Mr Ioannidis, a Greek pensioner resident in his own country, had to be hospitalised while visiting Germany. He suffers from a heart complaint and, according to the report of the doctor who treated him, he had to be admitted to hospital urgently as a result of angina. The patient was in possession of a valid Form E 111 (which gives entitlement to sickness benefit in kind while in another Member State) issued by the Idryma Koinonikon Asfalisseon (Greek social security institution - IKA). Mr Ioannidis subsequently applied to the German sickness fund for reimbursement of the expenditure incurred as a result of his stay in hospital, with the intention that it should be charged to the IKA. The German institution asked the IKA for Form E 112 (authorising an insured person to travel to another Member State to receive appropriate hospital or other treatment) accepting to reimburse the cost of hospitalisation.

However, the IKA informed the German sickness insurance fund that it could not meet the cost of such expenditure because the patient was a chronic sufferer and the deterioration of his condition had not been sudden, so that the conditions laid down by Greek legislation for the granting of authorisation ex post facto has not been met.

When Mr Ioannidis' objection was allowed, IKA brought an appeal before the Greek courts. The national court has referred a question to the Court of Justice as to whether the Greek provisionlaying down as an additional requirement for authorising ex post facto reimbursement of medical expenditure incurred by a pensioner abroad that the illness be sudden and the need for treatment be urgent is compatible with Community law.

The Advocate General's Opinion is not binding upon the Court of Justice. His role is, to propose to the Court, acting with complete independence, a decision on the legal points in order that the cases referred to it may be resolved.

The Advocate General points out that Community law treats pensioners more favourably than workers, given that the only requirement applicable to the former in order to be entitled to sickness benefits in kind in a Member State other than that in which they are resident is that they should need them. The legislature thereby aims to promote the movement of retired persons around the Union and avoid that they refuse to travel for fear of not being covered should their health deteriorate.

Following from that reasoning, Mr Ruiz-Jarabo argues that the institution of the place of stay cannot refuse the E 111 form issued by the institution of the place of residence, since the insured person would then be deprived of medical cover despite believing that, by the mere fact of being in possession of that form, he was entitled to sickness benefits in kind while in another Member State.

Accordingly, where a pensioner is visiting a Member State in which he is not resident and needs medical treatment, the institution of the place of stay cannot lay down conditions additional to those laid down by Community law, nor may it assess whether the need for treatment is urgent. Moreover, neither may the institution of the place of residence require the obtention of an ex post facto authorisation, as in the case of Greece.

The Advocate General is of the view that, if the authorities of the Member State of residence suspect that the purpose of the journey of the insured person covered by Form E 111 is to receive medical treatment and avoid the procedure applicable to all insured persons, they must examine other documents and facts (i.e. whether the name of the person concerned appears on a waiting list, whether he has been refused permission to seek medial treatment abroad, etc) indicating that that was the purpose of the journey.

Finally, Mr Ruiz-Jarabo concludes that where the institution of the place of stay refuses to accept Form E 111 without justification, the authorities of the place of residence must meet the costs incurred, in order that the pensioner is never at a disadvantage.

Unofficial document for media use only; not binding on the Court of Justice. Available in Spanish, French, Greek, English and Dutch. For the full text of the Opinion, please consult our internet page www.curia.eu.int  at approximately 3 pm today. For further information, please contact Mr Reinier Van Winden Tel: (352) 4303 3555 - Fax: (352) 4303 731