WRITTEN QUESTION E-2898/97 by Bartho Pronk (PPE) to the Commission (17 September 1997)

Subject: Sickness insurance in the European Union

Privately insured persons in the Netherlands have no right, on moving within the European Union, to form E-111 for urgent medical treatment in another Member State on the basis of Annex VI to Regulation 1408/71 ((OJ L 149, 5.7.1971, p. 2. )) (application of social security rules to employees and self-employed persons and members of their families moving within the Community).

1. Is it true that in Sweden, where a national sickness insurance scheme applies, other EU nationals to whom medical treatment is provided are expected, regardless of whether or not they are privately insured in their Member State of origin or are covered by the national scheme, to produce a form E-111?

2. In what other EU Member States operating a national sickness insurance scheme is form E-111 asked for when medical treatment is provided?

3. To what extent are those who are unable to produce a form E-111 - because, for instance, they cannot obtain one - required to pay for medical treatment at a price higher than that required to cover the cost price?

4. a) Are privately insured Netherlands nationals being denied their right to free movement pursuant to Articles 7a, 8a and 51 of the Treaty on European Union because they have no right to reimbursement for urgent medical treatment when staying in another Member State where a national sickness insurance scheme is in operation?

b) Does this not amount to a loophole in the European Union's social security legislation?

Answer given by Mr Flynn on behalf of the Commission (10 November 1997)

The Commission would like first of all to draw the Honourable Member's attention to the fact that Form E 111 is issued in compliance with the provisions of Regulation (EEC) No 1408/71 and Regulation (EEC) 574/72 ((These Regulations were updated by Regulation (EC) No 118/97 of 2 December 1996 amending and updating Regulation (EEC) No 1408/71 on the application of social security schemes to employed persons, to slf-employed persons and to members of their families moving within the Community and Regulation (EEC) No 574/72 laying down the procedure for implementing Regulation (EEC) No 1408/71 - OJ L 28, 30.1.1997. )) to persons who are insured for health care under the legislation of a Member State. The form attests this insurance and the right of the holder, inter alia, to receive health care benefits in kind, on behalf of the Member State in which that person is insured, from the Member State on whose territory he is staying temporarily and in accordance with the legislation applied by it (application of Articles 22 and 22a of Regulation No 1408/71). The Member State which provided the benefits may ask the Member State in which the person is insured to refund the actual costs it has incurred (application of Article 93 of Regulation (EEC) No 574/72). This system applies only to statutory insurance and not to private insurance.

On the basis of this information, the Commission can give the following answers to the various questions raised by the Honourable Member.

1. According to the information available to the Commission, the Swedish authorities require Form E 111 from any person who wishes to receive health care in Sweden, is staying temporarily in that country and is insured in another Member State. However, only those people insured under a statutory scheme will be able to provide this form and to invoke the above-mentioned provisions of Community law.

2. The Commission would point out that a Member State is entitled to ask a person who is staying temporarily on its territory to provide Form E 111 even if the Member State concerned has a national health service. It is true that certain Member States do not ask for this form in certain situations, but this means that they prefer not to use the system of refunds between Member States provided for by Regulation (EEC) No 574/72.

3. The Commission has no precise information on the costs of health care charged to persons who do not have Form E 111.

4. The Commission believes that the question of the geographical coverage of private health insurance is governed by the contract between the private insurer and the person insured.

However, the Commission is currently considering whether the private insurance schemes in the Netherlands could not be considered to be statutory in the light of the recent amendments to legislation in this Member State. If so, these schemes would come under the scope of the above-mentioned provisions.