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Le montant de la participation forfaitaire mentionnée au II de l'article L. 160-13 ne peut, sans être inférieur à 2 euros, excéder 3 euros.

\n
\n
" } }, "LEGIARTI000031670025": { "META": { "META_SPEC": { "META_ARTICLE": { "NUM": "L160-13", "ETAT": "MODIFIE", "TYPE": "AUTONOME", "DATE_FIN": "2016-01-28", "DATE_DEBUT": "2016-01-01" } }, "META_COMMUN": { "ID": "LEGIARTI000031670025", "URL": "article/LEGI/ARTI/00/00/31/67/00/LEGIARTI000031670025.xml", "NATURE": "Article", "ORIGINE": "LEGI" } }, "LIENS": { "LIEN": [ { "@id": "LEGIARTI000031687510", "@num": "9-1", "#text": "Loi n°89-1009 du 31 décembre 1989 - art. 9-1 (V)", "@sens": "cible", "@cidtexte": "JORFTEXT000000709057", "@nortexte": "SPSX8900080L", "@numtexte": "89-1009", "@typelien": "CITATION", "@naturetexte": "LOI", "@datesignatexte": "1989-12-31" }, { "@id": "LEGIARTI000034405848", "@num": "69", "#text": "Décret n°90-1215 du 20 décembre 1990 - art. 69 (V)", "@sens": "cible", "@cidtexte": "JORFTEXT000000717193", "@nortexte": "SPSS9001980D", "@numtexte": "90-1215", "@typelien": "CITATION", "@naturetexte": "DECRET", "@datesignatexte": "1990-12-20" }, { "@id": "LEGIARTI000044374888", "@num": "2", "#text": "Loi n° 91-1389 du 31 décembre 1991 - art. 2 (V)", "@sens": "cible", "@cidtexte": "JORFTEXT000000355917", "@nortexte": "SPSX9100077L", "@numtexte": "91-1389", "@typelien": "CITATION", "@naturetexte": "LOI", "@datesignatexte": "1991-12-31" }, { "@id": "LEGIARTI000051285010", "@num": "20-1", "#text": "Ordonnance n°96-1122 du 20 décembre 1996 - art. 20-1 (V)", "@sens": "cible", "@cidtexte": "JORFTEXT000000368749", "@nortexte": "DOMX9600135R", "@numtexte": "96-1122", "@typelien": "CITATION", "@naturetexte": "ORDONNANCE", "@datesignatexte": "1996-12-20" }, { "@id": "LEGIARTI000043138095", "@num": "Annexe", "#text": "Arrêté du 20 octobre 2010 - art. 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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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Un décret fixe le nombre maximum de participations forfaitaires supportées par chaque bénéficiaire au titre d'une année civile.

Un décret fixe les conditions dans lesquelles, lorsque l'assuré bénéficie de la dispense d'avance des frais, la participation forfaitaire peut être payée directement par l'assuré à l'organisme d'assurance maladie, prélevée sur le compte bancaire de l'assuré après autorisation de ce dernier ou encore récupérée par l'organisme d'assurance maladie sur les prestations de toute nature à venir. Ce décret fixe également les modalités de recueil de l'autorisation de l'assuré de prélèvement sur son compte bancaire et de renoncement à cette autorisation. Il peut être dérogé aux dispositions de l'article L. 133-3.

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.

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 payées, prélevées ou récupérées selon les modalités prévues au dernier alinéa du II. Il peut être dérogé à l'article L. 133-3.

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

" } }, "LEGIARTI000041396735": { "META": { "META_SPEC": { "META_ARTICLE": { "NUM": "L160-13", "ETAT": "MODIFIE", "TYPE": "AUTONOME", "DATE_FIN": "2021-09-01", "DATE_DEBUT": "2019-12-28" } }, "META_COMMUN": { "ID": "LEGIARTI000041396735", "URL": "article/LEGI/ARTI/00/00/41/39/67/LEGIARTI000041396735.xml", "NATURE": "Article", "ORIGINE": "LEGI" } }, "NOTA": { "CONTENU": "

Se reporter aux conditions d'entrée en vigueur prévues au V de l'article 35 de la loi n° 2019-1446 du 24 décembre 2019.

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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 aux frais d'hospitalisation est proportionnelle aux bases de calcul mentionnées à l'article L. 162-20-1. La participation de l'assuré peut être réduite en fonction de l'âge ou de la situation de famille du bénéficiaire des prestations.

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

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 ;

4° Prestations effectuées par un pharmacien d'officine et définies par arrêté des ministres chargés de la santé et de la sécurité sociale.

Le montant de la franchise est forfaitaire. Il peut être distinct selon les produits ou prestations de santé mentionnés aux 1°, 2°, 3° et 4° du présent III. La franchise est due dans la limite globale d'un plafond annuel.

Lorsque le bénéficiaire des prestations et produits de santé mentionnés aux 1°, 2°, 3° et 4° bénéficie de la dispense d'avance de frais, les sommes dues au titre de la franchise peuvent être payées, prélevées ou récupérées selon les modalités prévues au dernier alinéa du II. Il peut être dérogé à l'article L. 133-3.

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

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Conformément au VIII de l'article 51 de la loi n° 2020-1576 du 14 décembre 2020, ces dispositions entrent en vigueur le 1er septembre 2021.

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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 aux frais d'hospitalisation est proportionnelle aux bases de calcul mentionnées à l'article L. 162-20-1. 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 de l'assuré aux frais occasionnés par un passage non programmé dans une structure des urgences d'un établissement de santé, autorisée, est fixée à une somme forfaitaire due lorsque ce passage n'est pas suivi d'une hospitalisation dans un service de médecine, de chirurgie, d'obstétrique ou d'odontologie au sein de l'établissement. Le montant de cette participation est défini par arrêté des ministres chargés de la santé et de la sécurité sociale, pris après avis de l'Union nationale des caisses d'assurance maladie et de l'Union nationale des organismes d'assurance maladie complémentaire. Ce montant peut être réduit dans les cas mentionnés aux 3°, 4° et 13° de l'article L. 160-14 et à l'article L. 371-1 du présent code ainsi qu'à l'article L. 212-1 du code des pensions militaires d'invalidité et des victimes de guerre. Cette participation ne peut être supprimée, sauf dans les cas prévus à l'article L. 160-9, aux 11°, 15° et 18° de l'article L. 160-14 ainsi qu'aux articles L. 169-1 et L. 16-10-1 du présent code.

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

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 ;

4° Prestations effectuées par un pharmacien d'officine et définies par arrêté des ministres chargés de la santé et de la sécurité sociale.

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

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Conformément au I de l’article 5 de l’ordonnance n° 2021-1554 du 1^er décembre 2021, ces dispositions entrent en vigueur à une date fixée par décret et au plus tard le 30 juin 2022. L’article 1 du décret n° 2022-801 du 12 mai 2022 a fixé cette date au 14 mai 2022.

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\n

I.-La participation de l'assuré aux tarifs servant de base au calcul des prestations prévues aux 1° et 2° de l'article L. 160-8 et aux 2° et 3° de l'article L. 160-9-1 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 aux frais d'hospitalisation est proportionnelle aux bases de calcul mentionnées à l'article L. 162-20-1. La participation de l'assuré peut être réduite en fonction de l'âge ou de la situation de famille du bénéficiaire des prestations.

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

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 et au 1° de l'article L. 160-9-1 du présent code effectués en véhicule sanitaire terrestre ou en taxi, à l'exception des transports d'urgence ;

4° Prestations effectuées par un pharmacien d'officine et définies par arrêté des ministres chargés de la santé et de la sécurité sociale.

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

\n
" } }, "LEGIARTI000045058570": { "META": { "META_SPEC": { "META_ARTICLE": { "NUM": "L160-13", "ETAT": "MODIFIE", "TYPE": "AUTONOME", "DATE_FIN": "2022-12-25", "DATE_DEBUT": "2022-07-01" } }, "META_COMMUN": { "ID": "LEGIARTI000045058570", "URL": "article/LEGI/ARTI/00/00/45/05/85/LEGIARTI000045058570.xml", "NATURE": "Article", "ORIGINE": "LEGI" } }, "NOTA": { "CONTENU": "

Conformément au VII de l’article 36 de la loi n° 2021-1754 du 23 décembre 2021, les présentes dispositions entrent en vigueur à une date fixée par décret, et au plus tard le 1er juillet 2022.

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art. 3 (Ab)", "@sens": "cible", "@cidtexte": "JORFTEXT000047396757", "@nortexte": "SPRH2308496A", "@typelien": "CITATION", "@naturetexte": "ARRETE", "@datesignatexte": "2023-03-31" }, { "@id": "LEGITEXT000047564714", "#text": "Décret n°2023-382 du 19 mai 2023 (V)", "@sens": "cible", "@cidtexte": "JORFTEXT000047562556", "@nortexte": "SPRS2308195D", "@numtexte": "2023-382", "@typelien": "CITATION", "@naturetexte": "DECRET", "@datesignatexte": "2023-05-19" }, { "@id": "LEGITEXT000047912779", "#text": "Décret n°2023-701 du 31 juillet 2023 (V)", "@sens": "cible", "@cidtexte": "JORFTEXT000047911721", "@nortexte": "SPRS2316847D", "@numtexte": "2023-701", "@typelien": "CITATION", "@naturetexte": "DECRET", "@datesignatexte": "2023-07-31" }, { "@id": "LEGIARTI000048911679", "@num": "1", "#text": "Arrêté du 19 décembre 2023 - art. 1", "@sens": "cible", "@cidtexte": "JORFTEXT000048730514", "@nortexte": "SPRH2334455A", "@typelien": "CITATION", "@naturetexte": "ARRETE", "@datesignatexte": "2023-12-19" }, { "@id": "LEGIARTI000048884326", "@num": "4", "#text": "Décret n°2024-10 du 5 janvier 2024 - art. 4", "@sens": "cible", "@cidtexte": "JORFTEXT000048865493", "@nortexte": "MTRS2335028D", "@numtexte": "2024-10", "@typelien": "CITATION", "@naturetexte": "DECRET", "@datesignatexte": "2024-01-05" }, { "@id": "LEGITEXT000049157862", "#text": "Décret n°2024-113 du 16 février 2024 (V)", "@sens": "cible", "@cidtexte": "JORFTEXT000049155052", "@nortexte": "TSSS2402898D", "@numtexte": "2024-113", "@typelien": "CITATION", "@naturetexte": "DECRET", "@datesignatexte": "2024-02-16" }, { "@id": "LEGITEXT000049157872", "#text": "Décret n°2024-114 du 16 février 2024 (V)", "@sens": "cible", "@cidtexte": "JORFTEXT000049155060", "@nortexte": "TSSS2403085D", "@numtexte": "2024-114", "@typelien": "CITATION", "@naturetexte": "DECRET", "@datesignatexte": "2024-02-16" }, { "@id": "LEGIARTI000049221073", "@num": "1", "#text": "Arrêté du 29 février 2024 - art. 1", "@sens": "cible", "@cidtexte": "JORFTEXT000049219412", "@nortexte": "TSSH2403717A", "@typelien": "CITATION", "@naturetexte": "ARRETE", "@datesignatexte": "2024-02-29" }, { "@id": "LEGITEXT000051412662", "#text": "Arrêté du 15 avril 2024 (V)", "@sens": "cible", "@cidtexte": "JORFTEXT000049424905", "@nortexte": "TSSS2410825A", "@typelien": "CITATION", "@naturetexte": "ARRETE", "@datesignatexte": "2024-04-15" }, { "@id": "LEGITEXT000051423017", "#text": "Arrêté du 15 avril 2024 (V)", "@sens": "cible", "@cidtexte": "JORFTEXT000049424947", "@nortexte": "TSSS2410831A", "@typelien": "CITATION", "@naturetexte": "ARRETE", "@datesignatexte": "2024-04-15" }, { "@id": "LEGITEXT000051423481", "#text": "Arrêté du 15 avril 2024 (V)", "@sens": "cible", "@cidtexte": "JORFTEXT000049424865", "@nortexte": "TSSS2410806A", "@typelien": "CITATION", "@naturetexte": "ARRETE", "@datesignatexte": "2024-04-15" }, { "@id": "LEGITEXT000049536044", "#text": "Décret n°2024-432 du 13 mai 2024 (V)", "@sens": "cible", "@cidtexte": "JORFTEXT000049535616", "@nortexte": "TSSS2403086D", "@numtexte": "2024-432", "@typelien": "CITATION", "@naturetexte": "DECRET", "@datesignatexte": "2024-05-13" }, { "@id": "LEGITEXT000050503472", "#text": "Décret n°2024-1035 du 15 novembre 2024 (V)", "@sens": "cible", "@cidtexte": "JORFTEXT000050502225", "@nortexte": "MSAS2416386D", "@numtexte": "2024-1035", "@typelien": "CITATION", "@naturetexte": "DECRET", "@datesignatexte": "2024-11-15" }, { "@id": "LEGITEXT000051412013", "#text": "Arrêté du 24 mars 2025 (V)", "@sens": "cible", "@cidtexte": "JORFTEXT000051409745", "@nortexte": "TSSH2509957A", "@typelien": "CITATION", "@naturetexte": "ARRETE", "@datesignatexte": "2025-03-24" }, { "@id": "LEGITEXT000051422663", "#text": "Arrêté du 24 mars 2025 (V)", "@sens": "cible", "@cidtexte": "JORFTEXT000051421262", "@nortexte": "TSSH2509907A", "@typelien": "CITATION", "@naturetexte": "ARRETE", "@datesignatexte": "2025-03-24" }, { "@id": "LEGITEXT000051422982", "#text": "Arrêté du 24 mars 2025 (V)", "@sens": "cible", "@cidtexte": "JORFTEXT000051421292", "@nortexte": "TSSH2509954A", "@typelien": "CITATION", "@naturetexte": "ARRETE", "@datesignatexte": "2025-03-24" }, { "@id": "LEGIARTI000006689868", "@num": "L5111-2", "#text": "Code de la santé publique - 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D160-13 (Ab)", "@sens": "cible", "@cidtexte": "LEGITEXT000006073189", "@typelien": "CITATION", "@naturetexte": "CODE", "@datesignatexte": "2999-01-01" }, { "@id": "LEGIARTI000049536609", "@num": "D160-6", "#text": "Code de la sécurité sociale. - art. D160-6 (V)", "@sens": "cible", "@cidtexte": "LEGITEXT000006073189", "@typelien": "CITATION", "@naturetexte": "CODE", "@datesignatexte": "2999-01-01" }, { "@id": "LEGIARTI000049158658", "@num": "D160-7", "#text": "Code de la sécurité sociale. - art. D160-7 (V)", "@sens": "cible", "@cidtexte": "LEGITEXT000006073189", "@typelien": "CITATION", "@naturetexte": "CODE", "@datesignatexte": "2999-01-01" }, { "@id": "LEGIARTI000049158651", "@num": "D160-9", "#text": "Code de la sécurité sociale. - art. D160-9 (VD)", "@sens": "cible", "@cidtexte": "LEGITEXT000006073189", "@typelien": "CITATION", "@naturetexte": "CODE", "@datesignatexte": "2999-01-01" }, { "@id": "LEGIARTI000031813522", "@num": "D161-13-1", "#text": "Code de la sécurité sociale. - art. D161-13-1 (V)", "@sens": "cible", "@cidtexte": "LEGITEXT000006073189", "@typelien": "CITATION", "@naturetexte": "CODE", "@datesignatexte": "2999-01-01" }, { "@id": "LEGIARTI000031813511", "@num": "D325-6", "#text": "Code de la sécurité sociale. - art. D325-6 (V)", "@sens": "cible", "@cidtexte": "LEGITEXT000006073189", "@typelien": "CITATION", "@naturetexte": "CODE", "@datesignatexte": "2999-01-01" }, { "@id": "LEGIARTI000031813498", "@num": "D911-1", "#text": "Code de la sécurité sociale. - art. 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I.-La participation de l'assuré aux tarifs servant de base au calcul des prestations prévues aux 1° et 2° de l'article L. 160-8 et aux 2°, 3° et 8° de l'article L. 160-9-1 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 aux frais d'hospitalisation est proportionnelle aux bases de calcul mentionnées à l'article L. 162-20-1. 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 de l'assuré aux frais occasionnés par un passage non programmé dans une structure des urgences d'un établissement de santé, autorisée, est fixée à une somme forfaitaire due lorsque ce passage n'est pas suivi d'une hospitalisation dans un service de médecine, de chirurgie, d'obstétrique ou d'odontologie au sein de l'établissement. Le montant de cette participation est défini par arrêté des ministres chargés de la santé et de la sécurité sociale, pris après avis de l'Union nationale des caisses d'assurance maladie et de l'Union nationale des organismes d'assurance maladie complémentaire. Ce montant peut être réduit pour les assurés mentionnés aux 3° et 4° de l'article L. 160-14 et pour les bénéficiaires des prestations mentionnées à l'article L. 431-1, quel que soit le motif du passage. Cette participation ne peut être supprimée, sauf pour les bénéficiaires des prestations mentionnées à l'article L. 160-9 et les assurés mentionnés aux 11° et 13° de l'article L. 160-14 et à l'article L. 371-6, quel que soit le motif du passage, ainsi que pour les passages liés aux soins mentionnés aux 15° et 18° de l'article L. 160-14 et à l'article L. 169-2 et ceux en lien avec le risque sanitaire mentionné à l'article L. 16-10-1.

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

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 ;

4° Prestations effectuées par un pharmacien d'officine et définies par arrêté des ministres chargés de la santé et de la sécurité sociale.

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

" } }, "LEGIARTI000045058666": { "META": { "META_SPEC": { "META_ARTICLE": { "NUM": "L160-13", "ETAT": "MODIFIE", "TYPE": "AUTONOME", "DATE_FIN": "2022-05-14", "DATE_DEBUT": "2022-01-01" } }, "META_COMMUN": { "ID": "LEGIARTI000045058666", "URL": "article/LEGI/ARTI/00/00/45/05/86/LEGIARTI000045058666.xml", "NATURE": "Article", "ORIGINE": "LEGI" } }, "NOTA": { "CONTENU": "

Conformément au I de l’article 5 de l’ordonnance n° 2021-1554 du 1^er décembre 2021, ces dispositions entrent en vigueur à une date fixée par décret et au plus tard le 30 juin 2022.

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Article R160-19 AUTONOME VIGUEUR, en vigueur depuis le 18/02/2024 (Code de la sécurité sociale)