Type: Judgment

Authority: European Authorities: Euopean Union' Court of Justice

Date: 09/04/2025

Subject: The Court affirmed that EU Law precludes 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. According to the Court, EU Law does not preclude 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

Parties: Casa Judeţeană de Asigurări de Sănătate Mureș e a.

Classification: Solidarity - Art. 34 Social security

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