German sickness and long-term care insurance – Regulation (EC) No. 883/2004

Subject: German sickness and long-term care insurance – Regulation (EC) No. 883/2004

A German citizen living in Belgium contributed to the German sickness and long-term care insurance during his active career in Germany. Once he retired, he stopped paying into the German insurance schemes because he is a member of a Belgian health insurance fund. As his wife was suffering from a serious illness, he applied for a care allowance. He was informed by the German sickness insurance scheme that, on the basis of his wife’s Belgian nationality, of the insurance cover in Belgium, and of his residence in Belgium, his wife is insured as a frontier worker and is entitled to mutual benefits assistance (Leistungsaushilfe) from Germany. This takes the form of care benefits in kind rather than a care allowance, as the care allowance system does not exist in Belgium. The decision makes reference to Regulation (EC) No 883/2004.

1. Is the Commission aware of such situations in which a care allowance cannot be paid?

2. Is it correct that entitlements accrued in the German long-term care insurance scheme over the course of one’s professional life cease to exist after retirement and withdrawal from that insurance in the case of frontier workers (insured in the State of residence)?

3. If so, does the Commission intend to reconsider the current approach?

Answer given by Mr Schmit on behalf of the European Commission

(21 December 2022)

Regulation (EC) No 883/2004 (1) on the coordination of social security systems neither harmonises nor determines the details of the Member States' national social security systems. It might happen that a long-term care benefit takes the form of a benefit in kind in one Member State and the form of an allowance in another Member State.

Regulation (EC) No 883/2004 contains a set of conflict rules indicating which Member State has to pay sickness and long-term care benefits to a person who is in receipt of pension from one country (in this case Germany) but resides in another one (Belgium).

The general rule is that the insured person and his/her family members receive benefits in kind (e.g. medical care) from the Member State of residence, which will be paid back afterwards by the Member State of insurance. Cash benefits (and only cash benefits) can be exported from the Member State of insurance to the country of residence.

Since under the German legislation, the mutual benefits assistance (Leistungsaushilfe) is a benefit in kind, it cannot be exported to Belgium where the person concerned resides with his spouse.

Given the differences between the national social security legislations, which are not overcome by the coordination provisions of the above Regulation, it cannot be excluded that moving from one Member State to another may bring certain changes for the insured person in terms of entitlements to certain categories of benefits, in a particular case.

The ongoing revision of Regulation (EC) No 883/2004 does not imply any modification of the basic principles of the coordination of social security rules as regards long-term care benefits.

⋅1∙ OJ L 166, 30.4.2004 | | ( | | )