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Resolution 4B0 38116-2012, Of 8 August, The Social Institute Of The Armed Forces, Amending Annex 5 Of Resolution 4B0-38276-2009, Of 16 December, Which Approves Health Care Portfolio Of Services Of The...

Original Language Title: Resolución 4B0/38116/2012, de 8 de agosto, del Instituto Social de las Fuerzas Armadas, por la que se modifica el Anexo 5 de la Resolución 4B0/38276/2009, de 16 de diciembre, por la que se aprueba la Cartera de Servicios de Asistencia Sanitaria del ...

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TEXT

In the Health Care Services Portfolio of ISFAS, approved by Resolution 4B0/38276/2009, of 16 December, supplementary health benefits are included. These are financial support for prostheses and certain oral and dental measures, eye aids and other technical aids which have traditionally been the subject of health benefits provided by ISFAS.

In Annex 5 to this Resolution, the limits and conditions of access for supplementary health benefits are established which must be in line with the budgetary resources provided for in Law 2/2012, 29 of June 2012 General State Budget for the year 2012.

For the above and in the exercise of the powers conferred by Article 18 of the General Regulation of the Social Security of the Armed Forces, approved by Royal Decree 1726/2007 of 21 December, it is resolved:

First.

Modify Annex 5 of Resolution 4B0/38276/2009 of 16 December 2009 approving the health care services portfolio of ISFAS.

Annex 5, on supplementary benefits, is replaced by the one that is included as an Appendix to this Resolution.

Second.

This Resolution shall enter into force on the day following that of its publication in the "Official Gazette of the State", being applicable to applications for benefits which are issued from that date, irrespective of the date on which the the corresponding causative event took place.

Madrid, August 8, 2012. -General Secretary of the Social Institute of the Armed Forces, M. Soledad Alvarez de Miranda Delgado.

ANNEX 5

Complementary health benefits

1. Dentary capabilities

Aid for prostodoncia or prosthetic rehabilitation

Help limit

-

by full prosthesis

560

280

280

Rehabilitation by dentary pieces, fundas, or crowns (each)

35

Other Dentary Benefits

Help Limit

-

Treatment with osteintegrated implant (each, up to a maximum of six)

120

Empaste, shutter, or rebuilds (each)

20

Endodoncia (each piece treated)

40

Periodontics

900

Orthodontic treatment started before 18 years

500

12

12

Delimitation and access conditions:

A) The dental treatments included among the benefits covered by the Concerts subscribed by the ISFAS with Insurance Entities may not be subject to the aid set out in this Annex, in favour of the holders and beneficiaries benefiting from such Concerts.

B) The pieces, fundas or provisional crowns, are excluded because of their purely aesthetic nature.

C) Support for rehabilitation with dental prostheses is intended to cover the coverage of the corresponding treatment, with the limits established, and will reach both the precise clinical actions and the cost of the corresponding prosthesis.

All aid for rehabilitation treatments with dental prostheses will be subject to a three-year renewal period, so that the maximum aid that can be granted to a beneficiary by any type of Rehabilitation treatment with dental prostheses (complete, upper, lower or for fundas or crowns) shall be 560 € every three years, to be counted retrospectively from the date of the application.

Rehabilitation assistance with complete prostheses will be incompatible with other dental benefits, with the exception of assistance with osteo-integrated implants.

D) The aid for endodontics includes the aid for the fillings or obturation of the treated part (even if it is not expressly stated on the invoice), as it is understood that all endodontics concludes with the closure of the cavity by means of the corresponding fillings or obturation.

E) Repair treatments on temporary dentition will not be subject to aid.

F) The aid established for periodontic treatments covers the costs incurred, for one or more treatments, over a period of five years from the date of the first invoice. After the five years, a new period of equal duration begins, with the possibility of new aid under the same conditions; and so on.

The help not consumed in a period does not increase the maximum help for the following. For the temporary imputation of the treatments, the date of the corresponding invoice will always be taken.

The beneficiaries with full assistance by Insurance Entities will not be able to access the aid for periodontic treatments, since they are the subject of coverage by the respective Entity, provided that the processing established in the current Concert.

(G) Orthodontic treatments initiated before the age of 18 years may be the subject of financial aid, which shall be paid for once and for a single treatment. If the beneficiary has completed the 18-year period, the specialist shall be provided with a report, including the date of initiation of the treatment.

H) Support for osteintegrated implants can only be recognised for up to six implants for each beneficiary of the same, so that the beneficiaries who have already been recognised for the benefit of six implants Implants may not be subject to new benefits under this concept. These aids are compatible with aid for prosthetic rehabilitation.

I) Support for tartrectomy may only be recognized once every calendar year and, in accordance with the provisions of paragraph (A) above, it shall not be accessible to beneficiaries with full assistance with a Insurance Entity.

(J) The application for the relevant benefit must be accompanied by an invoice from the dentist or stomatologist, in which the details of the treatment and other requirements must be included.

In the invoices for rehabilitation treatments with dental prostheses, in accordance with the Additional Disposition 13ª of Law 26/2006 of Guarantees and the National Use of Medicines and Health Products, all of them must be broken down the concepts expressly detailing the cost of the prosthesis corresponding to the cost of the prosthetic laboratory. When an invoice issued by a dental technician is provided, the invoice or report of the dentist or stomatologist who has performed the rehabilitation treatment with prostheses must also be provided.

2. Eye capabilities

Prstations for glasses or lenses

42

away glass or near (drive)

Help limit

-

15

84

84

84

36

Lentile (drive)

33

Lintillas disposable (annual help)

66

Other ocular capabilities

40

Help limit

-

vision aids (telelupa glasses, magnifiers, filters, microscopes)

180

40

62

62

62

62

200

Delimitation and access conditions:

A) For access to performance by Glasses or Lentillas, the required optical graduation shall be equal to or greater than 0,5 dioptrias.

B) Aid for glasses, replacement of crystals and lentices, of any kind, are incompatible with each other, with only one of them being recognised for each calendar year in favour of the same beneficiary.

In the case of the replacement of crystals and lentices, aid may be recognised for two units at most, per beneficiary and natural year, but in any case the incompatibility with other aid for spectacles will be maintained. or lentices.

If the lentices are disposable, the maximum aid to be granted for this concept will be 66 € per calendar year and beneficiary, and should be requested at one time for granting.

The invoice date for the control of these limits will be taken into account.

C) Applications for aid for glasses, crystals and lentices must be accompanied by the corresponding invoice and, except in the case of therapeutic lentices, of the report in which the optical correction is reflected required by the beneficiary.

E) Benefits for low vision optical aids may be accessed by beneficiaries presenting a visual acuity equal to or less than 0.3 (3/10) with correction, in the best eye, or a visual field less than 10 ° from the fixing point. In this case, the application shall be accompanied by the report of a specialist in ophthalmology, detailing the visual acuity of the beneficiary and, where appropriate, the field of vision.

F) Treatments by means of refractive surgery techniques will give rise to economic aid only in the case of beneficiaries with stabilized refraction defects, therefore, aged over 21 years, and provided that they are requires a correction equal to or greater than 4 dioptrias. When a combination defect exists, the most severe defect must be reached.

The application must be accompanied by a medical report from a specialist in Ophthalmology, in which the diagnosis, the required optical correction and the therapeutic technique used, as well as the corresponding invoice, with the legal requirements already outlined for these benefits.

The amount of economic aid for refractive surgery will be equal to 50% of the cost of treatment without, in any case, this aid can exceed the limit of 200 € for the treatment of each eye.

3. Other technical aids

Prstation

Help

aid (for beneficiaries over 16 years)

423 €

Laringophone

Cost, as billed.

Silver cannulas for tracheotomy and laringuectomy

Cost, as billed.

Delimitation and access conditions:

A) The minimum period of regular renewal of these benefits shall be 4 years from the date of invoice, except for the silver cannula for tracheotomy which shall not be subject to renewal time.

B) If the items require any kind of repair, they may be the subject of an economic aid, the amount of which shall be at most 50% of the aid established for their purchase. The repair aid shall not affect the renewal time.

C) The aid for hearing aid, as provided for in this Annex, will be incompatible with the hearing aid provided for in the ISFAS Catalogue on Spelling Material (code 21 45 00).

When the bilateral adaptation of hearing aids is prescribed, both may be subject to financial support.

D) In the case of applications for silver cannula for tracheotomy and laringuectomy, the specialist's report should justify the need for this type of cannula.

E) In all cases, the applications must be accompanied by a prescription and the corresponding invoice, with the legal requirements established.