Tax & Legal

Referral to ECJ for VAT treatment of medical telephone consultations

The Supreme Tax Court has asked the European Court of Justice for clarification as to whether telephone advisory services provided by a company on behalf of state health insurance funds through so-called “health coaches” may be free from VAT.

The Supreme Tax Court asks the ECJ to determine whether the medical advice provided by an entrepreneur to insured persons on various health and disease issues by telephone on behalf of state health insurance funds is a VAT-exempt activity under Article 132 (1) on the common system of value added tax. According to Article 132 (1) “Member States shall exempt the following transactions….(c) the provision of medical care in the exercise of the medical and paramedical professions as defined by the Member State concerned.

Furthermore the Supreme Tax Court wishes to know, whether it is sufficient for a qualification in this respect ( required under EU-law) that the telephone consultations are carried out by “health coaches” (medical assistants, nurses) and that ultimately a doctor is consulted only in about one third of the cases. On behalf of state health insurance funds, the appellant operated a specific “telephone-hotline” to provide medical advice to insured persons. It also conducted patient support programs under which certain insured persons received situation-related information about their medical condition via a medical hotline and based on certain billing data and pathological pictures and symptoms.

In the opinion of the Supreme Tax Court the services provided in the course of activities via the health telephone do not fall within the scope of the VAT exemption as it is not certain whether the consultation will be accompanied by a medical treatment or whether it will become part of a complex health treatment. Unlike patient monitoring programs, information given to callers on the hotline is not taking into account previous medical findings or orders. The tax court points out that the medical treatments are without any personal contact and it therefore wishes to know whether – in the field of telemedicine – the fulfilment of additional requirements is necessary from an EU point of view.


Supreme Tax Court, resolution XI R 19/15 of 18 September 2018 published on 23 January 2019