Decision No S1 of 12 June 2009 concerning the European Health Insurance CardText of relevance to the EEA and to the EC/Switzerland Agreement

DECISION No S1

of 12 June 2009

concerning the European Health Insurance Card

(Text of relevance to the EEA and to the EC/Switzerland Agreement)

(2010/C 106/08)

THE ADMINISTRATIVE COMMISSION FOR THE COORDINATION OF

SOCIAL SECURITY SYSTEMS,

Having regard to Article 72(a) of Regulation (EC) No 883/2004

of the European Parliament and of the Council of 29 April

2004 on the coordination of social security systems (

), under

which the Administrative Commission is responsible for dealing

with all administrative questions or questions of interpretation

arising from the provisions of Regulation (EC) No 883/2004

and Regulation (EC) No 987/2009 of the European Parliament

and of the Council of 16 September 2009 laying down the

procedure for implementing Regulation (EC) No 883/2004 on

the coordination of social security systems (

Having regard to Article 19 of Regulation (EC) No 883/2004

concerning the entitlement of an insured person and the

members of his/her family, staying in a Member State other

than the competent Member State to benefits in kind which

become necessary on medical grounds taking into account the

nature of the benefits and the expected length of the stay,

Having regard to Article 27(1) of Regulation (EC) No 883/2004,

Having regard to Article 25(A) and (C) of Regulation (EC) No

987/2009,

Whereas:

(1)

The Barcelona European Council, held on 15 and

16 March 2002, decided: ‘that a European Health

Insurance Card will replace the current paper forms

needed for health treatment in another Member State.

The Commission will present a proposal to that effect

before the Spring European Council in 2003. Such a card

will simplify procedures, but will not change existing

rights and obligations.’ (point 34).

(2)

Given that the use of health and social security cards

differs widely from one Member State to another, the

European Health Insurance Card is initially introduced

in a format in which the data necessary for the

provision of health care and the reimbursement of the

costs can be read with the naked eye. This information

may additionally be incorporated in an electronic

medium. The use of an electronic medium will

furthermore become generalised at a later stage.

(3)

The European Health Insurance Card must conform to a

single model defined by the Administrative Commission,

which should both help facilitate access to health care

and help to prevent irregular, abusive or fraudulent use

of the card.

(4)

Institutions of the Member State determine the period of

validity of the European Health Insurance Cards they

issue. The period of validity of the European Health

Insurance card should take into account the presumed

duration of the insured person’s entitlement.

(5)

In the event of exceptional circumstances, a provisional

replacement certificate of limited duration should be

issued. ‘Exceptional circumstances’ may be theft or loss

of the European Health Insurance Card or departure at

notice too short for a European Health Insurance Card to

be issued. The provisional replacement certificate can be

requested by the insured person or the institution of the

State of stay.

(6)

The European Health Insurance Card should be used in

all situations of temporary stay during which an insured

person requires health care irrespective of the purpose of

the stay, be it for reasons of tourism, professional activity

or study. However the European Health Insurance Card

cannot be used when the purpose of the stay abroad is

solely to obtain healthcare.

(7)

In accordance with Article 76 of Regulation (EC) No

883/2004, Members States should cooperate to put in

place procedures to avoid that, in the event that a person

ceases to be entitled to sickness benefits in kind on

behalf of a Member State and becomes entitled to

benefits in kind on behalf of another Member State,

he/she continues to use the European Health Insurance

Card issued by the institution of the first Member State

beyond the date from which he is no longer entitled to

benefits in kind on its behalf.

24.4.2010 Official Journal of the European Union C 106/23

(

) OJ L 166, 30.4.2004, p. 1.

(

) OJ L 284, 30.10.2009, p. 1.

(8)

The European Health Insurance Card issued before the

entry into application of Regulations (EC) No 883/2004

and (EC) No 987/2009 will remain valid till the expiry

date mentioned on the card.

Acting in accordance with the conditions laid down in

Article 71(2) of Regulation (EC) No 883/2004,

HAS DECIDED AS FOLLOWS:

General principles

1. The European Health Insurance Card certifies the

entitlement of an insured person and a pensioner as well

as the members of their family, staying in a Member State

other than the competent Member State to benefits in kind

which become necessary on medical grounds taking into

account the nature of the benefits and the expected length

of the stay.

The European Health Insurance Card cannot be used in the

situation where the aim of the temporary stay is to receive

medical treatment.

2. The European Health Insurance Card shall be an individual

card made out in the name of the card holder.

3. The period of validity of the European Health Insurance

Card shall be determined by the issuing institution.

4. Benefits in kind provided by the institution of the Member

State of stay on the basis of a valid European Health

Insurance Card shall be reimbursed by the competent insti

tution in accordance with the provisions in force. A valid

European Health Insurance Card is a card where the validity

period indicated on the card has not expired.

The competent institution may not reject the refund of the

cost of benefits on the grounds that the person has ceased

to be insured with the institution which has issued the

European Health Insurance Card, provided that the

benefits were given to the holder of the card or the Provi

sional Replacement Certificate within the validity period of

the card or the certificate.

5. When exceptional circumstances prevent the issuing of a

European Health Insurance Card, a provisional replacement

certificate with a limited validity period shall be issued by

the competent institution. The provisional Replacement

Certificate can be requested either by the insured person

or the institution of the State of stay.

6. The European Health Insurance Card and the provisional

replacement certificate shall conform to a single model

meeting the characteristics and technical specifications laid

down by decision of the Administrative Commission.

Data contained on the European Health Insurance Card

7. The European Health Insurance Card shall contain the

following data:

— surname and forename of the card holder,

— personal identification number of the card holder or,

when no such number exists, the number of the insured

person from whom the rights of the card holder derive,

— date of birth of the card holder,

— expiry date of the card,

— ISO code of the Member State issuing the card,

— identification number and acronym of the competent

institution,

— logical number of the card.

Use of the European Health Insurance Card

8. The European Health Insurance Card can be used in all

situations of temporary stay during which an insured

person requires benefits in kind irrespective the purpose

of the stay, be it for reasons of tourism, professional

activity or study.

9. The European Health Insurance Card proves the entitlement

of the card holder in the Member State of stay to sickness

benefits in kind which become medically necessary and

which are granted during a temporary stay in another

Member State with a view to preventing the card holder

from being forced to return before the end of the planned

duration of stay to the competent State or the State of

residence to obtain the treatment he/she requires.

The purpose of benefits of this type is to enable the insured

person to continue his/her stay under safe medical

conditions.

C 106/24 Official Journal of the European Union 24.4.2010

10. The European Health Insurance Card does not cover

sickness benefits in kind in situations where the aim of

the stay is to receive medical treatment.

11. The European Health Insurance Card guarantees that the

card holder receives in the Member State of stay the

same treatment (procedures and tariffs) as person covered

by the sickness insurance scheme of this State.

Cooperation between institutions in order to avoid misuse of

the European Health Insurance Card

12. In the event that a person ceases to be entitled to sickness

benefits in kind on behalf of a Member State’s legislation

and becomes entitled to benefits in kind on behalf of the

legislation of another Member State, the institutions of the

Member States concerned should cooperate in order to

avoid the insured person continuing to use the European

Health Insurance Card issued by the institution of the first

Member State beyond the date from which he is no longer

entitled to benefits in kind on its behalf. Where appro

priate, the institution of the latter State shall provide a

new European Health Insurance Card.

13. This Decision shall be published in the Official Journal of the

European Union. It shall apply from the date of entry into

force of Regulation (EC) No 987/2009.

The Chair of the Administrative Commission

Gabriela PIKOROVÁ

24.4.2010 Official Journal of the European Union C 106/25