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Resolution Of 18 December 1996, Of The Judicial General Mutual Insurance Company, Which Publishes The Concert For The Provision Of Health Care To Members And Other Beneficiaries Of Mugeju During The Year 1997.

Original Language Title: Resolución de 18 de diciembre de 1996, de la Mutualidad General Judicial, por la que se publica el concierto para la prestación de asistencia sanitaria a los mutualistas y demás beneficiarios de MUGEJU durante el año 1997.

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TEXT

In application of the provisions of Article 10.2 of Royal Decree-Law 16/1978 of 7 June, which regulates the Social Security of civil servants in the service of the Administration of Justice, and in Article 63 of the Royal Decree Decree 3283/1978 of 3 November 1978 on the Rules of Procedure of the General Court of Justice, and on a call published by the Presidency Resolution of 29 October 1996 (Official Gazette of the State of 15 November 1996), Mutualidad has concluded concerts with various insurance entities authorized in the field of sickness (including health care) for the provision of health care to mutualists and other beneficiaries of the General Judicial Mutual Fund during 1997, which is renewable for the years 1998 and 1999.

In compliance with the number 8 of this call, the Presidency of the Mutual Association agrees to publish the text of this concert, as well as the relationship of the insurance entities that have subscribed to it.

First. -Text of the concert of the General Judicial Mutual with the insurance entities for the provision of health care to the mutualists and other beneficiaries of the Judicial General Mutual during the year 1997, renewable for the years 1998 and 1999.

CHAPTER I

Concert and Payee Object

1.1 Object of the concert.

1.1.1 The purpose of the concert is to provide healthcare to mutualists and other MUGEJU beneficiaries throughout the national territory. This assistance will be provided in accordance with the provisions of Royal Decree-Law 16/1978 of 7 June, which regulates the Special Social Security System of Personnel at the service of the Administration of Justice, seeking maximum homogeneity with the benefits granted by the National Health System. To this end, the contracting entity of the concert (hereinafter the entity) shall make available to the beneficiaries attached to it all the appropriate means of its own or agreed to provide a comprehensive quality health care or, if not have the same exceptional character, to assume or to reintegrate the costs incurred to the beneficiaries by the use of other means necessary for such assistance, all in accordance with the provisions of the concert clauses. In those cases expressly mentioned in the present concert, it is also necessary to reintegrate the expenses caused by the use of non-concerted means.

1.1.2 For its part, MUGEJU is obliged to pay the entity the amount per month and person provided for in clause 6.2, subject to the specifications and procedure contained in clause 6.3.

1.2 Beneficiaries in general.

1.2.1 Without prejudice to the provisions of clause 1.3, all mutualists and other healthcare beneficiaries of MUGEJU, determined in accordance with their own provisions, are beneficiaries for the purposes of this concert. rules, which have been attached to the entity for such purposes.

Recognition of the payee condition corresponds to MUGEJU.

1.2.2 For certain management purposes, and provided that the text of the clauses is derived from the text itself, the beneficiaries of the concert may be called holders if they have their own document of affiliation to MUGEJU, or simply beneficiaries, when they appear in the document of beneficiaries of a holder. In any event, the beneficiaries shall be assigned to the institution as long as the holder of the entity is dependent.

1.2.3 The holders who, where appropriate, were at 31 December 1996 and do not change the entity as provided for in clause 1.5 or in accordance with the rules governing the health network of the institution, shall be attached to the institution. Social security and those who choose it in accordance with the rules of that clause or when their discharge occurs in MUGEJU.

1.3 Maternity Beneficiaries. -In addition to the beneficiaries included in clause 1.2, they are also beneficiaries for maternity, for the purposes of this concert, the spouses of the mutualists or those who have come living with these in the same relationship of affectivity to that of spouse, even if they do not meet the condition of beneficiaries included in the corresponding document, provided that they are not holders attached to another entity of the present concert. In this case, the care covers the preparation for delivery and all the incidences and obstetric pathology of pregnancy, childbirth and puerperium.

1.4 Birth and extinction of beneficiaries ' rights.

1.4.1 Without prejudice to the following paragraph and in clause 1.6, the rights of beneficiaries start on the date on which they are assigned to the institution by the services of MUGEJU, without any time limit. of lack for any kind of assistance.

1.4.2 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 delivery until one month. From then on, this right is conditional on the formalisation of the membership with the consequent economic effects.

1.4.3 The rights of the beneficiaries are extinguished, in any case, on the date when the services of MUGEJU agree to their discharge in the same or in the entity.

1.5 Entity change. -Holders attached to the entity may change to another of the entities in the following assumptions:

A) On an ordinary and general basis, during the month of January of each year, in the form established by MUGEJU.

B) With extraordinary character:

a) When a change of destination occurs for the province-based holder.

(b) Where 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 Presidency of MUGEJU agrees to the opening of a special period of choice of entity.

1.6 Mutualists not attached to a medical entity.-The mutualist officer of MUGEJU who has not formalised his or her attachment to one of the concerted entities or to the public health network and who, specifying health care for himself or your beneficiaries will require you in the entity's offices, you will be entitled to receive it once you credit your membership status to MUGEJU.

The entity shall provide the assistance and, within the following five working days, shall notify MUGEJU of the facts to proceed to the discharge of the mutualist in the institution with the effect of the fifth of those days and to the credit of the expenditure on the assistance provided up to the date of discharge.

CHAPTER II

Entity Media

2.1 General rules.

2.1.1 The means of the entity are as follows:

A) Centers, facilities or establishments owned by the entity or arranged by the entity under any legal regime.

B) Personal health care, optional and non-optional, dependent on the entity through a relationship of a working nature or linked to it by a civil relationship.

For the purposes of this concert, the services of primary care and emergency services of the public health network are assimilated to the media of the entity, as provided for in the Annex I.

2.1.2 The entity shall have all the means, either own or agreed, that it contains in its catalogue of services.

MUGEJU, as a contracting party, may verify, where appropriate, the entity's compliance with the obligation laid down in the preceding paragraph.

Failure to comply with this obligation may cause termination of the concert.

2.1.3 The means of the entity must comply with the requirements established in general by the current health regulations, under the supervision that, with the same character, can proceed by the Health Administration competent.

To all intents and purposes, the specialists must have the title recognized, in the terms provided for in Royal Decree 127/1984 of 11 January, which regulates specialized medical training and obtaining the Title of Specialist Doctor.

If MUGEJU is aware of the possible non-compliance with these general requirements, it may be able to bring it to the attention of the competent health authority. This breach, and according to its seriousness and the degree of liability the entity would have incurred before MUGEJU, may be cause for termination of the concert.

2.1.4 Within each of the levels of assistance provided for in this Chapter, the means available to the institution shall, in any event, ensure the principle of the free choice of optional, taking into account the set out in clauses 2.2.1, 2.2.2, 2.2.3 and 2.2.4.

2.1.5 MUGEJU will communicate to the contracting entities of this concert the way in which they will provide the necessary information, allowing the integration of the data relating to the provision of services to the beneficiaries of MUGEJU, in order to ensure the comparability of the services between the different suppliers.

2.2 Healthcare stations.

A) Healthcare comprises the following modes:

a) Primary care.

b) Specialized care.

c) Pharmaceutical benefits.

d) Complementary benefits.

e) Health information and documentation services.

B) Healthcare is structured at care levels by population sizes:

a) Level I health care: Localities of up to 20,000 inhabitants.

b) Level II health care: Municipalities of more than 20,000 to 75,000 inhabitants.

c) Level III health care: Municipalities of more than 75,000 inhabitants and provincial capitals.

d) Level IV health care: Autonomous Communities.

Each level of higher population size includes all services from the lower levels.

In addition, the provisions of Annex IV shall be taken into account for the island territories.

2.2.1 Level I of health care. -Primary care: For localities from 1,000 and 20,000 inhabitants primary care will include health care at the outpatient, home and emergency level. General, Pediatrics, Nurse/or, Matron, Physiotherapist and Odontologo.

Media availability will conform to the following rules:

A general practitioner for every 1,500 inhabitants or fraction.

A Nurse/or for every 2,500 inhabitants or fraction.

A pediatrician for every 1,500 inhabitants under the age of fourteen or fraction.

A Matron and a Physiotherapist for every 20,000 inhabitants.

A Dentist for every 12,000 inhabitants.

Localities from 1,000 to 20,000 inhabitants will always have a general practitioner and a nurse.

Localities from 5,000 to 20,000 inhabitants will have, in addition to Paediatra, Matrona, Fiosiotherapist and Odontologo.

Primary care services portfolio.

The portfolio of primary care services will generally include the same benefits as for this level establishes Royal Decree 63/1995 of 20 January on the management of health benefits of the National System. Health and in a specific way the vaccinations of the child and the adult, the attention to patients with HIV/AIDS and the basic physioterapical treatments. In addition, primary emergency care will be given to people of any age, on an ongoing basis, during the twenty-four hours of the day, through medical and nursing care, on an outpatient basis or at the patient's home.

Extra criterion.

As a criterion for the provision of this clause, it will be taken into account that health care at the outpatient, home or emergency level by the general practitioner, the doctor, the nurse, or the replace with the primary care and emergency services of the public health network, as provided for in Annex I.

2.2.2 Health care level II.-In municipalities of more than 20,000 up to 75,000 inhabitants, in addition to the primary care services referred to in clause 2.2.1, the following care services specialized:

Outpatient assistance specialized in consultations, including, where appropriate, the conduct of outpatient surgery.

Specialist inpatient treatment including medical, surgical, obstetric and pediatric assistance.

Psychiatric assistance, including diagnosis and clinical follow-up in outpatient settings.

Urgent care: Hospital and extra-hospital.

At this level, institutions must have at least two optional optional, increased, where appropriate, in proportion to the number of beneficiaries according to the criteria used in the National System of Health.

(*) Health care level II specialist care portfolio (Table number I).

TABLE I

Level II specialized care services portfolio

External Queries/Hospitalization

Units

functional/Units

functional/Services/Services

Medical Area/Medical Area

A. Digestive.

Cardiology.

Stomatology.

Hemotherapy.

Internal medicine. /Internal medicine.

Obstetrics. /Ultrasound. /Obstetrics.

Pediatrics. /Paediatrics.

Psychiatry.

Rehabilitation. /Logopedia. /Rehabilitation.

U. C. I.

Surgical area/Surgical area

Anesthesia and resuscitation.

General surgery. /General surgery.

Gynecology. /Gynecology.

Ophthalmology. /Ophthalmology.

O. A. L. /O.R.L.

Traumatology. /Traumatology.

Central Services/Central Services

Clinical analysis. /Clinical analysis.

Pathological anatomy.

Pharmacy.

Radiodiagnosis. /General Radiology. /Radiodiagnosis. /General Radiology.

Ultrasound. /Ultrasound.

Mammography. /Mammography.

T. A. C. /T.A.C.

Emergency/Emergency

2.2.3 Level III health care. -In the municipalities of more than 75,000 inhabitants, in the cities of Ceuta and Melilla and in provincial capitals, they will be provided in addition to the services of primary care and attention specialised referred to in points 2.2.1 and 2.2.2 of the following:

Outpatient assistance specialized in consultations, which will include, where appropriate, the conduct of outpatient surgery.

Specialist assistance in hospitalization.

Specialist day hospital care for patients who need medical or nursing care and do not require a hospital stay.

Specialist assistance for home hospitalization.

Psychiatric care that includes clinical diagnosis and follow-up, outpatient regimen, and hospitalization in acute processes and the resharpening of chronic processes.

Urgent care: Hospital and extra-hospital.

At this level, the entities must have at least two optional optional, increased, if appropriate, in proportion to the number of beneficiaries according to the criteria used in the National System of Health.

(*) Portfolio of specialized care services of level III of health care (Tables II, III and IV).

TABLE II

Level III specialized care services portfolio

External Queries/Hospitalization

Units

functional/Units

functional/Services/Services

Medical Area/Medical Area

Allergology. /Allergology.

A. Digestive. /A. Digestive. /Endoscopy Digest.

Cardiology. /Electrophysiology. /Cardiology. /Electrophysiology.

Dermatology. /Dermatology.

Endocrinology. /Endocrinology.

Stomatology.

Hematology. /Hematology. /Day Hospital.

Internal medicine. /Internal medicine. /U. of Infectives.

Nephrology. /Hemodialysis and home peritoneal dialysis. /Nephrology. /Hemodialysis and peritoneal dialysis.

Pneumonia. /Pneumonia. /Endoscopy resp.

Neurology. /Neurology.

Obstetrics. /Ultrasound. /Obstetrics.

Medical oncology. /Medical oncology. /Chemotherapy.

Hospital of the day.

Pediatrics. /Paediatrics. /Neonatology.

Psychiatry. /Psychiatry. /Detox unit.

Hospital of the day.

Rehabilitation and physio. /Rehabilitation. /U. Early Attention.

U. For Home Hospitalization.

TABLE III

Level III specialized care services portfolio

External Queries/Hospitalization

Units

functional/Units

functional/Services/Services

Surgical area/Surgical area

Anesthesiology. /U. of Awakening.

U. Reanimation.

U. Pain.

Angiology and c. vascular.

General and digestive surgery. /General and digestive surgery. /laparoscopy.

maxillofacial surgery. /maxillofacial surgery.

Paediatric surgery. /Paediatric surgery.

Vascular surgery.

Gynecology. /Ultrasound. /Gynecology. /I.V.E.

Ligaruda of tubes.

Ophthalmology. /Ophthalmology.

O. A. L. /O.R.L.

Traumatology and c. orthopaedic. /Traumatology and c. orthopaedic.

Urology. /Urology. /Litotricia.

Vasectomy.

Endoscopy.

Intensive care unit. /Adults.

Paediatric.

TABLE IV

Level III specialized care services portfolio

External Queries/Hospitalization

Units

functional/Units

functional/Services/Services

Central Services/Central Services

Clinical-biochemical analysis. /Laboratory. /Pathological anatomy.

Biochemistry.

Pharmacology.

Hematology.

Immunology.

Microbiology.

Parasitology.

Pharmacy.

Neurophysiology. /Potential evoked.

E. M. G.

Radiodiagnosis. /General Radiology. /Radiology. /General Radiology.

Ultrasound. /Ultrasound.

Mammography. /Mammography.

T. A. C. /T.A.C.

R. N. M. /R.N.M.

Bone Densitometry. /Bone Densitometry.

Emergency/Emergency

2.2.4 Level IV of health care. -By Autonomous Communities, the entity must have the assistance provided in Table V. These services must exist, at least, in each Autonomous Community or, in its (a) the defect in an Autonomous Community bordering on that in which the beneficiary resides.

(*) Portfolio of specialized care services of the level IV of health care (Table V).

TABLE V

Level IV specialized care services portfolio

External Queries/Hospitalization

Services/Services/Functional Units

Cardiology. /Cardiology. /Hemodynamics diag.

Hemodynamics terap.

Cardiovascular surgery. /Cardiovascular surgery.

Plastic and restorative surgery. /Plastic and restorative surgery.

thoracic surgery. /thoracic surgery.

Nuclear medicine. /Nuclear medicine.

Neurosurgery. /Neurosurgery. /stereotaxic surgery.

Neurophysiology. /Sleep unit.

High-risk obstetrics.

Radiation oncology. /Cobaltotherapy.

Radiumtherapy and radiac isotopes.

Brachytherapy.

Linear accelerator.

Family planning. /Genetic Council.

Assisted reproduction unit. /F.I.V.

Artificial Insemination.

Semen Bank.

Transplants. /Heart.

Cornea.

Liver.

Bone Marrow.

Pancreas.

Lung.

Kidney.

Burn unit.

Unit injured medulars.

Lab. /Genetics.

Cytogenetics.

Molecular genetics.

Nuclear medicine.

Radiology. /Digital Angiography.

Gammacamara.

Interventional Radiology.

2.2.5 Guarantee of accessibility to the media. -In case of not having the means that in each level of care demands the portfolio of services of the present concert, and whenever this is due to the lack of sanitary resources (a) the institution must provide such means in the locations of the highest immediate level in which they exist, or if it is impossible for the public health network to agree with the public health network. In any case, the appropriate emergency health care shall be ensured at each level.

2.2.6 Emergency care. The emergency care shall be provided in accordance with clauses 2.2.1, 2.2.2 and 2.2.3 of this concert and according to the following specifications:

(a) Level I health care: Primary emergency care will be provided, on an ongoing basis, during the twenty-four hours of the day, to persons of any age, through medical and nursing care. Outpatient and home.

(b) Levels II and III of health care: In addition to the urgent care provided for the level I of health care, the institution must have the necessary hospital and extra-hospital emergency services. in clauses 2.2.2 and 2.2.3, as appropriate. Such services may be provided by the beneficiaries at all times and shall be provided with the required medical practitioners and the personal and material resources necessary for their function.

2.2.7 The entity shall provide access to the centres and services included in the service portfolios so that MUGEJU can check the adequacy of the institution's means with respect to the offer of services.

2.3 Complementary benefits.

2.3.1 Oxygenotherapy, ventilation and aerosoltherapy at home. -It requires a prescription from the specialist of the institution and presentation to it for authorization.

2.3.2 Orthoprosthetic station. -Fixed surgical prostheses will be carried out by the entity, with such medical devices as they require internal implantation in the patient through a certain act. surgical. Also included are the materials used to perform osteosynthesis techniques.

Oosteintegrated implants for dental prostheses are excluded.

2.3.3 Transport for healthcare.

A) Transport type:

Health transport is understood to be performed in the following ways:

a) Ordinary transport:

It is the one made by car, bus, railway, boat and plane.

These transfers will always be valued for their cost on scheduled bus or rail transport lines or, if they come from island provinces, or the cities of Ceuta and Melilla, ship or aircraft in normal class or tourist.

b) Extraordinary transport:

Comprises ambulance transport, medicalized ambulance, mobile UVI, aircraft, medicalized helicopter, and taxi.

This transport will be used in case the patient's pathology prevents him from moving in ordinary means, accredited this end by the written prescription of the optional on which the need for the transfer is recorded such means.

B) Derived benefits:

The beneficiary of MUGEJU shall be entitled to health transport by the entity whenever it is carried out to the nearest locality in which it has the means, in the following cases:

a) When the patient moves in extraordinary means of transport:

For reasons of urgency, from the place in which it occurs, for its entry into the center of the entity. In such cases, the prior written prescription of the practitioner who has provided the assistance, whether or not the entity, shall be required, stating the need for the transfer in those means.

To receive regular treatments, such as hemodialysis, radiation therapy, rehabilitation, or other treatments, from the place where you reside, on a temporary or permanent basis.

Between different levels of healthcare.

To services located outside a level III location of health care, in the event that the entity does not have the means required at this level.

b) When the patient moves in ordinary means of transport:

In order to receive regular treatments, from the locality in which it resides, on a temporary or permanent basis, to the nearest locality in which the entity has the means, provided that said locality has more than 25 kilometers.

A services level IV of health care, provided that it is outside the locality of residence.

Between different levels of health care, in the event of not having the means required in each of them, provided that the distance between the locality in which it resides and the one in which the assistance is provided 25 kilometers.

C) General conditions:

All displacements require prior authorization of the entity, except those that occur for reasons of urgency and in cases of use of ordinary means to move between levels of healthcare in the (i) of course not to have the means required in each of them.

The travel on extraordinary means of transport always requires written prescription from the optional one, stating the need for the transfer in those means.

Displacements made by less than 15 years of age will entitle the companion to the transport costs. Residents of the cities of Ceuta and Melilla are exempt from the above age requirement, which, in any case, must provide written prescription of the optional.

2.3.4 Health information and documentation. -Entity's faculty are required to:

(a) Inform the patient and his or her family members or relatives of their rights and duties, in particular, for the proper provision of informed consent and the use of health services.

b) Meet and deliver the discharge report at the end of the stay at a hospital institution or the specialist external care consultation report.

c) Communicate or deliver, at the request of the person concerned, a copy of his or her medical history or certain data contained therein, without prejudice to the obligation of his or her conservation in the health centre.

d) To comply with the medical reports of the parts of temporary incapacity, pregnancy, childbirth or maternity of MUGEJU presented by the mutualists, both for the initial discharge and for the continuity.

e) Facilitating 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 relevant rules, for the processing of the retirement procedures of mutualists for permanent incapacity for service.

f) Issue the medical reports required by MUGEJU to its beneficiaries for certain or complementary health benefits.

(g) The entity shall also, under the conditions and the arrangements set out in Annex IV, be required to make reports, explorations or tests to the mutualists by the institutions or institutions of its service portfolio. diagnosis specified in that Annex.

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

2.4 Incorporation of new means of diagnosis and treatment. -Any new diagnostic or treatment technique that appears after the signature of the concert will constitute a mandatory means for the entity when it is implanted in the public health network. In case of doubt it will be within the provisions of Royal Decree 63/1995, of January 20, on the Management of Health Benefits of the National System of Health.

2.5 Service Catalog of the entity.

2.5.1 The entity's catalogue of services contains the detailed relationship of the entity's own and concerted (public or private) means, and its purpose is to make it possible to use these means by the beneficiaries.

2.5.2 The service catalogues will be provincial-level and will include:

Portfolio of services by health care levels, broken down by external consultation and hospitalization, as provided for in clauses 2.2.1, 2.2.2, 2.2.3 and 2.2.4, ordered in descending order.

Relationship of emergency services, named hospital centers, optional, named and surnames, grouped by specialties, ambulance service and information service of the entity, with addresses, telephones and working hours.

A comprehensive list of the means of the entity requiring prior authorisation of the institution and which shall be in accordance with Annex III.

In addition to the above mentioned above, it will contain the relation of the information services, emergency services and ambulances corresponding to the other provinces, in order to facilitate their use in case of displacement of the beneficiaries.

2.5.3 The entity shall make its catalogue of services under its responsibility and the first working day of the beginning of the concert shall make available to the Provincial Delegations and Central Services of MUGEJU the number necessary copies for delivery to the persons who request them. Where appropriate, they shall be updated at least once a year by making the necessary number of copies, or addenda to the catalogues, available to MUGEJU on 31 December 1997 and 1998.

2.5.4 If there is any reduction in the service catalogues, the entity is obliged to ensure that patients are treated for serious pathological processes the continuity of the provision of the service with the same optional or until 31 December of the year in which the discharge had been made, provided that there was agreement of the optional or centre.

The casualties will be brought to the attention of the corresponding Provincial Delegations of MUGEJU within 15 working days and, if they reduce a catalogue of services in such a way that the minimum requirements are met In this chapter, the institution shall proceed to complete it at the same time, and shall also communicate to MUGEJU the services, centres or facultives to replace the casualties produced. In addition, if the reduction or changes affect more than 25% of the initial content of the catalogue, the entity is obliged to take the necessary measures to ensure that the holders attached to it are able to dispose of the new catalogues.

In the event that the entity does not comply with the above paragraph, it is required to assume the costs arising from the use by the beneficiaries of the services provided by the institutions and the optional in the last catalog in force.

CHAPTER III

Using the entity media

3.1 General Standard.-The effects provided for in Articles 10.2 of Royal Decree-Law 16/1978 of 7 June, and 63 of the Regulation of the General Judicial Mutual Law, are considered to be the means of the entity are the services, own or agreed, allocated for the health care of the beneficiaries attached to it.

The use of the means of the entity will always be carried out according to the current health regulations.

3.2 Scope of the protective action.

3.2.1 The beneficiaries may use the means of the entity in cases of common or professional illness, in those of injuries arising from accidents, whatever the cause, even if it is an act of terrorism, and pregnancy, childbirth and puerperium, as well as in the preventive actions collected at the concert.

3.3 Territorial scope. The right to the use of the means of the entity may be exercised throughout the national territory, regardless of whether they are themselves or agreed.

3.4 Common Provisions.

3.4.1 Identification.-The condition of the beneficiary must be credited in advance, displaying the corresponding document of affiliation to MUGEJU and, if applicable, the beneficiary. One and the other may be replaced by the individual health care document, issued by MUGEJU in accordance with its own rules.

In the case of maternity assistance to the beneficiaries referred to in clause 1.3 not included in the mutualist beneficiary document, the link or situation shall be credited by displaying the Family Book or any other means of proof admitted in law.

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

3.4.2 Assistance checks.-The checkouts of the assistance checks will be made by the entity and made available to the services of MUGEJU, for delivery to the beneficiaries, at no cost to them. They may also be provided in the offices of the institution.

The payee must deliver the corresponding attendance check when it comes to the entity's media. The use of such cheques shall be made exclusively, for the purposes of non-transferable, by the holder to which they correspond and by the beneficiaries included in their beneficiary document, the data being correctly completed The same is true.

The entity, after communication to MUGEJU, may completely or partially delete the check requirement. In this case, after agreement with MUGEJU, it may replace in whole or in part the system of checks by any other established on magnetic or analog supports.

3.4.3 Additional requirements.-The entity may require in the cases expressly specified in this concert, the additional requirements to be met, such as a prescription and prior authorization. Annex III contains a comprehensive list of the assumptions for the use of the means of the institution which require prior authorisation of the institution.

3.5 Freedom of choice for choice and centre. -beneficiaries will be able to choose freely optional and centre from among those listed in the entity's services catalogues throughout the national territory.

3.6 Health care content.

3.6.1 Assistance in external consultation.-The beneficiary will be directed directly to the chosen optional, primary and specialized care, to receive the assistance that he requires, without further requirement to prove his/her condition and deliver the corresponding attendance check.

3.6.2 Home Care. -In primary care, home care will be provided by primary care healthcare professionals at the patient's home when they are unable to travel, due to their disease, to the external query.

In specialized care, home care by an optional specialist requires the prior written prescription of the primary care physician. In any case, the specialist will inform the physician who requested the interconsultation on the diagnostic and therapeutic orientation of the case.

3.6.3 Urgent assistance. The urgent assistance may be obtained from the medical, pediatric and nursing physicians of the institution and, outside of the hours of consultation and in any case, of the emergency services of primary and specialised care of the entity, own or agreed.

3.6.4 Assistance in hospital treatment. -It will be provided in the institutions of the institution, own or concerted.

A) Requirements:

A hospital admission will require:

(a) The prescription of the same by the entity's physician, with indication of the center.

b) The authorization of the prescription flyer by the entity.

c) The presentation of the authorized steering wheel in the center.

B) Duration of hospitalization.

Hospitalization will persist while, in the opinion of the physician responsible for the care of the patient, there is a need for the patient, without the reasons for this social type.

C) Room type.

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

On an exceptional basis, MUGEJU may authorise the institution to have in its portfolio of hospital services that do not meet the requirement of the previous paragraph.

D) Expenses covered.

The entity covers all expenses incurred during the hospitalization of the patient, from admission to hospital discharge, including:

The performance of the examinations and diagnostic tests, and the application of the therapeutic treatments or procedures that the patient requires, both for the pathology treated and for any other intercurrant other than the the main process that prompted the entry.

The treatment of possible complications that may occur throughout the care process.

Additional treatments that the patient may require, such as: Dialysis, rehabilitation, etc.

Drug treatment, medicinal gases, fungible material, and sanitary products that are accurate.

Cures.

Diet according to prescribed diet.

parenteral and enteral nutrition.

Assistance by specialized medical equipment, nursing and auxiliary health personnel.

Stays in single room, including basic hotel services directly related to the hospitalization itself.

ICU stays.

E) Maternity hospitalization.

At the time of entry, the beneficiary must present at the center the prescription flyer authorized by the entity. In the event of circumstances preventing the presentation of the steering wheel, it must be provided as soon as possible and, in any case, before discharge.

For the purpose of the newborn care, the provisions of clause 1.4.2 shall be taken into account.

If the practice of the tubal ligation was decided at the same time of delivery without having indicated on the steering wheel the expenses caused by this concept will also be in charge of the entity.

F) Hospitalization for pediatric assistance.

Children will be given zero to fourteen years inclusive. In any case, the person accompanying the child shall be entitled to a bed and a companion pension.

When the companion resides in a location other than that of the health center and the characteristics of the nursing units of the center do not permit its lodging, the entity will pay a compensatory amount of 4,500 pesetas per year. day.

G) Home hospitalization.

Home hospitalization may be carried out in cases where the condition of the patient permits and makes it advisable. The indication must be made in writing by the doctor of the entity who comes to him, in the appropriate steering wheel or document. This document will be presented to the institution, so that it will authorize this hospitalization regime and assign the health care team to take care of the assistance.

In all cases of home hospitalization, including hemodialysis at home, the entity is obliged to provide adequate material and human means, including oxygen therapy, and the patient is also responsible for medication until the medical discharge or the pass to the situation of ordinary care home.

3.7 Pharmacy. -The faculty of the entity will prescribe the medicines and other pharmaceutical products, in the terms established in Royal Decree 83/1993, of 22 January, which regulates the selection of the drugs for the purpose of the of its funding by the National Health System, and subsequent developments. The prescriptions must be made in the official recipes of MUGEJU which, in talonaries, will make the headlines.

The acquisition will be made by the beneficiaries at the pharmacy offices, in accordance with the rules established by MUGEJU for their pharmaceutical provision.

If, as a result of the analysis by MUGEJU of the data corresponding to the requirements, certain measures are considered appropriate in relation to the same, the presidency of MUGEJU, after report of the Joint Commission National, may agree that it should be implemented and enforced by the entity.

Medicines qualified as hospital use in the rules of Prosereme 5 of the Directorate General of Pharmacy and Health Products of the Ministry of Health and Consumer Affairs will be provided by the pharmacy services (a) the institution's hospital.

The precise means, elements or pharmaceutical products for performing diagnostic techniques, such as contrast media or other, intrauterine devices (IUD) and insulin syringes will always be in charge of the entity.

3.8 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 alternative is appropriate, the beneficiary may request directly from the existing ambulance service in the locality the transfer of the patient to the emergency department of the entity to which he is assigned.

3.9 Complementary specifications.

3.9.1 Diagnosis and treatment of sterility. -The entity is obliged to assume the necessary expenses to obtain the diagnosis of sterility, which will be extended, where appropriate, to the couple. However, the treatment of the cause of sterility will only reach the spouse if it is a beneficiary included in the corresponding document.

3.9.2 Estomatology and dentistry. -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 justification of the optional specialist, whenever you consider it opportune and the periodontics.

They are excluded, both in terms of their cost and their placement, the fillings, the endodontics, the dental prostheses, the osteointegrated implants and the orthodontics.

However, when a service accident or occupational disease is involved, all treatments and actions, including the necessary dentures, as well as their placement, shall be carried out by the institution.

For periodontics and mouth cleaning, as well as, in case of an accident of service or professional illness, for dental prostheses, it will be necessary to provide a prescription for the optional specialist, together with a budget if The invention relates to a prosthesis for its depreciation by the entity.

3.9.3 Rehabilitation.

(a) The rehabilitation plan must be made by the entity's rehabilitator physician, and must contain:

Assessment of the functional status of the patient and the evolution of the process.

Exercise program.

Professionals responsible for the exercise program: Fiotherapist, foniatra, logopeda.

The number of sessions calculated to end the plan.

b) The rehabilitator physician will, in any case, supervise the patient's evolution and the plan's fulfillment by the assigned professionals, until the moment of discharge.

c) The rehabilitation plan must be submitted to the entity for authorization.

(d) The obligation of the entity shall end when the functional recovery has been achieved fully or as much as possible because it has entered the process into an unsurpassed stabilisation state, or when it becomes maintenance and occupational therapy, except in the case of a process of resharpening.

3.9.4 Psychiatry. -There is a need for psychiatric care including diagnosis, clinical follow-up and psychopharmacotherapy. Psychoanalysis, hypnosis, ambulatory narcolepsy and psychological tests are excluded.

Also, hospitalization is covered in the cases of patients affected by acute or chronic acute processes. If the revenue is produced in a non-concerted centre, the institution shall assume the assistance in accordance with the scale set out in Annex V.

Once the acute or chronic psychiatric processes in charge of the institution have been overcome, the beneficiary may request the economic assistance from MUGEJU, as appropriate, according to its specific regulations.

However, in cases of mental illness resulting from an accident of service or occupational disease, the entity shall bear the total amount of the costs of hospitalization, including chronic and non-limiting processes. temporary.

3.9.5 Plastic surgery. -Excluded cosmetic surgery that does not have a relationship with 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, cosmetic surgery in cases where, even if the lesions have been cured, deformations or mutilations shall be left that cause physical appearance or make the patient's total recovery difficult.

3.9.6 Transplants. Transplants of all kinds, as well as bone grafts, are included in the coverage. Organ procurement and transplantation shall be performed in accordance with the current health legislation, corresponding to the entity assuming all the costs of obtaining and transplantation of the organ or tissue.

3.10 Special Supposition.

(A) Where, by a decision of its own nature and for a given intervention, a beneficiary chooses a non-member of the physician with the institution, he may request that he take charge of the detention at a centre of the institution, 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 up to the fifth degree of kinship, both by consanguinity and by affinity.

B) The entity must authorize the internment, in his capacity, if one of these circumstances is present and if, moreover, the Doctor fulfils the conditions demanded by the center to act professionally in the same one.

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 case of a medical cause justifying it.

D) The entity shall cover the expenses of the internment in the terms of clause 3.6.4.D) with the exception of the doctors ' fees and, in the case of childbirth, Matrona, which shall be on behalf of the beneficiary.

CHAPTER IV

Using non-concerted media

4.1 General rule. -In accordance with Article 66 of the General Judicial Mutual Regulation, in conjunction with clause 3.1 of this concert, when a beneficiary, by his own decision or by his or her (a) family, use non-concerted means with the institution, must pay, without the right to reimbursement, the costs that may be incurred, except in cases of unjustified refusal of assistance and in the case of emergency assistance of a vital nature.

4.2 Unjustified denial of assistance.

4.2.1 In application of the provisions of Article 66 of the General Judicial Mutual Regulation, there is an unjustified refusal of assistance:

A) When the beneficiary does not obtain from the means of the entity an assistance requested subject to the conditions and requirements of this concert and, communicated in writing such circumstance to the entity, it does not offer him, also in writing and before the end of the third working day following the communication, the aid solution at the appropriate level.

In this case, the beneficiary will have the right to have the entity reinstate the expenses incurred. The refund shall be made within 10 working days of the date on which the beneficiary submits to the institution the appropriate written complaint, accompanying the supporting documents for such expenditure.

B) When the media availability requirements of clauses 2.2.1, 2.2.2, 2.2.3, 2.2.4 and 2.2.5 of this concert are not met.

In this case, the beneficiary may refer to the faculty or centers that exist at the appropriate level and, without the need to communicate to the entity the beginning of the assistance received, will have the right to the entity reintegrate the costs incurred. The refund shall be made within ten working days following the date on which the beneficiary submits to the institution the appropriate written complaint, accompanying the supporting documents for such expenditure.

C) When the entity, failing to comply with the obligations set out in the following two paragraphs, does not authorise the referral to an optional or non-concerted centre, without providing alternative assistance with its means own or agreed.

If an optional of the institution prescribes in writing, with exposure of the supporting medical causes, the need to go to an optional or non-concerted centre, the beneficiary must present the cited prescription in the the institution, in order to ensure that it, before the end of the tenth working day following the submission, authorises the referral to the non-agreed optional or centre, or offers a medical alternative with its means.

If the entity authorizes the referral to a non-agreed optional or center, it must authorize and assume the expenses incurred during the entire care process, without exclusions. If they offer their own or concerted means, they must ensure that they take care and can carry out the prescribed diagnostic or therapeutic technique.

In this case of refusal, the beneficiary who uses the other means specified in the prescription presented to the entity shall have the right to the same reintegrate the expenses incurred, equally without the need of inform you of the start of healthcare. The refund shall be made within 10 working days of the date on which the beneficiary submits to the institution the appropriate written complaint, accompanying the supporting documents for such expenditure.

(D) Where in a centre of the institution, in which a beneficiary is entered or who has come to receive assistance, the appropriate means are not available or are not available, according to the discretion of the institution or the The Court of State held that the aid was granted by the beneficiary to the non-concerted centre.

In this case of refusal, the beneficiary shall have the right to have the costs incurred directly by the entity, including those for the shipment. Not accurate

the beneficiary informs the entity of its entry into a non-concerted centre, since the refusal has originated in a centre of the institution itself.

4.2.2 The beneficiary may lodge a complaint with the relevant Provincial Delegation or at the central services of MUGEJU when the entity incurs any of the alleged unjustified refusal of assistance. provided for in the preceding paragraph, or does not reimburse the costs incurred within the time limits referred to in that paragraph.

4.2.3 The acceptance by the entity or, as the case may be, the statement by MUGEJU that there is an unjustified refusal of assistance, does not imply the acceptance or declaration, respectively, that 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 Life-critical urgent assistance.

4.3.1 Concept. -For the purposes set out in Article 66 of the General Judicial Mutual Regulation, it is considered a situation of urgency of a vital nature in that a pathology has occurred whose nature and symptoms (a) make foreseeable or very near vital risk, or irreparable damage to the physical integrity of the person, foreseeable if there is no immediate therapeutic action. To assess the concurrency of this circumstance, account shall be taken of the provisions set out in Annex VI.

The assistance required by the holders and beneficiaries of MUGEJU as a result or in the event of acts committed by persons integrated into organised and armed bands or groups shall be deemed to have been met initially by the parties. the characteristics set out in clause 4.3.1 and that the assistance received, if not used, also initially has the requirement laid down in clause 4.3.2, (A). The beneficiary or other person on his behalf must comply with the requirement set out in clause 4.3.2, B), and the remainder of clause 4.3.

4.3.2 Requirements. -For the beneficiary to be entitled to the reimbursement of expenses for the use of non-agreed means in a situation of vital urgency, the following requirements must be met:

A) That the non-concerted centre to which the patient is directed or transferred is reasonably chosen, taking into account the circumstances of the place and time when the pathology has occurred, as well as the decision-making capacity of the patient and, where appropriate, of the persons who provided the first aid.

B) That the beneficiary or other person on his behalf communicates to the entity, by any means that permits the communication, the assistance received in Emergency or, where appropriate, the hospital admission. The corresponding medical report should also be provided.

4.3.3 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 physician who is providing the assistance, decides to transfer the patient to an appropriate appropriate or appropriate center and the patient or his or her family members responsible refuse to do so.

B) When the patient is transferred to a second non-arranged centre and there are no causes to prevent his transfer to a centre of the institution.

4.3.4 Effects of the communication to the institution. -If the communication to the institution of the assistance received in a non-concerted center is carried out within the period of the fifteen days following the beginning of the assistance, the beneficiary shall be entitled to the full coverage of the costs incurred.

If this is done after the deadline, but before five years have elapsed since the beginning of the assistance, the beneficiary shall be entitled to the reimbursement of the expenses according to the scale shown as Annex V. the entity shall complete the refund within 10 working days of the date on which the beneficiary submits the supporting documents for such expenditure.

The clinical state of unconsciousness of the person concerned, not having relatives close to him or any other similar circumstance will interrupt the computation of the fifteen days foreseen for the communication to the entity.

4.3.5 Obligations of the institution. -When the institution receives the communication from the beneficiary it must reply in writing and within 15 days after receipt of the communication and the medical report, if it accepts the (a) a situation of vital urgency and, therefore, the direct payment or the remover, or, on the other hand, if it is not deemed to be compulsory for payment, because it has not been in a situation of vital urgency.

The absence of an answer within the prescribed period shall in any event entail the obligation of the total drawback entity or by scale, as appropriate.

4.3.6 Claim by the beneficiary. The beneficiary may lodge a complaint with the central services or provincial delegation of MUGEJU concerned when the institution fails to comply with the obligations set out in clause 4.3.5, and in case of discrepancy with the criterion of the entity.

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 10.2 of Royal Decree-Law 16/1978 of 7 June, governing the Social Security of Officials to the Service of the Administration of Justice, and 63 of Royal Decree 3283/1978 of 3 November 1978, for which the MUGEJU Regulation is adopted, has been excluded from the system established by Law 13/1995 of 18 May of Contracts of Public Administrations, in accordance with the provisions of the provided for in Article 3.1 (d) thereof.

5.1.2 They are concert-based relationships:

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 concert.

B) The relationship 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 body of MUGEJU which has the jurisdiction conferred upon it. the procedure, if appropriate, which is determined in this chapter. Against any of the agreements thus dictated, the resources provided for by Royal Decree 1810/1994 of 5 August 1994, for which the procedures of Judicial Mutualism and the Special Fund of MUGEJU are adapted to Law 30/1996, of 26 of November. The competent court shall, where appropriate, be the administrative dispute.

5.1.4 Within the limits and subject to the requirements and effects outlined in the Law on Contracts of Public Administrations, the Presidency of MUGEJU holds the prerogative to interpret the concert, to resolve the doubts to offer its compliance, to amend it for reasons of public interest, to agree on its non-compliance resolution and to determine its effects. The relevant agreements, after instruction in the appropriate file in which the entity is to be heard, shall be immediately executive. Against these agreements, it will be brought to the Court of the Government of MUGEJU, in accordance with the provisions of Article 2 of Royal Decree 1810/1994 of 5 August 1994.

5.1.5 The entity is obliged to provide MUGEJU with the data and checks requested to it about the different services that have been provided to the beneficiaries with their own means or with means agreed by the entity, having a system of information that allows us to know the number and type of services provided.

5.2 Nature and regime of care relations.

5.2.1 The present concert does not imply or cause any relationship between MUGEJU and the faculty or institutions of the entity providing the assistance. The relationship between the entity and the faculty or centers is, 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 purpose of the concert and are configured as autonomous relationships between the parties:

A) The relations of the beneficiaries with the faculty of the entity because it affects or relates to the scope of the professional exercise of such facultative.

B) The relations of the beneficiaries with the institutions of the institution, due to the care activity of those means or the operation of their facilities or for reasons affecting or referring to the scope of the exercise professional of the facultative 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 purposes of the concert even if, by virtue of the links between the faculty and the institutions, they can 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 their content and the knowledge and decision of the questions that may arise in the same will be the competence 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 responsible for the monitoring, analysis and evaluation of the performance of this concert. The Joint Committees shall also be aware of the complaints which may be made by the beneficiaries, in accordance with the provisions of this Chapter, in the light of these effects which the institution's intervention takes place for the same purpose. compliance with the procedure laid down in Article 84 of Law 30/1992, of 26 November, of the Legal Regime of Public Administrations and of the Common Administrative Procedure.

5.3.2 The operating system 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 they refer to the provincial level and the National Joint Commission when they affect the entire territory national.

If these are 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 MUGEJU, of the Provincial Delegate, who shall preside over them, and by an official or collaborator of that Delegation who shall act, in addition, as Secretary; and of the institution, by one or two representatives of the entity with sufficient decision-making powers. A medical adviser 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 within the first ten days of each month. They shall, on an extraordinary basis, 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) If the representatives of the entity do not attend the meetings for three 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 third hearing and in subsequent sessions in which he does not appear.

D) Minutes of each session shall be drawn up by the Secretary, whose project, with his signature, shall be sent immediately to the entity for his/her knowledge, conformity and return once signed by the representative of the same, at which time shall be understood as approved. If there are differences in the content of the minutes, they shall be resolved by means of appropriate arrangements between the two parties and, in any case, at the next meeting.

5.3.6 The National Joint Commission will be composed of three representatives of MUGEJU and three of the entity. The President shall be the President of MUGEJU or a person to whom he delegates and as Secretary shall act an official of MUGEJU, 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).

5.4 Procedure for complaints.

5.4.1 The beneficiaries will be able to claim from MUGEJU that, according to the provisions of clause 5.1, the entity agrees to the origin of any action by the entity:

A) When the entity refuses any of the authorisations specifically referred to in the concert or when it does not respond to the request of the same and, in addition, a positive effect is not foreseen for that absence of reply.

B) When the institution is required to directly assume some expenditure 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 will be told that, due to the lack of competence of MUGEJU, it is not possible to resolve the merits of the complaint, indicating that it may be made, if appropriate, to the doctors, or, where appropriate, the institution itself, in the ordinary court which corresponds according to the nature of the facts.

5.4.2 The complaints will be made in writing to the relevant Provincial Delegation or to the MUGEJU headquarters, accompanying all documents that can justify the complaint.

5.4.3 If the complaint concerns an urgent matter, the Provincial Delegation will be able to immediately take the necessary steps before the entity to obtain the satisfaction of the same, in which case it will be closed without more formalities with annotation of the solution adopted.

5.4.4 In case of non-successful or urgent complaints, 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 will be raised the corresponding record in which 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 If there are discrepancies within the Provincial Joint Committee, the case will be raised for study by the National Joint Commission, and will be included in the agenda of the first meeting to be held. Studied by it, it will resolve the Presidency of MUGEJU.

5.4.7 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 President of MUGEJU, according to clause 5.4.6, this maximum period shall be six months.

5.4.8 The resolutions passed by the provincial delegates and the president of MUGEJU will be notified to the entity and to the interested parties. The decisions of the same may be brought before the Board of Government of MUGEJU, in accordance with Article 2 of Royal Decree 1810/1994 of 5 August, in which the procedures of the Judicial Mutualism are adapted and Special Fund of MUGEJU, to Law 30/1996, of November 26.

5.5 Estimated refund claims execution procedure.

5.5.1 In the reimbursement claims positively resolved by the Provincial Delegates, the execution procedure will be as follows:

(A) The institution shall, within one month of the notification of the decision, proceed to the total or scale reimbursement of the costs claimed, on presentation, where appropriate, of the appropriate supporting documents, which shall, that end and if it has been filed, they shall be returned to the claimant.

B) Within the deadline, the entity shall inform the provincial delegate of MUGEJU:

a) That you made the credit or

(b) The payment has not been made because the data subject has not been submitted, because the payment has not been made for the same reasons or because the payment has not been accepted.

C) If MUGEJU had not received this communication within the indicated period or if, after this period, it was aware that the payment to the person concerned would have been denied, under any other reason, the Provincial Delegate, without further delay. In addition, it will be necessary to ensure that the agreement is reached and that the agreement will be issued and will be sent to the MUGEJU Health Assistance section. It shall also, without further requirements, propose the appropriate agreement to the President and deduct from the immediate need to be paid to the institution and pay directly to the person concerned, on behalf of the person concerned, the amount included in the certification, with an increase of 20 per 100 in terms of penalty to the entity and of reciprocal compensation to the holder for the delay in the refund.

5.5.2 In the case of reimbursement claims made positively by the Provincial Delegation of MUGEJU, prior to the study of the National Joint Commission, the payment of the amount that in each case corresponds will be carried out directly by MUGEJU to the person concerned on behalf of the entity, deducting the amount of the monthly fees to pay to the same and making it easier for the document to prove that you have made the payment on your own account.

5.5.3 Administrative decisions or judgments that resolve actions brought against the acts of MUGEJU in respect of reimbursement of expenses subject to this concert shall be executed, if appropriate, in accordance with the procedure set out in clause 5.5.2.

CHAPTER VI

Duration, price and economic regime of the concert

6.1 Duration of the concert.

6.1.1 The effects of this concert will be started at zero hours on 1 January 1997 and will be extended to 24 hours on 31 December 1997, without prejudice to what is set out in the clauses. next.

6.1.2 For 1998 and 1999, the possible extension, year by year, of the effects of the concert, by mutual agreement of the parties, expressed in writing in the month of October of the year preceding that of the extension, is foreseen. 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 laid down in clause 6.1.1.

6.1.3 If there is no agreement to extend the concert for 1998, the entity will continue to be bound by the content of the concert in 1997, for the collective that it has attached to the 31 December of that year, until 31 January of this year. 1998 or, in cases where an attendance was provided on the date of hospitalization or maternity care when the delivery was scheduled for the month of February, until the day on which the birth of the child was or the end of maternity care.

The entity shall be entitled to receive, for the month of January 1998 and for the collective assigned to 31 December 1997, the price per person/month to be established for the entities that subscribe to the extension of the concert for 1998. However, the amount to be paid for that month MUGEJU will retain a 10 per 100 until 31 December 1998, with the sole purpose of dealing, on behalf of the entity, to the reimbursements of expenses that are agreed during the said year to the amparo of the present concert If the estimated quantity is exhausted or the reimbursements are agreed after the date indicated, the entity is obliged to satisfy them directly and immediately.

The affected collective will have to choose a new entity within the time limit set by MUGEJU and the choice will have effect at zero hours on 1 February 1998, without prejudice, in any case, for the purposes of internments. In the first paragraph of this clause, hospitals and maternity.

6.1.4 How much is available in clause 6.1.3. will be of full application in the case that, extended the concert for 1998, does not extend, however, for 1999, understanding that the references of dates in that contained "The entities that subscribe to the 1998 concert" correspond to that of "the entities that subscribe to the new concert for the year 2000".

6.2 Concert Price.

6.2.1 The price that MUGEJU will pay to the entity for the obligations that it corresponds to under this concert in 1997 will be 4,792 pesetas/person/month.

This amount will be deducted the average expenditure for MUGEJU, in pesetas per person/month, for the orthopedic prostheses paid in the year preceding the total collective assigned to all the contracting entities of the concert in that year, with a percentage increase equal to that experienced by that figure over the previous year.

6.2.2 In each year of the extension of the concert, the determination of the price that MUGEJU will have to satisfy the entity will be carried out on the basis of increase the price paid in the immediate year precedence in the percentage of increase the appropriations for the health policy, included in the general budget of the State of the year in question, shall be recorded in respect of the initial budget for the preceding financial year.

6.2.3 In no case will the price to be paid by MUGEJU be higher than the price to be paid by MUFACE, for the health care concert of the same validity signed by that agency with the entities.

6.3 Economic arrangement of the concert.

6.3.1 Without prejudice to the birth and extinction for beneficiaries of the rights deriving from the concert in the terms provided for in the corresponding clauses, the high ones will cause economic effects at zero hours of day 1 of the month following the month in which they were produced and the casualties within 24 hours of the last day of the month in which they took place. Accordingly, each monthly payment shall take account of the number of holders and beneficiaries existing at zero hours of the day 1 of the month in question and shall be made by MUGEJU by name or bank transfer, within 15 months. the first days of the following month, prior to the holding or the discounts which come under the notice of convocation and the concert, with its annexes.

6.3.2 MUGEJU shall provide the provincial representation of the institution on a monthly basis, before the 16th of the month following the month in which they occur, a copy of the membership documents and the documents of the beneficiaries of the institutions. as a ratio of the number of holders and beneficiaries and the variations produced. It will also deliver MUGEJU, with the liquidation of each month, magnetic tape or relation to the data of all the ups, downs and variations in the previous month, communicating the figure of the total collective attached to the entity, referred to the zero hours of the first day of the month that is liquid.

6.3.3 The tape or relationship may be checked by the entity along with the information provided by MUGEJU, 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.

6.3.4 The entity shall present claims separately, in accordance with the above classification, and shall accompany magnetic tape or relation of the same technical characteristics as that provided by MUGEJU, containing the information on which the claim is based. Complaints must be submitted within three months of the monthly communication of the status of the collective and the relationship of incidents, after which no claim has been made the entity's compliance with the payment made on the basis of that collective. The complaints submitted will be resolved by MUGEJU within three months of the date of filing.

6.3.5 All taxes, arbitrations, fees and levies that are taxed on this concert or the acts that will be derived from it will be on behalf of the entity.

6.3.6 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 institution, 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.

6.3.7 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 subject of the concert, MUGEJU, without prejudice to the execution of the judgment, the amount paid to the relevant concerted entity shall be passed on, in accordance with the procedure under heading 5.5 of this concert.

Second. -Relationship of insurance entities that have signed the concert for the provision of health care to the mutualists and other beneficiaries of MUGEJU during the year 1997, renewable to the years 1998 and 1999:

Adeslas Insurance Company, Limited Company.

"Medical Assistance Collegial Extremena, Sociedad Anonima de Seguros" (AMECESA).

"Assured Islas Canarias de Seguros, Sociedad Anonima" (ASEICA).

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

"Insurance and Reinsurance Health Insurance, Public Limited Liability Company".

"Caser Salud, Compañía de Seguros, Sociedad Anonima".

La Equitable de Madrid.

"La Fuencisla, Sociedad Anonima".

"Previasa, Sociedad Anonima de Seguros y Reinsurance".

"Sanitas, Sociedad Anonima de Seguros".

Madrid, December 18, 1996. -President, Benigno Varela Autran.