Key Benefits:
Publics concerned: funding funds for the complementary protection of the universal coverage of disease risk; basic health insurance schemes; complementary management organizations of the complementary CMU.
Purpose: Revision of the modalities for the reimbursement of universal health coverage by the funding fund for the complementary protection of universal health risk coverage.
Entry into force: the text comes into force on the day after its publication.
Notice: The Social Security Funding Act for 2013 provided for the reimbursement of the complementary MAC management organizations based on their actual expenditures within a lump sum per recipient. This Order sets out the amount of the package and provides for the payment of four deposits each year, as well as the following year for regularization.
References: this decree and the provisions of Social Security Code to be edited on the Légifrance website (http://www.legifrance.gouv.fr). The decree is taken for the application of theArticle 22 of Act No. 2012-1404 of 17 December 2012 Social Security Funding for 2013.
The Prime Minister,
On the report of the Minister of Social Affairs and Health,
Vu le Social Security Code ;
Vu la Act No. 2012-1404 of 17 December 2012 Social Security Funding for 2013, including Article 22;
Considering the advice of the Board of the Central Agency for Social Security Organizations dated 28 June 2013;
Having regard to the advice of the Board of the National Health Insurance Fund on 9 July 2013;
Considering the opinion of the Central Council of the Agricultural Social Mutuality of 12 June 2013;
Given the advice of the National Union of Health Insurance Funds Board of 11 July 2013,
Decrete:
The Single Chapter of Title VI of Book VIII of the Social Security Code (Part III: Decrees) is supplemented by section 2 as follows:
“Section 2
“Financial arrangements for the funding fund for the complementary protection of universal coverage of disease risk
"Subsection 1
“General provisions
"Art. D. 862-1.-The annual package defined in the second paragraph of Article L. 862-2 shall be set for the year 2013, at 400 euros.
"Its amount is revalued on January 1 of each year from the level of the inflation hypothesis in the report attached to the year's financial bill pursuant toArticle 50 of Organic Law No. 2001-692 of 1 August 2001 relative to the financial laws, rounded to the lower euro. It is recognized annually by decree of ministers responsible for budget and social security.
"Subsection 2
“Organizational provisions
supplementary health insurance
"Art. O.C. 862-2.-For the annual reimbursement, pursuant to section L. 862-2, to the organizations referred to in the second paragraph of Article L. 862-4, four quarterly advances and regularization were made in the following year.
"The amount of each quarterly deposit is equal to the proceeds of the number of persons receiving the expenses referred to in section L. 861-3, who was arrested on the last day of the second month of the calendar quarter in question, by one quarter of the nine tenths of the annual plan amount defined in section D. 862-1.
"At the end of the calendar year under review, the difference between, on the one hand, the product of the average of the number of persons who have benefited from the expenses referred to in section L. 861-3 on the last day of the second month of each quarter and the amount of the annual plan defined in section D. 862-1 for the year under review and, on the other hand, the amount already allocated four quarterly.
"However, this regulation cannot lead to the fact that the total amount of the refund exceeds the amount of the expenses referred to in section L. 861-3 actually borne by the organization during the calendar year under review and recorded as of June 30 of the following year. When the sum of the deposits already made exceeds the amount of the deposit, a regulation shall be made in competition for the benefit of the fund.
"Regulation takes the form of a payment, as the case may be, of the fund or agency, before September 30 of the following year.
"Art. D. 862-3.-The annual reimbursement, pursuant to section L. 862-2, to the organizations referred to in the second paragraph of Article L. 862-4, shall be made in four quarterly payments.
"For each quarter, the amount of the refund is equal to a quarter of the amount of the tax credit calculated under section L. 863-1 relating to contracts in effect on the last day of the second month of the calendar quarter concerned.
"Art. O.C. 862-4.-The quarterly instalments defined in section D. 862-2 and the quarterly payments defined in section D. 862-3 are made in the form of imputations on the quarterly payments due by these organizations for the tax set out in section L. 862-4.
"However, where, for a particular quarter, the amount of the deposit set out in section D. 862-2 and the payment set out in section D. 862-3 exceeds the amount of the tax collected under section L. 862-4, the fund shall make the payment of the difference no later than the last day of the first month of the particular quarter.
"Subsection 3
“ Provisions relating to social security organizations
"Art. O.C. 862-5.-For the annual reimbursement, pursuant to article L. 862-2, to social security organizations, it shall be carried out:
"– four quarterly payments when the organization manages more than fifty thousand people benefiting from the device;
" – one deposit when the organization manages less than fifty thousand people;
"– to regularization in the following year.
"The quarterly instalments are calculated according to the terms set out in the second paragraph of Article D. 862-2. They are paid on February 15, May 15, August 16 and November 15 or, when one of these dates is not a business day, the next business day.
"The single deposit is paid on June 30 of the year or, where that date is not a business day, the next business day.
"Before September 30 of the following year, regularization is carried out in accordance with the terms defined in the third to fifth paragraphs of Article D. 862-2.
"Art. D. 862-6.-By derogation from the fourth paragraph of Article D. 862-5, the regularization of the annual reimbursement to the National Health Insurance Fund of employed workers is determined under the following conditions.
"When, for a particular calendar year, the amount of the expenses referred to in section L. 861-3 actually covered by that credit union exceeds the proceeds of the number of persons who have benefited from such care and the amount of the annual plan set out in section D. 862-1, the fund referred to in section L. 862-1 shall pay the credit union a supplementary amount equal to that difference. However, this payment may not have the effect of negatively deferring the funds again. In this case, the payment is reduced to due competition.
"An order of the ministers responsible for the budget and social security, taken after the credit union receives the final amount of the expenditure, notes annually the amount of this regulation.
"Art. D. 862-7.-The terms and conditions of remittance by the fund to social security organizations and the supporting documents or statements to be produced are specified by agreements signed between the fund and social security agencies. »
I. ― For the years 2013 and 2014, by derogation from articles D. 862-2 and D. 862-5 of the Social Security Code, the amount of the quarterly deposits is equal to the product of 92.50 euros and the number of persons receiving the expenses referred to in article L. 861-3 of the same code, which was arrested on the last day of the second month of the civil quarter.
II. ― For the year 2013, by derogation from section D. 862-6 of the Social Security Code, the regularization of the reimbursement to the National Health Insurance Fund of the employed workers provided for in this section is increased under the conditions set out in section II of the Act of 17 December 2012 of the Social Security Fund for 2013 referred to above taking into account the difference between the amount of the expenses mentioned in theArticle L. 861-3 of the Social Security Code and reimbursements made for the same year pursuant to the provisions of articles L. 862-3 and L. 862-4 of the same code in their writing prior to Act of 17 December 2012 referred to above Social Security Funding for 2013. Regularization is calculated within the limit of the fund's accounting income in 2013.
The Minister of Economy and Finance, the Minister of Social Affairs and Health and the Minister Delegate to the Minister of Economy and Finance, responsible for the budget, are responsible, each with respect to it, for the execution of this Order, which will be published in the Official Journal of the French Republic.
Done on 16 September 2013.
Jean-Marc Ayrault
By the Prime Minister:
Minister of Social Affairs
and Health,
Marisol Touraine
Minister of Economy and Finance,
Pierre Moscovici
Minister Delegate
to the Minister of Economy and Finance,
Budget Officer
Bernard Cazeneuve
