{ "article": { "LEGIARTI000031797331": { "META": { "META_SPEC": { "META_ARTICLE": { "NUM": "R160-20", "ETAT": "VIGUEUR", "TYPE": "AUTONOME", "DATE_FIN": "2999-01-01", "DATE_DEBUT": "2016-01-01" } }, "META_COMMUN": { "ID": "LEGIARTI000031797331", "URL": "article/LEGI/ARTI/00/00/31/79/73/LEGIARTI000031797331.xml", "NATURE": "Article", "ORIGINE": "LEGI" } }, "LIENS": { "LIEN": [ { "@id": "LEGIARTI000031795302", "@num": "2", "#text": "Décret n°2015-1865 du 30 décembre 2015 - art. 2", "@sens": "cible", "@cidtexte": "JORFTEXT000031740633", "@nortexte": "AFSS1528689D", "@numtexte": "2015-1865", "@typelien": "CREE", "@naturetexte": "DECRET", "@datesignatexte": "2015-12-30" }, { "@id": "LEGIARTI000031670012", "@num": "L160-13", "#text": "Code de la sécurité sociale. - art. L160-13 (V)", "@sens": "source", "@cidtexte": "LEGITEXT000006073189", "@typelien": "CITATION", "@naturetexte": "CODE", "@datesignatexte": "2999-01-01" }, { "@id": "LEGIARTI000006749240", "@num": "R322-9-3", "#text": "Code de la sécurité sociale. - art. R322-9-3 (T)", "@sens": "cible", "@cidtexte": "LEGITEXT000006073189", "@typelien": "CONCORDE", "@naturetexte": "CODE", "@datesignatexte": "2999-01-01" } ] }, "CONTEXTE": { "TEXTE": { "TM": { "TM": { "TM": { "TM": { "TM": { "TM": { "TITRE_TM": [ { "@id": "LEGISCTA000031795495", "@fin": "2999-01-01", "#text": "Sous-section 1 : Montant de la participation de l'assuré", "@debut": "2016-01-01" } ] }, "TITRE_TM": [ { "@id": "LEGISCTA000031795488", "@fin": "2999-01-01", "#text": "Section 3 : Participation de l'assuré social", "@debut": "2016-01-01" } ] }, "TITRE_TM": [ { "@id": "LEGISCTA000031795455", "@fin": "2999-01-01", "#text": "Chapitre préliminaire : Dispositions relatives à la prise en charge des frais de santé", "@debut": "2016-01-01" } ] }, "TITRE_TM": [ { "@id": "LEGISCTA000006141849", "@fin": "2999-01-01", "#text": "Titre VI : Dispositions relatives aux prestations et aux soins - Contrôle médical - Tutelle aux prestations sociales", "@debut": "1985-12-21" } ] }, "TITRE_TM": [ { "@id": "LEGISCTA000006126950", "@fin": "2999-01-01", "#text": "Livre I : Généralités - Dispositions communes à tout ou partie des régimes de base", "@debut": "1985-12-21" } ] }, "TITRE_TM": [ { "@id": "LEGISCTA000006106085", "@fin": "2999-01-01", "#text": "Partie réglementaire - Décrets en Conseil d'Etat", "@debut": "1961-01-12" } ] }, "@cid": "LEGITEXT000006073189", "@nature": "CODE", "TITRE_TXT": [ { "@fin": "2999-01-01", "#text": "Code de la sécurité sociale", "@debut": "1958-10-16", "@id_txt": "LEGITEXT000006073189", "@c_titre_court": "Code de la sécurité sociale." } ], "@date_publi": "2999-01-01", "@date_signature": "2999-01-01" } }, "VERSIONS": { "VERSION": [ { "@etat": "VIGUEUR", "LIEN_ART": { "@id": "LEGIARTI000031797331", "@fin": "2999-01-01", "@num": "R160-20", "@etat": "VIGUEUR", "@debut": "2016-01-01", "@origine": "LEGI" } } ] }, "BLOC_TEXTUEL": { "CONTENU": "

La participation forfaitaire mentionnée au II de l'article L. 160-13 n'est pas exigée au titre des ayants droit qui n'ont pas atteint l'âge de dix-huit ans au 1er janvier de l'année civile considérée.

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" } }, "LEGIARTI000006749240": { "META": { "META_SPEC": { "META_ARTICLE": { "NUM": "R322-9-3", "ETAT": "TRANSFERE", "TYPE": "AUTONOME", "DATE_FIN": "2016-01-01", "DATE_DEBUT": "2004-12-31" } }, "META_COMMUN": { "ID": "LEGIARTI000006749240", "URL": "article/LEGI/ARTI/00/00/06/74/92/LEGIARTI000006749240.xml", "NATURE": "Article", "ORIGINE": "LEGI", "ANCIEN_ID": "SSAXXXXXXXX2X322R09DXXAA" } }, "LIENS": { "LIEN": [ { "@id": "JORFTEXT000000866621", "#text": "Décret n° 85-1353 du 17 décembre 1985", "@sens": "source", "@cidtexte": "JORFTEXT000000866621", "@numtexte": "85-1353", "@typelien": "CODIFICATION", "@naturetexte": "DECRET", "@datesignatexte": "1985-12-17" }, { "@id": "LEGIARTI000006237422", "@num": "9", "#text": "Décret n°2004-1490 du 30 décembre 2004 - art. 9 () JORF 31 décembre 2004", "@sens": "source", "@cidtexte": "JORFTEXT000000423976", "@nortexte": "SANS0424379D", "@numtexte": "2004-1490", "@typelien": "CREATION", "@naturetexte": "DECRET", "@datesignatexte": "2004-12-30" }, { "@id": "LEGIARTI000031795302", "@num": "2", "#text": "Décret n°2015-1865 du 30 décembre 2015 - art. 2", "@sens": "cible", "@cidtexte": "JORFTEXT000031740633", "@nortexte": "AFSS1528689D", "@numtexte": "2015-1865", "@typelien": "TRANSFERE", "@naturetexte": "DECRET", "@datesignatexte": "2015-12-30" }, { "@id": "LEGIARTI000006742479", "@num": "L322-2", "#text": "Code de la sécurité sociale. - art. L322-2", "@sens": "source", "@cidtexte": "LEGITEXT000006073189", "@typelien": "CITATION", "@naturetexte": "CODE", "@datesignatexte": "2999-01-01" }, { "@id": "LEGIARTI000031797331", "@num": "R160-20", "#text": "Code de la sécurité sociale. - art. R160-20 (V)", "@sens": "source", "@cidtexte": "LEGITEXT000006073189", "@typelien": "CONCORDE", "@naturetexte": "CODE", "@datesignatexte": "2999-01-01" } ] }, "CONTEXTE": { "TEXTE": { "TM": { "TM": { "TM": { "TM": { "TM": { "TM": { "TITRE_TM": [ { "@id": "LEGISCTA000006186453", "@fin": "2999-01-01", "#text": "Sous-section 1 : Montant de la participation de l'assuré.", "@debut": "2004-12-31" } ] }, "TITRE_TM": [ { "@id": "LEGISCTA000006173383", "@fin": "2999-01-01", "#text": "Section 1 : Participation de l'assuré.", "@debut": "1985-12-21" } ] }, "TITRE_TM": [ { "@id": "LEGISCTA000006156608", "@fin": "2999-01-01", "#text": "Chapitre 2 : Prestations en nature", "@debut": "1985-12-21" } ] }, "TITRE_TM": [ { "@id": "LEGISCTA000006141864", "@fin": "2999-01-01", "#text": "Titre II : Assurance maladie", "@debut": "1985-12-21" } ] }, "TITRE_TM": [ { "@id": "LEGISCTA000006126956", "@fin": "2999-01-01", "#text": "Livre III : Dispositions relatives aux assurances sociales et à diverses catégories de personnes rattachées au régime général", "@debut": "1985-12-21" } ] }, "TITRE_TM": [ { "@id": "LEGISCTA000006106085", "@fin": "2999-01-01", "#text": "Partie réglementaire - Décrets en Conseil d'Etat", "@debut": "1961-01-12" } ] }, "@cid": "LEGITEXT000006073189", "@nature": "CODE", "TITRE_TXT": [ { "@fin": "2999-01-01", "#text": "Code de la sécurité sociale", "@debut": "1958-10-16", "@id_txt": "LEGITEXT000006073189", "@c_titre_court": "Code de la sécurité sociale." } ], "@date_publi": "2999-01-01", "@date_signature": "2999-01-01" } }, "VERSIONS": { "VERSION": [ { "@etat": "TRANSFERE", "LIEN_ART": { "@id": "LEGIARTI000006749240", "@fin": "2016-01-01", "@num": "R322-9-3", "@etat": "TRANSFERE", "@debut": "2004-12-31", "@origine": "LEGI" } } ] }, "BLOC_TEXTUEL": { "CONTENU": "
La participation forfaitaire mentionnée au II de l'article L. 322-2 n'est pas exigée au titre des ayants droit qui n'ont pas atteint l'âge de dix-huit ans au 1er janvier de l'année civile considérée.
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I.-La participation de l'assuré aux tarifs servant de base au calcul des prestations prévues aux 1°, 2° et 3° de l'article L. 160-8 peut être proportionnelle auxdits tarifs ou être fixée à une somme forfaitaire. Elle peut varier selon les catégories de prestations, les conditions dans lesquelles sont dispensés les soins, les conditions d'hébergement, la nature de l'établissement où les soins sont donnés. La participation de l'assuré peut être réduite en fonction de l'âge ou de la situation de famille du bénéficiaire des prestations.

La participation est fixée dans des limites et des conditions fixées par décret en Conseil d'Etat, par décision de l'Union nationale des caisses d'assurance maladie, après avis de l'Union nationale des organismes d'assurance maladie complémentaire. Le ministre chargé de la santé peut s'opposer à cette décision pour des motifs de santé publique. La décision du ministre est motivée. Le décret en Conseil d'Etat précise notamment le délai dont dispose l'Union nationale des caisses d'assurance maladie pour se prononcer et les conditions dans lesquelles le ministre chargé de la sécurité sociale se substitue à l'Union nationale des caisses d'assurance maladie en cas d'absence de décision de celle-ci, une fois ce délai expiré.

L'application aux spécialités pharmaceutiques mentionnées à l'article L. 162-17 des taux de participation mentionnés à l'alinéa précédent est déterminée par décision de l'Union nationale des caisses d'assurance maladie.

II.-L'assuré acquitte une participation forfaitaire pour chaque acte ou pour chaque consultation pris en charge par l'assurance maladie et réalisé par un médecin, en ville, dans un établissement ou un centre de santé, à l'exclusion des actes ou consultations réalisés au cours d'une hospitalisation. L'assuré acquitte également cette participation pour tout acte de biologie médicale. Cette participation se cumule avec celle mentionnée au I. Son montant est fixé, dans des limites et conditions prévues par décret en Conseil d'Etat, par l'Union nationale des caisses d'assurance maladie conformément à la procédure fixée au I.

Un décret fixe le nombre maximum de participations forfaitaires supportées par chaque bénéficiaire au titre d'une année civile.

Lorsque plusieurs actes ou consultations sont effectués par un même professionnel de santé au cours d'une même journée, le nombre de participations forfaitaires supportées par le bénéficiaire ne peut être supérieur à un maximum fixé par décret.

Un décret fixe les conditions dans lesquelles, lorsque l'assuré bénéficie de la dispense d'avance des frais, la participation forfaitaire peut être versée directement par l'assuré à la caisse d'assurance maladie ou être récupérée par elle auprès de l'assuré sur les prestations à venir. Il peut être dérogé aux dispositions de l'article L. 133-3.

III.-En sus de la participation mentionnée au premier alinéa du I, une franchise annuelle est laissée à la charge de l'assuré pour les frais relatifs à chaque prestation et produit de santé suivants, pris en charge par l'assurance maladie : 1° Médicaments mentionnés aux articles L. 5111-2, L. 5121-1 et L. 5126-4 du code de la santé publique, à l'exception de ceux délivrés au cours d'une hospitalisation ;

2° Actes effectués par un auxiliaire médical soit en ville, soit dans un établissement ou un centre de santé, à l'exclusion des actes pratiqués au cours d'une hospitalisation ;

3° Transports mentionnés au 2° de l'article L. 160-8 du présent code effectués en véhicule sanitaire terrestre ou en taxi, à l'exception des transports d'urgence.

Le montant de la franchise est forfaitaire. Il peut être distinct selon les produits ou prestations de santé mentionnés aux 1°, 2° et 3° du présent III. La franchise est due dans la limite globale d'un plafond annuel.

Lorsque plusieurs actes mentionnés au 2° sont effectués au cours d'une même journée sur le même patient, le montant total de la franchise supportée par l'intéressé ne peut être supérieur à un maximum. Il en est de même pour les transports mentionnés au 3°.

Lorsque le bénéficiaire des prestations et produits de santé mentionnés aux 1°, 2° et 3° bénéficie de la dispense d'avance de frais, les sommes dues au titre de la franchise peuvent être versées directement par l'assuré à l'organisme d'assurance maladie dont il relève ou peuvent être récupérées par ce dernier auprès de l'assuré sur les prestations de toute nature à venir. Il peut être dérogé à l'article L. 133-3.

Le Gouvernement présente chaque année au Parlement un rapport précisant les conditions dans lesquelles les montants correspondant à la franchise instituée par le présent III ont été utilisés.

Un décret fixe les modalités de mise en oeuvre du présent III.

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A modifié les dispositions suivantes :

- Code de la sécurité sociale.
\n Art. R332-5, Art. R160-3\n
\n

Article R160-20 AUTONOME VIGUEUR, en vigueur depuis le 01/01/2016 (Code de la sécurité sociale)