the taking charge for reimbursement of medical transport costs by the health insurance organization

May 13, 2020

medical transport


 the conditions, the methods of taking charge and the tariffs for reimbursement of medical transport costs by the health insurance organization :


Provisions apply to socially insured persons and those with their rights who suffer from chronic diseases such as the necessity of conducting dialysis in specialized centers, and when necessary their companions.

- - The costs of medical transportation for insured social patients can only be reimbursed if this medical transportation has been subject to a medical prescription.
The medical prescription must specify the type of medical transport to be used with regard to the patient's state of health and / or the care required.
However, prior medical prescription is not required when the patient is transported in the context of the medical emergency observed.

- - The costs of medical transport can give rise to reimbursement only if the patient calls upon a medical transport operator having satisfied the administrative, technical and medical conditions provided for in the matter.
- - The basic rate for reimbursement of services offered by medical transport operators is determined according to the category of vehicle used and the distance traveled.
- - The basic tariff for reimbursement of medical transport costs per kilometer traveled is fixed as follows:

- For transport by spécial medical ambulance:

* 27 DA: from the 1st to the 100th kilometer;
* 19 DA: from the 101st kilometer.

- For transport by medical ambulance:

* 18 DA: from the 1st to the 100th kilometer;
* 13.50 DA: from the 101st kilometer.

- For transport by light medical vehicle:

* 12 DA: from the 1st to the 100th kilometer;
* 9 DA: from the 101st kilometer.
- - The technical standards, medical equipment as well as the personnel assigned to the vehicles provided for in article 5 above are fixed by interministerial decree of the minister in charge of social security and the minister in charge of health.
- - The medical transport costs reimbursable under the conditions provided for in article 5 above apply to the journey consisting of the distance traveled between the patient's home or the place where he is taken care of and the nearest care structure , providing him with the care necessary for his state of health and / or vice versa.
- - In addition to the reimbursement of medical transport costs for the journey provided for in article 7 above, the nearest medical transport operator is granted a lump sum intended to compensate for the journey made up by the distance between the operator's headquarters and the patient's home or place of care, set as follows:
- 100 DA: less than 20 kilometers traveled;
- 200 DA: from 20 to 50 kilometers traveled;
- 300 DA: from 51 to 100 kilometers traveled;
- 150 DA: for every 50 kilometers beyond 100 kilometers traveled.
- - In the event that there is an absolute need to immobilize the vehicle at the level of the structure of
care due to the waiting of the patient (s), it is reimbursed 25 DA per quarter of an hour.
- - The reimbursement rates mentioned in the above articles are increased by 25% in the event of intervention at night or on a public holiday.
medical transport
The night surcharge applies from twenty-one (21) hours to five (5) hours.
There is only one increase when the intervention takes place on the night of a public holiday.
- - In the event of simultaneous medical transport of two patients in a light medical vehicle, the
reimbursement of medical transport costs is calculated under the conditions provided for in articles 5 to 10 above.
These costs are calculated at the rate of 100% for the first patient and reduced by 50% for the second patient.
- - The reimbursement of transport costs by any other means than those provided for in the provisions of this decree is effected according to the tariffs in use in the matter, in accordance with the regulations in force and on presentation of supporting documents, if applicable.
- - Medical transport costs are reimbursed upon presentation of an invoice, established by
The medical transport operator, accompanied by a certificate of treatment performed or any other document issued by the treatment structure concerned.
Medical transport costs also cover emergency acts carried out on board in the case of transport by ambulance.
- - The simultaneous medical transport provided for in the above article gives rise to the establishment, by
The medical transport operator, an invoice mentioning the simultaneous medical transport.
- - For the implementation of the provisions of this decree, social security organizations
establish conventions with medical transport operators, in accordance with the standard convention annexed.

CONVENTION OBJECT

Article 1. - The purpose of this agreement is to specify the methods of covering health transport costs by health insurance organizations and to fix the conditions under which transport by the health transport operator of social insured persons, their beneficiaries -right and, where applicable, their companions, when this mode of transport is required by the patient's state of health and prescribed medically, in application of the provisions of the decree fixing the conditions, the terms of care and the prices reimbursement of medical transport costs by health insurance organizations.

CHAPTER II

OBLIGATIONS OF THE SANITARY TRANSPORT OPERATOR

Art. 2. —The medical transport operator undertakes to:
- meet the administrative, technical and medical conditions provided for in this area;
- guarantee on board any medical vehicle in service the presence of health personnel, in accordance with the rules and customs in the matter;
- ensure availability so as to guarantee night and day service, as well as public holidays;
- ensuring comfort for the patient being transported;
- treat the patient with respect, consideration and good care;
- take the shortest and most convenient route when the patient is on board;
- respect the patient's appointment schedule.
Art. 3. — The medical transport operator must provide a file comprising the following documents:
- a copy of any document justifying the exercise of the medical transport activity;
- a document justifying the existence of the headquarters of the medical transport operator (ownership or lease) ;
- a technical sheet indicating the human and material resources used, accompanied by copies of the diplomas of the medical and / or paramedical staff;
- a copy of the vehicle registration cards as well as the technical control certificates of conformity concerning the vehicles;
- a copy of the vehicle all-risk insurance certificate;
- a certificate of updating of contributions issued by the national social security fund for the self-employed;
- a certificate of affiliation and updating issued by the national fund for the collection of social security contributions.
The medical transport operator must inform the social security organization of any change
intervening in his administrative situation, and this, within a maximum period of thirty (30) days.


CHAPTER III

PATIENT RIGHTS

Art. 4. — The insured person has the right to appeal to the medical transport operator of his choice.
The health insurance organization refrains from any intervention in this choice.


CHAPTER IV

TAKE-OVER PROCEDURES

Art. 5. - The services provided by the medical transport operator can only be covered if medical transport is medically prescribed.
The medical prescription must specify the type of medical transport to be used with regard to the patient's state of health and / or the care required.
However, prior medical prescription is not required when the patient is transported as part of the medical emergency noted.
The cost of medical transportation is subject to the prior agreement of the health insurance except in emergencies.
The insured person must submit to the social security organization to which he belongs, a request for cover established according to the form, the model of which is attached to this agreement, accompanied by the medical prescription for medical transport.
The aforementioned request form must mention the response of the health insurance organization and, if agreed, it specifies the benefits, the frequency and the rate of coverage.
Art. 6. - The reimbursement prices applicable to medical transport carried out by the medical transport operator are those fixed by the regulations in force.
The path to be taken care of consists of the distance between the patient's home or the place where he is taken in charge and the nearest care structure providing the care required by his state of health and / or vice versa.
In the event that the socially insured patient chooses to be transported to a care structure other than the nearest care structure, the additional transport costs resulting from this choice remain at his expense and are paid directly by him to the ’Medical transport operator.
Apart from the case provided for in the above paragraph, no additional costs may be claimed from the healthy insured patient.
Art. 7. - The rate of reimbursement of costs relating to the provision of medical transport is mentioned on the form cited in article 5 above.
This rate is, as a general rule, 80%, except in the case where the healthy insured patient is in a situation entitling him to reimbursement at the rate of 100%.
In the case where the care is delivered at the rate of 80%, the remaining 20% ​​is paid directly by the healthy insured patient to the medical transport operator.
Art. 8. - The costs relating to medical transport services are reimbursed directly by the health  insurance organization to the medical transport operator, who must send the healthy insured patient's affiliation agency:
-           an individual invoice established in accordance with the regulations in force in three (3) copies;
       -        The original of the care commitment issued by the health insurance organization;
       -        a form for requesting reimbursement of medical transport costs, the model of which is attached to this agreement, completed and signed, respectively, by the medical transport operator, the care structure and the socially insured patient.
Art. 9. - Invoices must be paid by the health insurance organization to the transport operator
sanitary within thirty (30) days following the date of their deposit, by check or by transfer to their current account.

CHAPTER V

CONTROL

Art. 10. - The medical transport operator undertakes to facilitate all the control operations that the departments of the health insurance organization are called upon to carry out within the framework of the implementation of this agreement.

CHAPTER VI

DURATION, MODIFICATION, TERMINATION OF THE CONVENTION, LITIGATION AND TERMINATION

Art. 11. - This agreement is concluded for a duration of one year from ...................., renewable by tacit agreement.
Art. 12. - Any modification to this agreement must be the subject of an addendum.
Art. 13. - The agreement may be terminated at any time by one of the contracting parties by registered letter addressed to the other party with three (3) months' notice.
Art. 14. - In the event of a dispute, the party which formulated its grievances addresses to the other party a complaint, accompanied by the necessary supporting documents.
The dispute is examined beforehand by the representatives of the two contracting parties with a view to an amicable settlement.
If the dispute persists, it is brought before the competent court.
Art. 15. - The agreement is terminated, in the event of non-compliance with its various clauses, by one or
The other of the parties.
Done at ......., on ............... corresponding to ......................
The medical transport operator
                                                                                                         health insurance organization






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