Keywords

Summary



Keywords

1. Social security for migrant workers — Sickness insurance — Pensioners and members of their family residing in a Member State other than the State liable for payment of the pension — Medical costs incurred in the Member State liable for payment of the pension — Assumption of responsibility by the Member State of residence — Conditions — (Council Regulation No 1408/71, Art. 22(1)(c)(i), and Art. 28; Council Regulation No 574/72, Art. 29)

2. Social security for migrant workers — Sickness insurance — Pensioners and members of their family residing in a Member State other than the State liable for payment of the pension — Institution competent to issue the prior authorisation necessary to go to another Member State in order to receive appropriate treatment there — Institution of the place of residence — (Council Regulation No 1408/71, Art. 22(1)(c)(i) and Art. 28)

Summary

1. Article 22(1)(c)(i) of Regulation No 1408/71, as amended and updated by Regulation No 2001/83, governs the entitlement to benefits in kind of pensioners and members of their family who, while residing in one Member State, apply to the competent institution for authorisation to go to the territory of another Member State in order to receive medical treatment there which is appropriate to their condition. That provision must be interpreted as also applying to socially insured persons in the above category who reside in a Member State other than the one which is liable for payment of that pension, and who benefit on that basis, following their registration with the institution of the place of residence, from the system laid down by Article 28 of that regulation, where those socially insured persons wish to go to the Member State liable for payment of the pension in order to receive medical treatment there.

Once a pensioner and the members of his family have subscribed to the system established by Article 28 of Regulation No 1408/71 by registering with the institution of the place of residence as Article 29 of Regulation No 574/72 requires, then, as the wording itself of Article 28 makes clear, that pensioner enjoys, for himself and his family, a right to benefits in kind provided as if the person concerned held a pension under the legislation of the Member State on whose territory he resides and were entitled to benefits in kind by virtue of that legislation. It follows that that institution and the Member State of residence become, for those socially insured persons, by reason of this legal fiction and the assimilation resulting therefrom, the competent institution and the competent State as regards the granting of those benefits. There is therefore nothing to prevent those socially insured persons who thus benefit from the system provided for in Article 28 of Regulation No 1408/71 from being made subject to Article 22(1)(c)(i) of that regulation, since those persons satisfy, as that latter provision requires, the conditions imposed by the legislation of the competent State, namely the Member State of their residence, for entitlement to benefits. Their movement to another Member State for the purposes of receiving benefits in kind guaranteed by that provision falls within the provisions of the latter, including where the movement in question is to the Member State liable for payment of the pension.

see paras 36, 40, 47-49, 51, operative part 1

2. The institution competent to issue the prior authorisation necessary in order to go to another Member State to receive appropriate medical treatment there, mentioned in Article 22(1)(c)(i) of Regulation No 1408/71 as amended and updated by Regulation No 2001/83, where the application for authorisation concerns a pensioner or members of his family who reside in a Member State other than the one which is liable for payment of that pension and who benefit, on that basis, following their registration with the institution of the place of residence, from the system provided for in Article 28 of that regulation is the institution of the place of residence of the persons concerned.

see para. 56, operative part 2