Regulation on the implementation of the allowance for private nursing care pursuant to the Thirteenth Chapter of the Eleventh Book of the Social Code (care provision supplement-Implementing Regulation-PflvDV)

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PflvDV

Date of completion: 20.12.2012

Full quote:

" Nursing Care Allowance-Implementing Regulation of 20 December 2012 (BGBl. I p. 2994) "

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Input formula

On the basis of § 130 of the Eleventh Book of the Social Code, which is defined by Article 1 (49) of the Law of 23. October 2012 (BGBl. 2246), the Federal Ministry of Health and the Federal Ministry of Finance and the Federal Ministry of Labour and Social Affairs are in agreement with the Federal Ministry of Finance and the Federal Ministry of Labour and Social Affairs: Unofficial table of contents

§ 1 Central Office

(1) In the case of the Deutsche Rentenversicherung Bund, the central body within the meaning of the Thirteenth Chapter of the Eleventh Book of the Social Code is established. The central body is responsible for the tasks arising from the thirteenth chapter of the Eleventh Book of the Social Code. (2) The German Pension Fund (Deutsche Rentenversicherung Bund) creates for the central body an annual economic plan, which will be held on 1 May of the in each calendar year for the following year to the Federal Ministry of Health. The economic plan requires the approval of the Federal Ministry of Health, which is granted in agreement with the Federal Ministry of Labour and Social Affairs. The economic plan shall be annexed to the budget of the German Pension Insurance Association. (3) The Federal Ministry of Health shall have the central authority annually until 1 May to provide overviews on the results of the previous financial year. The calendar year shall be presented and statistics on

1.

the total number of new private maintenance supplementary insurance schemes, which are newly funded in the relevant calendar year,

2.

the number of applications received in each calendar year, the number of applications rejected and the number of the procedures for which the application is made in accordance with Article 128 (2) sentence 9 of the Eleventh Book of the Social Code,

3.

the number of contracts announced in the relevant calendar year of subsidised private maintenance supplementary insurance, and

4.

the number of contracts suspended in the relevant calendar year pursuant to § 127 (2), first sentence, point 7 of the Eleventh Book of Social Law.

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Section 2 Disclosure to insurance undertakings

(1) If the central body comes to the conclusion that there is no entitlement to an allowance, it shall disclose the result of the test to the insurance undertaking by means of a data record. The test result can also be announced by dismissal of the data record transmitted in accordance with § 128, paragraph 1, sentence 4 of the Eleventh Book of Social Code, if the data record is published by one in the Error catalog especially marked error message is added. If the data record with a non-marked error message has been rejected by the central body, the insurance company shall not send an error-free until 30 June of the calendar year following the contribution year. (2) If the central body comes to the conclusion that the claim is entitled to an allowance, it shall give it to the insurance undertaking via the payment of the allowance by: Payout reference file known in accordance with § 7 (2). (3) Discovers the central office within the period of change in accordance with § 6 that the right to an allowance has not passed or has fallen away, it has to recover unduly credited or disbursed allowances and this is known to the insurance undertaking by a data set (4) If an insurance undertaking has already received a data record in accordance with paragraph 1 or paragraph 3 and the central body recognizes within the period of change in accordance with § 6 that there is nevertheless a claim for allowance, the central body shall not yet have: to repay the allowances credited or disbursed, and to In the event of an application pursuant to Section 128 (1) sentence 3 of the Eleventh Book of the Social Code, the central office of the insurance company shall inform the insurance company of the allowance number in the payout reference file. (6) In the event of an application for the setting of the Eleventh sentence of § 128 (2) of the Eleventh Book of the Social Code, the central body shall transmit the result of the determination to the insurance undertaking by a record. Unofficial table of contents

§ 3 obligations of the insurance undertaking in relation to the central body

(1) In the period from 1 January to 31 March of the calendar year following the contribution year, the insurance undertaking shall be obliged to provide the central body with an application record for the determination of eligibility for payment of the payment of the claim. of the allowance. The application record shall include the application required pursuant to Section 128 (1) sentence 1 of the Eleventh Book of Social Code and the data referred to in Article 128 (1) sentence 4 of the Eleventh Book of Social Code. Where more than one person is insured in an insurance contract, a separate application record shall be submitted for each person for which an allowance is sought. (2) The insurance undertaking shall recognise that for a contribution year for which it is has already submitted an application record, in at least one calendar month for which the allowance has been requested with this data record, has not been entitled to a grant, the insurance undertaking shall have this application record on cancel or rectify. The cancellation or rectification shall be effected immediately after knowledge of the non-existence of the claim to allowance. In so far as the cancellation or correction was made on the basis of the missing allowance pursuant to Article 126 (1) sentence 1 of the Eleventh Book of the Social Code, the insurance undertaking shall not forward a new application record until it has received a adequate evidence of the existence of the insured person's right of access. If the insurance undertaking finds that an already transmitted application data record is defective or that the conditions for the transmission have not been fulfilled, it shall also have to correct or correct this data record directly or to (3) In the event of an application for setting in accordance with Article 128 (2) sentence 9 of the Eleventh Book of the Social Code, the insurance undertaking shall forward the application immediately after receipt of the request with the necessary additional information to the central location as an electronic document. § § 11 and 12 shall apply accordingly. On a specific request from the central body, the application and the necessary additional information must be submitted in a different manner in each individual case. (4) The insurance undertaking shall transmit the central body to the central body by 31 March each year. The number of the private care supplementary insurance contracts announced in the previous calendar year and the number of contracts funded in accordance with Article 127 (2), first sentence, point 7 of the Eleventh Book of Social Law. Unofficial table of contents

§ 4 Application procedure

(1) The insurance undertaking shall apply for the allowance for the insured person in the presence of the authorization pursuant to Section 128 (1) sentence 2 of the Eleventh Book of the Social Code and the other conditions. The authorization pursuant to § 128 paragraph 1 sentence 2 of the Eleventh Book of the Social Code acts at the same time as an authorization pursuant to § 37 (1) sentence 2 of the Tenth Book of Social Code. It is not possible to apply for an application directly from the insured person to the central office. (2) The insurance company has to indicate in particular in the application data record that the insurance contract is subject to the eligibility requirements of the § § § § § § (3) Prior to the first transmission of the application record for an insured person, the insurance undertaking has received a in addition to the application for the conclusion of the Insurance contract

1.

to confirm that the conditions of § 126 of the Eleventh Book of the Social Code are fulfilled, and

2.

to obtain an obligation to notify the insurance undertaking of any changes in the conditions relating to the right of admission in accordance with Section 126 of the Eleventh Book of the Social Code, immediately after their entry.

The confirmation and the obligation shall be subject to the written form, unless a different form is appropriate due to special circumstances. If they are made on the same piece of pressure with which the application is made at the conclusion of the insurance contract, they must be highlighted in terms of printing technology. If the contract is concluded via the Internet, the same applies. The confirmation and the obligation are to be included in the application record to the central body. (4) The insurance company acquires knowledge that the insured person has moved abroad, it may only have an application record. if, for the period for which a care allowance is to be applied for, it is provided with appropriate proof that the allowance is in accordance with Section 126, first sentence, of the Eleventh Book of the Social Code. Section 3 (2) shall apply mutatily. Unofficial table of contents

§ 5 Enforcement procedure

The fixing procedure shall be admissible only if the central body has sent the insurance undertaking a data record in accordance with the first sentence of Article 128 (3) of the Eleventh Book of the Social Code. Unofficial table of contents

§ 6 Amendment of the audit result

(1) The test result in accordance with § 2 (1) and the test result pursuant to § 2 (3) may be repealed or amended as long as a request for the determination pursuant to section 128, paragraph 2, sentence 9 of the Eleventh Book of the Social Code of the Eleventh Book on the respective test result (2) The test result in accordance with § 2 (2) and the test result in accordance with § 2 (4) shall be amended if the insurance company has modified or cancelled an application record in accordance with § 3 (2). The first sentence shall apply if the insured person is to the insurance undertaking before the expiry of the 13. Month after transmission of one of the test results referred to in the first sentence, a request for amendment of the test result shall be submitted; section 3 (3) shall apply accordingly. Unofficial table of contents

§ 7 Payment of allowances, payout reference file

(1) The allowances shall be subject to payment by the central office on 20 April and 20 December of each year. § 26 of the Tenth Book of the Social Code applies accordingly. For the respective payment date, allowances shall be ordered which have been calculated from the central position until the end of the calendar month preceding the payment date. (2) By the end of the payment of the allowances, the payment shall be made to the Insurance companies provided a payout reference file. The form and content of the payout reference file determines the central location. Unofficial table of contents

§ 8 Return of allowances

(1) The insurance undertaking shall pay the repayments notified to it in an amount to the central body until the next following 10 June and 10 December. At the latest with the payment of the payment, the insurance undertaking shall forward to the central body a repayment reference file. The form and content of the repayment reference file determines the central position. (2) The central body can send a reminder by record to the insurance company before the start of execution. The central body decides on the crackdown. (3) The central body may be entitled to payment of the allowance for an insured person with claims for repayment of allowances for the insured person in relation to the insurance undertaking. Charge a person. The notification of the settlement shall be deemed to be the notification of the audit result. The insurance undertaking shall not be allowed to carry out any settlement or settlement with its own claims in relation to the central body. (4) The amount recovered shall be fixed by the central body in relation to the policyholders, provided that the repayment referred to in paragraph 1 or paragraph 3 is not possible or has not been effected in whole or in part. Unofficial table of contents

§ 9 Type of data transfer

(1) According to the Thirteenth Chapter of the Eleventh Book of the Social Code or under this Regulation, the transfer of data and of any advertisements, announcements or communications between the central body and the Insurance undertakings or their contractors in accordance with Article 12 (3) shall take the form of officially specified data sets by means of officially specified data transmission. (2) Paragraph 1 shall not apply to the transmission of data and to the data provided by the Displays and notifications pursuant to § 2 (2) and (5), § 3 (3) and (4), § 7 (2), § 8 (1) and § 13. Unofficial table of contents

§ 10 Technical Delivery Format

(1) The data sets must be transmitted in XML format. (2) The coded character set for a data transmission to be carried out in accordance with the Thirteenth Chapter of the Eleventh Book of Social Code or in accordance with this Regulation has the requirements of DIN 66303, June 2000 edition. In accordance with the specification of the central location, the character set is to be adapted to the respective state of the art. The DIN 66303 edition, June 2000, has been published by Beuth-Verlag GmbH, Berlin and Cologne, and is set up at the German Patent and Trade Mark Office in Munich. Unofficial table of contents

§ 11 Procedure for data transmission, interfaces

(1) In the case of the electronic transmission of the data sets by remote data transmission in accordance with § 9 paragraph 1, the interfaces determined for the respective transmission time are to be operated properly. The interfaces required for the transmission of data and the associated documentation will be made available for health via the Internet in a protected area of the central location after the Federal Ministry of Health has been approved. (2) If defects are found to affect a proper transfer of the data, the transfer of the data may be rejected. The sender shall be informed of the deficiencies. (3) The technical equipment for the transmission of data shall provide each notified body with respect to its area. Unofficial table of contents

§ 12 Transmission by remote data transmission

(1) In the case of remote data transmission, the relevant state-of-the-art measures shall be taken to ensure data protection and data security, in particular the confidentiality and integrity of the data as well as the data security and data security. Ensure the authentication of the transmitting and receiving body. In the use of generally accessible networks, encryption methods shall be used. The central body determines after consultation of the Association of Private Health Insurance e. (2) The central authority determines the transmission path to be used. (3) The required data may be obtained by a suitable contractor of the Insurance companies will be transferred to the central office if the requirements of § 11 of the German Federal Data Protection Act or comparable provisions of the national data protection laws are fulfilled. A contractor is suitable if he meets the requirements for data protection and data security in accordance with this Regulation. (4) The contractor responsible for the transmission of data in accordance with paragraph 3 shall be deemed to be the authorized representative of the contract. Communications from the central body to the insurance undertaking as long as it does not contradicts it. Unofficial table of contents

Section 13 Identification of the parties involved in the proceedings

(1) The insurance undertaking shall indicate the central body:

1.

the type of customer (insurance undertakings or contractors);

2.

the name and address;

3.

as far as required by the machine connection variant, the e-mail address,

4.

the telephone number and, where available, the fax number,

5.

the operating number,

6.

the type of connection to the mechanical connection of the insurance undertaking and

7.

the banking connection.

(2) In the case of the assignment of a contractor in accordance with Article 12 (3), the insurance undertaking of the central body shall also have the data referred to in paragraph 1 (1) to (6) and the client's or institutional number of the person concerned in the case of the contract holder. (3) The insurance undertakings involved in the procedure and the contractors designated in accordance with paragraph 2 shall receive from the central body a customer number and a password which shall provide access to the protected Internet area of the central location. In addition, the central body shall notify the banking connection to be used for repayments of allowances. (4) Any change in the data referred to in paragraphs 1 and 2 shall be the central body of the parties to the proceedings, indicating their Notify customer number immediately. Unofficial table of contents

§ 14 Recording and retention periods

The central body and the insurance undertakings shall record the data transmitted and shall keep them in order for a period of six years after the end of the year in which the transmission has been made. The records shall be deleted or destroyed at the end of the retention period referred to in the first sentence. Unofficial table of contents

§ 15 Administrative and final costs

In fares of eligible nursing supplementary insurance, the direct final costs, calculated in accordance with section 8 (1) (1) of the calculation regulation, may not be twice the total gross premium for the first month. . Indirect closing costs, claims settlement costs and other administrative costs according to § 8 (1) (2) to (4) of the calculation regulation may be included up to a total of 10 per cent of the gross premium. Unofficial table of contents

Section 16 Entry into force

This Regulation shall enter into force on 4 January 2013.