Case C-489/23, Casa Judeţeană de Asigurări de Sănătate Mureș and Others: Judgment of the Court (Fourth Chamber) of 4 September 2025 (request for a preliminary ruling from the Înalta Curte de Casaţie şi Justiţie – Romania) – AF v Guvernul României, Ministerul Sănătăţii and Casa Judeţeană de Asigurări de Sănătate Mureș (Reference for a preliminary ruling – Social security – Health insurance – Article 56 TFEU – Freedom to provide services – Regulation (EC) No 883/2004 – Article 20(1) and (2) – Medical treatment received in a Member State other than the insured person’s Member State of residence – Directive 2011/24/EU – Article 7(7) – Assumption of the costs of treatment incurred by the insured person – Reimbursement – National legislation making reimbursement of those costs conditional upon the completion of a medical assessment, carried out exclusively by a health professional belonging to the public health insurance system of the insured person’s Member State of residence, which has given rise to the issuing, by that health professional, of a document authorising the hospitalisation of that insured person – Significant limitation of the reimbursement of the costs of cross-border healthcare)
Date: 2025-09-04
Institutions: Court of Justice
Subjects: EU Member State, freedom to provide services, health care, health expenditure, health insurance, medical examination, patient's rights, payment, residence, therapeutics








C_202505552EN.000101.fmx.xml












Official Journal of the European Union


EN
C series













C/2025/5552


27.10.2025






Judgment of the Court (Fourth Chamber) of 4 September 2025 (request for a preliminary ruling from the Înalta Curte de Casaţie şi Justiţie – Romania) – AF v Guvernul României, Ministerul Sănătăţii and Casa Judeţeană de Asigurări de Sănătate Mureș


(Case C-489/23,
                (1)
Casa Judeţeană de Asigurări de Sănătate Mureș and Others)

(Reference for a preliminary ruling - Social security - Health insurance - Article 56 TFEU - Freedom to provide services - Regulation (EC) No 883/2004 - Article 20(1) and (2) - Medical treatment received in a Member State other than the insured person’s Member State of residence - Directive 2011/24/EU - Article 7(7) - Assumption of the costs of treatment incurred by the insured person - Reimbursement - National legislation making reimbursement of those costs conditional upon the completion of a medical assessment, carried out exclusively by a health professional belonging to the public health insurance system of the insured person’s Member State of residence, which has given rise to the issuing, by that health professional, of a document authorising the hospitalisation of that insured person - Significant limitation of the reimbursement of the costs of cross-border healthcare)
(C/2025/5552)
Language of the case: Romanian

Referring court

Înalta Curte de Casaţie şi Justiţie

Parties to the main proceedings


Applicant and appellant in the appeal on a point of law: AF

Defendants and respondents in the appeal on a point of law: Guvernul României, Ministerul Sănătăţii and Casa Judeţeană de Asigurări de Sănătate Mureș

Operative part of the judgment







1.


Article 7(7) of Directive 2011/24/EU of the European Parliament and of the Council of 9 March 2011 on the application of patients’ rights in cross-border healthcare, read in the light of Article 56 TFEU,
must be interpreted as precluding national legislation which makes reimbursement of the costs of cross-border healthcare incurred by an insured person in the Member State of affiliation subject to a medical assessment, carried out by a health professional belonging to the public health insurance system of that State, which has given rise to the issuing, by that health professional, of a document authorising the hospitalisation of that insured person.










2.


Article 20(1) and (2) of Regulation (EC) No 883/2004 of the European Parliament and of the Council of 29 April 2004 on the coordination of social security systems, read in the light of Article 56 TFEU,
must be interpreted as not precluding national legislation pursuant to which, where an insured person has, justifiably, been refused the prior authorisation required in order to receive certain cross-border healthcare, the amount of reimbursement of the costs of that healthcare by the Member State of affiliation is limited to the amount provided for by the health insurance scheme of that State, applying, to that end, a calculation method which significantly limits the amount of that reimbursement as compared with the costs actually incurred by the insured person in the Member State where he or she was provided with that healthcare, provided that that calculation method is based on objective, non-discriminatory and transparent criteria. Nevertheless, if, for reasons relating to his or her state of health or to the need to receive urgent treatment in a hospital, that person was prevented from applying for such a prior authorisation or was not able to wait for the decision of the competent institution on the application for authorisation submitted, he or she is entitled to obtain reimbursement, from the competent institution, of an amount equivalent to that which would ordinarily have been assumed by that institution if he or she had had such an authorisation.






(1)  OJ C, C/2024/1234.


ELI: http://data.europa.eu/eli/C/2025/5552/oj
ISSN 1977-091X (electronic edition)