Hospital Treatment in another EU/EEA country

Rules

Someone who is "ordinarily resident" in Ireland is someone who is living here and intends to continue to live here for at least a year.

Recent European Court of Justice cases may mean that the rules can be applied more extensively but this is not yet fully clear. (View further information on this issue in the section 'The European Court of Justice and the Watts Case', below).

The other EU member states are Austria, Belgium, Denmark, Germany, Finland, France, Greece, Italy, Luxembourg, The Netherlands, Portugal, Spain, Sweden, United Kingdom, the Czech Republic, Hungary, Poland, Malta, Cyprus, Estonia, Latvia, Lithuania, Slovakia, Slovenia, Romania and Bulgaria.

The EEA member states are Iceland, Liechtenstein and Norway.

The Health Service Executive may refer patients to other countries (i.e., outside the EU/EEA or Switzerland) and may agree terms for that referral but this is outside the scope of the EU regulations.

EU rules

The rules on entitlement to hospital treatment in another EU/EEA country or Switzerland rules apply in each member state.

The regulations do not deal with entitlement to services in your own country nor do they require any country to provide any particular treatment for its residents.

They do provide that you can be referred to another Member State for treatment in certain circumstances. There is no legislation in Ireland on the circumstances in which you may be entitled to be referred abroad. The Department of Health have issued guidelines to the Health Service Executive on the use of these provisions.

EU regulations provide that an individual from one Member State is entitled to medical benefits on the same basis as nationals in another Member State if authorised by the competent institution in his/her own state. The competent institution in Ireland is the Health Service Executive.

This authorisation may not be refused if

• the treatment in question is among the benefits provided for in the home state's legislation and
• the individual cannot be given this treatment within the time normally necessary for obtaining it in the home state, taking account of his/her current state of health and the probable course of the disease.

It should be noted that any member state may grant authorisations for treatment in another member state on a much wider basis. The regulation only stipulates when such authorisations may not be refused, it does not lay down the limits to when they may be granted.

The cost of such treatment is covered initially by the Member State providing it but that state is refunded by the home state.

Guidelines to the Health Service Executive (HSE)

The Department of Health's guidelines for the Health Service Executive (HSE) set out the conditions for referral to another EU/EEA country or Switzerland:

• Your application must be assessed before you go abroad, although some leeway may be allowed in extremely urgent cases.
• A hospital consultant must provide medical evidence of the details of your condition. The consultant must certify that:

• the treatment concerned is not available in this country
• there is urgent medical necessity for the treatment
• there is a reasonable medical prognosis
• the treatment is regarded as a proven form of medical treatment and
• the treatment abroad is in a recognised hospital or other institution and is under the control of a registered medical practitioner.

Form E112

The usual procedure is that a person who is authorised to go to another member state for treatment is issued with a Form E112 to establish his or her entitlement to the treatment. The issue of Form E112 implies a commitment by the Health Service Executive (HSE) to pay the cost of treatment.

Other arrangements

Arrangements that are made outside the terms of the EU Regulations, e.g., arrangements to send a patient to a non-EU or a non-EEA country or private arrangements for treatment, are considered to be outside the terms of the Regulations and the Health Service Executive (HSE) is not obliged to meet any of the costs involved. However, in exceptional circumstances, the HSE may may pay a contribution towards the cost of the service. It may, for example, pay the costs of treatment in private institutions in other EU/EEA countries or Switzerland that are made available to the health authorities in these countries for the treatment of public patients on a contract basis. In such cases, HSE Areas may have to verify that the charges are similar to the charges levied on patients from the home country.

European Court of Justice (ECJ) and the Watts Case

On 16 May 2006 the ECJ delivered an important decision in a case involving the rights of EU nationals to travel to other member states to avail of services. That case, (the Watts case) related to the rights of an EU national to apply for an E112 authorisation in order to travel abroad to avail of health services in another member state. Under the E112 scheme, a member state cannot refuse an application for an E112 authorisation where the health treatment is normally available in the home member state but cannot be provided in the individual's case without undue delay.