This content is currently being reviewed. Read about your rights in cross-border healthcare under EU law and the regulations for cross-border healthcare under Irish law.
The Cross Border Directive (CBD) is a scheme to get planned healthcare in another European Union (EU) or European Economic Area (EEA) member state.
Countries in the EU and EEA
EU countries are:
Austria, Belgium, Bulgaria, Croatia, Republic of Cyprus, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Latvia, Lithuania, Luxembourg, Malta, Netherlands, Poland, Portugal, Romania, Slovakia, Slovenia, Spain, Sweden
EEA countries are:
Iceland, Liechtenstein, Norway
The CBD only applies to healthcare that is publicly available in Ireland.
Other schemes to get healthcare abroad
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 or emergency healthcare while abroad
If the treatment you need is publicly available in Ireland, you can access it through the:
- Northern Ireland Planned Healthcare Scheme (NIPHS) – if you plan to have your treatment with a private healthcare provider in Northern Ireland
- Cross Border Directive Scheme - if you plan to have your treatment in an EU or EEA member state
You can access this healthcare in the same way you'd get public healthcare in 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.
Qualifying for the CBD scheme
To apply for the CBD scheme in Ireland you must:
- be ordinarily resident in Ireland - living in Ireland and can prove you intend to live in Ireland for at least 1 year
- be entitled to public healthcare in Ireland
- qualify for the healthcare you want as a public patient in Ireland
- have a valid referral letter
- follow the CBD process
You must pay for any healthcare that you get abroad. But under the scheme you can apply to the HSE for reimbursement towards the cost of the healthcare.
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.
Public healthcare process in Ireland
The typical steps to get healthcare or treatment in a public hospital in Ireland are:
- Visit your GP to discuss your condition.
- Your GP refers you to a hospital consultant and you are put on a hospital waiting list to see the consultant.
- You have a consultation with the consultant - this is called an outpatient appointment.
- The consultant either puts you on a waiting list for treatment or discharges you back to your GP if you do not need further hospital treatment.
- If you are on a waiting list for treatment, you are called for hospital treatment - this is called inpatient treatment.
- You have a follow-up appointment with the consultant.
- You are discharged back to your GP.
At any stage you can decide to leave the Irish system and get healthcare abroad under the CBD.
If you get your income from another country, you may not qualify for the CBD in Ireland.
Check that your referral is valid
You can use your public referral letter or waiting list letter to get healthcare abroad.
Your letter must include:
- the name and address of a hospital consultant
- your name, address and date of birth
- your current health and any other relevant information
- the healthcare you need
- the GP or consultant's signature - it cannot be signed by their nurse or secretary
- the date of the referral letter - the letter must be issued before your first appointment abroad
You do not have to use the consultant and hospital named in the referral letter. But your healthcare abroad must be the same medical specialty on your referral letter.
Contact the Cross Border Directive office in Ireland if you are unsure if you qualify for the CBD scheme. The office is known as the National Contact Point.
Referral from a doctor abroad
A GP abroad can refer you for healthcare under the CBD.
If you plan to use a referral from a doctor abroad, contact the National Contact Point.
Referral for community-based services
Your GP or consultant can refer you for community-based services.
You can also be referred for some community-based services by:
- public health nurses
- community dentists
- HSE orthodontists
- other HSE health specialists
Referral for addiction care
Only a GP or a consultant you see as a public patient can refer you for CBD healthcare.
You cannot use private healthcare accessed in Ireland as part of your patient pathway when using the CBD.
If you are unsure if you qualify, contact the National Contact Point.
Follow the CBD process
To claim a reimbursement you must follow the CBD process to use health services in another country:
- Have a valid letter of referral for public healthcare from a GP or hospital consultant in Ireland.
- Have a consultation with a healthcare provider abroad - this is called an outpatient appointment.
- Travel abroad for healthcare.
- Pay for any healthcare you get abroad.
- Complete the CBD pro forma invoice with your healthcare provider abroad.
- Apply for a reimbursement towards the cost of the healthcare abroad.
Keep proof that you travelled abroad for both your first consultation and the treatment. You will need to send it with your application.
If you need healthcare that involves an overnight stay in hospital, you can get prior notification before you go abroad.
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 dependant 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 the UK or Switzerland is your competent state, you cannot use the CBD scheme. This is when you pay your social security contributions in the UK or Switzerland. If you are unsure or need help, contact the National Contact Point in Ireland.
Costs covered by the CBD scheme
You can only claim a reimbursement towards the cost of your healthcare under the Cross Border Directive.
You cannot claim for:
- travel costs
- the cost of any prescription medicines you need
- translation costs
Maximum payments are based on the cost of public healthcare in Ireland.
The Drugs Payment Scheme (DPS) helps with the cost of prescribed medicines and some appliances. There is no means test for a DPS card.
Prescriptions from abroad
If you get a prescription from a healthcare provider abroad, you should be able to use it in Ireland.
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