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The maximum repayments for the Northern Ireland Planned Healthcare Scheme (NIPHS) are based on the healthcare costs in Ireland.
If you qualify for the NIPHS, repayments are based on whichever is the lesser amount:
- the cost of your healthcare in Northern Ireland
- what the healthcare would have cost in Ireland
You cannot claim repayment for:
- travel costs or accommodation
- any prescription medicine costs
If you get prior notification, you’ll know around how much you can claim back before getting inpatient healthcare in Northern Ireland.
Maximum repayments under NIPHS
You must pay for any healthcare that you get with a private provider in Northern Ireland.
The maximum amount you can be repaid depends on the type of healthcare you get. But if the healthcare costs less in Northern Ireland, you can only claim for what you paid.
Outpatient claims
Outpatient care is healthcare that involves a short appointment and you do not have an overnight hospital stay.
The maximum repayment for an outpatient consultation in a private hospital in Northern Ireland is €194.
If your consultation took place:
- before 1 March 2021, the maximum you can claim is €130
- between 1 March 2021 to 1 May 2023, the maximum you can claim is €178
Day-case claims
Day-case care is healthcare that does not involve an overnight hospital stay.
The maximum repayments for day-case care are based on healthcare costs in Ireland.
You can download a list of costs and DRG codes for day-case healthcare in Ireland.
If you had your treatment on or after 1 May 2023, use:
If you had your treatment from 1 July 2022 to 30 April 2023, use:
Inpatient claims
Inpatient care is healthcare that involves an overnight stay in hospital.
The maximum repayments for inpatient care are based on healthcare costs in Ireland.
You can download a list of costs and DRG codes for inpatient healthcare in Ireland.
If you had your treatment on or after 1 May 2023, use:
If you had your treatment from 30 June 2022 to April 2023, use:
If you had inpatient care in Northern Ireland before 17 April 2023, the HSE will deduct €80 per day, to a maximum of €800, from the amount you can be repaid.
You will not have to pay the €80 per day if any of the following apply:
- You have a medical card.
- You have already paid €800 for overnight stays in hospitals abroad or in Ireland in the 12 months before your treatment abroad.
- You had inpatient care in Northern Ireland after 16 April 2023.
Read more about hospital charges.