Background

1. National and regional ombudsmen in the European Network of Ombudsmen may ask the European Ombudsman for written answers to queries about EU law and its interpretation, including those which arise in their handling of specific cases.

2. On 2 August 2023, the Spanish Ombudsman submitted such a query to the European Ombudsman. The query concerns the information provided by the Commission on its website as regards the reimbursement of healthcare expenses (by a Spanish citizen) in the Netherlands by means of the European Health Insurance Card (EHIC).

3. The Spanish Ombudsman asked the Commission to confirm whether the information provided was accurate.

The questions addressed to the Commission

4. Based on the query on 28 August 2023, the Ombudsman asked the Commission the following question:

Could the Commission review the information it has provided on its website concerning the use of the European Health Insurance Card in order to determine whether the information is accurate and to consider whether further clarifications could be introduced to remove any ambiguity as regards the use of the card and the manner in which expenses are reimbursed?

The Commission's reply

5. 17 October 2023, the Commission sent its reply in which it explained that the holder of an EHIC is entitled to be treated ‘on the same terms’ as a citizen of the Member State where the treatment takes place (Member State of stay). Therefore, if citizens are required to pay for medical services in that Member State, this also applies to the holders of EHICs. Where payment is requested, there are two reimbursement procedures; (i) direct reimbursement from the institution of the Member State of stay or (ii) from the home Member State.

6. The Commission noted that general information on obtaining medical care abroad and on both procedures are set out on a dedicated part of its website and it provided the relevant link. In addition, there is also country specific information available from all the participating countries.

7. The Commission stated that it had contacted the relevant authorities in the Netherlands to verify that the EHIC procedure had been correctly followed by the Dutch hospitals. It was explained to the Commission that usually the holders of EHIC cards do not pay for medical treatment ‘upfront’, save in exceptional circumstances, for example where there is a concern as to the validity of the card. In those instances, the holder must pay for the treatment at the hospital and then seek reimbursement from their home Member State. The Commission understands that this procedure was followed in this case.

8. Finally, the Commission explained that it updates its EHIC webpage annually based on explanations provided by the national authorities of the participating Member States.

The European Ombudsman's conclusion

9. A copy of the Commission’s reply was provided to the Spanish Ombudsman who did not submit further comments.

10. The European Ombudsman considers that the issues raised in the query have been adequately clarified. The Ombudsman therefore closes the query.

The Spanish Ombudsman and the Commission will be informed of this report.

Rosita Hickey
Director of Inquiries

Strasbourg, 07/03/2024