Regulation (EC) No 631/2004 of the European Parliament and of the Council of 31 March 2004 amending Council Regulation (EEC) No 1408/71 on the application of social security schemes to employed persons, to self-employed persons and to members of their families moving within the Community, and Council Regulation (EEC) No 574/72 laying down the procedure for implementing Regulation (EEC) No 1408/71, in respect of the alignment of rights and the simplification of procedures (Text with relevance for the EEA and for Switzerland)
Date: 2004-03-31
Institutions: Council of the European Union, European Parliament
Subjects: simplification of formalities, social legislation, social-security benefit, social-security harmonisation, worker (EU)

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I

(Acts whose publication is obligatory)

REGULATION (EC) No 631/2004 OF THE EUROPEAN PARLIAMENT AND OF THE COUNCIL

of 31 March 2004

amending Council Regulation (EEC) No 1408/71 on the application of social security schemes to
employed persons, to self-employed persons and to members of their families moving within the
Community, and Council Regulation (EEC) No 574/72 laying down the procedure for imple-
menting Regulation (EEC) No 1408/71, in respect of the alignment of rights and the simplification
of procedures

(Text with relevance for the EEA and for Switzerland)

THE EUROPEAN PARLIAMENT AND THE COUNCIL OF THE EURO-
PEAN UNION,

(3)

Having regard to the Treaty establishing the European Com-
munity, and in particular Articles 42 and 308 thereof,

Having regard to the Conclusions of the Barcelona European
Council of 15 and 16 March 2002 concerning the creation of a
European Health Insurance Card,

Having regard to the proposal from the Commission,

Having regard to the opinion of the European Economic and
Social Committee (1),

After consulting the Committee of the Regions,

Acting in accordance with the procedure laid down in Article
251 of the Treaty (2),

Whereas:

Regulation (EEC) No 1408/71 currently provides for
access to different types of benefits in kind during a
temporary stay in a Member State other than the compe-
tent State or the State of residence, depending on the
category to which the insured person belongs, and
draws a distinction between ‘immediately necessary care’
and ‘necessary care’. For greater protection for insured
persons, provision should be made to bring into line the
rights of all insured persons in respect of access to bene-
fits in kind during a temporary stay in a Member State
other than the State in which the person concerned is
insured or resident.
insured
persons shall be entitled to the benefits in kind which
become necessary on medical grounds during their stay
in the territory of another Member State, taking account
of the nature of the benefits and the expected length of
the stay.

In these conditions, all

According to the conclusions of the Barcelona European
Council of 15 and 16 March 2002 a European Health
Insurance Card would replace the current paper forms
needed for health treatment in another Member State.
The Commission was called on to present a proposal to
that effect before the Spring European Council of 2003.
Such a card would simplify procedures.

(4)

It is essential that all measures be taken to ensure the
in all
implementation of Article 22(1)(a)(i)
proper
Member States with particular reference to care provi-
ders.

insured persons and institutions,

To attain and even surpass this objective by optimising
the advantages offered by the European Health Insurance
Card for
certain
changes to Council Regulation (EEC) No 1408/71 of 14
June 1971 on the application of social security schemes
to employed persons, self-employed persons and their
families moving within the Community (3) are necessary.

(5)

(1) OJ C 32, 5.2.2004, p. 78.
(2) Opinion of the European Parliament of 4 December 2003 and Deci-

sion of the Council of 4 March 2004.

(3) OJ L 149, 5.7.1971, p. 2. Regulation as consolidated by Regulation
(EC) No 118/97 (OJ L 28, 30.1.1997, p. 1) and last amended by
Regulation (EC) No 1386/2001 of the European Parliament and of
the Council (OJ L 187, 10.7.2001, p. 1).

For certain types of continuous treatment requiring a
specific infrastructure, such as dialysis, it is essential for
the patient that the treatment be available during his
stay in another Member State. In this connection, the
Administrative Commission establishes a list of the bene-
fits in kind that are subject to prior agreement between
the insured person and the institution providing the
treatment in order to guarantee the availability of the
care and the insured person's freedom to stay tempora-
rily in another Member State.

(1)

(2)

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(6)

(7)

(8)

(9)

Access to benefits in kind during a temporary stay in
another Member State is granted, in principle, on presen-
tation of the appropriate form provided for by Regu-
lation (EEC) No 574/72 of the Council of 21 March
1972 laying down the procedure for
implementing
Regulation (EEC) No 1408/71 (1). Certain Member States
still require — formally, even if not in practice — the
completion of extra formalities on arrival in their terri-
tory. These requirements, specifically the obligation to
submit systematically and in advance a certified state-
ment to the institution of the place of stay certifying
entitlement to benefits in kind, appear today to be need-
lessly restrictive and of a nature to hamper the free
movement of the persons concerned.

Member States should ensure that appropriate informa-
tion is provided regarding changes in rights and obliga-
tions introduced by this Regulation.

For the effective and fair implementation of Regulation
(EEC) No 1408/71, cooperation between the institutions
and the persons covered by the said Regulation is indis-
pensable. This cooperation presupposes, on the part of
both institutions and insured persons, the provision of
complete information on any changes that could affect
entitlement to benefits, such as any cessation or change
of the employment or self-employment of the insured
person, any transfer of the residence or place of stay of
that person or of a member of his family, changes in the
family situation or amendments to legislation.

Given the complexity of certain individual situations
involving the movement of persons, provision should be
made for a mechanism allowing institutions to rule on
individual cases in which differing interpretations of
Regulation (EEC) No 1408/71 and its implementing
Regulation could jeopardise the rights of the person
concerned. If a solution cannot be found whereby all the
rights of the individual concerned are observed, provi-
sion should be made for the option of referring the
matter to the Administrative Commission.

(10)

In order to bring the Regulation into line with develop-
ments in data processing, in which the European Health
Insurance Card is an essential element as it is intended in
the long term to constitute an electronic medium read-
able in all Member States, certain Articles of Regulation
(EEC) No 574/72 should be amended to cover the
its
concept of document as any content whatever
medium, written on paper or stored in electronic form
or as a sound or visual or audiovisual recording,

(1) OJ L 74, 27.3.1972, p. 1. Regulation as consolidated by Regulation
(EC) No 118/97 and last amended by Commission Regulation (EC)
No 1851/2003 (OJ L 271, 22.10.2003, p. 3).

HAVE ADOPTED THIS REGULATION:

Article 1

Regulation (EEC) No 1408/71 is hereby amended as follows:

1. Article 22 shall be amended as follows:

(a) subparagraph 1(a) shall be replaced by the following:

‘(a) whose condition requires benefits in kind which
become necessary on medical grounds during a stay
in the territory of another Member State, taking into
account the nature of the benefits and the expected
length of the stay;’

(b) the following paragraph shall be inserted:

‘1a.
The Administrative Commission shall establish a
list of benefits in kind which, in order to be provided
during a stay in another Member State, require, for prac-
tical reasons, a prior agreement between the person
concerned and the institution providing the care;’

(c) in paragraph 3, the first subparagraph shall be replaced

by the following:

‘Paragraphs 1, 1a and 2 shall apply by analogy to
members of the family of an employed or self-employed
person.’

2. Article 22a shall be replaced by the following:

‘Article 22a

Special rules for certain categories of persons

Notwithstanding Article 2, Article 22(1)(a) and (c) and (1a)
shall also apply to persons who are nationals of one of the
Member States and who are insured under the legislation of
a Member State and to the members of
their families
residing with them.’

3. Article 22b shall be deleted;

4. Article 25 shall be amended as follows:

(a) paragraph 1 shall be replaced by the following:

An unemployed person who was

‘1.
formerly
employed or self-employed and to whom the provisions
of Article 69(1) or Article 71(1)(b)(ii), second sentence
apply and who satisfies the conditions laid down in the
legislation of the competent State for entitlement to
benefits in kind and cash benefits, taking account where
necessary of the provisions of Article 18, shall receive
for the period of time referred to in Article 69(1)(c):

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(a) benefits in kind which become necessary on medical
grounds for this person during his stay in the terri-
tory of
the Member State where he is seeking
employment, taking account of the nature of the
benefits and the expected length of the stay. These
benefits in kind shall be provided on behalf of the
the
competent
Member State in which the person is
seeking
employment, in accordance with the provisions of
the legislation which the latter institution adminis-
ters, as if he were insured with it;

institution by the institution of

(b) cash benefits provided by the competent institution
in accordance with the provisions of the legislation
which it
administers. However, by agreement
between the competent institution and the institu-
tion of the Member State in which the unemployed
person seeks employment, benefits may be provided
by the latter institution on behalf of the former insti-
tution in accordance with the provisions of the legis-
lation of the competent State. Unemployment bene-
fits under Article 69(1) shall not be granted for the
period during which cash benefits are received.’

the place of stay, these benefits may be provided by the
latter institution on behalf of the former, in accordance
with the provisions of the legislation of the competent
State.

2.

Article 22(1a) shall apply by analogy.’

6. Article 34a shall be replaced by the following:

‘Article 34a

Special provisions for students and members of their
families

Articles 18, 19, 22(1)(a) and (c) and (1a), 22(2), second sub-
paragraph, 22(3), 23 and 24 and sections 6 and 7 shall
apply by analogy to students and the members of their
families as required.’

7. Article 34b shall be deleted;

8. the following Article shall be inserted:

(b) the following paragraph shall be inserted:

‘1a.

Article 22(1a) shall apply by analogy.’;

‘Article 84a

5. Article 31 shall be replaced by the following:

‘Article 31

Stay of a pensioner and/or members of his family in a
Member State other than the State in which they reside

A pensioner entitled to a pension or pensions under
1.
the legislation of one Member State or to pensions under
the legislation of two or more Member States who is entitled
to benefits under the legislation of one of those States shall,
with members of his family who are staying in the territory
of a Member State other than the State in which they reside,
receive:

(a) benefits in kind which become necessary on medical
grounds during a stay in the territory of the Member
State other than the State of residence,
taking into
account the nature of the benefits and the expected
the stay. These benefits in kind shall be
length of
provided by the institution of
in
accordance with the provisions of the legislation which
it administers, on behalf of the institution of the place
of residence of the pensioner or of the members of his
family;

the place of stay,

(b) cash benefits provided, where appropriate, by the
competent institution as determined by Article 27 or
28(2), in accordance with the provisions of the legisla-
tion which it administers. However, upon agreement
between the competent institution and the institution of

Relations between the institutions and the persons
covered by this Regulation.

The institutions and persons covered by this Regu-
1.
lation shall have a duty of mutual information and coopera-
tion to ensure the correct implementation of this Regu-
lation.

The institutions, in accordance with the principle of good
administration, shall respond to all queries within a reason-
able period of time and shall in this connection provide the
persons concerned with any information required for exer-
cising the rights conferred on them by this Regulation.

The persons concerned shall inform the institutions of the
competent State and of the State of residence as soon as
possible of any changes in their personal or family situation
which affect their right to benefits under this Regulation.

Failure

to respect

the obligation of

2.
information
referred to in paragraph 1, third subparagraph, may result
in the application of proportionate measures in accordance
with national
these measures shall be
equivalent to those applicable to similar situations under
domestic law and shall not make it impossible or excessively
in practice for claimants to exercise the rights
difficult
conferred on them by this Regulation.

law. Nevertheless,

3.
In the event of difficulties in the interpretation or
application of this Regulation which could jeopardise the
rights of a person covered by it,
the institution of the
competent State or of the State of residence of the person
involved shall contact
the Member
State(s) concerned. If a solution cannot be found within a
reasonable period, the authorities concerned may call on the
Administrative Commission to intervene.’

the institution(s) of

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Article 2

7.

in Article 23, the second paragraph shall be replaced by
the following:

Regulation (EEC) No 574/72 is hereby amended as follows:

1.

in Article 2, paragraph 1 shall be replaced by the
following:

‘1. Models of the documents necessary for application
of the Regulation and of the implementing Regulation
shall be drawn up by the Administrative Commission.

These documents may be transferred between institutions
either in paper or other form or by means of telematic
services as standardised electronic messages in accordance
with Title VIa. The exchange of information by means of
telematic services shall be subject to agreement between
the competent authorities or the bodies designated by the
competent authorities of the sending Member State and
those of the receiving Member State;’

2.

in Article 17, paragraphs 6 and 7 shall be deleted;

3.

in Article 19a, paragraph 2 shall be replaced by the
following:

Article 17(9) of the implementing Regulation shall

‘2.
apply by analogy.’

4. Article 20 shall be deleted;

5. Article 21 is replaced by the following:

‘Article 21

Benefits in kind in the case of a stay in a Member
State other than the competent State

1.
In order to receive benefits in kind under Article
22(1)(a)(i) of the Regulation, an employed or self-employed
to the care provider a document
person shall submit
issued by the competent institution certifying that he is
entitled to benefits in kind. That document shall be drawn
up in accordance with Article 2. If the person concerned is
not able to submit that document, he shall contact the
institution of the place of stay which shall request from
the competent institution a certified statement testifying
that the person concerned is entitled to benefits in kind.

A document issued by the competent institution for enti-
tlement to benefits in accordance with Article 22(1)(a)(i) of
the Regulation,
in each individual case concerned, shall
have the same effect with regard to the care provider as
the persons
national evidence of
insured with the institution of the place of stay.

the entitlements of

Article 17(9) of the implementing Regulation shall

2.
apply by analogy.’

6.

in Article 22, paragraph 2 shall be replaced by the
following:

Article 17(9) of the implementing Regulation shall

‘2.
apply by analogy.;’

‘However,
in the cases referred to in the second sub-
paragraph of Article 22(3) of the Regulation, the institu-
tion of the place of residence and the legislation of the
country of residence of the members of the family shall be
considered, respectively, as the competent institution and
as the legislation of the competent State for the purposes
of Articles 17(9), 21 and 22 of the implementing Regu-
lation.’

8. Article 26 is amended as follows:

(a) paragraph 1 shall be replaced by the following:

In order to receive benefits in kind under Article
‘1.
25(1)(a) and (1a) of the Regulation, an unemployed
person or a family member accompanying him shall
submit to the care provider a document issued by the
competent institution certifying that he is entitled to
benefits in kind. That document shall be drawn up in
accordance with the provisions of Article 2.
If the
person concerned is not able to submit that document,
he shall contact the institution of the place of stay
which shall request from the competent institution a
certified statement testifying that the person concerned
is entitled to benefits in kind.

A document issued by the competent institution for
to benefits in accordance with Article
entitlement
25(1)(a) of
in each individual case
the Regulation,
concerned, shall have the same effect with regard to
the care provider as national evidence of the entitle-
ments of persons insured with the institution of the
place to which the unemployed person has gone.’

(b) the following paragraph shall be inserted:

In order

‘1a.
to receive benefits in cash under
Article 25(1)(b) of the Regulation for himself and for
members of his family, an unemployed person shall
submit to the insurance institution of the place where
he has gone a certified statement for which, prior to
his departure, he shall have applied to the competent
insurance institution. If the unemployed person does
not submit that certified statement, the institution of
the place to which he has gone shall obtain it from the
competent institution. That certified statement must
testify the existence of the right to the benefits in ques-
tion under the conditions set out in Article 69(1) (a) of
the Regulation,
indicate the duration of such right
taking into account the provisions of Article 69(1)(c)
of the Regulation and,
in the case of incapacity for
work or hospitalisation, specify the amount of cash
benefits to be provided, where appropriate, by way of
sickness insurance during the abovementioned period.’

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(c) paragraph 3 shall be replaced by the following:

‘3.
Article 17(9) of
shall apply by analogy.’

the implementing Regulation

9. Article 31 shall be replaced by the following:

10.

‘Article 31

Benefits in kind for pensioners and members of their
families staying in a Member State other than the one
in which they reside

In order to receive benefits in kind under Article 31
1.
of the Regulation, a pensioner shall submit to the care
provider a document issued by the institution of the place
of residence certifying that he is entitled to the benefits in
kind. That document shall be drawn up in accordance with
Article 2. If the person concerned is not able to submit
that document, he shall contact the institution of the place
of stay which shall request from the institution of the
place of residence a certified statement testifying that the
person concerned is entitled to benefits in kind.

A document issued by the competent institution for enti-
tlement to benefits in accordance with Article 31 of the
Regulation, in each individual case concerned, shall have
the same effect with regard to the care provider as national
evidence of the entitlements of persons insured with the
institution of the place of stay.

Article 17(9) of the implementing Regulation shall

2.
apply by analogy.

3.
Paragraphs 1 and 2 shall apply by analogy in respect
of the granting of benefits in kind to the members of the
family covered by Article 31 of the Regulation. If these
family members reside in the territory of a Member State

other than that of the pensioner, the document referred to
in paragraph 1 shall be issued by the institution of their
place of residence.;’

in Article 117, paragraph 1 shall be replaced by the
following:
Based on the research and proposals of the Technical
‘1.
Commission referred to in Article 117c of
the imple-
menting Regulation, the Administrative Commission shall
adapt to new data processing techniques the models of
documents as well as the routing channels and the data
transmission procedures necessary for applying the Regu-
lation and the implementing Regulation.’

Article 3

Member States shall ensure that appropriate information is
provided regarding the changes in rights and obligations intro-
duced by this Regulation.

Article 4

For the purpose of the implementation of this Regulation, the
institutions in the State of stay shall ensure that all care provi-
ders are fully aware of the criteria set out in Article 22(1)(a)(i)
of Regulation (EEC) No 1408/71.

Article 5

This Regulation shall enter into force on 1 June 2004.

Direct access to care providers shall be guaranteed by 1 July
2004 at the latest.

This Regulation shall be binding in its entirety and directly applicable in all Member States.

Done at Strasbourg, 31 March 2004.

For the European Parliament

The President

P. COX

For the Council

The President

D. ROCHE