Slovakia, District Court in Košice II, 9 September 2014 22C/182/2013

Identification of the case

• Regulation of the Ministry of Health of the Slovak Republic No 67/2005 for healthcare providers in the provision and payment of benefits in kind
• The Slovak Act on Insurance No 580/2004
• The Slovak Act on Healthcare Providers, Healthcare Workers, Professional Organizations in Healthcare No 578/2004

• Regulation (EEC) No 1408/71 of the Council of 14 June 1971
• Regulation (EEC) No 574/72 of the Council of 21 March 1972

Summary of the case

A Polish national, Mr. I.D. (the first defendant) was hospitalised for urgent medical care at the L. Pasteur Hospital in Košice (the plaintiff). At the time, he only identified himself with an expired insurance card. Although Mr. I.D. did not fulfil his duty to identify himself with a valid insurance card or to request an E-form for healthcare (namely E 111, E 112, E 123), he did recognise his debt and he also pledged to settle it. During the proceedings, Mr. I.D. passed away, therefore, the prosecution against him was discontinued by decision No. 22C/189/2010. The hospital sought to settle the costs of Mr. I.D.’s hospitalisation with the largest Slovak insurance company – the General Health Insurance Company (the second defendant), as in accordance with the Slovak Act on Insurance. The Insurance Company denied the hospital’s claim, as the first defendant did not fulfil the above-stated duties.

The plaintiff stated that every EU resident has an equal right to access healthcare services without discrimination based on his finances, residence, type of disease, or access to healthcare services, as in accordance with Council Regulation No 1408/71 and the EU Charter of Fundamental Rights. As the healthcare provided to Mr. I.D. was urgent, the General Health Insurance Company bears the costs of his hospitalization, as provided by Article 9(3) Slovak Insurance Act. The second applicant objected, stating that they are only obliged to pay in cases where a form certified by the patient’s domestic insurance company is provided.

• Civil judicial enforcement

Before its reasoning, the court state that the ruling would be given with regards to the Regulation of the Ministry of Health of the Slovak Republic No 67/2005 (Regulation 67/2005), applying Council Regulation No 1408/71 and Council Regulation No 574/72, while its reasoning is based on the Slovak Act on Insurance; the Slovak Act on Healthcare and Services Relating to Healthcare; and the Slovak Act on Healthcare Providers. The primary question to be answered was the interpretation of Article 9(3) of the Slovak Act on Insurance and Article 9 of Regulation 67/2005 and, namely, which one prevails.

Article 9(3) states that a patient who has not applied for insurance is entitled only to coverage of urgent medical care, reimbursed by the largest Slovak health insurance company. The court continued with an enumeration of other relevant definitions, highlighting the wording of Article 35 of the Charter. The court also reiterated Article 9 of Regulation No 67/2005, stating that when an EU resident failed to identify himself with an E-form for healthcare or a European insurance card, a Slovak insurance provider covers his urgent medical care when it acquires a form certified by the patient’s domestic insurance company.

The court stated that Regulation No 67/2005 does not clarify whether the above-stated form shall be requested by the healthcare provider, by the Slovak insurance provider, or by the patient himself. Simultaneously, it is clear that when urgent medical care is at hand, the healthcare institution does not have the time to acquire this form itself. The court further stipulated that healthcare providers should not bear the costs for urgent medical care merely because the patient has not fulfilled his duty to identify himself with a certified form, has not registered himself at a Slovak insurance company, or has no Slovak medical insurance card.

The court proceeded to affirm that Member States may maintain the general conditions of eligibility, together with the regulatory and administrative requirements relating to healthcare and the reimbursement of healthcare, provided that these conditions are not arbitrary or discriminatory and are necessary and proportionate to their objective. Therefore, such requirements need to be applied objectively, transparently, and without discrimination, based mainly on medical considerations, without imposing an additional burden on other Member States’ citizens.

The court, therefore, concluded that reimbursement conditional on a document acquired before urgent medical treatment would constitute an obstacle to the free movement of services. Moreover, the defendant’s claim that an invalid European Insurance Card does not establish a right to the provision of urgent medical care, as within the meaning of Article 9(3), breaches the Slovak Constitution and other valid regulations, as it is impossible for the plaintiff to refuse to provide urgent medical care, merely because of a failure to identify oneself with a valid insurance card or a failure to request an E-form for healthcare.

Lastly, the validity of the debt acknowledgement by the first applicant could not have been ascertained, thus, no legal title emerged.

Role of the Charter and role of the general principles on enforcement

The national court emphasised that reimbursement conditional on a document acquired before urgent medical treatment of an EU national/resident would be in violation of Article 35 and would additionally constitute an obstacle to the freedom of services in the EU.

Additional notes on the decision

This case has not been referred to particularly, however, its reasoning with regards to the free movement of services and equal treatment has been repeated word by word in subsequent cases (see for instance the Hospital with a Healthcare Centre in Dunajská Streda v M.N. case).