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You are here: BAILII >> Databases >> Court of Justice of the European Communities (including Court of First Instance Decisions) >> Betriebskrankenkasse der Robert Bosch (Social security for migrant workers) [2004] EUECJ C-193/03 (14 October 2004) URL: https://www.bailii.org/eu/cases/EUECJ/2004/C19303.html Cite as: [2004] EUECJ C-193/3, [2004] EUECJ C-193/03 |
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JUDGMENT OF THE COURT (Sixth Chamber)
14 October 2004 (1)
(Social security - Reimbursement of medical expenses incurred in another Member State - Article 34 of Regulation (EEC) No 574/72 - Health insurance fund applying a simplified full reimbursement procedure for bills for small amounts)
In Case C-193/03,REFERENCE to the Court under Article 234 EC from the Sozialgericht Stuttgart (Germany), made by decision of 19 March 2003, received at the Court on 9 May 2003, in the proceedings Betriebskrankenkasse der Robert Bosch GmbHv
Bundesrepublik Deutschland,THE COURT (Sixth Chamber),
having decided, after hearing the Advocate General, to proceed to judgment without an Opinion,
gives the following
-˜1. If it is not possible during an employed or self-employed person-™s stay in a Member State other than the competent State to complete the formalities provided for in Articles 20(1) and (4) and 21, 23 and 31 of -¦ Regulation [No 574/72], his expenses shall, upon his application, be refunded by the competent institution in accordance with the refund rates administered by the institution of the place of stay. 2. The institution of the place of stay shall, at the request of the competent institution, supply it with the necessary information about such rates.If the institution of the place of stay and the competent institution are bound by an agreement providing either that no refund, or that a lump sum refund of benefits provided, in pursuance of Articles 22(1)(a)(i) and 31 of -¦ Regulation [No 1408/71], be made, the institution of the place of stay shall, in addition, be required to transfer to the competent institution the amount to be refunded to the person concerned in pursuance of the provisions of paragraph 1.-¦4. Notwithstanding paragraphs 1, 2 and 3, the competent institution may effect the reimbursement of expenses incurred in accordance with the rates it administers provided that it is possible to make a refund in accordance with these rates, that the expenses to be refunded do not exceed a level determined by the Administrative Commission and that the employed person or self-employed person or pensioner agrees to the application of this provision. In any case, the amount of reimbursement shall not exceed the amount of the expenses actually incurred.5. If the legislation of the State of residence does not provide for rates of reimbursement, the competent institution may effect the reimbursement under the conditions laid down in paragraph 4 without the agreement of the person concerned being necessary.-™
-˜1. An employed or self-employed person who satisfies the conditions of the legislation of the competent State for entitlement to benefits, taking account where appropriate of the provisions of Article 18, and: (a) whose condition necessitates immediate benefits during a stay in the territory of another Member State
...
shall be entitled:
(i) to benefits in kind provided on behalf of the competent institution by the institution of the place of stay or residence in accordance with the provisions of the legislation which it administers, as though he were insured with it; the length of the period during which benefits are provided shall be governed, however, by the legislation of the competent State;...-™.
-˜A pensioner entitled to a pension or pensions under 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 provided by the institution of the place of stay in accordance with the provisions of the legislation which it administers, the cost being borne by the institution of the pensioner-™s place of residence; ...-™. National legislation
-˜When the health insurance fund is unable to provide urgent benefits in time or wrongly refuses a benefit, thereby causing insured persons to incur expenses for that benefit which they must themselves cover, it shall reimburse the amount to the insured persons in so far as the benefit is necessary.-™
-˜Does Article 34 of Regulation (EEC) No 574/72 preclude, in the application of Paragraph 13(3) of the SGB V, a practice of flat-rate reimbursement by an insurance institution of medical treatment incurred in another Member State, in line with similar provisions regarding small amounts?-™
1 - Language of the case: German.