Opinion of the Advocate General — ECLI:EU:C:2003:43
Date: 2003-01-21
Based on: Treaty establishing the European Economic Community (1957)
Subject matter: Freedom to provide services;Social security for migrant workers
Procedure: Reference for a preliminary ruling
Origin: France

Summary of the Judgment 
1. Social security for migrant workers — Sickness insurance — Benefits in kind 
provided in another Member State — Article 22(1)(c)(i) of Regulation 
No 1408/71 — Consistency with Articles 49 EC and SO EC 
(Arts 49 EC and SO EC; Council Regulation No 1408/71, Art. 22(1)(c)(i)) 
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SUMMARY — CASE C-56/01 
2. Social security for migrant workers — Sickness insurance — Benefits in kind 
provided in another Member State — Second subparagraph of Article 22(2) of 
Regulation No 1408/71 — Scope 
(Council Regulation No 1408/71, Art. 22(2), second subpara.) 
3. Freedom to provide services — Restrictions — National rules on reimbursement of 
medical costs incurred in another Member State — Treatment provided in a 
hospital — Requirement of prior authorisation from the insurance fund in the 
Member State in which the person concerned is insured — Grant subject to a 
requirement that the treatment must be necessary — Whether permissible 
(Arts 49 EC and 50 EC) 
1. Art ic le 22(1)(c)( i ) of Regu la t ion 
No 1408/71, as amended and updated 
by Regulat ion N o 118/97, which 
makes the grant of benefits in kind in 
a Member State other than that in 
which the person concerned is insured 
subject to prior authorisation by the 
competent institution, is consistent 
with Articles 49 EC and 50 EC since, 
by guaranteeing that insured persons 
covered by the legislation of one 
Member State and granted authori­
sation have access to treatment in the 
other Member States on conditions of 
reimbursement as favourable as those 
enjoyed by insured persons covered by 
the legislation of those other States, it 
helps to facilitate the free movement of 
insured persons and the cross-border 
provision of medical services. 
(see paras 15, 2 1 , 25, 60, operative part 1) 
2. T h e s e c o n d s u b p a r a g r a p h of 
A r t i c l e 2 2 ( 2 ) of R e g u l a t i o n 
N o 1408/71, as amended and updated 
by Regulation No 118/97, must be 
interpreted as meaning that the auth­
orisation to go to another Member 
State to receive treatment to which that 
provision refers may not be refused 
where it is apparent, first, that the 
treatment in question is among the 
benefits provided for by the legislation 
of the Member State on whose territory 
the person concerned resides and, sec­
ondly, that treatment which is the same 
or equally effective cannot be obtained 
without undue delay in that Member 
State. 
In that connection, in order to deter­
mine whether that second condition is 
met, the competent ins t i tu t ion is 
required to have regard to all the 
circumstances of each specific case 
and to take due account not only of 
the patient's medical condition at the 
time when authorisation is sought and, 
where appropriate, of the degree of 
pain or the nature of the patient's 
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INIZAN 
disability which might, for example, 
make it impossible or extremely dif­
ficult for him to carry out a professional 
activity, but also of his medical history. 
(see paras 45-46, 60 operative part 2) 
3. Articles 49 EC and 50 EC must be 
interpreted as not precluding legis­
lation of a Member State which, first, 
makes reimbursement of the cost of 
hospital care provided in a Member 
State other than that in which the 
insured person's sickness fund is estab­
lished conditional upon prior authori­
sation by that fund and, secondly, 
makes the grant of that authorisation 
subject to the condition that it be 
established that the insured person 
could not receive within the territory 
of the Member State where the fund is 
established the treatment appropriate 
to his condition. However, authori­
sation may be refused on that ground 
only if treatment which is the same or 
equally effective for the patient can be 
obtained without undue delay in the 
territory of the Member State in which 
he resides. 
(see para. 60, operative part 3) 
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