Vanbraekel (Social security for migrant workers) [2001] EUECJ C-368/98 (12 July 2001)

Vanbraekel (Social security for migrant workers) [2001] EUECJ C-368/98 (12 July 2001)

When prior authorisation for cross-border hospital treatment is wrongly refused, the insured person is entitled to reimbursement equivalent to what would have been paid under the rules of the state of treatment. If the scheme of the state of insurance is more advantageous, additional reimbursement must be granted to...

Source-derived case information.

Citation
[2001] EUECJ C-368/98
Parties
Applicant: Abdon Vanbraekel and his six children, as heirs of Ms Jeanne Descamps; Respondent: Alliance nationale des mutualités chrétiennes (ANMC)
Jurisdiction
European Union
Procedural Posture
Preliminary Ruling (ecj) / Judgment on Reference From Cour De Travail De Mons
Outcome
Preliminary ruling issued; interpretation of EU law provided to national court.
Legal Topics
Cross Border Healthcare Reimbursement, Interpretation of Regulation No 1408/71, Freedom to Provide Services (article 59 Ec)
European Union Law Social Security Law Cross Border Healthcare Reimbursement Interpretation of Regulation No 1408/71 Freedom to Provide Services (article 59 Ec)

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Parties

Abdon Vanbraekel and his six children, as heirs of Ms Jeanne Descamps

Applicant

Alliance nationale des mutualités chrétiennes (ANMC)

Respondent

Procedural Posture

Preliminary Ruling (ecj) / Judgment on Reference From Cour De Travail De Mons

  1. 1 Whether reimbursement for cross-border hospital treatment must be calculated under the scheme of the state of insurance or the state of treatment when prior authorisation was wrongly refused
  2. 2 Whether Article 36 of Regulation No 1408/71 requires full reimbursement of all medical costs incurred abroad if authorisation was wrongly refused

Ratio Decidendi

When prior authorisation for cross-border hospital treatment is wrongly refused, the insured person is entitled to reimbursement equivalent to what would have been paid under the rules of the state of treatment. If the scheme of the state of insurance is more advantageous, additional reimbursement must be granted to cover the difference, as required by Article 59 EC. Article 36 does not entitle the insured person to reimbursement of all costs incurred abroad, but only to the extent provided by the applicable rules.

Court Disposition

Preliminary ruling issued; interpretation of EU law provided to national court.

Orders

  • Article 22(1)(c) and (i) of Regulation No 1408/71: reimbursement must be made according to the rules of the state of treatment; additional reimbursement required if the state of insurance provides a higher level of cover.
  • Article 36 of Regulation No 1408/71 does not entitle insured persons to reimbursement of all costs incurred abroad after wrongful refusal of authorisation.