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Health Insurance Companies Cannot Automatically Refuse Jehovah's Witnesses Request For Reimbursement of Medical Care Available Abroad

16/11/2020

The Court of Justice of the European Union has ruled that if a medical treatment confirmed as effective is available in one Member State contradicts the patient's religious beliefs, the patient is, in principle, entitled to claim reimbursement from his health insurance company for availing the effective healthcare available in another Member State that does not go against his or her religious beliefs. The decision of the insurance company must not discriminate on the grounds of religion or belief.

The Court of Justice of the European Union has repeatedly ruled on the issue of interstate reimbursement of healthcare. However, this case is controversial due to its unique facts and circumstances. Latvia refused to give a patient- a minor boy and a Jehovah's Witness, permission to undergo heart surgery in Poland. None of the Latvian healthcare providers were able to offer heart surgery without a blood transfusion, which Jehovah's Witnesses refuse. Therefore, the minor's father negotiated the possibility of performing the surgery in Poland, and asked the Latvian health insurance company to issue a permit for the surgery. The Latvian insurance company refused to issue the permit on the grounds that the minor's state of health does not require urgent provision of healthcare and, above all, the required healthcare can be provided to the minor under the same conditions as other patients. The father argued that health care was not actually available for his son in Latvia, and pointed out the inadmissible discrimination in access to healthcare on the grounds of their religion.

The system of providing hospital care in another Member State of the European Union works in such a way that Member States can reimburse the costs of care available in another Member State subject to prior authorization. In the Czech Republic, a permit authorising healthcare in another Member State is granted by the relevant health insurance company. Upon request, the insurance provider examines whether effective care is actually available for the patient in the Czech Republic. The Court has now said that fundamental rights, in particular the prohibition of any discrimination on grounds of religion or belief in Article 21 of the Charter of Fundamental Rights of the European Union, must also be respected in determining whether effective care is available in the home country. Restrictions must also not be an unjustified obstacle to the free movement of patients.

Member States typically argue that a system of prior consent protects sustainable access to a balanced supply of quality healthcare and the financial stability of the social security system. The Court has stated that both objectives are legitimate, but that it is always necessary to examine whether the instruments to achieve them are proportionate and legitimate. It states that the Member State in which the patient is insured will compensate or directly reimburse the costs of cross-border healthcare only to the extent of the costs that it would have borne if the healthcare had been provided in its territory.

Thus, a health insurance company cannot automatically refuse to authorize the reimbursement of hospital healthcare in another Member State for a patient who is insured with this insurance company if the hospital treatment, which is unquestionably effective, is available in the home Member State, but the treatment contradicts the patient's religious beliefs. The exception to this rule applies in cases where the health insurance company is able to objectively justify the refusal with a legitimate aim of securing treatment capacity or the competence of medical professionals, and the refusal is demonstrated as a proportionate and necessary means of achieving that aim. In the event of a dispute, the court must verify this.