Judgment — ECLI:EU:C:1998:171
Date: 1998-04-28
Language of the case: French
Court formation: Full Court
Based on: Treaty establishing the European Economic Community (1957)
Subject matter: Freedom to provide services
Concepts: Stay or residence outside the competent Member State;General;The various services
Procedure: Reference for a preliminary ruling
Origin: Luxembourg

Summary of the Judgment 
1. Social security for migrant workers — Powers of the Member States to organise their social 
security systems — Limits — Compliance with Community law — Treaty rules on freedom to 
provide services 
(EC Treaty, Arts 59 and 60) 
I -1931 
SUMMARY — CASE C-158/96 
2. Social security for migrant workers — Sickness insurance — Benefits provided in another 
Member State — Article 22 of Reguhtion No 1408/71 — Scope — Reimbursement by the 
Member States, at the tariffs in force in the competent State, of costs incurred in connection 
with treatment provided in another Member State — Whether excluded 
(Council Regulation No 1408/71, Art. 22) 
3. Freedom to provide services — Restrictions — National rules on reimbursement of medical 
expenses incurred in another Member State — Dental treatment — Requirement of prior 
authorisation by the sodai security institution of the State of insurance — Not permissible — 
Justification — Control of health expenditure — Protection of public health — None 
(EC Treaty, Arts 56, 59 and 60) 
1. The fact that national rules fall within the 
sphere of social security cannot exclude 
the application of Articles 59 and 60 of 
the Treaty. 
While Community law does not detract 
from the powers of the Member States to 
organise their social security systems, 
they must nevertheless comply with 
Community law when exercising those 
powers. 
2. Article 22 of Regulation N o 1408/71 is 
intended to allow an insured person, 
authorised by the competent institution 
to go to another Member State to receive 
there treatment appropriate to his con­
dition, to receive sickness benefits in 
kind, on account of the competent insti­
tution but in accordance with the provi­
sions of the legislation of the State in 
which the services are provided, in par­
ticular where the need for the transfer 
arises because of the state of health of the 
person concerned, without that person 
incurring additional expenditure. It is not 
intended to regulate and hence does not 
in any way prevent the reimbursement by 
Member States, at the tariffs in force in 
the competent State, of costs incurred in 
connection with treatment provided in 
another Member State, even without 
prior authorisation. 
3. Articles 59 and 60 of the Treaty preclude 
national rules under which reimburse­
ment, in accordance with the scale of the 
State of insurance, of the cost of dental 
treatment provided by an orthodontist 
established in another Member State is 
subject to authorisation by the insured 
person's social security institution. 
Such rules deter insured persons from 
approaching providers of medical services 
established in another Member State and 
I - 1932 
KOHLL v UNION DES CAISSES DE MALADIE 
constitute, tor them and their patients, a 
barrier to freedom to provide services. 
They are not justified by the risk of seri­
ously undermining the financial balance 
of the social security system, since reim­
bursement of the costs of dental treat­
ment provided in other Member States in 
accordance with the tariff of the State of 
insurance has no significant effect on the 
financing of the social security system, 
nor are they justified on grounds of 
public health within the meaning of 
Articles 55 and 66 of the Treaty in order 
to protect the quality of medical services 
provided to insured persons in other 
Member States and to maintain a bal­
anced medical and hospital service open 
to all. Since the conditions for taking up 
and pursuing the profession of doctor 
and dentist have been the subject of sev­
eral coordinating or harmonising direc­
tives, doctors and dentists established in 
other Member States must be afforded all 
guarantees equivalent to those accorded 
to doctors and dentists established on 
national territory, for the purposes of 
freedom to provide services. It has not 
been argued that such rules are indispens­
able for the maintenance of an essential 
treatment facility or medical service on 
the national territory of that Member 
State. 
I - 1933