WRITTEN QUESTION E-2780/02

by Luigi Cocilovo (PPE-DE) to the Commission

(3 October 2002)

Subject: Medical treatment during a stay in a Member State other than that of residence. Articles 22 and 31 of Regulation (EEC) No 1408/71

According to Article 22 of Council Regulation (EEC) No 1408/71(1) payment of the costs of medical and hospital treatment carried out in another EU Member State is dependent on prior authorisation by the competent insurance institution in the country of residence. As a rule this provision applies to all citizens, according to conditions laid down in various Court of Justice judgments.

Article 31 of the same Regulation appears to make an exception for pensioners and annuity holders. If they are staying in a Member State other than the one in which they reside but from which they receive a pension or annuity, they are entitled to medical treatment in accordance with the legislation of the country in which they are staying, whether or not it has been authorised by the insurance institution in the country of residence.

Can the Commission confirm this interpretation of Article 31? In its answer, can it consider the case of a citizen, resident in Italy, who receives a pension paid by both Belgium and Italy. If the pensioner, who has travelled to Belgium to visit his children and has with him form E 111 rather than E 113 or E 121, needs specialised treatment, is he authorised to receive it under the same terms as a pensioner resident in Belgium, i.e. benefiting from the preferential refunds provided for pensioners?

(1) OJ L 149, 5.7.1971, p. 2.

Answer given by Mrs Diamantopoulou on behalf of the Commission

(15 November 2002)

The Commission would like to inform the Honourable Member that the Community Regulation to which he refers, Regulation (EEC) No 1408/71(1), contains a specific section on sickness and maternity benefits and sets out three different situations in which health care may be obtained outside the Member State in which the person has health care insurance:

- where the person is resident in another Member State (Articles 19 and 20 of Regulation (EEC) No 1408/71 relate to workers, for example frontier workers, and Articles 27 to 30 of this Regulation relate to pensioners);

- during a visit to another Member State for reasons other than medical (Article 22(1)(a) of Regulation (EEC) No 1408/71 applies to workers and Article 31 of Regulation (EEC) No 1408/71 relates specifically to pensioners);

- where a person goes to another Member State specifically to receive treatment (Article 22(1)(c) of Regulation (EEC) No 1408/71). This provision applies to both workers and pensioners.

In principle, in these three situations, responsibility for the cost of health care received in a Member State other than the State providing insurance is determined by the legislation of the State in which the treatment has been provided (whether it is the country of residence or the country being visited).

The Honourable Member is comparing two different situations: he refers to the provisions of Article 22(1)(c), which relates to the question of authorisation to go abroad for the purpose of receiving medical care, and Article 31, which relates to pensioners staying temporarily in another Member State for reasons other than medical care (for example holidays, family visits, etc.).

The provisions of Article 22(1)(c) of Regulation (EEC) No 1408/71 relating to workers (ruling of the Court of Justice of the European Communities, 31 May 1979, in Case C-182/78 Pierik II) also apply to pensioners wishing to travel abroad to receive health care. This means that pensioners, like workers, need to obtain prior authorisation from the health insurance institution.

However, with regard to health care received during a visit for reasons other than medical care, a specific provision in Article 31 of Regulation (EEC) No 1408/71 offers them better cover than that provided for workers (Article 22(1)(a) of Regulation (EEC) No 1408/71).

In fact, Article 22(1)(a) of Regulation (EEC) No 1408/71 entitles most insured persons to emergency health care, while pensioners visiting a Member State other than the State of residence, as tourists or for family or other reasons, are entitled to all necessary treatment, emergency and other, during their stay in this State.

(1) Regulation (EEC) No 1408/71 of the Council of 14 June 1971 on the application of social security schemes to employed persons and their families moving within the Community, OJ L 149, 5.7.1971.