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Cross Border Directive - how to get healthcare abroad

The Cross Border Directive (CBD) allows you to get healthcare in another EU or EEA member state.

You can access this healthcare in the same way you'd get public healthcare in Ireland.

The healthcare must be planned. You need a valid referral and you must qualify for the healthcare you want as a public patient in Ireland.

Once you go abroad, you must pay for any healthcare that you get. But under the CBD you can then apply to the HSE  for reimbursement towards the cost of the healthcare. 

You can not claim reimbursement for:

  • the cost of any medicine you'll need afterwards
  • any travel costs

If you are having healthcare that involves an overnight stay in hospital, you can apply for prior authorisation before you go abroad.

Related topic

Apply for Cross Border Directive repayment

Using health services in another country

The process of using health services in another country under the CBD are:

  1. Qualify for public healthcare.
  2. Have a letter of referral from a public health professional in Ireland.
  3. Arrange a consultation with a healthcare provider abroad - this is called an outpatient appointment.
  4. Travel abroad for healthcare.
  5. Pay for any healthcare you receive.
  6. Apply for repayment towards the cost of the healthcare abroad.

You can not use telemedicine at any time during the CBD process. You must travel abroad to get healthcare.

Qualifying for the Cross Border Directive scheme

To get healthcare abroad and be refunded under the Cross Border Directive (CBD) you must:

  • be ordinarily resident in Ireland
  • be entitled to public healthcare in Ireland
  • not be in receipt of any state benefit from another EU or EEA member state
  • travel abroad for the healthcare
  • have a referral for public healthcare from a GP or hospital consultant in Ireland
  • provide a copy of a letter of referral or a letter from a hospital to say you're on a waiting list in Ireland
  • apply for repayment towards the cost of your healthcare abroad, after you have paid for it

Ordinarily resident means that you've been living in Ireland for at least one year or can prove your intention to remain in Ireland for at least one year.

Private patients

Only a GP or a consultant you are attending as a public patient can refer you for CBD healthcare.

Having private health insurance does not exclude you from CBD. But you cannot use your private health insurance to access your referral for healthcare abroad.

If you are unsure if you qualify for the Cross Border Directive, you can contact the Cross Border Directive office.

Using your referral to go abroad

You can use a referral for public healthcare in Ireland to access healthcare abroad under the CBD.

You don’t need to be referred specifically to a healthcare provider abroad. If your referral is to a public hospital in Ireland you can also use that referral to go abroad. But your healthcare abroad must be the same medical specialty you've been referred to in Ireland.

This referral usually comes from a GP or hospital consultant. You'll see your GP first and discuss your condition. They will then decide if you need a referral to a hospital consultant or if they can manage your condition.

Related topic

Cross Border Directive - using a referral to get healthcare abroad

Arranging a consultation abroad

Once you have a referral letter, you will need to contact a healthcare provider abroad. This is to make your first appointment with them.

First appointment

Your first appointment will be a consultation with the healthcare provider. It happens before you have any healthcare.

During the appointment you will meet the healthcare professional.

Having this consultation before you have any healthcare gives you time to decide if you:

  • are comfortable with the consultant and the hospital abroad
  • want to proceed with healthcare at a date in the future
  • have any questions before you go ahead

Related topic

Apply for Cross Border Directive repayment

Travel, telemedicine and the CBD

You must travel abroad to get healthcare. You must fund all your own travel costs. You can not claim for any travel costs under the CBD.

You can not use telemedicine at any time during the CBD process. This includes your outpatient appointment. Telemedicine is when you get a diagnosis, treatment or consultation using telecommunications technology.

For example, you can’t have your outpatient consultation with a consultant abroad by Skype or video.

Apply for Cross Border Directive repayment

Once you go abroad, you must pay for any healthcare that you get.

But under the CBD you can then apply to us (the HSE) to claim repayment towards the cost of the healthcare once you meet certain conditions.

If you meet these conditions and your application is successful, you will be reimbursed whichever is the lesser:

  • the cost of your healthcare abroad, or
  • what the healthcare would have cost in Ireland

It's free to apply for prior authorisation before you travel and to claim for repayment once you return.

Read about how to apply for the cost of your CBD healthcare.

Cross Border Directive, Treatment Abroad Scheme or EHIC

The CBD scheme is different to the Treatment Abroad Schemeor the European Health Insurance Card (EHIC).

  • The CBD only applies to healthcare that is publicly available in Ireland.
  • Treatment Abroad Scheme applies to treatments that are not available in Ireland.
  • The EHIC only applies to necessary healthcare while abroad

We recently updated this content. See the original version here

Page last reviewed: 08/11/2018
Next review due: 08/11/2021