Key Benefits:
The Prime Minister,
On the report of the Minister of Social Affairs, Health and Women ' s Rights,
Vu le Social Security Codeincluding articles L. 861-3, L. 863-7-1, D. 861-3 and D. 861-6;
Considering the advice of the Board of the National Health Insurance Fund for Employees dated 2 June 2015,
In view of the opinion of the Central Council of the Agricultural Social Community dated 11 June 2015,
Considering the referral of the National Union of Health Insurance Organizations Council dated 21 May 2015,
Stop it!
The statements of benefits referred to in Article D. 861-4 and Article D. 861-5 contain the following information:
1. The total amount paid.
2. The bank details of the transferee.
3. The mandate date.
4. The identifier of the paying agency.
5. Coordinates of the organization serving the basic plan benefits for any request for information or claim.
6. For each invoice:
- the name and name of the care recipient and, where applicable, its registration number on the national identification directory of natural persons;
- if the recipient of the care is not the insured, the name and first name of use of the insured and its registration number on the national identification directory of natural persons;
- the date of care;
- the nature of the benefit, the total amount and the amount refunded for the basic part and the supplementary part;
- the invoice number, when issued by the professional or health establishment;
- the references of the count;
- the contact details of the organization serving the additional benefits.
These benefits statements are transmitted electronically or, if technically impossible, on paper. The information contained in the electronic records conforms to the technical specifications defined by the terms of reference of the open standard for the exchange between the disease and external stakeholders established by the national health insurance funds.
The records are sent to the professional or health care institution within the payment times referred to in section D. 861-6, in the event of the use of an electronic health care sheet and at least once a month for benefits that have been paid when using paper support.
As part of the procedure provided for in the 3rd of Article D. 861-4, each additional health insurance agency:
- uses its own risk carrier identifier and, in case a technical concentrator acts by delegation on its behalf, the latter must also use the identifier specific to the complementary organism, the use of the "unique code" of the concentrator being prohibited;
- transmits to the compulsory health insurance each new membership, subscription, renewal or termination of a contract selected via the "adherent registration" type files corresponding to the reference 408.
The service rendered to the supplementary health insurance organization by the health insurance organization serving the benefits of the basic health insurance plan is charged on the basis of an amount per deposit amount to fifteen cents of euros excluding taxes in case of electronic exchanges and to a euro excluding taxes in case of paper exchanges between the said organizations.
Compensation for the service rendered is the subject of a billing by the organization serving the basic plan benefits on a quarterly maximum period.
The decision of May 26, 2000 taken under theArticle D. 861-6 of the Social Security Code and on the terms and conditions for the implementation of the fee waiver procedure within the framework of the supplementary health protection and the decision of 28 June 2000 on the technical and financial terms and conditions for the implementation of the procedure for dispensing costs under article D. 861-3, paragraph III, of the Social Security Code are repealed.
The Minister of Finance and Public Accounts, the Minister of Social Affairs, Health and Women's Rights and the Secretary of State responsible for the budget are responsible, each with regard to him, for the execution of this Order, which will be published in the Official Journal of the French Republic.
Done on June 29, 2015.
Manuel Valls
By the Prime Minister:
Minister of Social Affairs, Health and Women ' s Rights,
Marisol Touraine
Minister of Finance and Public Accounts,
Michel Sapin
The Secretary of State in charge of the budget,
Christian Eckert
