B.S.M. Geraets-Smits v Stichting Ziekenfonds VGZ and H.T.M. Peerbooms v Stichting CZ Groep Zorgverzekeringen.

JurisdictionEuropean Union
CourtCourt of Justice (European Union)
Writing for the CourtLa Pergola
ECLIECLI:EU:C:2001:404
Docket NumberC-157/99
Date12 July 2001
Celex Number61999CJ0157
Procedure TypeReference for a preliminary ruling
EUR-Lex - 61999J0157 - EN 61999J0157

Judgment of the Court of 12 July 2001. - B.S.M. Geraets-Smits v Stichting Ziekenfonds VGZ and H.T.M. Peerbooms v Stichting CZ Groep Zorgverzekeringen. - Reference for a preliminary ruling: Arrondissementsrechtbank te Roermond - Netherlands. - 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 of agreements - Hospital treatment costs incurred in another Member State - Prior authorisation - Criteria - Justification. - Case C-157/99.

European Court reports 2001 Page I-05473


Summary
Parties
Grounds
Decision on costs
Operative part

Keywords

1. Freedom to provide services - Services - Definition - Medical service provided in one Member State and paid for by the patient - Included - Reimbursement applied for under another Member State's sickness insurance legislation which is essentially of the type which provides for benefits in kind - No effect

(EC Treaty, Art. 60 (now Art. 50 EC))

2. Freedom to provide services - Services - Definition - Medical treatment in hospital financed directly by the sickness insurance funds on the basis of agreements and pre-set scales of fees - Included

(EC Treaty, Art. 60 (now Art. 50 EC)

3. Freedom to provide services - Restrictions - National rules on reimbursement of medical costs incurred in another Member State - Treatment provided in a hospital - Requirement of prior authorisation from the insurance fund in the Member State in which the person concerned is insured - Grant subject to requirements that the treatment must be normal and necessary - Whether permissible - Conditions

(EC Treaty, Art. 59 (now, after amendment, Art. 49 EC) and Art. 60 (now Art. 50 EC))

Summary

1. A medical service provided in one Member State and paid for by the patient should not cease to fall within the scope of the freedom to provide services guaranteed by the Treaty merely because reimbursement of the costs of the treatment involved is applied for under another Member State's sickness insurance legislation which is essentially of the type which provides for benefits in kind.

( see para. 55 )

2. The fact that hospital medical treatment is financed directly by the sickness insurance funds on the basis of agreements and pre-set scales of fees is not such as to remove such treatment from the sphere of services within the meaning of Article 60 of the Treaty (now Article 50 EC).

First, it should be borne in mind that that provision does not require that the service be paid for by those for whom it is performed and, second, the payments made by the sickness insurance funds under the contractual arrangements between them and the providers of health treatment, albeit set at a flat rate, are indeed the consideration for the hospital services and unquestionably represent remuneration for the hospital which receives them and which is engaged in an activity of an economic character.

( see paras 56-58 )

3. Article 59 of the EC Treaty (now, after amendment, Article 49 EC) and Article 60 of the EC Treaty (now Article 50 EC) do not preclude legislation of a Member State which makes the assumption of the costs of treatment provided in a hospital located in another Member State subject to prior authorisation from the insured person's sickness insurance fund and the grant of such authorisation subject to the condition that (i) the treatment must be regarded as normal in the professional circles concerned, a criterion also applied in determining whether hospital treatment provided on national territory is covered, and (ii) the insured person's medical treatment must require that treatment. However, that applies only in so far as

- the requirement that the treatment must be regarded as normal is construed to the effect that authorisation cannot be refused on that ground where it appears that the treatment concerned is sufficiently tried and tested by international medical science, and

- authorisation can be refused on the ground of lack of medical necessity only if the same or equally effective treatment can be obtained without undue delay at an establishment having a contractual arrangement with the insured person's sickness insurance fund.

In those circumstances such conditions are justifiable in view of the need to maintain an adequate, balanced and permanent supply of hospital care on national territory and to ensure the financial stability of the sickness insurance system.

( see paras 97, 105, 108 and operative part )

Parties

In Case C-157/99,

REFERENCE to the Court under Article 177 of the EC Treaty (now Article 234 EC) by the Arrondissementsrechtbank te Roermond (Netherlands) for a preliminary ruling in the proceedings pending before that court between

B.S.M. Geraets-Smits

and

Stichting Ziekenfonds VGZ

and between

H.T.M. Peerbooms

and

Stichting CZ Groep Zorgverzekeringen,

on the interpretation of Articles 59 of the EC Treaty (now, after amendment, Article 49 EC) and 60 of the EC Treaty (now Article 50 EC),

THE COURT,

composed of: G.C. Rodríguez Iglesias, President, C. Gulmann, A. La Pergola (Rapporteur), M. Wathelet and V. Skouris (Presidents of Chambers), D.A.O. Edward, J.-P. Puissochet, P. Jann, L. Sevón, R. Schintgen and F. Macken, Judges,

Advocate General: D. Ruiz-Jarabo Colomer,

Registrar: L. Hewlett, Administrator,

after considering the written observations submitted on behalf of:

- Stichting CZ Groep Zorgverzekeringen, by E.P.H. Verdeuzeldonk, acting as Agent,

- the Netherlands Government, by M.A. Fierstra, acting as Agent,

- the Belgian Government, by A. Snoecx, acting as Agent,

- the Danish Government, by J. Molde, acting as Agent,

- the German Government, by W.-D. Plessing and C.-D. Quassowski, acting as Agents,

- the French Government, by K. Rispal-Bellanger and C. Bergeot, acting as Agents,

- the Irish Government, by M.A. Buckley, acting as Agent, assisted by D. Barniville, BL,

- the Portuguese Government, by L. Fernandes and P. Borges, acting as Agents,

- the Finnish Government, by T. Pynnä and E. Bygglin, acting as Agents,

- the Swedish Government, by L. Nordling, acting as Agent,

- the United Kingdom Government, by M. Ewing, acting as Agent, assisted by S. Moore, Barrister,

- the Icelandic Government, by E. Gunnarsson and V. Hauksdóttir, acting as Agents,

- the Norwegian Government, by H. Seland, acting as Agent,

- the Commission of the European Communities, by P. Hillenkamp, P.J. Kuijper and H.M.H. Speyart, acting as Agents,

having regard to the Report for the Hearing,

after hearing the observations of Stichting Ziekenfonds VGZ, represented by H.G. Sevenster, J.K. de Pree and E.H. Pijnacker Hordijk, advocaten; Stichting CZ Groep Zorgverzekeringen, represented by E.P.H. Verdeuzeldonk; of the Netherlands Government, represented by M.A. Fierstra; of the Danish Government, represented by J. Molde; of the German Government, represented by W.-D. Plessing; of the French Government, represented by C. Bergeot; of the Irish Government, represented by D. Barniville; of the Austrian Government, represented by G. Hesse, acting as Agent; of the Finnish Government, represented by E. Bygglin; of the Swedish Government, represented by A. Kruse, acting as Agent; of the United Kingdom Government, represented by E. Ewing, assisted by S. Moore; of the Icelandic Government, represented by E. Gunnarsson; and of the Commission, represented by H.H. Speyart, at the hearing on 4 April 2000,

after hearing the Opinion of the Advocate General at the sitting on 18 May 2000,

gives the following

Judgment

Grounds

1 By order of 28 April 1999, received at the Court on 30 April 1999, the Arrondissementsrechtbank te Roermond (District Court, Roermond) referred to the Court for a preliminary ruling under Article 177 of the EC Treaty (now Article 234 EC) two questions on the interpretation of Article 59 of the EC Treaty (now, after amendment, Article 49 EC) and Article 60 of the Treaty (now Article 50 EC).

2 The two questions have been raised in proceedings between Mrs Geraets-Smits and Stichting Ziekenfonds VGZ (Stichting VGZ) and between Mr Peerbooms and Stichting CZ Groep Zorgverzekeringen (Stichting CZ) concerning the reimbursement of hospital treatment costs incurred in Germany and Austria respectively.

National legal framework

3 In the Netherlands, the sickness insurance scheme is based principally on the Ziekenfondswet of 15 October 1964 (Law on Sickness Funds, Staatsblad 1964, No 392, as subsequently amended, the ZFW), the Algemene Wet Bijzondere Ziektekosten of 14 December 1967 (Law on general insurance for special sickness costs, Staatsblad 1967, No 617, as subsequently amended, the AWBZ) and the Wet op de toegang tot ziektekostenverzekeringen (Law on access to sickness insurance, the WTZ). Both the ZFW and the AWBZ establish a system of benefits in kind under which an insured person is entitled not to reimbursement of costs incurred for medical treatment but to free treatment. Both laws are based on a system of agreements made between sickness funds and providers of health care. The WTZ, on the other hand, establishes a system under which insured persons are reimbursed costs and is not based on a system of agreements.

4 Under Articles 2 to 4 of the ZFW, workers whose annual income does not exceed an amount determined by law (NLG 60 750 in 1997), persons treated as such and persons in receipt of social benefits and dependent members of their families living with them in the same household are compulsorily and automatically insured under that law.

5 Article 5(1) of the ZFW provides that any person coming within its scope who wishes to claim entitlement under that law must register with a sickness fund operating in the municipality in which he resides.

6 Article 8 of the ZFW provides:

1. An insured person shall be entitled...

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54 practice notes
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    ...unabhängig von der Art und Weise der Finanzierung nicht unbegrenzt sind (Urteile vom 12. Juli 2001, Smits und Peerbooms, C‑157/99, EU:C:2001:404, Rn. 76 bis 79, vom 16. Mai 2006, Watts, C‑372/04, EU:C:2006:325, Rn. 108 und 109, sowie vom 5. Oktober 2010, Elchinov, C‑173/09, EU:C:2010:581, R......
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    ...v Sabena Case 149/77 [1978] ECR 1365, ECJ. Geraets-Smits v Stichting Ziekenfonds VGZ, Peerbooms v Stichting CZ Groep Zorgverzekeringen Case C-157/99 [2003] All ER (EC) 481, [2002] QB 409, [2002] 2 WLR 154, [2001] ECR I-5473, Goodwin v UK[2002] 2 FCR 577, [2002] 2 FLR 487, ECt HR. Grzelczyk ......
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    • 28 June 2007
    ...and self-employed workers who make use, under various circumstances, of their right to freedom of movement. 43 – See, inter alia, Case C-157/99 Smits and Peerbooms [2001] ECR I-5473, paragraphs 44 to 46; Case C-385/99 Müller-Fauré and Van Riet [2003] ECR I-4509, paragraph 100, and the case-......
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  • Rhiannon Morgan v Bezirksregierung Köln (C-11/06) and Iris Bucher v Landrat des Kreises Düren (C-12/06).
    • European Union
    • Court of Justice (European Union)
    • 20 March 2007
    ...and Watts, paragraph 86. 65 – Case 279/80 Webb [1981] ECR 3305, paragraph 10; Case C-158/96 Kohll [1998] ECR I-1931, paragraph 20; and Case C-157/99 Smits and Peerbooms [2001] ECR I-5473, paragraph 54. 66 – Case C-92/01 Stylianakis [2003] ECR I-1291, paragraph 18; Case C-293/03 My [2004] EC......
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    ...unabhängig von der Art und Weise der Finanzierung nicht unbegrenzt sind (Urteile vom 12. Juli 2001, Smits und Peerbooms, C‑157/99, EU:C:2001:404, Rn. 76 bis 79, vom 16. Mai 2006, Watts, C‑372/04, EU:C:2006:325, Rn. 108 und 109, sowie vom 5. Oktober 2010, Elchinov, C‑173/09, EU:C:2010:581, R......
  • Sarah Margaret Richards v Secretary of State for Work and Pensions.
    • European Union
    • Court of Justice (European Union)
    • 27 April 2006
    ...v Sabena Case 149/77 [1978] ECR 1365, ECJ. Geraets-Smits v Stichting Ziekenfonds VGZ, Peerbooms v Stichting CZ Groep Zorgverzekeringen Case C-157/99 [2003] All ER (EC) 481, [2002] QB 409, [2002] 2 WLR 154, [2001] ECR I-5473, Goodwin v UK[2002] 2 FCR 577, [2002] 2 FLR 487, ECt HR. Grzelczyk ......
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    • Court of Justice (European Union)
    • 28 June 2007
    ...and self-employed workers who make use, under various circumstances, of their right to freedom of movement. 43 – See, inter alia, Case C-157/99 Smits and Peerbooms [2001] ECR I-5473, paragraphs 44 to 46; Case C-385/99 Müller-Fauré and Van Riet [2003] ECR I-4509, paragraph 100, and the case-......
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