Frequently Asked Questions

Fact Sheet on the Cross Border Directive (CBD)

 

In general the CBD allows public patients in Ireland access necessary healthcare which they would be entitled to in Ireland, in another EU or EEA country. The patient can access the healthcare in the public or private setting abroad and claim reimbursement for the healthcare from the HSE upon return. The reimbursement rate is at the cost of the treatment abroad or the cost in Ireland whichever is the lesser.

 

What is the Cross Border Directive and how does it work?

1) How does this scheme work?The Cross Border Directive (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 and 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 National Contact Point (NCP).  Reimbursement will only be made to the patient or his or her parents/guardian in the case of a child. 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.

2) What treatments are available under the scheme?Any service which is provided by the public health services in Ireland can be availed of under the Cross Border Directive (CBD), for example

  • acute/psychiatric hospital services – day, inpatient, outpatient care,
  • community based outpatient care e.g.:
  • dental/orthodontics services (some exceptions i.e. dental screening services in schools)
  • speech & language services
  • occupational therapy services (some exceptions i.e. assessment for aids at home)
  • psychology services
  • physiotherapy services
  • disability services
  • methadone programme
  • ophthalmic (eye tests etc) services
  • mental health services

The above is based on current services provided by the HSE and excludes long term care e.g. nursing home care.

3) Who is eligible?Anyone who is entitled to access services as a public patient in Ireland (in general anyone who is ordinarily resident in Ireland) is eligible.  However, private patients may not access funding under the CBD or the Treatment Abroad Scheme (TAS) i.e. a referral from a consultant whom the patient is attending in a private capacity will not be accepted for the purposes of the CBD.  Private patients may revert to public patient pathways in order to avail of their entitlements under the CBD. Please note, 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.

4) Are there restrictions?The scheme is not applicable to persons seeking:

  • access to services which are not provided for within the legislation of the state
  • access to organ donation/transplant
  • access to long term/ residential care

5) How do I find out information on services abroad?Each country is required to establish a National Contact Point (NCP) which can be contacted to provide information on services in that country.  You can contact the Irish NCP (see contact details) for details of NCP in other member states, which can also be found here.

However, to access public health services here in Ireland you must be referred from a suitable clinician e.g. GP, consultant, or HSE clinician, this referral can then simply be used for the service abroad instead.  Therefore it is your referring clinician who should assist you in identifying the appropriate service abroad under the terms of the CBD. 

6) Do I have to be a public patient?Yes: in general any service provided by the HSE through the use of public funding to public patients can be described as public healthcare for the purposes of the Cross Border Directive.  Private patients are not public patients for the purposes of access to health care under EU Regulations and Directives.  Private patients should access funding for treatments abroad through their private health insurance. It is of course understood and accepted that any private patient can opt to avail of public patient status but only by following public referral pathways: private status cannot be used as a means of skipping waiting lists for the purposes of prioritised access. 

Please note, 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. 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.

7) Does the fact that I have private health insurance preclude me from applying for this scheme?No, patients who have private health insurance can and do opt not to use it in favour of being treated as public patients here in Ireland.  It is your status as a public patient which entitles you to opt for services under the terms of the CBD. 

It is of course understood and accepted that any private patient can opt to avail of public patient status but only by following public referral pathways: private status cannot be used as a means of circumventing waiting lists for the purposes of prioritised access.

Please note, 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.

8) Do I have to go to a public facility or can it be a private facility?A patient may avail of healthcare in a public or private facility abroad, but remember reimbursement is up to the cost of that healthcare in the public system of the home country.

 9) Can I access services outside Europe?The scheme is governed by EU regulations and is only applicable to services provided with EU/EEA* member states.

10) If I am on a waiting list can I apply?Yes.

11) Can I access the information online?Yes, on the HSE website here. Further webpages of interest can be found here

How do I apply? 

1) What is the application procedure?

In the case of an outpatient or day case episode of care there is no application procedure.  Applications are only required in the case of inpatient care.

Application Form process for prior authorisation (inpatient care only).

There is no “approval” process in respect of CBD healthcare. However, in an effort to protect patients the HSE introduced a system of prior authorisation in respect of inpatient care as allowed for under the Directive. This system of prior authorisation was introduced for the following reasons:

  • By completing the forms for prior authorisation the patient will ensure he/she has followed public patient pathways and will be eligible for reimbursement.
  • By completing the forms the patient will be in posession of the cost of the treatment from the provider abroad and will have been provided with an indication of the anticpated procedure code and thus an indication of the relevant reimbursement rate. (Please be advised that at this stage the reimbursement rate is only indicative as the treatment identified at prior authorisation may not in due course be the actual treatment provided. A patient is only entitled to reimbursement for the treatment he/she actually receives.)

The patient/applicant may 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.

The prior authorisation process is optional and not having applied for prior authorisation will not effect a patient’s entitlement to reimbursement.

 

2) Should I have a query in relation to completing the application form; can I call to the office to speak to someone?The Cross Border Directive office or National Contact Point is contactable by phone at 056 778 4546 or email at crossborderdirective@hse.ie.   The postal address is National Contact Point, HSE Cross Border Directive, St Canice's Hospital, Dublin Road, Kilkenny

3) Is the application form available in any other languages?

The application form is available in English language format only.

4) 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.

5) Does the HSE organise the appointment or do I have to organise it myself?The patient organises all appointments. 

6) Do I have to be medically assessed before I apply (inpatient)?Yes, as per Section B of the application form for cases requiring prior approval.

7) Do I have to be financially assessed before I apply? Financial assessment is not required.

8) Can I download an application form online? Yes.

9) Do I have to be referred by an Irish based consultant/doctor before I apply?No, you may be referred by a GP in another EU/EEA country or by a consultant whom you are attending in a public capacity in Ireland.

10) Can I apply myself or do I need to get my GP or my Consultant to complete the application also? You may not self-refer.  You must have a referral by your treating clinician.  You must have a referral from a GP or a consultant appropriate to the type of care you are seeking to access.

Please note, 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.

11) Must I be on a waiting list to qualify to use the CBD?

There is no requirement to be on a waiting list in order to access healthcare under the provisions of the CBD. You must have followed public patient pathways i.e. in general this means you must have a referral letter for the treatment you are seeking to operate abroad.

Reimbursements

1) How much does it cost?Reimbursement to patients will be at the cost of the treatment abroad or the cost of the treatment in Ireland whichever is the lesser.  An outpatient consultation in an acute hospital setting will be reimbursed at a maximum of €130. For other costs, the HSE uses HIPE/Casemix costings for the purposes of reimbursement the following is an example of how it should work:

The cost in Ireland is €10,000 with a €80.00 per night hospital charge.

If the cost in France is €11,000 and she was in hospital for 5 nights then the reimbursement rate will be €10,000 less €400 (€80 x 5 = €400) equals €9,600 reimbursement. 

If the cost in France was €5,000 and she was in hospital for 5 nights, then the reimbursement rate will be €5,000 as this is less than €10,000 minus €400.

The cost in Ireland is €10,000 which she can seek to have reimbursed from France plus the €80.00 overnight charge per night of stay which she would not be liable to have refunded to her. 

2) How and where do I apply for reimbursement? Requests for reimbursement will be made through the NCP office. We have introduced a pro-forma invoice so that patients will have a document which guides them through the required information in order to claim reimbursement. Use of the pro-forma invoice  is optional but it will ensure we have all the information we need to process the reimbursement as efficiently as possible.

 3) Does the HSE pay upfront or do I have to pay and claim re-imbursement?Patients must pay the service provider abroad and then will be entitled to claim re-imbursement on their return.

4) Will I get fully reimbursed and if so, how long will this process take?Reimbursement to patients will be at the cost of the treatment abroad less the €80 daily inpatient charge or the cost of the treatment in Ireland whichever is the lesser.

The HSE will endeavour to ensure that reimbursements are processed without undue delay.

5) If I do not have the finances available to pay in advance, is there any scheme available for me to access?There is no scheme available for this situation.

6) Is the cost of all my medication covered, i.e. if I get a 6 month prescription dispensed under the scheme while abroad, can I get the cost back?Prescription charges cannot be reclaimed under the CBD.  The HSE operates the Drugs Payment Scheme for patients entitled to funding for drugs.  The cost of medication availed for while accessing treatment under the CBD would be subject to the same terms and conditions of the Drugs Payment Scheme as if the treatment had been provided in Ireland.

7) Can I claim travel and subsistence expenses?Travel and subsistence expenses will not be provided by the HSE these will be a matter for the individual patient.

8) Is there a limit to the amount of funding available for the procedure?Yes, the maximum that a patient can claim for a procedure is the value that procedure would have cost in Ireland.  The HSE will use HIPE/Casemix costings for individual procedure costs.  To ensure you are receiving the correct notice of the value attached to the treatment your clinician will be required to provide you with what is called the ICD 10 and DRG code of the procedure (which is the HIPE code) then the NCP will be able to confirm the maximum reimbursement value to you in advance of any decision you may make on accessing services under the CBD.  

9) If I availed of treatment prior to application, can I seek reimbursement retrospectively?Yes, if the healthcare you availed of under the CBD without application would have met the terms of the CBD then it is likely your request for reimbursement would be approved. 

Treatment and Follow up

1) Can I avail of follow up care in Ireland or do I have to return to the EU country of treatment? Follow up care may be availed of in Ireland or a patient may return to the EU country of treatment.

2) Do I have to receive all my care abroad?No, you can apply for access to certain aspects of your care abroad with further care provided thereafter to be provided within the state as deemed appropriate.

3) If treatment is not successful, can I re-access the medical treatment in the EU country and will I get reimbursed?Yes and yes.

4) If something goes wrong with my treatment/procedure, can I return for follow up treatment and will this be covered by the scheme?Yes

5) If there are complications with the procedure, can I access the Irish healthcare system to put it right?Yes

6) In the unlikely event of fatality, does the HSE cover the cost of repatriation?No and we strongly recommend that all people who travel abroad for healthcare or any other reason take out the appropriate travel insurance in advance of leaving Ireland.

7) Would an interpreter be made available to me for any queries I might have?Not by the HSE but services abroad may make interpreter services available to patients from another country accessing their services.

8) Does the treatment/ procedure have to be available in Ireland already?Yes, if treatment/procedure is not available in Ireland, patients should apply under the E112 scheme. However, if patients would prefer to use the CBD we will accommodate that request.

9) Is there a limit to the amount of applications I can make?No.

10) If my application is refused, can I appeal?Yes.

11) Will my appeal be dealt with by a person independent to those administering the CBD scheme?Yes, the CBD office is under the line management of the General Manager, Commercial Unit of the Acute Hospitals Division, HSE.  All appeals will be directed to the General Manager for her decision.

12) Do I need to bring my EHIC with me?Yes, we recommend your European Health Insurance Card should be taken with you whenever you visit another EU member state for a temporary stay. An EHIC will not be applicable to the treatment under Cross Border Directive.

13) Does this replace the EHIC and Treatment Abroad Scheme?No. The provision of healthcare under both these schemes will remain in place. In fact, you will only be entitled to access your care under one scheme at any given time and you will be advised which is the most advantageous scheme to your circumstances in accordance with the regulations.