Change Of The General Social Security Act, The Commercial Law On Social Insurance, The Farmers Social Insurance Act And The Officials Sick - And Accident Insurance Act

Original Language Title: Änderung des Allgemeinen Sozialversicherungsgesetzes, des Gewerblichen Sozialversicherungsgesetzes, des Bauern-Sozialversicherungsgesetzes und des Beamten-Kranken- und Unfallversicherungsgesetzes

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28. Federal Act amending the General Social Security Act, the Industrial Social Security Act, the Farmers-Social Security Act and the Official Health and Accident Insurance Act

The National Council has decided:

table of contents

Article 1

Amendment of the General Social Insurance Act

Article 2

Amendment of the Industrial Social Insurance Act

Article 3

Amendment of the Farmers-Social Security Act

Article 4

Amendment of the Staff Regulations-Health and Accident Insurance Act

Article 1

Amendment of the General Social Insurance Act

The General Social Security Act-ASVG, BGBl. No. 189/1955, as last amended by the Federal Law BGBl. I No 187/2013, shall be amended as follows:

1. In § 80b, the following § 80c is added together with the heading:

" Contribution of the Federal Government to the financing of jaw regulations

§ 80c. (1) The federal government has up to 31. Jänner of each year, for the first time up to the 31. January 2016 for Kieferregulations 80 Mio. Euro to the dental health fund set up by the main association (§ 447i) to be transferred.

(2) By 31 July 2015, the Federal Government has 20 million Euro to the dental health fund set up by the main association (§ 447i) to be transferred. This has to allocate these funds appropriately to the health insurance institutions.

(3) The transfer of the funds pursuant to paragraphs 1 and 2 shall take place on the basis of the effective acquisition of the total contract in accordance with § 343e (1).

(4) If, in accordance with § § 153a of this Federal Act, 94a GSVG, 95a BSVG and 69a B-KUVG, the benefits in kind are provided under the terms of Section 343e (2) of the Treaty, the Federal Government has the funds for these services in the amount of the expected expenditure, however, at the most, in the amount referred to in paragraph 1 above, to the dental health fund set up by the main association (§ 447i). "

2. In accordance with § 153, the following § 153a together with the heading is inserted:

" Pine regulations for children and adolescents

§ 153a. (1) Treatment of children and adolescents in need of treatment will be completed until the completion of the 18. Without prejudice to the claim in accordance with § 153, the dental care provision is granted as a material benefit by the provision of the right to a dental treatment. Section 153 (3) third and fourth sentence shall not apply. There is a need for treatment if there is a significant tooth or jaw malposition.

(2) The need for treatment, the appropriate dental care and the quality requirements for the provision of the benefits in kind pursuant to paragraph 1 shall be uniform throughout Germany in the statutes of the health insurance institution under the regulations of the In accordance with the state of the art of dental science, the model statutes (§ 455 para. 2) are to be regulated.

(3) The main body shall have to provide a quality assurance system for the performance of the service referred to in paragraph 1. The health insurance institutions have to check the quality requirements, in particular the quality of the structure and the quality of results (success of the treatment) and to report on them to the main association.

(4) entitlement to reimbursement of expenses pursuant to § 131 shall consist in the provision of benefits under this provision, provided that:

1.

the payments (fees) to be provided for the regulations on the delivery of the jaw, including their changes, will be published on the Internet by the provider on a permanent basis; and

2.

there is an overall agreement on topping-up rates in accordance with § 343c,

if and as long as the total contract pursuant to § 343e (1) provides a comprehensive supply of benefits in kind or the provision of the benefits in kind pursuant to § 343e (3) is provided.

(5) The non-condition-coming and the omission of an overall contract according to § 343e shall be made available by the main association on the internet. The reimbursement of expenses for treatments as referred to in paragraph 1, which have already been initiated at the time of the presentation of the main association, shall remain unaffected. § 131a shall not apply if an overall contract is concluded in accordance with § 343e.

(6) The claim, the amount and the quality requirements for the award of a cost subsidy are uniform throughout Germany in the case of the absence of a regionally balanced comprehensive supply of material services (§ 343e). Sickness insurance carrier in accordance with the rules of the model statutes (§ 455 para. 2). § 131b shall not apply. "

3. In § 343c (1), the term " "for the performance of the fixed dentures" by the expression "for jaw regulations in accordance with § 153a and benefits of the fixed-seat dentures" replaced.

4. The following § § 343e and 343f together with the heading are added to § 343d:

" Contractual regulation for the implementation of jaw regulations for children and adolescents

§ 343e. (1) An overall contract shall be concluded between the Main Association and the Austrian Dentist Chamber, which shall regulate the provision of the service in accordance with § 153a. This overall contract shall be effective only if a number of dentists/dentists ' individual contracts to be determined on a regionally balanced supply has been concluded in accordance with this overall contract and, thus, a total number of dental practitioners has to be Comprehensive supply of services according to § 153a.

(2) If, by 31 December 2014, an overall contract pursuant to paragraph 1 with effect commensurate 1 July 2015 does not materially be concluded or thereafter enters into a contractual state, the following shall have the following:-on the basis of a supply plan to be drawn up by the main association -the sickness insurance institutions the benefit in accordance with § 153a, by special individual contracts of the same performance content with service providers, in particular dentists/dentists, group practices and independent ambulatories, as well as in their own facilities of the to provide health insurance institutions. Due to existing special contracts, there is no entitlement to reimbursement of expenses in accordance with § 131 and § 60 B-KUVG.

(3) By way of derogation from paragraph 1, the overall contract may also be effectively concluded if, by means of individual contracts on the basis of this overall contract, significantly more than two thirds of the service requirements of the children and young people according to § 153a ensures and there is a regionally balanced supply. In this case, the health insurance institutions in the sense of a comprehensive supply of benefits in kind have the benefit in accordance with § 153a, in addition to special individual contracts, with the same performance content with service providers, in particular Dentists, group practices and independent ambulatories as well as in their own facilities of the health insurance institutions in the sense of the supply plan according to para. 2 to be provided.

(4) If the comprehensive, equitable supply of benefits pursuant to paragraph 1 or 3 is no longer given, in particular on the basis of the dissolution of contractual relationships, the overall contract shall be deemed to have been terminated. This is to be assumed if the supply of benefits in kind by means of individual contracts on the basis of the overall contract covers less than two thirds of the needs of children and young people. The main association has made this fact available on the Internet. Section 348 shall apply with the proviso that the extent, amount and extent of the performance requirement is not the subject of the procedure, no change in the contract can be fixed and the application shall be submitted within four weeks after the date of the customer's presentation by the The main body has to be done.

Price transparency

§ 343f. The suppliers/suppliers of jaw regulations are to pay the prices for the services offered by them according to § 153a, 94a GSVG, 95a BSVG and 69a B-KUVG annually to the main association or the Austrian Dentists ' Chamber . The Austrian Dentist Chamber has to provide the main association with the notifications received by the Austrian Association of Dental Physicians. The main association has to publish all information reported to it on the Internet in this respect. "

5. In accordance with § 447h, the following § 447i and heading is inserted:

" Dental health fund

§ 447i. (1) A fund for dental health is to be established at the main association. The assets of this Fund shall be managed separately from the other assets of the Main Association. For each year, a clearance of accounts must be drawn up, which must, in any case, consist of a statement of success and a final balance sheet at the end of the year. In addition, a business report is to be drawn up at the end of each year and must be submitted to the Federal Ministry of Health with the closure of the accounts.

(2) The funds of the Fund shall be financed by:

1.

Federal funds according to § 80c and

2.

other revenue.

(3) Funds of the Fund to the extent of 80 million Euro per year is to be used for the provision of jaw regulations for children and young people in accordance with § § 153a of this Federal Law, 94a GSVG, 95a BSVG and 69a B-KUVG. Remaining funds shall be used for further services in the dental health sector.

(4) The main body shall allocate the funds according to paragraph 2 in accordance with § § 153a of this Federal Law, 94a GSVG, 95a BSVG and 69a B-KUVG in an appropriate way on the basis of the expenses incurred in the case of temporary-regulations. If the case of Section 80c (4) occurs, the actual costs incurred shall be taken into account after the final results have been obtained.

(5) The transfer of the funds to the health insurance institutions pursuant to this Federal Act, the Social Insurance Institute of the commercial economy, the social security institution of the farmers and the insurance institution to the public in the form of the institution of the In any case, health insurance takes place every six months by decision of the carrier conference.

6. In § 545 (7) the expression "§ 447a (10)" by the expression "§ § 80c and 447a (10)" replaced.

7. In accordance with § 681, the following § 682 shall be added together with the heading:

" Final determination on Art. 1 of the Federal Law BGBl. I No 28/2014

§ 682. § § 153a (1) and 343c (1) in the version of the Federal Law BGBl (Federal Law Gazette). I n ° 28/2014 will enter into force on 1 July 2015. "

Article 2

Amendment of the Industrial Social Insurance Act

The Industrial Social Security Act-GSVG, BGBl. No 560/1978, as last amended by the Federal Law BGBl. I n ° 139/2013, shall be amended as follows:

1. § 86 para. 5 lit. e will be the expression "with the exception of jaw regulations" by the expression "Kieferregulations not covered by § 94a" replaced.

2. In accordance with § 94, the following § 94a shall be inserted with the title:

" Pine regulations for children and adolescents

§ 94a. (1) Treatment of children and adolescents in need of treatment will be completed until the completion of the 18. Without prejudice to the claim in accordance with § 94 of the dental medically appropriate care provided by the provision of a carpenter's right in kind. There is a need for treatment if there is a significant tooth or jaw malposition.

(2) The need for treatment, the appropriate dental care and the quality requirements for the provision of the material in accordance with paragraph 1 are uniform throughout Germany in accordance with the regulations of the model statutes (§ 455 para. 2 ASVG) in accordance with the state of dental science.

(3) entitlement to reimbursement of expenses pursuant to § 85 (4)-without prejudice to the provisions of § 85 (2)-for benefits under this provision only and as long as the total contract provides a comprehensive supply of benefits in kind pursuant to § 343e ASVG ensures. If an overall contract is concluded in accordance with § 343e ASVG, Section 85 (4), second sentence, shall not apply.

(4) The claim, the amount and the quality requirements for the award of a cost replacement shall be uniform throughout Germany in the case of the absence of a comprehensive supply of benefits in kind (§ 343e ASVG) in the statutes of the insurance carrier rules. "

3. In accordance with § 353, the following § 354 shall be added together with the heading:

" Final determination on Art. 2 of the Federal Law BGBl. I No 28/2014

§ 354. § § 86 (5) lit. e and 94a (1) in the version of the Federal Law BGBl. I n ° 28/2014 will enter into force on 1 July 2015. "

Article 3

Amendment of the Farmers-Social Security Act

The Farmers-Social Security Act-BSVG, BGBl. N ° 559/1978, as last amended by the Federal Law BGBl. I n ° 139/2013, shall be amended as follows:

1. § 80 para. 3 lit. h is the expression "with the exception of mandibular regulations" by the expression "with the exception of the provisions of the jaw regulations not covered by § 95a" replaced.

2. In accordance with § 95, the following § 95a with headline is inserted:

" Pine regulations for children and adolescents

Section 95a. (1) Treatment of children and adolescents in need of treatment will be completed until the completion of the 18. Without prejudice to the claim in accordance with § 95, dental care provided by the dentist is granted in kind as a material benefit. Section 95 (4), first and second sentence, shall not apply. There is a need for treatment if there is a significant tooth or jaw malposition.

(2) The need for treatment, the appropriate dental care and the quality requirements for the provision of the material in accordance with paragraph 1 are uniform throughout Germany in accordance with the regulations of the model statutes (§ 455 para. 2 ASVG) in accordance with the state of dental science.

(3) Claim for reimbursement of costs or the grant of costs pursuant to § 80 (2) of the fourth and third last sentence shall consist of benefits under this provision only and for as long as the total contract provides a comprehensive supply of benefits in kind pursuant to § 343e ASVG ensures.

(4) The claim, the amount and the quality requirements for the award of a cost replacement shall be uniform throughout Germany in the case of the absence of a comprehensive supply of benefits in kind (§ 343e ASVG) in the statutes of the insurance carrier § 239 is not applicable. "

3. In accordance with § 345, the following § 346 shall be added together with the heading:

" Final determination on Art. 3 of the Federal Law BGBl. I No 28/2014

§ 346. § § 80 para. 3 lit. h and 95a para. 1 in the version of the Federal Law BGBl. I n ° 28/2014 will enter into force on 1 July 2015. "

Article 4

Amendment of the Staff Regulations-Health and Accident Insurance Act

The Civil And Accident Insurance Act-B-KUVG, BGBl. No 200/1967, as last amended by the Federal Law BGBl. I n ° 139/2013, shall be amended as follows:

1. In accordance with § 69, the following § 69a and heading is inserted:

" Pine regulations for children and adolescents

§ 69a. (1) Treatment of children and adolescents in need of treatment will be completed until the completion of the 18. Without prejudice to the claim in accordance with § 69 of the dental medically appropriate care provided by the provision of a carpenter's right in kind. § 69 (3) third and fourth sentence shall not apply. There is a need for treatment if there is a significant tooth or jaw malposition.

(2) The need for treatment, the appropriate dental care and the quality requirements for the provision of the material in accordance with paragraph 1 are uniform throughout Germany in accordance with the regulations of the model statutes (§ 455 para. 2 ASVG iVm § 158) in accordance with the state of dental science.

(3) The right to reimbursement of expenses pursuant to § 59 shall apply for benefits under this provision only and for as long as the total contract ensures a comprehensive supply of benefits in kind pursuant to § 343e ASVG. § 343e ASVG does not apply to an overall contract, § 60 shall not apply.

(4) The claim, the amount and the quality requirements for the award of a cost subsidy are uniform throughout Germany in the case of the absence of a comprehensive supply of benefits in kind (§ 343e ASVG) in the statutes of the insurance institution to the rules. § 60a is not applicable. "

2. In accordance with § 238, the following § 239 shall be added together with the heading:

" Final determination on Art. 4 of the Federal Law BGBl. I No 28/2014

§ 239. § 69a (1) in the version of the Federal Law BGBl. I n ° 28/2014 will enter into force on 1 July 2015. "

Fischer

Faymann