In application of the provisions of article 17 of Royal Decree 3/2000 of 23 June and 63 of Royal Decree 3283/1978 of 3 November, this Mutual General Judicial has signed concerts with various insurance entities for the ensuring access to the provision of health care in the national territory to mutualists and other beneficiaries of Mugeju who do not choose to receive it through the public health system by 2010, with a view to extending them for years 2011, 2012 and 2013.

In compliance with what was determined in the base number 8 of the call for applications published by Resolution of 21 October 2009, (BOE No. 265 of 3 November), the Management of the General Judicial Mutuality agrees:

First. -Publish the text of the concert for the assurance of access to the provision of health care in national territory to mutualists and other beneficiaries of Mugeju who do not choose to receive it through the system public health for the year 2010, which is included as addenda to this resolution.

INDEX

Chapter I. Object of the concert, scope of the protective action and scope of application.

1.1 Object of the concert and scope of the protective action.

1.2 Concert Beneficiaries.

1.3 Birth and extinction of beneficiaries ' rights.

1.4 Entity change.

1.5 Maternity Beneficiaries.

1.6 Identification of beneficiaries.

1.7 Healthcare cards.

1.8 Mutualists not attached to medical entity.

Chapter II. Portfolio of services.

2.1 General rules.

2.2 Content of the service portfolio.

2.3 Primary care services portfolio.

2.3.1 Content.

2.3.2 Home Assistance.

2.4 Specialized Care Services Portfolio.

2.4.1 Content.

2.4.2 Specialist assistance in queries.

2.4.3 Specialist day hospital, medical and surgical assistance.

2.4.4 Hospitalization in detention.

2.4.5 Home-based hospitalization.

2.4.6 Psychiatric hospitalization.

2.4.7 Rehabilitation and physical therapy.

2.4.8 Assisted human reproduction.

2.4.9 Mental health.

2.4.10 Other specifications.

2.5 Portfolio of emergency care services.

2.5.1 Access to urgent care.

2.5.2 Hospital emergency services.

2.6 Palliative Care.

2.7 Attention to dental health.

2.8 Pharmaceutical and dietary products.

2.8.1 Content.

2.8.2 Prescription.

2.8.3 Medicines in charge of the entity.

2.8.4 Rational use of the medication.

2.8.5 Procedure for the impact of drug costs unduly paid by Mugeju.

2.8.6 Computer-based Prescription.

2.8.7 Quality of the pharmaceutical prescription.

2.9 Transportation for healthcare.

2.9.1 Transport in ordinary media.

2.9.2 Transportation in extraordinary means.

2.9.3 A companion expense assistance.

2.10 Other supplementary benefits.

2.10.1 Preventive Programs.

2.10.2 Orthoprosthetic Prstation. Therapeutic or diagnostic surgical implants.

2.10.3 Oxygenotherapy and other respiratory therapies.

2.10.4 Podology.

2.11 Special Suppositions.

2.11.1 Optional Optional.

2.11.2 Military Hospitals.

Chapter III. Means of the entity.

3.1 General rules.

3.1.1 Scope.

3.1.2 General principles.

3.2 Media availability criteria.

3.3 Vendor Catalog.

3.3.1 General Criteria.

3.3.2 Content.

3.4 Promotional campaigns.

3.5 Issue responsibility for the entity's supplier catalog.

3.6 Invariability of the entity's supplier catalogs.

3.7 Principle of continuity of care.

Chapter IV. Use of non-concerted media.

4.1 General rule.

4.2 Unjustified denial of assistance.

4.2.1 Unjustified denial of assistance.

4.2.2 Entity Obligations.

4.2.3 Payee claim.

4.2.4 Other effects.

4.3 Vital character urgent assistance.

4.3.1 Concept and Requirements.

4.3.2 Scope.

4.3.3 Communication to the entity.

4.3.4 Entity Obligations.

4.5.5 Payee claim.

4.4 Transport in foreign media for health care in cases of unjustified denial of assistance and vital urgency.

Chapter V. Legal regime of the concert.

5.1 Nature and regime of the concert and the relationships in the building.

5.2 Nature and regimen of care relationships.

5.3 Mixed Commissions.

5.4 Procedure for claims.

5.5 Estimated claims execution procedure.

5.6 economic compensation for late payment in compliance with the obligations defined at the concert.

5.6.1 Economic compensation for non-compliance with obligations defined at the concert.

5.6.2 Procedure for the imposition of economic compensation.

Chapter VI. Health information and documentation.

6.1 General rules.

6.2 General activity information.

6.3 Economic information.

6.4 Information regarding the available media.

6.5 Healthcare documentation.

Chapter VII. Duration, economic regime and concert price.

7.1 Duration of the concert.

7.2 Economic arrangement of the concert.

7.3 Concert Price.

ATTACHMENT RELATIONSHIP

1. Means of assistance in rural areas.

2. Relationship of services that require prior authorization of the same and procedure for obtaining it.

3. Media availability criteria by care levels.

4. Pathologies with vital risk.

5. Care information systems.

6. The structure of the entity's media database.

7. Actions prescribed by the institutions for the assessment of disabilities and scales for reimbursement.

CHAPTER I

Object of the concert, scope of the protective action and scope of application

1.1 Object of the concert and scope of the protective action.

1.1.1 The object of the concert is to ensure access to the provision of health care in the national territory to the mutualists and other beneficiaries of Mugeju who do not choose to receive it through the Public Health System. This assistance will be provided in accordance with the provisions of the Royal Legislative Decree 3/2000 of 23 June, approving the recast text of the existing legal provisions on the Special Social Security Regime for personnel. service of the Administration of Justice, Law 14/1986 General of Health and Law 16/2003, of 28 May, of cohesion and quality of the National System of Health.

1.1.2 The contingencies covered by this concert are those arising from common or professional illness, injuries resulting from accidents, whatever the cause, even if it is an act of terrorism, and by pregnancy, childbirth and puerperium, as well as in the preventive performances collected at the concert.

1.1.3 Healthcare will be provided in accordance with the Services Portfolio established in this concert that will include at least the Common Services Portfolio of the National Health System, in accordance with the provisions of the Royal Decree 1030/2006 of 15 September establishing the portfolio of common services of the National Health System and the procedure for updating it.

1.1.4 To make the provision of comprehensive health care effective in accordance with such Service Portfolio, the signatory of the concert (hereinafter, Entity) shall make available to the beneficiaries attached to it (in (a), (b), (b), (b), (b), (c), (c), (c), (c), (c), (c), (c), (c), ( If exceptionally the Entity does not have such means, it shall be directly responsible for the expense caused by the use of non-agreed means in accordance with the terms of this concert.

1.1.5 For its part and for the same purpose, Mugeju is obliged to pay the Entity the amount per month and person provided for in Chapter 7, subject to the specifications and procedure contained in clause 7.3.

1.2 Concert Beneficiaries.

1.2.1 Without prejudice to the following point and clause 1.5, all mutualists and other beneficiaries of health care in Mujeju, determined to be eligible for the benefit of this concert, are eligible for the benefit of this concert. in accordance with its own rules. The recognition of the payee condition corresponds to Mugeju.

1.2.2 For certain purposes of management and provided that this is derived from the text of the Clauses itself, the beneficiaries of this may be called holders, if they have a document of affiliation to Mugeju of their own, or simply beneficiaries, when they appear in the document of beneficiaries of a holder. In any case, the latter shall be attached to the Entity as long as the holder of the entity is dependent. Exceptionally, the beneficiary may be assigned to an entity other than that of the holder who causes the right and if the Mujeju agrees.

1.2.3 The holders who, if any, are assigned to the Entity at 31 December 2009 and do not change the entity as provided for in clause 1.4 or according to the rules of membership of the Health Network shall be attached to the Entity. Social security and those who choose it in accordance with the rules of that clause or when their discharge occurs in Mugeju.

1.3 Birth and extinction of beneficiaries ' rights.

1.3.1 Without prejudice to the following paragraph and clause 1.6, the rights of the beneficiaries begin on the date on which they have been assigned to the Entity by Mujeju, without there being any time of absence for any type of assistance.

1.3.2 To the above mentioned effects, it is presumed that the newborn is attached to the Entity that caters to the mother, from the moment of the delivery until one month. From then on, this right is conditional on the formalisation of the membership with the consequent economic effects.

1.3.3 The rights of the beneficiaries shall be extinguished, in any event, on the date that Mujeju agrees to his or her absence from the same or the Entity.

1.4 Entity change.

1.4.1 The holders attached to the Entity may switch to another of the agreements in the following cases:

A) On an ordinary and general basis, once a year, during the month of January each year, in the form set by Mujeju.

B) With extraordinary character:

(a) When there is a change of destination for the active or resident mutualist of the retired mutualist or non-mutualist holder, involving in all cases change of province.

b) When the data subject obtains the written agreement of the two Entities concerned.

(c) Where, in the light of objective circumstances justifying the change of a plurality of holders affected by the same health care problem, the General Judicial Mutual Manager agrees to open the special term of choice of Entity.

d) In the particular cases in which, in the judgment of the General Judicial Mutual Manager, the exceptional circumstances justifying the change are met.

1.4.2 The merger of the Entity with another or other of the Concerted by Mugeju will not imply the opening of a special time of change, being automatically attached to the absorbing Entity or resulting from the merger the beneficiaries which, at the time of the merger, will be attached to the Entity/is extinguishing/s or to each of the merged Entities, and obliging the resulting absorbing Entity, from that moment, to guarantee all their rights in the intended terms at the present concert.

1.5 Maternity Beneficiaries.

1.5.1 In addition to the beneficiaries included in clause 1.2, the spouses of mutualists or those who are in a situation similar to that of the family are also beneficiaries for maternity, for the purposes of this concert. spouse, even if they do not fulfil the status of beneficiaries included in the relevant document, provided that they are not holders attached to another signatory of the present concert. In this case, healthcare covers birth preparedness and all incidences and obstetric pathology of pregnancy, childbirth and puerperium.

1.6. Identification of the beneficiaries.

1.6.1 The payee condition is credited, using the corresponding Mugeju affiliation document where the entity consists. Such a document can be punctually replaced by an individual certificate of the status of high in Mugeju, issued by it.

1.6.2 In cases where, for reasons of urgency, it is not possible to provide the above documentation in the act, the beneficiary must identify with his or her national identity document or other document attesting to his/her personality. and submit that documentation within the maximum period of forty-eight hours.

1.6.3 The maternity benefit condition of clause 1.5 must be expressly recognized by Mugeju, at the request of the mutualist.

1.7 Healthcare cards.

1.7.1 The Entity shall, at the time when the person is aware of the discharge of a beneficiary, give you a provisional card, assistance checks or any documentation that makes possible the use of means of the entity. It shall immediately issue the final card to be sent to the address of the beneficiary within a maximum of seven working days from the actual communication.

1.7.2 However, in cases where, in the light of the express request of a beneficiary of discharge in the institution, the provisional card or the document making possible its use of the means agreed, Mugeju, is not provided. issue a Resolution stating that all expenditure incurred for the assistance of the holder and its beneficiaries through the facultative, services and centres included in the table of suppliers of the entity may be invoiced directly to Mujeju for payment on behalf of the entity. Subsequently, the amount of these expenses shall be deducted from the monthly instalments to be paid to the Entity, in accordance with the procedure laid down in clause 5.5.2 of the concert without prejudice to financial penalties or compensation could be cordoned off.

1.7.3 The beneficiary must present the corresponding health card when it comes to the means of the Entity. In any event, the non-filing of such cards at the time of attendance, in cases where the Entity has not yet issued it, or in urgent situations, does not prevent or condition the right of the beneficiary to make use of the means of the Entity, being able to the beneficiary, in those cases to identify as determined in the clause 1.6.

1.7.4 The Entity is required to report and implement the necessary mechanisms for compliance with the above paragraphs by the professionals and centers of its Service Catalog.

1.7.5 If the health card is issued by a subconcerted entity, it must always bear the logo of the Concerted Entity with Mugeju, for the purpose of facilitating the use of means outside the provinces where it is the subconcerted.

1.8 Mutualists not attached to medical entity.

1.8.1 The Mugeju mutualist who has not formalized his or her affiliation to one of the Concerted Entities or the Public Health Network and who, specifying health care for himself or his beneficiaries, requires it in the offices of the Entity, you have the right to receive it.

1.8.2 The Entity shall provide the assistance and, within the following five working days, shall notify the facts to Mugeju to proceed to the discharge of the mutualist in the Entity with the effect of the fifth of those days and to the credit of the costs of the assistance provided up to the date of discharge.

CHAPTER II

Services Portfolio

2.1 General rules.

2.1.1 Healthcare to the beneficiaries of Mugeju attached to the Entity will be provided according to the Portfolio of Services established in this concert and comprises the set of techniques, technologies or procedures, The understanding of each of the methods, activities and resources based on scientific knowledge, through which the health benefits are effective.

2.1.2 The beneficiaries will have access to diagnostic or therapeutic techniques and procedures included in the portfolio of services contained in this concert, provided that the corresponding indication is established by an optional of the table of suppliers, irrespective of whether or not the technique or procedure is available in the geographical area in which they reside.

2.1.3 The benefits included in the Portfolio of Services to be provided by the Entity are guaranteed by the provision of necessary care resources by levels and geographical and population areas established in the Chapter 3 and Annex 3 of this concert.

2.2 Content of the service portfolio.

2.2.1 Prstations.-The content of the Services Portfolio to be provided by the Entity will comprise at least the benefits contained in the portfolio of common services of the National Health System, according to the regulations in Royal Decree 1030/2006 of 15 September establishing the portfolio of common services of the National Health System and the procedure for updating it, with the specific features set out in this Chapter and in Annex 3, this concert.

The Services Portfolio that is the object of the concert, is structured in the following capabilities:

1) Primary care.

2) Specialized care.

3) Emergency Care.

4) Palliative care.

5) Bucodental health.

6) Pharmaceutical delivery, dietetic products and other medical devices.

7) Healthcare transport.

8) Other capabilities:

Preventive programs.

Orthopedic: diagnostic or therapeutic surgical implants.

Oxygenotherapy and other respiratory therapies.

Podology.

Access to the benefits included in the Portfolio of Servants is guaranteed by the provision of the necessary care resources by levels and geographical and population areas set out in Chapter 3 of this concert.

2.2.2 Incorporation of new means of diagnosis and treatment. -The Services Portfolio determined in this chapter will be automatically updated by updating the Common Services Portfolio of the National System of Health, as provided for in Article 7 of Royal Decree 1030/2006, mentioned.

Any diagnostic or treatment technique that appears after the signature of the concert will be a mandatory means for the Entity when it is applied to patients within the National Health System in some of the own or concerted centres of the Health Services of the Autonomous Communities. In case of doubt, it will be in accordance with the aforementioned Royal Decree 1030/2006 and Law 16/2003 of 28 May, of cohesion and quality of the National Health System.

2.3 Primary care services portfolio.

2.3.1 Content. -Primary care is the basic and initial level of health care and will be provided by specialists in family and community medicine or general practitioners, pediatrics specialists and professionals nursing, without prejudice to the collaboration of other professionals.

You'll understand:

1. Healthcare on demand, scheduled and urgent, both at the consultation and at the patient's home.

2. The indication or prescription and, where appropriate, the performance of diagnostic and therapeutic procedures.

3. Palliative care for terminally ill patients.

Primary care is provided through primary care: consultation, home and urgent care.

2.3.2 Assistance in consultation.-The beneficiary will be directly directed to the healthcare professional chosen from Primary Care to receive the assistance that he needs, without further requirements to prove his/her condition and to present the corresponding health card, without prejudice to the provisions of clause 1.8.

2.3.3 Home Care. -Healthcare will be provided by Primary Care professionals at the patient's home, provided the clinical situation so requires, in the following cases:

A) In the case of patients who are unable to travel because of their illness.

B) In the case of chronic immobilized patients who need help from another person for the basic activities of daily life.

C) When dealing with terminally ill patients. Palliative care for these patients will include a comprehensive and continuous care of people with advanced disease, not susceptible to receiving treatments for curative purposes and with a limited life expectancy, with the objective of The main aim of alleviating suffering. The necessary advice shall be given to the persons concerned.

Home care includes the extractions and/or collection of home samples that are accurate, as well as all of the primary care procedures, including parenteral treatments, cures, and sondages.

2.3.4 Urgent assistance. The urgent assistance may be obtained from the general medical, pediatric and nursing physicians of the Entity and, outside of the hours of consultation and in any case, of the Emergency Services of Primary Care of the Entity.

2.4 Specialist care services portfolio.

2.4.1 Content. -Specialized care includes care, diagnostic and therapeutic activities whose nature requires specialist medical intervention.

Specialized care comprises:

1. Specialist assistance in consultation.

2. Medical or surgical day hospital specialized assistance.

3. Hospitalization in detention.

4. Home hospitalization.

5. Psychiatric hospitalization.

6. Rehabilitation and physical therapy.

7. Assisted human reproduction.

8. Mental health.

9. Other complementary specifications:

Plastic, aesthetic or restorative surgery.

Transplants.

2.4.2 Assistance specialized in consultations. -Comprises preventive, care, diagnostic, therapeutic and rehabilitation activities, which are provided in the field of specialized care in outpatient care.

2.4.3 Specialist day care, medical and surgical assistance. -Understanding-the care, diagnostic, therapeutic and rehabilitation activities, intended for patients requiring continued specialized care, including the most outpatient surgery, which do not require the patient to stay in the hospital.

The indication for the use of this resource corresponds to the optional specialist responsible for patient care, specifying the authorization of the Entity.

2.4.4 Hospitalization in detention. -Comprises medical, surgical, obstetric and pediatric care or the carrying out of diagnostic treatments or procedures, to patients who require continued care they need their internment.

The assigned revenue in a hospital will require prescription by the Entity, with indication of the center and authorization of the Entity.

In the cases of income made through the emergency services and the maternity hospital, the institution itself will carry out the necessary procedures before the Entity.

Requirements:

A) Duration. -hospitalization will persist while, in the opinion of the physician responsible for the care of the patient, the need arises, without which they can be reason to prolong the stay reasons of social type.

B) Type of room. The hospitalization shall be carried out in a single room with bath or shower and a companion bed, and must be provided by the higher level entity when it has not been available of the type indicated. In no case shall rooms which are part of the accommodation capacity of the centre be excluded.

Mugeju may authorize the Entity to have hospital facilities that do not meet the requirement of the previous paragraph in its Centers Provider Catalog. In the case of psychiatric hospitalization, no accompanying bed will be required.

C) Maternity hospitalization. -At the time of entry, the authorization of the Entity will be obtained directly by the corresponding hospital center.

For the purpose of newborn care, the provisions of clause 1.3.2 shall be taken into account.

If at the time of delivery, the practice of the tubal ligation was decided and it would not have been indicated in the prescription of the income, the entity is obliged to cover the expenses caused by this concept.

D) Hosptialization for pediatric care. -Children under 15 years of age will be provided. In any case, the person accompanying the child shall be entitled to a bed and a companion alimony.

When the companion resides in a municipality other than that of the health center and in addition the characteristics of the center do not allow its accommodation because it does not have the same or because the child is in the ICU, the Entity will pay the A compensatory amount of 47.76 euros per day. It shall not be paid when the accompanying person resides in the municipality where the hospital is located.

2.4.5 Home-based hospitalization. -Assistance under home hospitalization includes diagnostic and therapeutic activities to be carried out in a coordinated manner by the Hospitalization Unit. Home (UHD) as a consequence of procedures initiated at the level of specialized care, in order to guarantee continuity in the care provided to the patient, always prior to acceptance of the patient. The home hospitalization may be carried out in cases where the condition of the patient allows, it can benefit and be advisable. Such hospitalization will be carried out at home, especially if it is for palliative care and provided that family, domestic and proximity conditions to the hospital permit.

During this hospitalization, the responsibility for the patient's follow-up corresponds to the UHD and will be provided by the specialists (family physicians or internists) and the nursing staff who make up the UHD, which must be coordinated with the medical or surgical inpatient unit corresponding to the patient's pathology and with the hospital emergency room, in order to ensure the continuity of care.

The entry into the UHD can be performed from a hospital service through the appropriate referral report and from primary or specialized outpatient care. In the latter two cases, it will be up to the UHD to assess whether the patient meets the criteria for admission to the unit. The entry into the UHD will be subject to the same requirements for admission to a hospital. The clinical care received by the patient will be the same as those received in the hospital, and of these will be the same log of follow-up and evolution of doctors and nursing in the medical history. The UHD will inform the patient and his family, in writing, of how to contact the aforementioned unit, 24 hours, to respond to any incidents. When the discharge occurs, the UHD physician will issue the relevant medical part of discharge in the terms provided for by law.

As long as the patient remains admitted to the UHD, they are aware of the Entity and cannot be imputed by any means or to the mutualist or Mugeju, all the attentions, products and materials that it requires, as in all hospitalization, in addition to all medication, cures, non-common nutrition, complementary tests, interconsultations, absorbents, probes, home hemodialysis, and oxygen therapy. In any case, the ordinary household envelopes, the common nutrition and the services of clinical auxiliaries are excluded.

The Entity must communicate to Mugeju the relationship of beneficiaries who are in the Inpatient Hospitalization modality by stating the date of the start and, if any, of the completion of that service.

2.4.6 Psychiatric hospitalization. -hospitalization, including day care, will be prolonged for as long as the psychiatrist responsible for patient care considers it necessary and, therefore, up to hospital discharge and will cover all processes both acute and chronic. If the income is produced in a non-arranged centre, no prior authorization of the Entity is required and in this case, the same will pay to the affiliate the expenses of hospitalization with the limit of 81,18 euros per day. The refund shall be made within 10 working days of the date on which the beneficiary submits the supporting documents to the Entity.

Coverage of the social internment of patients affected by neurodegenerative dementias such as Alzheimer's and others is excluded.

However, the hospitalization of those patients who, suffering from some type of neurodegenerative dementia, requires psychiatric hospitalization due to inter-current or decompensation processes, will be attended. severe.

2.4.7 Rehabilitation and Physical Therapy.

A) Comprises. -The procedures for the diagnosis, evaluation and treatment of patients with a recoverable functional deficit, aimed at facilitating, maintaining or returning the greatest possible degree of functional capacity and independence to the patient, in order to reintegrate it into its usual medium.

The rehabilitation of the conditions of the musculoskeletal system, the nervous system, the cardiovascular system and the respiratory system, through physical therapy, occupational therapy, speech therapy and adaptation of technical methods (orthoprostheses).

B) Conditions. -Rehabilitation and physical therapy treatments must be prescribed by the rehabilitating physicians or by the medical specialists responsible for the pathologies susceptible to these treatments.

The patient's assessment of evolution and determination of discharge will be the responsibility of the rehabilitating physician or, where appropriate, of the optional specialist who applied for such treatment.

Treatments may be applied by rehabilitator, physiotherapist, logopeda, and occupational therapist, as appropriate.

C) Duration.-The number of sessions is subject to the optional criterion and the situation of the patient, the tables of duration of the sessions approved by the Spanish Society of Rehabilitation or other scientific societies.

The obligation of the Entity will terminate when the functional recovery has been achieved fully or as much as possible because it has entered the process into an insuperable stabilization state, since it is an attention directed to patients with a recoverable functional deficit, in any case the rehabilitation indicated by the process of resharpening.

2.4.8 Assisted human reproduction.

A) Diagnosis and treatment of sterility. -Entity is obliged to assume the necessary expenses to obtain the diagnosis of sterility, which will be extended, where appropriate, to the couple.

Assisted reproduction techniques shall be carried out by the Entity when the woman on whom the technique is to be performed is a beneficiary of Mugeju. The Entity shall be required to finance all necessary tests and actions on the partners of the mutualists subject to Assisted Reproduction techniques.

In addition, it will be on behalf of the Entity the cryopreservation of semen, oocytes and ovarian tissue during the period that marks the current legislation, in those cases of beneficiaries or beneficiaries that will undergo treatments. surgical and/or chemotherapy and radiation therapy. The cryopreservation of leftover frozen preembryos from a cycle of fertilization in Vitro will be the one that marks the Law on assisted reproduction techniques, and the time period of cryopreservation must be carried out by the Entity. set in the Guide to Recommendations in Assisted Human Reproduction.

In cases of freezing of oocytes and ovarian tissue for reproductive purposes in beneficiaries, the current regulatory requirements for the performance of controlled experiences should be complied with. reproductive, fertilisation of previously frozen ovocytes or ovarian tissue, related to the techniques of assisted human reproduction.

The entity undertakes to disseminate among its gynecologists and responsible reproduction units the "Guide of Recommendations in Assisted Human Reproduction", elaborated by Mujeju, in order to promote and ensure the development of good clinical practice and the appropriate and rational use of such provision. All the fertilisation techniques implemented in the national territory under Law 14/2006 of 26 May on assisted human reproduction techniques which also meet the criteria for the coverage of the provision are included. set forth in the above guide.

B) Criteria for coverage in assisted human reproduction.-The Guide to Recommendations in Human Reproduction Assisted in the above section sets out the principles of action agreed upon by a group of experts in (a) to ensure the rational use of assisted human reproduction techniques and to reduce the potential risks associated with their application, by establishing criteria for determining the situations in which the cover is to be met; of these techniques, all of which, with a view to the provisions of Law 14/2006 of 28 May, on Assisted Human Reproduction Techniques.

Taking into account these criteria, the coverage of Assisted Human Reproduction techniques will be assumed in the following situations:

In couples where there is a diagnosis of sterility, primary or secondary, by female or male factor, preventing the achievement of a pregnancy or where there is a clinical indication in accordance with the provisions of Articles 1 and 12 of Law 14/2006 of May 26, on Assisted Human Reproduction Techniques.

In women in whom there is a diagnosis of sterility by gynecological pathology that prevents the achievement of a pregnancy, regardless of whether or not there is a partner.

The existence of prior children will not be grounds for exclusion for coverage of Assisted Human Reproduction treatments, as long as the requirements set forth in this clause are met.

In any case, taking into account the technical criteria agreed by the expert group, the treatments will be subject to certain limits and conditions to ensure the greatest effectiveness and the lowest possible risk.

(C) Limits relating to the number of treatment cycles and the age of the patient. -The limits on the number of cycles established should be understood as referring to each expectation of achieving a child by pregnancy to term, that is, if as a result of an assisted reproductive treatment the birth of a child has been achieved, the approach of having a new child and the corresponding optional prescription, starts the computation of new cycles.

According to the above criteria, the following limits are established in the application of treatments by means of assisted human reproduction techniques:

	ovulation Induction	Artificial Insemination	IVF *	IVF with egg/preembryo
cycles			Maximum 4 cycles
Age	Limit 42 years			Under 46 years

* Including complementary techniques

In cases of use of ovocytes and ovarian tissue, as well as for the transfer of leftover preembryos of authorised IVF cycles, the age limit will be that established for the IVF technique with egg cell/preembryo donation.

For the correct interpretation and application of the established limits, the following criteria will be taken into account:

1. To consider that a patient has performed a IVF cycle, it must have reached at least the egg recovery phase.

2. Where there are leftover frozen preembryos from authorised IVF cycles, the transfer of the pre-embryos is part of the same IVF cycle in which the preembryos were obtained, the transfer of the pre-embryos up to the woman from whom she is from the age of 46 years.

3. A new IVF cycle shall not be permitted where cryopretained leftover preembryos from previous cycles exist.

4. If following the performance of a technique of assisted human reproduction and obtained a pregnancy the patient aborts, a new cycle may be repeated with the technique for which the gestation occurred, after the maximum number of cycles has been completed set.

5. For the computation of the number of cycles, the total number of cycles performed independently of the funder shall be taken into account. Therefore, in the event that a couple is engaged in the coverage of this concert, having previously undergone an assisted human reproduction treatment, account will be taken of the number of cycles that would have been performed up to that time and provide coverage to which it corresponds, until you complete the maximum number of cycles set.

D) Other limits and conditions. -1. In the case of assisted human reproduction techniques with the donation of gametes and preembryos, the costs resulting from the actions and, where appropriate, the medicinal products required by the donors, shall be borne by the Entity as part of the cost of the the technique used. In no case may the recipient of the donation be passed on.

2. Assisted reproductive techniques which are performed when the sterility of any member of the partner has been produced voluntarily or over-come as a result of the process are not considered to be included among the benefits financed. natural physiological of the completion of the person's reproductive cycle.

3. Coverage of the cryopreservation and maintenance of semen of beneficiaries who are to undergo surgery, radiotherapy, chemotherapy and certain drugs, which may have an important effect on their fertility, will be covered. during the period of time determined by the regulations in force at any time.

4. The coverage of the cryopreservation and maintenance of ovocytes and ovarian tissue of women, who will undergo surgery, radiotherapy, chemotherapy and certain drugs and/or reproductive techniques, will also be provided. assisted, and that of the leftover preembryos of authorised IVF cycles, until the woman is 46 years of age.

2.4.9 Mental health.

A) Content. -Comprises mental health care and psychiatric care that includes clinical diagnosis and follow-up, drug treatment and individual, group or family psychotherapy. Mental health care will be carried out in the treatment of hospitalization and on the basis of external consultations or day hospital, guaranteeing in any case the necessary continuity of care.

Hospitalization, including day care, will be prolonged for as long as the psychiatrist responsible for patient care considers necessary and therefore up to hospital discharge, and will cover all acute processes. as chronic.

Individual psychotherapy, group or family psychotherapy is included, provided that it has been prescribed by a psychiatrist of the Entity, carried out in a concerted manner with the same and that its purpose is the treatment of psychiatric pathologies. The entity is required to provide a maximum number of 20 sessions per calendar year (short psychotherapy or focal therapy), except for cases of eating disorders, in which all sessions will be provided which the psychiatrist responsible for Consider necessary for the correct evolution of the case.

B) Psychoanalysis, psychoanalytic psychotherapy, hypnosis and ambulatory narcolepsy are excluded, as well as the social internment of patients affected by neurodegenerative dementias such as Alzheimer's and others.

2.4.10 Other complementary specifications.

A) Plastic, aesthetic and restorative surgery. -It is excluded the plastic, aesthetic and restorative surgery that does not relate to accident, disease or congenital malformation. In the case of an accident of service or occupational disease, it shall be carried out in all its amplitude, including, if necessary, plastic, aesthetic and restorative surgery in cases where, even if the lesions have been cured, they will remain deformations or mutilations that result in changes in the physical appearance or make the patient's total recovery difficult.

B. Transplants.-The coverage of transplants of all types is included: organs, tissues and cells of human origin, as well as bone grafts. Organ procurement and transplantation will be performed in accordance with the current health legislation, corresponding to the Entity assuming all the expenses of obtaining and transplantation of the organ or tissue, including the studies of compatibility.

2.5. A portfolio of emergency care services.

2.5.1 Access to urgent care. -Emergency care is one that is provided to the patient in cases where their clinical situation requires immediate health care.

It will be dispensed both in health centers and outside of them, including the patient's home and in situ care, during the 24 hours of the day, through medical and nursing care, and with the collaboration of others. professionals.

The urgent assistance may be obtained from the general medical or family, pediatrics and nursing physicians of the Entity and, outside of the hours of consultation and in any case, of the Emergency Services of specific care devices or hospital settings of the Entity.

In addition, the Entity will have a telephone 900 for the demand for urgent care and the coordination of the different emergency and health emergencies, which will guarantee, 24 hours every day of the year, the accessibility and coordination of the resources available for this type of care.

2.5.2 Hospital emergency services. -Hospital emergency services will be available in the localities included in the level II, III and IV specialized care and in all the municipalities of less than 30,000 inhabitants where there is a hospital, dependent on the Health Service of the corresponding Autonomous Community, will attend the coverage of the assistance for its Emergency Service to the insured who suffer acute clinical situations that Require immediate attention.

The Hospital Emergency Service will facilitate access to any specialty that is accurate, and must be counted with physical or localized presence specialists. However, if the guard is located, the availability of the appropriate specialists must be guaranteed, once they are required by the Emergency Doctor, as soon as possible, depending on the pathology and clinical condition. of the patient, which may not be in any case longer than 30 minutes.

2.6 Palliative Care.

2.6.1 Comprises comprehensive, individualized and continuous care of people with advanced disease who are not susceptible to receiving treatments with a curative purpose and with limited life expectancy, as well as persons linked to them. This care, especially humanized and personalized, will be provided at the patient's home or in the health center, if necessary, establishing the necessary mechanisms to guarantee the continuity of care. The most appropriate place to provide palliative care at any time will be determined by the level of complexity of the patient, the availability of adequate family support and the choice of the patient and his family, among others. variables.

2.6.2 Medical entities will have to raise to Mugeju during 2010 plans to adapt to the National Strategy of the National Health System of Palliative Care of the Ministry of Health and Social Policy.

2.7 Attention to dental health.

2.7.1 You will understand the treatment of stomatological conditions in general, including any kind of extractions, cleaning of the mouth once a year or prior to the medical specialist, and periodontics. It will also include the oral health program aimed at children under 15 years of age, consisting of periodic reviews, application of topical fluoride, occlusal sealants, and fillings. In addition, this program will incorporate the actions that are included in the Dental Health Plan for the National Health System as a whole, with the same content, scope and rhythm of implementation. Pregnant beneficiaries will be given preventive follow-up of the oral cavity with topical fluoride application according to the individual needs.

2.7.2 There are excluded, both in terms of their cost and their placement, the fillings (except for the obturations of the dental health program), the endodontics, the dental prostheses and the osteointegrated implants and the orthodontic.

2.7.3 However, when medical illness or accident at the service of a service is carried out, all treatments and performances, including dental prostheses and osteointegrated implants, as well as their placement.

2.7.4 For periodontics and mouth cleaning, as well as, in the event of an accident of service or professional disease for dental prostheses, it will be necessary to prescribe an optional specialist of the Entity, together with budget, if this is a prosthesis, for authorization by the Entity.

2.7.5 The costs of hospitalization, operating rooms and anaesthetists necessary for the performance of the previous treatments and dental services, as well as those excluded from the coverage, will also be borne by the entity. of the concert to mentally disabled patients, provided that the treatments are carried out with means of the Entity.

2.8 Pharmaceutical and dietary products.

2.8.1 Content. -As a general rule, the portfolio of services of the pharmaceutical supply, except as provided for in clause 2.8.3, 1 and 2, to be provided by the Entity includes the indication and prescription by the optional, in Mujeju's official prescription, medicines and products included in the pharmaceutical and dietary products of the National Health System.

In the case of hospitalized patients, the portfolio of services to be provided by the Entity includes the indication, prescription and dispensing of those pharmaceutical and dietary products that require the patients who are being cared for in this care setting (internment, day hospital, home hospitalization, emergency room, dialysis unit, and other hospital-dependent units), which will be funded by the Entity.

2.8.2 Prescription. -The entitles of the Entity will prescribe the medications and other pharmaceutical products necessary for the outpatient treatment of the beneficiaries in the official recipes of Mujeju that, in talonaries, provide the holders, or through the computerised Recipe System, all of this with a view to the provisions of Law 29/2006 of 26 July on guarantees and the rational use of the medicinal product and medical devices, as well as in Royal Decree 1910/1984, of 25 September, Medical Recipe.

The entity will take the necessary measures to implement the Computerized Prescription System, with the standards of normalization established by the Mugeju, requiring its physicians to carry out manual fulfillment of such prescriptions are included in the mandatory entry data and the identification data of the prescriber (name and two surnames, number of collegial and province) must be stamped, in a perfectly readable form.

2.8.3 Medicines in charge of the entity. -1. The necessary medicines for the treatment of outpatients will be borne by the Entity and will be supplied by their means in the following cases:

A) Medicines marketed as a Hospital Use, the supply of which is carried out through the services of Hospital Pharmacy, in accordance with the provisions of Law 29/2006, of July 26, of guarantees and rational use of medicinal products and medical devices, whatever their conditions of use.

B) Medicines not authorised in Spain, but marketed in other countries, the supply of which, in accordance with the applicable regulations, must be carried out through Hospital Pharmacy Services, as their use of the hospital environment.

C) Drugs and pharmaceutical products financed in the National Health System that are not equipped with a seal, and which require the express intervention of specialists.

D) The precise means, elements or pharmaceutical products for performing diagnostic techniques, such as contrast media, drastic or other laxatives.

2. For the Pharmacy Services of the agreed hospital centers, the necessary medications for outpatient treatments will be dispensed in the following cases:

A) Drugs and pharmaceutical products financed in the National Health System that are not equipped with a seal, and which do not require the express intervention of specialists for their administration.

B) The Hospital Diagnostic drugs whose dispensation is expressly requested by Mugeju for the treatment of certain patients, in view of the existence of difficulties for their dispensing in pharmacy offices.

These drugs will be billed by the Entity for payment by Mugeju, according to the billing criteria and procedures to be established for each case.

3 They shall be in charge of the Entity and provided by their means to the beneficiaries of the medical devices listed below:

A) The home enteral nutrition administration systems, tracheotomy cannulas and laringuectomy and special vesical probes that are not dispensed by means of a Mugeju prescription, when such products have been duly indicated by an Entity specialist.

B) Intrauterine devices (IUD) of any prescribed nature.

C) Implantable products intended to have a biological effect or to be absorbed, in whole or in part, made from the sodium salt of hyaluronic acid.

D) The insulin syringes-including the corresponding needles-or other non-preloaded systems of administration thereof, as well as the fungible material of the insulin pumps and needles for the delivery of the pre-filled insulin systems that lack them.

E) The reactive strips for the measurement of glucose, glucosuria and combined glucose/ketone bodies, as well as the glucometro and the lancets needed for the measurement, in diabetic patients. In any case, the Entity shall guarantee such patients any of the products on the market when the optional prescriber is best suited to their individual needs and personal skills.

All of these products will be provided on the basis of diligence, proportionality and maximum care criteria for the patient.

In those cases where, for reasons attributable to the Entity, the supply will not conform to these criteria, the mutualist will be able to directly acquire the product and request the refund to the Entity.

2.8.4 Rational use of the drug. -In compliance with the provisions of Law 16/2003, of 28 May, of Cohesion and Quality of the National Health System, the Entity will promote the set of actions aimed at prescriptions of their physicians are in line with the precise doses, according to the individual patients ' requirements, during the appropriate period of time and at the lowest possible cost to them and the community.

Likewise, the Entity will encourage the rational use of the Drug by promoting the use of generic drugs among its physicians, as well as the prescription for active substance.

2.8.5 Procedure for the impact of the costs of drugs unduly paid by Mugeju. -Mugeju will proceed to discount the monthly payment of the premiums to the entity, the amount of those prescriptions of medicines and sanitary products made in official Mujeju recipes, and whose funding corresponds to the Entity, as provided for in this concert, in accordance with the provisions of clauses 7.2. and 7.3. of this concert.

On the other hand, the Entity undertakes to reintegrate the beneficiaries who so request, within a period of not more than fifteen days from the request for reimbursement, the amount that they would have paid in the Office of Pharmacy for these medicinal products or medical devices, the presentation by the person concerned of the corresponding bill of the Pharmacy is sufficient for these purposes.

2.8.6 Reported Prescription. The implementation of the Computerized Medical Prescription Program will be performed in a progressive manner. In a first phase it will extend to the doctors General or Family, Paediatrics and Internal Medicine in municipalities of more than 75,000 inhabitants. In any case, the doctors with the highest volume of prescriptions should be included in the official recipes that Mugeju determines.

The physicians included in the Computerised Prescription Program must meet the following requirements:

PC with laser printer.

Broadband connection.

Magnetic stripe reader.

Availability of specific paper, according to the technical specifications that are set by Mugeju.

electronic DNI or digital certificate.

The Programme will be targeted for specific funding, through the payment of a variable monthly capitative fee, depending on the extent of the programme's extension, quantified by the percentage of computerised prescriptions, prescriptions dispensed to holders and beneficiaries attached to the Entity.

2.8.7 Quality of the pharmaceutical prescription. -Special evaluation of the efficient use of drugs, through the use of generics, and the use of first-choice drugs in certain pathologies prevalent.

The assessment will be carried out by monitoring the following basic indicators for which minimum targets are set:

Percentage of generic drugs: percentage of EFG packaging dispensed on total drug packaging dispensed.

Use of first-choice antiulcerative drugs: percentage of Omeprazole DDDs dispensed, on the total of Proton Bomb Inhibitors.

Use of first choice hypolipemiants: percentage of Lovastatin, Pravastatin, and Simvastatin DDDs dispensed on the total of Estatins dispenses.

The objectives as well as the score assigned to the fulfillment of each objective are detailed in the table below and can be modified by the Mugeju Manager Resolution.

Antiulcerative

40

40

Indicators		Minimum target - Percent	Score to reach target
percentage			6
					13
Hipolipemiants		1
1
Percentage ddd omeprazole	80	1

The cost of the tools and actions to be developed by the Entity for the achievement of the objectives of quality improvement in the pharmaceutical prescription will be financed by a monthly capitative fee, which be paid exclusively for the months in which the abovementioned basic indicators, obtained from the data of the prescriptions given to the collective assigned to the Entity, give rise to a total score equal to or greater than 6 points.

2.9. Transport for health care.-The entity shall be responsible for the costs incurred for the displacements specified by the beneficiaries when using the assigned services, with the provisos set out in clause 4.4 in the cases and the conditions set out in this clause.

2.9.1 Transport in ordinary media.

A) It is considered as a means of ordinary transport, for the purposes of assistance provided for in the concert, which is carried out by car, bus, railway or, if it comes from being the island provinces or the cities of Ceuta or Melilla, by boat or plane.

B) The beneficiary shall be entitled to this type of transport in charge of the Entity, provided that it is carried out in the municipality closest to the usual or temporary residence in which the same holds the means, in the following assumptions:

Displacements to receive regular treatments, provided that the distance between the two municipalities is greater than 25 kilometers.

Movements motivated by the unavailability of the means required in the relevant municipality, as appropriate, in accordance with the provisions of clause 3.2.

Travel to Reference Services, located in a municipality other than that of residence, where such services are not available.

Commuting to a municipality other than that of residence for health care arising from an accident in service or occupational disease.

C) These transfers will always be valued at their cost, in normal or tourist class, on regular bus or rail transport lines or, if it comes from island provinces or the cities of Ceuta and Melilla, in ship or aircraft, to the nearest municipality in which the Entity has the means to complete the required assistance. The benefit shall include the return transfer.

2.9.2 Transportation in extraordinary means.

A) It is considered as a means of extraordinary transport, for the assistance provided in the concert, that is carried out by ambulance, medicalized ambulance, mobile UVI, plane and helicopter medicalized and taxi.

B) The beneficiary shall be entitled to this type of transport where, due to physical impossibility or other exclusively clinical causes, he/she cannot use ordinary transport, in the following cases:

For reasons of urgency, from the place where it occurs to the center of the Entity where the assistance is provided, or to the unarranged center where it is attended to in the event of vital urgency.

To receive regular treatments, such as hemodialysis, radiation therapy, rehabilitation, or others contemplated in this concert.

To receive any other assistance that needs to be addressed by the Entity.

The need for extraordinary means of transport shall be justified by the written prescription of the relevant optional, except in a situation of vital urgency.

C) Transfers shall be made to centres or services located within the municipality of habitual or temporary residence or, if the means are not available in this municipality, to the nearest municipality in which the Entity has the corresponding services or to the centre to which the patient has referred.

In all cases mentioned, the patient's return to his home after receiving the appropriate health care will be addressed, provided that the reasons for the need for transportation in the media persist. extraordinary. Otherwise, the costs arising from the movement of return on ordinary means of transport shall be covered.

In addition, when an displaced patient transited in a municipality other than the one of residence would have received urgent assistance, the entity will take care of the sanitary transport for their transfer to their municipality of residence, either to their home or to another health centre, where the need for this means of transport is due to strictly medical reasons.

D) Direct use of the Ambulance Service. -In cases of urgency in which it has not been possible to communicate with the Emergency and/or ambulance services of the Entity and no other alternative is appropriate, the beneficiary may request directly from the existing Ambulance Service in the locality the transfer to the Emergency Service of the Entity to which it is assigned and the Entity shall assume or reintegrate the expenses of the shipment.

2.9.3 Assistance for a companion's expenses. -You will be entitled to the transportation costs of a patient companion, in the following assumptions:

Displacement of beneficiaries under the age of 15 years.

Displacement of beneficiaries who credit a disability degree of more than 65%.

Displacement of beneficiaries resident in the cities of Ceuta and Melilla and in the island provinces, when indicated by their responsible doctor, circumstance that will be credited by the presentation of the prescription written from the optional.

2.10. Other capabilities.

2.10.1 Preventive Programs. -1. The institution shall provide the actions set out in paragraph 3.1. of Annex II to Royal Decree 1030/2006 which include:

A) Vacations in all age groups and, where appropriate, risk groups, according to the vaccination schedule of the National Health System, as well as those that may be indicated, in the general population or in risk groups, by situations which are being advised by epidemiological in collaboration with the competent health authorities. In particular, the development of:

Official schedules for systematic vaccination of the child of each Autonomous Community and cities with Autonomy Statute.

Antitetanus vaccination in adults.

Anti-flu vaccination campaigns in risk groups.

Vaccination from Hepatitis B to risk groups.

B) Indication and administration, if any, of antibiotic chemoprophylaxis in contacts with infectious patients for infectious diseases that require them.

C) Activities to prevent the occurrence of diseases by acting on risk factors (primary prevention) or to detect them in presymptomatic phase by screening or early diagnosis (secondary prevention):

a) Breast cancer: screening with mammography every 2 years in women over 50 years of age.

b) Cervical cancer: Pap smear in women aged 25-65 years. At the beginning, two cytologies with an annual frequency and then every 3-5 years, in accordance with the guidelines recommended by the Scientific Societies.

Women over the age of 65 years without cytologies in the last five years will be offered two cytologies annually and, if they are normal, no further interventions will be proposed.

Not to be screened in women with total hysterectomy.

The frequency of screening for secondary cervical or breast cancer prevention may be higher when indicated by the gynecologist based on higher risk criteria (genetic or other factors).

c) colon cancer.

2. The institution shall provide the appropriate actions in the field of primary and specialised care and shall have the necessary means to carry out the above preventive programmes, ensuring the appropriate information to the beneficiaries, as well as the timetable, addresses and timetables of the centres where they will be carried out.

The Entity will also forward to the Mugeju Delegations and to the central offices details of the vaccination centers available in the respective province with addresses, telephones, schedules and preventive programs. which are included in the same.

Mugeju will be able to specifically inform its beneficiaries and through the means that in each case it considers more appropriate, on the desirability of the realization of certain preventive programs of those included in the Portfolio of Services.

3. In cases where the institution has not developed any of the specific programmes provided for in clause 2.10.1.C), it must cover the coverage of the actions undertaken to the beneficiaries under a prevention programme. developed by the relevant health administrations.

2.10.2 Orthoprosthetic Prstation. therapeutic or diagnostic surgical implants. The orthoprosthetic performance of the entity includes:

Therapeutic or diagnostic surgical implants, including medical devices designed to be implanted in whole or in part in the human body by means of a given medical act or intervention surgical.

Renewal of any of the accessories, including the external ones of the aforementioned implants.

The materials used to perform osteosynthesis techniques.

Oosteintegrated implants for dental prostheses are excluded, except when they are caused by accident of service or occupational disease.

2.10.3 Oxygenotherapy and other respiratory therapies. -They want the written prescription of an Entity specialist and prior authorization of the same.

It includes the provision of any of the home respiratory therapy techniques served by the National Health System, when the circumstances of the patient so require, including the use of the liquid oxygen, pulsioximetry, and aerosoltherapy.

2.10.4 Podoology. -Podiological care is included for insulin-dependent diabetic patients as well as for diagnosed patients with neuropathic foot of etiology other than diabetes.

2.11 Special Suppositions.

2.11.1 Optional Optional.

A) When, by a decision of its own and for a given intervention, a beneficiary chooses a doctor outside the Entity, he/she may request that he/she take charge of the internment in a Center of the same, provided that the request is based on the continuity of care in serious pathological processes or on the doctor's family, including the concept of family to the fifth degree of kinship, both by consanguinity and by affinity.

B) The Entity must authorize the internment, in his or her capacity, if there are any of those circumstances and if, in addition, the physician fulfils the conditions required by the center to act professionally in it.

(C) Interment shall be authorised for the period of time which is normally considered sufficient for the intervention concerned, without prejudice to its extension in the event of a medical cause justifying it.

(D) The Entity shall cover the expenses of the internment in the terms of Clause 2.4.4, with the exception of the doctors ' fees and, in the case of childbirth, matron, which shall be on behalf of the beneficiary.

2.11.2 Military hospitals. -At the request of the beneficiary, the Entity may discretionally authorize his or her position, any treatment or detention in a military hospital.

CHAPTER III

Entity Media

3.1 General rules.-The effects provided for in Articles 17 of the recast of the current legal provisions on the Special Social Security Regime of the staff at the service of the Administration of Justice approved by Royal Decree-Law 3/2000 of 23 June, and 63 of the Regulation of the Mutual General Mutual Law, approved by Royal Decree 3283/1978 of 3 November, it is considered that the means of the Entity are the services, own or agreed, allocated for the health care of beneficiaries attached to it.

3.1.1 Scope. -For the purposes of this concert, they are considered as the entity:

A) Healthcare personnel dependent on the Entity through a relationship of a working nature or linked to it by a civil relationship.

B) Centers, facilities or establishments owned by the Entity or arranged by it under any legal regime.

C) Means that another Entity is available and that they are assigned by subconcert with the Concerted Entity, for the purpose of this concert.

(D) The primary care and emergency services of the Public Health Network, which are taken on behalf of the Entity, as provided for in Annexes 1, are assimilated to the means of the entity.

3.1.2 General principles:

A) Accessibility guarantee. -Entity must ensure access to the means that at each level of care requires the Portfolio of Services of this concert in the terms set out in Annex 3, except that these means are not exist at private or public level. If they are not operational, the provisions of clause 4.2.1 (B) shall apply.

B) Freedom of choice of optional and centre. -beneficiaries will be able to choose freely optional and centre from among those listed in the Services of the Entity Services in the entire national territory (old 3.5).

(C) Health Regulations. -The means of the Entity must comply with the requirements laid down in general by the health regulations in force, under the supervision which, with the same character, may be carried out by the Competent health administration.

The centres, establishments and services must be duly authorised in accordance with the provisions of Royal Decree 1277/2003 of 10 October laying down the basis for the approval of centres, health services and establishments as well as in the autonomous regulations in force, where appropriate, in the specific rules governing the activity.

Healthcare professionals must be qualified in accordance with the regulation laid down in Law 44/2003 of 21 November of the management of health professions.

If Mugeju is aware of the potential non-compliance with these general requirements, it will be brought to the attention of the competent health authority.

The Entity shall facilitate access to the centers and services included in the Services Portfolio so that Mugeju can check the adequacy of the institution's means with respect to the offer of services performed.

D. Additional requirements: prior authorization, medical prescription. -For the cases expressly provided for in this concert, the Entity may require additional requirements, such as medical prescription or prior authorization of the Entity. The entity, through the facultative that prescribes or carries out diagnostic tests or treatments that require authorisation, shall duly inform the beneficiary of this requirement. In no case may the beneficiary be made out of the unauthorised evidence if he has not been informed prior to the need for such prior authorisation or for lack of time, in the case of medical or surgical acts carried out at the time of the query.

The authorization of a given diagnostic or therapeutic means derives from the need to order and channel the benefits on the part of the Entity, to facilitate the service and avoid delays, but can never assume a restriction on access to the services recognized in the Services Portfolio. In no case shall a request for a diagnostic or therapeutic means, indicated by an individual of the Entity, be refused, which appears in the Services Portfolio established in this concert.

Annex 2 contains an exhaustive list of the alleged use of the means of the Entity that require prior authorisation of the Entity.

Access to the consultant physicians will be performed on a referral by another specialist and with authorization from the Entity.

3.2. Media availability criteria.

3.2.1 The benefits included in the Services Portfolio to be provided by the Entity will be structured by care levels and population sizes. In accordance with the provisions of clause 2.1 of this concert, the following care levels are distinguished:

1. The level of Primary Health Care, which has as its geographical and population framework the municipality.

2. The level of Specialized Care, which has as its geographical and territorial framework the municipality from 20,000 inhabitants.

3. For the Reference Services the geographical and population framework shall be that of the whole of the territory of the State.

Each top level includes all services at the lower levels.

In Annex 3, the criteria for the availability of means by care levels and population sizes are established.

3.3 Vendor Catalog.

3.3.1 General Criteria. -The Entity's Supplier Catalog contains the detailed relationship of the means of the Entity, and its purpose is to enable the use of these means by the beneficiaries.

The content of the Supplier Catalogue, both of the optional and of the centers, will be clear, complete and transparent, with all the optional and assistance centers agreed by the Entity that have been been offered for the subscription of this concert.

Mugeju may establish a common format of mandatory compliance for the elaboration of the tables, in order to have a homogeneous treatment in the different Concerted Entities.

The Entity will have all the means to record in its Supplier Catalog. Likewise, all the faculty and centers that provide services to the beneficiaries on behalf of the Entity must appear in the Supplier Catalog. Without prejudice to the foregoing, the Entity is empowered to allow certain physicians to appear differentiated in the catalogue as consultants for specific and complex areas of their specialty, provided that the specialty has at least of two non-consultant specialists. Access to these consultant specialists will be carried out after referral by another specialist and with the prior authorization of the Entity.

Mugeju may verify, when deemed appropriate, compliance by the Entity with the obligation provided for in the preceding paragraph.

When a beneficiary is cared for by a professional who works in the team of a concerted professional, it will be understood, for all purposes, that the same is part of the means of the Entity.

Certain practitioners may appear differentiated in the Catalogue as consultants for specific and complex areas of their specialty, provided that the specialty has at least two non-consultant specialists. Access to these consultant specialists will be carried out after referral by another specialist and with the prior authorization of the Entity.

When a beneficiary is cared for by a professional who works in the team of a concerted professional, it will be understood, for all purposes, that he himself, is part of the means of the Entity.

3.3.2. Content. -The Entity's Supplier Catalogues will be provincial-level, adapting to the care levels established at the concert, and will include:

A) The toll-free number 900 for care in emergency situations and cordination of resources for urgent care during the 24 hours every day. This number will be unique for the entire national territory and will be highlighted in the Service Catalogue and in the health card, which is referred to in clause 1.7.

B) Primary and Specialized Care, by level of care, municipalities included in each level and how to access benefits.

C) Relationship, with address, telephone, and operating schedules for the following services:

Emergency Services.

Hospital Centers.

Services for Palliative Care.

Doctors with first and last names, grouped by specialties.

Physiotherapists with first and last names.

Named and last names.

Named and surname nursing staff.

Ambulance Service.

Services for oxygen therapy, aerosoltherapy, and other respiratory therapies.

Other services: Assisted Reproduction Units, Rehabilitation Centers, psychotherapy, radiodiagnostics, laboratories, etc. The names and names of the professionals responsible for the assistance shall be included, together with the name of the professional.

Entity Information Service,

D) Information and Standards of Use, where a section will be included: " Guarantee of Accessibility to the Media: In those specialties in which the services offered are not operational, the beneficiary will be able to attend private individuals who, where appropriate, exist in the relevant municipality or municipalities within the same level of Equation, provided that there is no concerted means in the same level, or to the public health service. In such cases, the Entity shall bear the amount of the costs incurred for the use of non-concerted means. "

E) A comprehensive relationship of the means of the Entity that requires prior authorization of the entity; among the services that require prior authorization of the Entity, no other than the related services in the Annex 2.

The procedures for obtaining the entitlements of the Entity will be detailed.

F) Accurate instructions for the use of the Primary Care Services of the Public System in the Rural Environment, in outpatient, home and emergency conditions, in the terms provided for in the Conventions signed by Mugeju with the Health Services of the Autonomous Communities.

Also to be included are instructions for the use of primary care facilities available in municipalities of Autonomous Communities with which there are no collaboration agreements and in which there are no means agreed.

G) Services which, in each municipality, offer the Entity above the requirements set out in the concert, which would constitute its differentiated offer of services, as an element to facilitate the choice of Entity by of the beneficiaries.

These means shall form part of the offer of Services of the Entity and shall be subject to the general conditions laid down in the concert and in particular to the forecasts contained in clause 3.7.

In addition to the above points, the supplier catalogues will include a detachable or detachable addenda where the relationship of the remaining Information Services, Emergency and Ambulance Services is included. provinces, in order to facilitate their use in the event of the displacement of the beneficiaries, as well as a 24-hour telephone for continuous information to those concerned.

3.4 Promotional campaigns. -The Entity may advertise on its offer of services throughout the year and during the period of ordinary change, provided that such advertising is not carried out within the premises of agencies. (a) public and generally carried out without addressing specific professional groups, not being able to offer gifts to the mutualists in any event. Advertising may include health services, not covered by the coverage of the concert, which, where appropriate, are offered as a value added and offer differentiated from that of other suppliers.

The Entity is responsible for the fulfilment of these obligations by both its staff and the actions that other corporations, consortia, associations, foundations, social agents or other entities can perform. of any kind, whether for profit or not, that maintain any relationship of collaboration, legal, commercial, group or other nature and act in agreement or in the name of the Entity. Failure to comply with these obligations will result in the penalties provided for in clause 5.6.

3.5. Responsibility for editing the entity's supplier catalog.

3.5.1 Before 15 December of the year preceding the beginning of the duration of the concert or, if applicable, of the corresponding extension, the Entity must deliver in the Central Services of Mujeju the Catalogues of Suppliers in paper format corresponding to all the provinces. It shall also, within the same period, provide the beneficiaries with which they have attached, the Catalogue of suppliers of the relevant province in paper edition, by sending them to the address or being available at the premises and delegations of the Entity and deliver in the Provincial Delegations of Mugeju the number of copies requested by each of them for delivery to the beneficiaries who require it.

3.5.2 In turn, the Entity must have a Web page that informs the beneficiaries of Mugeju about the content of the Supplier Catalogues for all the provinces. In order to avoid confusion with the benefits offered to insured persons outside the present concert, this information must appear in a specific section of Mugeju and include for each province the contents specified in the clause 3.3.2. The information on the website should be updated as long as there are modifications, including the date of the last modification.

3.5.3 In the event that the Entity does not comply with the above two paragraphs, it is required to assume the costs arising from the use by the beneficiaries of the services provided by the institutions and optional items included in the latest Catalog in force or on your website.

3.5.4 The obligations of the Entity mentioned in the preceding paragraphs are also understood as referring to the updates of the Catalogs or "Addenda" to the same ones that, if necessary, will be valid in the years 2011, 2012 and 2013.

3.6. The invariability of the entity's supplier tables.

3.6.1 The Supplier Catalogue of the Entity should be maintained stable and ensure the principles of patient continuity of care. Therefore, the offer of means of the Entity advertised in the Catalog of Providers will only be able to register high of new services without that they can be produced low throughout the validity of the concert, except those that are carried out to request of the specialist or centres, by process of activity or transfer to another municipality or those who obey exceptional circumstances duly accredited. In this case, the casualties must be communicated to Mugeju, justifying the reasons, 30 days in advance.

3.6.2 If the casualty affects hospital centers or services, the entity must inform Mugeju of the beneficiaries who are being cared for in such centers or services.

3.6.3 In any case, the Entity is obliged to replace the professional or hospital that has caused a discharge in the shortest possible time, and must communicate to Mujeju the services, centers or facultative that are to replace the casualties. produced. It should also direct a communication, with a general nature, to the beneficiaries on the high or low levels produced in the Provider's Catalogues.

3.7 Principle of continuity of care.

3.7.1 If the absence of any professional of the Catalogues of Providers of the Entity is produced, the Entity is obliged to guarantee the patients in treatment, the continuity of care for the pathological process of the one that comes being treated, with the same optional, during the 12 months following the date on which the discharge occurred, provided there was compliance with the optional.

3.7.2 If the discharge refers to a health center or hospital service, the Entity is obliged to guarantee to the patients that the continuity of treatment of the patient is being treated in a given pathological process. process in that centre or service, for as long as the need for the centre or service persists or until the final discharge has been obtained in the process.

3.7.3 The Entity shall inform each of the beneficiaries in writing, within a period of not more than five working days, of their right to maintain the treatment and continuity of care in the said centre or service, the Entity. In the event that revenue or revisions are produced in such centres or services, by the same process, the Entity will continue to take charge of them, and the beneficiary will have to meet the requirements set out in the concert, prescription (by a concerted or non-concerted physician belonging to such a center or service) and prior authorization of the Entity. These obligations, as long as their content is not modified, are not interrupted by the completion of this concert or their respective extensions.

CHAPTER IV

Using non-concerted media

4.1 General Standard. -Pursuant to Article 66 of the Mujeju Regulation approved by Royal Decree 3283/1978 of 3 November, in conjunction with clause 3.1 of this concert, where a beneficiary, by own decision or by your family members, use non-agreed means with the Entity, pay, without right to refund, any expenses that may be incurred, except in cases of unjustified refusal of assistance and in urgent assistance of a vital character.

4.2 Unjustified denial of assistance.

4.2.1 Unjustified refusal of assistance. -In application of the provisions of Article 66 of the Mujeju Regulation, there is an unjustified refusal of assistance:

A) When the beneficiary requests in writing to the Entity the provision of a particular health care prescribed by a physician arranged by the Entity and is not offered, also in writing and before the end of the fifth business day following the communication, the care solution valid at the appropriate level.

B) Where the requirements for the availability of means provided for in this concert are not met, the beneficiary may refer to the optional or institutions at the appropriate level.

(C) Where an individual of the Entity prescribes in writing, with exposure of the medical reasons, the need to attend an optional or non-concerted centre, the beneficiary must present the said prescription. to the Entity, so that it, before the end of the tenth business day following the filing, authorizes the referral to the optional or non-concerted center, or offers a valid alternative to its means.

D) When in a means of the Entity, to which a beneficiary has come to receive assistance or in which it is entered, the appropriate resources are not available or not available, according to the criterion of the optional of the Entity or of the the centre of the assistance, and this is implicitly expressed in the referral from the beneficiary to a non-concerted centre.

4.2.2 Obligations of the Entity. -In any of the alleged unjustified refusal of assistance described in the above clause, the Entity is obliged to assume the expenses arising from the assistance, within the ten business days following the filing of the claim in the entity by the beneficiary

When the Entity knows that the beneficiary has received assistance in other means, it will make appropriate representations to the appropriate provider to take care of the expenses incurred by such assistance and that part of this is issued the corresponding invoice to the Entity.

If the beneficiary has paid the expenses directly to the healthcare provider, the entity shall make the refund within 10 working days of the date on which the beneficiary submits the supporting documents to the expenses.

4.2.3 Claim by the beneficiary. The beneficiary may lodge a complaint with the provincial delegation of Mugeju or the central services when the Entity incurs any of the alleged unjustified refusal of assistance provided for in clause 4.2.1, and would not have paid directly to the supplier or reintegrated the costs incurred to the beneficiary.

4.2.4 Other effects. -Acceptance by the Entity or, where appropriate, the statement by Mugeju that there is an alleged unjustified refusal of assistance, does not imply acceptance or declaration, respectively, that there is there has been a refusal of assistance for other civil or criminal purposes, for which, where appropriate, the beneficiary will have to go to the appropriate ordinary court.

4.3 Vital character urgent assistance.

4.3.1 Concept and requirements. -For the purposes set out in Article 66 of the Regulation of the Mutual General Mutual Law approved by Royal Decree 3283/1978 of 3 November 1978, it is considered a situation of urgency of a vital nature. the condition in which a pathology has occurred, the nature and symptoms of which make it possible to present an imminent or very imminent vital risk or irreparable damage to the physical integrity of the person in order to prevent immediate therapeutic action.

In order for the beneficiary to be entitled to cover the costs incurred by the use of foreign media in a vital emergency situation, the Centre outside the person to which the patient is directed is reasonably chosen, taking into account the circumstances of the place and time when the pathology occurred, as well as the decision-making capacity of the patient and, where appropriate, the persons who provided the first aid.

The assistance specified by the owners and beneficiaries of Mugeju as a result or in the event of acts committed by persons integrated into organized and armed bands or groups shall be deemed to have been met initially. vital urgency features and that the assistance received, if not used, also initially has the requirement laid down in the preceding paragraph.

4.3.2 Scope. The emergency situation of a vital nature extends from the entrance to the patient's discharge, except in the following two cases:

A) When the Entity, with the compliance of the medical team that is providing the assistance, offers a care alternative that allows the patient to be transferred to a proper or appropriate center and the patient or his or her responsible family members refuse to do so.

B) When the patient is referred to a second foreign center and there are no causes to prevent the continuity of treatment at a center of the Entity.

4.3.3 Communication to the Entity.-The beneficiary, or other person on his behalf, shall communicate to the Entity, by any means that permits the communication, the assistance received with other means within the time limit of the seven days following the start of the assistance, unless duly justified exceptional circumstances have prevented it from communicating the assistance received with other means. The relevant medical report should also be provided.

4.3.4 Obligations of the Entity. -When the Entity receives the communication from the beneficiary, it must answer in writing and within the fifteen days following the receipt of the communication, if it accepts the situation of urgency vital and therefore the payment of the costs incurred, or on the other hand, if it is not considered obligatory for the payment to understand that there has not been a situation of vital urgency.

In the first case, the Entity shall make the payment within 10 working days of the date on which the beneficiary makes the notification of the facts directly to the relevant services, unless the The person concerned would have brought forward the payment, assuming that he would return.

Where the beneficiary has not made the communication in time and form, the Entity shall reinstate the amount of assistance within 10 working days following the date on which the beneficiary submits the supporting documents.

4.3.5 Claim by the beneficiary. The beneficiary may lodge a complaint with the relevant Mujeju Delegation when the Entity fails to comply with the obligations set out in clause 4.3.4, in case of discrepancy with the the criterion of the Entity or the lack of response within the time limit set for that purpose.

4.4. Transport in foreign media for health care in cases of unjustified refusal of assistance and vital urgency. -Where in these cases the use of other means of transport, both ordinary and non- extraordinary, the conditions and requirements will be those set out in clause 2.9 of this concert. The beneficiary shall also have the right to have the entity reintegrate the costs incurred by the transfer. The refund shall be made within ten working days following the date on which the beneficiary submits the appropriate written complaint to the Entity, accompanying the supporting documents for such expenses.

CHAPTER V

Legal framework of the concert

5.1 Nature and regime of the concert and the relationships in the building.

5.1.1 The present concert, held under the provisions of articles 17 of the Royal Legislative Decree 3/2000, of 23 June, which approves the recast of the legal provisions in force on the Special Regime The Court of Justice of the Court of Justice of the European Communities, of the Court of Justice of the European Communities, of the Court of Justice of the European Communities, of the Court of Justice of the European Communities, of the Court of Justice of the European Communities public, and its legal status is determined by article 5.2 of the Royal Legislative Decree 3/2000 of 23 June and by the third paragraph of point 2 of Law 30/2007 of 30 October of Public Sector Contracts

5.1.2 They are relationships based on the:

A) The relations between Mugeju and the Entity, in order to comply with the rights and obligations which, according to clause 1.1, constitute the respective objects of the.

B) The relations between the beneficiaries and the Entity, in order to comply with the obligations set out in the preceding paragraph.

5.1.3 Issues arising in the field of the relations listed in paragraph B) of the above clause shall be of an administrative nature and shall be resolved by the General Judicial Mutual Manager, prior to the procedure, if applicable, which is determined in this Chapter. Against any of the agreements thus given, the administrative appeal corresponding to the provisions of Law No 30/1992 of 26 November 1992 of the Legal Regime of Public Administrations and of the Common Administrative Procedure, pursuant to Article 25 of the Recast Text of the current legal provisions on the Special Social Security Regime of the staff to the services of the Administration of Justice in the wording introduced by Article 43 of the Law 53/2002 of 30 December 2002 on fiscal, administrative and social measures. The competent jurisdictional order, if applicable, shall be the Administrative-Administrative Order.

5.1.4 Within the limits and subject to the requirements and effects outlined in Law 30/2007, of October 30, of contracts of the public sector, corresponds to the General Manager of the Judicial General, the faculty of interpretation the concert, to resolve the doubts that offer its fulfillment, to modify it for reasons of public interest, to agree its resolution for non-compliance with the Entity and to determine the effects of it.

5.2 Nature and regimen of care relationships.

5.2.1. The present concert does not imply or cause any relationship between Mugeju and the faculty or institutions of the Entity that provide the assistance. The relationships between the Entity and the faculty or centers are, in any case, alien to the concert.

5.2.2 Consequently, they are also alien to the set of rights and obligations that determine the purposes of the and are configured as autonomous relationships between the parties:

A) The relations of the beneficiaries with the powers of the Entity for cause that affects or relates to the scope of the professional exercise of such facultative.

B) The relations of the beneficiaries with the institutions of the Entity themselves or concerted, by reason of the care activity of these means or of the operation of their facilities or for reason that affects or relates to the field of the professional exercise of the faculty who, under any title, develop activity in such centers.

Both the relations of paragraph A and B) of this clause shall continue to be alien to the ends of the even if, by virtue of the links between the facultative and the institutions and the Entity, they may generate direct or subsidiary effects on these.

5.2.3 The relationships mentioned in the preceding clause will have the nature that, according to the law, corresponds to its content and the knowledge and decision of the questions that may arise in the same will be competition of the ordinary civil jurisdiction or, where appropriate, the criminal jurisdiction.

5.3. Joint commissions.

5.3.1 The Joint Committees, with joint membership, are committed to:

A) Monitoring, analysis and evaluation of the fulfillment of this concert.

B) The knowledge of the claims that may be made by the beneficiaries or, where appropriate, of trade by Mujeju, as provided for in this Chapter.

For the purposes of the tasks referred to in paragraphs (a) and (b) it is understood that with the intervention of the Entity it takes place for the same the fulfillment of the procedure laid down in article 84 of Law 30/1992, of 26 of November, the Legal Regime of Public Administrations and the Common Administrative Procedure.

5.3.2 The system of operation of the Joint Commissions will be regulated in the following Clauses and, as not provided for in them, the rules of Law 30/1992, of 26 November, of the Legal Regime of the Public administrations and the Common Administrative Procedure on the functioning of the collegiate bodies.

5.3.3 The functions mentioned in clause 5.3.1 will be performed by the Provincial Mixed Commissions when the facts have taken place in the provincial area and by the National Joint Commission when they affect the entire territory. national.

If this is claims the distribution of functions will be accommodated as provided in clause 5.4.

5.3.4 The Provincial Joint Committees shall be composed, by Mujeju, by the Provincial Delegate, who shall preside over them, and by an official or collaborator of that Delegation who shall also act as Secretary; and of the Entity, by one or two representatives of the Entity with sufficient decision-making powers. A medical advisor may attend the meetings.

5.3.5 The operation of the Provincial Mixed Commissions will be in accordance with the following rules:

A) Whenever there are issues to be dealt with, the Commission will hold regular meetings every month. On an extraordinary basis, they shall meet at the request of one of the parties.

B) In the event of an appearance at a meeting of the representatives of the Entity, the actions will be forwarded to the National Joint Commission for the study of the complaints and issues on the agenda.

C) In the event that the representatives of the Entity do not attend the meetings for two consecutive sessions, it is understood that the entity accepts the agreements that Mugeju adopts in relation to the matters that should have been examined at the second hearing and in subsequent sessions in which he does not appear.

D) Minutes of each session shall be drawn up by the Registrar, whose project, with his signature, shall be sent immediately to the Entity for knowledge, conformity and return. This refund, signed by the representative of the Entity, must be carried out within the maximum period of seven working days. Once signed by the representative of the same, at which time it will be understood approved. If there are discrepancies in the content of the minutes, they shall be settled by means of appropriate arrangements between the two parties and, in any case, at the following meeting.

5.3.6 The National Joint Commission will be composed of two representatives of Mugeju and two of the Entity. The president shall be the General Judicial Mutual Manager, or person to whom he delegates and as Secretary shall act as a Mujeju official, with a voice but without a vote.

5.3.7 The operation of the National Joint Commission shall be in accordance with the same rules as set out in clause 5.3.5 for the Provincial Commissions, except those contained in paragraph B). In the case of Madrid, in the absence of a provincial delegation, the National Joint Commission will carry out the functions of the Provincial Joint Commission.

5.4 Procedure for claims.

5.4.1 The beneficiaries will be able to claim from Mugeju that, according to the provisions of clause 5.1, they agree the origin of any action by the Entity:

A) When the Entity denies any of the authorizations specifically referred to in it or when it does not respond to the request of the same and in addition, a positive effect for such an absence of defence is not foreseen.

B) When the Entity is required to directly assume some expense or to reintegrate its amount and, upon request of the beneficiary, do not do so.

C) When the Entity fails to comply with any other obligations under the terms of the concert.

This administrative route will not be used for complaints on issues concerning the relationships mentioned in clause 5.2. In the event of a question, the person concerned shall be replied that, due to the incompetence of Mujeju, it is not possible to resolve the merits of the complaint, indicating that it may be acted upon, if appropriate, in relation to the optional, centres or, where applicable, the Entity itself, in the ordinary court that corresponds according to the nature of the facts.

In those exceptional cases where the beneficiary is unable to lodge a claim and a billing has occurred in his name for an assistance that the Entity may be required to reintegrate, Mugeju may initiate officiated the complaint to the Joint Commission that it considers appropriate, motivating the cause of this initiation of trade.

5.4.2 The complaints will be made in writing to the corresponding provincial delegation of Mugeju where the sorcerers have taken place, accompanying how many documents can be based.

5.4.3 Any claim, the Provincial Delegation, if initially considered as there are reasons for its estimation, will immediately take the necessary steps before the Entity to obtain satisfaction to the itself, in which case it will be archived without further processing with annotation of the adopted solution.

5.4.4 If the said steps do not prosper and regardless of their amount, the Provincial Delegation will formalize the appropriate file, will include it on the agenda of the immediate meeting of the Joint Commission Provincial and studied the same shall be lifted the corresponding act in which it will necessarily consist of the positions of Mugeju and the Entity on the proposed claim.

5.4.5 In all cases where the positions of the parties that make up the Provincial Joint Committee are consistent, the complaint will be resolved by the corresponding Provincial Delegate.

5.4.6 In case there are discrepancies within the Provincial Joint Committee, the file will be raised for study by the National Joint Commission, and will be included on the agenda of the first meeting to be held. Studied by it, will solve the General Judicial Mutual Manager.

5.4.7 No complaints may be filed in the National Joint Commission or the corresponding Provincial Joint Commission for similar issues that have already been resolved in advance, in a favorable manner and according to the Entity, by the Manager of the General Judicial Mutuality or Provincial Delegate, respectively, with the result of applying the criterion resulting from the corresponding National or Provincial Joint Commission.

5.4.8 The resolutions of the Provincial Delegates referred to in clause 5.4.5 shall be issued within the maximum period of three months. If the resolution corresponds to the General Judicial Mutual Manager, according to clause 5.4.6, this maximum period shall be six months. Such resolutions shall be notified to the Entity and to the persons concerned. Against them, an appeal may be brought, in accordance with the provisions of Articles 114 and 115 of Law No 30/1992 of 26 November 1992, of the Legal System of Public Administrations and of the Common Administrative Procedure, and in the Mugeju regulatory specific regulations.

5.5. Estimated claim execution procedure.

5.5.1 In the complaints positively resolved by the Provincial Delegates of the General Judicial Mutuality, the execution procedure will be as follows, depending on the object of the complaint:

(A) Where the claim is intended to permit a particular health care to be granted, the Entity shall, within 10 days of the notification of the decision, issue the appropriate authorization.

B) When the claim has as its object that the Entity directly assumes some expense, the Entity shall, within one month of the notification of the decision, make the payment to the healthcare provider.

C) Where the claim is for reimbursement of the costs claimed, the Entity shall, within one month of the notification of the decision, make the reimbursement, upon presentation, if appropriate, of the appropriate supporting evidence of expenditure, which, for that purpose and if presented, shall be returned to the claimant.

Within the time limits mentioned in the above clause, the Entity shall communicate to the provincial delegation and to the central services of Mugeju:

1. That it has issued the authorization, to make the direct payment to the health provider or to reimburse the expenses, or

2. That it has not carried out any of the above actions for reasons other than its will, especially since the person concerned has not, for the absence of the appropriate supporting documents or for not having been accepted, the payment for this.

5.5.2 If Mugeju had not received communication within the indicated time limit, or if it exceeded the deadline, it was aware that the payment was denied, the procedure will be initiated for Mugeju to pay directly to the supplier. the amount of the amount, with an increase of 20% in the case of payment to the beneficiary, by way of compensation for the delay.

5.5.3 In the case of claims positively resolved by the Management of Mugeju, the payment of the amount that in each case corresponds will be carried out directly by Mugeju to the interested person on behalf of the Entity, deducing the amount of the monthly fees to be paid to the same and making it easier for the document to prove that you have made the payment on your own account.

If the claimed assistance had been invoiced to the person concerned and the person concerned had not yet made the payment effective, Mugeju may make the direct payment to the creditor as of the date of the judgment, provided that the You expressly authorize such direct credit to your name.

5.5.4 The costs of potential recharges of aaward or late interest shall be borne by the Entity when the cause of delay is attributable to it.

5.5.5 Administrative decisions or judgments that resolve appeals against acts of Mugeju in respect of expenses subject to the present will be executed, if appropriate, in accordance with the procedure laid down in the clause 5.5.3.

5.5.6 Special procedure for unjustified refusal. -In the case of complaints concerning the use of services not provided for in the alleged unjustified refusal of assistance provided for in clause 4.2.1 of the concerto, Mugeju will document the appropriate file and give an audience to the Entity so that, within ten days, it will make the arguments that it considers appropriate, a procedure that will be carried out via fax.

The matter will fall to the Mujeju Management Resolution.

Where appropriate, the corresponding entitlement benefits shall be paid in accordance with the procedure laid down in clause 5.5.3 of this concert.

5.6 Economic compensation for late payment in compliance with the obligations defined at the concert.

5.6.1 Economic compensations for non-compliance with obligations defined in the. -Entity is required to meet the expected obligations and deadlines set, where appropriate, in clauses 3.4, 3.5, 3.6, 3.7, 6.2, 6.3 and 6.4 of this concert. If after the procedure set out in clause 5.6.2 is followed, it is determined that the Entity has incurred a breach of any of these obligations, the Management of Mugeju shall fix the following financial compensation:

(A) Failure to comply with the obligations laid down in clause 3.4 shall result in the payment of an economic compensation of EUR 150 000 for each of the provinces in which such non-compliance occurs.

B) If the Entity does not deliver the Supplier's Tables in the Delegations or Central Mujeju Services before December 15 of the year before the beginning of the concert or, if applicable, the for the extension, it will be obliged to pay an economic compensation of 7% (before 10%) of the amount of the monthly premium, corresponding to the collective of the provinces in which the catalogues would not have been delivered within the period antedcho, when the delivery takes place during the month of January. In the case of dilation of the delivery, the economic compensation shall be increased by an additional 5% for each month elapsed.

C) Failure to comply with the obligations laid down in clause 3.5 in relation to the updating of the Supplier Catalogues or, where appropriate, the elaboration of an "Addendum" thereto, shall give rise to the payment by the Entity of an economic compensation of EUR 3,000 per month of delay in respect of the date of delivery, which shall be 15 days from the requirement of the said documentation by Mugeju.

(D) Failure to comply with the obligations laid down in clause 4.2.1 (A), in relation to the refusal of an application for a benefit which, appearing on the Services Portfolio established in the latter, has been indicated by an optional authorized by the Entity, and studied the corresponding file has been dictated resolution by the manager of Mujeju. In this case, the Entity will be obliged to pay an economic compensation between 1,000 and 6,000 euros.

The Mugeju Management shall establish the criteria for establishing such compensation in a manner that is proportionate to the injury caused.

(E) Failure to comply with the obligations laid down in clause 6 shall give rise to the payment of an economic compensation of 2% of the total amount of the premiums of its collective, per month of delay produced in the delivery of the required information.

5.6.2 Procedure for the imposition of financial compensation. -In cases where a breach of the obligations under clause 3.4, 3.5, 3.6, 3.7, 6.2, 6.3 and 6.4 of the delegation has been detected Mujeju provincial or its central services which, after documenting the relevant file, will forward it to the Management of Mujeju, which in turn will give the Entity a hearing so that, within ten days, it will make the allegations it considers appropriate.

The matter will fall to the Mujeju Management Agreement against which the Minister of Justice may be brought before the Minister of Justice, in accordance with the provisions of Articles 114 and 115 of Law No 30/1992 of 26 November 1992. Legal status of the public administrations and the common administrative procedure, as amended by Law 4/1999, of 13 January, where appropriate, the economic compensation will be granted in the following monthly payment to the Entity.

CHAPTER VI

Healthcare information and documentation

6.1 General rules. In order for Mugeju to have the information necessary for the assessment of the health benefits to be covered by this concert, its planning and decision-making, the Entity provide all data on the services provided to the mutualists specified in this Chapter. Likewise, it will be done on those who, without being specified, could be sued by the Ministry of Health and Social Policy in the context of the development of the Information System of the National Health System for the duration of the present concert. It is also required to require your professionals to fill in the number of documents specified in this chapter.

In any case the Entity is obliged to comply and enforce the health professionals and health centers included in its Supplier Catalogue, all the requirements set out in Law 15/1999, of December 13, of Protection of Personal Data, in relation to the health information and documentation relating to the beneficiaries of Mugeju, as well as to safeguard the exercise of the rights of the patients referred to in Article 10 of Law 14/1986, of 25 of April, General Health and Law 41/2002 of 14 November, regulating the autonomy of the patient and rights and obligations in the field of information and clinical documentation, paying particular attention to the informed consent and to the respect of the previous instructions, in accordance with the provisions of Articles 10 and 11 of the Cited Law 41/2002.

6.2 General activity information.

6.2.1 The Entity shall have an information system that allows the number, type and cost of the services provided to the beneficiaries of Mugeju to be known by means of their own or concerted means.

6.2.2 The Entity shall provide Mujeju, in computerised form, with the data on care activity relating to the various services, outpatient and hospital, which have been provided, in accordance with the format set out in Annex 5 of the present concert.

6.2.3 Such data shall be submitted per calendar quarter due, within three months of the end of the corresponding quarter.

6.3 Economic Information. -The Entity shall provide the legally established statistical data of the Public Health Expenditure Satellite Accounts of the National Statistical Plan, as well as those of the National Statistical Plan, at the request of Mugeju. other data requested by the Ministry of Health and Social Policy within the Health Information System of the National Health System. All this in the format and with the periodicity required by Mujeju, for his subsequent transfer to the Ministry of Health and Social Policy.

6.4 Information relating to the means available.-The Entity shall provide before the entry into force of this concert to Mujeju the information relating to the means available to facilitate the benefits that are the subject of of the concert, in computer support. This information shall be provided in a database with the structure set out in Annex 6.

6.5 Healthcare documentation.

6.5.1 The Entity will actively take care that professionals and healthcare facilities included in its Supplier Catalogues meet the following obligations:

(a) Comply with the parts of sickness, accident or risk during pregnancy and maternity established by Mugeju, for the assessment and granting, where appropriate, of the sick leave of the officials, as well as those reports that are necessary to accredit these situations, with strict compliance with the law in force. In these parts, the diagnosis must be coded according to the international classification of diseases (CIE-9-MC, DSM-IV ...). To request from the optional their collaboration in the procedures directed to the verification of the pathology that originated the sick leave and its extensions.

b) Facilitate the medical records and reports provided for in the fifth paragraph of the Resolution of the Secretariat of State for Public Administration of 29 December 1995 and other concordant rules for the processing of the retirement procedures of mutualists for permanent incapacity for service.

c) Issue medical reports established by Mugeju to its beneficiaries for certain or complementary health benefits.

(d) Require their faculty and centres in their catalogue of suppliers to carry out the reports, explorations or diagnostic tests under the conditions and arrangements set out in Annex 7 to the mutualists. Annex is specified.

e) Issue the medical documentation or certification of birth, death and other ends for the Civil Registry, and other reports or certificates on the health status required by law or regulation.

(f) To comply with the requirements of orthoprosthetic material, the code of the orthoprosthetic product prescribed, as indicated in the General Catalogue of Orthopaedic Material approved by resolutions of the General Mutuality Court of Justice of 6 May 2008 (BOE No. (a) of 23 May 2008) for which the orthoprosthetic provision is regulated and the catalogue of orthoprosthetic material is approved, and 7 July 2008 (BOE No. 175 of 21 July 2008) to complete the provision and catalogue of ortho-prosthetic material of the Mujeju.

CHAPTER VII

Duration, economic regime and concert price

7.1 Duration of the concert.

7.1.1 The effects of this concert shall be initiated at zero hours on 1 January 2010 and shall be extended to 24 hours on 31 December 2010, without prejudice to the provisions of this Regulation. The following clauses.

7.1.2 For the years 2011, 2012, 2013 the present concert may be extended, year by year, by mutual agreement of the parties, expressed in writing in the month of October of the year preceding that of the extension. The calculation of the start and end of the extension period, referred to in the year in question, shall be done in the same manner as that set out in clause 7.1.1

7.1.3 If there is no agreement to extend the concert for the year 2011, the Entity will continue to be bound by the content of the concert in the year 2010, for the collective that has been assigned to the thirty-one of December of that year, until (a) on 30 January of the year 2011 or, in the case of the provision of a stay at the time of admission to hospital or maternity care when the delivery is scheduled for the month of February, up to the day in which the (a) that, respectively, the discharge or the termination of maternity care is completed. Notwithstanding the foregoing, the new Entity of Subscription, as set out in the third paragraph of this clause, shall in any event assume full coverage of the benefit as of 1 February 2011.

The entity shall be entitled to receive, for the month of January 2011 and for the collective assigned to thirty-one of December 2010, the price per person/month that is established for the Entities that subscribe to the extension of the for the year 2011. However, the amount to be paid for that month, Mugeju will retain ten percent until the thirty-one of December 2011, with the exclusive purpose of dealing, on behalf of the Entity, to the reimbursements of expenses that are agreed during that year under cover of the present. If the estimated quantity is exhausted or refunds are agreed after the date indicated, the Entity is obliged to satisfy them directly and immediately.

The affected collective will have to choose new Entity during the deadline set by Mugeju and the election will have effects at zero hours of the day one of February 2011, without prejudice, in any case, of the intended hospitalizations and maternity in the first paragraph of this clause.

7.1.4 How much is available in clause 7.1.3 will be of full application for the case that, extended the concert for the year 2011, does not extend, however, for the year 2012 or 2013, understanding that the references of dates in The contents are moved over the following years.

7.2 Economic arrangement of the concert.

7.2.1 Without prejudice to the birth and extinction for beneficiaries of the rights deriving from the terms provided for in the relevant clauses, the high level will cause economic effects at zero hours of the day one of the the month following the month in which they occur, the casualties at 24 hours on the last day of the month in which they took place.

7.2.2 Accordingly, each monthly payment shall take into account the number of holders and beneficiaries existing at zero hours of the day one of the month in question, to which the Mujeju effect will issue the timely certification. the number of holders and beneficiaries assigned to the Entity, differentiated by age, according to the parameters set out in clause 7.3.1. The payment shall be made by Mugeju, by name or bank transfer, within the first fifteen days of the following month, prior to the withholding or the discounts that come in accordance with the Resolution of Convocation and the concert, with its annexes. The monthly payment for December may be anticipated, in whole or in part, in the last ten days of that month.

7.2.3 Mugeju will make available to the Entity, in the first week of each month in electronic file, the complete relationship with all the data of the collective, including the high, low and variations produced during that period, referred to within 24 hours of the last day of the preceding month.

7.2.4 The electronic file with the relationship of the collective can be verified by the Entity, so that, if you estimate that there are differences, you can make the following claims:

A) Those relating to the holders, including those affecting their beneficiaries, if they exist.

B) Those relating to beneficiaries exclusively.

7.2.5 The Entity will file the claims separately, according to the above classification, and will accompany it with electronic file with the same technical characteristics as the one provided by Mujeju, containing the information on which the claim is based. Complaints must be submitted within a maximum of three months from the monthly communication of the status of the collective and the relation of incidents, after which, without any claim, it is understood that there is a conformity by the Entity, acquiring firmness the payment made according to that collective. The complaints submitted shall be settled by Mugeju within three months of the date of filing.

The consolidation of the finality of the payment, as referred to in the preceding paragraph, is without prejudice to the fact that in no case may an estate be attributed to Mujeju or to the Entity.

7.2.6 All taxes, arbitrations, fees and levies that are taxed on this concert or the acts that will result from it will be on behalf of the Entity.

7.2.7 In the case of health care for injuries caused or a disease caused by or aggravated by accidents covered by any form of compulsory insurance or when the cost of the healthcare provided must be satisfied by law or regulation by public bodies other than Mugeju or by private entities, the Entity, without prejudice to the provision of assistance in any event, may be subrogated to the rights and actions of the beneficiaries relating to the (a) the amount of expenditure arising from such health care, taking into account the necessary steps to be reintegrated into the cost of the project. The beneficiaries, for their part, shall be obliged to provide the Entity with the data necessary for this purpose.

7.2.8 Whenever there is a firm court judgment in which Mugeju is ordered to pay compensation, arising from direct or subsidiary liability for assistance actions included in the object of the, Mujeju, without Prejudice to the execution of the judgment, the amount paid to the corresponding agreed entity shall be passed in accordance with the procedure laid down in clause 5.5.5 of this concert.

7.3 Concert Price.

7.3.1. The payment is performed based on the following parameters:

(a) Mugeju shall pay the Entity the amount of EUR 76.00 per month, for each protected beneficiary who was 70 or more years of age at twenty-four hours on the last day of the previous month to which the payment corresponds, according to the high and low criteria which for economic purposes are set out in clause 7.2.1.

(b) Mujeju shall pay the Entity the amount of EUR 63.25 per month for each protected beneficiary who has an age of between 60 or more years and less than 70 years at 24 hours on the last day of the month prior to which the payment corresponds, according to the high and low criteria which for economic purposes are set out in clause 7.2.1.

(c) Mujeju shall pay the Entity the amount of EUR 57,10 per month for each protected beneficiary who is less than 60 years of age at 24 hours on the last day of the month preceding the date of payment, according to the high and low criteria which for economic purposes are set out in clause 7.2.1.

The amounts will be met by concept 13.102.312 E 251 within the body's budgetary availabilities.

7.3.2 The amount of the premium to be paid by each new beneficiary during the duration of this concert shall be that corresponding to the age group set out in the preceding paragraphs and according to the age of the beneficiary to his/her Date of discharge in the Mutuality.

In no case, during the duration of the concert, the amount of the premium will be altered even if the beneficiary over the course of the year, by age, changes the age group.

7.3.3 In case of an extension, the price for 2011 will see an increase over the year 2010 which will take into account the increase in the health policy credits, as well as the budgetary availability of Mujeju. In any event, the increase shall not be less than the variation provided for the CPI for the year to which the extension applies.

The Baremus for Reintegrans contained in Annex 7, paragraph B, and the quantities listed in clauses 2.4.4 D) and 2.4.6 shall be increased by the same percentage as the price of clause 7.3.3.

7.3.4. Specific targets for meeting objectives. -As provided for in clauses 2.8.6 and 2.8.7, the compensation of certain objectives will result in the payment of the following variable quotas per person per month:

A) The quota associated with the extension of the Computerized Prescription Program. -This fee will be paid when the prescriptions that are made in prescriptions reported by the doctors of the services of the Entity represent, less, 10% of the total of its prescriptions in Mujeju recipes.

Depending on the volume of prescriptions that are made on a computerised prescription, the amount of this quota will be as follows:

of Computerized Recipes - Percent	Monthly quota - Euros
10-20	0.15
21-40	41-
	61-70

B) A quota associated with objectives of improvement in the quality of the pharmaceutical prescription. -The months in which a score equal to or greater than 6 points is reached for the fulfilment of the objectives defined in clause 2.8.7, pay an additional fee per person and month, the amount of which shall be in relation to the score that is reached, according to the following scale:

6 points: € 0.20 fee.

7 points: € 0.30 fee.

8 points: € 0.45 fee.

9 points: € 0.65 fee.

The payment of the fees associated with the achievement of objectives shall be made quarterly, at the time the information relating to the billing of prescriptions for the corresponding quarter is available.

ATTACHMENTS

Attachment relationship

1. Means of assistance in rural areas.

2. Relationship of services that require prior authorization of the same and procedure for obtaining it.

3. Media availability criteria by care levels.

4. Pathologies with vital risk.

5. Care information systems.

6. The structure of the entity's media database.

7. Actions prescribed by the institutions for the assessment of disabilities and scales for reimbursement.

ANNEX 1

Support for rural areas

The beneficiaries of the concert must have access to primary care services throughout the national territory, but in the rural areas there is a circumstance that, in general, there are no private means. they may carry out such assistance under the responsibility of the Entity, since only the Health Services of the Autonomous Communities are provided with means.

In accordance with the provisions of general health legislation, such public bodies may provide urgent health care or may not be carried out by other means to any person, even if they are not a beneficiary of the General system of social security, claiming, where appropriate, the third party obliged to pay the cost of the assistance provided, so that, in order to enable the provision of such health services to the holders and other beneficiaries attached to the payment to the Entity and in accordance with the possibility of establishing collaboration agreements between the bodies of the State Administration and those of the authorities of the Autonomous Communities, as laid down in Article 6 of Law No 30/1992 of 26 November 1992, of the Legal Regime of Public Administrations and of the Administrative Procedure Common, in the wording given by Law 4/1999, of January 13.

First. -Mugeju may agree with the Health Services of the Autonomous Communities to provide the following services to the holders and other beneficiaries that the Entity has attached:

A) Primary care health services in municipalities up to 20,000 inhabitants where the Entity does not have sufficient sufficient means.

B) Emergency services in municipalities of up to 20,000 inhabitants, which are provided through Primary Care Services.

The Entity grants its express and total authorization to Mugeju for that purpose.

Second. -The Conventions will be common to all the contracting entities of the concert and the content of the assistance, the economic consideration and the relation of municipalities, agreed with the respective Autonomous Communities will be communicated to the Entity. The final amount of the agreement will be based on the collective affected and will be satisfied with the price that, once accrued and free, Mugeju must pay him for the present of the Health Care, understanding the payment on behalf of the Entity.

Third. -Mugeju will make every monthly payment charged to the amount of the same month that you must pay to the Entity for the concert, transferring the corresponding justification.

Fourth. -Authorization to Mugeju contained in the first point must be understood as ampara also the extension of the Conventions subscribed to the same end prior to January 1 of the year 2010.

ANNEX 2

Relationship of services that require prior authorization of the entity and procedure for obtaining it

1. Services required to authorize prior authorization of the Entity. -In accordance with the provisions of clause 3.1.2 d) of the concert, the provision of the services indicated below requires prior authorization of the Entity:

1.1 Hospitalizations:

A) Hospitalization.

B) Day Hospitalization.

C) Home hospitalization.

1.2 Diagnostic techniques, treatments and surgical techniques:

D) Outpatient surgery.

E) Odontostomatology: Tartrectomy-mouth cleaning-and Periodontics.

F) Rehabilitation and Physiotherapy.

G) Respiratory Therapies: Oxygenotherapy, Ventilation and Aerosoltherapy at Home.

H) Treatment of peritoneal dialysis and hemodialysis.

I) Oncology: Immunotherapy and Chemotherapy, Cobaltotherapy, Radiumtherapy and Radioactive isotopes, Brachitherapy and Linear Accelerator.

J) Diagnostic by image: Computed Axial Tomography, Magnetic Resonance Imaging, Orthotommography, Mammography, Interventional Radiology, PET-TAC, Gammagrafia, Doppler, and Densitometry Osea.

K) Neurophysiological studies: EEG, EMG, ENG

L) Study and endoscopic treatment.

M) Cardiology: Hemodynamic studies and treatments.

n) Obstetrics: Amniocentesis.

O) Ophthalmology: Retinography and laser treatment.

P) Treatment in Pain Unit.

Q) Study and treatment in Sleep Unit.

R) Renal lithotricia.

1.3 Psychotherapy.

1.4 Assistance to consultant physicians.

1.5 Podology.

1.6 All services corresponding to Level IV, except specialist queries, and Reference Services.

2. Procedure to be carried out by the Entity to provide mutualists and beneficiaries with prior authorisation for the provision of the services required by them.

2.1 The Entity shall have the necessary organisational resources to make it easier for mutualists and Muggeju beneficiaries to obtain the prior authorisation for the provision of the services referred to in point 1. of this Annex, by any of the following means:

A) Presentially, in any of your delegations.

B) Telefonically.

C) By fax.

D) Through the Entity's web page.

2.2 Mutualists or beneficiaries who require it may process the application for prior authorization by sending it to the Entity by any of the means available.

2.3 Prior authorization requests will contain the following information, regardless of the means used for sending them to the Entity:

A) Personal data of the applicant:

First and last names.

Health card number.

Contact phone (email or fax).

Province where the capability will be performed.

B) Data from the service for which prior authorization is requested:

Identification of the requested service.

Prescription date.

Identification of the prescription-making optional.

Expected date for the performance of the benefit, if any.

Health care facility where the prescription will be made, if any.

C) Request for advice.

The mutualist or beneficiary will be able to point out whether it requires advice from the Entity.

2.4 For periodontics and mouth cleaning, as well as, in case of an accident of service or professional disease for dental prostheses, it will be necessary to prescribe an optional specialist of the Entity, together with budget, if this is a prosthesis, for authorization by the Entity.

2.5 The Entity, once the application has been received, may confirm the professional or health center chosen by the applicant or, if it considers it appropriate, assign a different one, provided that it constitutes an alternative valid care for the performance of the requested benefit.

2.6 The authorization issued by the Entity will have an identification number, which will be unique and specific to the benefit requested and will detail the professional or health center where it is to be performed. The Entity may refer the entity to the mutualist or beneficiary for any of the following means:

A) In hand, when the application has been submitted in person to any of the delegations of the Entity and, this is possible.

B) By mail, telephone or fax, when the application has been submitted by fax or, where it has been presented in person, it is not possible to be processed in the act.

C) By email, when the request has been submitted through the Entity's web page.

The submission of the authorisation number shall enable the applicant for access to the authorised provision, without any restriction and under the conditions laid down in the concert.

2.7 The sending of the authorization to the mutualist or beneficiary by the Entity will be carried out as soon as possible, in order to avoid eventual delays in the access to the requested benefit. If the immediate processing is not possible, the Entity shall have no more than five working days for its submission, except in the case provided for in paragraph C of clause 4.2.1 of the concert, in which it shall have ten working days.

2.8 The Entity may only deny prior authorization if the request:

A) Carishes the necessary information, in which case you must immediately contact the applicant with the object of completing the missing one.

B) Refers to a provision not included in the Services portfolio, in which case it shall inform the mutualist or beneficiary of this circumstance.

C) It is not supported by the prescription of a concerted optional, as provided for in the concert, in which case it must also inform the mutualist or beneficiary of this circumstance.

2.9 When required by the applicant, the Entity will provide you with the advice you need to provide you with access to the benefit, as stipulated in the concert.

2.10 Where the need for urgent attention prevents obtaining prior authorisation for the performance of a benefit included in point 1 of this Annex, the beneficiary, or other person on his behalf, shall have a period of time. Five working days to request the appropriate authorisation by submitting the appropriate justification for the urgency.

2.11 The Entity shall include in its Supplier Catalogue, website and, where appropriate, other means of information to the mutualists and beneficiaries, all information in the procedure for obtaining prior authorizations resulting from the necessary to facilitate processing.

ANNEX 3

Media availability criteria by care levels

The Entity must ensure access to the means that at each level requires the Services Portfolio of this concert in the terms specified below, unless such means are not available at a private level or public.

1. Availability of Primary Care Media.

1.1 All the municipalities will have Primary Care, which will include health care at the outpatient, home and emergency level in charge of the general practitioner or family, pediatrician, nursing graduate, matron, physiotherapist, dentist and podiatrist, taking into account the following:

A) The municipalities of up to 5,000 inhabitants will always have a general or family doctor and a diploma in nursing.

B) The municipalities of 5,000 up to 10,000 inhabitants will also have a paediatrician, matron, physiotherapist and dentist.

C) The municipalities of more than 10,000 inhabitants will have at least two general or family doctors, two pediatricians, two nursing graduates, two physiotherapists and two dentists.

D) The municipalities of more than 20,000 inhabitants shall have at least one podiatrist.

E) The municipalities of more than 100,000 inhabitants will have primary care services in all the postal districts or in their defect in a border district. In any case, home care will be guaranteed to all beneficiaries.

1.2 The Primary Care of Emergency Care will be provided, on an ongoing basis, during the twenty-four hours of the day, through medical and nursing care in outpatient and home-based arrangements. If exceptionally, the Entity does not have the required means to ensure the coverage of this assistance by other private or public services.

1.3 As a supplementary criterion, it shall be taken into account that, in the rural areas expressly provided for in the Conventions referred to in Annex 1 to this concert, health care at the outpatient, home or emergency level In charge of the general practitioner or family, pediatrician, nursing graduate and matron can be provided by the Primary Care and Emergency Services of the Public Health Network. In any case, mutualists and beneficiaries resident in the municipalities listed in Annex I to the respective rural conventions may choose the means available to the entity in the municipalities to be close.

In the municipalities of Autonomous Communities with which no collaboration agreements have been formalized and in which no concerted means are available, the Entity will facilitate the access of the beneficiaries to the services of primary care dependent on the corresponding Autonomous Community.

In any case, and for the assistance of this concert, the primary care and emergency services of the Public Health Services are treated as an entity, as provided for in the rural conventions of Annex 1 to this concert.

2. Availability of specialized care facilities. The level of specialized care has as a geographical and population framework the municipality of more than 20,000 inhabitants.

2.1 Level I of Specialized Care. -Municipalities of more than 20,000 and up to 30,000 inhabitants will have at least the following services for specialized assistance

Table 1. Portfolio of Services for Specialized Care in Municipalities

of more than 20,000 inhabitants up to 30,000 inhabitants

Specialties

Gynecology and Obstetrics

External Queries
Analysis.	X
Orthopaedic and Traumatology Surgery	X
X
X
X	X (includes ultrasound)
ophthalmology.	X
Otorhinolaryngology	X

The Entity will facilitate palliative care through primary care means in coordination with the corresponding top-level devices.

2.2. Level II of Specialized Care.

2.2.1 The municipalities of more than 30,000 and up to 75,000 inhabitants will have in addition to the services of specialized outpatient care of level I, the means included in the portfolio of services of specialized care Level II outpatient care, which will include health care in hospital care, outpatient care and hospital emergency care.

2.2.2 The benefits included in the Portfolio of Services of Specialized Attention level II, will be facilitated by the Entity taking into account the means established in Table 2.

Table 2. Specialized Care Services Portfolio in Municipalities

of more than 30,000 inhabitants up to 75,000 inhabitants

specialties

and Digestive Appliance

X

Psychiatry, Psychology

hospitalization	External Queries	hospital urgencies *
Clinical Analysis: Hematology, Biochemistry	X
		X			X	X	X
Digestive Appliance. Endoscopy	X
	X	X
X	X	X
	X	X	X	X
Stomatology		X
Pharmacy
	Gynecology and Obstetrics (IVE, Ligature Tubes)	X	X (ultrasound)	X
		X
Medicine	X	X	X
Intensive Medicine/:ICU	X
ophthalmology	X	X
Oncology	X
Otorhinolaryngology	X	X	X
Paediatrics	X	X	X
	X
Radiodiagnostics: Conventional R., Ecography, Mamography, TAC	x	x
Physical Medicine and Rehabilitation (logopedia and physical therapy)		X

* Physical Presence.

2.2.3 In the municipalities of this level of care, the Entity must have at least two doctors of the specialties referred to in the external consultations of Table 2.

2.2.4 The Entity must have in the hospital emergency room of physicians of physical presence for the specialties mentioned in Table 2. However, if the guard is located, the availability of the specialists, once they are required by the ER doctor, as soon as possible depending on the patient's pathology and clinical condition, no longer than 30 minutes.

2.2.5 In case of hospitalization, the requirement of availability shall be deemed to be met if the hospital offered by the Entity is situated in a municipality bordering or adjacent to a distance that can be travelled from the urban core, in usual means of transport in a time not exceeding 30 minutes.

2.3. Level III of Specialized Care.

2.3.1 In the provincial capitals, the cities of Ceuta and Melilla and the municipalities of more than 75,000 up to 250,000 inhabitants the Entity will have, in addition to the means of specialized attention of levels I and II, of at least the The following services of Specialized Care, in outpatient consultation, in hospital of day, in the system of interment and home hospitalization.

2.3.2 The benefits included in the Portfolio of Services for these municipalities will be provided by the Entity taking into account the means set out in Table 3.

Table 3. Portfolio of Services for Specialized Care in the provincial capitals,

the cities of Ceuta and Melilla and the municipalities of more than 75,000

up to 250,000 inhabitants

specialties

Angiology and Vascular Surgery.

Nephrology: Hemodialysis, Dialysis peritoneal.

hospitalization	External Queries
	X
Analysis: Microbiology and Parasitology.	X	x
Anesthesia And Resuscitation: URPA.	X Pain Unit	X	X
X	X
Digestive System: Endoscopy.	x	x
: Pacemaker, Diagnostic and Therapeutic Hemodynamics		x	x
Surgery and Digestive Apparatus.	X Laparoscopy	x	x
Traumatology.	X	X	X
	X
X		Endocrinology and Nutrition.
	x
	Gynecology and Obstetrics.	X Diagnostics prenatal	x	X
Hematology and Hemotherapy: Day Hospital.	x	X (Hematology)
Medicine.	X	X	X
Intensive Medicine: Adult ICU.
x	x
Neumology: Bronchoscopy.	x	x
Neurophysiology: E.E.G., E.M.G.	x	x
Neurology.	X	X
ophthalmology.	X	X	X
Oncology: Day Hospital.	x	X
Otorhinolaryngology.	X	X	X
Paediatrics:.	X Neonatology	X	X
Radiodiagnostic: RNM.	X	X Densitometry Osea
		X
	X					X
X The_table_table_izq"> Urology.	X Litotricia. Vasectomy	X
X	X

* Physical Presence.

2.3.3 In the municipalities of this level of care, the Entity must have at least two doctors of the specialties referred to in the external consultations of Table 3.

2.3.4 The Entity must have in the hospital emergency room of physicians of physical presence for the specialties mentioned in Table 3. However, if the guard is located, the availability of the specialists must be guaranteed, once they are required by the emergency room doctor, as soon as possible according to the patient's pathology and clinical condition, not more than 30 minutes.

2.3.5 In case of hospitalization, the requirement of availability shall be deemed to be met if the hospital offered by the Entity is situated in a municipality bordering or adjacent to a distance that can be traveled from the core urban, in usual means of transport in a time not exceeding 30 minutes.

2.4 Level IV of Specialized Care.

2.4.1 In those municipalities with a population of more than 250 000 inhabitants, in addition to the means of Attention for levels I, II and III, referred to in Tables 1, 2 and 3, the Entity will have the services of The following specialized.

2.4.2 The benefits included in the Services Portfolio for these municipalities will be provided by the Entity taking into account the means set out in Table 4.

Table 4. Portfolio of Services for Specialized Care in Municipalities

with population exceeding 250,000 inhabitants

Cardiology.

Gynecology and Obstetrics.

	Hospitalization	External Queries
Clinical Analysis. Cytogenetics. Pharmacology. Genetics. Immunology.	X
	X	X		X
X Digestive System.	X (Endoscopic Capsule)	X	X
X Electrophysiology	X	X
Surgery.	X Defibrillator Implantable	X
Maxillofacial Surgery.	X	X
Surgery.	X	X
Plastic and Repairing Surgery.	X
X	X
X (High Risk Obstetrics)	X (U. Assisted Reproduction)
	Nuclear Medicine. Diagnostic. Therapeutic. PET. PET-TAC.	X	X
Nephrology.	X	X	X
Neumology.	X	X	X
Clinical Neurophysiology. Evoked potentials. Sleep Unit.	X	X
Clinical Neurophysiology. Evoked potentials. Sleep Unit.	X	X
	X
		X	X	X	X
X			X
IntervenZionist Radiology.	X
ICU.	X
Unit.	X
T Unit.	X
X
palliative care unit.	X	x

* Physical Presence.

2.4.3 In the municipalities of this level of care the Entity must have at least three optional specialties referred to in the external consultations section of Table 4.

2.4.4 The Entity must have in the hospital emergency room of physicians of physical presence for the specialties mentioned in tables 2, 3 and 4. However, if the guard is located, the availability of the specialists must be guaranteed, once they are required by the emergency room doctor, as soon as possible according to the patient's pathology and clinical condition, which may not be in any case greater than 30 minutes.

2.4.5 In case of hospitalization, the requirement of availability shall be deemed to be met if the hospital offered by the Entity is situated in a municipality bordering or adjacent to a distance that can be travelled from the urban core, in usual means of transport in a time not exceeding 30 minutes.

2.5 Reference Services.

2.5.1 The Reference Services will have as a geographical and population framework the whole of the territory of the State, and the beneficiary can go to that which within the means offered by the Entity, be of his preference.

2.5.2 Within the Specialized Care Services Portfolio the services specified in Table 5 will be considered as Reference.

Table 5. Reference Services Portfolio

	Cancer Treatments.	Surgery with Esophageal Cancer Intent. Surgery with curative intent of pancreatic cancer. Surgery for liver metastases. Combined oncology surgery of the pelvic organs. Radioguided surgery. Radiosurgery of the central and extracranial nervous system. Complex treatments of radiation therapy and chemotherapy.
Transplantation of organs, tissues, and cells of human origin.	Organ. Tissues and cells.
Toracic Surgery.
Unit of Brain Damage.
Medular Injured Unit.
Unit of Burns.

2.5.3 The Entity will offer at least three reference service alternatives whenever they are available.

2.5.4 All Autonomous Communities with more than five million inhabitants (Andalusia, Catalonia, Madrid and Valencia) will have at least one Reference Service to carry out bone marrow and corneal transplantation.

3. Island territory.-The additional special conditions for the islands of the Balearic and Canary Islands are as follows:

3.1 For the purposes of primary care, the population of each municipality and the health care delivery shall be taken as a reference for the population of each island.

3.2. In case of non-existence of the means required on each island, the Entity shall guarantee assistance on the nearest island which has the same, and must assume the travel expenses.

3.3 Healthcare in Reference Services, if not available in the corresponding Autonomous Community, will be provided on that service that the beneficiary chooses.

3.4 In case the patient needs to be accompanied, the travel expenses of the companion will be borne by the Entity. To this end, it shall be provided to the Medical Reporting Entity that such need is justified.

ANNEX 4

Life-threatening pathologies

A purely indicative and non-exhaustive title, in the following cases it will be understood that there is an imminent or very near risk of not obtaining an immediate therapeutic action, so that, if the Requirements under clause 4.3.1. shall result from the reimbursement of expenses in the event of the use of means other than the Entity:

1. Intracranial or intracerebral acute bleeding, genital, digestive, respiratory, renal or rupture of blood vessels in general, with significant loss of blood or internal bleeding.

2. Complete or incomplete abortions. Uterine rupture or the complication of extra-uterine pregnancy. Gravidic toxicosis.

3. Cardiac, renal, hepatic, circulatory, traumatic, toxic, metabolic or bacterial shocks. Commas. Allergic reactions with involvement of the general state.

4. Acute respiratory, renal or cardiac failure.

5. Acute abdomen, formulated as a diagnosis, prior or presumption. Acute abdominal pain.

6. Lesions with external tears with imputation of viscera.

7. Hip fractures or the head of the femur.

8. Cerebrovascular accidents.

9. Acute poisonings. Acute sepsis.

10. Anuria. Acute urine retention.

11. Diphtheria. Botulism. Meningitis. Meningoencephalitis. Acute form of ulcerative colitis. Acute gastroenteritis with involvement of the general state.

12. Obstruction of the upper respiratory tract. Pulmonary embolism. Pleural effusion. Spontaneous pneumothorax. Acute lung oedema. Dyspnea. Bronchial asthma crisis.

13. Myocardial infarction. Hypertensive crisis. Peripheral arterial embolism. Asistolia. Paroxysmal tachycardia.

14. Diabetic coma. Hypoglycaemia.

15. Seizures. Childhood seizures. Toxicosis of the infant.

16. Acute adrenal insufficiency. Acute failure of peripheral circulation. Severe alterations of electrolyte metabolism.

ANNEX 5

Care information systems

1. Information on ambulatory activity. -On a quarterly basis, the Entity will communicate to Mugeju the accumulated data of ambulatory activity broken down by:

1.1 Medical query activity.

Table Annex 5.1. Medical consultation activity

Specialty

Anesthesiology and Resuscitation.

Intensive Medicine.

Neurosurgery.

Oncology.

Query No. *	Cost
Family General Medicine.
Paediatrics.
Angiology and Vascular Surgery.
Digestive.
.
Surgery.
General and Digestive Apparatus.
and Maxillofacial Surgery.
Orthopaedic and Traumatology Surgery.
Surgery.
, Aesthetic, and Repairing Surgery.
Medical-Surgical and Venereology dermatology.
Endocrinology and Nutrition.
stomatology/dentistry.
Hematology and Hemotherapy.
Medicine.
Nuclear Medicine.
Nephrology.
Neumology.
Neurology.
Obstetrics and Gynecology.
Radioterapic Oncology.
Otorhinolaryngology.
Psychiatry.
Rehabilitation.
Rheumatology.
Treatment.
Urology.
-price concerted service /capitative payment.
Other **.

* All queries are included (first, check, and home).

** This section will be used when there is a concept that does not fit in the previous sections; in this case, each concept must be specified.

1.2 Other outpatient activity.

Table Annex 5.2 Other Outpatient Activity

Activity	# patients	N. queries/sessions/services	Cost
D. U. E.
Matron.
Therapy.
Foniatria/Logopedia.
Podology.
Psychotherapy.
transport:
Other capabilities: Reactive glucose, insulin syringes, pharmacy (V04, Hospital Use ...)
	Indemnities: Direct Payments to Secured by using non-concerted media, CMP, CMN, Rural Zone Conventions.
Dialysis	Number of patients
Hemodialysis.
Dialysis.
Continuous Outpatient Peritoneal Dialysis (CAPD).

1.3 Diagnostic tests

Table Annex 5.3 Diagnostic Tests

Tomography (TAC)

	by image	No. of studies	Cost
Simple Radiology (head, trunk, limbs, stomatological radiology).
Special Radiology (contrast radiology, mammography ...).
Interventional Radiology.
/Doppler (does not include echocardiography or gynecological ultrasound).
Nuclear Resonance.
Densitometry Osea.
Other techniques.

Analysis:	N. of Determination	Cost
Biochemistry.
Endocrinology (determinations
Genetics.
		Immunology.
Immunology.
Microbiology.
Parasitology.
Other determinations.

Pathological Anatomy: (Cytology, PAAF, Other ...)

# of Studies	Cost
Biopsies.
PAAF.
Other.

Medicine	# of studies	Cost
PET.		PET.

Other diagnostic tests:

Ecocardiography/Echo doppler

Gastrocopies.

Colposcopies.

Broncocopies.

Urology.

Number of studies	Cost
Allergy.
Allergic tests.
	.
Ergometry.
	Holter.
(excludes hemodynamics and electrophysiology).
Digits.
colonoscopies.
Other.
Ecopies.
Other.
Neumology.
Spirometries.
	.
Electromyography.
Poligrafia.
Other.
	. A. L.
Acoustic Otoemissions.
.
Auditries.
.
urodynamic studies.

2. Information on hospital activity. -On a quarterly basis, the Entity shall communicate to Mugeju the accumulated data of hospital activity broken down by:

2.1 Conventional Hospitalization.

Table Annex 5.4 Conventional Hospitalization

	Revenue #	Stays *	Cost
Medical.
.
Obstetrics * *.
Partos.
Mental Health.
Care.
Neonatology Level of Care I, II, and III.

* No. of stays accumulated quarterly by line of activity.

2.2 Day and Home Hospitalization.

Table Annex 5.5 Day and Home Hospitalization

Day Hospital *	Patient #	# of sessions/days **	Cost
Oncothemological.
Psychiatry.
Other.
Hospitalization

* Excludes the surgical day hospital.

** Number of sessions accumulated quarterly per activity line.

3. Emergency activity information.-On a quarterly basis, the Entity shall communicate to Mugeju the accumulated emergency activity data broken down by:

Table Annex 5.6 Emergency Activity Information

	Emergency Nº	Cost
Ambulatory* *
**
/Service fixed price urgency.
Other.

* Hospital emergency: all those who have been treated in the emergency services of a hospital, including those who have finished in hospital admission.

** Outpatient emergencies: are all those that have been attended by the emergency services of the non-hospital health centers (polyclinics, external emergency services, etc.)

*** Home urgencies: These are all urgent assistance attended at the patient's home for emergency services.

4. Information on surgical activity. -On a quarterly basis, the Entity shall communicate to Mugeju the accumulated data of surgical activity broken down by:

Table Annex 5.7 Surgical Activity

			Num.	Cost
Major Surgery.	Scheduled Surgical Interventions with Hospitalization.
	Urgent Surgical Interventions with Hospitalization.
	Ambulatory Surgical Interventions in the operating room (CMA).
	Ambulatory Urgent Surgical Interventions (CMA)
minor surgery.	Minor surgery interventions.

5. Other diagnostic and therapeutic procedures. -On a quarterly basis, the Entity shall communicate to Mugeju the accumulated data of other therapeutic procedures broken down by:

Table Annex 5.8 Other diagnostic and therapeutic procedures

	Number of procedures	Cost
Intracranial Neurostimulator Implant.
Simple Radiosurgery.
Fractious radiosurgery.
cardiac hemodynamics:
Total Stents Number.
Electrophysiological Studies diagnostics.
electrophysiological studies:
Implant/defibrillator replacement.
Other.
Reproduction Cycles Assisted.

ANNEX 6

Structure of the entity's media database

Entity general data table

Names	Type	Length	Description of the fields:
Entity.	Text.	60	Full name.
Urgences Phone.	Alfico.	9	Free Emergency and Resource Coordination Phone
Address.	Text.	150	Address of the Provincial Delegation of the Entity.
Code.	5	Postal Code
.		5		4		INE Municipality Code where you perform the professional activity
Province.	Alfico.	2	INE Province Code.
.	Alfico.	9	Provincial Delegation Phone.
Ambulance_Telefono_.			9	9	.
	Fax.	9	Number of FAX for authorizations.
page.	Text.	60	Address of the Entity's web page

Professional data table

Names,

Postal Code.

Province 2.

Type,	Length	Description of the fields:
Clinic_link.	Text.	150	Clinic or Center where the professional performs his/her activity (in his case the same description as in Catalogue Hospital National)
Name.	Text.	50
Name.	Text.	50	Professional name
.	150		Address in Spain
Alphanumeric.	5	Postal Code.
.	Alphanumeric.	4	INE Municipality Code where you perform the professional activity.
Province.	Alfico.	2
Province 2.	Alfico.	Province 2.	2	Code Other Province in which figure in the Services Catalog
Professional Activity.	Alfico.	1	1. Doctor. 2. Nursing professional. 3. Odontologo 4. Physiotherapist 5. Psychologist 6. Logopeda. 7. Podologo. 8. Other
.	Alfico.	2	Subspecialty.
	.	150	Free text
NIF.	9		Num.
Num. Collegiate.	Alfico.	9	Number of collegiate.
E-mail.	Text.	50	Email Address.
Phone.	Alfico.	9	Contact Phone

(1) Specialty code, WTO:

01 General Medicine.

02 Pediatrics.

03 Alergology.

04 Clinical Analysis.

05 Pathological Anatomy.

06 Anesthesia and resuscitation.

07 Angiology and vascular surgery.

08 Digestive Aparate.

09 Cardiology.

10 Cardiovascular Surgery.

11 General surgery and digestive system.

12 maxillofacial surgery.

13 Pediatric Surgery.

14 Plastic and restorative surgery.

15 thoracic surgery.

16 Medical-surgical dermatology and venereology.

17 Radiodiagnosis.

18 Endocrinology and Nutrition.

19 Estomatology.

20 Geriatrics.

21 Hematology and hemotherapy.

22 Immunology.

23 Intensive Medicine.

24 Internal Medicine.

25 Nuclear Medicine.

26 Nephrology.

27 Pneumonia.

28 Neurosurgery.

29 Clinical Neurophysiology.

30 Neurology.

31 Obstetrics and Gynecology.

32 Ophthalmology.

33 Medical Oncology.

34 Radio-terapic Oncology.

35 Otorhinolaryngology.

36 Psychiatry.

37 Rehabilitation.

38 Rheumatology.

39 Treatment of pain.

40 Traumatology and orthopedic surgery.

41 Urology.

Non-Internment Center Data Table

Names,

Phone.

Format/Type	Length	Description of the fields:
Clinic_.	Text.	150	Naming.
.	150		Address in Spain
Code.	alphanumeric.	5	Postal Code.
.	Text.	4	Province.
	.	2		of Center.
alphanumeric.	5		Code set out in Annex 1 to Royal Decree 1277/2003 of 10 October 2003. (1)
Service.	Text.	1	S/N.
CIF/NIF.	alphanumeric.	9	.
	E-mail.		50	50
.
Alfico.	9	Contact phone.
Services Physicians.	Alfico.	5	WTO_Code.
of diagnostic techniques.			The codes of the techniques that are performed in the center between tabs (2) will be included.

(1) Type of center

C. 2.1 Medical Queries.

C. 2.2 Consultations from other healthcare professionals.

C. 2.4 Polivalent Centers.

C. 2.5 Specialized Centers.

C. 2.5.1 Dental clinics.

C. 2.5.2 Assisted human reproduction centers.

C. 2.5.3 Centers for voluntary termination of pregnancy.

C. 2.5.4 Outpatient surgery centers.

C. 2.5.5 Dialysis centers.

C. 2.5.6 Diagnostic Centers.

C. 2.5.7 Mobile Health Care Centers.

C. 2.5.8 Transfusion centers.

C. 2.5.9 Fabric banks.

C. 2.5.11 Mental health centers.

C. 2.5.90 Other specialized centers.

C. 2.90 Other Non-Internal Healthcare Providers.

(2) Offering of techniques.

Lab.

100 Sample Extraction/Collection Point.

101 Hematology.

102 Biochemistry.

103 Microbiology and parasitology.

104 Immunology.

105 Genetics.

106 Hormone Levels.

107 Drug Levels.

Radiodiagnostic.

121 Conventional Radiology (simple and contrast).

122 Mammography.

123 TAC.

124 Ecography.

125 Densitometry.

126 Digital Angiography.

127 Interventional Radiology.

Other Dianostic Techniques.

141 Endoscopy.

151 Gammagrafia.

161 EEG.

162 EMG.

163 Potentials evoked.

170 PET-TAC.

Medical Specialties.

The WTO code will be entered.

Clinical and hospital data table

Names,

CIF/NIF.

Phone.

Num_beds.

Format/Type	Length	Description of the fields:
Code.	Alfico.	6	National Hospital Code
150	Denomination
	Denomination.			150
Denomination.
	Address	Text.	150	Address in Spain
Postal Code.	Alfico.	5	Postal Code.
.	Alfico.	4	INE Township Code.
Province,.	Alfico.	2	Province Code INE.
Type.	Alfico.	1	1. General. 2. Specialized. 3. Medium and long stay. 4. Psychiatric 5. Other
Service.	Text.	1	S/N.
9	9	.
	E-mail.		50	50
.
Alfico.	9	Contact phone.
Unit Home Hospitalization (UHD).	Text.	2	Yes/No.
Alfico.	4	Number of beds installed

ANNEX 7

Performances prescribed by the non-capacity assessment bodies and scale for their recovery

A. Reports, explorations or tests prescribed by the disability assessment bodies and other organs of Mugeju. -The Entity, in accordance with clause 6.5.1.d) of the concert shall facilitate the performance of medical reports, examinations or tests of (a) a diagnosis which prescribes the members of the Mujeju mutualists with the powers of the non-capacity assessment bodies in the retirement procedure for permanent incapacity for the service provided for in the Resolution of the Secretary of State for the Public Administration of 29 December 1995 and for the concordant rules, or proceedings for a complaint of major invalidity or of a permanent non-invalidating injury, as set out in Articles 72 and 76 of the General Judicial Mutual Regulation adopted by Royal Decree 3283/1978 of 3 November 1978, to which the end of the required to make any such reports, explorations or tests carried out by the mutualists, through the facultative, services or centres of its service portfolio and in the form set out in point 1, to the mutualists.

For your part and for the same purpose, Mugeju is obliged to pay each Entity the amount indicated in point 2 below, within the period also provided for in that point.

1. The mutualist to whom the performance of a performance referred to in the preceding paragraph is prescribed shall present the form in which the prescription has been made in the Mujeju Provincial Delegation for the relevant authorization.

Mugeju, once the applicant's affiliation has been verified, shall authorise the prescription by stamping the stamp model in the form set out in point 3.

The mutualist will then present the same form in the Offices of the Entity to which it is attached. This, in view of the authorization granted by Mugeju:

(A) It shall issue and deliver to the mutualist immediately the necessary flyers for the performance of the reports, explorations or tests specified in the prescription, with the express indication of the optional or centers on which they must be performed.

B) In the original of the form authorised by Mujeju, the reception by the mutualist of the steering wheel or the steering wheels shall be recorded, in accordance with the formula set out in point 3 of this Annex. The reception shall be accredited with the signature of the mutualist, or, where appropriate, of the recipient other than the mutualist, stating in this case his national identity document and his relationship with that person.

C) Deliver a photocopy of the form to the mutualist.

2. At the end of each calendar quarter, the Entity shall transmit to Mujeju the reports, explorations or tests carried out in the quarter, with an express indication of the corresponding price, which shall be, precisely, the one on the scale, which shall be contains as paragraph B in this Annex. Each report, examination or test that is recorded in the relationship shall be justified by the original of the corresponding prescription form, completed in the form provided for in point 1, and with the invoices meeting the conditions and requirements established in the relevant legislation in this respect.

Within the month following receipt of the relationship, Mugeju will pay the Entity the amount of the reports, scans or tests that appear on it.

3. For the application of paragraph 1, the following models shall be used:

Seal model for authorization of prescriptions BY Mugeju:

Mugeju

AUTHORIZED PRESCRIPTION For the assignment of optional PRESENTESE is printed in the OFFICES OF THE MEDICAL ENTITY of the mutualist	(SPACE FOR THE SIGNATURE OF THE DIRECTOR OF THE SERVICE OR HEAD OF THE DELEGATED OFFICE)

Note. The signature may be included in the stamp.

Formula for crediting the delivery of flyers by the entity:

I have received from the Entity the precise documents to carry out the actions prescribed in this form.

........................, a .... of ......................... of 20 ....

THE MUTUALIST,

(Signature of the mutualist or, where applicable, of the person representing him, in this case the number of the DNI and its relation to that person)

Note. -It will be entered by the Entity, whenever possible, at the bottom right of the form.

B. Diagnostic test recovery scale.

Denomination test

Maximum rate per unit - (euros)	Content
Analytics Determinations
30.40		Parameter and reference figure
Profile	58.08	Parameter and reference figure.
Profile	45.61	Parameter and reference figure.
Reumatological Profile	45.58	Parameter and reference figure.
Profile Nephrologic	55.36	Parameter and reference figure.
Gasometry	26.38	Parameter and reference figure.
Coagulation	15.93	Parameter and reference figure.
77.66		77.66	Parameter and reference figure
97.06		97.06	Parameter and reference figure
Simple Radiography (Torax or Abdomen)	25.35	25.35
		25.35	25.35	25.35	Table_table_izq"> Placas in two positions per segment.
Computed Axial Tomography (TAC)	176.33	Plate and Report.
Computed Axial Tomography (TAC) with contrast (TAC + contrast)	200,27	Plate and Report.
Nuclear Resonance (RNM)	250.67	Plate and Report.
Resonance Magnetic Resonance (RNM + contrast)	309.58	Plate and Report.
Osea Densitometry	88.33	Report.
119,86		Record and Report.
Ecography (all the regions)	90.94	Report.
Potential Evoked (visual, hearing, somesthetic, cognitive)	149.06	Report.
Electroencephalogram (EEG)	97.49	Record and report.
148.97		148.97	148.97 Table_table_izq"> Record and Report.
Electroneurogram (ENG)	85.26	Record and report
Electrocardiogram (ECG)	72.90	Record and report.
Holter	98.64	Report.
Effort Test (Bruce Protocol)	83.79	Report.
Unconventional effort test (by stress ECO)	103.28	Report.
Unconventional Effort Test (by ECO with dobutamine)	66.78	Report.
Ergospirometry: Effort test with direct determination of consuming O2	127.01	Report.
myocardial gamma (SPECT) with Bruce P or pharmacological stimulation	222.37	Report.
ECO-Cardiac Doppler	108.44	Graphic: Report and Data (Ejection Fraction and Spending)
Vascular ECO-Doppler	104.85	Report.
Spirometry	40.46	Record: data (CV, FEV1) in three takes before.
spirometry with bronchodilation	49.98	Record: data (CV, FEV1) in three takes before and after bronchodilation.
Alveolo-capillary Broadcast (DLCO or TLCO)	57.25	Report and data.
Plestimography (lung volumes)	36.68	Report and data.
232.65		Written Report.
Campimetry digital	82.86	Graphic: Data and Report
Electroretinogram	94.65	Written Report.
99.73		Written Report.
Tonal Audiometry in cabin	33.97	Graphic both Air and bone indication ears
vestibular tests	157.28	Written report.
Posturography	110,15	Written report.
epicutane (contact)	101.38	Result Test: Rating (graduation) of results.
Neuro-psychological assessment report	104.82	Written Report.
Psychiatric Assessment Report	100.53	Written Report.
Medical Report specialized	89,27	Written report.
Medical Report	97.51	Written Report.
shoulder and Shoulder Muscle and Joint Balance by Biomechanics Technique.	299.13	Record and report.
Hip Joint And Muscle Balance: Knee or Ankle Per Biomechanics technique.	228.15	Record and Report.
Valuation Capability by Biomechanics Technique	40,53	Record and report.
articular balance, Cervical, Dorsal or Lumbar by biomechanics technique	212.94	Record and report
Valuation Biomechanical LBP Functional LBP	583.05	Record and report
Valuation Cervicalgia functional by biomechanics technique	583.05	Record and report.
assessment of postural balance by biomechanics technique		Log and Report.

Source: Diagnostic tests used in the Medical Unit of the Inabilities Assessment INSS Provincial Directorate of Madrid 2009.

Second.-Publish the relationship of the entities that are signatories to the concerts referred to in the previous paragraph and that is as follows:

ADESLAS Insurance Company, Limited Company.

Inter-provincial Health Insurance Assistance, Limited Company (ASISA).

United Insurance Fund, Insurance and Reinsurance Company, Company Limited (CASER).

DKV Seguros y Reinsurance, Sociedad Anónimas Española, (Sociedad Unipersonal).

FAMILY MAPFRE, Insurance and Reinsurance Company, Company Anonymous.

SANITAS, Insurance Company.

Madrid, January 12, 2010.-The General Secretariat of the General Judicial Mutuality, P. S. (Royal Decree 1206/2006, of October 20), the General Secretariat of the Judicial General Mutuality, María del Mar García Ferrer.