Cross-Border Healthcare Directive
If you are entitled to public health services in Ireland, you may opt to access those services in another member state of the European Union (EU) or European Economic Area (EEA), which also includes Iceland, Liechtenstein and Norway, and be repaid the cost if you meet the requirements. This is provided for by the Cross-Border Healthcare Directive (EU Directive 2011/24/EU, pdf).
The amount that will be repaid is the cost of the public healthcare treatment in Ireland, or the cost of your treatment abroad, if that is less. It does not include other costs such as travel.
Treatments that qualify for the Treatment Abroad Scheme are not covered under the Cross-Border Healthcare Directive. In general, the Treatment Abroad Scheme covers treatments that are not available in Ireland while the Cross-Border Healthcare Directive only covers treatments that are publicly funded and available in Ireland. Read about the differences between the two schemes.
Funding will only be reimbursed for healthcare that is publicly funded and available in Ireland but the referral may be to a public or private health service in the other country. You pay the costs of treatment and then apply for a refund when you return to Ireland.
Examples of healthcare that is available under the scheme include:
- Day, in-patient and out-patient care in acute hospital services, including psychiatric services
- Community-based out-patient care
- Dental and orthodontic services (with some exceptions, such as dental screening services in schools)
- Speech and language services
- Occupational therapy services (with some exceptions, such as assessment for aids at home)
- Psychology services
- Physiotherapy services
- Disability services
- Ophthalmic services
- Mental health services
- Methadone programme
- Addiction care (following the process to access addiction care abroad)
Some health services are not included, for example, organ transplantation and long-term care such as nursing home care.
The HSE has provided a list of Frequently Asked Questions about the Cross-Border Healthcare Directive.
How to apply
To use health services in another country and be refunded under the Cross-Border Healthcare Directive you must:
- Be referred to the health service abroad
- Get prior authorisation if it is required for your treatment
- Apply for a refund of your costs
Referral to healthcare abroad
In the same way that you would be referred to public health services in Ireland, you must be referred to the health service you require abroad. This may be, for example, by your GP (family doctor) or public hospital consultant. In the case of some community-based services the appropriate referral could be by a Health Service Executive (HSE) professional such as a public health nurse, community dentist or HSE orthodontist.
The referral letter should specify the healthcare required, the health professional abroad you are being referred to and their clinic, hospital or other location. You, or the person referring you, should be satisfied that the healthcare provider abroad is qualified and suitable. If you wish to access information on services or service providers abroad please contact the National Contact Point for the other EU/EEA State.
Make sure that the service you are seeking to access abroad is covered by the Cross-Border Healthcare Directive. Your referring clinician can advise you about this but if you are in doubt you can contact the National Contact Point in Ireland to check.
If the treatment involves an overnight stay in hospital then it will need to be authorised in advance by the HSE. For other treatment it is advisable to check whether prior authorisation is required by contacting the National Contact Point.
The application form for prior authorisation (pdf) must be completed by you and by the medical professional who is referring you for treatment abroad. Completed applications take 15 to 20 working days to process and you will be notified of the decision by letter.
Prior authorisation is also required for healthcare that involves:
- Highly specialised and cost-intensive medical infrastructure or equipment
- Treatments presenting a particular risk for the patient or the population
- A healthcare provider that could give rise to serious and specific concerns relating to the quality or safety of the care
Applying for a refund of costs
To get a refund of the costs that you pay for your treatment, you and your healthcare provider abroad must complete the HSE Cross-Border Healthcare Directive Pro-Forma Invoice (pdf) and submit it with the invoice from the healthcare provider and receipt.
The refund will only be made to the patient (or to the parents of a child patient).
The HSE has published the refund amounts for different treatments. Treatments are listed according to a code – you can get the code for your treatment from the healthcare professional who has referred you. If you prefer, or if your treatment is not listed, you can get details of the refund rates from the National Contact Point.
The maximum refund for a hospital outpatient consultation is €130. If you have more than one consultation on the same day with consultants in the same speciality, the daily limit is €130.
For in-patient treatment, the charges for public in-patients in public hospitals in Ireland will apply. These charges will be deducted from the amount of the refund.
If your application is refused you can appeal to the Assistant National Director of the Contracts Department of the HSE – contact the National Contact Point.
Where to apply
The HSE has established a National Contact Point office for the administration of the Cross-Border Healthcare Directive in Ireland.