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 cannot 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 give us prior notification before you go abroad.
UK and Northern Ireland
You can no longer use the CBD to access healthcare in the UK. This is because the UK left the EU on 31 December 2020.
But if you have started your healthcare in the UK and began to receive that healthcare before 2021, you may still be able to apply for reimbursement under the HSE Cross Border Directive.
Northern Ireland Planned Healthcare Scheme
The Northern Ireland Planned Healthcare Scheme (NIPHS) is a scheme to allow you get healthcare in Northern Ireland. It began on 1 January 2021.
You can access the Northern Ireland Planned Healthcare Scheme in a similar way to how you access the Cross Border Directive.
Using health services in another country
The process of using health services in another country under the CBD are:
- Qualify for public healthcare.
- Have a letter of referral from a public health professional in Ireland.
- Arrange a consultation with a healthcare provider abroad - this is called an outpatient appointment.
- Travel abroad for healthcare.
- Pay for any healthcare you receive.
- Complete the CBD pro forma invoice with your healthcare provider abroad.
- Apply for repayment towards the cost of the healthcare abroad.
You cannot 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.
Check which country can process your claim
You may need to apply for the CBD scheme in another country if you:
- get your income from another EU or EEA country
- are a dependent of someone who gets their income from another EU or EEA country
Contact the National Contact Point for the other country to check if they are responsible for your claim. They can also tell you if you are entitled to a reimbursement.
If your income comes from the UK or Switzerland, you cannot use the CBD scheme.
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.
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.
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
Telemedicine and the CBD
Telemedicine is when you get a diagnosis, treatment or consultation using telecommunications technology such as by Skype or video call.
If you are travelling abroad for inpatient care, you cannot use telemedicine for your outpatient appointment.
You must have your outpatient appointment in person or your inpatient healthcare is not eligible for reimbursement.
You can use telemedicine for outpatient consultations for day-case healthcare in line with HSE guidelines on video and audio consultations (April 2020). The consultation must happen on a date before you are admitted for day-case treatment.
There is currently no identified reimbursement rate for an e-health consultation.
Costs covered by the CBD scheme
You can only claim for the cost of your healthcare under the Cross Border Directive scheme.
You cannot claim:
- travel costs
- the cost of any prescription medicines you need - but if you have a valid prescription, you should be able to use it in Ireland
- translation costs
The Drugs Payment Scheme (DPS) helps with the cost of prescribed medicines and some appliances. There is no means test for a DPS card.
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 give us prior notification before you travel and to claim for repayment when you return.
CBD and other schemes to access healthcare outside of Ireland
The CBD only applies to healthcare that is publicly available in Ireland.
The CBD scheme is different to other schemes to access healthcare outside of Ireland, such as:
- Treatment Abroad Scheme - applies to treatments that are not available in Ireland
- European Health Insurance Card (EHIC) - only applies to necessary healthcare while abroad
- Northern Ireland Planned Healthcare Scheme (NIPHS) - applies to private healthcare in Northern Ireland that is publicly available in Ireland
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