Advanced Search

Resolution Of December 19, 2012, Of The Judicial General Mutual, Why Certain Socio-Health And Complementary Aids Shall Be Deleted And Your Requirements And Amounts Are Modified.

Original Language Title: Resolución de 19 de diciembre de 2012, de la Mutualidad General Judicial, por la que se suprimen determinadas ayudas socio-sanitarias y complementarias y se modifican sus requisitos y cuantías.

Subscribe to a Global-Regulation Premium Membership Today!

Key Benefits:

Subscribe Now for only USD$40 per month.

TEXT

The Royal Decree-Law 20/2012 of 13 July 2012 on measures to guarantee budgetary stability and to promote competitiveness, establishes the implementation of structural reforms in public administrations through a A range of measures which must be jointly operated as a fundamental instrument of economic policy in such a way as to improve their functioning by bringing it more effectively into line with the current situation, while maintaining the quality of the service provided to the citizen.

The limitation of the budgetary availability of the public administrations imposed by the current economic situation imposes on the basis of the principle of solidarity that must prevail in all the Public administrations-the inevitable need to adopt measures to reduce spending by this General Judicial Mutual Fund, even though they are aware that some of them will be a sacrifice of special intensity for those who perceive remuneration from public resources.

On the basis of such premises, the General Judicial Mutuality is obliged to modify the current regime of certain social and complementary aids that it grants to its collective by suppressing those that, not estimated substantial, neither in terms of their social character nor in terms of their size, if they represent an important reduction in expenditure and make it possible to maintain-with minimum modifications-other aid of a priority nature.

The aim being pursued is therefore to ensure those other benefits that are essential for affecting situations of particular need of the mutualists.

Consequently, the following capabilities and aids are deleted:

(a) Aid for the transport and stay of the patient's companion in practice has proved to be a benefit which, without satisfying collective needs, has been considered to be a residual one, and the cost of which is at the level of management it was disproportionate to the extent to which the mutualists were minimally assisted.

b) The HPV vaccination aid that has ceased to have a medical and legal justification since the Autonomous Communities have been incorporating this vaccine into their different official calendars generally at the age of 14 years, because it obtains its maximum effectiveness in pediatric age when the HPV infection is associated with age, in relation to sexual behavior. In such circumstances, their funding outside the assumptions and periods covered by the autonomic vaccination schedule is not justified.

(c) The support of the standing orthesis, which is homogeated with the other Mutualities of officials and the orthoprosthetic catalogues of the Autonomous Communities, in which it lacks coverage.

d) Economic aid for refractive surgery, a treatment whose price has been declining substantially in recent years, thus losing its justification of origin.

e) The relief from discharge dental ferrule that is homogeated with the other Mutualities of officials and the orthoprosthetic catalogues of the Autonomous Communities, in which it lacks coverage.

The modification of the scheme of certain benefits affects the amounts of financial aid for dental and ophthalmological services which have to be adjusted, taking into account the aid granted in other Member States. Mutual funds of officials, prioritizing and reordering the benefits according to the actual needs of the collective, updating the amounts of the aid in accordance with the current costs of the treatments and the financial sufficiency.

Article 14 of Royal Decree 1206/2006, of 20 October, which regulates the composition and functioning of the governing bodies, administration and representation of the General Judicial Mutuality, attributes to the management the management and management powers of the Mutuality, in order to meet its objectives.

Article 6.2 of the same legal text allows the Management of the General Judicial Mutuality, when it is required by special circumstances, to adapt the implementation of the annual Plan of Action and the approved budget for the financial year, implementing alternatives and determined the appropriate means and procedures for their compliance.

Because of the above, this Management in use of the powers granted to it by Royal Decree 1206/2006, of October 20, already mentioned and after informing the Permanent Commission, as provided by article 12.1 ,f) of the same norm, agrees:

1. Delete the following socio-sanitary aids with effect from 1 January 2013:

-Campaign for vaccination against the papilloma virus initiated on 01/01/2009, completed by the instruction of the judicial general mutual, of 17 January 2011, which regulates the extension of the preventive program of vaccination against the human papilloma virus to some beneficiaries resident in the Catalan community born in 1996.

-Aid for transport/stay, complementary to the health care contained in the Resolution of 31/03/2009 of the Management of the Judicial General Mutuality ("BOE" of 14/04/2009).

2. Delete the following dental and ophthalmological aids, with effect from 1 January 2013:

-Economic aid for refractive surgery, regulated in point 5.1 of the resolution of 27/12/2007, of the Management of the Judicial General Mutuality ("BOE" of 18/01/2008), for which the circular number 73 of the Mutual legal mutual assistance, in relation to financial support for dental, ophthalmological and other supplementary benefits.

-Aid for discharge dental ferrule, regulated in the first point of the Resolution of the Management of the Judicial General Mutual Law of 07/07/2008 ("BOE" of 21/07/2008), for which the provision of the dental service is complemented (Resolution of 27/12/2007, "BOE" of 18/01/2008) and the Catalogue of orthoprosthetic material of the Judicial General Mutuality. (Resolution of 6/05/2008, "BOE" of 23/05/2008).

-Orthesis of the foot, regulated by the Resolution of the Management of the General Judicial Mutuality of 07/07/2008 ("BOE" of 21/07/2008), for which the Catalogue of orthoprosthetic material of the General Judicial Mutuality is complemented (Resolution of 6/05/2008, "BOE" of 23/05/2008).

3. To modify the economic aid for supplementary, dental and ophthalmological benefits contained in the Resolution of 27/12/2007, of the Management of the Judicial General Mutuality ("BOE" of 18/01/2008), the amounts, requirements and periods of absence as set out below are set out below:

I. Complementary health benefits:

1. General requirements:

1.1 Model and place of the request. The application for the benefit shall be completed by completing the application form for the support of prostheses, which can be found on the website of the mutual "www.mugeju.es".

The application, accompanied by the documents that are required in each case, as indicated in point 2. º, must be presented in the Central Services of the Judicial General Mutuality (Marques del Duero street, 7, 28001 Madrid), or the Provincial Delegation concerned.

1.2 Documents to accompany the request. The application form must be accompanied by: 1) original invoices containing all legal requirements for their validity as such; 2) medical reports supporting the requirements for each aid.

2. Dental capabilities:

2.1 Cuantia and lack periods:

dental device (top and bottom, 28-piece)

500,00 €

3 years.

250,00 €

3 years.

Dentary pieces (maximum of 14 without control of the situation)

35.00 € c/u

3 calendar years.

Emppaste, shutter (maximum of 14 no control Situation) Excluded under 15 years under Medical Entities

20,00 € c/u

3 years

1/part

50,00 € c/u

1 time in life.

Implant (maximum of 14 without situation control)

150.00 €

3 years

Orthodontics (only those started before 18 years)

500,00 €

Once in a lifetime

Tartrectomy cleaning of the mouth

18.00 €

1 calendar year.

Periodontics (only attached to INSS)

$600

2 calendar years

2.2 Requirements and conditions for granting:

This help is configured as an invoice-based expense refund, with the limit of the amount set in the table above.

In no case will the aid be higher than the cost paid by the mutualist.

The dental benefits included in the Concerts between the General Judicial Mutuality and the health care providers (Social Security or private entities), will not be able to give rise to the established aid in this Resolution. Therefore, the actions to be included in the Health Plan of the National Health System as a whole will be excluded from the scale of economic aid for dental, ophthalmological and other health benefits. This is a mutual respect. Also, benefits that will be covered in the future by health care concerts with insurers will be excluded.

Provisional pieces, castings, and fillings will not be the cause of economic aid.

When the optional justifies the performance of an endodontic, you must specify whether or not you have made fillings. If not indicated, no amount will be paid for this.

Orthodontic treatment, only if it has been started before the age of 18, will be granted for once in a lifetime, with the possibility of partial payments up to the legal maximum of 500 euros.

For the calculation of the benefits granted, the date of the corresponding invoice will be taken into account.

3. Eye performance:

3.1 Cuantia and lack periods:

(away or near)

40.00 €.

2 calendar years.

bifocal glasses (far and near)

70.00 €.

2 calendar years

Crystal (away or near)

15.00 € c/u.

2 calendar years

bifocal

30 € c/u.

2 years natural.

Lintillas (two units/calendar year)

33 €/unit

1calendar year.

disposable Lins (annual help)

66 €/ year

1 calendar year

Lente

62.00 € c/u

-

-vision technical aids (telelupa glasses, magnifiers, microscopes, filters.)

180 €

1 calendar year

3.2 Requirements and conditions for granting:

This help is configured as an invoice-based expense refund, with the limit of the amount set in the table above. In no case shall the aid be higher than the cost paid by the mutualist.

In the case of the lentices, maximum two lentices per beneficiary and calendar year shall be granted, even if the maximum eligible amount is not exceeded. For disposable lentices (benefit incompatible with lentices), maximum aid is granted for this concept per beneficiary per calendar year of 66 euros, and should be requested at one time. Therefore, the maximum annual aid for both concepts (lentices and disposable lentices) will be EUR 66. These limitations will not govern therapeutic lenses.

The bifocal/multifocal glasses will only be paid as such when both the distance and near graduation are credited.

Low Vision is understood to be those people who, even after medical treatment and/or common optical correction, have a vision of 0.3 (3/10) in the best eye or a visual field less than 10 ° from the fixation point. In the case of optical aid for low vision it will require a report of an optional Ophthalmology specialist to accredit that circumstance, and only a maximum of 180 euros per calendar year and beneficiary will be awarded.

In the case of prismatic aid, it will be required to report the optional specialist in Ophthalmology which accredits the corresponding alteration of the ocular motility, and will be awarded a maximum of 180 euros per calendar year and beneficiary.

II. Other supplementary benefits:

Headphone

-

425 € /u

2 calendar years.

Headphone repair

210 €/u

2 calendar years.

antiesfaces

125 €

2 years natural.

Laringophone

100%

-

100%

-

1. Requirements and conditions for granting:

This help is configured as an invoice-based expense refund, with the limit of the amount set in the table above. In no case shall the aid be higher than the cost paid by the mutualist.

The renovation and repair of hearing aids will have a period of lack of two natural years. Repair aid shall not affect the renewal time-limits shall not be paid in respect of any warranty period.

The hearing aid, as provided for in this Annex, will be incompatible with the hearing aid provided in the MUGEJU Catalogue of Orthopaedic Material.

For the calculation of the benefits granted, the date of the corresponding invoice will be taken into account.

Transitional disposition.

Applications that have had a date of entry into the registry of this General Judicial Mutuality until December 31, 2012, shall be processed in accordance with the regulations in force on that date.

Repeal provision.

Repealed:

The Resolution of the Management of the Judicial General Mutuality of 27/12/2007 ("BOE" of 18/01/2008).

The Resolution of the Management of the Judicial General Mutuality of 07/07/2008 ("BOE" of 21/07/2008).

Final disposition.

This Resolution shall enter into force on 1 January 2013.

Madrid, December 19, 2012.-The Manager of the General Judicial Mutuality, Celima Gallego Alonso.