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