Accessing healthcare in another EU/EEA member state through the Cross Border Directive on Healthcare.
The provision of health services in Ireland is governed by legislation including the Health Acts 1970 - 2013 (as amended), under the Health Act 1970-2013 (as amended) everyone who is ordinarily resident in Ireland qualifies for public health care. A private outpatient appointment in the Republic of Ireland may not be used under any circumstances to exercise rights for the purposes of reimbursement under the provisions of the Cross Border Healthcare Directive. The attendance of a private appointment in Ireland deems the patient a private patient and not a public patient for the purpose of provisions the Cross Border Directive.
The Cross Border Directive allows for EU residents to access health services in EU member states other than their own.
The Cross Border Directive allows for Irish residents to avail of healthcare in other EU member states that they would be entitled to within the public health system in Ireland, which is not contrary to Irish legislation. The costs must be borne by the individual and he/she then seeks reimbursement for the cost of the healthcare upon return to Ireland.
Similarly under the Cross Border Directive persons resident in other EU member states may access healthcare in Ireland.
The HSE operates the European Union Cross-Border Healthcare Directive (CBD), for persons entitled to public patient services in Ireland who may seek to avail of those services in another EU/EEA* member state. This is governed under Directive 2011/24/EU of the European Parliament and of the Council of 9 March 2011 on the application of patients’ rights in cross-border healthcare, as per the procedures set out in governing EU Regulations and Directives and Irish legislation. A private outpatient appointment in the Republic of Ireland may not be used under any circumstances to exercise rights for the purposes of reimbursement under the provisions of the Cross Border Healthcare Directive. The attendance of a private appointment in Ireland deems the patient a private patient and not a public patient for the purpose of provisions the Cross Border Directive.
Within these governing EU Regulations and Irish legislation, the CBD provides for the cost of publicly funded healthcare in Ireland to be availed of and the costs to be reimbursed subject to compliance with the applicable administration processes adopted by the HSE in the administration of the CBD. What this means is that if you are entitled to public health services here in Ireland, you may opt to access those services in another EU/EEA* member state. The cost of the services you avail of under the CBD in another EU/EEA* member state will be reimbursed at the cost of the service in the country where you availed and paid for it or the identified cost here in Ireland – whichever is the lesser.
The procedures to exercise your rights to access health services abroad under the CBD:
If you are availing of public health services in Ireland and you choose to opt to access those services in another EU/EEA* State then here are the steps you should follow:
1) Have you got an appropriate referral?
To avail of public health services in Ireland you must be referred to those services by your GP, a hospital consultant you are attending on a public basis or in the case of certain community based services by a HSE professional e.g. a Public Health Nurse, Community Dentist, HSE Orthodontist, etc. (Please note private patients are not public patients for the purposes of accessing funding under the CBD or the Treatment Abroad Scheme. Private patients should access funding for their care via their private health insurer.) Under no circumstance will an outpatient appointment in a private capacity in Ireland be accepted for the purpose of accessing healthcare abroad under the Cross Border Directive. Public referral pathways as applicable in Ireland must be adhered to. Public consultant appointments can only be accepted. A private outpatient appointment in the Republic of Ireland may not be used under any circumstances to exercise rights for the purposes of reimbursement under the provisions of the Cross Border Healthcare Directive. The attendance of a private appointment in Ireland deems the patient a private patient and not a public patient for the purpose of provisions the Cross Border Directive.
Please also be aware that there is no obligation on your GP or other clinician to provide a referral to a provider abroad. While in most instances referring doctors will be happy to discuss and agree this option with you, he/she is not obliged to provide a referral to a service abroad. For example a clinician could refuse to provide a referral to a service abroad in cases where he/she is unfamiliar with the service or has concerns about the quality and/or safety of the service, or the appropriateness of the service to meet the patient’s overall needs, etc.
2) If you decide you wish to access the healthcare in question in another EU/EEA* State you will require an appropriate referral from your GP or treating physician in Ireland. A referral from a GP abroad is also acceptable and a consultant abroad can be considered a referring consultant where a referral from a GP to that consultant is evidenced. The letter should stipulate the healthcare required, general clinical and personal history as appropriate, the health professional abroad you are being referred to and the clinic/hospital/location where that health professional operates from. It is the responsibility of the patient or his/her referring clinician to satisfy him/herself as to the qualifications, suitability and practice rights of the service provider abroad. If you or your referring clinician wishes to access information on services or service providers in other EU/EEA States please contact the National Contact Point for the other State. Details of the National Contact Points for the other EU/EEA* States are available at: http://ec.europa.eu/health/cross_border_care/docs/cbhc_ncp_en.pdf .
In instances where you or your referring clinician wish to enquire about the qualifications etc of the clinician you wish to attend abroad you may submit an email to Catherine Donohoe at email@example.com who will contact the Internal Market Information (IMI) section of the EU and seek the clarifications required. The type of questions usually pursued in this way relate to the qualifications of the doctor abroad, whether there are any restrictions to his practice, his registration, etc. If you are seeking such information you should be precise about what information you wish to have confirmed and specifically identify the doctor in question.
3) Ensure the service you are seeking to access abroad is covered by the provisions of the CBD. The CBD excludes certain health services, e.g. services of public health, long term care, organ transplantation, etc. Your referring clinician will be able to advise you in relation to this but if you are in doubt contact the National Contact Point staff via the contact details on this page or via email at firstname.lastname@example.org and they will be able to clarify the position for you.
4) How does this scheme work:
The CBD allows for patients ordinarily resident in Ireland who require and are entitled to public healthcare services to be referred to another EU/EEA* member state for that care and be reimbursed in accordance with the legislation. It will be a matter for the patient or his/her referring doctor to identify the clinician abroad and satisfy him/herself in relation to the qualifications, quality and safety of the services being availed of in the other jurisdiction. Funding will only be reimbursed for healthcare that is publicly funded and available in Ireland and which is not contrary to Irish legislation. Reimbursement will be made in line with published reimbursement rates available from the NCP. Reimbursement will only be made to the patient or his or her parents/guardian in the case of a child. No payments will be made to third parties, except in the case of a patient’s death, and this will be subject to the executor of the estate providing evidence of the outstanding liability and evidence of the settlement of that liability upon which the reimbursement will be processed and made to the legal representative of the deceased patient
5) What healthcare is available under the scheme?
Acute/Psychiatric Hospital Services – Day, Inpatient, Outpatient Care. Community based outpatient care (to include dental, ophthalmic, orthodontics, speech & language, etc.) The above is based on current services provided by the HSE and excludes long term care e.g. nursing home care.
Accessing orthodontic treatment in another EU member State under the Cross Border Directive (CBD)
In line with normal procedures in the HSE dental service, access to orthodontics under the Cross Border Directive will be via an assessment by a primary care clinician the HSE . This is generally provided between the ages of 11-13 years of age (coincident with 6 th class or first year in secondary school) but can be provided anytime up to 16 years of age in accordance with the legislation .
Patients requiring primary care non surgical orthodontic care are eligible to apply for reimbursement of orthodontic fees in line with the provisions of the Cross Border Directive.
The HSE will reimburse orthodontic fees up to a maximum of €2,200, or the cost of the treatment abroad, whichever is the lesser.
Assessment for eligibility for orthodontic treatment (categorisation) as per the HSE Orthodontic Assessment Tool (please see link below).
€100 maximum reimbursement
€1,800 maximum reimbursement
Treatment Completion – at end of retainer phase
€300 maximum reimbursement
Assessment: If your child has been referred by a HSE Primary Care Dentist for Orthodontic Assessment with a view to Orthodontic Treatment, the maximum reimbursement amount for that assessment under the HSE Cross Border Directive is €100. The assessment abroad must be done in line with the HSE Orthodontic Assessment Tool.
Treatment: The maximum amount payable for Orthodontic Treatment is €1,800 (to be paid as/when claims for reimbursement are submitted).
Treatment Completion - Final Payment: When your child is in the retainer phase of their treatment the maximum amount payable for that phase of their treatment is €300 (final payment not due for payment until retainer phase).
Details are available from the National Contract Point via telephone 056 778 4547 or 056 778 4546 or 056 778 4556 or the HSE Cross Border Directive website www.hse.ie/crossborderdirective
Speech & Language Services
Occupational Therapy Services (some exceptions i.e. assessment for aids at home)
Ophthalmic Services (Eye Tests etc)
Mental Health Services
For details of HSE Addiction Care Pathways follow this link.
6) How do I apply?
- Outpatient and Day Case
There is no application process for outpatient or day case care. Once you have a referral from a GP or treating consultant here in Ireland you may proceed with your out patient appointment. A referral from a GP abroad is also acceptable and a consultant abroad can be considered a referring consultant where a referral from a GP to that consultant is evidenced. Following the appointment you would then submit the invoice, receipts, pro-forma invoice, proof of travel etc to the HSE for reimbursement. If you wish to know the reimbursement rate prior to your appointment please contact the CBD office and we will be happy to advise you.
- Inpatient (involving an overnight stay)
You should seek prior authorisation for all episodes of inpatient care (involving an overnight stay) under the CBD prior to accessing that care.
Prior authorisation application form process: The patient/applicant must submit a fully completed application form accompanied by the appropriate referring letter in sufficient time to allow the HSE assess and make a decision on same. The onus is on the patient to submit a fully completed application form and to provide the necessary information from the referring clinician. Incomplete applications will be returned to the patient/applicant for provision of the appropriate information prior to re-submitting to the CBD office.
7) When I apply, how long does the decision process take?
A decision can be expected between 15 and 20 working days following the receipt of a completed application and any other information/clarification requested.
8) Do you need prior authorisation?
If the service you are seeking to avail of in another EU/EEA State involves an overnight or longer stay in hospital then you will need prior authorisation. Prior authorisation can be obtained by contacting the National Contact Point (NCP) at the details below or by emailing email@example.com and the staff will provide you with the necessary forms.
9) Before you depart for your healthcare abroad download the pro-forma invoice via this link . It is strongly recommended that you bring this pro-forma invoice with you and ask your treating clinicians abroad to complete it for you. The reason for this is that the pro-forma invoice contains the information the HSE will need to process your claim for reimbursement upon your return. You will also be required to provide the invoice from the foreign provider and proof of payment. If you do not download the pro-forma invoice and ask the provider abroad to complete it for you in English you will be required to provide a certified translation of the invoice from the foreign provider. The HSE will not organise or fund the translation of any documents for reimbursement this is the responsibility of the patient.
10) When you return to Ireland you should submit the completed pro-forma invoice, the invoice from the service abroad and your receipt to the National Contact Point office at the HSE Cross Border Directive, St Canice's Hospital, Dublin Road, Kilkenny Tel: 056 778 4547 or 056 778 4546 or 056 778 4556 or via email in PDF format to firstname.lastname@example.org .
11) Reimbursement will be made to the patient (reimbursement will not be made to any third party or the service provider. The HSE will only accept court appointed/approved power of attorney for the purpose of CBD reimbursements) once the documents have been processed.
For details of the application and reimbursement procedures please follow this link.
National Contact Point: HSE Cross Border Directive, St Canice's Hospital, Dublin Road, Kilkenny
Tel: 056 778 4547 or 056 778 4546 or 056 778 4556
*Switzerland have yet to complete the process to have the Directive apply to them.