Abstract: the provisions of EU law that are relevant to health insurance are either competition law and state aid, or public procurement. Which regime applies depends mainly on the definition of undertaking. At the same time the internal market rules are also relevant, notably the non-life insurance Directives which limit the ability of Member States to intervene in insurance conditions, but with an exception for schemes that substitute for social security. This reflects the balancing act between compulsory coverage and privatisation of risk that characterises the increasing importance of health insurance as part of the policy mix which Member States apply to problems of funding and guaranteeing the provision of healthcare. JEL codes: I1; I18; K21; K23; K32 Keywords: health insurance and: competition law; state aid; public procurement 1. Introduction Within the EU, health insurance is so far primarily a phenomenon of the Bismarck systems of which it forms the defining feature. In this paper the term health insurance covers publicly defined (minimum packages) of care as well as (often voluntary) supplementary insurance. In all cases health insurance involves third party payment of medical expenses as well as pooling of risks, in some cases based on solidarity within the population of the particular insurer, and sometimes between insurers if a system of risk equalisation is implemented.