Scheduled Treatment - Information on Coverage of Specific Benefit in Kind

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:

09/08/2018

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

10/01/2015

Mirko Brusca

First draft

v0.2

21/04/2015

Mirko Brusca

Final adjustment after Chris SEGAERT and Alyson LONGSTAFF review

v0.3

19/08/2015

Carine Molle

Document history: table is now in reverse chronological order.

Grammatical corrections (minor correction) based on feedback received from Alyson LONGSTAFF in another BUC.

Chapter 2:

2.1 last sentence of paragraph has been modified

2.2 Basic Regulation No 883/994 has been replaced by No 883/2004

Chapter 5

Section 5.3:

- Diagram for "Identify Participants" sub-process has been added

- Diagram for "Fill and send SED" sub-process has been replaced by the new one

v0.4.0

19/01/2016

Carine Molle

Document has been updated with remarks and comments received from Belgium.

As agreed during the AHG Members 04/11/2015, H_BUC_01 is added for Case Owner and Counterparty

AD_BUC_05 Forward is added for Counterparty

Claimant is removed from the BUC.

Parts of the document have been added in order to be in line with document presentation and content to be approved by Administrative Commission.

Chapter 2

2.1 Detailed Description is renamed and updated. Last sentence is

removed.

2.2 Legal Base is updated.

Chapter 3 Actors & Roles

Claimant is removed.

Chapter 4: RUP Table Representation

"Actors" – Claimant is removed

"Main Scenario" – step 5 and Step 8 are added

"Exceptions" has been added

"Includes" is updated

"Alternatives scenarios" are added

- Branch 1 and 2 : H_BUC_01 is added for Case Owner and Counterparty

- Branch 3: AD_BUC_05 Forward is added for Counterparty

"Special Requirements" is updated according to the branches added

Section 4.2 Request – Reply SEDs is added

Section 4.3 Attachments allowed is added

Section 4.4 RUP UC Diagram Representation is updated

(H_BUC_01 and AD_BUC_05 Forward are added, Claimant is removed)

Section 4.5 SED and Sub-process versioning is added

Chapter 5: Business Processes

Section 5.1 Case Owner is updated (H_BUC_01 is added and claimant removed)

Section 5.2 Counterparty is updated (H_BUC_01 and AD_BUC_05 are added)

Section 5.3 Called Sub Processes (Identify Participants is updated)

Section 5.4 Main Scenario is removed

Chapter 6 Appendices

Section 6.1 Related Use Cases is removed

Section 6.2 Privacy and Security Assumptions is removed

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)

v0.4.1

02/03/2016

Carine Molle

Editorial changes.

Section 4.1 RUP Table Description

Branch 3: At [step 5] has been replaced by

After [step 5] and before [step 6]

Section 5 Business Processes

Diagrams have been replaced by the new ones.

v0.99.0

15/04/2016

Carine Molle

Candidate for AC Approval as agreed by the Sickness rapporteur.

v0.99.1

01/06/2016

Carine Molle

Document has been updated based on remarks received during AC document review process.

Section 4.1 RUP Table Description

Preconditions are changed.

v1.0.0

28/06/2016

Valérie

Banchereau

Status logo set to 'Approved' following AC approval of June, 20th 2016.

Alignment to the standard description and layout of the BUC.

v1.1.0

13/06/2017

Eric Briffoz

Change Request EESSI-1798: As agreed by AHG members, "AD_BUC_07 – Reminder" has been added for Case Owner and Counterparty:

- Correction Section 4: description of Branches 'Reminder' – Branches 4 and 5

-Correction Section 4, Branch 1 and 2, withdraw the use of H_BUC_01 as 'Reminder'

v1.1.1

20/06/2017

Joël Fiora

-Included BPMN picture in section 5

v1.1.2

29/06/2017

Joël Fiora

- removed Use Case diagram

v4.1.0

09/08/2018

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 any consideration as to which part(s) may be realized 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, and business processes.

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 utilizes. 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 concerning Scheduled Treatment - Information on Coverage of Specific Benefit in Kind. The different elements like use case description, business actors, and business process as well as supporting UML diagrams and BPMN models pertaining to the Scheduled Treatment - Information on Coverage of Specific Benefit in Kind case.

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 Scheduled Treatment - Information on Coverage of Specific Benefit in Kind 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 Scheduled Treatment - Information on Coverage of Specific Benefit in Kind business process.

Chapter 4 describes in detail the Scheduled Treatment - Information on Coverage of Specific Benefit in Kind business process based on the RUP use case template, as well as the relationship to other use cases.

Chapter 5 describes the Scheduled Treatment - Information on Coverage of Specific Benefit in Kind business process using business process modelling notation (BPMN).

Description

Business Scenario

When an insured person asks for an authorization to receive treatment outside the competent Member State, the competent institution, prior to issuing a portable document S2, asks an institution in the Member State where the insured person is to undergo a scheduled treatment whether the particular treatment is covered in that Member State of stay. This BUC models the exchange of information needed in the aforementioned case.

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)

S014

S015

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 Institution of the competent Member State where the insured person asks an authorization to receive an appropriate (scheduled) treatment outside the Member State of residence / competent Member State.

Counterparty

In this BUC The Counterparty is the Institution of the Member State of stay where the insured person is going to receive the treatment.

Table 2: Actors & Roles

Use Case

RUP Table Representation

Use Case ID:

S_BUC_07

Use Case Name:

Scheduled Treatment - Information on Coverage of Specific Benefit in Kind

Created By:

Mirko Brusca

Last Updated By:

Carine Molle

Date Created:

10/01/2015

Last Revision Date:

02/03/2016

Actors:

Case Owner

Counterparty

Description:

This case deals with the situation when the insured person (claimant) asks for the authorization to receive an appropriate (scheduled) treatment outside the Member State of residence / competent Member State. The competent institution, prior to issuing a portable document S2, needs to know whether the particular treatment is among the benefits in kind covered by the Member State of stay.

This case models the request for information issued by the competent institution of the competent Member State and the reply by the

institution in the Member State of stay.

Trigger:

The insured person applies for an authorisation to the institution of the competent Member State/Member State of residence

Preconditions:

The insured person has applied for an authorization for a scheduled treatment outside his/her country of residence.

Post Conditions:

Competent institution is informed whether the particular treatment is covered in that Member State of stay.

Main Scenario:

Identify Participants

The Case Owner identifies the Member State where the person is to undergo a scheduled treatment;

The Case Owner then identifies the correct institution in the Member State of stay. There will be only one counterparty. The Case Owner and the Counterparty are herein collectively referred to as the Participants;

Request for information

The Case Owner fills in the Information of "Request for information if treatment is provided for by Member State of stay" (S014) entering the nature of its request (i.e. whether the treatment is provided for by the legislation of the Member State of stay and/or how much the treatment would cost);

The Case Owner sends the S014 to the Counterparty;

Reply to the request

The Counterparty receives S014;

The Counterparty fills in an "Information if treatment is provided for by Member State of stay" (S015) with the requested information (i.e. whether the treatment is provided for by the legislation of the Member State of stay, its cost,

etc.);

The Counterparty sends the S015 to the Case Owner;

The Case Owner receives the S015;

This use case ends here.

Alternative Scenarios:

The Following Branches determine the use of Horizontally Defined Sub Processes within the Business Process

At any step after [step 5] the Counterparty may optionally choose to request AdHoc Information from Case Owner

The Counterparty executes business use case H_BUC_01 – Adhoc Exchange of Info;

[This Branch] Ends.

At any step after [step 8] the Case Owner may optionally choose to request AdHoc Information from Counterparty

The Case Owner executes business use case H_BUC_01 – Adhoc Exchange of Info;

[This Branch] Ends.

The Following Branches determine the use of Administrative Defined

Sub Processes within the Business Process

After [step 5] and before [step 6], the Counterparty may optionally choose to Forward this Business Process to another Institution within its MS who assumes responsibility for changing it

The Counterparty executes business use case AD_BUC_05 – Forward Case;

[This Branch] Ends.

At any step after [step 5], the Case Owner may optionally choose to send a reminder in order to receive Information expected and not yet received.

The Case Owner executes business use case AD_BUC_07_ -_Reminder;

[This Branch] Ends

At any step after [step 5], the Counterparty may optionally choose to send a reminder in order to receive Information expected and not yet received.

The Counterparty 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 individualized the case can concern only one person.

SR1: Rules about 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 when the first SED is received by the 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 SED that have a logical pairing to one another, usually this is known as a request-reply pair.

REQUEST SED

REPLY SED(s)

S014

S015

Attachments Allowed

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

SED

Attachments

S014

Allowed

S015

Allowed

Artefacts used

The following table specifies the artefacts that are used in this Business Use Case.

Artefact name

Artefact type

S014

SED

S015

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 Scheduled Treatment - Information on Coverage of Specific Benefit in Kind using BPMN 2.0.

Main Process

Figure 2: depicts the use case end-to-end of 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

Replies

Action/Resolution

Close date

28/06/2016

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

Scheduled for update.