In application of the provisions of Articles 19.1 of Law 29/1975 of 27 June on Social Security of Civil Servants of the State, and 75.3 of the General Regulation of Administrative Mutualism, approved by Decree 843/1976, of March 18, this General Mutuality of Civil Servants of the State (MUFACE) signed a concert with the corresponding Social Security Management Entities so that the mutualists and other beneficiaries of the same could receive the provision of health care through the Health Network of Social Security. This concert has an indefinite effect and establishes that health care will be provided in accordance with the conditions in force for the General Social Security Regime.

Under the same precepts mentioned above, and in accordance with the procedure laid down in the second article of the Order of the Ministry for Public Administrations of 21 October 1986 laying down the Rules on the recruitment regime and the assets of MUFACE, this mutual, prior public notice, has also subscribed to a concert with various Health Care Insurance Entities, during the year 1997.

In order to make it possible to choose the holders affiliated with MUFACE of the entity for which they wish to receive healthcare and so that, in case they opt for a Insurance entity, they know the content and the regime of the benefit, this General Address agrees:

First. To publish, as an annex to this resolution, the text of the concert signed for the healthcare of mutualists and other beneficiaries of MUFACE during 1997, with the following entities of Health Care Insurance:

"aegon Insurance Union, Company Anonymous".

"Adeslas Insurance Company, Limited Company".

"Extremendous Collegial Medical Assistance, Insurance Company."

"Assured Canary Islands of Insurance, Company Anonymous".

"Interprovincial Health Insurance Assistance, Limited Company".

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

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

"Safe Swan Clinic, Anonymous Company".

"Groupama Ibérica, Seguros y Reinsurance, Sociedad Anonymous".

"Collegiate Igualatory of Surgical Medical Assistance, Anonymous Insurance Company".

"Colegial Surgical Medical Equal, Anonymous Insurance Company".

"The Equitable of Madrid, Company of Insurance, Company Anonymous".

"Previasa, Sociedad Anonima de Seguros y Reinsurance".

"Gaditana Medical Union, Insurance Company".

Second. To determine that during the month of January 1997, the holders affiliated to MUFACE who so wish may change the entity, through the appropriate application, to be assigned to the National Social Security Institute (Social Security Health Network). or any of the ones listed in the preceding paragraph of this resolution. Holders who do not apply for change shall continue to be assigned to the same entity as they have chosen.

The month of January of each year will be unique for the changes of the ordinary entity, and extraordinary changes can be made only in the specific cases foreseen in the corresponding concerts.

Third. Provide that in the Provincial Services and the Delegated Offices of MUFACE are exposed, at the disposal of the holders who wish to consult them, the Catalogues of Services of the respective province corresponding to the Entities of Insurance of Assistance Concerted health. In those Provincial Services and Delegated Offices, Annex V may also be consulted, in which the scale for reintegrating, which by its technical nature, is not published, can be found.

Madrid, December 19, 1996. -Director General, Ana Maria Pastor Julian.

ANNEX

Concert of the General Mutuality of Civil Servants of the State for the provision of health care to mutualists and other beneficiaries of MUFACE during the year 1997

INDEX

Chapter I: Object of the concert and beneficiaries.

1.1 Object of the concert.

1.2 Beneficiaries in general.

1.3 Maternity Beneficiaries.

1.4 Birth and extinction of beneficiaries ' rights.

1.5 Entity change.

1.6 Mutualists not attached to medical entity.

Chapter II: Means of the entity.

2.1 General rules.

2.2 Healthcare stations.

2.2.1 Health Care Level I.

2.2.2 Level II health care.

2.2.3 Level III health care.

2.2.4 Level IV health care.

2.2.5 Media accessibility guarantee.

2.2.6 Emergency care.

2.3 Complementary benefits.

2.3.1 Oxygenotherapy, ventilation and aerosoltherapy at home.

2.3.2 Orthoprosthetic Prstation.

2.3.3 Transport for healthcare.

2.3.4 Health information and documentation.

2.4 Incorporation of new means of diagnosis and treatment.

2.5 Service Catalog of the entity.

Chapter III: Using the means of the entity.

3.1 General Rule.

3.2 Scope of the protective action.

3.3 Territorial scope.

3.4 Common Provisions.

3.4.1 Identification.

3.4.2 Assistance Checks.

3.4.3 Additional requirements.

3.5 Freedom of choice for Faculty and Center.

3.6 Health care content.

3.6.1 Assistance in external query.

3.6.2 Home Assistance.

3.6.3 Urgent assistance.

3.6.4 Assistance in hospitalization.

a) Requirements.

b) Duration of hospitalization.

c) Room type.

d) Expenses covered.

e) Maternity Hospitalization.

f) Hospitalization for pediatric assistance.

g) Home hospital.

3.7. Pharmacy.

3.8 Direct use of ambulance service.

3.9 Complementary specifications.

3.9.1 Diagnosis and treatment of sterility.

3.9.2 Stomatology and Dentistry.

3.9.3 Rehabilitation.

3.9.4 Psychiatry.

3.9.5 Plastic surgery.

3.9.6 Transplants.

3.10 Special Supposition.

Chapter IV: Use of Unconcerted Media.

4.1 General Rule.

4.2 Unjustified denial of assistance.

4.3 Life-critical urgent assistance.

4.3.1 Concept.

4.3.2 Requirements.

4.3.3 Scope.

4.3.4 Effects of communication to the entity.

4.3.5 Entity obligations.

4.3.6 Claim of the beneficiary.

Chapter V: Legal framework of the concert.

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

5.2 Nature and regime of care relations.

5.3 Mixed Commissions.

5.4 Procedure for complaints.

5.5 Estimated refund claims execution procedure.

Chapter VI: Duration, Price and Economic Regime of the Concert.

6.1 Duration of the concert.

6.2 Concert Price.

6.3 Economic arrangement of the concert.

INTRODUCTION

The right to health protection, enshrined in Article 43 of the Spanish Constitution, is one of the fundamental aspects of the welfare state.

In order to consolidate and advance the achievement of the achievements of the State of Welfare, health systems are oriented towards more flexible formulas that guarantee efficiency and efficiency in the production of health and equity in access to services, along with user satisfaction and a greater approach to the needs of the population and individual preferences.

In order to achieve these objectives it is important to separate the competencies and functions, keeping the State as planner, controller and funder, and leaving to the offer of existing services the provisional function of the same.

This model is the one that inspires and gives rise to the healthcare system of MUFACE, and it is the same one that all analyses and proposals for review are directed to.

MUFACE is responsible for achieving the objectives of improving health and ensuring the quality of services for its beneficiaries, in the framework of the available resources, considering the accessibility of resources This is a fundamental right, which is aimed at equality and equity in the provision of services. This, along with the freedom of choice, constitutes the success of the model.

Furthermore, it is essential to continue to make progress in the equalization and comparability of all the alternatives of provision that can be chosen through the permanent and continuous development of information systems, in order to to have data, on the characteristics of the services provided, to allow comparisons between the different suppliers.

For the reasons set out above, the rules that define the services to be provided by the providers, and the quality indicators that allow the evaluation of the behavior of the providers, should be established. To this end, an instrument for regulating this system is necessary, and the present concert constitutes that instrument.

CHAPTER I

Concert and Payee Object

1.1 Object of the concert.

1.1.1 The purpose of the concert is to provide health care to mutualists and other MUFACE beneficiaries throughout the national territory. This assistance will be provided in accordance with Law No 29/1975 on Social Security of Civil Servants of the State, and Law 14/1986 General of Health, seeking the maximum homogeneity with the benefits provided by the System National of Health. 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 or specific means to provide a comprehensive quality health care or, in the case of 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 and to the same end, MUFACE 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 beneficiaries of healthcare of MUFACE, determined in accordance with their own rules, 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 MUFACE.

1.2.2 For certain purposes of management and provided that the text of the clauses itself is derived, the beneficiaries of the concert may be called the holders, if they have a document of affiliation to MUFACE itself, 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, if any, would hold them as at 31 December 1996 and do not change their entity as provided for in clause 1.5, or according to the rules of membership of the Health Network, 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 MUFACE.

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 been living with them in the same way. the relationship of affectivity to that of the spouse, even if they do not fulfil the status of beneficiaries included in the corresponding document, provided that they are not holders assigned 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 have been assigned to the institution by the services of MUFACE, 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 MUFACE agree to their discharge in the same or in the entity.

1.5 Entity change.

The holders attached to the entity may switch to another of the concerted ones in the following cases:

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

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 MUFACE Directorate-General agrees to the opening of a special period of choice of entity.

1.6 Mutualists not attached to medical entity.

The MUFACE mutualist officer who has not formalized his or her membership of a concerted entity or the Public Health Network, and who, specifying health care for himself or his beneficiaries, requires it in the offices of the entity, will have the right to receive it once it accredits its status as an official of the State Civil Administration.

The entity shall provide the assistance and, within the following five working days, shall notify the facts to MUFACE to proceed to the high 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) Health personnel, whether 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 primary care and emergency services of the Public Health Network are assimilated to the entity's means, 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.

MUFACE, 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 verify the adequacy of the means arranged by the entity to satisfy the requirements established at each level of attendance, it will be taken as a reference as established in the Resolution of 11 April 1980, of the Secretary of State for Health, Ministry of Health and Social Security, for which health care is regulated with means other than the beneficiaries of Social Security.

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 MUFACE 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 MUFACE, may be cause for termination of the concert.

2.1.4 Within each of the Assistant Levels 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 MUFACE will communicate to the signatories of this concert the way in which they will have to provide the necessary information, allowing the integration of the data relating to the provision of services to the beneficiaries of MUFACE, 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) Health Care Level I: 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 at the lower levels.

For the island territories, account shall also be taken of the provisions of Annex II.

2.2.1 Health Care Level I.

Primary Care: For localities from 1,000 to 20,000 inhabitants Primary Care will comprise healthcare at the outpatient, home and emergency level by the general practitioner, paediatrician, nurse or midwife, physiotherapist and dentist.

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 midwife 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 nurse.

Localities from 5,000 to 20,000 inhabitants will also have a paediatrician, matron, physiotherapist and dentist.

Primary Care Services Portfolio.

The Primary Care Services Portfolio 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. Also, the Primary Care of Urgency will be provided, to people of any age, continuously, during the twenty-four hours of the day, through the medical and nursing care, in the outpatient system or in the patient's home.

Criterion.

As a criterion for the provision of this clause, it shall be taken into account that health care at the outpatient, home or emergency level of the general practitioner, paediatrician, nurse or midwife may be replace with the primary and emergency services of the Public Health Network, as provided for in Annex I.

2.2.2 Health Care Level II.

In the 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 services of Specialized Care:

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

Specialist assistance in hospitalization, 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, on-the-go optional, in proportion to the number of beneficiaries in accordance with the criteria used in the National System of Health.

Health Care Level II Specialized Care Services 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.

Servi. Central/Servic. Central

Clinical analysis. /Clinical analysis.

Pathological anatomy.

Pharmacy.

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

Mammography. /Mammography.

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

Emergency/Emergency

2.2.3. Level III of health care.

In the municipalities of more than 75,000 inhabitants, in the cities of Ceuta and Melilla, and in the provincial capitals, they will be provided in addition to the services of Primary Care and Specialized Care provided in the clauses 2.2.1 and 2.2.2, 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, which includes clinical diagnosis and follow-up, outpatient regimen, and hospitalization in acute processes and chronic process resharpening.

Urgent care: Hospital and extra-hospital.

At this level, institutions must have at least two optional, on-the-go optional, in proportion to the number of beneficiaries in accordance with the criteria used in the National System of Health.

Health Care Level III Specialized Care Services Portfolio (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.

Digestive apparatus. /digestive apparatus. /Endoscopy digest.

Cardiology. /Eletrophysiology. /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. /Resp Endoscopy.

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-based hospitality.

TABLE III

Level III specialized care services portfolio

External Queries/Hospitalization

Units

functional/Units

functional/Services/Services

qirurgic Area/Surgical Area

Anesthesiologist. /U. of Awakening.

U. Reanimation.

U. Pain.

Angiology and C. Vascular.

Gral surgery. and Digest. /Gral surgery. and Digest. /laparoscopy.

Maxillofacial Surgery. /Maxillofacial Surgery.

Pediatric Surgery. /Paediatric Surgery.

Vascular Surgery.

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

Ligature of Trompas.

Ophthalmology. /Ophthalmology.

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

Traumatology and C. Orthopaedic. /Traumatology and C. Orthopaedic.

Urology. /Urology. /Litotricia.

Vasectomy.

Endoscopy.

unit C. Intensive. /Adults.

Paediatric.

TABLE IV

Level III specialized care services portfolio

External Queries/Hospitalization

Units

functional/Units

Functional/Services/Services.

S. Central/S. Central

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

Biochemistry.

Pharmacology.

Hematology.

Immunology.

Micobiology.

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 Health Care.

By Autonomous Communities, the entity must have the care facilities shown in Table V. Such services must exist, at least, in each Autonomous Community or, failing that, in an Autonomous Community bordering on to the one in which the beneficiary resides.

Health Care Level IV Specialized Care Services Portfolio (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 Repairing Surgery. /Plastic and Repairing Surgery.

thoracic Surgery. /Thoracic Surgery.

Nuclear Medicine. /Nuclear Medicine.

Neurosurgery. /Neurosurgery. /Stereotaxic Surgery.

Neurophysiology. /Sleep Unit.

High Risk Obstetrics.

radioterapic Oncology. /Cobaltotherapy.

Radiuntherapy and Radiac Isotopes.

Brachytherapy.

Linear Acelator.

Family planning. /Genetic Advice.

Assisted Reproduction Unit. /F.I.V.

Artificial Insemination.

Bank of Semen.

Transplants. /Heart.

Cornea.

Liver.

Bone Marrow.

Pancreas.

Lung.

Kidney.

Burns Unit.

Medular Injured Unit.

Lab. /Genetics.

Cytogenetics.

Molecular Genetics.

Nuclear Medicine.

Radiology. /Digital Angiography.

Gammacamara.

Interventional Radiology.

2.2.5 Media accessibility guarantee.

In case of not having the means that at each level of care requires the Portfolio of Services of the present Concert and whenever this is due to the lack of private health resources or the impossibility to arrange with the Public Health Network, the entity shall provide such means in the locations of the highest immediate level in which they exist. In any case, the appropriate emergency health care shall be ensured at each level.

2.2.6 Emergency care.

Urgency attention shall be provided in accordance with clauses 2.2.1, 2.2.2 and 2.2.3 of this Agreement and according to the following specifications:

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

(b) Levels II and III of Health Care: In addition to the Emergency Care established for the level I of Health Care, the institution must have the Hospital Emergency Services 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 doctors and the personal and material resources necessary for their function.

2.2.7 The entity will facilitate access to the Centers and Services included in the Services Portfolio so that MUFACE 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.

Requires the entity's specialist prescription and presentation to the entity for authorization.

2.3.2 Orthopreprosthetic Prstation.

The entity will be in charge of the fixed surgical prostheses, understanding for those medical devices that need an internal implantation in the patient, through a certain surgical act. They are included. Also, the materials used to perform osteosynthesis techniques.

Oosteintegrated implants for dental prostheses are excluded.

2.3.3 Transport for Health Care.

A) Type of transport: Health transport is understood to be carried out 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 appropriate, for being 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, medicalized aircraft and 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 MUFACE shall be entitled to health transport by the entity, provided that 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 periodic treatments, such as hemodialysis, radiation therapy, rehabilitation, or other treatments referred to in this Concert, from the place where you reside, on a temporary or permanent basis.

Between different levels of Healthcare.

To services located outside a level III locality 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 Level IV Health Care Services, provided that it is outside the residence.

Between different levels of health care, in the event of not having the means required in each one 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 Health Care 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.

The entitles of the entity 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 in a hospital institution or the external consultation report for specialized care.

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, both for the initial discharge and for the continuity, the medical reports of the Parties of Temporary Incapacity, Pregnancy, Delivery or Maternity of MUFACE presented by the mutualists.

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 MUFACE to its beneficiaries for certain or complementary health benefits.

(g) The entity is also obliged, under the conditions and the arrangements set out in Annex IV, to enable the institutions of its portfolio of services to carry out the reports, explorations or tests of the mutualists. 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 signing of the Concert will be mandatory for the entity when it is implemented in the Public Health Network. In case of doubt, the provisions of Royal Decree 63/1995 of 20 January on the Management of Health Benefits of the National Health System will be available.

2.5 Service Catalog of the entity.

2.5.1 The Service Catalog of the entity contains the detailed relationship of the means of the entity, own and concerted (public or private), and its purpose is to enable the use of these means by the beneficiaries.

2.5.2 The Services Catalogues will be provincial-level and will include:

Health Care Levels Services Portfolio, 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 the Emergency Services, named Hospital Centers, with the name, name and surname, 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 Relationship of the Information, Emergency and Ambulance Services for the other provinces, in order to facilitate their use in case of displacement of the beneficiaries.

2.5.3 The entity shall establish under its responsibility its Service Catalogue and the first working day of the beginning of the validity of the Concert shall make available to the Provincial Services and Delegated Offices of MUFACE the number necessary copies for delivery to the persons who request them. Where appropriate, they shall be updated at least once a year, making the necessary number of modified copies available to MUFACE on 31 December 1997 and 1998 or 'addenda' to the Catalogs.

2.5.4 If there is any reduction in the Services Catalogues, the entity is obliged to guarantee patients in the treatment of serious pathological processes, the continuity of the provision of the service with the same optional or Centre until 31 December of the year in which the discharge has occurred, provided that there is conformity of the optional or Centre.

The casualties will be brought to the attention of the corresponding MUFACE Provincial Services within 15 working days and, if they reduce a Service Catalog in such a way that the minimum requirements are not met established in this Chapter, the entity shall complete it simultaneously, and shall also communicate to MUFACE the Services, Centres or Facultals to replace the casualties produced. In addition, if the reduction or changes affect more than 25 per 100 of the original 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 Catalogs.

In the event that the entity does not comply with the above paragraph, it is required to assume the expenses arising from the use by the beneficiaries of the services provided by the Centers and optional in the latest Catalog in force.

CHAPTER III

Using the entity media

3.1 General Rule.

For the purposes of Articles 19.2 of the Social Security Law of Civil Servants of the State and 90.1 of the General Regulation of Administrative Mutualism, the means of the entity are considered to be the own or agreed services allocated for the health care of 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 taken in 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 their own or concerted.

3.4 Common Provisions.

3.4.1 Identification.

The condition of the beneficiary must be credited in advance, displaying the corresponding Affiliate Document to MUFACE and, if applicable, the beneficiary's. One and the other may be replaced by the Individual Health Care Document, issued by MUFACE 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's Beneficiaries ' Document, the link or situation will 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 Provincial Services of MUFACE for delivery to the beneficiaries at no cost to them. They may also be provided at the offices of the entity.

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

The entity, after communication to MUFACE, may completely or partially delete the requirement for checks. In this case, after agreement with MUFACE, 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 stated in this Concert, any additional requirements, such as a prescription flyer 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 of optional and center.

The beneficiaries will be able to choose freely optional and center from among those listed in the service catalogues of the entity throughout the national territory.

3.6 Health care content.

3.6.1 Assistance in external query.

The beneficiary will be directly directed to the optional Primary and Specialized Care, to receive the assistance that he requires, without further requirement to credit his condition and to deliver the corresponding cheque of assistance.

3.6.2 Home Assistance.

In Primary Care, home care will be provided by primary healthcare professionals at the patient's home, when the patient is unable to move, due to his illness, to the outpatient clinic.

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 doctor who requested the interconsultation on the diagnostic and therapeutic orientation of the case.

3.6.3 Urgent assistance.

Urgent assistance may be obtained from the institution's general medical, pediatric and nursing faculty, and outside of the consultation schedules and in any case, the Primary Care Emergency Services and Specialized of the Entity, own or concerted.

3.6.4 Assistance in hospitalization.

It will be provided in the entity's own or concerted centers.

A) Requirements.

A hospital admission will require:

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

b) The authorization of the "flyer" of prescription by the Entity.

c) The presentation of the authorized "flyer" 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, MUFACE 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 in the Center the "flyer" of prescription authorized by the entity. In the case of circumstances which prevent the "steering wheel" from being presented, 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 is decided at the same time of delivery without having indicated in the "steering wheel" of income, the expenses caused by this concept will also be borne by the Entity.

F) Hospitalization for pediatric assistance.

Children will be provided from 0 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 you, in the right hand 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 the treatment. medication until the medical discharge or the pass to the situation of ordinary care home.

3.7 Pharmacy.

The entity's doctors 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 medicines for the purpose of their funding by the National Health System, and further developments. The prescriptions must be made in the official recipes of MUFACE 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 MUFACE for their pharmaceutical provision.

If, as a result of the analysis by MUFACE of the data corresponding to the requirements, certain measures are considered appropriate in relation to the same, the Directorate-General of MUFACE, prior to the Commission's report The National Mixed Party may agree on its implementation and compliance with the Entity.

The medicines qualified as Hospital Use in the standards 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 Hospital in charge of the entity.

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 ambulance service.

In cases of urgency where 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 Ambulances existing in the locality the transfer of the patient to the Emergency Service 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 Stomatology and Dentistry.

It will include 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 specialist, and the periodontics.

They are excluded, both as regards their cost, as well as their placement, the fillings, the endodontics, the dental prostheses, the osteointegrated implants and the orthodontics.

However, when you have an accident of service or professional illness, all treatments and performances, including the necessary dental prostheses, as well as placement, will be carried out by the Entity.

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 authorization by the entity.

3.9.3 Rehabilitation.

(a) The rehabilitation plan shall be made by a rehabilitating physician of the entity, and shall 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 compliance 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.

Psychiatric assistance is covered, 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 Entity 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 Entity have been overcome, the beneficiary will be able to request from MUFACE the economic assistance that is necessary 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.

It is excluded that cosmetic surgery is not related 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, 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 doctor with the institution, he/she may request the institution to 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 detention, in his capacity, if any of those circumstances are present and if, in addition, the physician fulfils the conditions required by the Center to act professionally in the same.

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 costs of the internment in the terms of clause 3.6.4.D), with the exception of the doctors ' fees and, in the case of delivery, matron, which shall be on behalf of the beneficiary.

CHAPTER IV

Using non-concerted media

4.1 General Rule.

In accordance with the provisions of Articles 19 of the Social Security Act of Civil Servants of the State and 90 of the General Regulation of Administrative Mutualism, in conjunction with clause 3.1 of this concert, where a beneficiary, by his own decision or his or her family members, uses means not agreed with the institution, he or she shall pay, without entitlement to reimbursement, any costs incurred, except in cases of unjustified refusal of assistance and in the urgent assistance of a vital nature.

4.2 Unjustified denial of assistance.

4.2.1 In application of the provisions of Article 90.2 of the General Regulation of Administrative Mutualism, unjustified refusal of assistance is produced:

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 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.

C) When the entity, failing to comply with the obligations set out in the following two paragraphs, does not authorize the referral to an optional or non-concerted Center, 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 you offer your own or concerted means, you must ensure that they are in attendance 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 of the shipment. It is not necessary for the beneficiary to inform the Entity of his/her income in a non-concerted place, since the refusal has been originated in a Center of the Entity itself.

4.2.2 The beneficiary may lodge a complaint with the relevant Provincial Service or Delegated Office when the Entity incurs any of the alleged unjustified refusal of assistance provided for in paragraph 1. (a) the Commission shall, in accordance with the procedure laid down in Article 3 (2),

4.2.3 The acceptance by the Entity or, as the case may be, the statement by MUFACE 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 90.3 of the General Regulation of Administrative Mutualism, it is considered a situation of urgency of a vital nature in that a pathology has occurred whose nature and symptoms do the foreseeable or very imminent vital risk, or irreparable damage to the physical integrity of the person, without immediate therapeutic action. It is also considered a situation of emergency of a vital nature the injuries or bodily harm suffered by the officials of the National Police Corps in the exercise of the functions own of the Body or as a consequence or with occasion of acts committed by persons integrated into organised and armed bands or groups.

4.3.2 Requirements.

In order for the beneficiary to be entitled to the reimbursement of expenses for the use of non-concerted means in a situation of vital urgency, the following requirements must be met:

A) That the non-concerted Center to which the patient is directed or transferred is reasonably chosen, taking into account the circumstances of the place and time in which 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 in his/her name communicates to the Entity, by any means that allows to be aware of the communication, the assistance received in Emergency or, where appropriate, the hospital admission. It must also provide the relevant medical report.

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-concerted Center and there are no causes to prevent their transfer to a Center of the Entity.

4.3.4 Effects of communication to the Entity.

If the communication to the Entity of the assistance received in a non-concerted Center is made within the period of the fifteen working days following the start of the assistance, the beneficiary shall be entitled to the total 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 institution shall make 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 Entity Obligations.

When the Entity receives the communication from the beneficiary, it must reply in writing and within 15 days of receipt of the communication and of the medical report, if it accepts the situation of vital urgency and, either the direct payment or the remover, or, on the other hand, if the payment is not deemed to be compulsory, because it does not have a vital emergency situation.

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

4.3.6 Claim of the beneficiary.

The beneficiary may lodge a complaint with the relevant Provincial Service or the corresponding MUFACE Delegated Office when the Entity fails to comply with the obligations provided for in clause 4.3.5, and in the event of a discrepancy. with the criteria 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 19.1 of Law 29/1975 of 27 June on Social Security of Civil Servants of the State, and 75.3 of the General Regulation of Mutualism Administrative, approved by Decree 843/1976, of 18 March, is excluded from the scheme established in Law 13/1995, of 18 May, of Contracts of the Public Administrations, in accordance with the provisions of Article 3.1 (d) of the same, and accommodates the provisions of the second article of the Order of the Ministry for Public Administrations 21 October 1986 laying down rules on the arrangements for the hiring and assets of MUFACE, without prejudice to the application of the principles of the Law on Public Administration Contracts to resolve doubts and gaps that may arise.

5.1.2 They are concert-based relationships:

A) The relations between MUFACE 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 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 body of MUFACE which has the jurisdiction conferred upon it. the procedure, if applicable, which is determined in this Chapter. Against any of the agreements thus issued, an ordinary appeal to the Minister of Public Administration. The competent court shall, where appropriate, always 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 Directorate-General of MUFACE holds the prerogative to interpret the concert, to resolve the doubts that it offers its compliance, amend it for reasons of public interest, agree on its non-compliance resolution and determine the effects of the non-compliance. The corresponding agreements, after instruction of the appropriate file in which the Entity will be given a hearing, shall terminate the administrative route and shall be immediately executive.

5.1.5 The Entity is obliged to provide MUFACE with the data and checks requested of 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 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 to arise between MUFACE and the institutions of the Entity that provide the assistance. The relationships between the Entity and the faculty or the 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 ends of the Concert and are configured as autonomous relations between the parties:

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

B) The relations of the beneficiaries with the Centers of the Entity, because of the care activity of those means or the functioning of their facilities or for reason that affects or relates to the own 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 ends of the Concert, even if, by virtue of the links between the facultative and the Centers and the Entity, 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 Joint committees, with joint membership, have the task of monitoring, analysing and evaluating compliance with this Convention. 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 intervention of the Entity 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 the Law of the Legal Regime of Public and Public Administrations will apply. 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 MUFACE, by the Director of the Provincial Service, who shall preside over them, and by an official of that service, who shall also act as Secretary; and the Entity, by one or two representatives of the Entity with sufficient decision-making powers. The Medical Advisor of the Provincial Service 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 included in the agenda.

C) In the event that the representatives of the Entity do not attend the meetings for three consecutive sessions, it is understood that the entity accepts the agreements that the MUFACE takes 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 lifted by the Secretary, whose project, with his signature, shall be sent immediately to the Entity for 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 following meeting.

5.3.6 The National Joint Commission will be composed of three representatives of MUFACE and three of the Entity. The President shall be the Director of the Department of Basic Benefits or the official in whom he delegates and as Secretary shall act as an official of MUFACE, 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 MUFACE that, according to the provisions of clause 5.1, they agree the origin of any action on the part of the Entity:

E) When the Entity denies any of the authorizations 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 such absence of reply.

F) 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.

G) 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 replied that, due to the incompetence of MUFACE, it is not possible to resolve the merits of the complaint, indicating that it may be formulated, if appropriate, in relation to the medical practitioners. or, if applicable, the Entity 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 corresponding Provincial Service or Delegation of MUFACE, accompanying all documents that can justify the same.

5.4.3 If the complaint concerns an urgent matter, the Provincial Service may 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 non-emergency complaints, the Provincial Service will formalise the appropriate file, it will be included in the agenda of the immediate meeting of the Joint Commission Provincial and studied the same will be raised the corresponding Act in which it will necessarily consist of the positions of MUFACE and the Entity on the claim raised.

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 Director of the corresponding Provincial Service.

5.4.6 In case there are discrepancies within the Provincial Joint Commission, the file will be raised for study by the National Joint Commission and will be included in the agenda of the first meeting to be held. It will be studied by the Directorate-General of MUFACE.

5.4.7 The decisions of the Directors of the Provincial Services referred to in clause 5.4.5 shall be issued within the maximum period of three months. If the resolution corresponds to the MUFACE Directorate-General, according to clause 5.4.6, that maximum period shall be six months.

5.4.8 Resolutions issued by the Directors of the Provincial Services and the Directorate General of MUFACE will be notified to the Entity and to the interested parties. It may be brought against them for ordinary recourse to the Minister of Public Administration, in accordance with Articles 107 to 114 of the Law on the Legal Regime of Public Administrations and the Administrative Procedure. Common, in relation to the article 2. of Royal Decree 1733/1994, of July 29, for which the procedures in matters of Administrative Mutualism are adapted.

5.5 Estimated refund claims execution procedure.

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

H) The Entity shall, within one month of the notification of the decision, proceed to the full or bare reimbursement of the expenses claimed, upon presentation, if any, of the appropriate supporting documents, which, that end and if it has been filed, they shall be returned to the claimant.

I) Within the aforementioned period, the Entity must inform the Provincial Service of MUFACE:

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 MUFACE had not received this communication within the indicated time limit or if, after this deadline, it was aware that the payment to the person concerned would have been refused, on any occasion, the Director of the Provincial Service, without further formalities and provided that there is a concert in force, will issue certification of the adopted agreement and subsequent events and will forward it to the Financial Department of MUFACE. It shall, without further requirements, propose the appropriate agreement to the Directorate-General and deduct from the immediate payment to the Entity 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, positively resolved by the Directorate General of MUFACE, 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 MUFACE to the person concerned on behalf of the Entity, deducting the amount of the monthly fees to pay to it and making it easier for the document to prove that you have made the payment on your own account.

5.5.3 Administrative Resolutions or Statements that resolve actions brought against acts by MUFACE in respect 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 will be extended to 24 hours on 31 December 1997, without prejudice to what is set out in the clauses. following:

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 which it has attached to 31 December of that year, until 31 January of this year. 1998 or in the cases where there was an attendance at the time of hospitalization or maternity care when the delivery was scheduled for the month of February, until the day on which, respectively, the or the end of maternity care.

The entity will 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 MUFACE will retain 10 per 100 until 31 December 1998, with the sole purpose of dealing, on behalf of the Entity, with 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 refunds are agreed after the date indicated, the Entity is obliged to satisfy them directly or immediately.

The affected collective will have to choose new Entity during the time limit set by MUFACE and the choice will have effects at zero hours of day 1 February 1998, without prejudice, in any case, to the expected hospitalizations and maternity in the first paragraph of this clause.

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 is moved the following year and that the appointment of the Entities that sign the extensions of the concert for 1998 corresponds 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 MUFACE will pay to the Entity for its obligations under this concert in 1997 will be 4,792 pesetas/person/month minus "PR", which will be satisfied by the application budget 22.102.412L.251.

By "PR" means the average expenditure for MUFACE, in pesetas per person/month, for the orthopaedic prostheses paid in the year preceding the total collective attached to all the contracting entities of the concert in that year, with a 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 MUFACE 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 previous financial year.

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 one of the month in question and shall be made by MUFACE, by name or bank transfer, within 15 months. the first days of the following month, prior to the retentions or discounts that come in accordance with the Resolution of Convocation and the concert, with its Annexes.

6.3.2 MUFACE, through the appropriate Provincial Service, shall provide monthly to the provincial representation of the Entity, before the 16th of the month following that in which they occur, a copy of the documents of the the membership of the public and of the beneficiaries of the high level, as well as a link between the number of holders and beneficiaries and the variations produced. It will also deliver MUFACE, 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 assigned 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 verified by the Entity along with the information provided directly by the Provincial Services of MUFACE, 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 file claims separately, in accordance with the above classification, and shall accompany magnetic tape or relation of the same technical characteristics as that provided by MUFACE, 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 conformity by the Entity, acquiring firmness the payment made according to that collective. The complaints submitted will be resolved by MUFACE within three months of the date of filing.

6.3.5 All taxes, arbitrations, fees and charges that are taxed in this Concert or the acts that derive from it shall be of account 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 legally or regulatively by public bodies other than MUFACE or by private entities, the Entity, without prejudice to cover in any event the assistance, may be subrogated in 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, will be obliged to provide the Entity with the necessary data.

6.3.7 Whenever there is a firm Judicial Judgment in which MUFACE is ordered to pay compensation, arising from direct or subsidiary liability for assistance actions included in the object of the Concert, MUFACE, without prejudice to the execution of the judgment, it shall have an impact on the amount paid to the corresponding concerted entity, in accordance with the procedure under heading 5.5 of this Concert.

ANNEX I

Support for rural areas

According to this Concerto, the Entity must have certain means of health care throughout the national territory, but in rural areas there is a circumstance that, in general, there are no means (a) private persons who may be able to carry out such assistance under the responsibility of the Entity, since only the National Institute of Health and the Management Bodies of the Health Care of the Autonomous Communities are provided with transfers in this area of competence.

In accordance with the provisions of the General Health Law, 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, reintegrating, 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 mutualists and other beneficiaries attached to the Entity:

First. -MUFACE may agree with the National Institute of Health and the Management Agencies of the Health Care of the Autonomous Communities the provision of the following services to the mutualists and others beneficiaries that the Entity has attached to:

A) Primary healthcare services in populations that do not have sufficient private means.

B) Emergency services in populations of up to 20,000 inhabitants.

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

Second. -The Conventions may be common to all the Entities signatory to the Concert and its amount, known and accepted by the Entity, will be imputed to the same according to the collective affected and satisfied with charge that, once accrued and free, MUFACE must pay you for the present Health Care Concert, understanding the payment on behalf of the Entity.

Third. -MUFACE will make every monthly payment charged to the amount of the same month that must be paid to the Entity by the Concert, transferring the corresponding justification.

Fourth.-The authorization of MUFACE contained in the first point must be understood as ampara also the extension of the Conventions subscribed to the same purpose before 1 January 1997.

ANNEX II

Island Territory

Additional special conditions for the islands of the Balearic and Canarian archipelagos

1.1 The Entity will count on the islands of the Balearic and Canary Islands with sufficient and stable means to provide health care.

In non-capital islands with a population of less than 75,000 inhabitants, the catalogue of services of the Entity shall include the services provided for in Chapter II of this Concert for Levels I and II of Assistance Health. In case of non-existence of such means, the Entity shall guarantee assistance on the nearest island in which it has the same, and must assume the travel expenses.

1.2 Level IV Health Care, if it is not available in the relevant Autonomous Community, will be provided in that Community which is closer to the time of travel.

1.3 The Entity shall assume the costs of posting the beneficiary, the Services of Level III and IV of Health Care and in the event of non-existence of means provided for in Point 1.1 above, in the specified means in clause 2.3.3 (A) or (B), as the case may be, on the basis of a written prescription from the Entity.

For such purposes, the Entity shall immediately pay, upon presentation by the beneficiary of the Report of the Optional Who has provided the assistance, with an indication of the assistance practiced and the date on which it was made or, in case of detention, of the initial and final dates, and the invoice of expenditure.

In case the patient needs accompanying, the travel expenses of the companion will be in charge of the Entity. To this end, it must be brought before the Entity's Report of the optional assistance in which the need is justified.

ANNEX III

Relationship of Entity services that require prior authorization of the same

1. Queries and hospitalizations:

a) Hospitalization.

b) Home hospitalization.

c) Outpatient surgery.

2. Diagnostic techniques, treatments and surgical techniques:

a) Odontostomatology: Tartrectomy (mouth cleaning) and Periodontics.

b) Rehabilitation: All techniques.

c) Oxygenotherapy, ventilation and aerosoltherapy at home.

d) Peritoneal dialysis and hemodialysis treatments.

e) Oncology: Immunotherapy and Chemotherapy.

f) Diagnostic by image: Computed Axial Tomography, Magnetic Resonance Imaging, Spelling and Mammography.

g) Treatment in Pain Unit.

h) Treatment in Sleep Unit.

i) All services corresponding to Level IV of Health Care.

j) Renal Litotricia

3. Transport for Health Care:

a) Transportation in extraordinary means.

b) Transport in ordinary media:

For periodic treatments.

To services of Level IV of Health Care outside the locality of residence.

ANNEX IV

Reports, scans, or tests prescribed by the disability assessment bodies

the entity, in accordance with clause 2.3.4.g) of the Concert, shall facilitate the performance of medical reports, examinations or diagnostic tests which prescribe to MUFACE mutualists the facultative of the organs of the assessment of disabilities under the retirement procedure for permanent disability for the service regulated in the Resolution of the Secretariat of State for Public Administration of 29 December 1995 and consistent rules, to which (a) an end to the obligation to make the mutualists attached to it the said reports; scans or tests through the faculty, services or centers of your Services Portfolio and in the form set forth in the First Point.

For your part and for the same purpose, MUFACE is obliged to pay each Entity the price indicated in the second point, within the period also provided for in that point.

First.-The mutualist to whom the performance of a performance of those indicated in the preceding paragraph is prescribed shall present the form in which the prescription has been made in its Provincial Service or delegated Office of MUFACE for the relevant authorisation.

The Provincial Service or Delegate Office, once the applicant's affiliation has been checked, will authorize the prescription by stamping on the form the stamp model shown in the third point.

The mutualist will then present the same form in the Offices of the Entity to which it is attached. It is, in the light of the authorisation granted by MUFACE:

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

B) In the original of the form authorised by MUFACE, the person receiving the receipt by the mutualist of the flyers or the flyers shall be sent under the formula set out in the third paragraph 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 the latter.

C) A photocopy of the form will be delivered to the mutualist.

Second. -At the end of each calendar quarter, the Entity shall transmit to the Financial Department of MUFACE the ratio of the reports, explorations or tests carried out in the quarter, with an express indication of the corresponding price, which will be, precisely, the one listed in Annex V of this Concerto. 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 the first subparagraph.

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

Third. The following models will be used for the application of the first point:

(MODEL OMITTED)

Note. The signature may be included in the stamp.

B) Formula for crediting the receipt of flyers by the Entity:

I received from the Entity

the precise documents to carry out the actions prescribed in this form.

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The mutualist,

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

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