When a migrant worker temporarily staying in a Member State other than the competent state requires a prosthesis, a hearing aid, or admission to a sanatorium, the host-state institution cannot simply provide that benefit. Article 24(2) of Council Regulation (EEC) No 1408/71 of 14 June 1971 establishes a prior-authorization gate: before the institution of the place of stay may grant a substantial benefit in kind, it must obtain authorization from the competent institution. The Regulation does not itself enumerate which benefits are "substantial." Decision No 115 of 15 December 1982, adopted by the Administrative Commission of the European Communities on Social Security for Migrant Workers, answers that question with a closed, exhaustive list of twelve categories. Decision No 115, preamble and para. 1; Regulation (EEC) No 1408/71, Art. 24(2)
The Regulatory Framework
Article 24(2) of Regulation (EEC) No 1408/71 draws a structural distinction between ordinary benefits in kind, which the host-state institution provides immediately in accordance with its own legislation, and substantial benefits in kind, which require prior authorization from the competent institution before the host-state institution may grant them. The competent institution is the social security institution of the Member State whose legislation governs the worker, which is ordinarily the state of employment.
The Administrative Commission's authority rests on Article 81 of Regulation (EEC) No 1408/71, which makes it responsible for all administrative questions and questions of interpretation arising from the Regulation and subsequent regulations. Regulation (EEC) No 1408/71, Art. 81 Decision No 115 was adopted under that authority, acting in accordance with Article 80(3) of the same Regulation.
Without a uniform catalogue, each institution would apply its own national conception of what is "substantial," producing inconsistent treatment of migrant workers across the Community. Decision No 115 replaced Decision No 93 of 24 January 1974, updating and consolidating the prior enumeration. Decision No 115, para. 2
The Twelve Categories
Decision No 115, paragraph 1, lists the prostheses, major appliances and other substantial benefits in kind referred to in Article 24(2) of Regulation (EEC) No 1408/71, in so far as they are provided for under the legislation administered by the institution of the place of stay or of the place of residence. The list is exhaustive. Only the twelve enumerated categories trigger the authorization requirement.
Category (a) covers surgical appliances, orthopaedic appliances and supporting apparatus, including orthopaedic corsets of reinforced material, together with any additional parts, accessories and aids. Decision No 115, para. 1(a)
Category (b) covers orthopaedic footwear and remedial footwear, including non-orthopaedic remedial footwear. Decision No 115, para. 1(b)
Category (c) covers maxillary and facial prostheses and wigs. Decision No 115, para. 1(c)
Category (d) covers ocular prostheses, contact lenses, magnifying spectacles and telescopic spectacles. Decision No 115, para. 1(d)
Category (e) covers hearing aids. Decision No 115, para. 1(e)
Category (f) covers dental prostheses, both fixed and removable, and obturators for use in the buccal cavity. Decision No 115, para. 1(f)
Category (g) covers invalid vehicles, whether manually operated or motorized, wheelchairs, other mechanical means permitting the disabled to move about, and guide dogs for the blind. Decision No 115, para. 1(g)
Category (h) covers the renewal of any item listed in categories (a) through (g). Decision No 115, para. 1(h) The express inclusion of renewal is significant in practice. Replacement of an existing appliance or prosthesis might otherwise be characterized by a host-state institution as routine maintenance rather than a substantial benefit in kind. Category (h) removes that ambiguity: renewal triggers the same prior-authorization requirement as the initial provision of the item.
Category (i) covers spa treatment. Decision No 115, para. 1(i)
Category (j) covers accommodation and medical treatment in a convalescent home, a sanatorium, an establishment or home for the handicapped (including the blind, the deaf and dumb, and the mentally handicapped), or an open-air sanatorium. It also covers stays in a preventorium under the specific conditions addressed in the following section. Decision No 115, para. 1(j)
Category (k) covers functional or occupational rehabilitation. Decision No 115, para. 1(k)
Category (l) closes the enumeration with a rule of broad reach: any subsidy granted to cover part of the costs of the benefits listed in categories (a) through (k) is itself a substantial benefit in kind requiring prior authorization. Decision No 115, para. 1(l) The authorization gate therefore applies not only to the direct provision of a device or service but also to any financial contribution made toward its cost.
The 20-Day Threshold
Category (j) applies to stays in a preventorium under a specific rule. The prior-authorization requirement is triggered where the length of stay in a preventorium seems likely to exceed 20 days in the opinion of the attending physician or, where the legislation of the country in which the person is present so requires in such cases, in the opinion of the medical consultant of the institution of the place of stay or of the place of residence. Decision No 115, para. 1(j)
The category also applies retroactively: where, contrary to the original opinion of the physician or consultant, the length of stay in fact exceeds 20 days, the category is engaged in respect of that extended stay.
Two points follow. First, the trigger is prognosis, not actual duration: an anticipated stay of more than 20 days is sufficient to engage the requirement. Second, the authorization gate cannot be avoided simply because the original prognosis was under the threshold and was later overtaken by events.
A structural distinction within category (j) requires attention. For convalescent homes, sanatoria, establishments for the handicapped, and open-air sanatoria, no duration threshold applies: the authorization gate opens on admission regardless of anticipated length of stay. The 20-day threshold is specific to preventoria alone, reflecting the different clinical character of that setting.
Practitioner Implications
Decision No 115 took effect on 1 January 1983 and replaced Decision No 93 of 24 January 1974. Decision No 115, para. 2 For practitioners dealing with social security coordination matters that span those dates, the pre-1983 and post-1982 catalogues must each be applied to benefits granted in their respective periods.
The decision was published in Official Journal C 193, 20 July 1983, and is reproduced in the Spanish and Portuguese special editions at Chapter 05, Volume 3, page 49. It is available in the EUR-Lex archive under document identifier 31983Y0115.
For firms advising cross-border workforce clients, three questions govern the Article 24(2) analysis. First: was the worker temporarily staying in a Member State other than the competent state when the benefit was required? Second: does the benefit fall within one of the twelve categories of Decision No 115? Third: was prior authorization obtained from the competent institution before the host-state institution provided the benefit? Absence of authorization does not automatically shift the cost to the worker, but it materially affects the reimbursement analysis between the two institutions.
Category (l) warrants particular attention. Where a host-state institution grants a partial subsidy toward dental prostheses under category (f), that subsidy is itself a category (l) benefit requiring prior authorization. Practitioners handling reimbursement disputes should check whether the contested payment falls under categories (a) through (k), under category (l), or under both characterizations.
Primary sources, not summaries.
Frequently Asked Questions
Does the authorization requirement under Decision No 115 apply to self-employed persons as well as employed persons?
The personal scope of Regulation (EEC) No 1408/71, set out in Article 2, covers employed persons, self-employed persons, and members of their families moving within the Community. Decision No 115 defines the categories of substantial benefits in kind for the purposes of Article 24(2) and follows that same personal scope. Self-employed persons temporarily staying in a Member State other than the competent state are subject to the same prior-authorization requirement when any of the twelve categories is needed.
If a worker is admitted to a convalescent home for an anticipated stay of three days, does prior authorization apply?
Yes. Category (j) of Decision No 115 applies to accommodation and medical treatment in a convalescent home without any minimum-duration threshold. Decision No 115, para. 1(j) The 20-day threshold operates only in respect of stays in a preventorium. Admission to a convalescent home triggers the prior-authorization requirement from the outset regardless of the anticipated or actual length of the stay.
Does category (h) apply when the worker seeks renewal of an appliance in the competent state?
Category (h) and the authorization structure in Article 24(2) of Regulation (EEC) No 1408/71 apply only when the worker is temporarily staying in a Member State other than the competent state. Regulation (EEC) No 1408/71, Art. 24(2); Decision No 115, para. 1(h) Where the worker is in the competent state, Article 24(2) and Decision No 115 are not engaged: the competent institution's own legislation governs.
Which institution issues the authorization, and which institution provides the benefit?
The competent institution, meaning the institution of the Member State whose legislation governs the worker's social security entitlements, issues the prior authorization. The host-state institution, meaning the institution of the Member State where the worker is temporarily staying, provides the benefit once authorization has been received. Article 24(2) of Regulation (EEC) No 1408/71 establishes this two-institution structure; Decision No 115 determines which benefits require the authorization step before provision can occur. Regulation (EEC) No 1408/71, Art. 24(2); Decision No 115, para. 1
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