Decree of the Ministry of Finance No. 227 / 1998 Coll.
Decree of the Ministry of Finance establishing a more detailed definition of the heading and amount of the income and expenditure of public health insurance funds of health insurance companies, the conditions for their creation, use, admissibility of transfers of funds between them and their management, the limit of the cost of the activities of health insurance companies covered by the resources of the basic fund, including the procedure for calculating this limit
Valid
Order
Effective from 01.01.1999
227
DECLARATION
Ministry of Finance
of 21 September 1998
establishing a more detailed definition of the heading and amount of revenue and expenditure of public health insurance funds of health insurance undertakings, the conditions for their formation, use, admissibility of transfers of funds and their management, the limit of the cost of the activities of health insurance undertakings covered by the resources of the basic fund, including the calculation procedure for this limit
The Ministry of Finance, after consulting the Ministry of Health, provides for the Act No. 551 / 1991 Coll., on the General Health Insurance Company of the Czech Republic, as amended by Act No. 127 / 1998 Coll., and pursuant to Article 16 (4) of the Act No. 280 / 1992 Coll., on departmental, branch, corporate and other health insurance companies, as amended by Act No. 127 / 1998 Coll.:
Basic Fund
(1) The source of the basic fund of the General Health Insurance Corporation of the Czech Republic and of the ministerial, branch, corporate and other health insurance companies (hereinafter referred to as the "health insurance company") are:
(a) the payment of insurance premiums for public health insurance (1) (hereinafter referred to as "insurance premiums"), including advances and their billing. Repayment of overpayments of insurance premiums (12) and reimbursement of incorrectly implemented insurance premiums is a reduction in the resources of the basic fund,
(b) monthly statement of the results of the redistribution of premiums, 2)
(c) compensation for damage, 3)
(d) contractual fines paid by health care establishments under contract with the health insurance company, 4)
(e) financial donations to health insurance companies for which the donor did not specify the purpose of the donation;
(f) transfers of funds from other funds made in accordance with this decree;
(g) balances of the basic fund cancelled by health insurance undertakings in the event of the merger or merger of health insurance undertakings, 5)
(2) The source of the general health insurance fund of the Czech Republic (7) is the following revenue, in addition to the revenue referred to in paragraph 1:
(a) periodic penalty payments, 8)
(b) premiums and fines, 9)
(c) the funds generated by the use of the basic fund.
(3) For health insurance companies, with the exception of the General Health Insurance Corporation of the Czech Republic, the items referred to in paragraph 2 constitute the income side of the basic fund only if the balance of the basic fund has not been achieved. The evaluation shall be carried out in the context of the annual accounts. The condition of a balanced management is the positive balance of the bank account of the basic fund without the credit being used for the fulfilment of the reserve up to a minimum amount, 10) the payment of all outstanding liabilities and allocations to other funds under this decree.
(4) The basic fund of a health insurance undertaking shall be used to finance:
(a) reimbursement of public health insurance obligations (11) to medical institutions, less claims on accounts revisions carried out, the application of regulatory mechanisms and unduly invoiced healthcare, less claims on other health insurance companies or other entities, under financial settlement contracts for healthcare payments;
(b) reimbursement of necessary and urgent treatment abroad, 13)
(c) remuneration associated with the purchase, repair and lease of medical equipment lent to insured persons,
(d) interest payments on loans received to strengthen the basic fund;
(e) bank charges for the management of the basic fund's accounts and postal charges relating to the basic fund, for the payment of medical care, for the collection of premiums, fines, periodic penalty payments and premiums;
(f) the allocation to the operational fund up to the operating cost limit referred to in Article 7;
(g) allocation to the reserve fund;
(h) allocations from fines, periodic penalty payments and surpluses to the prevention fund;
(i) exceptional allocation to the operational fund to cover increased expenditure 13a) Military health insurance companies of the Czech Republic.
(5) On the basis of the basic fund, health insurance undertakings shall be cleared:
(a) depreciation of premiums due and periodic penalty payments, 14)
(b) depreciation of premiums and fines. 9)
(6) In addition, health insurance companies, with the exception of the General Health Insurance Company of the Czech Republic, will pay a contribution to the reinsurance fund. 15)
(7) The funds of the basic fund are kept by the health insurance company in a separate bank account; in several separate bank accounts, they may be kept for the purposes of separate records of income in order to enable the correct amount to be checked.
(8) The balance of the basic fund is transferred to the following financial year.
Reserve Fund
(1) The source of the health insurance reserve is:
(a) the applicant's deposit, 16)
(b) the allocation of insurance premiums carried out by the transfer from the basic fund, 17)
(c) income from securities income and income from the sale of securities, 17)
(d) interest on a separate bank account in the management of the reserve fund;
(e) a donation by the donor to strengthen the reserve fund;
(f) the balance of the pool of the merged health insurance undertaking.
(2) From the health insurance reserve, the funds are drawn to:
(a) transfer to the basic fund to cover the base fund deficit and, in other cases, provided for by law, 17)
(b) bank account fees and postal charges relating to the reserve fund;
(c) losses on the sale of securities that were part of the reserve;
(d) the reimbursement of health care from the decision of the liquidator of the health insurance company. 18)
(3) The funds of the reserve fund are deposited in a separate bank account. The allocation from the basic fund to the reserve fund shall be settled at the latest within the framework of the annual accounts. The resources of the reserve fund may be deposited on short-term fixed-term deposits only if the health insurance undertaking does not thereby breach the obligation to transfer to the basic fund. 17)
(4) Where the resources referred to in paragraph 1 (c), (d), (e) and (f) exceed the annual allocation and this allocation is not necessary, part of the funds by which the reserve fund exceeds its fixed minimum amount may be transferred to the basic fund, subject to the approval of the Management Board.
(5) If the resources of the basic fund, after the payment of the commitments, the addition of the operational fund and, in the case of health insurance companies established under a special legislation19) as well as the payment of the contribution to the hedge fund, do not create the funds necessary to supplement the reserve to the amount laid down by law, the resources referred to in Article 1 (2) shall be transferred to the basic fund as a priority. In order to create a legal allocation to the reserve, the health insurance undertaking shall also use the positive balance of the operational fund. In order to make the allocation to the reserve, the health insurance undertaking shall use the balance of the operational fund even if the negative balance of the basic fund funds is established. The allocation to the reserve may not be made on the negative balance of the basic fund.
(6) When merged with another health insurance undertaking, the basis for calculating the allocation to the reserve fund is the amount of the expenditure of the basic fund of a health insurance undertaking continuing to operate, which shall be increased by the share of the expenditure of the basic fund of the cancelled health insurance undertaking in terms of the number of insured persons who were its insured at the date of the merger. The calculation adjustment shall be reflected in all periods included in the calculation of the limit. When health insurance companies are merged, the expenditure of the basic funds of the two health insurance undertakings for the period included in the calculation shall be converted into a proportion corresponding to the number of insured persons of the health insurance undertakings concerned at the date of the merger.
Operational Fund
(1) The source of the health insurance company's operational fund is:
(a) the allocation from the basic fund up to the annual limit laid down in Article 7 (1);
(b) a donation by a donor to strengthen the operational fund;
(c) the allocation from the reproduction fund of capital assets after approval by the Board of Health Insurance companies;
(d) interest on the bank account in the management of the funds of the operational fund;
(e) the balance of the operational funds when the health insurance undertakings are merged or merged;
(f) revenue from the sale of capital goods.
(2) From the operational fund of the health insurance undertaking, the funds are drawn to:
(a) reimbursement of the operating expenses of a health insurance undertaking related to public health insurance;
(b) allocations to the social fund up to the total allocation referred to in Article 4 (2) (a);
(c) the transfer of funds to the basic fund to supplement the allocation to the reserve fund;
(d) transfer to the capital reproductions fund carried out on the basis of a decision of the Board of Directors of the health insurance undertaking;
(e) interest payments on loans used to offset the negative balance of the operational fund;
(f) bank account fees and postal charges relating to the operational fund;
(g) the payment of fines and periodic penalty payments resulting from non-compliance with the procedures laid down by law for the health insurance undertaking; 20) also fines, periodic penalty payments or other penalties for breach of contractual relations concluded by the health insurance undertaking, 21)
(h) reimbursement of health care from the decision of the liquidator of the health insurance company, 18)
(i) the transfer to the reproduction fund of capital goods equal to the positive difference between the selling and the balance price of the capital goods sold.
(3) The funds of the operational fund shall be kept in a separate bank account. The balance of the operational fund shall be transferred to the following financial year. The funds available temporarily may be used to acquire short-term financial assets.
(4) In accordance with Article 7 (3), funds shall be transferred from the operational fund's bank account to the reproductions fund's bank account at the amount of the amortised depreciation of all assets, including the financial value of the residual price of the disposal assets and the positive difference between the selling and the outstanding price of the assets sold.
(5) The allocation from the basic fund to the operational fund shall be made in advance according to the expected amount of income and the number of insured persons in the quarter concerned. The amount of the advance shall be specified on the basis of the actual results of the operation at 31 March, 30 June and 30 September of the current year in accordance with the procedure laid down in Article 7. The final allocation to the operational fund shall be settled at a maximum of the limit calculated with reference to the annual accounts data.
(6) Where a health insurance undertaking carries out an activity subject to corporation tax in accordance with the law (22) and the approved statute, it shall ensure separate monitoring and accounting of all costs and revenues of that activity. If, during the current year, the funds of the operational fund bear the share of the costs associated with that activity, they shall transfer quarterly advances from the funds of the taxed activity to the operational fund's bank account which shall be settled at the latest within the financial statements. Similarly, the Military Health Insurance Corporation of the Czech Republic is engaged in the payment of operating expenses related to the creation and management of the preventive care fund and the provision of medical care. 22a)
Social Fund
(1) The Social Fund of a health insurance company is used for the benefit of the staff of a health insurance company to ensure cultural, social and other needs.
(2) The social fund's resources are:
(a) a basic allocation of no more than 2% of the annual cost of wages and salary compensation that has been settled with the operational fund, consisting of the transfer of funds from the operational fund;
(b) additional post-tax profit allocation;
(c) repayment of loans to employees;
(d) other income [e.g. compensation from insurance companies 23)] relating to expenditure on the social fund;
(e) interest on the social fund funds deposited in a separate bank account;
(f) donations by donors to strengthen the social fund of a health insurance undertaking;
(g) balances of social funds of combined and coherent health insurance companies;
(h) the payment of claims on funds whose balances were transferred on 1 January 1999 to the social fund of a health insurance undertaking.
(3) The social fund of a health insurance undertaking shall be used in accordance with the annual budget and the principles of its application, which form part of the approved health insurance plan of the health insurance undertaking. The issue of this fund is also the payment of commitments whose balances were transferred to the social fund of a health insurance undertaking on 1 January 1999. 24) In addition, bank and postal charges relating to the deposit of the social fund in a separate bank account shall be paid from the social fund of the health insurance undertaking.
(4) The use of the Social Fund of a health insurance undertaking shall be subject to the following principles:
(a) the funds of the social fund shall be kept in a separate bank account;
(b) expenditure on the social fund may be effected only up to the amount of the funds available;
(c) the funds of the social fund may not be transferred to other funds by the health insurance company, except in the case of the winding-up procedure, 18)
(d) the Fund's unused funds shall be transferred to the following financial year;
(e) when merged with another health insurance undertaking, the balance of the social fund of the affected health insurance undertaking shall be transferred to the social fund of the health insurance undertaking with which it has merged; the instalments of the loans granted from the cancelled social fund shall be transferred to the Fund in the following period; This shall be done in the case of other revenue or expenditure related to the abolished Social Fund,
(f) in the case of the merger of health insurance undertakings, the balances of the accounts of the cancelled health insurance undertakings shall be transferred to the bank account of the newly created health insurance undertaking. This social fund shall also be transferred in the following period of repayment of the loans granted from the abolished social funds; This shall also be done in the case of other income or expenditure related to the social funds of cancelled health insurance undertakings,
(g) when the health insurance undertaking is wound up, the procedure laid down in Article 7 (4) shall be followed.
Investment Property Fund
(1) The source of the investment property fund of the health insurance undertaking is:
(a) property acquired from the funds of the capital reproductions fund at cost;
(b) capital goods taken over free of charge at the replacement cost;
(c) newly identified and unrecorded capital goods at replacement cost.
(2) The following shall be settled on the investment property fund of the health insurance undertaking:
(a) a reduction in the capital of the capital asset in the amount of the residual price of the capital asset when it is excluded from use as a result of wear, loss, impairment or sale;
(b) capital goods transferred free of charge;
(c) written-off costs for permanently discontinued investments;
(d) a reduction in the capital goods fund by the value of the accounting depreciation.
Capital reproductions fund
(1) A fund for the reproduction of capital goods by a health insurance company is used for the acquisition of capital goods by a health insurance company.
(2) The source of the fund for the reproduction of capital goods of a health insurance undertaking is:
(a) settlement of depreciation of all capital goods, including the residual price of the disposal assets, pursuant to Article 7 (3);
(b) a further transfer of funds from the operational fund on the basis of approval by the Board of Health Insurance,
(c) the transfer from the operational fund referred to in Article 3 (2) (i), equal to the positive difference between the sale and the balance price of the capital goods sold;
(d) a donation by the donor to strengthen the capital reproductions fund;
(e) following the approval of the Management Board, the grant of profits after tax from an activity subject to corporation tax intended to finance the capital goods of a health insurance company which will also be used for the activities of a health insurance company subject to corporate tax, operated in accordance with the health insurance scheme. The amount of the subsidy shall be calculated in proportion to the estimated use of the purchase price of the investment property in question. Similarly, the Military Health Insurance Corporation of the Czech Republic is making progress in calculating the State Budget subsidy from the Ministry of Defence chapter to cover the share of investment expenditure related to the creation and management of the preventive care fund and the health care brokerage fund,
(f) interest earned by the management of funds in the bank account of that fund;
(g) the balance of the capital reproductions fund of the merged or merged health insurance undertaking;
(h) the special-purpose subsidy from the State budget resulting from the contract concluded. 25)
(3) From the fund for the reproduction of capital goods of a health insurance company, the funds are drawn to:
(a) acquisition of capital goods, including advances provided;
(b) interest payments on loans used to purchase investments in connection with an approved health insurance plan;
(c) allocation to the operational fund, with the agreement of the Board of Directors of the health insurance undertaking;
(d) bank account fees and postal charges relating to this fund;
(e) the use of funds from the decision of the liquidator of the health insurance undertaking.
(4) The balance of the capital reproductions fund shall be transferred to the following financial year. The funds shall be kept in a separate bank account.
Limit of the cost of health insurance business
(1) The annual limit on the cost of the activities of a health insurance undertaking covered by the resources of the basic fund shall be determined on the basis of the funds received from insurance premiums for public health insurance after the reallocation, the proceeds of periodic penalty payments, fines, premiums and damages. The amount of the limit of funds constituting the sum of the allocations to the operational fund, the social fund and the capital reproductions fund shall be calculated according to the following formula:
L = PC: 100 × koef.
where:
| L | představuje limit nákladů na činnost zdravotní pojišťovny z prostředků veřejného zdravotního pojištění v Kč, |
| PC | představují příjmy v Kč za kalendářní rok z veřejného zdravotního pojištění po přerozdělení, z výnosu penále, pokut, přirážek k pojistnému a náhrad škod, |
| koef. | představuje koeficient v procentech zaokrouhlený na dvě desetinná místa a vypočtený podle vzorce |
coef. = -0,66 / 10550 × p + 4 + 0,66 / 10550 × 50,
where:
| p | představuje jednu tisícinu průměrného počtu pojištěnců propočteného z měsíčních údajů pro přerozdělování za hodnocené období zaokrouhlenou směrem nahoru na celé číslo. |
(2) The limit of the cost of the health insurance undertaking's activities referred to in paragraph 1 shall include the funds to be allocated to the social fund as provided for in Article 4 (2) (a), the allocation to the reproduction fund as provided for in Article 6 (2) (a) and the balance of the total allocation remaining in the operational fund.
(3) The allocation of funds to the operating cost limit shall be carried out as follows:
(a) the total limit L shall be settled as an allocation to the operational fund;
(b) an allocation of the basic allocation calculated in accordance with Article 4 (2) (a) shall be transferred from the operational fund to the social fund at the same time as an allocation of the value of the accounting depreciation, including the residual value of the discarded assets for the financial year in question, to the resources of the reproductions fund;
(c) the balance of the funds from the total allocation L following the implementation of the allocations referred to in (b) shall constitute the own allocation to the operational fund.
(4) In the case of a health insurance undertaking in liquidation, the calculation of the operating costs limit referred to in paragraphs 1 to 3 and in Article 3 (5) shall be interrupted on the date of commencement of the liquidation. No allocation to the social fund and the capital reproduction fund shall be made for a further period. The basic fund shall be transferred to the operational fund only to the extent necessary to ensure the operation of the liquidated health insurance undertaking, as decided by the liquidator or insolvency administrator, where the bankruptcy of the health insurance undertaking is declared. The amount and purpose of the operational fund expenditure shall be checked in the context of the management control of the health insurance undertaking in liquidation. 27)
(5) The annual limit on the cost of the operation of the Military Health Insurance Corporation of the Czech Republic, determined in accordance with paragraph 1, does not include expenditure paid by means of an exceptional allocation from the basic fund to the operational fund in accordance with Paragraph 1 (4) (i). In the context of the evaluation of the annual report of the Military Health Insurance Corporation of the Czech Republic, this expenditure shall be calculated separately and the authorised amount shall be proposed by the Ministry of Health in agreement with the Ministry of Finance for approval by the Government. 28)
Transitional provision
The initial balances of the public health insurance funds on 1 January 1999 shall be made up of the final balances of all funds of health insurance undertakings, with the exception of funds arising exclusively from the profit or loss after tax, adjusted for the outstanding amounts of commitments, claims, dubious accounts, financial investments, accruals and off-balance-sheet accounts in accordance with the transfer bridge between the business account schedule and the health insurance account schedule. The initial balance of the investment property fund on 1 January 1999 expresses the total value of all the assets of the health insurance undertaking at outstanding prices.
Repeal
Decree No 301 / 1997 Coll., setting out the maximum amount of the activity costs and the maximum amount of expenditure on the acquisition of tangible and intangible property by health insurance undertakings, is hereby repealed.
Efficacy
This Decree shall take effect on 1 January 1999.
Minister:
Mgr. Svoboda v. r.
1) Act No. 592 / 1992 Coll., on Insurance for General Health Insurance, as amended by Act No. 10 / 1993 Coll., Act No. 15 / 1993 Coll., Act No. 161 / 1993 Coll., Act No. 324 / 1993 Coll., Act No. 42 / 1994 Coll., Act No. 241 / 1994 Coll., Act No. 59 / 1995 Coll., Act No. 149 / 1996 Coll., Act No. 48 / 1997 Coll. and Act No. 127 / 1998 Coll.
2) Article 21 (5) of Act No. 592 / 1992 Coll., as amended by Act No. 324 / 1993 Coll., Act No. 59 / 1995 Coll. and Act No. 149 / 1996 Coll.
3) § 55 of Act No. 48 / 1997 Coll., on Public Health Insurance and on the amendment and addition of certain related laws.
4) Article 17 of Act No. 48 / 1997 Coll., as amended by Act No. 2 / 1998 Coll.
5) Article 6 of Act No. 280 / 1992 Coll., on departmental, branch, corporate and other health insurance companies, as amended by Act No. 149 / 1996 Coll.
6) Article 13 of Act No. 280 / 1992 Coll., as amended by Act No. 60 / 1995 Coll., Act No. 149 / 1996 Coll., Act No. 48 / 1997 Coll. and Act No. 127 / 1998 Coll.
7) Act No. 551 / 1991 Coll., as amended by Act No. 592 / 1992 Coll., Act No. 10 / 1992 Coll., Act No. 60 / 1995 Coll., Act No. 149 / 1996 Coll., Act No. 48 / 1997 Coll., Act No. 305 / 1997 Coll., Act No. 93 / 1998 Coll. and Act No. 127 / 1998 Coll.
8) Paragraph 18 (1) of Act No. 592 / 1992 Coll., as amended by Act No. 161 / 1993 Coll. and Act No. 59 / 1995 Coll.
9) Sections 44 and 45 of Act No. 48 / 1997 Coll. § 26 of Act No. 592 / 1992 Coll.
10) Paragraph 18 (1) of Act No. 280 / 1992 Coll., as amended by Act No. 60 / 1995 Coll. and Act No. 149 / 1996 Coll.
11) § 17 of Act No. 48 / 1997 Coll., as amended by Act No. 2 / 1998 Coll. § 40 of Act No. 48 / 1997 Coll.
12) Article 14 of Act No. 592 / 1992 Coll., as amended by Act No. 161 / 1993 Coll., Act No. 324 / 1993 Coll. and Act No. 59 / 1995 Coll.
13) § 14 of Act No. 48 / 1997 Coll.
13a) For example, Act No. 148 / 1998 Coll., on the Protection of classified information and on the amendment of certain laws, as amended by Act No. 164 / 1999 Coll.
14) § 26c of Act No. 592 / 1992 Coll., as amended by Act No. 127 / 1998 Coll.
15) § 22a of Act No. 280 / 1992 Coll., as amended by Act No. 48 / 1997 Coll.
16) Article 4a of Act No. 280 / 1992 Coll., as amended by Act No. 60 / 1995 Coll. and Act No. 149 / 1996 Coll.
17) § 7 of Act No. 551 / 1991 Coll., as amended by Act No. 60 / 1995 Coll. and Act No. 149 / 1996 Coll. § 18 of Act No. 280 / 1992 Coll., as amended by Act No. 60 / 1995 Coll. and Act No. 149 / 1996 Coll.
18) Paragraph 6a (3) of Act No. 280 / 1992 Coll., as amended by Act No. 149 / 1996 Coll. and Act No. 127 / 1998 Coll.
19) Act No. 280 / 1992 Coll., as amended by Act No. 10 / 1993 Coll., Act No. 15 / 1993 Coll., Act No. 60 / 1995 Coll., Act No. 149 / 1996 Coll., Act No. 48 / 1997 Coll., Act No. 93 / 1998 Coll. and Act No. 127 / 1998 Coll.
20) For example, § 18 (2) of Act No. 592 / 1992 Coll., as amended by Act No. 161 / 1993 Coll., Act No. 59 / 1995 Coll., § 20 (3) of Act No. 592 / 1992 Coll., as amended by Act No. 59 / 1995 Coll., § 23a of Act No. 280 / 1992 Coll., as amended by Act No. 60 / 1995 Coll. and Act No. 149 / 1996 Coll. and § 24b of Act No. 551 / 1991 Coll., as amended by Act No. 60 / 1995 Coll.
21) For example, § 17 of Act No. 48 / 1997 Coll., as amended by Act No. 2 / 1998 Coll. and § 40 of Act No. 48 / 1997 Coll.
22) For example, § 54 of Act No. 48 / 1997 Coll.
22a) Decree No. 41 / 2000 Coll., laying down detailed conditions for the creation and use of funds of the Military Health Insurance Agency of the Czech Republic for the reimbursement of medical care paid in excess of the public health insurance from the State Budget of the Ministry of Defence.
23) Act No. 185 / 1991 Coll., on Insurance, as amended by Act No. 320 / 1993 Coll., Act No. 60 / 1995 Coll. and Act No. 149 / 1995 Coll.
24) § 7 (4) of Act No. 551 / 1991 Coll., as amended by Act No. 127 / 1998 Coll. § 16 (5) of Act No. 280 / 1992 Coll., as amended by Act No. 127 / 1998 Coll.
25) For example Act No. 300 / 1992 Coll., on State aid for research and development, as amended by Act No. 1 / 1995 Coll.
26) Paragraph 19 (1) of Act No. 280 / 1992 Coll., as amended by Act No. 127 / 1998 Coll.
27) Paragraph 7 (1) of Act No. 280 / 1992 Coll., as amended by Act No. 60 / 1995 Coll. and Act No. 149 / 1996 Coll.
28) Paragraph 15 (2) of Act No. 280 / 1992 Coll., as amended.
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Regulation Information
| Citation | Decree of the Ministry of Finance No. 227 / 1998 Coll., which provides for a more detailed definition of the heading and amount of the income and expenditure of public health insurance funds of health insurance companies, the conditions for their creation, use, admissibility of transfers of funds and their management, the limit of the cost of the activities of health insurance companies covered by the resources of the basic fund, including the procedure for calculating this limit |
|---|---|
| Regulation Type | Order |
| Author | - |
| Collection | Code of Laws |
| Date of Promulgation | 07.10.1998 |
|---|---|
| Effective from | 01.01.1999 |
| Effective until | - |
| Status | Valid |
The regulation text is for informational purposes only.
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