Keywords

Summary



Keywords

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 50 EC — (Arts 49 EC and 50 EC; Council Regulation No 1408/71, Art. 22(1)(c)(i))

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)

Summary

1. Article 22(1)(c)(i) of Regulation No 1408/71, as amended and updated by Regulation No 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 authorisation 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, 21, 25, 60, operative part 1

2. The second subparagraph of Article 22(2) of Regulation No 1408/71, as amended and updated by Regulation No 118/97, must be interpreted as meaning that the authorisation 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, secondly, 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 determine whether that second condition is met, the competent institution 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 disability which might, for example, make it impossible or extremely difficult 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 legislation 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 established conditional upon prior authorisation 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, authorisation 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