EESSI – CDM 4.3
S-Sickness
S_BUC_23-v4.3.4
Refund of Overpayment
BUC Guidelines
TABLE OF CONTENTS
S_BUC_23 – Refund of Overpayment 5
How to start this BUC? 6
What is my role in the social security exchange of information I have to complete? 6
CO.1 Who do I need to exchange information with? 6
CO.2 How do I identify the correct institution to exchange information with? 6
CO.3 How do I proceed after having identified the Counterparty? 7
CO.4 What should I do if I received ' Acceptance of request for refund of overpayment' - SED S053A? 7
CO.5 What should I do if I received 'Contestation of request for refund of overpayment' - SED S053C? 7
CO.6 How to create 'Decision on the Refund of Overpayment' - SED S054? 8
CO.7 What should I do if I received 'Decision on the Refund of Overpayment' - SED S054? 8
CP.1 What should I do if I have received the ‘Request for refund of overpayment (RRO)' SED S051? 8
CP.2 I am responsible for the business process 8
CP.3 What should I do if I am not responsible for the business process? 8
CP.4 What should I do if I want to create and send ‘Acceptance of request for refund of the overpayment – SED S053A? 9
CP.5 What should I do if I want create and send ‘Contestation of request for refund of the overpayment – SED S053C? 9
CP.6 What should I do if I received a Reply to the Contestation of request for refund of Overpayment? 9
CP.7 What should I do if I received Information on the Refund of Overpayment' - SED S054? 9
CP.8 How to create 'Decision on the Refund of Overpayment' - SED S054? 10
BPMN diagram for S_BUC_23 11
Structured Electronic Documents (SEDs) used in the process 11
Administrative sub-processes 11
Sample scenarios 11
Document Control Information
Document Control
Value
Project Title
Electronic Exchange of Social Security Information (EESSI)
Document Name
S_BUC_23-v4.3.4
Document Category
BUC guidelines
Revision
CDM Package
CDM 4.3.4
Last Update
Project Milestone
30/04/2024
EESSI - 2024
Document Status
Final
Sensitivity (TLP)
Distribution terms
Traffic Light Protocol (TLP) = “GREEN”
The distribution of this document is done strictly in line with the Traffic Light Protocol (TLP) established by the European Commission's note AC 790/15 REV for the EESSI project documentation.
In line with the note AC 790/15 REV, this document is labelled as TLP = “Green”. Therefore, it can be circulated widely within the EESSI community. However, the document or the information herein may not be published or posted on the Internet, nor released outside of the EESSI community.
Connected/Embedded Files
None
Authors
European Commission, DG EMPL A4, EESSI BA
Revised by
European Commission, DG EMPL A4, EESSI BA
Approved by
European Commission, DG EMPL A4, EESSI PMO
Document history
Milestone /
Component version
Publication Date
Changes/Corrections
Description
v0.1
17/07/2017
First draft of the document submitted for review to the Sickness Ad Hoc group
v0.2
31/08/2017
Comments received from AHG integrated:
typos and language checks
section "Description" simplified
Version submitted for AC review.
v0.3
06/12/2017
Implemented changes related to the implementation of a contestation loop.
v0.99
08/12/2017
Version submitted for AHG final review.
Version submitted for AC approval.
v1.0
20/12/2017
AC approved version.
v1.1
25/01/2018
Correction of link between SEDs and Forms – JIRA Ticket EESSI-2436
v4.1.0
11/09/2018
Performed patch changes to reference the new CDM version 4.1.0
v4.2.0
01/09/2019
Implementation of Change Request EESSI-5134: improving the Contestation loop: CP.6 updated: if contestation accepted, go to CP.4.
v4.2.1
23/07/2021
Implementation of Change Request EESSI-8567: improvement the BUC guidelines and related SED guidelines
v4.3.0
31/08/2021
Performed patch changes to reference the new CDM version 4.3.0
v4.3.1
07/12/2021
Implementation of Change Request EESSI-6438: including the contestation rules
Links update
v4.3.4
30/04/2024
Implementation of change request EESSI-11405 by adding the Sample Scenarios section.
Implementation of change request EESSI-12076 by adding a paragraph related to the attachments to the CO.3, CP.3 and CP.5 steps.
S_BUC_23 – Refund of Overpayment
Description: When claims based on actual costs, fixed amounts or for interest on late payment, have been settled by a debtor Member State then realises that its responsibility in that case has ceased, either partly or entirely, or a change in circumstances occurred and an overpayment is identified, this business use case can be applied.
This particular case is only applicable if the refund of the costs can not be reached by a contestation.
This particular case cannot be used if the responsibility for a certain matter has changed from one institution to another within a debtor/ creditor state. In this case, the refund must be requested and/or received on the basis of national law.
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 Regulation No 883/2004
Implementing Reg (987/09)
SED
35 (2)
41
62
63
64
65
66
67
68
69
S051 Request for refund of overpayment (RRO)
S053A Acceptance of request for refund of overpayment (ACP_RRO)
S053C Contestation of request for refund of overpayment (COC_RRO)
S053R Reply to Contestation of request for refund of overpayment (RPY_COC_RRO)
S054 Information on refund of overpayment (IRO_RRO)
Request – Reply SEDs:
REQUEST SED
REPLY SED(s)
S051 Request for refund of overpayment (RRO)
S053A Acceptance of request for refund of overpayment (ACP_RRO)
S051 Request for refund of overpayment (RRO)
S053C Contestation of request for refund of overpayment (COC_RRO)
S053C Contestation of request for refund of overpayment (COC_RRO)
S053R Reply to Contestation of request for refund of overpayment (RPY_RRO)
Glossary of relevant terms used in S_BUC_23:
Term used
Description
Case Owner
In this BUC the Case Owner is the Liaison Body which has paid claims (Debtor) or received payments for claims (Creditor) based on actual costs, fixed amounts or for interest on late payment, and which sends a request for refund of overpayment following a change in circumstances.
In this BUC, the Case Owner could be both Debtor or Creditor.
Counterparty
In this BUC the Counterparty is the Liaison Body which has paid claims (Debtor) or received payments for claims (Creditor) based on actual costs, fixed amounts or for interest on late payment, and which receives a request for refund of overpayment.
In this BUC, the Counterparty could be both Debtor or Creditor.
How to start this BUC?
In order to help you understand S_BUC_23 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 Liaison Body of a Member State
where a claim for reimbursement based on actual costs, fixed amounts or claim for interest on late payment have been settled and paid, and realise that your responsibility for the cases ceased, either partly or entirely or circumstances changed;
and you identified an overpayment, either you received the overpayment (Creditor Liaison Body) or you identified the Member State which has overpaid (Debtor Liaison Body);
and due to deadlines to be respected for contestations, it is not possible anymore to find a solution within S_BUC_19 and S_BUC_21;
and you send a ‘Request for refund of overpayment (RRO)’ SED S051
your role will be defined as the Case Owner.
I am the Case Owner. (step CO.1)
If you are the Liaison Body that receives a 'Request for refund of overpayment (RRO)’ SED S051 from an Liaison Body of another Member State for which a claim for reimbursement based on actual costs, fixed amounts or claim for interest on late payment have been settled and paid with, your role will be defined as the Counterparty.
I am the Counterparty. (step CP.1)
CO.1 Who do I need to exchange information with?
As the Case Owner, your first step in any new request for refund of
overpayment will be to identify the Member State that you need to exchange information with. The second step is to identify the relevant Liaison Body in this Member State that is responsible for the information you require. In this Business Use Case, the institution can be chosen only among the Liaison bodies responsible for health insurance. This activity will define the Counterparty you will be working with. There can only be one Counterparty in this Business Use Case.
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 of (a) former Member State(s) of employment, you will have to check which institution was the Liaison Body in the processes S_BUC_19, S_BUC_21 or S_BUC_22. The counterparty should be the institution which falsely received the payment or which issued the unjustified payment.
In order to update contact details, you may 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."
To access the IR please use the following link.
I have now identified the Liaison Body from the Member State I need to contact. (step CO.3)
CO.3 How do I proceed after having identified the Counterparty?
Fill out the ‘Request for refund of overpayment (RRO)’ SED S051. You clarify if you have overpaid, in this case you will be the "Debtor Liason Body", or if you received the overpayment, in which case you will be the "Creditor Liaison Body". You complete the required information in the sections related to the global information for the Request for refund of overpayment and the individual information. You should also indicate the reference to the original claim that has already been paid.
Please note that when submitting requests for a refund of an overpayment, you have to submit separate requests for each batch of claims of SEDs S080, S100 and S026.
All attachments supporting the reply must be attached to the individual part of the S051. An attachment that is not correctly referenced to a specific individual part might not be handled properly.
Next, the Counterparty will:
accept the request for refund of overpayment and fill in the ‘Acceptance of request for refund of overpayment (ACP_RRO)’ SED S053A
or contest the request for refund of overpayment and fill in the ‘Contestation of request for refund of overpayment (COC_RRO)’ SED S053C
I have received SED S053A from the Counterparty. (step CO.4)
I have received SED S053C from the Counterparty. (step CO.5)
CO.4 What should I do if I received ' Acceptance of request for refund of overpayment' - SED S053A?
You have received from the Counterparty ' Acceptance of request for refund of overpayment '' - SED S053A with information about the accepted individual requests for refund of overpaid amounts.
If you are the "Debtor Liaison Body", you will send the Information on the decision on refund of overpayment to the Counterparty.
If you are the "Creditor Liaison Body", you expect to receive the Information on the decision on refund of overpayment from the Counterparty.
I want to send ‘Decision about the refund of the overpayment' – (Step CO.6)
I have received ‘Decision about the refund of the overpayment' – (Step CO.7)
CO.5 What should I do if I received 'Contestation of request for refund of overpayment' - SED S053C?
You have received from the Counterparty a 'Contestation of request for refund of overpayment' - SED S053C with information about the individual requests that are contested by the Counterparty.
You will need to fill in a 'Reply to Contestation of Identification of the Overpayment' SED S053R where you indicate if you accept or not the Contestation, and send this SED S053R to the Counterparty.
After receiving a contestation, only one reply can be sent for that contestation. All attachments supporting the reply must be attached to the individual part of the S053R. An attachment, that is not correctly referenced to a specific individual part, cannot be forwarded to the competent institution, and might not be handled properly.
After a contestation was received, no acceptance of the individual overpayment can be expected until the contestation has been settled by both parties.
Depending on the circumstances the following actions are possible:
I have received a new 'Contestation of request for refund of Overpayment' - SED S05EC (Step CO.5)
CO.6 How to create 'Decision on the Refund of Overpayment' - SED S054?
You are the Debtor Liaison Body which has received from the Counterparty acceptance for the identified overpayments. You create 'Information on refund of overpayment' - SED S054 to inform the Counterparty about how the refund has to be done, i.e. against which sending the refund of the overpayment will be offset.
You have to fill out all required data.
You send SED S054 to the Counterparty.
Unless there are still some overpayments for which a decision has to be sent, the use case ends here.
CO.7 What should I do if I received 'Decision on the Refund of Overpayment' - SED S054?
You are the Creditor Liaison Body and you have received from the Counterparty 'Information on refund of the overpayment' - SED S054 with information about how to proceed with the overpaid amounts.
In this SED S054, the Counterparty informs you against which sending the refund of the overpayment will be offset.
Unless there are still some overpayments for which a decision has to be received on S054 the use case ends here.
CP.1 What should I do if I have received the ‘Request for refund of overpayment (RRO)' SED S051?
If you have received a 'Request for refund of overpayment (RRO)' SED S051 from the Case Owner, first, you check if you are responsible for the business process in accordance with your national procedures.
I am responsible for the business process. (step CP.2)
I am not responsible for the business process. (step CP.3)
CP.2 I am responsible for the business process
If you have received a 'Request for refund of overpayment (RRO)' SED S051 from the Case Owner and you are responsible for the business process, you have to accept or contest this request.
If you accept some or all individual requests for refund of overpayment, you must fill in the ‘Acceptance of request for refund of overpayment (ACP_RRO)’ SED S053A
Or, if you contest some or all individual requests for refund of overpayment you must fill in the ‘Contestation of request for refund of overpayment (COC_RRO)’ SED S053C
After a contestation was sent, no acceptance of the request for refund of overpayment is allowed until the contestation has been settled by both parties
I want to create and send ‘Acceptance of request for refund of the overpayment – SED S053A' – (Step CP.4)
I want to create and send ‘Contestation of request for refund of the
overpayment – SED S053C' – (Step CP.5)
CP.3 What should I do if I am not responsible for the business process?
If your Member State was chosen incorrectly as a recipient of 'Request for refund of overpayment (RRO)' SED S051, you have to contest the request.
Fill out the Contestation of request for refund of overpayment (RPY_RRO)' SED S053C , by entering the required information. For each individual payment you have to select the reply code “99-Other” with Other = “Wrong Counterparty Member State”.
All attachments supporting the reply must be attached to the individual part of the S053C. An attachment that is not correctly referenced to a specific individual part might not be handled properly.
Next you send the SED S053C to the Case Owner.
The Business Use Case ends here.
CP.4 What should I do if I want to create and send ‘Acceptance of request for refund of the overpayment – SED S053A?
If you want to accept some or all individual claims of overpayment, you have to create a send ‘Acceptance of request for refund of the overpayment – SED S053A by selecting the individual requests that you want to accept.
Then you send the SED S054A to the Case Owner.
Depending on the situation, the following actions are possible:
You want to contest individual requests for refund of overpayment
If you are the "Debtor Liaison Body", you will send the Information on the decision on refund of overpayment to the Counterparty.
If you are the "Creditor Liaison Body", you expect to receive the Information on the decision on refund of overpayment from the Counterparty.
I want to create and send ‘Contestation of request for refund of the overpayment – SED S053C' – (Step CP.5)
I have received 'Information on the Refund of Overpayment' – SED S054 (Step CP.7)
How to create 'Information on the Refund of Overpayment' - SED S054? (Step CP.8)
CP.5 What should I do if I want create and send ‘Contestation of request for refund of the overpayment – SED S053C?
If you want to contest some or all individual claims of overpayment, you have to create a 'Contestation of request for refund of the Overpayment' - SED S053C.
You must select the individual request you want to contest and fill out all the requested information. The reason for contestation must be selected.
All attachments supporting the reply must be attached to the individual part of the S053C. An attachment that is not correctly referenced to a specific individual part might not be handled properly.
Then you send the SED S053C to the Case Owner. The Case Owner will
reply by sending the 'Reply to the Contestation of request for refund of Overpayment' – SED S053R
I have received a 'Reply to the Contestation of request for refund of Overpayment' – SED S053R (Step CP.6)
CP.6 What should I do if I received a Reply to the Contestation of request for refund of Overpayment?
If you have received a 'Reply to the contestation of Identification of the Overpayment' S053R, you can either create a new contestation of identification of overpayment, or you can proceed with the acceptation of the contested overpayments if you accept the reply to contestation from the Case Owner.
I want to create and send ‘Acceptance of request for refund of the overpayment – SED S053A' – (Step CP.4)
How to create 'Information on the Refund of Overpayment' - SED S054? (Step CP.8)
CP.7 What should I do if I received Information on the Refund of Overpayment' - SED S054?
You are the Creditor Liaison Body and you have received from the Case Owner the 'Information on refund of the overpayment' - SED S054 with information about how to proceed with the overpaid amounts. In this SED, the Case Owner informs you about how the refund has to be done, i.e. against which sending the refund of the overpayment will be offset.
Unless there are still some overpayments for which a decision has to be received on S0554 the use case ends here.
CP.8 How to create 'Decision on the Refund of Overpayment' - SED S054?
You are the Debtor Liaison Body which has received from the Case Owner acceptance for the identified overpayments, or the contestation loop is completed and a decision must be taken about the refunding of some of the individual request.
You create the 'Information on the Refund of Overpayment' - SED S054 to inform the Case Owner about how the refund has to be done, i.e. against which sending the refund of the overpayment will be offset.
You send SED S054 to the Case Owner. The Case Owner receives SED S054.
Unless there are still some overpayments for which a decision has to be sent on S054, the use case ends here.
BPMN diagram for S_BUC_23
Click here to open the BPMN diagram(s) for S_BUC_23.
Structured Electronic Documents (SEDs) used in the process
The following SEDs are used in S_BUC_23:
SED S051 – Request for refund of overpayment (RRO)
SED S053A - Acceptance of request for refund of overpayment (ACP_RRO)
SED S053C - Contestation of request for refund of overpayment (COC_RRO)
SED S053R - Reply to Contestation of request for refund of overpayment (RPY_COC_RRO)
SED S054 – Information on refund of overpayment (IRO_RRO)
Administrative sub-processes
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
Sample scenarios
For scenarios samples please consult the additional files presented in the ‘Sample scenarios’ folder.