Automated processing of personal data by the State Medical Benefits Office

As part of its work, the State Medical Benefits Office (SPME) collects personal information relating to persons who are insured by the State Medical Benefits Office and their assignees: surname, first names, address, social security number, bank details, information on civil status and medical information.

This information is processed electronically to enable payment for medical services to be reimbursed, pay social benefits and keep records. It is dealt with in strict compliance with medical confidentiality.

In accordance with the Act no.1.165 of 23 December 1993 pertaining to the protection of personal data, amended, automated processing by the State Medical Benefits Office relating to the use of personal data was submitted to the Data Protection Authority of Monaco (CCIN) and a favourable opinion was received.
 

Any insured person or assignee covered by the State Medical Benefits Office may request information and, if necessary, rectification of the information relating to him/her.

All rights of access to personal data may be exercised by simply sending a letter to the Head of the State Medical Benefits Office, or directly at the State Medical Benefits Office's reception desk. Exercising the right of access to medical data may, in certain cases, require the person concerned to be accompanied by a doctor.

For any corrections to data, a written request must be made to the Head of this Office.

However, persons concerned by processing operations undertaken by a legal person governed by public law, such as the State Medical Benefits Office, do not have the right to object to the processing of their information.
 

Processing operation: Registration with the State Medical Benefits Office

Deliberation No.2011-18 of 14 February 2011

Purpose of processing:

• Registration of persons insured by the State Medical Benefits Office and their assignees/establishments and medical and health service providers.

Recipient of information:

• The Princess Grace Hospital, in the context of third-party payment procedures, in accordance with the Sovereign Ordinance No. 14.532 of 17 July 2000 implementing the special Franco-Monegasque administrative arrangement relating to the reimbursement of expenses incurred in French and Monegasque healthcare establishments

Information provided: 

• Surname and first name, date of birth, family relationship, registration number, coverage rate and period of entitlement

Information provided: 

• For authorised staff from the Expenditure Control Authority: surname and first name, date of birth, family relationship, registration number, medical procedure performed, amount invoiced and amount reimbursed, the beneficiary of the payment 
• For authorised staff from the Public Treasury: surname and first name, bank details, amount of the transfer

Processing operation: The reimbursement of medical benefits in kind

Deliberation No. 2013-26 of 6 March 2013

Purpose of processing:

• Account management and reimbursement of medical benefits in kind.

Recipient of information:

• The staff of the Expenditure Control Authority, as part of their work to monitor the commitment, authorisation and payment of public expenditure, in order to enable them to verify the reimbursement details of the medical expenses dealt with by the State Medical Benefits Office 
• The staff of the Public Treasury, solely for the information necessary for payment, with all health data removed 

Processing operation: Reimbursement of medical benefits

Delibaration No. 2013-110 of 16 September 2013

Treatment withdrawn - last date of use: 23 September 2023.

Purpose of processing:

• To enable persons insured with the State Medical Benefits Office to consult a list of their medical payments and monitor their reimbursement via the online service

Recipient of information:
The persons concerned.
Information provided: 

• For each procedure or service reimbursed: surname and first name of the insured person, surname and first name of the recipient of the care, surname and first name of the practitioner and health professional who prescribed or performed the procedure, rate of reimbursement, general description of the procedure (without reference to the list of reimbursable treatments), amount invoiced and amount reimbursed

Processing operation: Breast cancer screening campaign

Deliberation No. 2014-03 of 4 February 2014

Purpose of processing:

• A file sent annually by the State Medical Benefits Office to the Monaco Health Screening Centre targeting the population concerned by breast cancer screening

Recipient of information:

• Authorised staff from the Monaco Health Screening Centre

Information provided: 

• Civil status, surname and first name, date of birth, age during the year of treatment, registration number and family relationship to the entitlement holder, occupation of the insured person or dependent
• Address and contact details: entitlement holder's address
• Health information: date of last the screening examination reimbursed within the last three years

Processing operation: Dental examination by the State Medical Benefits Office

Deliberation No.2014-96 of 10 June 2014

Purpose of processing:

• Dental examination by the dental consultant from the State Medical Benefits Office

Recipient of information:

• None

Information provided: 

• None

Processing operation: Medical examination by the State Medical Benefits Office

Deliberation No. 2016-22 of 24 February 2016

Purpose of processing:

• Medical examination by the medical consultant from the State Medical Benefits Office

Recipient of information:

• None

Information provided: 

• None

Processing operation: Electronic treatment forms

Deliberation No. 2016-52 of 20 April 2016

Purpose of processing:

• Digitisation of medical claims for the reimbursement of medical services

Recipient of information:

• Health professionals (who are registered and subscribe to the FSE portal of the Monaco Social Security Funds) in order to create an electronic treatment form, further to the entry of the insured person's registration number and FSE code. Some are located in France, a country with an adequate level of protection

Information provided: 

• Surname and first name, occupation of the beneficiary or dependent gender, date of birth, age and 80% or 100% coverage rate)

Processing operation: Access granted to health professionals and/or healthcare establishments for the purpose of verifying the registration and rate of reimbursement for recipients of benefits provided by the State Medical Benefits Office

Deliberation No. 2017-45 of 19 April 2017

Purpose of processing:

• To ensure the accuracy of the billing information received from the health professional and/or healthcare establishment by having the State Medical Benefits Office confirm the administrative information

Recipient of information:

• Health professionals or the staff of the contracted healthcare establishments, in charge of invoicing for care services. Some are located in France, a country with an adequate level of protection

Information provided: 

• Surname and first name, occupation of the beneficiary or dependent gender, date of birth, age and 80% or 100% coverage rate)

Processing operation: management of invoice rejections/returns of payment to health professionals and/or healthcare establishments issuing electronic invoices to the State Medical Benefits Office

Deliberation No. 2017-46 of 19 April 2017

Purpose of processing:

• Managing rejections of electronic invoices issued by health professionals and healthcare establishments 
• Managing the third-party payment of healthcare invoices to health professionals and healthcare establishments that have issued electronic invoices

Recipient of information:

• Health professionals or the staff of the contracted healthcare establishments, in charge of invoicing for care services. Some are located in France, a country with an adequate level of protection

Information provided: 

• In the case of payment: surname and first name, occupation of the beneficiary or dependent, invoice number, amount invoiced and amount reimbursed
• In the case of non-payment (invoice rejection): surname and first name, occupation of the beneficiary or dependent, invoice number, amount invoiced and the reason for rejection

Processing operation: abdominal aortic aneurysm screening campaign

Deliberation No. 2017-47 of 19 April 2017

Treatment withdrawn - last date of use 23 September 2023

• Data deleted on 3 May 2024

Purpose of processing:

• A file sent annually by the State Medical Benefits Office to the Monaco Health Screening Centre targeting the population concerned by abdominal aortic aneurysm screening

Recipient of information:

• Authorised staff from the Monaco Health Screening Centre

Information provided: 

• Civil status, surname and first name, date of birth, age during the year of treatment, registration number and family relationship to the entitlement holder, occupation of the insured person or dependent
• Address and contact details: entitlement holder's address
• Health information: date of last the screening examination reimbursed within the last three years

Processing operation: family dependency allowances

Deliberation No. 2018-210 of 19 December 2018

Purpose of processing:

• Allocating, calculating and monitoring family dependency allowances

Recipient of information:

•  Authorised staff of the Housing Department when processing an application for National Housing Aid, and only for those who have requested this information
• Authorised staff of the Public Treasury, solely for the information necessary for payment

Information provided

• For authorised staff of the Housing Department: Civil status, surname and first name, amount of benefits received
• For authorised staff of the Public Treasury: surname and first name, bank details, amount of the transfer

Processing operation: Consultation of health reimbursements for State Medical Benefits Office beneficiaries

Deliberation No. 2021-172 of 21 July 2021

Purpose of processing:

• View reimbursements, download statement forms, send reimbursement data to additional health insurance organisations, display policyholder cards and electronic care sheets

Recipient of information:

• Additional health insurance organisations that are signatories to the agreement relating to the electronic transmission of medical service statement forms for those who have requested the transmission

Information provided: 

• For each procedure or service reimbursed: surname and first name of the insured person, surname and first name of the recipient of the care, surname and first name of the practitioner and health professional who prescribed or performed the procedure, rate of reimbursement, general description of the procedure (without reference to the list of reimbursable treatments), amount invoiced and amount reimbursed

Processing operation: operation: management of pensions linked to accidents at work and occupational illnesses

Deliberation No. 2021-277 of 15 December 2021

Purpose of processing:

• Awarding, calculating and monitoring pensions for accidents at work and occupational illnesses

Recipient of information:

• For authorised staff of the Public Treasury, solely for the information necessary for payment, with all health data removed

Information provided

• Surname and first name, bank details, amount of the transfer