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Accessing healthcare abroad under Cross Border Directive

To use health services in another country and be refunded under the Cross Border Directive (CBD) you must:

  • be referred to the health service abroad by a GP or consultant
  • get prior authorisation if it is required for your treatment
  • apply for a refund of the cost of the treatment

Referral by a doctor in Ireland

You must get a referral by your GP or consultant to get most types of CBD treatment. Your doctor will discuss your options with you and they may refuse to refer you for CBD treatment.

Your referral letter from your GP in Ireland must include:

  • the name and address of a hospital consultant - you don't have to use the consultant and hospital named in the referral letter
  • your name, address and date of birth
  • your current health and any other relevant information
  • the healthcare you need
  • the GP's signature and date of the referral letter

Your GP may refuse to refer you if they’re:

  • unfamiliar with the service abroad
  • concerned about the quality of the service abroad
  • concerned that the service will fully meet your medical needs

Your referring GP in Ireland can advise you if your healthcare is covered by the CBD but if you are in doubt contact the National Contact Point:

The National Contact Point Office
Cross Border Directive
HSE
St Canice’s Hospital
Kilkenny
Co. Kilkenny
Phone: 056 778 4546
crossborderdirective@hse.ie

Referral by a doctor abroad

A GP or consultant abroad can refer you for CBD treatment. For example, a GP in Spain can write you a referral letter for treatment in an EU or EEA hospital. Your referral letter from your GP or consultant abroad must state:

  • the healthcare you need
  • your general clinical and personal history
  • the health professional abroad you're being referred to
  • the clinic, hospital or location where that health professional operates

You should make sure that the healthcare you’re going to get abroad is covered by the CBD.

If you're getting a referral from a doctor abroad for inpatient treatment you follow the same application process as if you were applying from Ireland.

Referral for community-based services

A GP or consultant does not have to refer you for certain types of treatment. Public health nurses, community dentists, HSE orthodontists and other health specialists such as physiotherapists and occupational therapists can refer you CBD treatment if you want any of these community-based services:

  • addiction care
  • chiropody and podiatry
  • day care
  • dental
  • disability services
  • hearing services
  • home care services
  • home help services
  • methadone programmes
  • mental health services
  • occupational therapy
  • optical services
  • physiotherapy
  • psychology services
  • respite care
  • speech and language therapy

Inpatient treatment

When you have a referral from your GP or consultant for inpatient care – treatment that involves an overnight stay in hospital – you should apply for prior authorisation.

Prior authorisation means you have followed the correct way to access healthcare abroad under the CBD and will be eligible for repayment. You will need to complete an application form.

The hospital abroad will then schedule your inpatient treatment.

Prior authorisation

If the treatment involves an overnight stay in hospital, you should get get authorisation in advance from us. 

Prior authorisation is optional. But we advise you to get it before you travel. If successful, it can give you peace of mind before you travel that you will be refunded the cost of your treatment after you have it.

Your consultant in the hospital you are attending abroad has to fill in the prior authorisation form.

They must make a note of the code for the treatment you are getting under the HSE's list of treatments and cost of those treatments.

This will help to give you an indication of how much you can claim back from us for the treatment you receive.

Prior authorisation happens before you have your treatment abroad and before you pay for it. This gives you time to decide if you:

  • can afford the treatment upfront or can secure the funding
  • are comfortable with the consultant and the hospital abroad
  • are willing to go ahead if there is a shortfall between the cost of the treatment abroad and how much you can claim back from us. You would be responsible for paying the shortfall.

To apply for prior authorisation, please download the prior authorisation application form.

You must then send it with your referral letter to:

The National Contact Point Office
Cross Border Directive
HSE
St Canice’s Hospital
Kilkenny
Co. Kilkenny

We usually take about 20 working days to decide on your application for inpatient treatment.

If we approve your application for inpatient treatment, you can then go abroad to get your treatment.

Outpatient treatment

You don’t have to apply for prior authorisation if you are going for outpatient care – treatment that doesn’t involve an overnight hospital stay. You just need to have a referral from your GP or consultant.

But it is worth checking whether it is worthwhile getting prior authorisation before you travel. You can do this by contacting the National Contact Point.

You will need to arrange an outpatient appointment with your healthcare provider abroad. You must attend that appointment in person.

The hospital abroad you're going to will schedule your outpatient treatment.

You should read the guide on applying for Cross Border Directive repayment before you get treatment abroad so you understand:

  • if the treatment you're getting will be repaid under the CBD
  • how much of the treatment cost you can apply to be repaid

You must pay for any treatment you get and then apply for repayment.

Appeal against an application decision

If your application for prior authorisation is refused you can appeal that decision by writing to the:

General Manager
Commercial Unit of the Acute Hospitals Division

HSE
St Canice's Hospital
Dublin Road
Kilkenny
Co. Kilkenny
Phone: 056 778 4547
crossborderdirective@hse.ie

Orthodontic care

Orthodontic care under the CBD is usually available to children between the ages of 11 and 13, but can be provided up to the age of 16. The patient must be referred by an HSE dentist.

The HSE will repay orthodontic fees up to a maximum of €2,200, or the cost of the treatment abroad, whichever is the lesser.

The maximum amounts repayable for each stage of orthodontic treatment are:

  • assessment for eligibility for orthodontic treatment: €100
  • orthodontic treatment: €1,800
  • treatment completion – at end of retainer phase: €300 maximum reimbursement

Prescriptions from abroad

You can not claim for the cost of any prescription drugs you need after your treatment.

If you get a prescription from a healthcare provider abroad and want to use it in Ireland it must contain the following:

  • your name written in full with no initials
  • your date of birth
  • prescriber’s name written in full with no initials
  • professional healthcare qualification of the prescriber
  • contact details of the prescriber - email and telephone or fax, including the international dialling code
  • prescriber’s signature
  • date of the prescription’s issue
  • the ‘common name’ of the medicinal product or medical device prescribed - this means the chemical drug name not a brand name drug, unless your doctor says you must use a certain brand name drug or the brand name drug is a biological medicinal product such as Humira, Enbrel or NeoRecormon
  • form of the drug, for example tablet, capsule, solution
  • strength of the drug
  • quantity and dosage of the drug
  • instructions for using the drug

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