Regulation On The Implementation Of The Allowance For Private Care Plans After The Thirteenth Chapter Of The Eleventh Book Of The Social Code

Original Language Title: Verordnung zur Durchführung der Zulage für die private Pflegevorsorge nach dem Dreizehnten Kapitel des Elften Buches Sozialgesetzbuch

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

Non-official Table of Contents

PflvDV

Date of expiry: 20.12.2012

Full quote:

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

Footnote

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unofficial Table of Contents

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. N ° 2246), the Federal Ministry of Health, in agreement with the Federal Ministry of Finance and the Federal Ministry of Labour and Social Affairs, : href="index.html#BJNR299400012BJNE000200000"> Non-official table of contents

§ 1 Central Office

(1) The German Pension Insurance Association is the central body within the meaning of the thirteenth chapter of the Eleventh Book of Social Law set up. The central body is responsible for the tasks arising from the Thirteenth Chapter of the Eleventh Book of Social Law.(2) The Deutsche Rentenversicherung Bund shall draw up an annual economic plan for the central body, which shall be 1. May be submitted to the Federal Ministry of Health for the following year in the respective calendar year. 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 Deutsche Rentenversicherung Bund.(3) The Federal Ministry of Health shall have the central office annually up to 1. May provide overviews of the results of the previous calendar year and statistics on
1.
of the total number of products and of the total number of Calendar year of newly funded private care-supplementary insurance,
2.
the number of applications received in the relevant calendar year for funding, the number of rejected Applications as well as the number of the fixing procedures according to § 128 (2) sentence 9 of the Eleventh Book of Social Code,
3.
the number of the announced in the relevant calendar year Contracts of sponsored private care-supplementary insurance as well as
4.
the number of the number of books in each calendar year pursuant to § 127 (2) sentence 1, point 7 of the Eleventh Book Social Code of Retirement Contracts.
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§ 2 Announcement of insurance companies

(1) central to the result that there is no entitlement to an allowance, it shall disclose the result of the test to the insurance undertaking by means of a 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 set with a non-marked error message has been rejected by the central office, the insurance company will forward it to the 30. June of the calendar year following the contribution year, no error-free record, this dismissal of the data set shall also be deemed to be the announcement of the result of the test.(2) If the central body comes to the conclusion that the claim is entitled to an allowance, it shall inform the insurance undertaking of the payment of the allowance by means of the payout reference file in accordance with § 7 (2).(3) The central body within the period of change in accordance with § 6 that the right to an allowance has not passed or has fallen away has to reclaim unduly credited or disbursed allowances and this is the case. Insurance undertakings shall be notified by a data set.(4) If an insurance undertaking has already received a data record in accordance with paragraph 1 or paragraph 3 and if 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: (b) to repay the allowances credited or disbursed and to disclose this to the insurance undertaking by a record.(5) In the event of an application pursuant to Section 128 (1) sentence 3 of the Eleventh Book of the Social Code, the central body shall inform the insurance undertaking 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 data record. Non-official table of contents

§ 3 Non-disclosure of the insurance company to the central body

(1) The insurance company is , in the period of 1 January 2008, January to 31 January March of the calendar year following the contribution year, the central body shall submit an application record for the determination of eligibility for payment of the allowance. The application record shall include the application required under 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 Law. 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 has already submitted an application record, in at least one calendar month for which the allowance has been requested with that data record, no claim to allowance shall be made available to the insurance undertaking. , the insurance undertaking has to cancel or rectify this application record. 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 Section 126 (1) sentence 1 of the Eleventh Book of the Social Code, the insurance undertaking shall not submit a new application record until it has received a new application record. 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 immediately correct or cancel this data record.(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 directly after its receipt with the necessary additional information to the central body as an electronic document. § § 11 and 12 shall apply accordingly. In particular, the request and the necessary additional information shall be transmitted in a different manner on a specific request from the central body.(4) The insurance undertaking shall forward to the central body a yearly basis up to 31 December 2008. The number of 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 the Social Code of the Eleventh Book of Social Law. Non-official table of contents

§ 4 Application procedure

(1) The insurance company has, in the presence of the proxy pursuant to § 128, paragraph 1, sentence 2 of the Eleventh Book of Social Code as well as the other conditions to apply for the allowance for the insured person. 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 directly to the insured person in relation to the central office.(2) The insurance undertaking shall particularly indicate in the application data record that the insurance contract fulfils the eligibility requirements of Section 127 (2) of the Eleventh Book of Social Code and in this respect an industry-standard contract model was used.(3) Prior to the first-time transmission of the application record for an insured person, the insurance undertaking has obtained from that person, in addition to the application for the conclusion of the insurance contract,
1.
confirm that the requirements of § 126 of the Eleventh Book of the Social Code are fulfilled, and
2.
to obtain an obligation for the insurance company to make any changes to the conditions relating to the right to pay according to § 126 of the Eleventh Book of the Social Code, .
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 shall be included in the application record to the central body.(4) If the assurance undertaking is aware that the insured person has been moved abroad, it may only transmit an application record if he or she has received a request for care for the period for which a care allowance is to be applied for. suitable proof that the allowance is made in accordance with § 126 sentence 1 of the Eleventh Book of the Social Code. Section 3 (2) shall apply mutatily. Non-official table of contents

§ 5 Enforcement procedure

The commit procedure is only allowed if the central location of the Insurance company has sent a data record in accordance with § 128 (3) sentence 1 of the Eleventh Book of Social Code. Non-official table of contents

§ 6 Change of test result

(1) The test result according to § 2 (1) as well as the test result according to § 2 paragraph 3 may be shall be repealed or amended as long as a request for the determination pursuant to Section 128 (2) sentence 9 of the Eleventh Book of the Social Code has not yet been made binding on the relevant 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 undertaking has modified or cancelled an application data 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. Non-official table of contents

§ 7 Payout of allowances, payout reference file

(1) The allowances will be on the 20. April and 20. December of one year by the central post for payment. § 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) At the latest with the instruction of the payment of the allowances, a payout reference file shall be made available to the insurance undertaking. The form and content of the payout reference file determines the central location. Non-official table of contents

§ 8 Revocation requests

(1) The insurance company has the returned claims to the insurance company up to the next 10. June and 10. to pay to the central office in an amount. At the latest with the payment of the payment, the insurance undertaking shall have to send a repayment reference file to the central body. The form and content of the repayment reference file determines the central location.(2) The central body may, before the commencement of enforcement, transmit a reminder by record to the insurance undertaking. The central office decides on the crackdown.(3) The central body may charge against the insurance company claims for payment of the allowance for an insured person with claims for repayment of allowances for this insured person. The notification of the settlement shall be deemed to be the notification of the audit result. The insurance undertaking shall not make any statements or settlement with its own claims in relation to the central body.(4) The amount of the recovered amount shall be fixed by the central body vis-à-vis the policyholder, 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 transmission

(1) According to the Thirteenth Chapter of the Eleventh Book of the Social Code, or after this Regulation shall be made in the form of an official transfer of data and of any advertisements, announcements or communications between the central body and the insurance undertakings or its contractors in accordance with Section 12 (3) of this Regulation. required data sets by means of officially designated remote data transmission.(2) Paragraph 1 shall not apply to the transmission of data as well as to the notification and notifications issued pursuant to § 2 (2) and (5), § 3 (3) and (4), § 7 (2), § 8 (1) and (13). Non-official table of contents

§ 10 Technical Delivery Format

(1) The records are to 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 shall comply with the requirements of DIN 66303, issue June 2000. 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 published by the German Patent and Trade Mark Office in Munich. Non-official table of contents

§ 11 Data transfer procedures, interfaces

(1) When the records are electronically transmitted by The transmission of data in accordance with § 9 paragraph 1 is to be used properly for the interfaces determined for the respective transmission time. The interfaces required for the transmission of data and the accompanying documentation will be made available in a protected area of the central office via the Internet after approval of the Federal Ministry of Health.(2) If deficiencies 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 agency with a means of transmission. Non-official table of contents

§ 12 Transmission by remote data transmission

(1) The data transmission is related to the state of the art to take appropriate measures to ensure data protection and data security, in particular to ensure the confidentiality and integrity of the data and 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. V. the encryption method to be used, which must correspond to the respective state of the art.(2) The central location shall determine the transmission path to be used.(3) The necessary data may be transferred to the central body by a suitable contractor of the insurance undertaking, if the conditions of § 11 of the 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 entrusted with the transmission of data in accordance with paragraph 3 shall be deemed to be the receiving agent for communications from the central body to the insurance undertaking, as long as it does not contradicts the latter. Non-official table of contents

§ 13 Identification of those involved in the procedure

(1) The insurance company has the central body to view:
1.
the customer type (insurance companies or contractors),
2.
the name and the Address,
3.
as far as due to the machine connection variant required the email address,
4.
the phone number and, if any, the telefax number,
5.
the operational number,
6.
the type of connection to machine connection of the insurance company and
7.
the Banking connection.
(2) In the case of the assignment of a contractor in accordance with Section 12 (3), the insurance company shall also have the data referred to in paragraph 1 (1) to (6) and the client or institution's number from the contractor. of the person concerned with the contractor.(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 to access the protected Internet area of the central office . In addition, the central unit shall inform the bank details of the bank details to be used for repayments of allowances.(4) Any change in the data referred to in paragraphs 1 and 2 shall be notified forthwith to the central body by the parties to the proceedings, indicating their customer number. Non-official table of contents

§ 14 Recording and retention periods

The central body and the insurance companies have submitted the to record data and to keep them in order for a period of six years from the end of the year in which the transmission has taken place. The records shall be deleted or destroyed at the end of the retention period referred to in the first sentence. Non-official table of contents

§ 15 Administrative and final costs

In fares of eligible care, additional insurance may be taken into account. direct final costs in accordance with Section 8 (1) (1) of the calculation regulation shall not exceed twice the total gross premium to be paid 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. Non-official table of contents

§ 16 Entry into force

This regulation occurs on the 4. January 2013 will be in force.

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