CELEX: C2003/158/01
Language: en
Date: 2003-07-05 00:00:00
Title: 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)

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                                       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
                          of 13 May 2003                                     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
                                                                             —     Article 59 of the EC Treaty (now, after amendment,
Onderlinge Waarborgmaatschappij OZ Zorgverzekering-                                Article 49 EC) and Article 60 of the EC Treaty (now
en UA, and between E.E.M. van Riet and Onderlinge                                  Article 50 EC) must be interpreted as not precluding legislation
    Waarborgmaatschappij ZAO Zorgverzekeringen (1)
                                                                                   of a Member State, such as that at issue in the main
                                                                                   proceedings, which (i) makes the assumption of the costs of
(Freedom to provide services — Articles 59 of the EC Treaty                        hospital care provided in a Member State other than that in
(now, after amendment, Article 49 EC) and 60 of the EC                             which the insured person’s sickness fund is established, by a
Treaty (now Article 50 EC) — Sickness insurance — System                           provider with which that fund has not concluded an agreement,
providing benefits in kind — System ofagreements —                                 conditional upon prior authorisation by the fund and (ii) makes
Medical costs incurred in another Member State — Prior                             the grant of that authorisation subject to the condition that
           authorisation — Criteria — Justification)                               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
                          (2003/C 158/01)                                          can be obtained without undue delay in an establishment which
                                                                                   has concluded an agreement with the fund;
                    (Language of the case: Dutch)
                                                                             —     by contrast, Articles 59 and 60 of the Treaty do preclude the
                                                                                   same legislation in so far as it makes the assumption of the
(Provisional translation; the definitive translation will be published             costs of non-hospital care provided in another Member State by
                   in the European Court Reports)                                  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
In Case C-385/99: Reference to the Court under Article 234                         under which insured persons are entitled not to reimbursement of
EC by the Centrale Raad van Beroep (Netherlands) for a                             costs incurred for medical treatment, but to the treatment itself
preliminary ruling in the proceedings pending before that                          which is provided free of charge.
court between V.G. Müller-Fauré and Onderlinge Waarborg-
maatschappij OZ Zorgverzekeringen UA, and between
E.E.M. van Riet and Onderlinge Waarborgmaatschappij ZAO
Zorgverzekeringen, on the interpretation of Article 59 of the                (1 ) OJ C 20 of 22.1.2002.
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,