Judgment of the Court of 13 May 2003 in Case C-385/99 (Reference for a preliminary ruling from the Centrale Raad van Beroep): V.G. Müller-Fauré v Onderlinge Waarborgmaatschappĳ OZ Zorgverzekeringen UA, and between E.E.M. van Riet and Onderlinge Waarborgmaatschappĳ ZAO Zorgverzekeringen (Freedom to provide services — Articles 59 of the EC Treaty (now, after amendment, Article 49 EC) and 60 of the EC Treaty (now Article 50 EC) — Sickness insurance — System providing benefits in kind — System ofagreements — Medical costs incurred in another Member State — Prior authorisation — Criteria — Justification)
Date: 2003-07-05
Institutions: Court of Justice
Subjects: EU national, Netherlands, health insurance, interpretation of the law, residence, social security

5.7.2003

EN

Official Journal of the European Union

C 158/1

I

(Information)

COURT OF JUSTICE

COURT OF JUSTICE

JUDGMENT OF THE COURT

of 13 May 2003

F. Macken, N. Colneric, S. von Bahr and J.N. Cunha Rodrigues,
Judges; D. Ruiz-Jarabo Colomer, Advocate General; H.A. Rühl,
Principal Administrator, for the Registrar, has given a judgment
on 13 May 2003, in which it has ruled:

in Case C-385/99 (Reference for a preliminary ruling from
the Centrale Raad van Beroep): V.G. Müller-Fauré v
Onderlinge Waarborgmaatschappij OZ Zorgverzekering-
en UA, and between E.E.M. van Riet and Onderlinge
Waarborgmaatschappij ZAO Zorgverzekeringen (1)

(Freedom to provide services — Articles 59 of the EC Treaty
(now, after amendment, Article 49 EC) and 60 of the EC
Treaty (now Article 50 EC) — Sickness insurance — System
providing benefits in kind — System ofagreements —
Medical costs incurred in another Member State — Prior
authorisation — Criteria — Justification)

(2003/C 158/01)

(Language of the case: Dutch)

(Provisional translation; the definitive translation will be published
in the European Court Reports)

In Case C-385/99: Reference to the Court under Article 234
EC by the Centrale Raad van Beroep (Netherlands)
for a
preliminary ruling in the proceedings pending before that
court between V.G. Müller-Fauré and Onderlinge Waarborg-
and between
maatschappij OZ Zorgverzekeringen UA,
E.E.M. van Riet and Onderlinge Waarborgmaatschappij ZAO
Zorgverzekeringen, on the interpretation of Article 59 of the
EC Treaty (now, after amendment, Article 49 EC) and
Article 60 of the EC Treaty (now Article 50 EC), the Court,
composed of: G.C. Rodríguez Iglesias, President, M. Wathelet
(Rapporteur) R. Schintgen and C.W.A. Timmermans (Presi-
dents of Chambers), D.A.O. Edward, A. La Pergola, P. Jann,

— Article 59 of

the EC Treaty (now, after amendment,
the EC Treaty (now
Article 49 EC) and Article 60 of
Article 50 EC) must be interpreted as not precluding legislation
of a Member State, such as that at
issue in the main
proceedings, which (i) makes the assumption of the costs of
hospital care provided in a Member State other than that in
which the insured person’s sickness fund is established, by a
provider with which that fund has not concluded an agreement,
conditional upon prior authorisation by the fund and (ii) makes
the grant of that authorisation subject to the condition that
such action is necessary for the insured person’s health care.
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 an establishment which
has concluded an agreement with the fund;

— by contrast, Articles 59 and 60 of the Treaty do preclude the
same legislation in so far as it makes the assumption of the
costs of non-hospital care provided in another Member State by
a person or establishment with whom or which the insured
person’s sickness fund has not concluded an agreement con-
ditional upon prior authorisation by the fund, even when the
national legislation concerned sets up a system of benefits in kind
under which insured persons are entitled not to reimbursement of
costs incurred for medical treatment, but to the treatment itself
which is provided free of charge.

(1) OJ C 20 of 22.1.2002.