Statussen in snapshot voor premiejaar 2019 Used contract: Not - PowerPoint PPT Presentation

INFOSS Statussen snapshot (UC15) Leen Van Looveren 05/05/2020 1

Definities – herhaling (UC02) Used contract: contract on which the NIHDI premium will be transferred if nothing would change before the payment day Valid contract: a contract which could be used for payment if linked to a premium request. A contract is valid if the contract: • Is not deleted • Is active at least 1 day (the contract must have a start date on or before 31/12 of the current year -1) • Can be closed • Can be suspended 2

Statussen in snapshot voor premiejaar 2019 • Used contract: – Not used – Used • Request Status – NotApplicable : During the premium year, this state means no premium request has been initiated on this contract for a HCW. As a consequence, no request status is applicable. – PremiumYearInitiating : During the premium year, this state means no decision has been taken yet regarding the premium request on this contract for a HCW. – DecisionPremiumRefused : this decision means that a premium request was initiated for the HCW during the premium process, but that the HCW did not qualify for the premium. No amount is to be payed. – ReadyForPayment : this decision means that the HCW qualifies for the premium. The premium amount will be put in payment. • PaymentDone : this state is set once NIHDI has done the payment. • PaymentFailed : this state is set should the payment have failed (closed account, e.g.). After the situation has been sorted out, the payment will be reissued and the state will be set to ReadyForPayment. 3

Koppeling contract aan premiejaar 2019 door het Riziv begin mei • One valid contract for a HCW – This will be the used contract. • More than one valid contract for a HCW – the contract of the insurer or pension fund that received last year the payment will be the used contract • If the insurer of pension fund sent only one contract • Used contract: – Not used – Used • Request Status – NotApplicable : During the premium year, this state means no premium request has been initiated on this contract for a HCW. As a consequence, no request status is applicable. – PremiumYearInitiating : During the premium year, this state means no decision has been taken yet regarding the premium request on this contract for a HCW. – DecisionPremiumRefused : this decision means that a premium request was initiated for the HCW during the premium process, but that the HCW did not qualify for the premium. No amount is to be payed. – ReadyForPayment : this decision means that the HCW qualifies for the premium. The premium amount will be put in payment. • PaymentDone : this state is set once NIHDI has done the payment. • PaymentFailed : this state is set should the payment have failed (closed account, e.g.). After the situation has been sorted out, the payment will be reissued and the state will be set to ReadyForPayment. 4

Acties door de verzekeraar in de loop van de maand mei • Een gekoppeld contract aan premiejaar 2019 wordt ontkoppeld – Bij schorsen – Bij verwijderen – Bij wijzigen van begin- of einddatum zodat er geen overlap meer is met het premiejaar • Een niet-gekoppeld contract aan premiejaar 2019 wordt niet automatisch gekoppeld – Bij insturen nieuw contract – Bij wijzigen van een niet-gekoppeld contract • Used contract: Not used • Request Status: NotApplicable • Een gekoppeld contract aan premiejaar 2019 blijft gekoppeld ➢ Bij andere wijzigingen ➢ Wijziging begin- of einddatum met behoud van een overlap met het premiejaar ➢ Wijzigen gestructureerd bericht ➢ … • Used contract: Used • Request Status: PremiumYearInitiating

Koppeling contracten aan premiejaar 2019 door het Riziv begin juni Enkel voor de zorgverlener die nog géén gekoppeld contract heeft voor 2019 • Zelfde regels als begin mei: – One valid contract for a HCW • This will be the used contract. – More than one valid contract for a HCW • the contract of the insurer or pension fund that received last year the payment will be the used contract • If the insurer of pension fund sent only one contract • Snapshot-status voor premiejaar 2019: • Used contract: Used • Request Status: PremiumYearInitiating 6

Acties door de verzekeraar in de loop van de maand juni • Wijzigen van gekoppeld contract aan premiejaar 2019 (schorsen, verwijderen, wijzigen van begin- of einddatum , …): ➢ Contract blijft gekoppeld • Used contract: Used • Request Status: PremiumYearInitiating • Insturen nieuw contract of wijzigen van niet-gekoppeld contract voor premiejaar 2019: ➢ Geen automatische koppeling aan premiejaar 2019 • Used contract: Not used • Request Status: NotApplicable

Acties door de zorgverlener in de loop van de maand juni • Een niet-gekoppeld geldig contract koppelen aan het premiejaar 2019 • Used contract: Used • Request Status: PremiumYearInitiating • Een gekoppeld contract ontkoppelen van het premiejaar 2019 • Used contract: Not used • Request Status: NotApplicable

Koppeling contracten aan premiejaar 2019 door het Riziv op 30 juni Enkel voor de zorgverlener die géén gekoppeld contract heeft voor 2019 • Zelfde regels als begin mei en juni – One valid contract for a HCW • This will be the used contract. – More than one valid contract for a HCW • the contract of the insurer or pension fund that received last year the payment will be the used contract • If the insurer of pension fund sent only one contract • Snapshot-status voor premiejaar 2019: • Used contract: Used • Request Status: PremiumYearInitiating 9

Acties door de verzekeraar tussen juli en eind december • Wijzigen van gekoppeld contract aan premiejaar 2019 (schorsen, verwijderen, wijzigen van begin- of einddatum , …): ➢ Contract blijft gekoppeld • Used contract: Used • Request Status: PremiumYearInitiating • Insturen nieuw contract of wijzigen van niet-gekoppeld contract voor premiejaar 2019: ➢ Geen automatische koppeling aan premiejaar 2019 • Used contract: Not used • Request Status: NotApplicable

Acties door de zorgverlener tussen juli en eind september • Een niet-gekoppeld geldig contract koppelen een het premiejaar 2019 • Used contract: Used • Request Status: PremiumYearInitiating • Een gekoppeld contract ontkoppelen van het premiejaar 2019 • Used contract: Not used • Request Status: NotApplicable

Beslissing premie social statuut 2019 door het Riziv tussen oktober en januari • Toekenning premie social statuut 2019 ➢ De premie zal worden uitbetaald • Used contract: – Not used – Used • Request Status – NotApplicable : During the premium year, this state means no premium request has been initiated on this contract for a HCW. As a consequence, no request status is applicable. – PremiumYearInitiating : During the premium year, this state means no decision has been taken yet regarding the premium request on this contract for a HCW. – DecisionPremiumRefused : this decision means that a premium request was initiated for the HCW during the premium process, but that the HCW did not qualify for the premium. No amount is to be payed. – ReadyForPayment : this decision means that the HCW qualifies for the premium. The premium amount will be put in payment. • PaymentDone : this state is set once NIHDI has done the payment. • PaymentFailed : this state is set should the payment have failed (closed account, e.g.). After the situation has been sorted out, the payment will be reissued and the state will be set to ReadyForPayment. 12

Beslissing premie social statuut 2019 door het Riziv tussen oktober en januari • Toekenning premie social statuut 2019 ➢ De premie werd uitbetaald • Used contract: – Not used – Used • Request Status – NotApplicable : During the premium year, this state means no premium request has been initiated on this contract for a HCW. As a consequence, no request status is applicable. – PremiumYearInitiating : During the premium year, this state means no decision has been taken yet regarding the premium request on this contract for a HCW. – DecisionPremiumRefused : this decision means that a premium request was initiated for the HCW during the premium process, but that the HCW did not qualify for the premium. No amount is to be payed. – ReadyForPayment : this decision means that the HCW qualifies for the premium. The premium amount will be put in payment. • PaymentDone : this state is set once NIHDI has done the payment. • PaymentFailed : this state is set should the payment have failed (closed account, e.g.). After the situation has been sorted out, the payment will be reissued and the state will be set to ReadyForPayment. 13