Keywords

Summary



Keywords

1. Social security for migrant workers - Sickness insurance - Benefits in kind provided in another Member State - Article 22 of Regulation No 1408/71 - Refusal of authorisation unfounded - Reimbursement by the competent State of costs incurred in connection with treatment provided in another State - Determination of the amount of reimbursement in accordance with the provisions in force in the State in which the treatment was given - Freedom to provide services - Obligation to make additional reimbursement covering any difference between that amount and that resulting from the application of the provisions in force in the competent State

(EC Treaty, Art. 59 (now, after amendment, Art. 49 EC); Council Regulation No 1408/71, Art. 22)

2. Social security for migrant workers - Sickness insurance - Benefits in kind provided in another Member State - Article 36 of Regulation No 1408/71 - Scope - Right to reimbursement of all costs incurred - Excluded

(Council Regulation No 1408/71, Art. 36)

Summary

1. Article 22(1)(c) and (i) of Regulation No 1408/71, in the version amended and updated by Council Regulation (EEC) No 2001/83, is to be interpreted as meaning that, when an insured person has been authorised by the competent institution to go to another Member State for treatment, the institution of the place where the treatment is provided is required to provide him with benefits in kind in accordance with the rules on assumption of the costs of health care which the latter administers, as if the person concerned were registered with it.

Where the request of an insured person for authorisation on the basis of Article 22(1)(c) of that regulation has been refused by the competent institution and it is subsequently established that such refusal was unfounded, the person concerned is entitled to be reimbursed directly by the competent institution by an amount equivalent to that which would have been borne by the institution of the place of stay under the rules laid down by the legislation applied by the latter institution if authorisation had been properly granted in the first place.

As Article 22 of that regulation is not intended to regulate any reimbursement at the tariffs in force in the Member State of registration, it does not have the effect of preventing or prescribing payment by that State of additional reimbursement covering the difference between the system of cover laid down by the legislation of that State and the system applied by the Member State of stay, where the former is more advantageous than the latter and such reimbursement is provided for by the legislation of the Member State of registration.

Article 59 of the EC Treaty (now, after amendment, Article 49 EC) is to be interpreted as meaning that, if the reimbursement of costs incurred on hospital services provided in a Member State of stay, calculated under the rules in force in that State, is less than the amount which application of the legislation in force in the Member State of registration would afford to a person receiving hospital treatment in that State, additional reimbursement covering that difference must be granted to the insured person by the competent institution.

( see para. 53, and operative part 1 )

2. Article 36 of Regulation No 1408/71, in the version amended and updated by Regulation No 2001/83, cannot be interpreted as meaning that it follows from that provision that a covered person who has requested authorisation on the basis of Article 22(1)(c) of that regulation and been refused by the competent institution is entitled to reimbursement of all the medical costs which he incurred in the Member State in which he received treatment once it is established that the rejection of his request for authorisation was unfounded.

( see para. 56, and operative part 2 )